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Background: Substance use disorders (SUD) might concern as many as 8-15% of physicians. Previous studies suggest that self-diagnosis and self-medication are common practices among physicians. The aim of this review was to identify if barriers to seeking help and medical care for impaired physicians exist. We also aimed at characterizing the nature of these barriers.Methods: The review included scientific papers published on the MEDLINE and PsychINFO databases between January 2000 and September 2018. The inclusion criteria were: (i) articles that focused on SUD in physicians. The exclusion criteria were: (i) no mention of SUD; (ii) no mention of barriers to seeking help; (iii) articles focused on burn-out and work-related stress; (iv) articles focused on risk factors or treatments for SUD; (v) articles focused on psychiatric comorbidities and (vi) those focused on other professionals.Results: Potential barriers to seeking help that were identified for impaired physicians with SUD included denial of the disease and of loss of performance, fear of stigma, psychiatric comorbidities, fear of familial/social/professional and economic consequences and a lack of knowledge.Conclusions: Different barriers to seeking help could be identified. Priority should be given to educating medical students to ameliorate this. Increased awareness should reduce the stigma, which, even nowadays, still prevents some physicians from seeking help. [ABSTRACT FROM AUTHOR]

The article explores how anti–coronavirus disease 2019 (COVID-19) vaccination reduces symptomatic and asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections with information on the relative strengths of the neutralizing antibody responses conferred by vaccination and a natural infection or on the benefit of vaccinating a previously infected person. It mentions that about ongoing studies on the persistence of neutralizing antibodies after a first infection.

Abstract: The role of psychosocial and physical factors in the development of musculoskeletal pain (MSP) has now been clearly demonstrated. However, it is unclear whether these factors contribute to specific regional MSP or to multisite pain. The main goal of this study was to assess the impact of work-related factors according to gender on the development of regional and multisite MSP. A total of 12,591 subjects (65% men and 35% women) who were born in 1938, 1943, 1948, and 1953 and were participating in a French longitudinal prospective epidemiological survey (ESTEV) in 1990 to 1995 were eligible. Personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between chronic MSP (regional body site or multisite), personal factors, and occupational factors were analyzed using logistic regression modeling. The incidence of regional MSP and multisite pain in 1995 were, respectively, 17% and 25.6%. For women, highly repetitive movements predicted neck/shoulder pain; posture and vibrations predicted arm and low back pain; and effort with tools predicted arm pain. For men, forceful effort and vibrations predicted neck/shoulder pain; posture and forceful effort predicted lower limb and low back pain; and forceful effort and effort with tools predicted arm pain. Physical constraints (ie, forceful effort or vibrations) were associated with multisite pain in both genders. Only for women, psychological factors were risk factors predictive of upper limb pain and in 3 or 4 painful anatomical sites. These results support the hypothesis that some physical and psychological work-related factors are predictive of regional or multisite MSP but differ according to gender. Gender differences and risk factors for work-related musculoskeletal pain should be also taken into account to more effectively target preventive measures. [Copyright &y& Elsevier]

Abstract: The role of psychosocial and physical factors in the development of shoulder pain has now been clearly demonstrated. However, only a few studies have analyzed these associations over time. The main goal of this study was to evaluate the predictive value of work-related psychological and mechanical factors on chronic shoulder pain. A total of 12,714 subjects (65% men) born in 1938, 1943, 1948, and 1953 participating in a French prospective longitudinal epidemiological investigation in 1990 to 1995 Enquête Santé Travail Et Vieillissement (ESTEV) were included. Clinical examination was performed by 400 trained occupational physicians. Personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between chronic shoulder pain and personal and occupational factors were analyzed using logistic regression modeling. A total of 1706 subjects experienced chronic shoulder pain in 1990, and 2089 experienced chronic shoulder pain in 1995. The incidence of chronic shoulder pain in 1995 was 11% (n=1355). Forceful effort (odds ratio [OR]=1.24 95% CI [1.05–1.44], awkward posture (OR=1.34 95% CI [1.19–1.52]), decision latitude (OR=1.19 [1.04 to 1.35]), and psychological demand (OR=1.19 95% CI [1.06–1.32]) in 1990 were significantly associated with chronic shoulder pain in 1995, even after adjustment for personal factors and previous shoulder pain status. Awkward posture (OR=1.43 [1.25 to 1.63]), psychological demand (OR=1.24 [1.09 to 1.40]), and decision latitude (OR=1.21 [1.04 to 1.41] work-related factors in 1990 were associated with the development of chronic shoulder pain between 1990 and 1995. These results suggest that awkward posture, forceful effort, job demand, and decision control are predictors of chronic shoulder pain at work. Interventions designed to reduce the incidence of chronic shoulder pain must include both mechanical and psychological factors. [Copyright &y& Elsevier]

Abstract: The role of psychosocial factors in the development of upper limb musculoskeletal disorders has now been clearly demonstrated. However, only a few studies have analysed the association between the organisational work environment and musculoskeletal disorders in health care workers. The main goal of this study was to test the hypothesis that some specific organisational constraints may be related to upper limb musculoskeletal symptoms experienced by registered nurses, independently of the effort/reward imbalance model and major confounding factors. In 2006, 2194 female registered nurses in 7 French teaching hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded to valid self-report questionnaires (ERI [effort–reward imbalance], Nordic-style questionnaire). The organisational work environment was assessed by the self-rated Nursing Work Index—Extended Organisation scale. Multilevel models were used for analyses. We found that 2 organisational health care constraints: low level of shared values about work between members in the unit and lack of support from the administration were significantly associated with upper limb symptoms, independently of ERI perceptions. This study identified and quantified specific health care organisational factors that have an impact on nurses’ upper limb symptoms, sometimes independently of ERI perception. A prospective study is needed to clarify the causal role of psychosocial and organisational work factors in upper limb injury in nurses. Organisational approaches may be more effective in improving health at work and may also have a longer-lasting impact than individual approaches. Specific health care organisational factors measured by a new tool (Nursing Work Index—Extended Organisation) have an effect on nurses’ upper limb symptoms, independently of effort–reward imbalance perception. [Copyright &y& Elsevier]

Background: Fipronil represents a chemical class of insecticides acting at the γ-aminobutyric acid receptor in pests. Fipronil has been associated with a significant increase in the incidence of thyroid gland tumors concomitant with prolonged exposure to thyroid-stimulating hormone (TSH) in rats. An association between human TSH concentration and thyroid cancer has been also reported. The primary objective of this study was to test the hypothesis that chronic occupational fipronil exposure may be associated with abnormal thyroid function tests. Methods: In 2008, 159 workers of a factory manufacturing fipronil-containing veterinary drugs were assessed. Serum concentrations of TSH, total thyroxine, free thyroxine, fipronil, and fipronil sulfone were measured. Results: A positive and significant correlation was observed between serum fipronil or fipronil sulfone levels and duration of fipronil exposure. Serum fipronil sulfone concentration was negatively correlated with TSH concentration in fipronil-exposed workers, but with no significant increase in thyroid function test abnormalities. Conclusion: This study did not show that chronic fipronil exposure was associated with an increase of thyroid function test abnormalities. But, despite the fact that fipronil exposure in rats has been associated with increased serum TSH, fipronil sulfone concentrations were negatively correlated with serum TSH concentrations in fipronil-exposed workers, raising the possibility that fipronil has a central inhibitory effect on TSH secretion in humans. Close occupational medical surveillance, therefore, appears to be required in factory workers manufacturing fipronil-containing veterinary drugs. Larger epidemiological studies as well as investigations on possible thyroid-disrupting mechanisms of fipronil are also required. [ABSTRACT FROM AUTHOR]

Purpose: The effect of one pesticide spraying season on DNA damage was measured on B and T lymphocytes among open-field farmers and controls. Methods: At least two peripheral blood samples were collected from each individual: one in a period without any pesticide application, several weeks after the last use (January, at period P0), and another in the intensive pesticide spraying period (May or June, at period P4). DNA damage was studied by alkaline comet assay on isolated B or T lymphocytes. Results: Longitudinal comparison of DNA damage observed at both P0 and P4 periods revealed a statistically significant genotoxic effect of the pesticide spraying season in both B ( P = 0.02) and T lymphocytes ( P = 0.02) in exposed farmers. In contrast, non-farmers did not show any significant modifications. DNA damage levels in B and T lymphocytes were significantly higher in farmers than in non-farmers during the P4 period ( P = 0.003 and P = 0.001 for B and T lymphocytes, respectively) but not during the P0 period. The seasonal effect observed among farmers was not correlated with either total farm area, farm area devoted to crops or recent solar exposure. On average, farmers used pesticides for 21 days between P0 and P4. Between the two time points studied, there was a tendency for a potential effect of the number of days of fungicide treatments ( r = 0.43; P = 0.11) on T lymphocyte DNA damage. Conclusions: A genotoxic effect was found in lymphocytes of farmers exposed to pesticides, suggesting in particular the possible implication of fungicides. [ABSTRACT FROM AUTHOR]

Background: The advent of chronic myeloid leukaemia (CML) tyrosine-kinase inhibitors (TKI) has led to new paradigms including occupational rehabilitation.Objectives: This study aimed to characterize the impact of CML treatment on sick leaves within the 2 years following diagnosis in working-age patients.Methods: A cohort of all 18-60-year-old newly diagnosed CML patients initiating a TKI between January 1st 2011 and December 31st 2014 in France was identified in the French National Healthcare database (Système National des Données de Santé [SNDS]). Patients with a sick leave identified in the 24 months after TKI initiation were compared with sex and initiation date matched controls in a nested case-control design. Factors associated with sick leaves were identified through a conditional logistic regression model, providing adjusted odds-ratio (OR) with their 95% confidence interval (CI).Results: Among 646 18-60-year-old patients, 268 were prescribed at least one sick leave in the study period, with 176 (27.2%) having their first sick leave prescribed after TKI initiation. The median number of sick days over the 2-years period was 115 per patient (interquartile range 25.5-384.5). In the nested case-control study (176 cases and 176 matched controls), sick leaves were more likely observed with second generation TKI (OR 4.11 [1.80-9.38]), whereas they were less likely observed in case if social deprivation (OR 0.07 [0.02-0.28].Conclusion: More than 25% of working-age CML patients had at least one sick leave within 2 years of TKI initiation, with a higher impact of second generation TKI, and with a median duration of 115 days. [ABSTRACT FROM AUTHOR]

The article highlights a study which compared the decline in lung function between blue-collar workers exposed and not exposed to welding fumes. Five-year lung function decline was assessed in subjects included in the Etude Santé Travail Et Vieillissement (ESTEV) study. The study found that blue-collar workers with welding fume exposure have accelerated decline in lung function.

The SARS-CoV-2 virus has spread world-wide since December 2019, killing more than 2.9 million of people. We have adapted a statistical model from the SIR epidemiological models to predict the spread of SARS-CoV-2 in France. Our model is based on several parameters and assumed a 4.2% seroprevalence in Occitania after the first lockdown. The recent use of serological tests to measure the effective seroprevalence of SARS-CoV-2 in the population of Occitania has led to a seroprevalence around 2.4%. This implies to review the parameters of our model to conclude at a lower than expected virus transmission rate, which may be due to infectivity varying with the patient's symptoms or to a constraint due to an uneven population geographical distribution. [ABSTRACT FROM AUTHOR]

Purpose: The objective of our study was to assess the rate of work adjustments 1 year after the diagnosis in a population of female breast cancer (BC) survivors, in the context of the French system of social protection. We also characterised these adjustments and their influence on the reduction of professional exclusion of patients 1 year after the diagnosis.Methods: This observational, prospective study was conducted from February 2015 to April 2016 among female patients with BC. Inclusion criteria were women aged between 18 and 65 years, treated for BC and integrated into the labour market at the time of diagnosis (working or on sick leave). Exclusion criteria were metastatic BC, retired patients and refusal to participate. A 1-year follow-up was scheduled, and data collection was performed with questionnaires.Results: In total, 213 patients were included between February 2015 and April 2016. One year after the diagnosis (T1), among 185 BC survivors, 78 (42.2%) patients were working. Among them, 13 patients did not interrupt their occupational activity and 65 returned to work after a period of sick leave. Sixty-four patients returned to work after the end of chemotherapy (after 6 months), and one returned to work before this therapeutic threshold. Sixty-six patients (35.7%) benefited from at least one adjustment of their work conditions to facilitate their return to work (RTW) or maintenance at work: working hours were decreased for 43 patients, and workstation changes were performed for 22 patients. An occupational health physician was involved for some patients; work adjustments were prescribed to 42 patients, 7 patients had medical restrictions for physical reasons and 4 patients had restrictions for psychological reasons. Forty-three patients benefited from part-time work prescribed for therapeutic reasons.Conclusions: Referral to occupational health physicians and work adjustments remain limited in the process of RTW or maintenance at work after BC in France, despite their positive impact. [ABSTRACT FROM AUTHOR]

• To our knowledge, it is the first study to gather, in a comprehensive manner, employment data on LC patients. • Being employed is correlated with a better quality of life regarding physical functioning. • On a societal perspective, RTW of LC patients represents a priority as the costs associated with work loss and reduction of productivity have a significant impact. • New drug therapies may increase the patients' chance of resuming their former activities (including working). • Therefore, potentially reduce the economic burden they place on healthcare systems. The aim of this systematic review is to identify, in a comprehensive manner, the impact of lung cancer on the employment status of survivors. The Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) statement was used as a formal guideline. The systematic review includes scientific papers published between January 2000 and October 2018. The search strategy queried the database MEDLINE. Inclusion criteria comprised: (1) inclusion of patients diagnosed with lung cancer (LC) (2); assessment of employment status or employment outcomes or work adjustments or return to work (3); inclusion of scientific papers published in peer-reviewed journals (4); inclusion of articles written either in English or in French. Literature reviews were not included. A total of 642 scientific papers were retrieved. Twenty-three articles were included in the systematic review: 5 longitudinal studies and 18 cross-sectional studies. LC survivors are 2–3 times more likely to be unemployed as compared with control groups. Previous studies highlight a median duration of sickness absence increased for LC survivors compared to control groups. The strongest decline in earnings was observed among LC survivors as compared to other cancer types. LC is associated with a significant impact on employment of patients. The promising results of recent therapeutic strategies could lead to a better social and professional prognosis. A reduction of indirect costs is to be expected. [ABSTRACT FROM AUTHOR]

Patients with chronic myeloid leukemia treated with breakpoint cluster region-Abelson tyrosine kinase inhibitors are likely to survive in excess of 20 years after diagnosis. New challenges appear as we consider life after the disease, including professional challenges and the social reintegration of patients. The purpose of this study was to determine the impact of chronic myeloid leukemia on employment within 2 years after diagnosis. This prospective, observational study included patients diagnosed with chronic myeloid leukemia and treated with a tyrosine kinase inhibitor. Two populations were defined as patients who reported modifications in their professional activity during the study (Acti-Pro+) and patients who did not report a modification (Acti-Pro-). Cancer survivors received a self-assessment questionnaire. The primary endpoint was to determine the professional status of patients. One hundred patients completed the questionnaire. Sixty-six patients out of 100 reported professional activity within 2 years after their diagnosis. During the 2 years after the diagnosis, 65.2% (95% confidence interval (CI), 53.7-76.7) of patients faced modifications in their professional activity due to chronic myeloid leukemia or adverse effects of drug treatments (group Acti-Pro+); in contrast, 34.8% of patients did not report any impact on their occupational activity (group Acti-Pro-). Among modifications to work organization, a change in the number of working hours was the most represented. Other modifications comprised changes in status or work pace. A majority of chronic myeloid leukemia patients face professional consequences of their disease and treatments. Our findings suggest that adverse drug reactions are a major factor affecting the occurrence of work modifications in this context. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium bovis (M. bovis) is the main causative agent of bovine zoonotic tuberculosis. The aim of this systematic review is to highlight the occupational exposure to bovine tuberculosis due to M. bovis. Methodology/principal findings: A computer based literature search was carried out to identify papers published between January 2006 and March 2017. “PubMed, Cochrane Library and Science Direct” databases were searched systematically. Articles presenting the following properties were included: (i) focusing on M. bovis; (ii) concerning occupational exposure to bovine tuberculosis. A quality assessment was performed after selection of studies. Our search strategy identified a total of 3,264 papers of which 29 studies met the inclusion criteria. Of the 29 articles, 17 were cross-sectional studies (6 were of high quality and scored in the range of 6–7, 11 were of moderate quality and scored in the range 3–5), 10 were case reports, and 2 were reviews. Different occupational fields exposing to the disease were described: livestock sector, particularly in contact with dairy cattle (farmers, veterinaries and assistants, abattoir workers) and working in contact with wildlife (hunters, taxidermists). Conclusions: A specific guideline for occupational practitioners taking care of employees exposed to bovine tuberculosis is warranted and should be tailored to level of exposure. This review was intended to be the first step of such a project. Articles were identified from various continents and countries with different socio-economic situations, broadening our understanding of the worldwide situation. Published data on occupational exposure in developed countries are scarce. We had to extrapolate findings from countries with higher prevalence of the disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: The relationships between asbestos exposure and colorectal cancer remain controversial. OBJECTIVES: We examined the association between asbestos exposure and colorectal cancer incidence. METHODS: Volunteer retired workers previously exposed to asbestos were invited to participate in the French ARDCo screening program between 2003 and 2005. Additional data on risk factors for colorectal cancer were collected from the ARDCo-Nut subsample of 3,769 participants in 2011. Cases of colon and rectal cancer were ascertained each year through 2014 based on eligibility for free medical care following a cancer diagnosis. Survival regression based on the Cox model was used to estimate the relative risk of colon and rectal cancer separately, in relation to the time since first exposure (TSFE) and cumulative exposure index (CEI) to asbestos, and with adjustment for smoking in the overall cohort and for smoking, and certain risk factors for these cancers in the ARDCo-Nut subsample. RESULTS: Mean follow-up was 10.2 years among 14,515 men, including 181 colon cancer and 62 rectal cancer cases (41 and 17, respectively, in the ARDCo-Nut subsample). In the overall cohort, after adjusting for smoking, colon cancer was significantly associated with cumulative exposure (HR = 1.14; 95% CI: 1.04, 1.26 for a 1-unit increase in ln-CEI) and ≥ 20-40 years since first exposure (HR = 4.67; 95% CI: 1.92, 11.46 vs. 0-20 years TSFE), and inversely associated with 60 years TSFE (HR = 0.26; 95% CI: 0.10, 0.70). Although rectal cancer was also associated with TSFE 20-40 years (HR = 4.57; 95% CI: 1.14, 18.27), it was not associated with ln-CEI, but these findings must be interpreted cautiously due to the small number of cases. CONCLUSIONS: Our findings provide support for an association between occupational exposure to asbestos and colon cancer incidence in men. CITATION: Paris C, Thaon I, Hérin F, Clin B, Lacourt A, Luc A, Coureau G, Brochard P, Chamming's S, Gislard A, Galan P, Hercberg S, Wild P, Pairon JC, Andujar P. 2017. Occupational asbestos exposure and incidence of colon and rectal cancers in French men: the Asbestos-Related Diseases Cohort (ARDCo-Nut). Environ Health Perspect 125:409-45; http://dx.doi. org/10.1289/EHP153 [ABSTRACT FROM AUTHOR]

The article discusses the differences between the different vaccines Hypertension and Covid‑19 vaccines. Topics include risk was calculated using the reporting odds ratio (ROR), a ratio similar to the odds ratio in case–control studies with confidence intervals; and increase in sympathetic tone for immediate hypertension and/or an interaction with the renin-angiotensin system for tardive hypertension.

The role of psychosocial factors in the development of upper limb musculoskeletal disorders has now been clearly demonstrated. However, only a few studies have analysed the association between the organisational work environment and musculoskeletal disorders in health care workers. The main goal of this study was to test the hypothesis that some specific organisational constraints may be related to upper limb musculoskeletal symptoms experienced by registered nurses, independently of the effort/reward imbalance model and major confounding factors. In 2006, 2194 female registered nurses in 7 French teaching hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded to valid self-report questionnaires (ERI [effort-reward imbalance], Nordic-style questionnaire). The organisational work environment was assessed by the self-rated Nursing Work Index-Extended Organisation scale. Multilevel models were used for analyses. We found that 2 organisational health care constraints: low level of shared values about work between members in the unit and lack of support from the administration were significantly associated with upper limb symptoms, independently of ERI perceptions. This study identified and quantified specific health care organisational factors that have an impact on nurses' upper limb symptoms, sometimes independently of ERI perception. A prospective study is needed to clarify the causal role of psychosocial and organisational work factors in upper limb injury in nurses. Organisational approaches may be more effective in improving health at work and may also have a longer-lasting impact than individual approaches. [ABSTRACT FROM AUTHOR]