Evaluation de la nuisance acoustique professionnelle par analyse collective du déficit auditif

National audienceLe déficit auditif induit par l'exposition au bruit professionnel reste préoccupant. Pour prévenir ce risque, deux approches sont utilisables : le mesurage des niveaux d'exposition au bruit et le suivi audiométrique des travailleurs exposés. Ces approches ont cependant des limites. Compte tenu des parcours professionnels, il n'est souvent pas possible d'extrapoler à la totalité d'une carrière le résultat de mesures d'exposition au bruit effectuées dans des circonstances spécifiques. Quant à l'interprétation des pertes auditives des travailleurs, elle reste toujours difficile, et les effets attribuables à l'âge ou à des facteurs extraprofessionnels s'opposent à une interprétation collective aisée des résultats. Pour remédier à ces difficultés, des méthodes d'analyse de données audiométriques ont été élaborées pour évaluer le risque collectif, par usine et par atelier : - dénombrement du pourcentage constaté des atteintes auditives excédant un seuil spécifié, - analyse sous contrôle de l'effet de l'âge, par classement en zones de « perte auditive moyenne standard » et en stades de « pertes auditives significatives » liées au bruit professionnel. Le logiciel AudioGT® permet de mettre en œuvre ces différentes approches de l'analyse collective du déficit auditif et de caractériser la nocivité sonore des ateliers. Ces méthodes ont été appliquées à plusieurs groupes de travailleurs et les résultats sont discutés en vue de montrer en quoi ce type d'analyse de données médicales peut inciter à la prévention collective du risque lié au bruit professionnel

Underreporting of occupational blood and body fluid exposure in French university hospitals in 2017

International audienceBACKGROUND: Occupational blood and body fluid exposures (OBBFEs) are one of the biological risks run by health professionals, especially in hospitals. OBJECTIVE: The objectives of this study were to assess the occurrence and reporting of occupational blood and body fluid exposures (OBBFEs) in university hospital medical staff and to investigate factors associated to declared OBBFE and factors associated to reported OBBFE. METHODS: A self-administered questionnaire has been e-mailed to all junior and senior medical staff in four university hospital centers in one administrative region of France in 2017. RESULTS: 292 of the 1,228 respondents declared at least one OBBFE. More than two-thirds (70.2%) were under-reporters and more than half (53.8%) non-reporters. Younger subjects, surgical specialties and other associated work accidents were risk factors for OBBFE. Considering the reporting procedure too complex was a risk factor for underreporting. CONCLUSIONS: Underreporting by hospital medical staff was a persistent phenomenon, with a high rate. The OBBFE reporting procedure needs rethinking

Évaluation d’un auto-questionnaire de repérage des expositions professionnelles chez les patients atteints de cancer bronchopulmonaire

International audienceTen to 29% of lung cancers might be linked to occupational factors but 60% of them are not compensated. The PROPOUMON project aimed to improve the identification, recognition and compensation of occupational lung cancer as occupational disease using a self-administered questionnaire (AQREP). One objective was to assess the AQREP, comparing it with the questionnaire drawn up by the French Language Pneumology Society (Q-SPLF). From March 2014 to September 2015, 90 lung cancer patients treated at the Centre Léon-Bérard responded to the AQREP and Q-SPLF. The two physicians in charge of the consultation assessed independently whether or not a consultation was indicated. A certificate for the compensation process was proposed when a suspicion of high or average imputability was identified. Analysis of the questionnaires was concordant for 73% of the patients. The AQREP has a sensitivity of 72% and a specificity of 73%. Its positive and negative predictive values were 62 and 82%. The information provided by 24 patients were discordant between questionnaires. In two patients with discordant evaluation (AQREP+/Q-SPLF-; AQREP-/Q-SPLF+), one Initial Medical Certificate (IMC) was written. This study made it possible to conclude that AQREP is relevant for the identification of potentially occupational lung cancers. Collegial discussion of complex cases might be considered. The project is currently been extended to other centers and to lymphoma.Dix à 29 % des cancers bronchopulmonaires seraient d’origine professionnelle dont 60 % ne seraient pas indemnisés. Le projet Propoumon vise à améliorer le repérage, la reconnaissance et l’indemnisation des cancers bronchopulmonaires d’origine professionnelle en maladie professionnelle à partir d’un auto-questionnaire (AQREP). Un des objectifs était d’évaluer sa capacité à détecter les patients pouvant bénéficier d’une consultation « cancers professionnels », en le comparant avec le questionnaire de la Société de pneumologie de langue française (Q-SPLF). De mars 2014 à septembre 2015, 90 patients suivis au centre Léon-Bérard pour un cancer bronchopulmonaire ont répondu aux deux questionnaires. Les deux médecins responsables de la consultation évaluaient de façon indépendante, sur la base de l’AQREP ou du Q-SPLF, l’indication d’une consultation. Si à l’issue de la consultation des arguments en faveur d’une origine professionnelle étaient réunis, une démarche de déclaration était proposée. L’analyse des questionnaires par les médecins était concordante à 73 %. L’AQREP a une sensibilité de 72 % et une spécificité de 73 %. Ses valeurs prédictives positive et négative sont de 62 et 82 %. Les informations renseignées par 24 patients étaient discordantes entre les questionnaires. Pour deux patients ayant une évaluation discordante (AQREP+/Q-SPLF- ; AQREP-/Q-SPLF+), un « Certificat médical initial » a été rédigé. Le premier a été refusé par l’Assurance maladie, le second est en cours d’instruction. Cette étude a permis de conclure en la capacité de l’AQREP à repérer les cancers bronchopulmonaires potentiellement d’origine professionnelle. Une réunion de concertation pour discuter des cas complexes pourrait être envisagée. Le projet s’élargit actuellement à d’autres centres et aux lymphomes

Évaluation d’un auto-questionnaire de repérage des expositions professionnelles chez les patients atteints de cancer bronchopulmonaire

International audienceTen to 29% of lung cancers might be linked to occupational factors but 60% of them are not compensated. The PROPOUMON project aimed to improve the identification, recognition and compensation of occupational lung cancer as occupational disease using a self-administered questionnaire (AQREP). One objective was to assess the AQREP, comparing it with the questionnaire drawn up by the French Language Pneumology Society (Q-SPLF). From March 2014 to September 2015, 90 lung cancer patients treated at the Centre Léon-Bérard responded to the AQREP and Q-SPLF. The two physicians in charge of the consultation assessed independently whether or not a consultation was indicated. A certificate for the compensation process was proposed when a suspicion of high or average imputability was identified. Analysis of the questionnaires was concordant for 73% of the patients. The AQREP has a sensitivity of 72% and a specificity of 73%. Its positive and negative predictive values were 62 and 82%. The information provided by 24 patients were discordant between questionnaires. In two patients with discordant evaluation (AQREP+/Q-SPLF-; AQREP-/Q-SPLF+), one Initial Medical Certificate (IMC) was written. This study made it possible to conclude that AQREP is relevant for the identification of potentially occupational lung cancers. Collegial discussion of complex cases might be considered. The project is currently been extended to other centers and to lymphoma.Dix à 29 % des cancers bronchopulmonaires seraient d’origine professionnelle dont 60 % ne seraient pas indemnisés. Le projet Propoumon vise à améliorer le repérage, la reconnaissance et l’indemnisation des cancers bronchopulmonaires d’origine professionnelle en maladie professionnelle à partir d’un auto-questionnaire (AQREP). Un des objectifs était d’évaluer sa capacité à détecter les patients pouvant bénéficier d’une consultation « cancers professionnels », en le comparant avec le questionnaire de la Société de pneumologie de langue française (Q-SPLF). De mars 2014 à septembre 2015, 90 patients suivis au centre Léon-Bérard pour un cancer bronchopulmonaire ont répondu aux deux questionnaires. Les deux médecins responsables de la consultation évaluaient de façon indépendante, sur la base de l’AQREP ou du Q-SPLF, l’indication d’une consultation. Si à l’issue de la consultation des arguments en faveur d’une origine professionnelle étaient réunis, une démarche de déclaration était proposée. L’analyse des questionnaires par les médecins était concordante à 73 %. L’AQREP a une sensibilité de 72 % et une spécificité de 73 %. Ses valeurs prédictives positive et négative sont de 62 et 82 %. Les informations renseignées par 24 patients étaient discordantes entre les questionnaires. Pour deux patients ayant une évaluation discordante (AQREP+/Q-SPLF- ; AQREP-/Q-SPLF+), un « Certificat médical initial » a été rédigé. Le premier a été refusé par l’Assurance maladie, le second est en cours d’instruction. Cette étude a permis de conclure en la capacité de l’AQREP à repérer les cancers bronchopulmonaires potentiellement d’origine professionnelle. Une réunion de concertation pour discuter des cas complexes pourrait être envisagée. Le projet s’élargit actuellement à d’autres centres et aux lymphomes

Evaluation of commercial Anti-SARS-CoV-2 neutralizing antibody assays in seropositive subjects

International audienceThe virus neutralization test (VNT) is the reference for the assessment of the functional ability of neutralizing antibodies (NAb) to block SARS-CoV-2 entry into cells. New competitive immunoassays measuring antibodies preventing interaction between the spike protein and its cellular receptor are proposed as surrogate VNT (sVNT). We tested three commercial sVNT (a qualitative immunochromatographic test and two quantitative immunoassays named YHLO and TECO) together with a conventional anti-spike IgG assay (bioMérieux) in comparison with an in-house plaque reduction neutralization test (PRNT50) using the original 19A strain and different variants of concern (VOC), on a panel of 306 sera from naturally-infected or vaccinated patients. The qualitative test was rapidly discarded because of poor sensitivity and specificity. Areas under the curve of YHLO and TECO assays were, respectively, 85.83 and 84.07 (p-value >0.05) using a positivity threshold of 20 for PRNT50, and 95.63 and 90.35 (p-value =0.02) using a threshold of 80. However, the performances of YHLO and bioMérieux were very close for both thresholds, demonstrating the absence of added value of sVNT compared to a conventional assay for the evaluation of the presence of NAb in seropositive subjects. In addition, the PRNT50 assay showed a reduction of NAb titers towards different VOC in comparison to the 19A strain that could not be appreciated by the commercial tests. Despite the good correlation between the anti-spike antibody titer and the titer of NAb by PRNT50, our results highlight the difficulty to distinguish true NAb among the anti-RBD antibodies with commercial user-friendly immunoassays

Evaluation of commercial anti-SARS-CoV-2 antibody assays and comparison of standardized titers in vaccinated healthcare workers.

International audienceWith the availability of vaccines, commercial assays detecting anti-SARS-CoV-2 antibodies (Ab) evolved towards quantitative assays directed to the spike glycoprotein or its receptor binding domain (RBD). The main objective of the present study was to compare the Ab titers obtained with quantitative commercial binding Ab assays, after 1 dose (convalescent individuals) or 2 doses (naïve individuals) of vaccine, in healthcare workers (HCW). Antibody titers were measured in 255 sera (from 150 HCW) with 5 quantitative immunoassays (Abbott RBD IgG II quant, bioMérieux RBD IgG, DiaSorin Trimeric spike IgG, Siemens Healthineers RBD IgG, Wantai RBD IgG). One qualitative total antibody anti RBD detection assay (Wantai) was used to detect previous infection before vaccination. The results are presented in binding Ab units (BAU)/mL after application, when possible, of a conversion factor provided by the manufacturers and established from a World Health Organization (WHO) internal standard. There was a 100% seroconversion with all assays evaluated after two doses of vaccine. With assays allowing BAU/ml correction, Ab titers were correlated (Pearson correlation coefficient, ρ, range: 0.85-0.94). The titer differences varied by a mean of 10.6% between Siemens and bioMérieux assays to 60.9% between Abbott and DiaSorin assays. These results underline the importance of BAU conversion for the comparison of Ab titer obtained with the different quantitative assays. However, significant differences persist, notably, between kits detecting Ab against the different antigens. A true standardization of the assays would be to include the International Standard in the calibration of each assays to express the results in IU/m

Exposure to loud noise and risk of vestibular schwannoma: results from the INTERPHONE international case‒control study

Objective Studies of loud noise exposure and vestibular schwannomas (VS) have shown conflicting results. The population-based INTERPHONE case‒control study was conducted in 13 countries during 2000-2004. In this paper, we report the results of analyses on the association between VS and self-reported loud noise exposure. Methods Self-reported noise exposure was analyzed in 1024 VS cases and 1984 matched controls. Life-long noise exposure was estimated through detailed questions. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using adjusted conditional logistic regression for matched sets. Results The OR for total work and leisure noise exposure was 1.6 (95% CI 1.4-1.9). OR were 1.5 (95% CI 1.3-1.9) for only occupational noise, 1.9 (95% CI 1.4-2.6) for only leisure noise and 1.7 (95% CI 1.2-2.2) for exposure in both contexts. OR increased slightly with increasing lag-time. For occupational exposures, duration, time since exposure start and a metric combining lifetime duration and weekly exposure showed significant trends of increasing risk with increasing exposure. OR did not differ markedly by source or other characteristics of noise. Conclusion The consistent associations seen are likely to reflect either recall bias or a causal association, or potentially indicate a mixture of both

Assessment of serological techniques for screening patients for COVID-19 (COVID-SER): a prospective, multicentric study

Introduction The COVID-19 pandemic caused by SARS-CoV-2 threatens global public health, and there is an urgent public health need to assess acquired immunity to SARS-CoV-2. Serological tests might provide results that can be complementary to or confirm suspected COVID-19 cases and reveal previous infection. The performance of serological assays (sensitivity and specificity) has to be evaluated before their use in the general population. The neutralisation capacity of the produced antibodies also has to be evaluated.Methods and analysis We set up a prospective, multicentric clinical study to evaluate the performance of serological kits among a population of healthcare workers presenting mild symptoms suggestive of SARS-CoV-2 infection. Four hundred symptomatic healthcare workers will be included in the COVID-SER study. The values obtained from a control cohort included during the prepandemic time will be used as reference. A workflow was set up to study serological response to SARS-CoV-2 infection and to evaluate antibody neutralisation capacity in patients with a confirmed SARS-CoV-2 infection. The sensitivity and specificity of the tests will be assessed using molecular detection of the virus as a reference. The measurement of IgM and IgG antibodies will be performed once per week for 6 consecutive weeks and then at 6, 12, 18, 24 and 36 months after the diagnosis. The kinetics of IgM and IgG will determine the optimal period to perform serological testing. The proportion of false negative PCR tests in symptomatic subjects will be determined on the basis of subsequent seroconversions.Ethics and dissemination Ethical approval has been obtained from the national review board for biomedical research in April 2020 (Comité de Protection des Personnes Sud Méditerranée I, Marseille, France) (ID RCB 2020-A00932-37). Results will be disseminated through presentations at scientific meetings and publications in peer-reviewed journals.Trial registration number NCT04341142