Background: Primary care teams (PCTs) are recognised to improve the quality of care. However, few studies have examined which PCT composition best meets patients' primary care (PC) needs. Aim: To describe the composition of PCTs in 11 Western countries and investigate potential associations with GPs' opinions about their practice's ability to manage patients with chronic conditions and communicate with caregivers. Design & setting: A secondary analysis of the data from 11 Western countries that participated in the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians was conducted. Method: A hierarchical clustering algorithm was used to characterise different types of PCT according to the composition of the healthcare professionals (HCPs) making them up, in addition to GPs. Associations between practice types and two GP-reported indicators were subsequently assessed: their practice's coordination with social services (SS) and other community providers (CPs); and ability to manage patients with chronic conditions. Results: Overall, 13 200 responses were analysed. Five types of PCT were characterised (traditional, multidisciplinary, nurse-centred, psychologist-centred, and physiotherapist-centred). The traditional type represented 51.6% of all PCTs; they were mainly composed of moderate percentages of all the HCPs. The multidisciplinary type (11.9%) were composed of high percentages of the different HCPs. After controlling for country, the multidisciplinary type reported better coordination with SS and CPs than did traditional ones (odds ratio 0.39, 95% confidence interval = 0.29 to 0.53). Conclusion: Multidisciplinary PCTs reported better outcomes than traditional ones regarding their coordination with SS and CPs, and perceived ability to manage patients with chronic conditions. These results should encourage governmental efforts to promote PC that uses multidisciplinary PCTs.

The micronucleus (MN) assay in buccal cells is a widely used, non-invasive biomarker for detecting genotoxic effects in human populations. However, its application in assessing dose-response relationships to particulate matter exposure remains limited. Our aim was to evaluate the association between MN frequency in exfoliated buccal cells and exposure to subway particulate matter among Parisian subway workers. We also investigated whether MN frequency was associated with biomarkers of oxidative stress and metabolism-related effects. We recruited 303 subway workers and collected their buccal cell samples. Concentrations of metals in urine and exhaled breath condensate were quantified using inductively coupled plasma mass spectrometry, and effect biomarkers were analyzed via liquid chromatography-mass spectrometry. Factor analyses were used to characterize metal mixtures and oxidative stress profiles. Associations with MN frequency were assessed using multivariable Poisson regression models adjusted for confounders. Despite that all 269 workers who provided buccal cell samples had low exposures, urinary titanium concentrations were significantly associated with increased MN frequency (RR = 2.013, p = 0.004). Furthermore, oxidative stress constituting mainly of urinary malondialdehyde and 8-hydroxy-2 '-deoxyguanosine showed a statistically significant association with increased MN frequency in buccal cells (RR = 1.214, p = 0.045). Women exhibited a significantly lower MN frequency in buccal cells compared to men. No statistically significant associations were found with PM10 air concentrations nor employment duration. Urinary titanium concentrations and oxidative stress biomarkers were significantly associated with MN frequency in buccal cells, suggesting that MN frequency may reflect systemic biological effects even in low-exposure settings.

BackgroundOccupational exposures can endanger the health of pregnant workers and their unborn children. The Department of Occupational and Environmental Health of Unisanté has established a specialized occupational health consultation to assist pregnant workers, employers and gynecologists in implementing maternity protection provisions in the workplace.ObjectiveThe study aims to assess the satisfaction of the users of the consultation, describe their overall experience and identify the benefits and limitations of the consultation.MethodsA mixed-methods approach was used. A telephone questionnaire with both closed and open-ended questions was administered to pregnant workers who had attended the consultation in 2021, as well as to their employers and gynecologists. Quantitative data on users' satisfaction were statistically analyzed using STATA 17, while responses to open-ended questions were thematically analyzed using MAXQDA20.ResultsAll users expressed high levels of satisfaction: 95% of pregnant workers, 88% of employers and 97% of gynecologists were satisfied with the consultation. Users highlighted the value of the consultation in providing insight into the legal framework and occupational risks, as well as the neutrality and support of occupational health physicians. However, they reported challenges in implementing recommended measures and ineffective monitoring of their application.ConclusionsThe study indicates that users are highly satisfied with the services provided by the consultation. It is recommended that these services be maintained and extended to other regions of Switzerland, with particular attention to pregnant women who do not have access to such services in their company.

Air pollution, a major global issue, comprises various solid and gaseous pollutants in urban environments, including particulate matter (PM) and volatile organic compounds (VOCs). Benzene, toluene, ethylbenzene, and isomeric xylenes (BTEX) constitute about 80% of VOC emissions, primarily from vehicle exhaust, tobacco smoke, petrol, paints, adhesives, and solvents, posing significant health risks including carcinogenic effects. Here we explore the impact of exposure to various measured air pollutants (NO2, O3, PM10, PM2.5, PAHs, and BTEX) on DNA damage among residents (N = 60) of Zagreb, Croatia during the colder part of the year due to anticipated higher pollutant levels. This was done by evaluating primary DNA damage using the comet assay and associating it to measured air pollutants and to blood values of BTEX as a biomarker of exposure. Measured DNA damage was also associated with additional lifestyle factors and sociodemographic data. Statistically significant positive correlations between % tail DNA and air pollutants were observed only for daily average for pyrene, measured one day prior to blood sampling. Passive smokers showed significantly higher DNA damage levels compared to non-smokers. The study emphasizes the importance of evaluating cumulative environmental exposures and their health effects, consistent with the exposome concept. Despite improvements in air quality across Europe, urban pollution levels remain hazardous, necessitating robust public health interventions to mitigate long-term health risks.

BACKGROUND:Phthalate exposures might alter male reproductive health, but human evidence remains limited and inconsistent. Occupational settings often involve consistently high exposures from known sources, providing a basis for developing risk reduction strategies and interventions. OBJECTIVES:Evaluate dose-response relationships between phthalate exposures in professional printers (urinary metabolites) and male reproductive hormones, which were examined twice in one working week for workweek values (mean) and within-week changes, (ratio) responses. METHODS:Occupational biomonitoring of 59 male printers was used to assess exposures to 18 phthalates by measuring 35 urinary phthalate metabolites. Blood samples collected on the first and last day of the workweek were analyzed for total testosterone, calculated free testosterone (cFT), bioavailable testosterone (BioT), measured free testosterone, sex hormone-binding globulin (SHBG), luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol (E2), and inhibin B (INHB). Multiple covariate-adjusted linear regressions were used to evaluate the dose-response relationship. RESULTS:cFT hormonal workweek response was negatively associated with di-n-butyl phthalate (DnBP) metabolites while SHBG was positively associated with di-ethyl-hexyl phthalate (DEHP) metabolites. BioT and E2 within-week responses were negatively associated with the DiBP metabolite mono-2-hydroxy-isobutyl phthalate (2OH-MiBP). Overall, ten low-molecular-weight phthalate metabolite concentrations were positively associated with INHB, while eight high-molecular-weight phthalate metabolite concentrations were negatively associated with FSH. Occupational exposure to these phthalates was elevated, as median concentrations of their metabolites were between 2- to 7-fold higher than general population levels. CONCLUSIONS:Occupational exposures to certain phthalates in professional printers were associated with hormonal patterns, indicative of anti-androgenic reproductive disturbance and potential alteration of the HPG axis.

Propylene glycol ethers (PGEs) consist of a major α-isomer (secondary alcohol group) and a minor β-isomer (primary alcohol group). Animal studies have reported toxic effects of the β-isomer metabolites, but human metabolism of PGEs remains poorly understood. We aimed to characterize the metabolism of two common PGEs in humans. Nine participants were exposed under controlled conditions (4 h) to propylene glycol ethyl ether (PGEE) or propylene glycol propyl ether (PGPE) (<35 ppm). Blood and urine samples were collected, and the respective β-isomers metabolites; 2-ethoxypropanoic acid (2-EPA) and 2-propoxypropanoic acid (2-PPA) were quantified. The 2-PPA blood absorption rate was 0.0005 ± 0.0002 µg/mL/h*ppm followed by rapid urinary elimination (half-life: 2 h) and slower secondary elimination (half-life: 10 h). No dose-response was observed for 2-EPA; therefore, β-PGEE metabolism was investigated in vitro using human liver S9 fractions. We provide 2-EPA hepatic kinetic and enzyme kinetic parameters. We recommend using of 2-PPA as a biomarker for PGPE exposures.

Organic solvents such as propylene glycol ethers (PGEs) represents more than 20 different substances and are incorporated in thousands of commercial and professional products. Two PGEs commonly used in Europe and found mainly in cleaning and water-based paint products are propylene glycol ethyl ether (PGEE) and propylene glycol propyl ether (PGPE). Given their volatile properties, inhalation is the most common route of exposure. The aim of this study was to characterize human toxicokinetics following PGEE and PGPE inhalation exposure. The participants were exposed (4 h) at rest to a single PGE (between 15 and 35 ppm) under controlled conditions and blood, urine, and exhaled breath were collected. Our study shows that both PGEs were rapidly detected in blood (absorption rate: 0.01 µg/mL/h*ppm) and elimination was more important through urine (half-life: 1 h) than exhaled breath (half-life: 2 min). We also evaluated the impact of a moderate physical activity (30 min, 100 W) during exposure. A significant increase of blood absorption (absorption rate: 0.03 µg/mL/h*ppm) and internal dose (increase of 48

BACKGROUND:Male reproductive decline has been linked to phthalate exposure. Di-butyl phthalate isomers (DnBP and DiBP) are endocrine disruptors with inconsistent evidence regarding effects on the hypothalamic-pituitary-gonadal/thyroid (HPG/T) axis. OBJECTIVE:To perform a dose-response meta-analysis of associations between DnBP and DiBP exposure and HPG/T-axis hormones. METHODS:Five databases were searched. The associations between urinary DBP metabolite concentrations (mono-n-butyl phthalate [MnBP], mono-iso-butyl phthalate [MiBP], or nonspecific DBP metabolites [∑DBPm]) and hormone levels (TT, fT, SHBG, LH, FSH, E2, INHB, and TSH) were analyzed using meta-regressions (unadjusted [UA], covariate-adjusted [CA], fertility-adjusted [FA]). RESULTS:From 10,410 records, 19 studies (N = 12,128) were considered. MiBP was negatively correlated with LH (UA: β=-0.117, p = 0.02; CA: β=-0.094, p = 0.012; FA: β=-0.125, p = 0.009), positively with E2 (CA: β=0.084, p = 0.045), and SHBG (CA: β=0.09, p = 0.034; FA: β=0.091, p = 0.015). MnBP was positively associated with TSH (UA: β=0.152, p = 0.001; CA: β=0.188, p = 0.006). CONCLUSIONS:DBP-isomers exposure is associated with altered HPG/T-axis hormone levels.

More than eight million premature deaths annually can be attributed to air pollution, with 99% of the world’s population residing in areas below recommended air quality standards. Hence, the present study aimed to examine the association between primary DNA damage and air pollution data among 123 participants enrolled between 2011 and 2015 in Zagreb, Croatia. While most measured air pollutants adhered to regulatory limits, benzo[a]pyrene concentrations bound to PM10 exceeded them. Factorial analysis narrowed down air pollution data to four exposure factors (particulate matter, two metal factors, and other pollutants). Despite the absence of significant positive associations between modeled air pollution exposure factors and comet assay descriptors (tail length, tail intensity, tail moment, and highly damaged nuclei), the critical health implications of air pollution warrant further investigations, particularly with biomarkers of exposure and different biomarkers of effect in populations facing air pollution exposure.

Introduction Daily exposition to ether glycols is common. Caretakers using cleaning products are critically exposed by combining physical activity with exposition to highly concentrated products. Previous animal studies showed hemato-, respiratory and autonomic nervous system toxicity amongst others. Yet, no controlled study explored the combination of an exposition to glycol ethers with physical activity in humans. Methods 30 young healthy participants were exposed a control condition (ambient air) and to one of three vaporized glycol ethers: propylene glycol n-propyl ether (PGPE, 25 ppm, n = 10) or propylene glycol ethyl ether (PGEE, 35 ppm, n = 10) or propylene glycol monomethyl ether (PGME, 35 ppm, n = 10) in a single-blind cross-over design. They performed an orthostatic test (5-min supine, 5-min standing) and a 6-min steady-state exercise at 1.5 W/kg followed by 10-min recovery in PGPE/PGEE conditions. In addition, an incremental exercise to exhaustion followed in PGME condition. Heart rate variability (HRV) was measured throughout the protocol, Heart rate recovery (HRR) was assessed during the 10-min recovery post steady-state exercise. Root-mean-square of the successive differences (RMSSD), power spectrum of the low- (LF) and high-frequency (HF) bands, tau, amplitude and T30 were computed for HRR. Near Infrared spectroscopy (NIRS) and cardiac output (using thoracic impedance) were measured for PGME exposition. PO2, PCO2 and pH were measured regularly via arterialized and venous blood sampling. Results Resting values of supine LF (1,180 ± 851 vs. 2,993 ± 2,259 ms2) and standing RMSSD (32 ± 17 vs. 41 ± 17 ms) increased under PGEE. Supine and standing HR decreased under PGPE (65.5 ± 4.8 vs. 61.3 ± 6.9 and 83.8 ± 7.0 vs. 76.1 ± 10.0 bpm) whereas standing RMSSD (26.6 ± 10.0 vs. 37.0 ± 14.9 ms) and LF (825 ± 474 vs. 2,028 ± 1,471 ms2) increased. Parasympathetic reactivation (e.g., RMSSD, LF and HF) was increased post-exercise under exposition to all three glycol ethers. In addition, amplitude significantly increased when exposed to PGEE. However, unexpectedly, HRR was neither slowed nor speeded. Finally, no differences were observed in any NIRS variables or cardiac output. Accordingly, the modelled muscle oxygen diffusion coefficient was not modified between any solvent conditions. Arterialized blood pH (7.35 ± .06 vs. 7.39 ± .04) and PaCO2 (34.1 ± 5.0 vs. 35.7 ± 4.3 mmHg) increased whilst PaO2 (81.8 ± 9.7 vs. 77.9 ± 10.6 mmHg) decreased. Discussion/Conclusion: The decrease in supine/standing HR associated with a general increase in HRV during recovery likely indicate an increase in parasympathetic modulation, which is compatible with the sedative effects of glycol ethers previously described in animal models. However, HR recovery was not altered. Despite no change in the O2 diffusion coefficient, there was an increase in PaCO2, a decrease in PaO2 and an increase in blood pH, all indicative of potential impaired blood oxygenation during exercise, to be further investigated. To conclude, exposition to different glycol ethers induced an enhanced parasympathetic activation without any changes in HR recovery or O2 diffusion.

Abstract Background Vascular remodeling following incomplete thrombus resolution is considered to be a key factor in the progression to chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE). Recent data demonstrated that Angpt2, which controls signaling via the Tie2 receptor, could interfere with the normal process of thrombus resolution. Our prior findings have shown that patients presenting with acute PE and having plasma levels of Angt-2 ≥5.5 ng/ml at admission are at a significantly increased risk (93 times higher) of being diagnosed with CTEPH in subsequent assessments. Purpose To externally validate the prognostic performance of Angpt2 for the development of CTEPH. Methods In a prospective cohort study of unselected consecutive all-comers with PE, survivors of the index acute event underwent 3-, 12- and 24-month follow-up with venous blood sampling for subsequent biomarker measurements. Angpt2 was measured on admission using specific enzyme linked immunosorbent assays (ELISA) detecting both the endogenous and the recombinant protein, according to the manufacturer (R&D Systems). Results Overall, 319 patients with acute PE (median age: 62 [IQR, 50-73]; females: 55.2%) were included in the analysis with a median Angpt2 plasma level of 2.6 ng/ml (IQR, 1.8-3.7) (Figure 1). Patients with PE and Angpt-2 plasma levels above the median had more often comorbidities, such as chronic heart failure (24.2% and 11.0.%; p=0.045), chronic kidney disease (33.3% vs 14.0%; p=0.010), or diabetes (27.3% vs. 12.9%; p=0.032). Angpt2 plasma levels correlated with haemodynamic status and parameters indicating severe PE (right ventricle dysfunction, r=0.129 [p=0.021) and troponin, r=0.246 [p<0.001]). In total, post-PE impairment (PPEI) was diagnosed in 33 (10.3%) and CTEPH in four (1.3%) patients during follow-up. Angpt2 plasma levels were higher on admission in patients developing PPEI or CTEPH during follow-up compared to patients without PPEI or CTEPH (PPEI vs non-PPEI: median, 3.2 [2.3-4.1] ng/ml vs. 2.5 [1-3.4] ng/ml, p=0.035; CTEPH vs. non-CTEPH: median, 5.1 [2.9-10.5] ng/ml vs. 2.5 [1.7-3.6] ng/ml, p=0.055). Regarding the diagnosis of CTEPH during follow-up, ROC analysis illustrated an AUC for Angpt2 (0.779 [95% CI 0.56–0.99]; p=0.055]) (Figure 2). By using univariate logistic regression analysis, the calculated predefined Angpt2 cut-off value of ≥5.5 ng/ml was associated with a 9.2-fold increased risk (1.3–67.4, p=0.030) for a diagnosis of CTEPH during follow-up. Conclusion We were able to validate in a different patient cohort the usefulness of Angpt2 as a novel biomarker to identify patients at risk for CTEPH.

In aging populations, the Global Initiative for Obstructive Lung Disease (GOLD) spirometry threshold may misclassify normal spirometry as airflow limitation. The Global Lung Initiative (GLI) method provides age-adjusted criteria. We investigated how the use of GOLD or GLI thresholds in an algorithm affects the classification of elderly smokers into COPD risk phenotypes. Using a modified COPDGene algorithm, including exposure, symptoms, and abnormal spirometry, 200 smokers aged 60 years and older were classified into 4 mutually exclusive phenotypes: Phenotype A (no symptoms, normal spirometry; reference), Phenotype B (symptoms, normal spirometry; possible COPD), Phenotype C (no symptoms, abnormal spirometry; possible COPD), and Phenotype D (symptoms, abnormal spirometry; probable COPD). Abnormal spirometry was defined according to the GOLD or GLI criteria. A comparison was made between the GOLD- and GLI-defined phenotypes. Using GLI criteria/cut-offs, 18.5

Exposure assessments to metalworking fluids (MWF) is difficult considering the complex nature of MWF. This study describes a comprehensive exposure assessment to straight and water-based MWFs among workers from 20 workshops. Metal and organic carbon (OC) content in new and used MWF were determined. Full-shift air samples of inhalable particulate and gaseous fraction were collected and analysed gravimetrically and for metals, OC, and aldehydes. Exposure determinants were ascertained through observations and interviews with workers. Determinants associated with personal inhalable particulate and gaseous fractions were systematically identified using mixed models. Similar inhalable particle exposure was observed for straight and water-based MWFs (64–386 µg/m3). The gaseous fraction was the most important contributor to the total mass fraction for both straight (322–2362 µg/m3) and water-based MWFs (101–699 µg/m3). The aerosolized particles exhibited low metal content irrespective of the MWF type; however, notable concentrations were observed in the sumps potentially reaching hazardous concentrations. Job activity clusters were important determinants for both exposure to particulate and gaseous fractions from straight MWF. Current machine enclosures remain an efficient determinant to reduce particulate MWF but were inefficient for the gaseous fraction. Properly managed water-based MWF meaning no recycling and no contamination from hydraulic fluids minimizes gaseous exposure. Workshop temperature also influenced the mass fractions. These findings suggest that exposures may be improved with control measures that reduce the gaseous fraction and proper management of MWF.

Abstract Background In order to implement targeted type 2 diabetes (T2D) prevention measures for the workplace, it is important to identify high-risk occupations. Most previous studies examine the association between T2D and occupation cross-sectionally, but longitudinal studies are missing. This study aims to investigate the 10-year incidence of T2D in the working population of a German cohort and identify occupations with an increased risk. Methods Data from the population-based Gutenberg Health Study (GHS) were used to examine occupation at baseline (2007-2012) and T2D incidence at the 10-year follow-up. Occupational phases were coded into categories according to the KldB 2010. T2D was defined as either a physician-diagnosed T2D, HbA1c-level ≥6.5% or use of antidiabetic drugs. Age- and sex-standardised incidence and 95% confidence intervals (CI) were calculated for occupational groups based on the age- and sex-distribution of the German population. Standardised incidence ratios (SIR) and 95% CI were calculated using the incidence in the total GHS working population as the reference. Results Of 8130 workers at baseline, 45.2% were female, the mean age was 48.4 years and 4.5% had prevalent T2D. 388 cases occurred between baseline and the 10-year follow-up within the subgroup of persons without prevalent T2D at baseline and with follow-up data (n = 5954). The standardised incidence was 6.9%. “Food production and processing” (20.7%), “cleaners” (16.5%) and “drivers and mobile plant operators” (14.8%) had the highest standardised incidences. Compared to the total working population, we observed a threefold increased SIR for employees in “food production and processing” (3.0, 95% CI 1.8-4.7) and a two times higher SIR for “cleaners” (2.2, 95% CI 1.0-4.7) and “drivers and mobile plant operators” (2.2, 95% CI 1.3-3.3). Conclusions We identified occupations with an increased risk of T2D. Preventive measures and etiological research on work-related risks should focus on these occupations. Key messages • The highest standardised incidence was observed in the occupational groups “food production and processing”, “cleaners” and “drivers and mobile plant operators”. • Targeted prevention measures for type 2 diabetes in the workplace should focus on these occupational groups with increased incidence.

IntroductionAfin de prévenir les problèmes de santé et les complications de grossesse liés à des conditions de travail délétères, la réglementation suisse accorde aux employées enceintes une protection spécifique. Néanmoins, son application est lacunaire. Pour soutenir les acteurs impliqués dans l’application de ces politiques de protection (travailleuses enceintes, gynécologues–obstétriciens, entreprises), le département de santé, travail et environnement d’Unisanté propose une consultation spécialisée en médecine du travail. Les gynécologues peuvent y référer leurs patientes dans le cas où l’entreprise ne dispose pas d’un médecin du travail attitré.ObjectifsCette étude vise à évaluer la contribution de la consultation en médecine du travail en termes de poursuite ou reprise du travail sans dangers pour les employées enceintes.MéthodesEntre 2015 et 2021, des indicateurs concernant les travailleuses venues à la consultation, ainsi que leurs employeurs, ont été recueillis par les médecins du travail après chaque consultation. Des analyses statistiques descriptives et corrélationnelles ont été réalisées par le biais du logiciel STATA 17.RésultatsSur les 328 situations de travail analysées, 98 % présentaient au moins un danger pour la travailleuse enceinte et/ou sa grossesse. Parmi les 272 entreprises contactées, seules 14 % avaient réalisé une analyse de risques et 39 % disaient avoir réalisé certains aménagements (e.g., adaptations de poste ou reclassements) avant la consultation. Les actions menées dans le cadre de la consultation ont permis de juger 44 % (n=121) des situations professionnelles sans dangers, permettant ainsi aux employées enceintes de poursuivre ou reprendre leur travail. Une orientation précoce vers la consultation et des mesures préventives préexistantes dans l’entreprise ont été identifiées comme des prédicteurs de réussite de la consultation en termes de retour au travail sécurisé.Discussion et conclusionLes entreprises examinées présentent des mesures insuffisantes pour protéger adéquatement les employées enceintes, les exposant potentiellement à des risques pour leur santé ou les poussant à un retrait précoce du travail. La consultation constitue une intervention efficace permettant aux travailleuses enceintes de poursuivre ou retourner à leur emploi en toute sécurité. Afin d’en accroître l’efficacité, il est nécessaire de sensibiliser les professionnels de la santé aux effets positifs de la consultation afin d’encourager des adressages précoces, et les entreprises à l’importance de connaître et se conformer à la législation en implémentant de manière préventive et anticipée les mesures de protection pour leurs collaboratrices enceintes.

Abstract Background Chronic obstructive pulmonary disease (COPD) affecting 334 million people in the world remains a major cause of morbidity and mortality. Proper diagnosis of COPD is still a challenge and largely solely based on spirometric criteria. We aimed to investigate the potential of nitrosative/oxidative stress and related metabolic biomarkers in exhaled breath condensate (EBC) to discriminate COPD patients. Methods Three hundred three participants were randomly selected from a 15,000-transit worker cohort within the Respiratory disease Occupational Biomonitoring Collaborative Project (ROBoCoP). COPD was defined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as post-bronchodilator ratio of Forced Expiratory Volume in 1st second to Forced Vital Capacity < 0.7 in spirometry validated by an experienced pulmonologist. Discriminative power of biomarker profiles in EBC was analyzed using linear discriminant analyses. Results Amongst 300 participants with validated spirometry, 50.3% were female, 52.3 years old in average, 36.0% were current smokers, 12.7% ex-smokers with mean tobacco exposure of 15.4 pack-years. Twenty-one participants (7.0%) were diagnosed as COPD, including 19 new diagnoses, 12 of which with a mild COPD stage (GOLD 1). Amongst 8 biomarkers measured in EBC, combination of 2 biomarkers, Lactate and Malondialdehyde (MDA) significantly discriminated COPD subjects from non-COPD, with a 71%-accuracy, area under the receiver curve of 0.78 (p-value < 0.001), and a negative predictive value of 96%. Conclusions These findings support the potential of biomarkers in EBC, in particular lactate and MDA, to discriminate COPD patients even at a mild or moderate stage. These EBC biomarkers present a non-invasive and drugless technique, which can improve COPD diagnosis in the future.

ContexteLes salariés reprenant leur activité professionnelle après chirurgie d’une tendinopathie (rompue ou non) de la coiffe des rotateurs, survenue dans un contexte professionnel, éprouvent fréquemment des difficultés et sont exposés à un risque de perte d’emploi, voire de désinsertion professionnelle. Cela concerne particulièrement les travailleurs manuels lourds après l’âge de 40 ans.MéthodeQuatre-vingt-seize travailleurs dans cette situation clinique ont été inclus et suivis de manière longitudinale, depuis le stade préopératoire jusqu’à 1 an après leur retour au travail, ou 20 mois après la chirurgie en cas de non-retour au travail. Ils ont complété de manière itérative une série de questionnaires validés au plan international, portant sur leurs conditions de travail, leur santé et leurs perceptions relatives au retour au travail. Ils ont également passé des tests fonctionnels. Durant la période de suivi, leur situation professionnelle a été documentée (au travail ou non, à des tâches habituelles ou aménagées, à temps plein ou partiel). Les analyses statistiques portaient sur des modèles simples et multiples de prédiction de la trajectoire de retour–maintien au travail. Cette trajectoire était caractérisée comme stable, instable, ou sans retour au travail.RésultatsL’âge médian de l’échantillon s’élevait à 49,5 ans [45,0–54,0] ; 67,7 % des participants occupaient des postes de travail très exigeants pour l’épaule. Par l’intermédiaire d’un modèle multiple, trois facteurs prédictifs du type de trajectoire ont été identifiés : une excellente/très bonne/bonne santé perçue (versus une santé perçue médiocre/mauvaise) au stade préopératoire, le fait d’avoir bénéficié d’une chirurgie reconstructrice d’un tendon rompu (versus une chirurgie palliative d’une tendinopathie non rompue) et un travail peu/moyennement sollicitant pour l’épaule (versus un travail très sollicitant) étaient significativement associés à une trajectoire favorable de retour au travail.ConclusionLes facteurs prédictifs identifiés sont faciles à recueillir en pratique médicale et infirmière quotidienne. Ils devraient aider à repérer des patients–salariés risquant d’éprouver des difficultés lors du processus de retour au travail, afin d’optimiser leur prise en charge au cours des soins et par les professionnels de la santé au travail, tout au long du parcours de retour–maintien au travail. Ils pourraient également faciliter le dialogue entre le médecin du travail et le praticien–conseil de l’Assurance maladie.

The impact of the urban built environment on cardiovascular and respiratory health has been studied extensively in children and adults. However, limited research exists on this topic in older adults. To fill this gap, we conducted a ten-year retrospective study of a cohort of elderly people living in Lausanne. We extracted cardiac and respiratory health outcomes of people living at the same address. A geographic information system (GIS) application was used to join spatial data between participant address and characteristics of the built environment (building age, building density, road density, proximity to vegetation and lake, elevation). To capture the impact of the urban landscape characteristics on the health of older people, the built environment descriptors, were considered alone and aggregated. Principal component analysis (PCA) was employed to resolve the multicollinearity among the built environment descriptors, while agglomerative hierarchical clustering was used to reveal underlying patterns and relationships within built environment variables. In addition, to better assess the effectiveness of ventilation in their homes, we characterized indoor air-associated mycobiomes in a representative sample of homes. This involved employing both culture-based methods and metabarcoding of the first internal transcribed spacer (ITS1) of the ribosomal DNA. The analysis revealed a significant association between exposure to the built environment as a whole and heart disease in the elderly. A higher prevalence was observed for the cluster of buildings near the lake/highway. The period of building construction showed an association with the prevalence of chronic lung disease and chronic cough, with a higher prevalence observed in houses built between 1975 and 2013. The contribution of indoor air pollution to worsening respiratory health was confirmed by higher Aspergillus spore loads and increased relative abundance of Gloeophyllum and Aureobasidium in indoor air, all of which were associated with respiratory outcomes. This research highlights the crucial influence of the built environment on the health status of the elderly population, with implications for targeted interventions and public health policy development.