Exposition professionnelle maternelle aux solvants organiques et malformations congenitales

L objectif général de ce travail était d étudier la relation entre exposition professionnelle maternelle aux solvants organiques et malformations congénitales.Ce projet s est appuyé sur les données de la cohorte PELAGIE. Il s agit d une cohorte mère enfant avec inclusion de 3 421 femmes en début de grossesse en population générale en Bretagne. L exposition aux solvants était définie par différentes méthodes (expositions déclarées, matrices emplois-expositions, dosages urinaires de métabolites de solvants chlorés et d éthers de glycol).Nous avons mis en évidence une relation entre l exposition aux solvants mesurée par des méthodes indirectes et les malformations congénitales. Puis, pour un échantillon aléatoire de451 femmes, nous avons étudié les déterminants de la détection urinaire des métabolites de solvants. Enfin, dans le cadre d une étude cas-témoins dans la cohorte, la relation entre métabolites urinaires de solvants et malformations congénitales a été étudiée.The aim of this project was to study the relation between maternal occupational exposure to solvents and congenital malformations.This project used data from the PELAGIE study. This is a mother child cohort which had included 3 421 women from the general population at the beginning of their pregnancy in Britany. Occupational exposure to solvents was assessed by different methods (self-report, job exposure matrix, and urinary determination of glycol ethers and chlorinated solvents metabolites).We have shown an association between solvent exposure using indirect method of assessment and congenital malformations. Using a randomized sample of 451 women, we have studied the occupational and non occupational determinants of urinary detection of glycol ethers and chlorinated solvents metabolites. Finally, we have studied in a nested case-control study, the relation between urinary solvent metabolites and congenital malformations.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Itch characteristics in five dermatoses: non-atopic eczema, atopic dermatitis, urticaria, psoriasis and scabies.

International audienceItch is a frequent symptom in many diseases. Some studies have used questionnaires to evaluate pruritus by targeting a single type of dermatitis, for example, studying atopic dermatitis (AD) with the "Eppendorf Itch Questionnaire"(1, 2), and uraemic pruritus (3). Questionnaires have also been used to study psoriasis (4) and urticaria (5). The pathophysiological mechanisms of itch, especially with regard to the mediators and transmitters involved, can vary according to the itch-inducing disease. It is possible that itching sensations may be experienced differently by each patient and depending on the underlying disease. O'Neill et al. (6) and Reich et al. (7) have shown that itching sensations can vary between various skin diseases. The present study used an exploratory approach to highlight the qualitative (symptomatological) features of pruritus in different dermatoses, using a non-validated questionnaire in French, adapted from previous questionnaires (1, 2)

Biomechanical and organisational constraints of pregnant women at work: definition of exposure levels using a consensus method (Delphi)

OBJECTIVES: To identify the biomechanical and organisational constraints that influence pregnancy outcomes and define the exposure levels at which the risks for pregnancy become significant. SETTING AND PARTICIPANTS: We applied a consensus method (Delphi) consisting of a literature review followed by expert opinions on exposure levels. The group of experts was made up of 12 people from different medical specialities and working in various structures in France. OUTCOME MEASURES: The studied variables were: (1) exposure: night work/shift work, weekly hours at work, lifting of heavy loads, prolonged standing and multiple exposure and (2) pregnancy outcomes: prematurity, low birth weight and spontaneous miscarriages. RESULTS: The consensus method resulted in the following recommendations. The time spent working must not exceed 40 hours/week; in the absence of a consensus on the level of exposure, night and/or shift work must be avoided; prolonged standing must not exceed 3 hours/day; lifting must be limited to carrying loads <11 kg, with a daily load <100 kg; multiple exposure must be avoided, in particular: vibration, night work/shift work, time spent working exceeding 40 hours/week, prolonged standing and lifting of heavy loads. CONCLUSIONS: These results could help the occupational physician to address the question of whether an exposed employee should remain at work, considering her individual characteristics (medical history, family situation, socioeconomic level, etc) in consultation with pregnancy specialists (obstetricians, midwives)

Maternal fish and shellfish intake and pregnancy outcomes: A prospective cohort study in Brittany, France

<p>Abstract</p> <p>Background</p> <p>Recommendations about risks and benefits of seafood intake during pregnancy have been published in the last decade, but the specific health effects of the different categories of seafood remain unknown. Fish and shellfish may differ according to their fatty acid content and their concentration of chemical pollutants and toxins. Not taking these particularities into account may result in underestimating of both the positive and negative effects of seafood on birth outcomes and partly explains inconsistent results on the subject.</p> <p>Methods</p> <p>In the PELAGIE cohort study, including 2398 pregnant women from Brittany, we fit multiple linear and logistic regression models to examine associations of fish (salt-water fish only) and shellfish intake before pregnancy with length of gestation, birthweight, and risks of preterm births, low birthweight or small-for-gestational-age (SGA) babies.</p> <p>Results</p> <p>When fish and shellfish consumptions were considered simultaneously, we observed a decrease in the risk of SGA birth with increasing frequency of fish intake: OR = 0.57 (95%CI: 0.31 to 1.05) for women eating fish twice a week or more compared with those eating it less than once a month. The risk of SGA birth was significantly higher among women eating shellfish twice a week or more than among those eating it less than once a month: OR = 2.14 (95%CI: 1.13 to 4.07). Each additional monthly meal including fish was significantly related to an increase in gestational length of 0.02 week (95%CI: 0.002 to 0.035). No association was observed with birthweight or preterm birth.</p> <p>Conclusion</p> <p>These results suggest that different categories of seafood may be differently associated with birth outcomes, fish consumption with increased length of gestation and shellfish consumption with decreased fetal growth.</p

La mastite au cours de l allaitement maternel, incidence, prise en charge et facteurs de risque. (étude prospective d'une cohorte de 642 couples mère-enfant)

Cette étude présente un suivi prospectif d une cohorte de 642 femmes allaitantes pendant 12 semaines, en Finistère. Elle rapporte un taux de poursuite d'allaitement à 12 semaines de 58,3% et une incidence cumulée d'un premier épisode de mastite de 11,7%. La majorité des femmes ayant présenté une mastite (76,4%) a consulté un professionnel de santé et les conseils prodigués sont dans l ensemble adaptés et éfficaces. Toutefois 16,4% ont reçu des conseils de sevrage, inadaptés. La prescription d antibiotiques n'est pas conforme aux recommandations, notamment en ce qui concerne l'indication, le type d'antibiotiques et la durée du traitement. Les facteurs de risque mis en évidence sont le traumatisme du sein, les crevasses et la fatigue, le facteur protecteur identifié est la presence d'un plus grand nombre de tétées dans les 48 heures précédentes. D autres études sont nécessaires afin de mieux comprendre les mécanismes) physiopathologiques et de mieux définir la prise en charge notamment les indications de l'antibiothérapie.BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Evaluation des expositions aux produits biologiques et chimiques, et du port des équipements de protections individuelles des aides-soignants du CHRU de Brest

BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Etude de la relation entre exposition professionnelle maternelle aux solvants, malformations congénitales et retard de croissance intra-utérin (résultats à partir d'une cohorte de 3421 femmes enceintes résidant en Bretagne)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Concerning the plausibility of the findings reported in 'Prenatal exposure to glycol ethers and cryptorchidism and hypospadias a nested case-control study' by Smet and Kelsey authors' response

International audienceReply Letter to Smet and Kelsey: Concerning the plausibility of the findings reported in “Prenatal exposure to glycol ethers and cryptorchidism and hypospadias: a nested case–control study”, Warembourg et al, Occup Environ Med 2018;75:59–6

Birthweight difference of singletons conceived through in vitro fertilization with frozen versus fresh embryo transfer: An analysis of 5406 embryo transfers in a retrospective study 2013-2018

International audienceINTRODUCTION: Perinatal risks after frozen embro transfer (FET) have been reassuring but some authors suggest that birthweights are higher after FET than after fresh embryo transfer (ET). The primary objective of this retrospective study, conducted in Clinique de la Sagesse, Rennes (France) from December 2013 to March 2017, was to determine whether a difference in birthweight exists between children conceived through in vitro fertilization (IVF) with frozen versus fresh ET. The secondary objective was to compare live birth rates after frozen versus fresh cycles.MATERIAL AND METHODS: All couples undergoing IVF were included. Cycles with gamete donation and twin pregnancies were excluded. Hormone therapy was used in all embryo transfers. The main outcome measures were the child's birthweight, mode of delivery, gestation length and sex, maternal characteristics, and IVF characteristics. The primary endpoint was birthweight.RESULTS: We studied 5406 embryo transfers and the 708 resulting singleton live births on which birthweight data were available. Mean birthweight was 3357g after frozen embryo transfer versus 3183g after fresh embryo transfer (p<0.001). After adjusting for confounding factors, the children born after frozen embryo transfer were 165.2g heavier (95%CI [92.96-237.51]). No difference was found in gestation length. Live birth was obtained after the 1.6th IVF attempt. Live birth rate was higher for fresh cycles (19% versus 12%, p<0.001), and the caesarean rate lower (16% versus 21%).DISCUSSION: Birthweight was higher after frozen embryo transfer for a similar gestational age. Further research is needed to elucidate the mechanisms responsible for this difference

Facteurs prédictifs de la douleur dans les gestes techniques dermatologiques. [Predictive factors for pain in technical dermatological procedures].

International audienceBACKGROUND: Technical procedures in dermatology are painful. AIM: The aim of the study was to determine predictive factors for pain in such procedures. PATIENTS AND METHODS: This observational study evaluated pain by means of a numerical pain rating scale and a questionnaire about the circumstances of the pain and the use of analgesic methods. Data were analysed using Excel and SAS software. RESULTS: Five hundred and forty-six questionnaires were analysed. Among the patients, 45.4% had mild pain, 34.5% moderate pain and 20.1% severe pain. The least painful procedures were cryotherapy, surgical excision and biopsy, debridement and curettage. Procedures causing moderate to severe pain were treatments involving laser and lights as well as injections (hyaluronic acid, intralesional corticosteroids, botulinum toxin). Pain scores were higher for procedures involving fingers, toes and armpits, while the least painful areas were the trunk and limbs. Among the patients, 62.5% had no preventive analgesia before the procedure, 37.5% had preventive analgesia and 34.2% underwent local or topical anaesthesia (3.7% by cold, 2.0% by oral premedication, 0.5% by hypnosis and 0.4% by nitrous oxide). CONCLUSION: Awareness of predictive factors for pain could allow better use of analgesic methods to offer the patient relief and improve the quality of the procedure