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Resume Objectifs Le personnel de laboratoire de preparation dans les secteurs de recherche cumule des expositions a des produits de nettoyage, a des substances chimiques et au latex ; les animaliers sont exposes aux memes nuisances ainsi qu’aux allergenes des animaux de laboratoire. Ces expositions entrainent des symptomes respiratoires, ORL, oculaires ou cutanes de type allergique ou irritatif. L’objectif de cette etude est de determiner la prevalence de ces symptomes, de documenter la presence d’immunoglobulines E (IgE) specifiques contre certains de ces allergenes et de decrire les facteurs professionnels associes afin d’ameliorer la politique de prevention sur site. Methodes Les salaries d’un institut de recherche ( n = 131, dont 49 % exposes a des animaux de laboratoire) ont repondu aux questionnaires medical et professionnel sur leurs symptomes, leurs tâches et expositions. Ils ont beneficie d’une recherche d’IgE specifiques aux pneumallergenes (Phadiatop ® ) et de dosages d’IgE specifiques dirigees contre les allergenes d’animaux de laboratoire, le latex et les ammoniums quaternaires (AQ). Des explorations fonctionnelles respiratoires (courbe debit/volume) ont ete realisees ainsi que des mesures de monoxyde d’azote dans l’air exhale. Resultats Soixante-douze salaries (55 %) declarent au moins un symptome rythme par le travail, que ce soit lors de la realisation des tâches, de la manipulation des animaux et des produits ou du port de gants en latex. La rhinite est le plus frequent des symptomes (27 %), puis la conjonctivite (23 %), toux seche (21 %), gene oropharyngee (14 %), eczema (11 %) et asthme (2 %). La duree mensuelle des tâches est plus importante chez les salaries symptomatiques. Chez 13 salaries (21 % chez les 63 chez qui le dosage a ete fait), des IgE specifiques d’allergenes d’au moins un animal de laboratoire ont ete mises en evidence. Les prevalences d’IgE specifiques contre le latex d’une part et les ammoniums quaternaires d’autre part sont les memes, soit 4 % ( n = 5). Le terrain atopique favorise une sensibilisation aux animaux de laboratoire. Les resultats des EFR revelent un syndrome obstructif dans 6 cas. La concentration de NO exhale est plus elevee chez les salaries symptomatiques que chez les salaries asymptomatiques. Le personnel est expose a de multiples nuisances (detergents/desinfectants, produits de preparation de milieux de culture et animaux) qui induisent des effets concomitants, irritatifs et allergiques. Conclusion Devant cette importante prevalence de symptomes chez des salaries exposes, en particulier la rhinite qui peut preceder le developpement d’un asthme, une politique de prevention a ete renforcee afin de remplacer, si possible certains produits, de diminuer les niveaux d’exposition aux allergenes et aux irritants, d’ameliorer le port des equipements de protection individuelle et l’observance des protocoles d’utilisation des produits detergents/desinfectants et de preparation des milieux de culture.

Introduction : les arrets en cours de grossesse jouent un role sous-estime selon plusieurs etudes. Elles mettent en evidence l’existence de facteurs de risque concernant la penibilite physique pour la survenue de contractions, d’arrets de travail, d’hospitalisations et de prematurite. Les donnees obtenues sur la totalite des salariees de l’Assistance Publique des Hopitaux de Paris (AP-HP) permettent d’eviter tous les biais de recueil et de determiner l’impact potentiel d’une politique de reduction de la penibilite physique.Methode : les resultats de quatre annees ont pu etre analyses. La base de donnees utilisee est PILOTE RH, application intranet restituant des informations extraites de GIPSIE qui a ete jusqu’en 2008 le logiciel institutionnel de gestion des carrieres de tous les agents de l’AP-HP.Resultats : en 2008, les 3 937 femmes ayant eu un « conge de couches » (CC) ont cumule 132 360 jours d’arret « maladie ordinaire » (MO) (soit 33,6 jours en moyenne) en dehors des jours de « grossesse pathologique » (GP) et des « suites de couches ». Les arrets MO de l’ensemble des 53 132 femmes s’elevent a 11,5 j. par agent. Mais, la mise a part des femmes ayant eu un CC reduit le nombre de jours d’arret a 9,7 j. Cette difference pese pour 15,6 % du total de l’absenteisme MO. Les resultats sont similaires les quatre annees.L’analyse par grade, pour 2008, montre que le nombre moyen de jours d’arret pour MO, hors femmes ayant eu un CC, diminue avec la penibilite physique des postes evaluee par l’etude PRESST-NEXT : ASH 19,9 j., AS 13,7 j., IDE 8,2 j., IDE specialisees 7,7 j., medico-techniques 5,7 j. et cadres 5,1 j. Pour les femmes ayant eu un CC, le nombre moyen de jours d’arret MO, est le plus eleve pour les AS (41,9 j.) suivi par les ASH (36 j.) et les IDE (36 j.) et legerement moins pour les IDE specialisees (28,3 j.). Par contre, dans les metiers ayant le moins de penibilite physique les femmes ont moins de 25 j. d’arret MO l’annee de leur CC : medico-techniques 21,3 j., cadres 23,1 j. et administratifs 23,7 j. Les resultats sont similaires les quatre annees.Pour les IDE, c’est 25,5 % du total des arrets MO qui sont attribuables aux femmes ayant eu une grossesse, et 34,4 % de l’ensemble arrets MO +15 j. GP.Discussion : une action de reduction de la penibilite physique dans des etablissements tests pourrait etre menee. La reduction des jours d’arret en cours de grossesse peut etre un indicateur rapide d’evaluation de l’efficacite des investissements.Les ameliorations beneficieront a l’ensemble des agents, a moyen terme, avec une reduction des risques de « troubles musculo-squelettiques » (TMS) et lombalgies. Une telle action permet aussi de maintenir l’employabilite des salaries plus âges et d’integrer des personnes en situation de handicap dans un travail qui a pour eux un sens fort et qu’ils ne veulent pas abandonner.

Among the wheat prolamins, D-type glutenins display a highly repetitive sequence similar to omega-gliadins, but they contain a cysteine, that allows them to be included in the gluten macropolymers. An omega-gliadin-like D-type glutenin, an alpha-gliadin, and an omega 5-gliadin-like D-type glutenin were obtained as recombinant proteins and compared using synchrotron radiation circular dichroism. This technique evidenced the strong thermostability of the omega 5-gliadin-like protein. The IgE reactivity of recombinant proteins was evaluated using 45 sera from wheat-allergic patients. The sera from patients diagnosed with cutaneous hypersensitivity to hydrolyzed wheat proteins often reacted with the omega-gliadin-like D-type glutenin and alpha-gliadin, whereas the IgE reaction was less frequent after dietary sensitization. So, these two proteins could be useful to diagnose these diseases. The sera from patients with exercise-induced anaphylaxis recognized the omega 5-gliadin-like protein as a positive control and, less frequently, the other proteins tested. Only some sera from patients with baker's asthma reacted with the proteins tested.

Objective Knowledge on the time-course (trends) of work-related asthma (WRA) remains sparse. The aim of this study was to describe WRA trends in terms of industrial activities and the main causal agents in France over the period 2001–2009. Method Data were collected from the French national network of occupational health surveillance and prevention ( Reseau National de Vigilance et de Prevention des Pathologies Professionnelles (RNV3P)). Several statistical models (non-parametric test, zero-inflated negative binomial, logistic regression and time-series models) were used and compared with assess trends. Results Over the study period, 2914 WRA cases were included in the network. A significant decrease was observed overall and for some agents such as isocyanates (p=0.007), aldehydes (p=0.01) and latex (p=0.01). Conversely, a significant increase was observed for cases related to exposure to quaternary ammonium compounds (p=0.003). The health and social sector demonstrated both a growing number of cases related to the use of quaternary ammonium compounds and a decrease of cases related to aldehyde and latex exposure. Conclusions WRA declined in France over the study period. The only significant increase concerned WRA related to exposure to quaternary ammonium compounds. Zero-inflated negative binomial and logistic regression models appear to describe adequately these data.

Background Light is a powerful synchronizer of the biological clock and of the sleep/wake cycle. Blind people have more sleep disturbances than people without eyesight problems. However, whether visually able people who are underexposed to bright natural light suffer from sleep wake disorders has never been examined. This study tried to assess the prevalence of sleep and wake disorders in subjects working in environments that are not exposed to natural light. Methodology A setting–controlled cross–sectional epidemiological study was carried out. A representative sample of 13 296 French employees of a single transportation company participated in the study. During working hours, 4635 subjects (34.9%) experienced no light exposure (NLE) and 8661 were partially or completely exposed (LE) to natural light. Sleep disorders, sleep quality, and sleepiness were assessed using subjective tools: the Sleep Disorders Questionnaire–French version (SDQFV) and the Epworth Sleepiness Scale (ESS). Light exposure was estimated on workers' schedules and by objective measurements of light intensity (lux meter). Principal findings On a univariate analysis, complaints of poor sleep and sleepiness were significantly higher in NLE workers compared to LE: nonrestorative sleep (36.8% vs. 29.5%; P Significance These data suggest that underexposure to natural light at work may significantly impair sleep and wake disorders in non–light-exposed workers.

Resume Introduction L’intolerance environnementale idiopathique (IEI) ou hypersensibilite chimique multiple est « une pathologie chronique regroupant des symptomes subjectifs multiples lies a une exposition aigue ou chronique a des stimuli environnementaux habituellement non nocifs et sans anomalie clinique objective ». Aux Etats-Unis, la prevalence est estimee entre 1 et 4 %. En France, cette pathologie est encore peu connue et les donnees epidemiologiques manquent compte tenu de l’absence d’outils diagnostiques universellement reconnus. Pourtant de tels outils existent, tels que les criteres diagnostiques definis en 1999 par la conference de consensus de l’American College of Occupational and Environmental Medicine et les questionnaires valides que sont le Quick Environmental Exposure and Sensitivity Index (QEESI © ) et le Chemical Odor Sensitivity Scale (COSS) en langue anglaise. Objectif Mettre a disposition une version francaise du QEESI © . Methode Nous avons realise la traduction francaise du QEESI © , autorisee et approuvee apres traduction inverse par C.S. Miller, auteur du questionnaire original. Celui-ci sera donc desormais disponible pour les francophones. Resultat Le questionnaire QEESI © en version francaise est maintenant telechargeable sur le site http://www.drclaudiamiller.com . Conclusion Ce travail de traduction doit donner lieu a une evaluation quantitative du questionnaire traduit afin de confirmer ses qualites psychometriques : fiabilite, validite et stabilite dans le temps. Differentes perspectives d’utilisation sont envisagees : (1) en clinique, pour documenter les observations de patients souffrant d’IEI (pour lesquels nous proposons l’utilisation d’un dossier type) ou eventuellement d’autres syndromes subjectifs rapportes a l’environnement, pour le suivi des patients par rapport a une proposition therapeutique, par le medecin du travail pour l’investigation sur le terrain d’un episode aigu d’exposition a l’origine d’un syndrome psychogenique de masse ; (2) en recherche, par exemple pour la selection des cas et des temoins, ou pour l’evaluation de l’efficacite d’une therapeutique.

Introduction La medecine du travail (MT) est une specialite medicale qui connait actuellement un important deficit d’attractivite. Promouvoir cette discipline aupres des etudiants en medecine est un enjeu primordial pour les annees a venir. Aucune donnee dans la litterature n’evalue jusqu’a present la pertinence d’outils de promotion de la MT et leur impact sur le choix futur de specialite. Objectif L’objectif de cette etude etait d’evaluer l’impact d’une video d’information sur la MT aupres des etudiants en medecine francais. Materiel et methode Un film d’animation numerique sur le role des medecins du travail a ete realise et diffuse sur internet ( https://youtu.be/aM6lKtBv-wQ ) par courriel et sur les reseaux sociaux du 28 juin au 29 aout 2017. Une etude avant-apres a ete menee aupres des repondants se declarant etudiants en 4e, 5e et 6e annee de medecine. Un auto-questionnaire en ligne a permis d’evaluer le niveau d’information ressentie concernant la MT et l’evolution induite par le film sur l’interet vis-a-vis de la discipline (0 a 10), l’image nouvellement percue, le souhait d’y realiser un stage d’externe ou de la choisir eventuellement a l’issue de l’ECN. Le critere principal de jugement etait l’amelioration du score d’interet vis-a-vis de la MT (0 a 10). Resultats Sur les 1096 reponses au questionnaire, 623 correspondaient a des etudiants de 4eme, 5eme ou 6eme annee de medecine. Avant visionnage, 78 % des etudiants se disaient peu ou pas informes sur le role du medecin du travail. Apres exposition a la video, plus de la moitie des etudiants (53,3 %) affirmaient avoir une meilleure image de la MT. La note moyenne d’interet (de 0 a 10) attribuee vis-a-vis de la MT augmentait en moyenne de 1,23/10 ± 1,32 passant de 4,5 ± 2,2 a 5,8 ± 1,9 (p Conclusion Cette etude montre qu’une video d’information sur la MT a destination des etudiants en medecine est susceptible d’en ameliorer l’image. Elle tend a mettre egalement en avant la curiosite des etudiants en medecine vis-a-vis de la MT. L’augmentation du nombre de terrains de stage disponibles pourrait etre une piste interessante pour repondre a cette curiosite. D’autres etudes sont necessaires pour confirmer ces resultats.

Summary To assess the effects of napping + bright light on shift work drivers sleepiness at the wheel, we performed a pilot study on nine shift workers on three shifts (morning, afternoon, night), driving on a private road circuit. Sleepiness at the wheel was measured by ambulatory polysomnography and assessed using 30-s segments of recordings with a percentage of theta electroencephalogram of at least 50% (15 s) of the period recorded. Sleepiness was also assessed by the Stanford Sleepiness Scale (SSS). Participants drove the same car on two similar 24-h periods of work, with three drivers in each shift (morning, afternoon, night), separated by 3 weeks. During the baseline period, the subjects were told to manage their rest as usual. During the second experimental period, they had to rest lying in a dark room with two naps of 20 min and then exposed to bright light (5000 lux) for 10 min. Subjects showed a significantly decreased sleepiness at the wheel with an average of 10.7 ± 6.7 episodes of theta sleep during the baseline (766 ± 425 s) versus 1.0 ± 1.0 episode lasting 166 ± 96 s during the second period (P = 0.016; P = 0.0109). The percentage of driving asleep was also significantly reduced (3.7% ± 1.9% versus 0.9% ± 0.6%, P = 0.0077). The average SSS score in the group decreased from 2.76 ± 1.27 to 2.28 ± 0.74 (P = 0.09). In this pilot and preliminary study, a combination of napping and bright light pulses was powerful in decreasing sleepiness at the wheel of shift work drivers.

Resume L’insomnie est un trouble frequent en sante au travail. La prevalence se situe autour de 19 % en population generale et autour de 30 % en population de salaries. De nombreux travaux soulignent la gravite des consequences professionnelles de l’insomnie : absenteisme, accidents du travail multiplies par 4,5 chez l’insomniaque. L’insomnie est un trouble subjectif, dont la definition consensuelle se refere aux classifications DSM IV et ICSD-2. L’approche clinique de l’insomnie exige un diagnostic positif, l’evaluation de sa gravite et l’etude des comorbidites. L’intervention du medecin du travail se situe soit au stade precoce de la maladie, soit en prevention secondaire au cours d’une desadaptation au travail de l’insomniaque. Le depistage et l’orientation vers une prise en charge des patients souffrant de troubles du sommeil sont un enjeu important en sante au travail.

Summary This article is focused on the French legislation concerning shift work and night work. The authors explain the actual work organization and the medical survey in terms of obligations. Recommendations about the medical visit are proposed to help occupational physician.

Resume Cet article de revue reprend les bases physiologiques de l’adaptation au travail de nuit et poste, notamment liees a l’horloge biologique et au sommeil. Il fait le point des consequences medicales du travail poste et de nuit : troubles du sommeil et de l’eveil, risque accidentel, pathologies cardiovasculaires, troubles digestifs et endocriniens, risque d’obesite et cancers.

Resume Objectif Le but de cette etude est d’estimer l’exposition au benzene chez les employes de stations-service, les citernistes et les personnels de depots. Materiels et methodes Deux campagnes de mesures ont ete menees, 158 salaries de 24 stations-service et huit depots representatifs du parc francais ont ete inclus dans la premiere etude, 74 salaries de trois depots dans la seconde. Chaque salarie volontaire a beneficie d’une evaluation de son exposition au benzene par un dosage individuel de benzene atmospherique et par un dosage urinaire en fin de poste d’acide trans,trans -muconique urinaire (t,t-MA). Le poste de travail exact de chaque sujet a ete precise ainsi que le tabagisme. Resultats Pour la premiere campagne, 158 sujets ont ete inclus, 146 prelevements atmospheriques etaient exploitables ; 154 dosages urinaires en fin de poste ont ete realises. Dans les stations-service, sur les 109 dosages de benzene atmospherique exploitables, 97 (81 %) etaient inferieurs a la limite de quantification (LQ = 0,07 mg/m 3 ), (mediane 3 ; etendue : 3 ). Sur 114 dosages de t,t-MA urinaire realises en fin de poste, 85 (75 %) etaient en dessous de la limite de detection (LD = 0,02 mg/l). La mediane etait inferieure a la LD (etendue : 3 , la mediane de 0,15 mg/m 3 (etendue : 3 ). De plus, sur les 40 prelevements de t,t-MA realises, 34 (85 %) etaient en dessous du seuil de detection. La mediane etait donc inferieure a la LD (etendue : 3 (etendue : 0,04–1,68 mg/m 3 ), celle des personnels de depot de 0,05 mg/m 3 ( 3 ) pour les tâches generales, 0,27 mg/m 3 (0,22–0,32 mg/m 3 ) pour le depotage « fer » des essences et inferieur a la LQ pour le depotage « barge ». Conclusion Pour la majeure partie des salaries de l’etude, l’exposition etait inferieure aux limites de quantification des methodes utilisees en metrologie et biometrologie. Dans les conditions normales d’exercice professionnel des employes de stations-service et des depots, le niveau d’exposition moyen est inferieur a 10 % de la VME actuelle. Il s’agit donc de groupes professionnels faiblement exposes au benzene. En terme de surveillance medicale vis-a-vis de ce risque chimique, le medecin du travail devra adapter son suivi en fonction de la presence actuelle ou passee de tâches potentiellement exposantes et devra tenir compte d’eventuels dysfonctionnements.

Summary Purpose of the study To analyse the annual level of global external, internal and skin exposure to ionizing radiation of employees in a university health care establishment (AP–HP). Method The exposure to ionizing radiation was assessed among the 6,618 subjects (7.12% of the personnel of AP–HP) occupationally exposed. Their external exposure was monitored using 43,680 passive dosimeters, every month (34.8%) for category A or three months (65.2%) for category B. Ring dosimeters were used to measure the finger doses for workers in nuclear medicine and interventional radiology. Moreover, 1,672 workers in controlled zone had electronic dosimeters. The internal exposure was determined by radiochemical and radiometric measurements. Results The annual average external effective dose was low (0.032 mSv). No internal contamination was observed. Total body doses and skin doses never exceeded the dose limit. Ring dosimeter gave a better assessment of finger doses. The upper doses were observed in radiotherapy (0.038 mSv) and nuclear medicine (0.66 mSv). Conclusion The occupational exposure of health care workers was very far from the regulatory total body dose limit (20 mSv). These measurements remain a step into the radiation protection optimization process needed by the stochastic effects of ionizing radiation, without known threshold.

Archives des Maladies Professionnelles et de l'Environnement - Vol. 69 - N° 5-6 - p. 695-707

Summary Introduction 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. Methods 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. Results 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%. Conclusion 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.

Monsieur G., 36 ans, consulte en mai 2006 pour un eczema du visage et du cou associe a une rhinite et un asthme. Il travaille comme agent polyvalent dans une societe d'ebenisterie depuis 5 ans. Il effectue de la decoupe de panneaux de bois, il est expose aux poussieres d'un grand nombre de bois differents, resineux et tropicaux. Le contact est cutane direct, manuporte et aeroporte. De plus, il effectue le collage et le vernissage des panneaux. Il manipule des durcisseurs contenant des isocyanates et des diluants a base de solvants. Il ne porte que rarement un masque de protection respiratoire et ne met pas de gants. La dermatose evolue depuis plusieurs mois, rythmee par l'activite professionnelle, avec guerison complete pendant les periodes de conges et les vacances. Les lesions sont erythemato-squameuses et prurigineuses, localisees au visage, notamment aux paupieres, ainsi que sur le cou. Il s'y associe une rhinite et une gene respiratoire. Il signale des episodes d'asthme dans son enfance et chez un frere et une soeur. Monsieur G. beneficie de tests epicutanes comprenant la batterie standard europeenne, la batterie plastiques-colles, ainsi que des tests avec les poussieres de bois qu'il utilise a son travail : iroko, ebene de Macassar, bete, cedre du Liban, bois de rose, palissandre de Santos, palissandre des Indes, peuplier argente, sapin, pin d'Oregon, sucupira, teck, merisier. Ces poussieres sont diluees dans la vaseline a 10 %. Les tests sont tres positifs (+++) aux poussieres de palissandre de Santos et negatifs pour les autres substances (photographie). Les epreuves fonctionnelles respiratoires (EFR) objectivent des valeurs spirometriques de base normales avec une hyperreactivite bronchique non specifique (test a la metacholine positif a 948 microgrammes). Les dosages des IgE specifiques vis-a-vis des isocyanates sont positifs a 0,82 kU/1 (classe 2) pour les HDI et negatifs pour les MDI et TDI. Quelle est la conduite a tenir en matiere de reparation pour ce patient ?

Un homme de 40 ans, machiniste (conducteur de bus) depuis 1987, est adresse a la consultation du sommeil, pour ronflements et somnolence diurne, par le medecin du travail. Dans l'attente des examens necessaires au diagnostic, le patient est reclasse transitoirement a un poste sedentaire, sans conduite de vehicule. Il presente une hypertension arterielle traitee par beta-bloquant (Detensiel®: 1 cp/jour), un syndrome depressif traite par inhibiteur de la recapture de la serotonine (Deroxat®: 1/2 cp 3 fois par jour) et il signale des migraines ophtalmiques. Il se plaint de ronflements et d'une somnolence importante la journee. Le score d'Epworth est a 12. L'examen clinique retrouve une obesite moderee (poids: 103 kg, taille: 1,78 m) avec un indice de masse corporelle (IMC) a 33,5 kg/m 2 . Devant la suspicion d'un syndrome d'apnees du sommeil, une polygraphie ventilatoire a ete realisee. Cet enregistrement n'a pas mis en evidence de syndrome d'apnees du sommeil (index d'apnee-hypopnee a 4,2/heure pour un index normal < 10/heure). En raison du poste de securite occupe par le patient et devant la plainte de troubles de la vigilance non expliques, un enregistrement polysomnographique du sommeil et des tests iteratifs de latence d'endormissement (TILE) ont ete effectues. Ces examens ont mis en evidence un sommeil d'assez bonne structure et comportant des proportions assez satisfaisantes de sommeil recuperateur avec deux grands cycles perturbes par quelques eveils en rapport avec des mouvements de jambes et quelques apnees sans que l'on puisse parler d'index pathologique. Le test des latences multiples a retrouve une latence moyenne d'endormissement de 6 minutes 30 secondes, avec la presence de deux endormissements en sommeil paradoxal. Le bilan a donc ete complete par un typage HLA de classe II. Le resultat etait positif pour le marqueur DQB 1*0602 associe a la narcolepsie. Le diagnostic de narcolepsie a donc ete retenu, et un traitement par Modafinil (Modiodal®) a ete debute. Sur le plan professionnel, le patient est actuellement en attente d'un poste de reclassement definitif. Il vient d'effectuer des demarches aupres de la Prefecture de police en ce qui concerne son permis de conduire. Apres la mise en route du traitement, l'efficacite de ce dernier a ete evaluee par un test de maintien d'eveil qui a retrouve une vigilance normale sous traitement par Modafinil.

BACKGROUND Severity of occupational asthma at diagnosis is an important prognostic factor. The aim of this study was to determine which factors affect the severity of occupational asthma with a latency period at diagnosis. METHODS The study population consisted of 229 consecutive subjects with occupational asthma with a latency period recruited by four occupational health departments and divided into two groups according to the severity of the disease at diagnosis. The moderate-severe (FEV(1) /=70% predicted and PD(20) methacholine >300 microg, n = 128) groups were compared in terms of clinical and demographic parameters. Multivariate analysis using logistic regressions was performed to examine factors associated with asthma severity. RESULTS Duration of symptoms before diagnosis was significantly longer in the moderate-severe group (mean +/- SD: 6.3 +/- 6.8 years vs 3.4 +/- 4.4 years, P < 0.001). Sex ratio, age, atopy, smoking habits, duration of exposure before symptoms, and molecular weight of the causal agent were not significantly different between the two groups. On multivariate analysis, only duration of symptoms before diagnosis was associated with asthma severity (aOR = 1.12, 95% CI 1.05-1.18, P < 0.001). CONCLUSIONS Severity of occupational asthma with a latency period at diagnosis was associated with duration of symptoms before diagnosis, but not with the type of causal agent. This finding emphasizes the need for early diagnosis and avoidance of exposure.

The aim of this study was to assess the long-term asymptomatic effects of low-dose radiation on microvascular structure among interventional physicians, whose hands are exposed to ionizing radiation during daily practice. The study, approved by the national ethics committee, included 186 radiation-exposed (surgeons, cardiologists, radiologists) and 35 unexposed physicians, all of whom had provided written consent. The subjects completed a questionnaire describing their current and past daily practice, from which tentative estimates of current and cumulative radiation exposure estimates were computed. Subject dermal microcirculation state was assessed by capillaroscopy of the nail fold of eight fingers (thumbs excluded) based on photographs. Two quantitative scores characterizing extravasation and morphological abnormalities based on seven semiquantitative indices were obtained from post hoc coding of the photographs by five capillaroscopists. These evaluations were randomized and blind to the exposure. The effect of the radiation exposure on both abnormality scores was modelled using multilevel proportional odds regression adjusted for potential confounders. The proportion of physicians for which the most frequent act is close to the radiation source was highest among surgeons, but with fewer weekly acts. The median duration of exposure was highest among radiologists and cardiologists. No exposure effect could be detected on the extravasation score. The morphological anomaly score increased significantly with duration of exposure and estimated cumulative exposure among surgeons and interventional radiologists, unlike cardiologists among whom no effect could be detected. It is concluded that the shown effects of chronic low-dose exposure to ionizing radiation on physician microvascular structure reveal the importance of increased exposure monitoring and prevention.

Resume Objectifs La sous-estimation des maladies d’origine professionnelle en France est due a de multiples determinants, notamment a la meconnaissance par le corps medical de l’origine professionnelle des maladies et de la reglementation. L’objectif de cette etude est de preciser le niveau de formation, quantitatif et qualitatif, des etudiants en medecine en cours dans le cursus de deuxieme cycle des etudes medicales en France. Materiel et methodes Cette etude transversale nationale a ete realisee en 2004 par questionnaire, envoye a l’ensemble des facultes metropolitaines (n = 37). Resultats Trente-cinq facultes (95 %) ont repondu au questionnaire. La duree moyenne d’enseignement theorique recu par un etudiant de deuxieme cycle au cours de son cursus est de 9,1 heures ± 4,4 heures (minimum : 2 h, maximum : 18 h). Bien que la definition des notions d’accident de travail et de maladies professionnelles soient abordees dans l’ensemble des facultes, les autres themes varient quantitativement et qualitativement d’une faculte a l’autre. L’assiduite des etudiants est egalement fluctuante et environ 30 % des etudiants arrivent en fin de cursus sans avoir recu aucun enseignement de medecine du travail. Conclusions L’enseignement de la medecine du travail lors du deuxieme cycle des etudes medicales apparait reduit et inadapte aux enjeux de sante publique poses par la sante au travail.

Insomnia is a common sleep complaint even in young adults and has important daytime consequences. Several subjective and objective tools are recommended to assess the magnitude of the problem and to try to find a cause. Chronic insomnia is often caused by precipitating factors, such as acute stress, work conditions, illness, and travel, and perpetuating factors, such as poor sleep hygiene, anxiety, and medications. Insomnia may have implications in athletic performance resulting from physical and cognitive effects. Several pharmacologic and nonpharmacologic approaches are employed in the management of insomnia that have proven effective for short-term treatment. The pharmacologic approaches include the use of zolpidem and specific GABA agonists, benzodiazepines for specific indications, antidepressants, and melatonin. The nonpharmacologic approaches include stimulus control, sleep restriction, relaxation strategies, and cognitive behavioral therapy.

Objectives Methacholine bronchial responsiveness and variations in the pulmonary function of workers exposed to wheat flour and a reference group were compared. Methods Each subject [140 men exposed to flour (bakers and pastry makers) and 77 controls] completed a standardized questionnaire. Bronchial responsiveness was quantified by measuring the slope between percentage decrements in forced expiratory volume in 1 second (FEV 1 ) and cumulative methacholine dose. FEV 1 and peak expiratory flow (PEF) were recorded four times a day for 15 days using a handheld electronic spirometer. The variability in the FEV 1 and PEF readings was expressed as variation coefficients (100 × standard deviation/mean). Results The mean duration of exposure to flour was 14 (SD 9) years. Rhinitis was significantly more common in the exposed group than in the control group (30.7% versus 11.7%, P=0.001). The mean FEV 1 and PEF did not significantly differ between the two groups. The slope of the dose–response to methacholine and the variation coefficients were lower among the unexposed nonsmokers than among the exposed workers and smokers. The differences were significant for the exposed smokers. The two variation coefficients correlated with each other (r=0.82) but not with the slope of the methacholine challenge. Conclusions Occupational exposure to flour and smoking increase bronchial responsiveness, as measured by the slope of the dose–response to methacholine and the variation coefficients of airflow. However, methacholine bronchial responsiveness and the variability of lung function do not measure exactly the same aspect of airway behavior.

Background: Our aims were to compare the doses of wheat and rye flour that induce early bronchial responses in occupationally exposed asthmatic subjects and to assess the effects of the dose of inhaled flour, the duration of exposure and the dose rate. Methods: Ten patients underwent tests with lactose, wheat flour and rye flour. We compared the decrease in forced expiratory volume in 1 s (FEV1) observed during the challenge with flour and with lactose. We also calculated the amount of flour that was instantaneously active. Results: Seven subjects had significantly decreased FEV1 values following exposure to wheat and rye flour and two subjects only did so for rye flour. The provocative dose (PD, dose required to reduce FEV1 by 15%) of rye was lower than that of wheat flour (geometric mean; PD15 rye: 95 μg; wheat: 368 μg). The calculated doses of rye and wheat flour were better correlated with the change in FEV1 than were the cumulative doses. Conclusion: The bronchial response was greater with rye than with wheat flour. The response was related to the dose of allergen inhaled and to the dose rate.

Aims: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. Methods: A total of 322 hairdressing apprentices and 277 office apprentices (controls) were studied. Two cross sectional surveys were conducted in 1994 and 1996/97 with longitudinal follow up for a subgroup of apprentices (191 hairdressing apprentices and 189 office apprentices). Results: In the initial phase, the prevalence of respiratory symptoms was significantly lower among hairdressing apprentices than among office apprentices. Lung function test results showed significantly higher values for hairdressing apprentices. Non-specific bronchial reactivity was similar in the two groups. In the final phase, results for respiratory symptoms were similar. The incidence of respiratory symptoms was not significantly different between hairdressing apprentices and office apprentices. Subjects who dropped out had lower values for FVC and FEV1 in the initial phase than those who completed the final phase. There was a significant deterioration of FEV1 and FEF25–75% in hairdressing apprentices compared to office apprentices. There was a link between atopy and the incidence of most of the respiratory symptoms (day/night cough, wheezing, dyspnoea, mucosal hyperresponsiveness) and between smoking and the incidence of bronchial hyperreactivity. There was no significant correlation between change in lung function tests and specific hairdressing activities reported at the end of the apprenticeship or with environmental working conditions in hairdressing salons. Conclusions: Although a healthy worker effect can be suspected, results showed a significant deterioration of baseline values of lung function tests in the hairdressing apprentice group. However, no clear link was shown between change in lung function tests and specific parameters of occupational activities.

International audience; Abstract : Quality of life is a central concern in medicine.Thus estimation of the number of years of life free of some disease lost due to an occupational exposure is frequently required. The amount of compensation due to the worker relies upon this estimation. The motivating example is a French case-control study on the occurrence of lung cancer for workers exposed to asbestos (J.C. Pairon et al, 2009). We adapt to case-control study the threshold regression (TR) model, also named first hitting time model (FHT), which was initially developed for cohort studies. This model allows us to treat the occupational exposure as an accelerator of the time to onset of the disease, while the other covariates are divided into two classes, acting differently on the time to onset: the built-in ones (like genetic factors for example) and the lifelong ones (like tobacco consumption for example). The first hitting time model developed by M.-L. T. Lee and G. A. Whitmore, 2006 , 2010, enables us to separate the covariates into three different kinds : first the initial covariates, like sex, past family disease history, genetic factors, that act on the initial amount of health of the subject. Then the lifelong covariates, like biological and environmental covariates that act on (or account for) the decrease of the initial amount of health. It may include for example cholesterol level and tobacco consumption. Finally the occupational exposure under study may accelerate the time to onset of the considered disease. The number of years lost due to occupational exposure to asbestos is then derived from the model by replacing for each exposed subject his time to onset by the decelerated time he would have had when exposure is removed and all other factors in the model remain the same.

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.

International audience; We rely on a recent French matched case-control study to investigate the effect of occupational exposure to asbestos on the occurrence of lung cancer. We build a large collection of threshold regression models, data-adaptively select a better model in it by multi-fold likelihood-based cross-validation, then fit the resulting better model by maximum likelihood. A necessary preliminary step to eliminate the bias due to the case-control sampling is made possible because the conditional distribution of being a case given the matching variable and the marginal distribution of the matching variable can be computed beforehand based on two studies independent from our dataset. The implications of the fitted model in terms of expected years of life free of lung cancer lost due to the occupational exposure to asbestos are discussed.

International audience; We analyze the effect of occupational exposure to asbestos on the occurrence of lung cancer based on arecent French case–control (CC) study. We build a large collection of threshold regression models, dataadaptivelyselect a better model by CC-weighted likelihood-based cross-validation and then fit this bettermodel by CC-weighted maximum likelihood. The CC-weighting allows us to draw valid inferences fromCC data without relying on a logistic regression. This is possible because the joint distribution of theindicator of being a case and matching variable is available beforehand owing to two studies independentfrom our data set. The implications of the fitted model in terms of years of life free of lung cancer lost dueto the exposure to asbestos are discussed.

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.

International audience; AbstractEstimation of the number of expected years of life free disease lost due to an occupational exposure is frequently required asthe amount of compensation due to the worker relies upon this estimation. The motivating example was a French case-cohort study on the occurrence of lung cancer for workers exposed to asbestos. For a case-cohort study the most usual models are the logistic ones. But this is adequate only if the aim is to evaluate the risks of developing the disease, which is not our objective. Several models, though, can be used in order to solve our problem. One of the simplest is the Cox model involving the professional exposure as a covariate at the same level as other risk factors that could also induce lungcancer, like for example family history of cancer and tobacco consumption. But we can also think of adapting to case-control study the threshold regression model, also named first hitting time model (fht), which was initially developed for cohort studies. This model allows us to treat the professional exposure as an accelerator of the time to onset of the disease, while the other covariates are divided into two classes, acting differently on the time to onset: the built-in ones (like genetic factors for example) and the lifelong ones, (like tobacco consumption for example.

International audience; Cleaning products may cause work-related asthma, but information regarding the specific exposures involved is scarce. We aimed to determine the associations between asthma and occupational exposure to cleaning agents in hospital workers. Analyses were conducted in 179 (136 women) hospital workers and a reference population of 545 subjects (18-79 years) from the French case-control and familial Epidemiological study on the Genetics and Environment of Asthma (2003-2007). Exposures to cleaning agents were estimated using three methods: self-report, expert assessment and an asthma-specific job-exposure matrix (JEM). Associations between cleaning products and current asthma were evaluated by logistic regressions, stratified by sex and adjusted for age and smoking status. According to expert assessment, 55% of male and 81% of female hospital workers were exposed to cleaning/disinfecting tasks weekly (p

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.

The IgE reactivity of the recombinant glutenin subunits P73 and B16, and of their repetitive N-terminal and nonrepetitive C-terminal halves, was analyzed using dot-blot with sera from patients diagnosed with baker's asthma, wheat-dependent exercise-induced anaphylaxis, or allergy to hydrolyzed wheat proteins. The linear epitopes of B16 were identified using the Pepscan method. Except for one common epitope, the IgE binding domains of glutenins differ from those of omega 5-gliadins. Secondary structure content of the proteins was determined using synchrotron radiation circular dichroism (SRCD): while a structures were predominant in all glutenin subunits, fragments, or chimeras, a high IgE reactivity was associated with proteins rich in beta structures. Mixing B16 halves induced conformational interaction, as evidenced by dynamic light scattering and SRCD. IgE reactivity was correlatively increased, as when the halves were associated in the B16 P73 chimera. These results suggest that structural interaction between N- and C-terminal halves may promote epitope presentation.

OBJECTIVES--This study assessed the prevalence of respiratory manifestations among French pig and dairy farmers and determined the relationship between bronchial reactivity and respiratory manifestations. METHODS--The pig farmers included 102 men working more than half-time inside swine confinement buildings. There were 51 male dairy farmers and 81 male referents. The demographic characteristics of the three groups were similar except for more smokers among the referents. Each subject completed a standardized questionnaire. Pulmonary function tests were performed before and after a methacholine challenge (cumulative doses 80, 240, and 560 micrograms). Airborne dust, ammonia, and carbon dioxide were measured inside 28 swine confinement buildings. RESULTS--The pig farmers were exposed to a total dust level of 2.41 mg.m-3. The respirable particle concentration was low. The pig and dairy farmers had a significantly higher prevalence of cough and morning phlegm than the referents. Before the methacholine challenge, the dairy farmers had nonsignificantly lower mean lung function values than the other groups. Among the subjects with no history of asthma, nonspecific bronchial hyperreactivity was significantly higher among the pig and dairy farmers than among the referents. There was a fall in the forced expiratory volume in 1 s (FEV 1.0) that was greater than 10% in 6.7% of the referents, 17.9% of the swine workers, and 35.6% of the dairy farmers. This result was unchanged after adjustment for the initial FEV1.0. CONCLUSIONS--The prevalence of respiratory symptoms was significantly higher among the pig farmers without base-line lung function impairment. However, both the pig and the dairy farmers had increased bronchial reactivity.