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We investigated serum neutralizing activity against BA.1 and BA.2 Omicron sublineages and T cell response before and 3 months after administration of the booster vaccine in healthcare workers (HCWs).HCWs aged 18-65 years who were vaccinated and received booster doses of the BNT162b2 vaccine were included. Anti-SARS coronavirus 2 IgG levels and cellular response (through interferon γ ELISpot assay) were evaluated in all participants, and neutralizing antibodies against Delta, BA.1, and BA.2 were evaluated in participants with at least one follow-up visit 1 or 3 months after the administration of the booster dose.Among 118 HCWs who received the booster dose, 102 and 84 participants attended the 1-month and 3-month visits, respectively. Before the booster vaccine dose, a low serum neutralizing activity against Delta, BA.1, and BA.2 was detectable in only 39/102 (38.2%), 8/102 (7.8%), and 12/102 (11.8%) participants, respectively. At 3 months, neutralizing antibodies against Delta, BA.1, and BA.2 were detected in 84/84 (100%), 79/84 (94%), and 77/84 (92%) participants, respectively. Geometric mean titres of neutralizing antibodies against BA.1 and BA.2 were 2.2-fold and 2.8-fold reduced compared with those for Delta. From 1 to 3 months after the administration of the booster dose, participants with a recent history of SARS coronavirus 2 infection (n = 21/84) had persistent levels of S1 reactive specific T cells and neutralizing antibodies against Delta and BA.2 and 2.2-fold increase in neutralizing antibodies against BA.1 (p 0.014). Conversely, neutralizing antibody titres against Delta (2.5-fold decrease, p 0.0001), BA.1 (1.5-fold, p 0.02), and BA.2 (2-fold, p 0.0001) declined from 1 to 3 months after the administration of the booster dose in individuals without any recent infection.The booster vaccine dose provided significant and similar response against BA.1 and BA.2 Omicron sublineages; however, the immune response declined in the absence of recent infection.

Herpes zoster (HZ) was suspected as a predictive cutaneous manifestation of COVID-19, with a debated prognostic significance. We report a series of 5 cases of HZ occurring after vaccination with a nucleoside-modified messenger RNA (mRNA) COVID-19 vaccine (Comirnaty, Pfizer-BioNTech). These new cases do not prove causality between COVID-19 vaccination and HZ. The pathophysiologic mechanism remains elusive, but local vaccine-induced immunomodulation may be involved. The occurrence of HZ does not justify avoiding the second injection of vaccine due to the benefit of vaccination.

Long-term care facility (LTCF) older residents display physiological alterations of cellular and humoral immunity that affect vaccine responses. Preliminary reports suggested a low early postvaccination antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study was to focus on the specific T-cell response. We quantified S1-specific IgG, neutralizing antibody titers, total specific IFNγ-secreting T cells by ELISpot, and functionality of CD4+- and CD8+-specific T cells by flow cytometry, after two doses of the BNT162b2 vaccine in younger and older people, with and without previous COVID-19 infection (hereafter referred to as COVID-19-recovered and COVID-19-naive subjects, respectively). Frailty, nutritional, and immunosenescence parameters were collected at baseline in COVID-19-naive older people. We analyzed the immune response in 129 young adults (median age 44.0 years) and 105 older residents living in a LCTF (median age 86.5 years), 3 months after the first injection. Humoral and cellular memory responses were dramatically impaired in the COVID-19-naive older (n = 54) compared with the COVID-19-naive younger adults (n = 121). Notably, older participants’ neutralizing antibodies were 10 times lower than the younger’s antibody titers (p + and IFNγ+IL-2+TNFα+ cells among specific CD4+ T cells, and the frequency of specific CD8+ T cells were lower in COVID-19-naive older participants than in COVID-19-naive young adults (p p = 0.0018, respectively). However, COVID-19-recovered older participants (n = 51) had greater antibody and T-cell responses, including IFNγ+ and IFNγ+IL-2+TNFα+-specific CD4+ T cells (p +-specific CD8+ T cells (p + and CD8+ T cells, in addition to impaired antibody response, and that specific studies are warranted to assess the efficiency of SARS-CoV-2 mRNA-based vaccines, as in other immunocompromised subjects. Our study also shows that, despite their physiological alterations of immunity, vaccination is highly efficient in boosting the prior natural memory response in COVID-19-recovered older people.

We quantified S1-specific IgG, neutralizing antibody titers, specific IFNγ secreting T cells and functionality of specific CD4+ and CD8+ T cells in 130 young adults (median age 44.0 years) and 106 older residents living in a long-term care facility (86.5 years) after 2 doses of BNT162b2. Three months after the first injection, humoral and cellular memory responses were dramatically impaired in the 54 COVID-19-naive older compared to the 121 COVID-19-naive younger adults. Notably, older participants’ neutralizing antibodies, detected in 76.5% (versus 100% in young adults,P< 0.0001), were ten times lower than the younger’s antibody titers (P< 0.0001). Antibody and T cell responses were greater among the 52 COVID-19-recovered than among the 54 COVID-19-naive older adults (P< 0.0001). Our study shows that 2 doses of BNT162b2 does not guarantee long-term protection against SARS-CoV-2 in the older. An additional dose should be considered to boost their specific memory response.

Introduction Historiquement le carcinome epidermoide cutane (CEc) est le premier cancer d’origine professionnelle a avoir ete decrit chez les ramoneurs exposes aux suies de combustion. Desormais majoritairement lie aux ultraviolets (UV), il existe cependant certaines localisations comme le vestibule nasal ou l’exposition solaire n’est pas en cause et ou l’origine professionnelle doit etre recherchee. Nous rapportons un cas de CEc du vestibule nasal avec exposition professionnelle aux derives de la houille. Materiel et methodes Un homme de 72 ans consultait pour un nodule cutane de la cavite nasale anterieure evoluant depuis deux mois). Un scanner cervico-facial montrait une tumeur du vestibule de 10 × 5 mm, sans adenopathie cervicale. La biopsie cutanee identifiait un carcinome epidermoide cutane invasif. Le patient, livreur de charbon, rapportait une exposition professionnelle pendant 30 ans aux poussieres issues de briquettes de charbon. Une etude complementaire sur la biopsie ne suggerait pas d’infection a papillomavirus humain (HPV). Un traitement chirurgical de la tumeur a ete realise et une declaration en maladie professionnelle a ete conseillee (tableau 16 bis sur les derives de la houille). Discussion Le carcinome epidermoide de la cavite nasale anterieure est considere comme un cancer cutane car, bien que partageant certaines similitudes avec les cancers des voies aeriennes superieures (sexe-ratio masculin, tabagisme, âge moyen 65 ans, mauvais pronostic), son aspect histologique est proche de celui de l’epiderme. Contrairement a la majorite des CEc, l’exposition aux UV n’est pas en cause dans cette localisation et d’autres facteurs, extra-professionnels (infection HPV) ou professionnels, doivent etre recherches. Parmi les cancerogenes professionnels prouves pour la peau (arsenic, huiles minerales derivees du petrole), l’oncogenicite des derives de la houille est liee aux hydrocarbures aromatiques polycycliques (HAP). Le brai de houille, utilise comme liant dans les agglomeres de charbon, pourrait donc etre implique dans le developpement des CEc du vestibule nasal au cours de l’activite de briquetage par l’intermediaire des poussieres volatiles penetrant dans les narines. Conclusion L’identification de l’origine professionnelle des cancers cutanes est essentielle pour permettre au patient une reconnaissance en maladie professionnelle donnant droit a une indemnite proportionnelle aux sequelles. Celle-ci est donc particulierement interessante dans le CEc du vestibule nasal, localisation rare de cancer cutane mais necessitant une chirurgie souvent mutilante.

Introduction La pandémie à COVID-19 est responsable de près de 3 millions de décès. En l’absence de traitement curatif à ce jour, la prévention est la seule stratégie efficace pour la contrôler. La vaccination est un des piliers de cette prévention. Elle a commencé par les sujets les plus fragiles, les résidents d’établissement d’hébergement pour personnes âgées dépendantes (EHPAD). Ils ont bénéficié des premiers vaccins disponibles à ARN messager depuis le 28 décembre 2020. Ils présentent une immunosénescence physiologique à l’origine habituellement d’une immunité innée moins efficiente et ou d’une immunité adaptative moins durable. Les données concernant cette population âgée particulière sont absentes sur la réponse immunitaire vaccinale et les facteurs (âge, comorbidités, statut nutritionnel) pouvant modifier les réponses du système immunitaire. L’objectif de ce travail est de comparer la qualité de la réponse vaccinale anti-SARS-CoV-2 par rapport à des sujets immunocompétents de 18 à 65 ans. Matériels et méthodes Étude observationnelle prospective monocentrique d’une cohorte de résidents d’EHPAD et d’unités de soins de longue durée de plus de 65 ans d’un centre hospitalo-universitaire français par rapport à des professionnels de santé et du médicosocial de 18 à 65 ans. Les 2 groupes bénéficient de la vaccination par COMINARTY(BNT162b2), 2 doses à 21 jours d’intervalle. Les objectifs sont : – évaluer l’amplitude de la réponse lymphocytaire T totale anti-S à 3 mois : nombre de cellules sécrétrices d’interféron gamma ; – évaluer l’amplitude de la réponse lymphocytaire T CD4+ et T CD8+ spécifique anti-S à 3 et 9 mois (nombre de lymphocytes T spécifiques anti-S détectés à 3 et 9 mois, après enrichissement en T CD4+ et en T CD8+) ; – évaluer l’amplitude de la réponse humorale spécifique anti-S à 3 et 9 mois (taux d’anticorps totaux anti-S et d’anticorps neutralisants). Seules les données pour les réponses à 3 mois seront disponibles pour cette communication. Résultats Description de la population: EHPAD de 104 lits et USDL de 96 lits avec 162 résidents présents avec une moyenne d’âge de 83 ans et des comorbidités lourdes avec un GIR moyen pondéré de 761 en EHPAD et de 865 en USLD. Quatre-vingt-sept résidents ont présenté une infection à COVID-19 documentée entre mars et décembre 2020. Quatre-vingt-quinze pour cent des résidents ont bénéficié d’une vaccination anti-SARS-CoV-2 et 90 % ont accepté la participation à l’étude. Pour le groupe contrôle 125 professionnels du CHU ont été inclus à l’étude en collaboration avec l’équipe de la médecine du travail et le centre de vaccination. Les premières données à 3 mois en Elispot après immunisation naturelle anti-S : – sujets 65 ans : médiane 33 spots (n = 34) ; – sujets > 75 ans : médiane 22 spots (n = 13). Conclusion À suivre.

Exposure to environmental and occupational particulate matter (PM) induces health effects on the cardio-pulmonary system. In addition, associations between exposure to PM and metabolic syndromes like diabetes mellitus or obesity are now emerging in the literature. Collection of exhaled breath condensate (EBC) is an appealing non-invasive technique to sample pulmonary fluids. This hypothesis-generating study aims to (1) validate an ion chromatography method allowing the robust determination of different metabolism-related molecules (lactate, formate, acetate, propionate, butyrate, pyruvate, nitrite, nitrate) in EBC; (2) apply this method to EBC samples collected from workers exposed to quartz (a known inflammatory particle), to soapstone (a less inflammatory particle than quartz), as well as to controls. A multi-compound standard solution was used to determine the linearity range, detection limit, repeatability and bias from spiked EBC. The biological samples were injected without further treatment into an ion chromatograph with a conductivity detector. RTube® were used for field collection of EBC from 11 controls, 55 workers exposed to soapstone and 12 volunteers exposed to quartz dust. The analytical method used proved to be adequate for quantifying eight anions in EBC samples. Its sub-micromolar detection limits and repeatability, combined with a very simple sample preparation, allowed an easy and fast quantification of different glycolysis or nitrosative stress metabolites. Using multivariate discriminant analysis to maximize differences between groups, we observed a different pattern of anions with a higher formate/acetate ratio in the EBC samples for quartz exposed workers compared to the two other groups. We hypothesize that a modification of the metabolic signature could be induced by exposure to inflammatory particles like quartz and might be observed in the EBC via a change in the formate/acetate ratio.

Objective Low beryllium exposure can induce pulmonary granulomatosis, so called berylliosis. For occupational health monitoring, it is more relevant to assess the internal dose of Be received by the lungs than urinary or atmospheric Be. Exhaled breath condensate (EBC) is a matrix collected non-invasively that derives from the airway lining fluid. EBC beryllium (Be) levels were evaluated as a marker of occupational exposure in a primary aluminum production plant. Methods We collected urine and EBC from controls and workers recently exposed to beryllium in the pot room and the anode repair sectors, and calculated a cumulative beryllium exposure index (CBEI) summing the number of years of employment in each task and multiplying by the estimated average beryllium exposure for the task. Concentrations of beryllium and aluminum were measured in EBC (Be-EBC and Al-EBC) and in urine (Be-U and Al-U) by ICP-MS. Results and conclusion We have shown that it was possible to measure Be and Al in workers’ EBC. Compared with controls and after adjustment for smoking status, levels of Be-EBC and Al-EBC were higher in pot room workers and exposed subjects, respectively. Due to its relationship with CBEI, but not with Be-U, it appears that Be-EBC could be a promising marker of occupational exposure and provide additional toxicokinetic information in occupational health studies.

Annual vaccination rates among French health care workers (HCWs) are in decline even in Emergency Services to which patients at highest risk of influenza complications are admitted, and in which HCWs have the greatest risk of exposure to influenza from patients. We aimed here to identify knowledge and attitudes towards influenza vaccination of HCWs in Emergency Services. We collected 344 self-administered questionnaires of 1060 HCWs. Only 18% of HCWs were vaccinated against influenza. Physicians were vaccinated more often (55%) than nurses (16%) or aid nurses (11%). The most important barriers to vaccination were reported as being a lack of time (33%), lack of safety of the vaccine (31%), fear of contracting influenza due to vaccination (29%), and lack of effectiveness (23%). Being vaccinated was significantly related to a higher knowledge score based on epidemiological influenza items (OR (95% CI)) (1.63 (1.08-2.46)) and vaccine features items (2.36 (1.36-4.10)).

Introduction Les cancers cutanes sont les premiers dont l’origine professionnelle a ete decrite. Malgre l’existence de tableaux de maladies professionnelles (MP) liees a l’arsenic, aux huiles derivees du petrole et aux derives de la houille, pour les carcinomes epidermoides (CE) ou basocellulaires (CBC), le nombre de reconnaissance en MP est en regression en France pour ces pathologies. Materiel et methodes Dans le cadre de leur prise en charge globale, les patients recus en reunion de concertation pluridisciplinaire d’onco-dermatologie au CHU de Lille ont complete un autoquestionnaire retracant leur parcours professionnel et leurs expositions actuelles ou passees a certains facteurs de risques averes : ultraviolets (UV), arsenic, radiations ionisantes, derives de la houille et huiles derivees du petrole. Le service de Pathologies Professionnelles a expertise les donnees d’exposition et a propose une consultation pour conseiller le patient sur une demande de reconnaissance en MP. Nous avons effectue une analyse retrospective des donnees d’expositions colligees. Resultats Entre septembre 2019 et mars 2020, 256 patients ont ete inclus (taux de participation 63 %), majoritairement de sexe masculin (55,8 %) avec un âge median de 73 ans. 34,7 % des patients consultaient pour un CBC, 30,1 % pour un melanome et 14 % pour un CE. Les expositions aux UV (16 %) et aux huiles minerales (13,7 %) etaient le plus rapportees. Une declaration en MP a ete conseillee a 15 patients (5,9 %) : 8 en lien avec un tableau de MP et 7 pour des expositions hors tableau, majoritairement liees aux UV (6/15), dont 2 pour un melanome. Discussion La prevalence des expositions professionnelles a des cancerogenes cutanes est importante ; cependant, leur sous-reperage conduit a une sous-declaration. Aucun tableau de MP n’existe concernant l’exposition aux UV, facteur de risque majeur de survenue de cancer cutane. Dans ce cas, la reconnaissance en MP resulte de l’avis du Comite Regional de Reconnaissance en MP (CRRMP) qui doit statuer sur le lien direct et essentiel entre la pathologie et l’exposition en prenant en compte l’exposition solaire extraprofessionnelle. La hausse des propositions de declarations de MP « hors tableau » par les dermatologues devrait permettre une evolution des tableaux ainsi qu’une meilleure indemnisation du patient. Conclusion La part professionnelle des cancers cutanes parait non negligeable mais la reconnaissance en MP se heurte a de nombreux obstacles. Un reperage de l’exposition professionnelle par autoquestionnaire permet de proposer plus facilement une demande de reconnaissance en MP, notamment en l’absence de tableau specifique, donnant droit a une indemnite proportionnelle aux sequelles.

Introduction Etre responsable de structure (UF, service, clinique, pole) dans un etablissement hospitalo-universitaire inscrit le medecin dans une dimension de manager complementaire a celles de clinicien, chercheur et enseignant. Dans un monde hospitalier en tension, comment ces medecins apprehendent-ils leurs missions de medecins-managers ? Quels regards portent-ils sur leur sante au travail et celle de leurs confreres ? Objectifs Les objectifs sont : faire un point sur leurs conditions d’exercice, evaluer leur charge de travail, la conciliation vie professionnelle/vie privee, leur etat de sante global (physique, psychique, niveau d’epuisement professionnel) et leur sensibilisation a la question du bien-etre au travail. Methode Notre etude a ete realisee au sein de la population des responsables fonctionnels du CHU de Lille du 03 juin au 31 juillet 2019, par l’intermediaire d’un questionnaire diffuse par messagerie professionnelle. Resultats 222 questionnaires ont ete recueillis sur les 421 responsables recenses, soit un taux de reponse de 53 %. Les resultats ont ete traites selon differentes thematiques dont la charge de travail, la sante percue, les contraintes psycho-organisationnelles, l’equilibre vie privee/vie professionnelle ou encore l’epuisement professionnel. 49 % trouvent l’exercice d’une responsabilite satisfaisant. Ils le jugent complexe (a 93 %), deplorent un manque d’accompagnement (76 % le pensent necessaire lors de la prise de fonction) et estimeraient une formation utile (a 75 %). 70 % ont deja songe a renoncer definitivement a leur mission de manager au cours des 12 derniers mois. L’impact du travail sur leur sante et leur vie personnelle est vecu negativement (respectivement 58 % et 68 % d’insatisfaits de leurs horaires et rythme de travail pour leur sante et vie privee). Ils sont 61 % a penser pouvoir jouer un role dans le bien-etre au travail de leurs confreres, 86 % a estimer qu’il est de leur devoir d’avoir une attention particuliere a la sante de leurs confreres. Concernant l’epuisement professionnel, evalue grâce a l’echelle MBI, 18,9 % presentent un niveau d’epuisement emotionnel eleve, 18,5 % un score de depersonnalisation eleve et 35,7 % un score d’accomplissement personnel faible. Conclusion Les principales pistes de reflexion et axes d’amelioration degages par l’analyse des donnees concernent : la reconnaissance et la meilleure prise en compte du management medical au sein de l’institution, la formation specifique de ces medecins, les outils complementaires a amener aux responsables medicaux, deja convaincus de leur role de veilleur aupres de leurs confreres, afin de leur permettre d’etre d’avantage acteurs dans la prevention des risques psycho-sociaux des praticiens hospitaliers.

Introduction En sante travail, les visites medicales sont souvent imposees aux salaries dans le cadre du suivi de sante des travailleurs. Ces visites medicales se deroulent dans un objectif de prevention et pour des salaries qui n’ont pas forcement une degradation de leur etat de sante. Objectif L’objectif de ce travail etait donc de mettre en regard les attentes et les craintes des salaries lors de la visite periodique et la perception qu’en ont les medecins du travail. Methodologie Distribution d’un auto-questionnaire aux salaries venant en visite medicale periodique au sein d’un service inter-entreprises de sante au travail de la metropole Lilloise et d’un questionnaire aux medecins de ce meme service (enquete realisee entre avril et juin 2016). Resultats Nous avons recueilli 359 questionnaires de salaries et 39 de medecins. Concernant les salaries, les trois principales attentes lors de la visite periodique sont : obtenir l’avis d’aptitude (81,3 %), etre apte sans restriction medicale (69,2 %) et enfin obtenir des conseils de prevention (43,7 %). Les medecins eux, pensent que les attentes principales des salaries lors de cette visite concernent l’echange sur leurs difficultes au travail (94,9 %), l’obtention de conseils de prevention (87,7 %) et des restrictions medicales adaptees a leur etat de sante (87,7 %), et enfin l’obtention de l’avis d’aptitude (84,6 %). Il est interessant d’observer que les medecins pensent majoritairement que les salaries souhaiteraient parler de leurs difficultes au travail alors qu’ils ne sont que 24,2 % des salaries a repondre ainsi (p Conclusion Le decalage entre les attentes et les craintes des salaries et la perception des medecins sur celles-ci doit faire reflechir sur le contenu du colloque singulier. La transmission d’un message adapte est necessaire pour que la sensibilisation des salaries soit optimale.

Introduction La relation medecin–patient en medecine du travail est singuliere, notamment parce qu’elle se developpe dans une demarche preventive, ou le patient n’est pas forcement un malade (au sens d’une degradation de son etat de sante). Cette relation est par ailleurs imposee dans le cadre du suivi de sante obligatoire des travailleurs et le salarie n’a pas le choix de son praticien. Objectif Dans cette relation medecin–patient particuliere, l’objectif a ete d’etudier les modalites de transmission de l’information medicale du salarie au medecin du travail et d’analyser les determinants de cette transmission. Methodologie Distribution d’un auto-questionnaire aux salaries venant en visite medicale de sante au travail, quel que soit le type de visite, au sein d’un service de sante au travail inter-entreprises de la metropole lilloise (enquete realisee entre avril et juin 2016). Resultats Le recueil de 359 questionnaires aupres des salaries a permis de mettre en evidence que 55,7 % des salaries interroges declarent transmettre spontanement leurs informations medicales au medecin du travail, 24,5 % declarent les transmettre si le medecin aborde le sujet, 2,5 % declarent les transmettre s’ils se sentent en confiance et enfin 3,6 % declarent qu’ils ne transmettront sous aucun pretexte leurs informations medicales au medecin du travail. Les salaries sont 46,2 % a penser qu’ils sont obliges de delivrer toutes les informations concernant leur sante au medecin du travail et 10 % pensent meme pouvoir etre sanctionnes par leur employeur s’ils ne delivrent pas toutes ces informations au medecin. Un lien statistiquement significatif a ete mis en evidence entre la transmission de l’information medicale du salarie au medecin du travail et le fait que le salarie connaisse le medecin avant la visite. Il y a par ailleurs une influence negative statistiquement significative entre la transmission de cette information et le fait que les salaries craignent que le secret medical soit trahi ; en sachant que 10,3 % craignent que le secret medical soit trahi. Par contre nous n’avons pas montre de lien statistiquement significatif entre le type de visite medicale realisee et la transmission de l’information medicale. Enfin, il n’y avait pas non plus de lien entre la confiance envers le medecin du travail et le fait de connaitre le medecin. Conclusion La transmission de l’information medicale par le salarie est influencee par le lien de confiance entre le salarie et le praticien, independamment de la connaissance prealable du medecin et du type de visite medicale.

Background Biomarkers in exhaled breath condensate (EBC) are potentially sensitive indicators of early biochemical changes in airways following exposure to pneumotoxic substances, particularly in susceptible subjects. NOx are the stable end products of the nitrite–nitrate–NO oxidative stress pathway and can be used to monitor airway inflammatory diseases, especially in asthma. Nevertheless, population-based surveys are needed to better interpret EBC NOx levels in clinical studies. The aim of this study was to establish reference values of EBC NOx in a large group of middle-aged, healthy adults of a sample of the general population with particular focus on the smoking status. Methods The EBC NOx levels were analysed from 2872 subjects among the ELISABET population-based cross sectional study including a representative sample of men and women aged from 40 to 66 years olds conducted in northern France, which included comprehensive questionnaires by interview and spirometry data. Healthy participants were defined as participants with no self-reported respiratory disease. Results For the healthy subjects (n = 1251), the median NOx concentration (IQR) was equal to 7.2 μM (3.12) and concentrations of NOx in EBC did not differ significantly according to smoking status. The upper fifth percentile (95%) (ULN) of NOx concentrations among healthy subjects was equal to 13.6 μM, ranging from 12.7 μM (smokers) to 14.4 μM (ex smokers). Among subjects with EBC NOx values higher than the ULN and compared with subjects that had EBC NOx values lower than the ULN, we found a significant higher proportion of subjects with current asthma (10.5% vs 6.5%) or with chronic bronchitis symptoms (7.6% vs 3.3%). Conclusion This population-based study has provided the distribution and the upper limit reference value of a nitrosative stress biomarker (NOx) in EBC of middle aged, healthy adults. EBC NOx levels were not associated with smoking status.

The theme of psychosocial risks remains in the workplace. It is therefore essential that all members of a company are made aware of the terminology and specific prevention actions in this field. Distinguishing between the manifestations of these risks and their causes and consequences helps to improve prevention.

Several epidemiological studies have shown the impact on respiratory health of pollution of nitrogen dioxide (NO2), particulate matter (PM10), and ozone (O3) as an environmental mixture. However, the influence of individual components of airborne pollutants is less well known. Our study examined the cumulative effects of a single pollutant, NO2, on sensitized rats by measurement of isoprostane release in exhaled breath condensate (EBC). Three groups of six rats were used: (1) controls (only exposed to air), (2) sensitized and challenged by ovalbumin and exposed to air, and (3) sensitized, challenged by ovalbumin, and exposed to NO(2). There was no marked change in 8-isoprostane levels in EBC of sensitized rats, whereas a significant increase of 8-isoprostane was found in rats sensitized and exposed to NO2. Data indicate effect of exposure to NO2 is evident as increased 8-isoprostane levels in EBC, a relevant marker for assessment of pulmonary inflammation or oxidant stress and conventionally found in EBC of asthmatic subjects.

Spirometry plays a pivotal role in the clinical evaluation and management of respiratory diseases. Pulmonary function varies with age, height, sex and ethnicity, and test results need to be compared with predicted values and lower limits of normal (LLN) and upper limits of normal (ULN), that are appropriate for the individual being tested [1]. The European Community for Steel and Coal (ECSC) first published reference spirometric values for healthy non-smokers in 1983 based on a collation of regression equations [2]. In 2012, the Global Lung Function Initiative (GLI) presented prediction equations derived from measured values of a large population [1]. These newer statistical procedures provided us for the first time with a single equation for ages from 3 years through to 95 years. Measured values are converted to z-scores which describe how many standard deviations a measured value differs from the predicted value and these are independent of sex, age and height. GLI reference equations better describe a middle-aged, healthy French population than the ECSC values

A particle exposure assessment based on the dose deposited in the lungs would be the gold standard for the evaluation of any resulting health effects. Measuring particles in exhaled breath condensate (EBC)-a matrix containing water and airway lining fluid-could help to evaluate particle retention in the lungs. This study aimed to (1) validate a nanoparticle tracking analysis (NTA) method for determining the particle number concentration and their hydrodynamic size distribution in EBC, and (2) apply this method to EBC collected from workers exposed to soapstone (n = 55) or quartz dust (n = 12) and controls (n = 11). A standard latex bead solution was used to determine the linear range, limit of detection (LOD), repeatability (coefficient of variation, CV), and bias in spiked EBC. An LM10 NanoSight instrument with NTA version 3.1 software was used for measurement. RTubes(®) were used for field collection of EBC. The repeatability obtained for a D50 size distribution in EBC showed less than 8% variability, with a bias

OBJECTIVE: This study aimed to test longitudinal associations linking the work-unit-level psychosocial and organizational work environment and biomechanical constraints to workers’ shoulder pain in the French multi-centre cohort ORSOSA study of registered nurses (RN) and nursing assistants (NA). METHODS: We analyzed 1896 female RN and NA, who were free of shoulder pain in 2006 and in the same position and work unit in 2008. Incident shoulder pain (SP) was defined as self-reported pain that persists for ≥4 days and/or increases during a lateral movement of the arm away from the midline of the body (abduction). Both cross-sectional and longitudinal models were built to test if work-unit-level features or their influences on both work tasks and individual perception of the work environment directly influence the risk of developing incident SP. RESULTS: RN in work units with understaffing issues or poor relationships reported higher levels of biomechanical constraints in movements and postures and a lower level of perceived job security and stability. NA who experienced such issues reported higher levels of biomechanical constraints in indirect patient-handling activities only. The exposure to these latter factors was associated with higher two-year incident SP among workers. CONCLUSION: This study shows that the work-unit-level organizational characteristics may impact workers’ musculoskeletal disorders by conditioning both work-task-related biomechanical exposures and individual perception of the working environment. In healthcare settings, primary prevention programs to reduce MSD would benefit from a focus on work unit level exposures.

The theme of psychosocial risks remains in the workplace. It is therefore essential that all members of a company are made aware of the terminology and specific prevention actions in this field. Distinguishing between the manifestations of these risks and their causes and consequences helps to improve prevention.

Trois enjeux positionnent la sante au travail des soignants comme un probleme de sante publique : le maintien au travail des soignants dans un contexte de forte insatisfaction au travail, la preservation de la sante des soignants et enfin, le maintien de la qualite des soins. Le programme pluridisciplinaire ORSOSA (ORganisation des SOins et SAnte des soignants) est un programme de recherche interventionnelle en sante des populations visant l'amelioration de la qualite de vie au travail des soignants. Il vise a developper un outil de diagnostic des contraintes psychosociales et organisationnelles (CPO) et des contraintes mecaniques (CM) puis a le mettre en oeuvre dans une demarche de prevention primaire. Il comprend deux phases : la recherche (ORSOSA 1) et l'intervention (ORSOSA 2). Dans ORSOSA 1, une cohorte prospective de soignants a ete developpee et a permis de construire et valider un outil de diagnostic des CPO et des CM au niveau de l'Unite Fonctionnelle (UF). La demarche ORSOSA 2 repose sur l'utilisation de l'outil pour mettre en place une dynamique collective et consensuelle, a partir des restitutions collectives des forces et faiblesses de l'UF, pour faire emerger des preconisations pour ameliorer la qualite de vie au travail. ORSOSA est actuellement deploye sur 4 CHU (Lille, Bordeaux, Grenoble et Strasbourg) avec chacun 5 hopitaux de proximite. La reflexion continue sur l'evaluation et le suivi de la demarche.

International audience; Objectives: This longitudinal study aimed to test the hypothesis that organizational work factors (OWFs) may be related to depressive symptoms through an increased effort-reward imbalance (ERI) ratio among registered nurses (RNs) and nursing assistants working in hospitals. Methods:We studied 2117 female RNs and nursing assistants who stayed in the same work unit and position during the follow-up from the ORSOSA (ORganisation des SOins-SAnt'e) longitudinal study. The work characteristics and workers' health were assessed in 2006 and 2008. Results: We confirmed our hypothesis of both direct and mediated effects of OWFs on workers' health. We showed that issues about patient-related information exchanges increased RNs' depressive disorders by increasing first a perceived ERI. Conclusions: Our results advocate integrating both the work organizational level and the individual level into preventive actions to improve workers' mental health.

Resume Objectif Fournir des informations quantitatives sur l’emphyseme chez les fumeurs asymptomatiques, correlees aux epreuves fonctionnelles respiratoires (EFR). Patients et methodes La population de l’etude se composait de 75 fumeurs (fumeurs actifs : n = 39 ; ex-fumeurs : n = 36) et 25 non-fumeurs, qui ont beneficie d’une tomodensitometrie (TDM) thoracique en rendu volumique-haute-resolution avec quantification automatique de l’emphyseme et d’EFR. Resultats Chez les fumeurs actifs, le pourcentage d’emphyseme etait plus eleve dans le poumon droit (p = 0,041) et dans le lobe superieur droit (p = 0,037). Nous n’avons pas observe de variation du pourcentage global d’emphyseme en fonction du stade GOLD (p = 0,77). Les fumeurs atteints d’emphyseme avaient des valeurs moyennes significativement plus elevees de CRF (p = 0,0012), de VR ( 0,05). Nous avons trouve des correlations entre le pourcentage d’emphyseme et : (a) la consommation de cigarettes des fumeurs actifs (r = 0,34215 ; p = 0,0330) et des ex-fumeurs (r = 0,44104 ; p = 0,0071) ; et (b) des alterations de CPT, CRF, VR et DLCO chez les fumeurs. Conclusion La TDM quantitative permet de mettre en evidence des specificites de distribution regionale et des alterations fonctionnelles precliniques chez les fumeurs emphysemateux.

Brazil is an exporter of precious stones and craftsmen often work in poor conditions. We assessed silica-related diseases among crystal craftsmen and the complexity of its control.Case-series including 118 subjects evaluated from 2006 to 2015, based on medical interviews, chest X-rays, spirometry, and respirable silica samples.Median age and length of exposure were 32 and 13 years, respectively. Silicosis, with 1/0 as a threshold, was diagnosed radiologically in 57 individuals (48.3%). Respirable silica concentrations were 0.9-29.3 times greater than the Brazilian occupational exposure limit. A Receiver Operating Characteristic (ROC) curve with the same diagnosis threshold showed best discrimination at a cut point of 12.5 years of exposure, corresponding to 4.85 mg-y/mCrystal craftsmen continue to suffer from silicosis, lung function impairment, comorbidity, and death due to silicosis. To date collective protection in some work sheds has not diminished silica levels. Long-term follow-up is needed to evaluate further improvements in preventive measures. Am. J. Ind. Med. 60:239-247, 2017. © 2017 Wiley Periodicals, Inc.

The analysis of exhaled breath condensate (EBC) offers the potential for identifying lung disease markers in humans and animals, but methodological issues and standardised procedures need to be addressed before the technique can be considered for use in applications to help understand the role of environmental pollution in respiratory diseases. The purpose of this study was to develop and implement a new device using a glass-chamber for collecting EBC non-invasively from rats in order to analyse EBC markers in lipopolysaccharide (LPS)-induced acute lung injury. Eighty-four adult rats were used in five different series of experiments to determine the source of EBC formation, intra-day and inter-day variability, and the influence of environmental parameters on EBC markers. The hypothesis that inflammation induces an oxidative stress was assessed by measuring pH, nitrogen oxides (NOx) and hydrogen peroxide (H 2 O 2 ) in EBC. The results confirmed that EBC fluid was generated at the level of the respiratory tract. The repeatability studies of disease markers indicated higher concentrations of NOx and H 2 O 2 at midday compared to the morning, but there were no significant difference between measurements on consecutive days. EBC volume was influenced by both ambient temperature and humidity. Moreover, 3 h after LPS challenge, significantly increased concentrations of both NOx and H 2 O 2 were observed in EBC of the LPS group compared with controls ( P = 0.005 and P = 0.027, respectively). These results suggested that EBC collection may be a valuable tool to monitor the presence of markers, such as NOx and H 2 O 2 , in an animal model of LPS-induced acute lung injury.

A new method for the analysis of particulate matter in lungs is proposed. It combines the exhaled breath condensate technique and Raman spectroscopy. The sampling method is noninvasive, which is suitable for the detection of occupational exposure to dust. The chemical composition of dust particles is assessed by Raman microspectroscopy. The effectiveness of this method as a means of identifying markers of occupational exposure to mica dust is evaluated. Copyright © 2011 John Wiley & Sons, Ltd.

Resume Les auteurs rapportent l’experience du service de medecine du travail et de pathologie professionnelle de Sfax (Tunisie) en matiere de prevention active de l’hepatite virale B, a travers une etude descriptive interessant tout le personnel des hopitaux universitaires de Sfax. Il s’agit d’un bilan de 18 ans de vaccination effectuee dans les deux centres hospitalo-universitaires de Sfax. La periode d’etude s’etale du 1er janvier 1990 jusqu’au 31 decembre 2007. es objectifs de notre etude etaient d’evaluer l’application d’une politique vaccinale recommandee, d’etudier l’efficacite de cette campagne vaccinale et d’analyser l’adhesion du personnel de sante a leur propre prevention. Ce travail a porte sur 2610 personnels hospitaliers soit 1223 hommes (46,9 %) et 1387 femmes (53,1 %). Seuls 1730 individus repartis en 756 hommes (61,8 %) et 974 femmes (70,2 %) ont participe a cette action. L’etude de la serologie prevaccinale a permis d’identifier : 72 porteurs de l’antigene HBs (4,2 %) ; 436 agents immunises (25,2 %) ; 1222 candidats a la vaccination (70,6 %) dont 1124 etaient vaccines (92,0 %). La prevalence de la vaccination selon le grade hospitalier est maximum chez les techniciens superieurs (99,0 %). La prevalence de la seroconversion postvaccinale a ete de l’ordre de 87,9 %. Environ 12,1 % ont ete selectionnes mauvais repondeurs et ont ete candidats a une quatrieme injection. Seulement 48,5 % en ont beneficie, dont 48,5 % avaient developpe des anticorps protecteurs. A la fin de la premiere annee de vaccination 82,1 % (923/1124) des candidats a la vaccination avaient participe ; alors que les taux de participation aux rappels a cinq, dix et 15 ans avaient ete respectivement 79,5, 57,2 et 48,4 %.

Resume But de l’etude Le corps medical hospitalier, bien qu’expose a des risques professionnels, ne beneficie en general pas d’un suivi aussi rapproche que le personnel paramedical. Au centre hospitalier regional universitaire de Lille, la commission medicale d’etablissement a demande la mise en place d’un suivi medical du personnel medical effectue par le service de medecine du travail du personnel hospitalier. Il a ete instaure au mois d’octobre 2000. Methode Dans ce cadre, une etude transversale visant a evaluer les besoins a ete mise en place de mai 2001 a mars 2002, en interrogeant 222 medecins et pharmaciens venus dans le service. Resultats L’enquete a revele une faible protection immunitaire vis-a-vis de la vaccination DTP (70 % pensaient etre a jour), de l’hepatite B (63 % etaient correctement immunises) et de la tuberculose (20 % ne connaissaient pas leur statut immunitaire). La connaissance des risques lors d’un accident d’exposition au sang (AES) etait insuffisante : 35 % des sujets enquetes evaluaient correctement le risque de transmission du virus de l’hepatite B, 57 % celui du virus de l’hepatite C et 66 % celui du virus de l’immunodeficience humaine. Par ailleurs, 22 % ne declaraient jamais leur AES. La protection contre les rayonnements ionisants etait egalement insuffisante : 18 % des sujets exposes ne portaient jamais de tablier de plomb ou de cache-gonades ; 25 % ne portaient jamais de dosifilm-poitrine. Conclusion Les resultats de cette etude soulignaient bien la necessite d’un suivi medical regulier du corps medical en medecine du travail.

Pulmonary fibrosis in systemic sclerosis (SSc) involves inflammatory processes in the lower respiratory tract. Analysis of exhaled breath condensate (EBC) is a non-invasive method for studying inflammatory mediators, such as cytokines, which are of interest from both physiological and therapeutic perspectives. The aim of this study was to assess and compare cytokine concentrations in the EBC of SSc patients and controls.EBC was collected from 19 SSc patients and 19 controls. We used a multiplex assay test kit to assay interleukin (IL)-2, -4, -6, -10, tumour necrosis factor-alpha, and interferon-gamma in samples concentrated by lyophilization.Cytokine concentrations in EBC were higher in SSc patients than in controls. The stepwise analyses showed that IL-4 was the biomarker which contributed most to the discrimination between controls and patients (Wilk's Lambda = 0.55, p0.001). We observed significant negative correlations of EBC cytokines with total lung capacity and diffusion capacity of the lung for carbon monoxide.These findings suggest that EBC sampling permits the non-invasive study of inflammation in SSc patients, and may be correlated with the severity of interstitial lung disease.

To evaluate the depiction of lung and pleural asbestos-related lesions with low-dose four-detector row spiral computed tomography (CT).Eighty-three male workers with a mean duration of occupational exposure to asbestos of 18 years underwent CT as part of a medicolegal investigation. CT examination included low-dose multi-detector row spiral CT of the entire thorax, with reconstruction of contiguous 5-mm-thick images, and thin-section CT, which served as the reference standard for the detection of pleural and parenchymal asbestos-related abnormalities. Two main groups of abnormalities were identified: (a) pleural plaques and diffuse pleural thickening and (b) thickened interstitial short lines, curvilinear subpleural lines, ground-glass opacity with or without bronchiectasis, and honeycombing. The frequencies of the depiction of these abnormalities on the low-dose multi-detector row images and the thin-section images were compared by using the McNemar test.No significant differences were observed between the low-dose and thin-section CT images in the depiction of either (a) parietal pleural fibrosis consisting of pleural plaques (identified in 67 [81%] vs 65 [78%] workers, P =.157), which appeared mainly as thick, calcified pleural linear structures; or (b) features of parenchymal fibrosis, which consisted of various combinations of intralobular and septal lines (identified in 12 [14%] vs 13 [16%] workers, P =.564), subpleural curvilinear lines (identified in 10 [12%] vs eight [10%] workers, P =.157), and ground-glass opacity with (identified in six [7%] vs six [7%] workers) or without (identified in five [6%] vs three [4%] workers, P =.317) traction bronchiectasis. A honeycombing pattern was depicted on only the thin-section CT images (P.001). Emphysema (identified in 26 [31%] vs 14 [17%] workers at low-dose and thin-section CT, respectively; P.001) and noncalcified nodules (identified in 18 [22%] workers vs one [1%] worker, P.001) were depicted significantly more frequently on the low-dose images than on the thin-section images.Low-dose multi-detector row spiral CT accurately depicts asbestos-related disease.

The health of hospital workers, nurses and nurse-aids constitutes a public health challenge for three reasons: maintenance of personnel at work in a context in which many express their desire to quit their jobs, protection of their health, and maintenance of quality of care. ORSOSA (ORganisation des SOins et SAnté des soignants) is a multidisciplinary interventional population health research programme designed to improve quality of life in the workplace of healthcare workers. This programme is designed to develop a tool to diagnose psychosocial and organisational work factors (POWFs) and mechanical constraints (MC), and then to implement this method in primary prevention interventions. ORSOSA consists of two steps: research (ORSOSA 1) and intervention (ORSOSA 2). In ORSOSA 1, a prospective cohort of healthcare workers was developed to construct and validate the diagnostic tool of work-related constraints at the work unit level. ORSOSA 2 consists of using the tool to implement both a collective and consensual dynamic based on collective restitution of the strengths and weaknesses of the work unit in order to propose recommendations for better quality of life at work. ORSOSA is now deployed in 4 teaching hospitals (Lille, Bordeaux, Grenoble and Strasbourg), each with 5 peripheral hospitals. Evaluation and follow-up of the programme is ongoing.

International audience; Background: Many studies have supported the role of organizational work factors (OWFs) on the risk of cardiovascular diseases (CVDs) and CVD risk factors, including arterial hypertension. However, a little information is available concerning the role of collective stressors deriving from work organization on nurse's risk of hypertension. This study aimed to test the independent longitudinal relationships linking the 2-year incidence of arterial hypertension to collective stressors at the work unit level, among baseline normotensive female hospital registered nurses and nursing assistants, after adjusting for known individual predictors of CVDs and for occupational stress.Method: Arterial hypertension was defined as the intake of antihypertensive drug or as blood pressure (BP) measures higher than 140 mmHg (SBP) or 90 mmHg (DBP) at both the clinical visit and 1 month later. We analyzed the effect of OWFs at the work unit level, constraints related to the physical work environment and the individual perception of the work environment in 2006 on the risk of arterial hypertension in 2008 among 1882 initially normotensive female healthcare workers followed in the French Organisation des soins et santé des soignants (ORSOSA) cohort.Results: We showed that OWFs at the work unit level may influence the 2-year risk of arterial hypertension independently of work factors at the worker level, baseline BP, age and BMI. In this study, OWFs affected 2-year risk of arterial hypertension only through direct effects.Conclusion: Our results pointed out the possibility of a primary prevention of arterial hypertension through interventions based at the work unit level among healthcare workers.

The fibrogenicity and carcinogenicity of asbestos fibers are dependent on several fiber parameters including fiber dimensions. Based on the WHO (World Health Organization) definition, the current regulations focalise on long asbestos fibers (LAF) (Length: L ≥ 5 μm, Diameter: D < 3 μm and L/D ratio > 3). However air samples contain short asbestos fibers (SAF) (L < 5 μm). In a recent study we found that several air samples collected in buildings with asbestos containing materials (ACM) were composed only of SAF, sometimes in a concentration of ≥10 fibers.L-1. This exhaustive review focuses on available information from peer-review publications on the size-dependent pathogenetic effects of asbestos fibers reported in experimental in vivo and in vitro studies. In the literature, the findings that SAF are less pathogenic than LAF are based on experiments where a cut-off of 5 μm was generally made to differentiate short from long asbestos fibers. Nevertheless, the value of 5 μm as the limit for length is not based on scientific evidence, but is a limit for comparative analyses. From this review, it is clear that the pathogenicity of SAF cannot be completely ruled out, especially in high exposure situations. Therefore, the presence of SAF in air samples appears as an indicator of the degradation of ACM and inclusion of their systematic search should be considered in the regulation. Measurement of these fibers in air samples will then make it possible to identify pollution and anticipate health risk. © 2014 Boulanger et al. licensee BioMed Central Ltd., SCOPUS: re.j, info:eu-repo/semantics/published

National audience; Du fait de la nature même de leur travail, les soignants sont parmi les professionnels les plus touchés par les troubles musculo-squelettiques (TMS). Cette étude longitudinale vise à identifier les déterminants des douleurs de l’épaule liés à l’environnement psychosocial et organisationnel de travail et aux contraintes biomécaniques des infirmières et des aides-soignantes travaillant en CHU en France.

To evaluate the frequency and morphologic characteristics of air trapping in volunteers with various smoking habits.Two hundred fifty volunteers (133 women, 117 men; mean age, 39 years), including 144 smokers, 47 ex-smokers, and 59 nonsmokers, prospectively underwent inspiratory and expiratory high-spatial-resolution computed tomography (CT) and pulmonary function tests (PFTs). The frequency and characteristics of air trapping were evaluated according to the population's smoking habits and PFT results.The overall frequency of air trapping was 62% (155 of 250 subjects). Lobular air trapping was depicted in 117 (47%) of 250 subjects, without significant differences among smokers (n = 91), ex-smokers (n = 33), and nonsmokers (n = 31) (P =.118). Segmental and lobar air trapping (38 [15%] of 250) were more frequent among smokers (24 [26%] of 91) and ex-smokers (nine [27%] of 33) (P.001). No relationship was found between air trapping and functional indexes of small-airway disease when the CT pattern of air trapping was considered. The strongest relationship between CT abnormalities and functional alterations at the small-airways level was between inspiratory CT features of bronchiolitis: ground-glass opacity, ill-defined micronodules, bronchiolectasis, and air flow at low lung volumes.Whereas a significant relationship was observed between segmental and lobar air trapping and cigarette consumption, lobular air trapping was not found to reflect functional impairment at the small-airways level.

A back school was established in 1992 at the University Hospital of Lille (France) for employees with low back pain. We report its medical and socioeconomic benefits with a mean time to follow-up of 4 years. Our retrospective study included 108 health care workers and provides objective data (absenteeism, use of health care) and subjective information (progression of pain and disorder, social and professional impact) before training and a mean of 4 years after training. We found that 92% of the participants were satisfied with the training and that back pain had regressed or resolved for 55% of them. Both the frequency and duration of pain had decreased significantly. Seventy percent continue to apply the advice they received in their everyday life. Dealing with the problems specific to professional activities contributed to reduce the strain experienced on the job by the health care workers and improved their satisfaction at work. Global absenteeism was reduced by 57.8%, whereas it was reduced by 33% for back pain alone 4 years after implementing this program. Our study provides evidence of the positive impact of this type of training on the way back pain is perceived and on everyday life. The assessment of the cost/efficiency ratio completes the list of durable benefits reported here.

In the last few years, many studies have been carried out concerning the effects of fumes from stainless steel (SS) welding on the health of welders. The respiratory effects of exposure to SS welding fumes have already been studied, but the results of lung function investigations have not been consistent. However, the main factor of risk for the welders' health seems to be related to the great concentration of chromium and nickel contained in fumes coming from SS welding. The aim of this study was to detect the chronic effects of SS welding exposure on pulmonary symptoms and ventilatory function tests. Respiratory symptoms and lung function tests were studied in 134 SS welders and 252 controls (C). Welders and controls were of similar average age, height, and duration in employment. The smoking habits of the groups were also similar. The medical questionnaire on respiratory symptoms was a version of the Medical Research Council questionnaire, modified by the British Occupational Hygiene Society. The flow-volume curves were performed with a calibrated pneumotachograph spirometer before each subject started working. After adjustment for tobacco habits, the SS welders presented a higher prevalence of bronchial irritative symptoms such as cough (P = 0.01) or sputum production (P = 0.02) than the controls. On the other hand, chronic bronchitis appeared to be significantly linked to tobacco consumption. The pulmonary function analysis underscored no significant difference between stainless steel welders and controls (forced expiratory volume in one second, observed/predicted: SS = 0.99 vs C = 0.98; maximal midexpiratory flow, observed/predicted: SS = 0.90 vs C = 0.92; maximal expiratory flow at 50 % of the forced vital capacity, observed/predicted: SS = 0.95 vs C = 0.95). On the other hand, by the mean of the two-ways analysis, a significant tobacco effect was found, without exposure or interaction of tobacco-exposure effects. There was no influence of the specific welding processes on the spirographic parameters, but a decrease in spirographic values after 25 years of welding activity was evident. The results of multiple regression indicated that age was not a confounding factor.

Air and biological monitoring were used for assessing external and internal chromium exposure among 116 stainless steel welders (SS welders) using manual metal arc (MMA), metal inert gas (MIG) and tungsten inert gas (TIG) welding processes (MMA: n = 57; MIG: n = 37; TIG: n = 22) and 30 mild steel welders (MS welders) using MMA and MIG welding processes (MMA: n = 14; MIG: n = 16). The levels of atmospheric total chromium were evaluated after personal air monitoring. The mean values for the different groups of SS welders were 201 micrograms/m3 (MMA) and 185 micrograms/m3 (MIG), 52 micrograms/m3 (TIG) and for MS welders 8.1 micrograms/m3 (MMA) and 7.3 micrograms/m3 (MIG). The curve of cumulative frequency distribution from biological monitoring among SS welders showed chromium geometric mean concentrations in whole blood of 3.6 micrograms/l (95th percentile = 19.9), in plasma of 3.3 micrograms/l (95th percentile = 21.0) and in urine samples of 6.2 micrograms/l (95th percentile = 58.0). Among MS welders, mean values in whole blood and plasma were rather more scattered (1.8 micrograms/l, 95th percentile = 9.3 and 1.3 micrograms/l, 95th percentile = 8.4, respectively) and in urine the value was 2.4 micrograms/l (95th percentile = 13.3). The analysis of variance of chromium concentrations in plasma previously showed a metal effect (F = 29.7, P0.001), a process effect (F = 22.2, P0.0001) but no metal-process interaction (F = 1.3, P = 0.25). Concerning urinary chromium concentration, the analysis of variance also showed a metal effect (F = 30, P0.0001), a process effect (F = 72, P0.0001) as well as a metal-process interaction (F = 13.2, P = 0.0004). Throughout the study we noted any significant differences between smokers and non-smokers among welders. Taking in account the relationships between chromium concentrations in whole, plasma or urine and the different welding process. MMA-SS is definitely different from other processes because the biological values are clearly higher. These higher levels are due to the very significant concentrations of total soluble chromium, mainly hexavalent chromium, in welding fumes.

Objective: We present pulmonary disorders of four employees who were exposed to high concentration of pure mica dust in a muscovite milling unit. Method: All cases underwent traditional examinations with a dualenergy chest computed tomographic scan. An analysis of exhaled breath condensate by Raman microspectrometry and of mineralogical content of a lung biopsy was performed for one case. Results: All cases showed bilateral micronodular ground glass opacities and mediastinal and hilar hyperdense lymph nodes consistent with the nodal sequestration of mineral particles. Histological analysis showed giant cell granulomas without typical silicotic nodule with high concentration of birefringent particles consistent with mica. Mica particles found in the exhaled breath condensate were identical to particles in ambient air at the company. Conclusion: Occupational exposure to mica dust is responsible for diffuse infiltrative lung disease by overload processes.