Qualitative and Semiquantitative Assessment of Exposure to Engineered Nanomaterials within the French EpiNano Program: Inter- and Intramethod Reliability Study

The relatively recent development of industries working with nanomaterials has created challenges for exposure assessment. In this article, we propose a relatively simple approach to assessing nanomaterial exposures for the purposes of epidemiological studies of workers in these industries. This method consists of an onsite industrial hygiene visit of facilities carried out individually and a description of workstations where nano-objects and their agglomerates and aggregates (NOAA) are present using a standardized tool, the Onsite technical logbook. To assess its reliability, we implemented this approach for assessing exposure to NOAA in workplaces at seven workstations which synthesize and functionalize carbon nanotubes. The prediction of exposure to NOAA using this method exhibited substantial agreement with that of the reference method, the latter being based on an onsite group visit, an expert’s report and exposure measurements (Cohen kappa = 0.70, sensitivity = 0.88, specificity = 0.92). Intramethod comparison of results for exposure prediction showed moderate agreement between the three evaluators (two program team evaluators and one external evaluator) (weighted Fleiss kappa = 0.60, P = 0.003). Interevaluator reliability of the semiquantitative exposure characterization results was excellent between the two evaluators from the program team (Spearman rho = 0.93, P = 0.03) and fair when these two evaluators’ results were compared with the external evaluator’s results. The project was undertaken within the framework of the French epidemiological surveillance program EpiNano. This study allowed a first reliability assessment of the EpiNano method. However, to further validate this method a comparison with robust quantitative exposure measurement data is necessary

Occup Environ Med

OBJECTIVES: Asthma has significant occupational consequences. The objective of our study was to investigate the links between asthma and the career path, taking into account gender and age at asthma onset. METHODS: Using cross-sectional data collected at inclusion in the French CONSTANCES cohort in 2013-2014, we studied the links between each career path indicator (number of job periods, total duration of employment, numbers of part-time jobs and work interruptions due to unemployment or health issues, employment status at inclusion) on the one hand, and current asthma and asthma symptom score in the last 12 months on the other hand, as reported by the participants. Multivariate analyses were performed separately for men and women using logistic and negative binomial regression models adjusted for age, smoking status, body mass index and educational level. RESULTS: When the asthma symptom score was used, significant associations were observed with all of the career path indicators studied: a high symptom score was associated with a shorter total duration of employment as well as a greater number of job periods, part-time jobs and work interruptions due to unemployment or health issues. These associations were of similar magnitude in men and women. When current asthma was used, the associations were more pronounced in women for some career path indicators. CONCLUSION: The career path of asthmatic adults is more often unfavourable than that of those without asthma. Efforts should be made to support people with asthma in the workplace, in order to maintain employment and facilitate the return to work.La cohorte CONSTANCES - Infrastructure épidémiologique ouverte pour la recherche et la surveillanc

Attributable risk in men in two French case-control studies on mesothelioma and asbestos

International audiencePleural mesothelioma is a primary tumor of the pleura that is mainly due to asbestos exposure. To study the relationship between mesothelioma and occupational asbestos exposure in France, two case-control studies (A and B) were conducted. A substantial difference in the attributable risk in the population (AR) was observed among men: 44.5% (95% CI: [32.6-56.4]) in study A and 83.2% (95% CI: [76.8-89.6]) in study B. As different exposure assessment expert methods were used, the main objective of this work was to re-estimate the AR men in two case-control studies according to a common standardized exposure assessment by using a Job Exposure Matrix (JEM) and to assess the role of subjects' selection. The initial observed AR difference was maintained: 36.3% (95% CI: [24.3-50.3]) in study A and 69.7% (95% CI: [51.7-83.2]) in study B. Further investigations highlighted the potential selection bias introduced in both studies, especially among controls. The AR could be underestimated in study A and overestimated in study B. After weighting subjects according to distribution of socio-economic status in the general population for controls and according to distribution of socio-economic status of cases registered by the French National Mesothelioma Surveillance Program, re-estimated AR values were 52.4% in study A and 70.2% in study B. These results provide additional information to describe the relationship between pleural mesothelioma and occupational asbestos exposure, but also confirm the importance of subjects' recruitment in case control studies, particularly control selection

Underdiagnosis of obstructive lung disease: findings from the French CONSTANCES cohort

International audienceBackground: The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France. Methods: CONSTANCES is a French population-based cohort of adults aged 18-69 years at inception. We analysed data collected at inclusion in 2013-2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV 1 /FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD. Results: Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28-2.32]), without respiratory symptoms (aPR: 1.51 [1.28-1.78]), and with preserved lung function (aPR: 1.21 [1.04-1.41] for a 10-point increase in FEV 1 % predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD. Conclusion: Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals

Qualité de la spirométrie dans la cohorte Constances et prévalence du trouble ventilatoire obstructif

International audienceINTRODUCTION – The aim of this study was to describe the quality of spirometry tests and to provide a preliminary estimation of airway obstruction (AO) prevalence among the first participants to the CONSTANCES cohort. METHODS – CONSTANCES is an epidemiological population-based cohort composed of a representative sample of voluntary participants selected randomly and aged 18-69 years. Spirometry tests (pre-bronchodilator flow-volume curves) were performed according to standard operating procedures. A sample of spirometry tests, rated as valid by the operator, was checked by two chest physicians. The prevalence of AO (defined by a FEV1/FVC <0.70) was estimated among the 30-69 years old participants included as of 31/01/2014 with valid tests. RESULTS – About 99% of the sampled operator-valid tests were rated as of acceptable quality by the chest physi-cians. During the physical exam, among the 28,315 participants aged 30-69 years, 15,206 (53.7%) had a valid spirometry test. Among them, 5.6% had a FEV1/FVC below 0.7 (men 7.7%, women 3.8%). CONCLUSION – The quality control confirmed that the spirometry tests rated as valid by the operator were of acceptable quality. Nevertheless, only 53.7% of participants achieved a valid spirometry test, highlighting the difficulty to perform optimal spirometry tests. About 5.6 % of adults aged 30-69 years had a pre-bronchodilator FEV1/FVC<0.7.Introduction-Cet article présente une évaluation de la qualité des spirométries et une première estimation de la prévalence du trouble ventilatoire obstructif (TVO) chez les premiers participants à Constances. Méthodes-Constances est une cohorte épidémiologique constituée de volontaires tirés au sort et âgés de 18 à 69 ans à l'inclusion. Les spirométries (courbes débit-volume sans test de bronchodilatation) ont été réalisées selon une procédure standardisée. Leur qualité a été évaluée par deux pneumologues sur un échantillon de courbes jugées exploitables par l'opérateur. La prévalence du TVO a été estimée chez les adultes de 30 à 69 ans recrutés au 31 janvier 2014 et ayant une spirométrie exploitable. Le TVO a été défini par un rapport VEMS/CVF <0,70. Résultats-Les spirométries jugées exploitables par l'opérateur étaient acceptables ou optimales pour 99% de l'échantillon de spirométries étudié. Parmi les 28 315 participants âgés de 30 à 69 ans lors de l'examen de santé, 15 206 (53,7%) avaient une spirométrie acceptable ; 5,6% d'entre eux (hommes : 7,7% ; femmes : 3,8%) avaient un TVO. Conclusion-Le contrôle qualité a confirmé que les spirométries jugées de bonne qualité par l'opérateur étaient acceptables. Toutefois, seuls 53,7% des participants ont eu une spirométrie exploitable, confirmant la difficulté à réaliser l'examen de manière optimale. Le rapport VEMS/CVF était inférieur à 0,7 chez 5,6% des adultes âgés de 30 à 69 ans

Qualité de la spirométrie dans la cohorte Constances et prévalence du trouble ventilatoire obstructif

International audienceINTRODUCTION – The aim of this study was to describe the quality of spirometry tests and to provide a preliminary estimation of airway obstruction (AO) prevalence among the first participants to the CONSTANCES cohort. METHODS – CONSTANCES is an epidemiological population-based cohort composed of a representative sample of voluntary participants selected randomly and aged 18-69 years. Spirometry tests (pre-bronchodilator flow-volume curves) were performed according to standard operating procedures. A sample of spirometry tests, rated as valid by the operator, was checked by two chest physicians. The prevalence of AO (defined by a FEV1/FVC <0.70) was estimated among the 30-69 years old participants included as of 31/01/2014 with valid tests. RESULTS – About 99% of the sampled operator-valid tests were rated as of acceptable quality by the chest physi-cians. During the physical exam, among the 28,315 participants aged 30-69 years, 15,206 (53.7%) had a valid spirometry test. Among them, 5.6% had a FEV1/FVC below 0.7 (men 7.7%, women 3.8%). CONCLUSION – The quality control confirmed that the spirometry tests rated as valid by the operator were of acceptable quality. Nevertheless, only 53.7% of participants achieved a valid spirometry test, highlighting the difficulty to perform optimal spirometry tests. About 5.6 % of adults aged 30-69 years had a pre-bronchodilator FEV1/FVC<0.7.Introduction-Cet article présente une évaluation de la qualité des spirométries et une première estimation de la prévalence du trouble ventilatoire obstructif (TVO) chez les premiers participants à Constances. Méthodes-Constances est une cohorte épidémiologique constituée de volontaires tirés au sort et âgés de 18 à 69 ans à l'inclusion. Les spirométries (courbes débit-volume sans test de bronchodilatation) ont été réalisées selon une procédure standardisée. Leur qualité a été évaluée par deux pneumologues sur un échantillon de courbes jugées exploitables par l'opérateur. La prévalence du TVO a été estimée chez les adultes de 30 à 69 ans recrutés au 31 janvier 2014 et ayant une spirométrie exploitable. Le TVO a été défini par un rapport VEMS/CVF <0,70. Résultats-Les spirométries jugées exploitables par l'opérateur étaient acceptables ou optimales pour 99% de l'échantillon de spirométries étudié. Parmi les 28 315 participants âgés de 30 à 69 ans lors de l'examen de santé, 15 206 (53,7%) avaient une spirométrie acceptable ; 5,6% d'entre eux (hommes : 7,7% ; femmes : 3,8%) avaient un TVO. Conclusion-Le contrôle qualité a confirmé que les spirométries jugées de bonne qualité par l'opérateur étaient acceptables. Toutefois, seuls 53,7% des participants ont eu une spirométrie exploitable, confirmant la difficulté à réaliser l'examen de manière optimale. Le rapport VEMS/CVF était inférieur à 0,7 chez 5,6% des adultes âgés de 30 à 69 ans

Occupational exposures to solvents and asthma in the Constances cohort

International audienc

Occupational Exposures to Organic Solvents and Asthma Symptoms in the CONSTANCES Cohort

International audienceSolvents are used in many workplaces and may be airway irritants but few studies have examined their association with asthma. We studied this question in CONSTANCES (cohort of 'CONSulTANts des Centres d'Examens de Sante'), a large French cohort. Current asthma and asthma symptom scores were defined by participant-reported respiratory symptoms, asthma medication or attacks, and the sum of 5 symptoms, in the past 12 months, respectively. Lifetime exposures to 5 organic solvents, paints and inks were assessed by questionnaire and a population-based Job-Exposure Matrix (JEM). Cross-sectional associations between exposures and outcomes were evaluated by gender using logistic and negative binomial regressions adjusted for age, smoking habits and body mass index. Analyses included 115,757 adults (54% women, mean age 47 years, 9% current asthma). Self-reported exposure to &gt;= 1 solvent was significantly associated with current asthma in men and women, whereas using the JEM, a significant association was observed only in women. Significant associations between exposures to &gt;= 1 solvent and asthma symptom score were observed for both self-report (mean score ratio, 95%CI, women: 1.36, 1.31-1.42; men: 1.34, 1.30-1.40) and JEM (women: 1.10, 1.07-1.15; men: 1.14, 1.09-1.18). Exposure to specific solvents was significantly associated with higher asthma symptom score. Occupational exposure to solvents should be systematically sought when caring for asthma