Introduction. The laboratory of epidemiology of the institute of radioprotection and nuclear safety (IRSN) and the A REVA company are conducting a morbidity study on active workers from the AREVA site of La Hague. Data used for the study are extracted from disease registration system (called Chimed) monitored by the local occupational health department. To assess the quality of this system, we have cross-matched cancer incidence data from two different sources: local occupational health department and cancer registries (used as a gold standard).Materials and methods. A cancer case is an AREVA worker who has been diagnosed with cancer and whose diagnosis has been registered in the Chimed database between 01/01/1999 and 31/12/2009. The Chimed database and the cancer registries' database were matched in order to calculate sensitivity (capacity to detect the true positives) and positive predictive value (probability that a worker with a positive screening result has the disease).Results. The population study contains 5211 workers of the AREVA site of La Hague. The cross-matching has provided following results: 30 cases were registered in both sources database, 23 cancer cases were registered by cancer registries but not by Chimed and 4 cases were recorded in the Chimed database but not in the cancer registries. Our results show that Chimed's sensitivity is about 57%, using cancer registries as the gold standard. The positive predictive value is about 89%.Discussion and conclusion. Our study has showed that about one cancer case out of two was recorded in the Chimed database. In the present state, the Chimed database cannot be used to perform an exhaustive inventory of cancer eases among active workers. In order to improve nuclear worker cancer surveillance by the local occupational health department, standardized and systematic procedures for cancer data collecting are needed.

BACKGROUND:This article presents the mortality data compiled among a cohort of workers at risk of internal uranium exposure and discusses the extent to which this exposure might differentiate them from other nuclear workers. METHODS:The cohort consisted of 2897 Areva-NC-Pierrelatte plant workers, followed from 1st January 1968 through 31st December 2006 (79,892 person-years). Mortality was compared with that of the French population, by calculating Standardized Mortality Ratios (SMR) and 95% confidence intervals (CI95%). External radiation exposure was reconstructed using external dosimetry archives. Internal uranium exposure was assessed using a plant-specific job-exposure-matrix, considering six types of uranium compounds according to their nature (natural and reprocessed uranium [RPU] and solubility [fast-F, moderate-M, and slow-S]). Exposure-effect analyses were performed for causes of death known to be related to external radiation exposure (all cancers and circulatory system diseases) and cancer of uranium target-organs (lung and hematopoietic and lymphatic tissues, HLT). RESULTS:A significant deficit of mortality from all causes (SMR=0.58; CI95% [0.53-0.63]), all cancers (SMR=0.72; CI95% [0.63-0.82]) and smoking related cancers was observed. Non-significant 30%-higher increase of mortality was observed for cancer of pleura (SMR=2.32; CI95 % [0.75-5.41]), rectum and HLT, notably non-Hodgkin's lymphoma (SMR=1.38; CI95 % [0.63-2.61]) and chronic lymphoid leukemia (SMR=2.36; CI95% [0.64-6.03]). No exposure-effect relationship was found with external radiation cumulative dose. A significant exposure-effect relationship was observed for slowly soluble uranium, particularly RPU, which was associated with an increase in mortality risk reaching 8 to 16% per unit of cumulative exposure score and 10 to 15% per year of exposure duration. CONCLUSION:The Areva-NC-Pierrelatte workers cohort presents a non-significant over-mortality from HLT cancers, notably of lymphoid origin, unrelated to external radiation exposure. The pilot study suggests an association between mortality from the HLT and lung cancers and exposure to slowly soluble RPU compounds. The results of this study should be investigated further in more powerful studies, with a dose-response analysis based on individual assessment of uranium absorbed dose to uranium-target organs.

Background Medical surveillance of uranium miners can include periodic chest X-ray examinations. This study aimed to assess the X-ray exposure due to occupational health monitoring in the French cohort of uranium miners, and to test whether consideration of this additional radiation exposure impacts the excess risk of lung cancer death associated with radon exposure. Method X-ray exposure due to occupational health monitoring was estimated retrospectively based on review of a sample of miners’ medical records and bibliographic data. Four exposure scenarios were designed, differing in their assumptions about the type of procedures performed, their frequency, and the lung dose delivered. Radon exposure and lung doses from exposure to α-particle emitters and external γ rays have previously been individually assessed. Exposure-risk and dose-risk relations were estimated by Poisson regression with a linear excess relative risk (ERR) model. Results The cohort included 5086 miners with a mean follow-up duration of 30.1 years. The mean number of chest X-ray examinations ranged from 15.1 in the lowest to 34 in the highest-exposure scenario, and produced a mean cumulative lung dose ranging from 4.6 to 34.2 mGy. The role of occupation-related imaging screening X-ray procedures in total equivalent lung dose appeared insignificant compared to α-emitter exposure. X-ray exposure was not associated with lung cancer mortality risk. The ERR associated with radon remained significantly positive when X-ray exposure was included in the multivariate analysis. Conclusions X-ray exposure did not confound the exposure-risk relation between radon and lung cancer.

The investigation of potential adverse health effects of occupational exposures to ionizing radiation, on uranium miners, is an important area of research. Radon is a well-known carcinogen for lung, but the link between radiation exposure and other diseases remains controversial, particularly for kidney cancer. The aims of this study were therefore to perform external kidney cancer mortality analyses and to assess the relationship between occupational radiation exposure and kidney cancer mortality, using competing risks methodology, from two uranium miners cohorts. The French (n = 3,377) and German (n = 58,986) cohorts of uranium miners included 11 and 174 deaths from kidney cancer. For each cohort, the excess of kidney cancer mortality has been assessed by standardized mortality ratio (SMR) corrected for the probability of known causes of death. The associations between cumulative occupational radiation exposures (radon, external gamma radiation and long-lived radionuclides) or kidney equivalent doses and both the cause-specific hazard and the probability of occurrence of kidney cancer death have been estimated with Cox and Fine and Gray models adjusted to date of birth and considering the attained age as the timescale. No significant excess of kidney cancer mortality has been observed neither in the French cohort (SMR = 1.49, 95 % confidence interval [0.73; 2.67]) nor in the German cohort (SMR = 0.91 [0.77; 1.06]). Moreover, no significant association between kidney cancer mortality and any type of occupational radiation exposure or kidney equivalent dose has been observed. Future analyses based on further follow-up updates and/or large pooled cohorts should allow us to confirm or not the absence of association.

This article presents the mortality data compiled among a cohort of workers at risk of internal uranium exposure and discusses the extent to which this exposure might differentiate them from other nuclear workers.The cohort consisted of 2897 Areva-NC-Pierrelatte plant workers, followed from 1st January 1968 through 31st December 2006 (79,892 person-years). Mortality was compared with that of the French population, by calculating Standardized Mortality Ratios (SMR) and 95% confidence intervals (CI95%). External radiation exposure was reconstructed using external dosimetry archives. Internal uranium exposure was assessed using a plant-specific job-exposure-matrix, considering six types of uranium compounds according to their nature (natural and reprocessed uranium [RPU] and solubility [fast-F, moderate-M, and slow-S]). Exposure-effect analyses were performed for causes of death known to be related to external radiation exposure (all cancers and circulatory system diseases) and cancer of uranium target-organs (lung and hematopoietic and lymphatic tissues, HLT).A significant deficit of mortality from all causes (SMR=0.58; CI95% [0.53-0.63]), all cancers (SMR=0.72; CI95% [0.63-0.82]) and smoking related cancers was observed. Non-significant 30%-higher increase of mortality was observed for cancer of pleura (SMR=2.32; CI95 % [0.75-5.41]), rectum and HLT, notably non-Hodgkin's lymphoma (SMR=1.38; CI95 % [0.63-2.61]) and chronic lymphoid leukemia (SMR=2.36; CI95% [0.64-6.03]). No exposure-effect relationship was found with external radiation cumulative dose. A significant exposure-effect relationship was observed for slowly soluble uranium, particularly RPU, which was associated with an increase in mortality risk reaching 8 to 16% per unit of cumulative exposure score and 10 to 15% per year of exposure duration.The Areva-NC-Pierrelatte workers cohort presents a non-significant over-mortality from HLT cancers, notably of lymphoid origin, unrelated to external radiation exposure. The pilot study suggests an association between mortality from the HLT and lung cancers and exposure to slowly soluble RPU compounds. The results of this study should be investigated further in more powerful studies, with a dose-response analysis based on individual assessment of uranium absorbed dose to uranium-target organs.

Objectives Understanding the effect of chronic low dose radiation exposure is crucial for radiation protection. This study analyses mortality of workers monitored for external radiation exposure while employed at three major French nuclear companies. Method The cohort includes all workers employed at least one year by CEA, AREVA NC or EDF between 1950 and 1994, monitored for radiation exposure and alive on 1 January 1968. The mortality follow-up was to 2004. Vital status and causes of death were obtained from national registries. Standardised mortality ratios were assessed using national rates as the reference. Results A total of 59 004 workers were followed-up for an average of 25 years. Mean age at end of follow-up was 56 years. Less than 1% of workers were lost to follow-up. 6310 deaths occurred between 1968 and 2004 including 2547 cancer deaths. A strong healthy worker effect was observed (all-cause SMR = 0.61, 95%-CI: 0.60–0.63). Significant excess mortality was observed for pleura cancer (SMR= 1.71, 95%-CI: 1.24–2.30) and for melanoma (SMR= 1.43, 95%-CI: 1.04–1.92), with no significant trend in SMRs for these outcomes across categories of cumulative radiation exposure. Conclusions This analysis of French nuclear workers confirms a healthy worker effect but also an excess risk of death from pleura cancer and melanoma. This cohort study is the most informative ever conducted in France among nuclear workers.

Objectives There is currently no consensus for an association between risk of Circulatory System Diseases (CSD) and low exposure to ionising radiation. The aim is to study the relationship between CSD mortality and radon exposure in the French cohort of uranium miners considering classical CSD risk factors. Method The French cohort includes 5086 uranium miners followed from 1946 through 2007. Among the 1935 deaths, 442 were from CSD, including 167 cases of IHD and 105 cases of CVD. Annual radon exposures were assessed individually. A nested case-control study was performed to collect individual information concerning classical CSD risk factors (weight, height, smoking status, blood pressure, blood glucose and cholesterolemia) from medical files for 76 cases of death from CSD (including 26 from IHD and 16 from CVD) and 237 controls, matched for attained age and birth date and counter-matched for cumulative radon exposure. Results In the whole cohort, a significant association with cumulative radon exposure was observed for CVD mortality, but not for CSD or IHD mortality. In the case-control study, no significant unadjusted Odd-Ratio for cumulative radon exposure was observed for any endpoint. Analyses adjusted on CSD risk factors, for which missing data do not exceed 25%, are ongoing. Conclusions The issue of CSD associated to ionising radiation is crucial for radiation protection. The present study, allowing to consider individual data on major classical CSD risk factors, will contribute to improve knowledge on the effects of low dose exposure.

Objectives A cohort of nuclear workers employed in the fuel processing cycle was set-up in France in 2009 to assess the risk of cancer and non-cancer mortality related to uranium, in a context of occupational multi-exposure. Vital status and causes of death are now available. Method The cohort includes workers employed at least 6 months between 1958 and 2006 by AREVA and CEA (French Atomic Energy Commission). Exposure assessment was realised by a dual approach combining individual monitoring data and specific job-exposure matrices, considering radiation exposures, chemical agents and physical stresses (heat and noise). Additional information like tobacco consumption and various clinical parameters (Body Mass Index, blood pressure, lipid profile etc.) was also collected from the Occupational Health Services. Vital status and causes of death were collected from French national registries. Results The cohort includes 12 739 workers (88% men) with an average duration of employment of 17 years. The median year of birth is 1944. At the end of follow-up (31/12/2010), 19% are deceased and 96% of the causes of death are identified. Cancers (mainly lung, prostate and lymphatic and haematopoietic tissue cancers) represent 43% of all causes of death, non-cancers (mainly diseases of the circulatory system) 48% and external causes 9%. The analyses using French national mortality rates as reference will be presented. Conclusions The observed mortality is that of an even young population and at this stage no further conclusions can be drawn. This cohort, with this wealth of data, will be very informative for the investigation of uranium related risks.

Accumulating evidence shows that T cells penetrate the central nervous system (CNS) parenchyma in several autoimmune, infectious, and degenerative neurological diseases. The structural and functional consequences for CNS neurons of their encounter with activated T cells have been investigated in several experimental systems, including ex vivo co-cultures, electrophysiology, and in vivo imaging. Here, we review the modalities of neuron/T cell interactions. We substantiate the contention that T cells are directly responsible for neuronal damage in a large number of neurological diseases and discuss mechanisms of neuronal damage mediated by distinct T cell subsets, the impact of which differs depending on the disease. Finally, we describe how a better understanding of the mechanisms at play offers new possibilities for therapeutic intervention.

La recherche sur les théories du complot connaît un engouement grandissant ces dernières années. Les travaux sont issus de diverses disciplines du champ des sciences humaines. Ils mettent notamment en évidence que l’adhésion aux croyances conspirationnistes connaît un rebond à chaque moment de « crise ». La crise sanitaire que nous traversons n’échappe pas à la règle : la pandémie de COVID-19 se double d’une infodémie, selon le mot de Tedros Ghebreyesus, Directeur Général de l’Organisation mondiale de la santé. En effet, on assiste à la production et la diffusion à l’échelle internationale de fausses informations et, notamment, d’explications complotistes du coronavirus et de ses conséquences. Cette flambée du conspirationnisme est l’occasion d’interroger les enjeux psychiques et psychopathologiques de ce phénomène face à la « crise », qu’elle soit collective ou individuelle, sanitaire ou existentielle. Après avoir procédé à une revue de l’importante littérature scientifique internationale consacrée, ces derniers mois, aux théories conspirationnistes relatives à la crise sanitaire du COVID-19, nous soutenons l’intérêt d’aborder le phénomène conspirationniste sous un angle psychopathologique.Research on conspiracy theories (CT) has increased significantly in recent years. Studies come from various disciplines in the field of the humanities and social sciences. They show in particular that adherence to CT rebounds at every moment of “crisis”. The health crisis we are experiencing is no exception: COVID-19 pandemic entails an “infodemic”, according to Tedros Ghebreyesus, General Director of the World Health Organization. Indeed, we are witnessing the production, and international dissemination, of false informations, including conspiracy explanations of the coronavirus and its consequences. This outbreak of CT is an opportunity to examine the psychological and psychopathological issues of this phenomenon in the face of the “crisis”, whether collective or individual, health or existential.We present a review of the important international scientific literature regarding CT related to the health crisis of the COVID-19.Work that addresses CT related to the COVID-19 crisis has resulted in more than fifty publications in recent months. This research is mainly in the fields of social psychology, medical psychology, differential psychology, political science and public health. The rates of adherence to CT related to COVID-19 are of great concern. The literature mentions predisposing factors to the adherence or diffusion of CT on COVID-19: inclination for CT in general, low level of education, low knowledge of the disease, high level of anxiety, acceptance of xenophobic policies, unfavourable attitude towards marginal groups, nationalist stance. Unsurprisingly, there is widespread agreement in the literature that the conspiracy-prone fringe of the population is less likely to comply with government recommendations related to contamination risks, such as handwashing, social distancing, wearing masks, and using diagnostic tests. This crisis thus demonstrates once again that the circulation of false news and adherence to CT is not just a marginal and inconsequential thinking: it concerns a very large part of the population, with a potentially tragic impact in terms of public health. While there is usually no significant difference in adherence to CT according to gender, it would seem that women are less affected by CT related to the COVID than men, regardless of their political affiliation. Finally, studies on the links between adherence to COVID-related CT and stress levels do not seem to reach a consensus. The same uncertainty can be found in work on other types of CT.These results suggest that in order to understand the psychological causes of CT, it may be useful to address the psychodynamic issues underlying adherence to these beliefs. In particular, a psychopathological approach to this phenomenon enables to understand these beliefs as a defensive solution to cope with psychic vulnerability. CT involves overproducing meaning, as delusion does: CT can be considered as the collective, cultural equivalent of a delusional production. Moreover, it is impervious to arguments and evidences, in the same manner as delusion. However, it differs from it by at least two major characteristics: it is shareable and socializing; it gives rise to a consistent attitude.

During a serious accident at the Fukushima Dai-ichi Nuclear Power Plant (FDNPP), a huge quantity of radionuclides was released into the atmosphere and ocean. We measured anthropogenic radionuclides in surface air at Tsukuba, about 170 km from the FDNPP. On March 15, 2011, we detected the radioactivity released from the Fukushima accident in air samples at Tsukuba. The major radionuclides that we observed were radioiodine (131I, 132I, 133I) and radiocesium (134Cs, 136Cs, 137Cs). This radioiodine consisted of gaseous and particulate forms; the percentage of particulate 131I in the total 131I ranged from 0 to 86%. The percentage of the particulate 131I to the total 131I increased on the arrival of the plumes from major emissions of the FDNPP. After activities of the radionuclides attained the maximum on March 15, 2011, the FDNPP-derived radionuclides decreased rapidly in surface air. The activity median aerodynamic diameter of 131I-bearing particles was 0.7 μm, while those of 134Cs- and 137Cs-bearing particles were larger than 1 μm. Large variations of ratios of 131I/137Cs, 132Te/137Cs, and 99Mo (99mTc)/137Cs (all involving different elements) suggest that the behaviors of these radionuclides in the atmosphere, including the processes of their emission, differed each other.

Objective The long-term effects of protracted low level ionising radiation exposure are investigated in a combined analysis of French nuclear workers employed by the Commissariat à l'Energie Atomique (CEA), AREVA Nuclear Cycle (AREVA NC) and Electricité de France (EDF). Associations between cumulative external radiation dose and mortality due to solid cancers, leukaemia and circulatory disease were examined. Methods All workers hired by CEA, AREVA NC and EDF between 1950 and 1994 who were employed for at least 1 year, badge-monitored for radiation exposure and alive on 1 January 1968 were included. Individual data of annual exposure to penetrating photons (X-rays and gamma rays) were reconstructed for each worker. Estimates of radiation dose–mortality associations were obtained using a linear excess relative risk (ERR) Poisson regression model. Results Among the 59 021 nuclear workers, 2312 died of solid cancer, 78 of leukaemia and 1468 of circulatory diseases during the 1968–2004 period. Approximately 72% of the cohort had a non-zero cumulative radiation dose estimate, with a mean cumulative dose of 22.5 mSv. Positive but non-significant ERR/Sv were observed for all solid cancers, leukaemia excluding chronic lymphocytic leukaemia (CLL), ischaemic heart diseases and cerebrovascular diseases. A significant ERR/Sv was found for myeloid leukaemia. Conclusions This is the first combined analysis of major French cohorts of nuclear workers. Results were consistent with risks estimated in other nuclear worker cohorts and illustrate the potential of a further joint international study to yield direct risk estimates in support to radiation protection standards.

BACKGROUNDNuclear workers may be exposed to a variety of chemical hazards, in addition to radiation. We examined the effect of chemical exposures on cancer mortality among French uranium processing workers at the AREVA NC Pierrelatte facility.METHODSA cohort of 2,897 uranium processing workers employed for at least 6 months was followed from 1968 through 2006. Exposure to uranium and potentially carcinogenic chemicals was assessed with a plant-specific job-exposure matrix. Mortality hazard ratios (HRs) for cancers of the lung, lymphohematopoietic system, kidney and bladder, brain and central nervous system (BCNS), and prostate were estimated for each specific chemical exposure, with Cox regression models stratified for sex and calendar period and adjusted for socioeconomic status. Additional adjustments enabled us to examine the effect of co-exposure to uranium and other chemicals.RESULTSExposure to aromatic solvents was associated with increased risk of BCNS malignancies after adjustment for other chemicals (HR=6.53, 95% CI=1.14-37.41; n=6) and for other chemicals and uranium (HR=7.26, 95% CI=0.90-58.19) in the annual exposure status model. Selected groups of lymphohematopoietic cancers were found associated with solvent exposure. Inconclusive results were found regarding chromium (VI) exposure, since only 2 workers died from lung cancer among 109 exposed.CONCLUSIONBased on our pilot study, it seemed important to take into account chemical exposures in the analyses of cancer mortality among French uranium processing workers.

Malaria is an acute and chronic illness characterized by paroxysms of fever, chills, sweats, fatigue, anemia, and splenomegaly. It is still an important health problem in malaria-endemic countries. Children living in malaria-endemic areas have elevated Epstein-Barr Virus (EBV) loads in the circulation and acute malaria infection leads to increased levels of circulating EBV that are cleared after anti-malaria treatment. There are many reports about the association of Plasmodium falciparum (P. falciparum) malaria and EBV infection. Here we report a case who had coinfection of Plasmodium vivax (P. vivax) malaria and EBV infection. To the best of our knowledge this is the first case indicating the association of P. vivax malaria and EBV infection.

Heart failure is a clinical condition that notably affects the lives of patients in rural areas. Partnering of a rural satellite hospital with an urban academic medical center may provide geographically underrepresented populations with heart failure an opportunity to access to controlled clinical trials (CCTs).We report our experience in screening, consenting and enrolling subjects at the VCU Health Community Memorial Hospital (VCU-CMH) in rural South Hill, Virginia, that is part of the larger VCU Health network, with the lead institution being VCU Health Medical College of Virginia Hospitals (VCU-MCV), Richmond, VA. Subjects were enrolled in a clinical trial sponsored by the National Institutes of Health and assigned to treatment with an anti-inflammatory drug for heart failure or placebo. We used the electronic health record and remote guidance and oversight from the VCU-MCV resources using a close-loop communication network to work with local resources at the facility to perform screening, consenting and enrollment.One hundred subjects with recently decompensated heart failure were screened between January 2019 and August 2021, of these 61 are enrolled to date: 52 (85%) at VCU-MCV and 9 (15%) at VCU-CMH. Of the subjects enrolled at VCU-CMH, 33% were female, 77% Black, with a mean age of 52 ± 10 years.The use of a combination of virtual/remote monitoring and guidance of local resources in this trial provides an opportunity for decentralization and access of CCTs for potential novel treatment of heart failure to underrepresented individuals from rural areas.ClinicalTrials.gov: NCT03797001

Décrire les risques professionnels liés à la pratique de l’anesthésie et donner les moyens de les prévenir.Recherche dans la banque de données Medline, dans les revues spécialisées de médecine du travail et dans la banque de données de la caisse régionale maladie d’Île-de-France, des articles de langue française et anglaise. Les mots clés employés séparément ou en combinaison étaient les suivants : anesthésie, risques professionnels, gaz anesthésique, stress, conditions de travail, burnout, toxicomanie, accident d’exposition au sang, allergie au latex, radiation ionisante, électrocution, explosion.Ont été sélectionnés les revues générales et les articles originaux. Pour les risques plus anecdotiques, ont également été sélectionnés les cas cliniques isolés et les lettres à la rédaction en fonction de leur pertinence comparée aux données existantes de la littérature.Après regroupement selon la nature du risque, les articles ont été analysés pour la description, l’analyse et la prévention du risque.Il existe plusieurs risques professionnels liés à la pratique de l’anesthésie. La toxicité des gaz anesthésiques, en particulier du protoxyde d’azote, a été mise en évidence dès le début de leur utilisation. L’abandon des gaz les plus toxiques et l’application de mesures de protection collectives (système d’évacuation des gaz anesthésiques, ventilation des salles d’intervention, utilisation de circuit avec réinhalation) permettent de diminuer considérablement le risque lié à leur emploi. Le risque d’accidents d’exposition au sang diminue également grâce à l’élimination des pratiques à risque et l’utilisation de matériel sécurisé. L’évolution des techniques de fabrication et le dépistage ont permis de rendre négligeable le risque d’allergie au latex. Le risque lié à l’exposition aux rayonnements ionisants est, quant à lui, mieux contrôlé du fait d’une réglementation très stricte en matière de radioprotection. L’activité anesthésique au bloc opératoire comporte des risques d’électrisation d’incendie et d’explosion. L’amélioration technique des dispositifs utilisés et l’éviction des produits les plus dangereux ont permis de diminuer ces risques. Non spécifiques de la pratique de l’anesthésie mais néanmoins inquiétants, deux nouveaux risques sont identifiés : la toxicomanie et l’épuisement professionnel ou burnout. Leur importance croissante est difficile à évaluer mais leurs conséquences pour les patients et les anesthésistes peuvent être particulièrement graves pouvant aller jusqu’au décès. Leur prévention, qui est mieux connue, repose sur le dépistage précoce par les membres de l’équipe, l’amélioration des conditions de travail et une meilleure reconnaissance professionnelle.Certains des risques professionnels liés à la pratique de l’anesthésie sont connus depuis plusieurs dizaines d’années et les moyens de prévention mis en œuvre permettent de diminuer leur incidence. Il s’agit de la toxicité des gaz anesthésiques, des accidents d’exposition au sang, de l’exposition aux rayonnements ionisants, de l’allergie au latex, de l’électrisation et du risque d’explosion au bloc opératoire. Deux risques prennent de plus en plus d’importance : la toxicomanie et l’épuisement professionnel. Le dépistage précoce, l’amélioration des conditions de travail et une meilleure reconnaissance professionnelle sont les meilleurs moyens de les prévenir.To evaluate the occupational hazards related to the practice of anaesthesia and to give the preventing measures related to these risks.The Medline data bank, the specialized reviews of Occupational medicine and the bank of data of the Regional Case Disease in “Île-de-France” were consulted. The key words employed separately or in combination were: anaesthesia, occupational hazards, anaesthetic gas, stress, working conditions, burnout, addiction, occupational blood exposure, latex allergy, ionizing radiation, electrocution, explosion.General reviews and original articles were selected. We also selected isolated clinical cases and letters to editor according to their relevance compared with the existing literature.After grouping the data according to the nature of the risk, the articles were analyzed for description, the analysis and the prevention of the risk.There are several occupational hazards related to the practice of anaesthesia. The toxicity of anaesthetic gases and particularly of nitrous oxide was highlighted at the beginning of their use. Most toxic gases were abandoned and the application of collective protection measures (system of evacuation of anaesthetic gas, ventilation of operating rooms, use of closed circuit for anaesthesia) made it possible to decrease considerably the risk related to inhalational anaesthesia. Occupational blood exposure also decreases thanks to a better observance of safety rules and the use of protected material. The risk of latex allergy has decreased considerably with the substitution of latex by other material. The risk related to the exposure to ionizing radiations is better controlled because very strict regulations have been implemented. The operating room environment involves risks of electrification, fire and explosion. New risks have been identified: drug-addiction and the painfulness of work or burnout. Their frequency is difficult to evaluate but they can have serious consequences for the patients and the anaesthetists. Their prevention relies on early tracking by the members of the team, the improvement of working conditions and a better professional recognition.Toxicity of anaesthetic gases, occupational blood exposure, exposure to ionizing radiations, latex allergy, electrification and the risk of explosion in the operating room are well identified professional risks of anaesthesia. Measures have been implemented to reduce their incidence. Two risks are increasingly recognized: drug-addiction and burnout. Early tracking, the improvement of working conditions and a better professional recognition are the best way to prevent them.

Identifier les facteurs de risque professionnels des troubles musculosquelettiques (TMS) des membres supérieurs chez les agents de La Poste.Entre 2008 et 2010, 45 médecins du travail ont recueilli, au cours d’une consultation de médecine du travail, des informations anonymes relatives à l’organisation et à l’environnement du travail de 703 postiers atteints de TMS. Un groupe de 466 référents indemnes de TMS a été constitué à partir des mêmes consultations médicales. Les variables relatives aux efforts physiques et aux facteurs psychosociaux ont été regroupées dans des scores.Un mauvais score biomécanique (OR = 4,3 ; IC à 95 % = [2,3–7,8]), un mauvais score psychosocial (OR = 3,5 ; IC à 95 % = [2,5–5,1]), le genre féminin (OR = 2,9 ; IC à 95 % = [2,2–4,0]), un âge de plus de 50 ans (OR = 3,0 ; IC à 95 % = [2,1–4,4]) sont les principaux facteurs de risque identifiés. Le travail de tri incluant le tri manuel, la manutention et le travail sur machine sont associés à un risque élevé de TMS ainsi que la distribution vélo et piétonne. Les atteintes de l’épaule sont plus fréquentes que celles du poignet et du coude.Cette étude descriptive permet d’explorer certains facteurs individuels et d’autres liés à l’organisation et à l’environnement du travail qui sont associés au risque de TMS. Une analyse étiologique de type cas–témoins mériterait d’être conduite pour tester ces hypothèses. Cependant, des pistes pour renforcer les actions de prévention sont d’ores et déjà définissables.To identify risk factors related to occupational musculoskeletal disorders of the upper limbs in the French Post office workers.Between 2008 and 2010, 45 occupational physicians gathered during consultation anonymous information relating to the organization and the working environment of 703 post office workers with musculoskeletal disorders. A control group of 466 workers free of musculoskeletal disorders was formed from the same medical consultations. Variables related to physical effort and psychosocial factors were grouped into scores.A bad biomechanical score (OR = 4.3, 95% CI = (2.3, 7.8), a poor psychosocial score (OR = 3.5, 95% CI = (2.5, 5.1)), female gender (OR = 2.9, 95% CI = (2.2, 4.0)), age over 50 years (OR = 3.0, 95% CI = (2.1, 4.4)) are the main risk factors identified. The sorting work including manual sorting, handling and working on machine are associated with high risk of MSDs as well as bicycle and pedestrian distribution. Shoulder lesions are more frequent than those of wrist and elbow.This descriptive study explores individual factors and others work-related organizational and environmental factors that are associated with the risk of MSDs. An etiological analysis of the case–control type should be conducted to test these hypotheses. However, ways to strengthen prevention efforts are already definable.

Objectives Increased risk of circulatory system diseases (CSDs) was observed in nuclear workers handling uranium and plutonium in Russia and the UK. This work examines the CSD mortality after chronic intake of uranium among 2897 workers (79 892 person-years) at a uranium processing plant (1960-2006) in France.Methods Cumulative exposure to different uranium compounds, classified by their isotopic composition and solubility type, was quantified on the basis of a plant-specific job-exposure matrix and individual job histories. HRs and associated 95% CI for CSD (n=111) and specific CSD categories were estimated using Cox regression models, stratified on sex and birth cohort and adjusted for potential confounders. The effect of smoking was analysed among 260 smokers (42 CSD deaths).Results Compared to unexposed workers, CSD mortality was increased among workers exposed to slowly soluble reprocessed uranium (RPU) (HR=2.13, 95% CI=0.96 to 4.70) and natural uranium (HR=1.73, 95% CI=1.11 to 2.69). The risk increased with cumulative exposure and exposure duration. In the subgroup of smokers, the risk estimates were higher but with larger CI=HR 1.91 (95% CI 0.92 to 3.98) for natural uranium and HR 4.78 (95% CI=1.38 to 16.50) for RPU.Conclusions The authors observed that exposure to slowly soluble uranium, namely RPU, may increase the risk of CSD mortality. However, these results are preliminary since the study is lacking statistical power and many other biological and lifestyle-related factors may cause CSD. More detailed investigations are necessary to confirm these findings and analyse in depth the effects of internal radiation exposure on the circulatory system.

Le volume, la nature des repas et, d'une manière plus générale, la prise alimentaire influencent la durée et la répartition des différentes phases du sommeil. Il existe une relation forte entre apports énergétiques et état de vigilance. Quel que soit le moment de la journée, la prise alimentaire se traduit par une baisse de la vigilance. Le rôle joué par le statut énergétique cellulaire dans ces relations est abordé dans le présent article ; de même sont évoquées les influences de quelques peptides périphériques (bombésine, leptine, insuline, ghréline) et de neuropeptides connus pour leur effet orexigène (orexines, neuropeptide Y). Parallèlement à l'apport énergétique total, certains macronutriments spécifiques ou composés alimentaires influent sur l'état de vigilance. C'est le cas des glucides, mais aussi des lipides, qui altèrent l'état de vigilance, ce qui conduit à conclure que tout apport alimentaire dont la composition s'éloigne de la norme altère l'état de veille. Les rôles joués par certains acides aminés comme le tryptophane ou la tyrosine sont précisés. L'importance de cette question est rappelée du fait que, dans nos sociétés, un parfait niveau de vigilance est requis, aussi bien aux postes de travail que pendant les loisirs, alors que statistiquement, la durée du sommeil diminue. En dehors de situations à haute dépense énergétique, il convient de préconiser la prise de repas de faible apport énergétique, qui ne seront ni enrichis en glucides ni en protéines. L'utilisation potentielle de la caféine afin de maintenir la vigilance dans les situations de privation de sommeil est rappelée.Both amount and content of meals, and more generally food intake affect sleep duration and its content. There is a strong relationship between energy intake and wakefulness, and previous studies showed that food ingestion per se increased objective signs of sleepiness. The role played by the cellular energy status is discussed in the present paper. Even, the effects of peptides produced either in peripheral tissues, such as bombesin, leptin, insulin, ghrelin, or at the central level such as orexins or neuropeptide Y are also reported in the present review. Moreover, some specific macronutrients or food constituents affect vigilance.Both carbohydraterich and fat-rich meals cause an enhancement in sleepiness in human. These findings led to suggest that subjects eating meals that differed greatly from standard food, either by increasing carbohydrate or fat, induced sleepiness. The role played by specific amino acids such as tryptophan or tyrosine is discussed. Sleep deprivation is a growing problem in our industrial societies and increased sleepiness related to shift and night work is also a major problem that needs to be taken into account for maintaining health. The prevention of nutritional conditions able to increase alterations in vigilance should be carefully considered. Excluding environmental conditions of high energy expenditure, the consumption of low caloric meals is recommended. These meals should provide standard quantities of macronutrients, except when subjects are very active ; under these conditions, high-carbohydrate meals are needed. The potential use of caffeine is specified, in order to increase walkefulness.