BACKGROUND:Underreporting of occupational diseases related to asbestos exposure remains a matter of concern in France. The aim of this study was to evaluate the number of claims for compensation for asbestos-related non-malignant pulmonary or pleural occupational disease in subjects having undergone a chest CT-scan in a multiregional screening programme. METHODS:Among the 5444 voluntary retired asbestos-exposed subjects recruited in four regions between 2003 and 2005 who had undergone a chest CT-scan, the number of claims for compensation for an asbestos-related pulmonary or pleural benign disease was analysed in 2006 and 2010. RESULTS:Following CT-scan screening, 17.2% of participants were acknowledged as presenting with an asbestos-related non-malignant occupational disease, essentially pleural plaques, by the French National Health Insurance fund. Underreporting decreased as duration of follow-up after CT-scan increased. Nevertheless, 4 years after CT-scan, underreporting was still as high as 36% for subjects identified as presenting with pleural plaques. Mean duration between the date of CT-scan and the date of recognition as occupational disease was 7.4 months, shorter in cases where screening was coordinated by specialized centres. CONCLUSION:A plan of action for an easier claiming process for compensation of asbestos-related diseases is desired. This could probably be obtained through improved sensitization of physicians engaged in the follow-up of asbestos-exposed subjects, and by standardization of the interpretation and reporting of asbestos-related abnormalities observed on chest CT-scans.

Purpose of the study. It has already been emphasized that occupational cancers are underreported in France. A study was conducted in the Ile-de-France region on bladder cancer cases and sinonasal cancers aiming to evaluate the frequency of exposure to occupational carcinogens, to identify related sectors of activity and to facilitate compensation as occupational diseases (OD) and finalize a routine tool for the identification of relevant occupational exposures.Method. All incident cases of sinonasal cancer living in Ile-de-France and bladder cancer in workers living in three districts of Ile-de-France fully covered by social insurance as long-term diseases between 2005 and 2007 were eligible. Volunteer subjects answered a detailed occupational questionnaire. Evaluation of exposure to aromatic amines and polycyclic aromatic hydrocarbons was performed by two experts in occupational diseases, with information returned to the usual doctor, and suggestion of claim for compensation as OD when appropriate. The number of claims for OD and/or compensation as OD was studied.Results. Among 1162 eligible cases of bladder cancer, 58% volunteered to participate. Claim for compensation as OD was proposed to 7% of the subjects, but only 22% of them did. Among 151 eligible cases of sinonasal cancer, 48% participated. Claim for compensation as OD was proposed to 35% of the subjects and only 53% of them did. All claims for compensation as OD were accepted.Conclusion. A substantial fraction of patients with bladder cancer or sinonasal cancer could claim for compensation as OD in this series, but few of them did. As individual and collective medico-social issues of compensation for OD are important, information of physicians and patients should be reinforced. Moreover, systematic identification of occupational exposure should be proposed to incident cases of bladder or sinonasal cancer cases. (c) 2012 Elsevier Masson SAS. All rights reserved.

Background It is uncertain whether isolated pleural plaques cause functional impairment.Objective To analyse the relationship between isolated pleural plaques confirmed by CT scanning and lung function in subjects with occupational exposure to asbestos.Methods The study population consisted of 2743 subjects presenting with no parenchymal interstitial abnormalities on the high-resolution CT (HRCT) scan. Asbestos exposure was evaluated by calculation of an individual cumulative exposure index (CEI). Each subject underwent pulmonary function tests (PFTs) and HRCT scanning. Variables were adjusted for age, smoking status, body mass index, CEI to asbestos and the centres in which the pulmonary function tests were conducted.Results All functional parameters studied were within normal limits for subjects presenting with isolated pleural plaques and for those presenting with no pleuropulmonary abnormalities. However, isolated parietal and/or diaphragmatic pleural plaques were associated with a significant decrease in total lung capacity (TLC) (98.1% predicted in subjects with pleural plaques vs 101.2% in subjects free of plaques, p=0.0494), forced vital capacity (FVC) (96.6% vs 100.4%, p<0.001) and forced expiratory volume in 1 s (FEV1) (97.9% vs 101.9%, p=0.0032). In contrast, no significant relationship was observed between pleural plaques and FEV1/FVC ratio, forced expiratory flow at 25-75% FVC and residual volume. A significant correlation was found between the extent of pleural plaques and the reduction in FVC and TLC, whereas plaque thickness was not related to functional impairment.Conclusions The results show a relationship between isolated parietal and/or diaphragmatic pleural plaques and a trend towards a restrictive pattern, although the observed decrease in FVC and TLC is unlikely to be of real clinical relevance for the majority of subjects in this series.

Notre étude cible en priorité, mais pas exclusivement, les grandes, moyennes et petites entreprises marocaines afin de recueillir des informations sur leurs engagements face au concept de développement durable, en prenant en compte le système de management de la santé et sécurité au travail comme base de cette démarche de développement.Notre travail a été élaboré sur la base d’un questionnaire conçu par l’Association pour les pratiques de développement durable (l’APDD) et adapté au contexte marocain. Il comporte 23 items regroupés en quatre rubriques : stratégie d’entreprise, actions de l’entreprise, relations de l’entreprise avec ses partenaires extérieurs, informations et formation. Pour bien assimiler ce concept, une présentation de la définition de développement durable selon le rapport de Brundtland a été jointe en annexe au questionnaire.Le taux de réponse de l’enquête a atteint 75,4 %, sur un échantillon de 203 entreprises. Les résultats ont été analysés sous deux angles selon la taille de l’entreprise et selon leurs activités. Les résultats ont montré que la fonction de santé et sécurité au travail est souvent (69,3 %) rattachée à la direction des ressources humaines, ce qui exige une interaction technique et organisationnelle entre les directions de la santé et sécurité au travail et les ressources humaines.Il y a une forte implication des entreprises marocaines en santé et sécurité au travail. Cependant, les réponses montrent que la santé et sécurité au travail sont souvent confiées à un directeur des ressources humaines, ce qui exige des formations complémentaires afin de développer leurs habiletés techniques et organisationnelles dans ce domaine. Cette enquête permet de décrire les points où les différences sont les plus marquées entre petites, moyennes et grandes entreprises.The study focuses primarily but not exclusively on Moroccan big, medium and small companies in order to collect information about their engagements in sustainable development by considering the occupational Health and Safety management system as a basis for this development approach.Our work was developed on the basis of a questionnaire designed by the Association for the practice of sustainable development and adapted to the Moroccan context. This questionnaire includes 23 items grouped under four headings: company's strategy, company's corporate relations with external partners, information and training. For a better assimilation of this concept, a definition of sustainable development according to the Brundtland report was attached as an appendix to the questionnaire.The response rate of the survey reached 75.4%, with a sample of 203 companies. The results were analyzed in two ways: distinguishing between small and medium companies, with less than 250 employees, and big companies with more than 250 employees; separating companies according to their activities. Analysis of the results showed that the occupational health and safety function is often (69.3%) attached to the Human Resources Department. This requires technical and organizational interaction between the occupational health and safety and the human resources managers.There is a strong involvement of Moroccan companies in occupational health and safety. However, the occupational health and safety function is often entrusted to a human resources manager, which requires additional training to develop his technical and organizational skills in this area. This survey describes the points where the differences are the greatest between small, medium and large companies.

Background: Relationships between parietal pleural plaques and lung function impairment still remain controversial. Aims: This study analyses the relationships between isolated pleural plaques and lung function, among subjects occupationally exposed to asbestos. Methods: The study population consisted of 2,743 subjects included in a large-scale pilot screening program for asbestos-related diseases in four regions of France between 2003 and 2005. All had been occupationally exposed to asbestos, and were free of interstitial disease on high resolution chest computed tomography (HRCT). The asbestos exposure was assessed with calculation of an individual cumulative exposure index (CEI) taking into account all job periods for each subject. Each included subject benefited from pulmonary function tests (PFT) and HRCT was interpreted by a panel of expert radiologists in thoracic imaging. In both univariate and multivariate analysis, variables were adjusted on tobacco status, body mass index (BMI), CEI to asbestos and the center where PFT were made. Results: Isolated pleural plaques were associated with a significant decrease of TLC (p=0.049), FVC (p=0.001) and FEV1 (p=0.003). On the other hand, no significant relationship was observed between pleural plaques and FEV1/FVC ratio, FEF25-75% and RV. A significant correlation was found between the extent of pleural plaques and the reduction of FVC (p trend=0.0089) and TLC (p trend=0.0046). By contrast, thickness of pleural plaques was not related to any functional impairment. Conclusions: Our results are in favor of a relationship between isolated parietal and/or dipahragmatic pleural plaques and a trend to restrictive pattern.

Aim of the study. Bladder cancer is the second most common occupational cancer, associated with past exposure to polycyclic aromatic hydrocarbons (PAHs) and aromatic amines. However, workplace exposure screening is very difficult. The main goal of this study was to offer a screening tasks questionnaire to evaluate occupational exposure to bladder carcinogens.Method. Thanks to the works presented at the Institut National de Recherche et de Securite (INRS) symposium "How to finish with bladder cancer" in 2007, we selected exposure tasks according to frequency and intensity specifications. Exposure levels, based on metrology data, took into account exposure duration and probability of exposure to aromatic amines.Results. Forty-three questions have been considered: five related to potential occupational exposure to aromatic amines, 38 to polycyclic hydrocarbons. Exposure to aromatic amines has been reported, in a number of industries, including dyestuff, rubber and pesticide manufactures, plastics manufacturing and research sectors, or pharmaceutical industry. Exposure to PAH mixtures have been reported in several industries and occupations, including aluminium produc-Lion (mainly when the Soderberg process is used), coke production, iron and steel foundries, coal tar and related products and chimney sweeps.Discussion. This questionnaire is a screening tool to evaluate past occupational exposure, which could be used for post-exposure follow-up care. However, this questionnaire is not exhaustive.Conclusion. This screening tasks questionnaire can help occupational physicians to evaluate occupational exposure to bladder carcinogens. (C) 2011 Published by Elsevier Masson SAS.

Occupational exposure to polycyclic aromatic hydrocarbons (PAH) is associated with an increased risk of urothelial carcinoma (UC). FGFR3 is found mutated in about 70% of Ta tumors, which represent the major group at diagnosis. The influence of PAH on FGFR3 mutations and whether it is related to the emergence or shaping of these mutations is not yet known. We investigated the influence of occupational PAH on the frequency and spectrum of FGFR3 mutations. We included on 170 primary urothelial tumors from five hospitals from France. Patients (median age, 64 yr) were interviewed to gather data on occupational exposure to PAH, revealing 104 non- and possibly PAH exposed patients, 66 probably and definitely exposed patients. Tumors were classified as follows: 75 pTa, 52 pT1, and 43 >= pT2. Tumor grades were as follows: 6 low malignant potential neoplasms (LMPN) and 41 low-grade and 123 high-grade carcinomas. The SnaPshot method was used to screen for the following FGFR3 mutations: R248C, S249C, G372C, Y375C, A393E, K652E, K652Q, K652M, and K652T. Occupational PAH exposure was not associated with a particular stage or grade of tumors. Thirty-nine percent of the tumors harbored FGFR3 mutations. After adjustment for smoking, occupational exposure to PAH did not influence the frequency [OR, 1.101 95% CI, 0.78-1.52], or spectrum of FGFR3 mutations. Occupational exposure to PAH influenced neither the frequency nor the spectrum of FGFR3 mutations and there was no direct relationship between these mutations and this occupational hazard. (C) 2009 Wiley-Liss, Inc.

RATIONALE:Whether occupational exposure to asbestos causes airway obstruction remains controversial.OBJECTIVES:This study evaluated lung function in relation to cumulative exposure to asbestos in a large cohort of retired or unemployed workers exposed to asbestos.METHODS:The study population consisted of 3,660 volunteer subjects. An individual cumulative exposure index to asbestos was calculated for each subject, and information was obtained on smoking status. Pulmonary function tests were performed in all subjects; high-resolution chest computed tomography was also performed in 3,335 subjects.MEASUREMENTS AND MAIN RESULTS:Values of FEV(1)/FVC and FEF(25-75%) did not differ between five classes (quintiles) of cumulative exposure to asbestos, and no significant correlation was observed between cumulative exposure to asbestos and pulmonary function parameters, after adjustment for sex, tobacco consumption, emphysema, and body mass index. Furthermore, the proportion of abnormal pulmonary function tests did not differ between the five classes of cumulative exposure to asbestos.CONCLUSIONS:The results do not support a causal relationship between asbestos exposure alone and airway obstruction. However, the study sample may not be representative of all people occupationally exposed to asbestos, because a fraction of subjects with previously diagnosed asbestosis probably did not participate in this screening program.

Idiopathic Environmental Intolerance (Multiple Chemical Sensitivity) "Idiopathic environmental intolerance" has become the universally accepted terminology for a syndrome that has been referred to by various names, the most common of which was "multiple chemical sensitivity". This syndrome frequently but not necessarily links a highly varied collection of symptoms with an olfactory perception in the general or occupational environment of chemicals considered noxious by patients. This ailment is mainly studied in Western countries, where its prevalence varies quite substantially. Numerous and diverse etiopathogenic theories have been proposed, some suggesting a toxic cause (immunotoxic or neurotoxic mechanisms, etc.), others suggesting a psychopathological origin akin to those of psychosomatic diseases. Whatever the cause, this syndrome has highly negative repercussions on patients' personal and professional lives. This impact can be reduced through a medical approach that takes the patient's complaints into account, limits additional testing and workups to what is necessary to rule out other diagnoses, and aims at striking the best possible balance between banning suspected chemicals and preserving occupational and social activities.

Introduction. Idiopathic environmental intolerance (IEI) or multiple chemical sensitivity (MCS) is "a chronic disorder that is characterized by multiple subjective symptoms linked to acute or chronic exposure to environmental stimuli that are harmless for he general population, and presents no objective clinical anomaly". The prevalence of IEI in the USA has been estimated to stand between I and 4%. In France., this syndrome remains little known, with a lack of epidemiological data since no universally accepted diagnostic tool exists in our language. Yet such tools do exist in English, for instance the diagnostic criteria defined in 1999 by the consensus conference of the American College of Occupational and Environmental Medicine, and two English-language validated questionnaires: the Quick Environmental Exposure and Sensitivity Index (QEESI(C)) and the Chemical Odor Sensitivity Scale (COSS).Purpose. To provide a French translation of the QEESI(C).Method. With the permission and under the supervision of Professor C.S. Miller, the author of the original questionnaire, we have translated the QEESI(C) into French. Our translation, which has been approved after reverse translation, will therefore be available to French-speaking patients.Result. The French version of the QEESI(C) is now available for download on http://www.drclaudiamiller.com.Conclusion. This French version will now he submitted to a quantitative assessment in order to ensure that the translated questionnaire has retained its psychometric qualities: reliability, consistency and stability over time. The QEESI(C) can serve several purposes: (1) in a clinical setting, it may be used to evaluate IEI patients' self-reported environmental intolerances and symptoms, or to document responses to treatment. It may also help occupational physicians for workplace investigations in case of acute accidental exposures initiating mass psychogenic illness; (2) in a research setting, it can be used to select cases and controls, or to evaluate therapeutic proposals. (C) 2010 Elsevier Masson SAS. All rights reserved.

Most studies on asbestos-related diseases are based on chest radiographs, and dose-response relationships are still controversial. The aim of this study was to describe the most relevant parameters of asbestos exposure linked to pleural plaques and asbestosis diagnosed by high-resolution computed tomography (HRCT). A large screening programme including systematic HRCT examinations was organised from 2003 to 2005 in France for formerly asbestos-exposed workers. The time since first exposure (TSFE), level, duration and cumulative exposure to asbestos were used in adjusted unconditional logistic regression to model the relationships of the two diseases. Analysis of a population of 5,545 subjects demonstrated that TSFE (p<0.0001) and cumulative exposure (p = 0.02) (or level, depending on the models used), were independently associated with the frequency of pleural plaques. Only cumulative exposure (p<0.0001) or level of exposure (p = 0.02) were significantly associated with asbestosis. All trend tests were significant for these parameters. To date and to our knowledge, this study is the largest programme based on HRCT for the screening of asbestos-exposed subjects. Both time-response and dose-response relationships were demonstrated for pleural plaques, while only dose-response relationships were demonstrated for asbestosis. These parameters must be included in the definition of high-risk populations for HRCT-based screening programmes.

Aim of the study. The aim of this study is to evaluate benzene exposure (contained in gasoline) among service station attendants, Load tanker drivers and terminal staff.Methods. Two follow-up studies have been designed, 158 workers among 24 service stations and eight depots (n = 8) front representative French oil companies were selected for the first study, 74. workers among three depots for the second. Benzene exposure assessment was carried out for every worker by means of benzene vapour sampling device measuring atmospheric benzene concentration and by urinary trans,trans-muconic acid (t,t-MA) determination. Workplace and job description were clearly defined for each subject, as well as tobacco consumption and exposure incidents.Results. In the first study, atmospheric samples (146 performed) and urinary t,t-MA tests (154 end of shift) were collected among 158 selected subjects. For service station attendants, 109 atmospheric benzene samples were valid and 97 (81%) resulted in values below the quantification limit (QL = 0.07 mg/m(3)) (median < 0.07 mg/m(3) range: < 0.07-0.33 mg/m(3)). Eighty-five (75%) out of 114, end-of-shift urine t,t-MA samples resulted in values below the detection limit (DL = 0.02 mg/l). The median was below detection limit, with values ranging between 0.10-3.2 mg/l. In depots, 39 atmospheric benzene samples were suitable for analysis: the geometric average concentration of airborne benzene was 0.16 mg/m(3) and the median reached 0.15 mg/m(3)(range: < 0.07-0.43 mg/m(3)). Thirty-four out of 40 t,t-MA tests (85%) were under the DL. The median was below the DL with values ranging between less than 0.02 to 0.42 mg/l. In the second study, 74. workers were included, 73 atmospheric samples were analysed as well as 64 urinary samples. The airborne benzene geometric average exposure for tanker drivers was 0.15 mg/m(3) (range: 0.04-1.68 mg/m(3)). For depot staff according to the task carried out these values were 0.05 mg/m(3) (range: < QL-0.43 mg/m(3)), 0.27 mg/m(3) (range: 0.22-0.32 mg/m(3)) and below QL for generic tasks, rail car unloading and barge unloading respectively.Conclusion. For most studied workers, the exposure level was below QL of monitoring and biomonitoring methods used. Under normal work conditions, the average exposure level of service station and depot staff is indeed lower than 10% of the occupational exposure limit. These are therefore jobs with low benzene exposure levels. The occupational physician should adapt his medical surveillance related to this chemical risk according to the identification of past or current benzene exposing tasks and should take into account the occurrence of possible exposure incidents. (C) 2009 Published by Elsevier Masson SAS.

Objectives. The identification of the common core competencies required for future occupational physicians have been the subject of several publications in Europe, Australiasia or in the United States within this last decade. Nevertheless, the requirement to take into account the needs of customer have usually not been met. Therefore, we used a focus group approach to make appropriate and consensual recommendations for a new curriculum.Material and methods. A first list of competencies (divided into knowledge, experience and competence) was derived from the aforementioned works. This list was then submitted to occupational physicians, postgraduate students in occupational medicine, employers, trade union representatives and directors of occupational health services during six focus group sessions. Participants were asked to react on the initial list and to rate the items in terms of importance for the curriculum. A final list of competencies was therefore established, including the contributions of all participants.Results. All participants appreciated the method used and to be consulted on this future curriculum. All the established competency areas of occupational physicians were regarded as important by the stakeholders and a broad consensus was obtained about the required competencies of occupational physicians among the different subgroups of the study population. Among the items of the initial list, 34 items were modified or deleted and more emphasis was given on psychosocial risks. The final list included 219 items.Discussion. This focus group approach provided useful insights in the definition of the common core competencies required for future occupational physicians in France and allowed us to elaborate a consensual curriculum. This new curriculum is on the way to be implemented in France, in all the medical faculties involved in postgraduate training in occupational medicine. Nevertheless, when considering the amount of knowledge that is to be acquired by students, the topics of breadth and depth and of initial versus continuing education should be addressed. (C) 2008 Elsevier Masson SAS. All rights reserved.

Aim of the study. Medium-density fiberboard (MDF) is a board manufactured from wood fibers bound together with a synthetic resin adhesive. Given the emission of wood dust considered thinner, the release of chemical compounds, such as formaldehyde from the adhesives, the important progression of the market of this product and knowing that wood dust and formaldehyde are classified by the IARC as groupe 1 carcinogens for ethmoidal cancer and nasopharyngeal cancer, respectively, the question asked is that of the appearance of new occupational pathologies, concerning, in particular, the bronchopulmonary system. The aim of this article is to determine the occupational-toxicological effects of MDF on health.Method. The method is based on literature analysis and proposes a synthesis of the Current data on the medical effects related to occupational exposure to MDF wood dust.Conclusion. The available data on human toxicity attributable to MDF consist mainly of upper airway and skin irritation and allergy natures of the superior airways and skin. No link of causality could be established for other cancerous localizations, in particular pulmonary. (c) 2008 Elsevier Masson SAS. All rights reserved.

Le déficit des habiletés sociales est une problématique centrale du fonctionnement adaptatif des enfants ayant un trouble du déficit de l’attention avec hyperactivité (TDAH). Cet article propose une synthèse narrative de l’état des connaissances actuelles concernant la description des difficultés sociales, leurs impacts sur le statut social et les relations d’amitié chez les enfants ayant un TDAH. Il présente les facteurs modérateurs et médiateurs de la trajectoire développementale de ces difficultés en exposant les limites de la littérature actuelle. Les perspectives d’intervention sont abordées sous l’angle de l’efficacité des composantes des programmes répertoriés et des cibles d’intervention étudiées. Selon ces perspectives, il est notamment recommandé d’offrir un programme d’entraînement aux habiletés sociales qui tiennent compte de la nature des difficultés de l’enfant ayant un TDAH. De plus, les activités de mise à niveau des connaissances devraient être en concordance avec les besoins de ces enfants. Afin de favoriser les transferts des apprentissages, la mise en pratique devrait se réaliser dans des contextes variés et dans les milieux naturels des enfants. Finalement, les agents naturels sont perçus comme les vecteurs principaux de la généralisation des comportements et de la transformation du contexte social dans lequel évolue l’enfant.Social skills deficit is a central issue in adaptive functioning of children with attention deficit hyperactivity disorder (ADHD).This article is a narrative summary based on a review of the international literature, French and English, regarding social skills of children with ADHD. The definition of ADHD is derived from DSM-5 terminology.This article provides current state of knowledge of social problems in children with a ADHD and their impact on social status and friendship as well as moderating and mediator factors affecting the developmental trajectory of these difficulties. The efficiency of the social skills training programs are discussed in regard to their modalities and targets.Although some limitations exist in current researches, social skills of children with ADHD could be improved under some conditions. It is notably preferable to offer social skills training programs that take into account the particular nature of their perceived difficulties. Refresher training courses should be developed in accordance with these children's learning needs. In order to optimise children's acquisition of taught social skills, activities should be carried out in their natural environment and in various contexts. Finally, caregivers are perceived as the main agents of change in these children's behaviour modification and social context transformation.

OBJECTIVE: To assess the frequency of computed tomography (CT) scan pleural and interstitial changes in a population of urban transportation workers with low cumulative exposure to asbestos, and to measure inter-reader agreement.DESIGN: A total of 269 male volunteers (mean age 54.0 +/- 2.3 years, mean estimated cumulative exposure index 1.7 +/- 2.3 fibres/ml-years), underwent a CT scan which was read independently by three experienced readers, with further consensus reading in case of pleural or parenchymal abnormalities. Inter-reader agreement was assessed by means of Kappa statistic.RESULTS: On consensus reading, four subjects had interstitial opacities, three had diffuse pleural thickening and 26 (9.7%) had pleural plaques that were unilateral in 65% of cases and <= 2 min thick in 54% of cases. No correlation was observed between pleural plaques and latency, duration of exposure or cumulative exposure. The inter-reader agreement for the detection of pleural abnormalities was fair.CONCLUSION: In this relatively young population with low cumulative exposure to asbestos, the prevalence of pleural abnormalities was low. These abnormalities were very limited in thickness and extent, leading to marked inter-reader variability and making it difficult to assess their relationship to asbestos exposure.