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OBJECTIVES: This study aimed to develop and evaluate a job-exposure matrix (JEM) specific to healthcare workers, JEM Soignances, based on self-reported data. METHODS: The JEM was constructed using data from healthcare workers within the CONSTANCES cohort (N=12 489). Job titles and sectors of activity (eg, hospital activities) defined occupational groups. We assessed 24 exposures covering organizational, psychosocial, physical, chemical and biological factors. Several methods (group-based frequency, CART, random forest, extreme gradient boosting machine) were applied using a 70% training sample. Performance was evaluated on the remaining 30% using area under the ROC curve (AUC) and Cohen’s Kappa (κ). Two alternative JEM were proposed using only job titles or adding healthcare establishment size and type (public/private) to define occupational groups. RESULTS: All methods offered similar discriminatory power (AUC). We selected the group-based frequency method as it was the most understandable and easiest to implement. Of the 24 included exposures, 15 demonstrated satisfactory performance, with nine showing good discriminatory power and fair-to-moderate agreement, such as physical effort at work (AUC=0.861, κ=0.556), ionizing radiation exposure (AUC=0.865, κ=0.457), carrying heavy loads (AUC=0.840, κ=0.402), shift work (AUC=0.807, κ=0.383), and formaldehyde exposure (AUC=0.847, κ=0.289). The remaining nine exposures mainly showed poor-to-moderate discriminatory power and poor agreement. Compared to JEM Soignances, the job title-only JEM performed poorly, while the one incorporating healthcare establishment size and type showed similar results. CONCLUSIONS: JEM Soignances provides good internal performance and validity. Future research will assess its external validity by comparing it with existing JEM and examining its predictive validity regarding known associations between exposures and health outcomes (eg, long working hours and strokes).

OBJECTIVES: This study aimed to construct and evaluate a gender-specific job exposure matrix (JEM) for 27 physical work exposures, based on self-report.METHODS: We constructed a JEM using questionnaire data on current physical exposures from 29 381 male and 35 900 female asymptomatic workers aged 18–69 years in the French CONSTANCES cohort study. We excluded workers with musculoskeletal pain to reduce potential reporting bias. We grouped 27 self-reported physical exposures using the French national job codes and stratified by gender. We compared individual and group-based exposures using the performance indicators Cohen’s kappa (κ), sensitivity, specificity, and area under the receiver operating curve (AUC).RESULTS: JEM validation showed fair-to-moderate agreement (κ 0.21–0.60) for most physical exposures for both genders except for ‘reach behind’ (poor), ‘bend neck’ (poor), ‘finger pinch‘ (poor), standing’ (good), ‘use computer screen’ (good), and ‘use keyboard or scanner’ (good). We found the highest AUC for ‘standing’ (men 0.85/ women 0.87), ‘kneel/squat’ (men 0.80/women 0.81), ‘use computer screen’ (men/women 0.81), and ‘use keyboard or scanner’ (men 0.82/ women 0.84). The AUC was

ObjectivesThough the rise of big data in the field of occupational health offers new opportunities especially for cross-cutting research, they raise the issue of privacy and security of data, especially when linking sensitive data from the field of insurance, occupational health or compensation claims. We aimed to validate a large, blinded synthesized database developed from the CONSTANCES cohort by comparing associations between three independently selected outcomes, and various exposures.MethodsFrom the CONSTANCES cohort, a large synthetic dataset was constructed using the avatar method (Octopize) that is agnostic to the data primary or secondary data uses. Three main analyses of interest were chosen to compare associations between the raw and avatar dataset: risk of stroke (any stroke, and subtypes of stroke), risk of knee pain and limitations associated with knee pain. Logistic models were computed, and a qualitative comparison of paired odds ratio (OR) was made.ResultsBoth raw and avatar datasets included 162,434 observations and 19 relevant variables. On the 172 paired raw/avatar OR that were computed, including stratified analyses on sex, more than 77% of the comparisons had a OR difference ≤0.5 and less than 7% had a discrepancy in the statistical significance of the associations, with a Cohen's Kappa coefficient of 0.80.ConclusionsThis study shows the flexibility and the multiple usage of a synthetic database created with the avatar method in the particular field of occupational health, which can be shared in open access without risking re-identification and privacy issues and help bring new insights for complex phenomenon like return to work.

Since the beginning of the COVID-19 pandemic, there has been a growing literature on COVID and work (1). Major editorials (2–4) and reports from international associations and agencies (5–8) have highlighted the importance of occupational health research in COVID-19 prevention and management. Occupational health research has focused on specific worker populations with high prevalence of COVID-19, particularly healthcare workers, and has studied the associations between different work exposures to SARS-CoV-2 and incidence of COVID-19. Some countries have also begun to provide workers’ compensation for occupationally-acquired COVID-19 (9–13). Return to work (RTW) following COVID-19 is another crucial topic that has been studied among patients with severe cases of SARS-CoV-2 infection in different countries (14–18). Clinicians have also observed patients who suffer from persistent symptoms following COVID-19, often called “long-COVID” (19). Through analyses of large health databases, a variety of post-acute sequelae among patients with COVID-19 have been identified, including malaise, fatigue, musculoskeletal pain, anemia, and other respiratory, neurocognitive, mental health, metabolic, cardiovascular, and gastrointestinal disorders (20). The World Health Organization defined a “post COVID-19 condition” among individuals with a history of probable or confirmed SARS-CoV-2 infection with symptoms continuing three months from the onset of COVID-19 infection, which last for at least two months, and which cannot be explained by an alternative diagnosis (21). Common symptoms include fatigue, shortness of breath, cognitive dysfunction, and generally have a significant impact on everyday functioning. Symptoms may be of new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time. The “Global Burden of Disease Long COVID Collaborators”, a worldwide collaboration, defined three main post-COVID condition symptoms: (i) persistent fatigue with bodily pain (myalgia) or mood swings; (ii) cognitive problems, often forgetfulness or concentration difficulties, commonly referred to as “brain fog;” and (iii) ongoing respiratory problems (shortness of breath and persistent cough as the main symptoms) (22). This task force showed that, in a pooled study of over one million subjects, the prevalence of post-COVID condition was 0.9% [95% confidence interval (CI) 0.3–2.0%] after one year, but was at as high as 15% for symptoms that were presents at three months. Different factors were associated with a post-COVID condition, including age 20–49 years, female sex, and initial severity of illness (including hospitalization, intensive care unit admission, and mechanical ventilation) (22–24). For example, 26.6% (95% CI 11.5-47.8) of women who needed intensive care support had a post-COVID condition after a year. In 2023 in the United Kingdom, it was estimated that 2.0 million people living in private households (3.0% of the population) were experiencing self-reported post-COVID conditions (defined as symptoms continuing for more than four weeks after the first confirmed or suspected COVID-19 infection that were not explained by something else) (25). In the sample, more than 85% were in the working age. The consequences of such unexpected persistence of disease on the health of the workforce are large. Most of the post-COVID symptoms found in the general population were similar for workers: in a recent review including 60 cohort studies of working age adults and 10 cases studies, the most frequently reported post-COVID-19 symptoms were fatigue (92%), shortness of breath (82%), muscle pain (44%) and joint pain (35%) (26). In a recent study with a 15-month follow-up of workers, similar symptoms were reported as well as cognitive symptoms and autonomic dysregulation (27). This study also assessed the Work Ability Index, and found that women had a larger self-reported reduction in work ability following COVID infection than men. RTW and work factors related to post-COVID condition have been examined in small samples of workers, and found that poorer work ability was related to previous comorbidities, symptoms of fatigue, and some occupational and work organizational factors (28–31). Previous comorbidities related to chronic disease (obesity, hypertension and respiratory disorders), were associated with slower RTW among healthcare workers hospitalized for COVID-19. Asthenia / reported loss of memory and sleep disorders were associated with the longest duration of work absence (>3 months) (29). Some type of work and activity sectors have also been related to RTW outcomes. For example, in a small Canadian descriptive study, among healthcare workers physicians had better improvement than nurses and healthcare assistants (28), and business, finance and management sectors had overall the RTW outcome though not significant (31). Modification of work duties improved RTW in this same study, whereas skeptical reactions from employers and colleagues and lack of support from the social welfare system complicated RTW in a qualitative study (30).Aben et al (32) conducted a study among employees who reported sick due to COVID-19 (N=30 396) or flu-like symptoms not due to COVID-19 (N=15,862), using routinely collected data from a national Dutch occupational health service. Even though there was a 100% RTW rate three months after a flu-like syndrome, the RTW rate after COVID-19 was only 92.8%. The authors were also able to determine important predictors contributing to later return to work in specific statistical models: older age [hazard ratio (HR) 0.99, 95% CI 0.99–0.99], female sex (HR 0.88, 95% CI 0.86–0.90), belonging to a risk group – including chronic illness, compromised immune system, diabetes, and obesity (HR 0.85, 95% CI 0.82–0.89), and some specific symptoms like shortness of breath and fatigue (HR for both symptoms 0.70, 95% CI 0.68–0.72) (32). However, other potential predictors (working conditions and workplace factors, economic context, resources, personal and lifestyle factors) were not exhaustively considered, and understanding causal relation between these factors and the RTW predictors identified is difficult. Aben et al (32) also highlighted that time-to-RTW was shortened as different virus variants became dominant over time. For example, 12.8% of employees who contracted COVID-19 were absent from work for >12 weeks during the alpha virus dominant period, but this number declined to 5.8% in the delta virus-dominant period and to 1.4% in the omicron virus dominant period (32). Strategies promoting return to work for those with post-COVID-19 conditions will need to be implemented and could be comparable to programs developed for other chronic conditions, since post-COVID conditions share some similarities to post-intensive care syndrome, fibromyalgia, and chronic fatigue syndrome (15, 33, 34). These patients have better outcomes following integrative health approach that combines traditional medical management, non-pharmacological treatments including physical therapy, and behavior and lifestyle changes (35, 36). As with RTW following other illnesses, RTW efforts post-COVID should look out for potential red flags or complications (19). Guidelines recommend that occupational practitioners should be included in the process as early as possible, and give importance to job accommodations for improving work ability of such workers (5, 8, 37). An observational study on a small sample of workers undergoing specific rehabilitation for post-COVID conditions reported significant but modest improvements on a variety of symptoms, though only half of the participants were able to return to work (31). Additional research in working populations is needed with larger observational cohorts, randomized controlled trials, and mixed approaches to evaluate the cost-effectiveness of integrative care and other approaches in preserving work ability for these patients (38–40).In conclusion, COVID-19 remains an important topic for the occupational health research agenda, including acute and post COVID conditions. Although there is still debate about the definition of what a `post-COVID condition` entails, the sheer number of patients who are not returning to work in a timely manner or returning to work with limitations, and the lack of research interventions available should lead occupational health practitioners and researchers to work not only to prevent infection but to prevent or reduce work disability resulting from the COVID-19 pandemic and future pandemics.Acknowledgements and conflict of interest. Authors are paid form their institutions. AD is editor in chief of Archives des maladies professionnelles et de l’environnement and received form a regional grant (TEC-TOP, Pays de la Loire Region, Angers Loire Metropole, University of Angers, CHU Angers). References 1. Burdorf A, Porru F, Rugulies R. The COVID-19 pandemic: one year later - an occupational perspective. Scand J Work Environ Health 2021;47:2457. https://doi.org/10.5271/sjweh.3956 2. Burdorf A, Porru F, Rugulies R. 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In this work, PM2.5 was sampled at Dunkerque, a medium-sized city located in northern France. The mean concentration of PM2.5 during the sampling period was 12.6 ± 9.5 μg·m−3. Samples were analyzed for elemental and organic carbon (EC/OC), water-soluble organic carbon (WSOC), humic-like substances (HULIS-C), water-soluble inorganic ions, and major and trace elements. The origin and the variations of species concentrations were examined using elemental enrichment factors, bivariate polar plot representations, and diagnostic concentration ratios. Secondary inorganic ions were the most abundant species (36% of PM2.5), followed by OC (12.5% of PM2.5). Secondary organic carbon (SOC) concentrations were estimated to account for 52% of OC. A good correlation between SOC and WSOC indicated that secondary formation processes significantly contribute to the WSOC concentrations. HULIS-C also represents almost 50% of WSOC. The determination of diagnostic ratios revealed the influence of anthropogenic emission sources such as integrated steelworks and fuel oil combustion. The clustering of 72 h air masses backward trajectories data evidenced that higher concentrations of PM2.5, OC, and secondary inorganic aerosols were recorded when air masses came from north-eastern Europe and the French continental sector, showing the considerable impact of long-range transport on the air quality in northern France.

Introduction: With recent higher awareness of the necessity of improving healthcare workers’ well-being, we aimed to overview systematic reviews dealing with interventions on well-being, occupational health, and aging of healthcare workers. Methods: From three databases (PubMed, Embase, and Web of Science), a scoping review of systematic reviews was carried out to determine current knowledge on interventions focused on the well-being or aging of healthcare workers. Only systematic reviews were considered, with appropriate extraction and quality evaluation. Results: Of the total of 445 references identified, 10 systematic reviews were included, mostly published since 2019. Nurses were the most frequent targets of interventions, and mental health was the main outcome described. The overall level of quality was also heterogenous, with high to low-quality reviews. Conclusions: Workers' mental health well-being was the major outcome targeted by intervention, with varying level of evidence. Further studies are needed with integrative approaches on global health and life course perspectives, with a focus on the plurality of settings, worker types, and women.

The aim was to describe out-of-hospital cardiac arrest (OHCA) occurring in the workplace of a large emergency network, and compare the evolution of their management in the last 15 years. A retrospective study based on data from the Northern Alps Emergency Network compared characteristics of OHCA between cases in and out the workplace, and between cases occurring from January 2004 to December 2010 and from January 2011 to December 2017. Among the 15,320 OHCA cases included, 320 occurred in the workplace (2.1%). They were more often in younger men, and happened more frequently in an area with access to public defibrillation, had more often a shockable rhythm, had a cardiopulmonary resuscitation started by a bystander more frequently, and had a better outcome. Cardiopulmonary resuscitation started by a bystander was the only chain of survival link that improved for cases occurring after December 2010. Workplace OHCA seems to be managed more effectively than others; however, only a slight survival improvement was observed, suggesting that progress is still needed.

Abstract Background Shoulder pain, which is a widespread condition, can lead to participation restrictions in daily and professional life. However, there are few studies focusing on the differences between daily life limitations and work limitations. This study aims at identifying the factors associated with limitations in personal and professional life in a population of working age suffering from shoulder pain. Methods A sample of working age job seekers and workers with shoulder pain was drawn from the last general population cross-sectional French study on disability. Limitations were categorized depending on whether they related to daily life and/or work. The variables assessed were age, sex, state of health, activity restrictions, need for accommodation, and aggravating living conditions or aggravating working conditions. Separate Quasi-Poisson regressions were performed for each type of limitation. Results The sample consisted of 795 individuals of which 33.7% had no limitation, 21.7% were limited in daily life, 6.0% at work, and 38.6% in both. Factors significantly associated with daily life limitations and work limitations and their computed Prevalence Ratios (PR) were the need for accommodation (PR = 2.16), activity restrictions (PR = 2.28), perceived poor health (PR = 2.42) and low income (PR = 1.64). Aggravating living conditions and aggravating working conditions were associated with daily life limitations (PR of 1.69 and 0.63 respectively). Conclusions The present study identifies factors associated with disability in a population with shoulder pain. Further research should be carried out in order to study health-related periods of cessation of work.

BackgroundStudies began investigating occupational exposures as a source of contamination to SARS-CoV-2, yet few considered the variation in SARS-Cov2 pandemic activity for these exposures. Several indicators were built to assess SARS-Cov2 activity though they usually serve a specific purpose and have limitations. The aim was to compare qualitatively different estimators of the SARS-CoV-2 pandemic activity and to create an estimator of pandemic activity level based on daily hospital admissions for job-exposure matrices (JEM) usage.MethodsFrom publicly available French databases, we retrieved all data from March 19, 2020 (first day available) to March 25, 2021 (day of data collection) on four different estimators: percentage of intensive care bed occupied, reproductive number, tests' positive rate and number positive tests. An indicator based on new daily hospital admissions was created for a COVID JEM. Due to the heterogeneity of the estimators, a qualitative comparison was carried out.ResultsDuring the study period, three major outbreaks took place. Though the number of positive tests was the first indicator to worsen during the 2nd outbreak, it failed to identify variation during the outbreak. Though each indicators behaved differently during the study period, the indicator based on new daily hospital admissions and the positive rate seemed to be the closest to one another.ConclusionThis study highlights the heterogeneity of the indicators used during the first and second SARS-Cov2 outbreaks in France. An indicator based on new daily hospital admissions seems to be a good candidate for estimating SARS-CoV-2 epidemic activity for COVID JEMs and is easily available in countries where usual indicators are not commonly accessible.

Objective Cold environments are a potential risk factor for stroke. The aim of this study was to investigate the association between performing work tasks in cold environments and the occurrence of a first stroke event.Methods From the French population-based cohort CONSTANCES (‘Cohorte des consultants des Centres d'examens de santé’ in French), we collected data from baseline questionnaires along with medical interviews on cardiovascular risk factors and reported exposure to cold temperatures (

Introduction: Systematic reviews are routinely used to synthesize current science and evaluate the evidential strength and quality of resulting recommendations. For specific events, such as rare acute poisonings or preliminary reports of new drugs, we posit that case reports/studies and case series (human subjects research with no control group) may provide important evidence for systematic reviews. Our aim, therefore, is to present a protocol that uses rigorous selection criteria, to distinguish high quality case reports/studies and case series for inclusion in systematic reviews.Methods: This protocol will adapt the existing Navigation Guide methodology for specific inclusion of case studies. The usual procedure for systematic reviews will be followed. Case reports/studies and case series will be specified in the search strategy and included in separate sections. Data from these sources will be extracted and where possible, quantitatively synthesized. Criteria for integrating cases reports/studies and case series into the overall body of evidence are that these studies will need to be well-documented, scientifically rigorous, and follow ethical practices. The instructions and standards for evaluating risk of bias will be based on the Navigation Guide. The risk of bias, quality of evidence and the strength of recommendations will be assessed by two independent review teams that are blinded to each other.Conclusion: This is a protocol specified for systematic reviews that use case reports/studies and case series to evaluate the quality of evidence and strength of recommendations in disciplines like clinical toxicology, where case reports/studies are the norm.

Background Long‐working hours (LWH) are a probable risk factor for ischemic heart diseases (IHD); however, no previous study has considered duration of exposure to LWH when addressing this topic. We aimed to determine the association between cumulative exposure to LWH and IHD while accounting for relevant confounders. Methods and Results In this retrospective study, we included all baseline participants from the French population‐based cohort CONSTANCES. Part‐time employees and those who reported a cardiac event in the 5 years before LWH exposure were excluded. From self‐administered questionnaires and clinical examinations, we obtained participants’ age, sex, body mass index, occupational status, smoking habits, high blood pressure, diabetes mellitus, familial history of cardiovascular disease, dyslipidemia, exposure to LWH, and its duration. We defined LWH as working for >10 hours daily for at least 50 days per year. The main outcome was reported history of IHD, ie, myocardial infarction or angina pectoris, during a clinical examination. Of 137 854 included participants, 69 774 were men. There were 1875 cases (1.36%) of IHD, and exposure to LWH was reported by 42 462 subjects (30.8%) among whom 14 474 (10.50%) reported exposure for at least 10 years. Overall, exposure to LWH for ≥10 years was associated with an increased risk of IHD, adjusted odds ratio (aOR) 1.24 (1.08–1.43), P=0.0021. In stratified analyses, this effect was not observed in women, but was significant amongst men, aOR 1.28 (1.11–1.48), P=0.0008. Conclusions This large population‐based study supports an association between cumulative exposure to LWH and IHD in men. Future research should consider relevant strategies for reducing LWH exposure and duration.

The recent editorial by Dr Susan Peters “Although a valuable method in occupational epidemiology, job-exposure matrices are no magic fix” ably describes the strengths and limitations of job-exposure matrix (JEM) approaches in occupational epidemiology research (1). In addition to their use in research, we would like to add that JEM may also be of use in compensation and surveillance efforts in occupational health. JEM could assist the compensation process by supporting the assessment of relevant exposures related to specific health conditions (2). The potential usefulness of a JEM as a decision tool for compensation of work-related musculoskeletal disorders has been examined (3). Because occupational diseases are often under-recognized, another practical application is using a JEM to screen for occupational exposures as part of health surveillance. Use of JEM to screen for asbestos and wood dust exposure in the clinical setting has shown promising results (4–6). By summarizing multiple exposures at a job level (7), JEM may also assist policy-makers in setting priorities for hazards and controls at work, as well as occupational practitioners to target prevention efforts and direct the conduct of more precise exposure measures to particular jobs. Sharing JEM across different countries may be useful in providing estimates of exposures across larger populations to calculate global burden of disease related to occupational exposure. The JEMINI (JEM InterNatIonal) initiative was launched to explore the possibility of developing international JEM that could be used across countries (8). Beginning with physical (biomechanical) exposures, this open group has started homogenizing job coding systems and comparing some available JEM. Estimating differences in the level of exposure between countries will require much more work, without guaranteed success. As Peters mentioned, many limitations exist in the use of JEM. Users of JEM must consider the source of exposure data – expert assessments, data collected from individual workers, or environmental sampling. The coding of occupations is time consuming and can introduce error (9), and more testing of and comparison with automated job coding systems is needed (10). JEM reflect an “average” level of exposure within a job at the expense of individual variation. At population level, JEM can offer a useful estimate of exposures. If used at an individual level in a clinical or compensation setting, JEM cannot replace the professionals involved in exposure assessment but may help them focus their action more effectively on complex situations that require their expertise. In conclusion, these JEM developed for research might also be used as a public health tool, provided that their limitations are properly taken into account. References 1. Peters S. Although a valuable method in occupational epidemiology, job-exposure matrices are no magic fix. Scand J Work Environ Health 2020;46:2314. https://doi.org/10.5271/sjweh.3894 2. Kerbrat J, Descatha A. (The recognition of health consequences of difficult working conditions in France and its evaluation with the use of a job-exposure matrix). Arch Mal Prof Environ. 2018;79:493500. https://doi.org/10.1016/j.admp.2017.12.001 3. Fadel M, Valter R, Quignette A, Descatha A. Usefulness of a job-exposure matrix « MADE » as a decision tool for compensation of work-related musculoskeletal disorders. Eur J Public Health 2019;29:86870. https://doi.org/10.1093/eurpub/cky274 4. Lorentz E, Despreaux T, Quignette A, Chinet T, Descatha A. (Screening of occupational exposure to asbestos and silica by job-exposure matrix among patients with lung cancer and mesothelioma). Rev Mal Respir. 2019;36:108895. https://doi.org/10.1016/j.rmr.2019.08.006 5. Imbernon E, Goldberg M, Spyckerell Y, Steinmetz J, Bonenfant S, Fournier B. (Use of a job-exposure matrix for the screening of occupational exposure to asbestos). Rev Epidemiol Sante Publique 2004;52:717. https://doi.org/10.1016/S0398-7620(04)99018-9 6. Carton M, Bonnaud S, Nachtigal M, Serrano A, Carole C, Bonenfant S, et al. Post-retirement surveillance of workers exposed to asbestos or wood dust: first results of the French national SPIRALE Program. Epidemiol Prev. 2011;35:31523. 7. Guéguen A, Goldberg M, Bonenfant S, Martin JC. Using a representative sample of workers for constructing the SUMEX French general population based job-exposure matrix. Occup Environ Med. 2004;61:58693. https://doi.org/10.1136/oem.2003.010660 8. Descatha A, Evanoff BA, Andersen JH, Fadel M, Ngabirano L, Leclerc A, et al. JEMINI (Job Exposure Matrix InterNatIonal) Initiative: a Utopian Possibility for Helping Occupational Exposure Assessment All Around the World? J Occup Environ Med. 2019;61:e3201. https://doi.org/10.1097/JOM.0000000000001631 9. Petersen SB, Flachs EM, Svendsen SW, Marott JL, Budtz-Jørgensen E, Hansen J, et al. Influence of errors in job codes on job exposure matrix-based exposure assessment in the register-based occupational cohort DOC*X. Scand J Work Environ Health 2020;46:25967. https://doi.org/10.5271/sjweh.3857 10. Buckner-Petty S, Dale AM, Evanoff BA. Efficiency of autocoding programs for converting job descriptors into standard occupational classification (SOC) codes. Am J Ind Med. 2019;62:5968. https://doi.org/10.1002/ajim.22928