Development of a Questionnaire for the Search for Occupational Causes in Patients with Non-Hodgkin Lymphoma: The RHELYPRO Study

Non-Hodgkin lymphoma (NHL), multiple myeloma and chronic lymphocytic leukemia are possibly related to environmental and/or occupational exposure. The primary objective of this study was to develop a questionnaire for screening patients with these blood disorders who might benefit from a specialized consultation for possible recognition of the disease as an occupational disease. The study included 205 subjects (male gender, 67.3%; mean age, 60 years; NHL, 78.5%). The questionnaire performed very satisfactorily in identifying the exposures most frequently retained by experts for their potential involvement in the occurrence of NHL. Its sensitivity and specificity in relation to the final expertise were 96% and 96% for trichloroethylene, 85% and 82% for benzene, 78% and 87% for solvents other than trichloroethylene and dichloromethane, 87% and 95% for pesticides, respectively. Overall, 15% of the subjects were invited to ask National Social Insurance for compensation as occupational disease. These declarations concerned exposure to pesticides (64%), solvents (trichloroethylene: 29%; benzene: 18%; other than chlorinated solvents: 18%) and sometimes multiple exposures. In conclusion, this questionnaire appears as a useful tool to identify NHL patients for a specialized consultation, in order to ask for compensation for occupational disease

Lombalgies par effort de soulèvement chez le personnel de soins (à propos de la mise en place de l'analyse de ces accidents par la méthode de l'Arbre des Causes dans les services de soins aux personnes âgées du CHU de Bordeaux)

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Suivi de l'expérimentation du travail en 12 heures dans trois services au centre hospitalier universitaire de Bordeaux

Les horaires atypiques de travail concernent près de deux salariés sur trois. Le travail en 12 heures est un mode de fonctionnement de plus en plus répandu. Celui-ci est apprécié des travailleurs car il permet de diminuer le nombre de jours travaillés, et des employeurs car il permet une organisation plus souple. Cependant, il reste très controversé car même si les différentes études réalisées retrouvent des résultats contradictoires, de nombreux effets sur la santé sont suspectés, tels qu'une fatigue, somnolence, prise de poids... Trois services du CHU de Bordeaux ont expérimenté ce mode de fonctionnement : la réanimation médicale, la réanimation pédiatrique et les permanenciers du SAMU. Notre enquête a été réalisée dans ces trois services. Un suivi a été mis en place avant le passage en 12 heures, à 6 mois et à 1 an, à l'aide d'un questionnaire reprenant divers scores et échelles évaluant la fatigue, la somnolence, la vigilance, l'organisation du travail et les indicateurs de santé globale Il n'a pas été retrouvé d'impact du travail en 12 heures sur la santé des agents que nous avons suivis. Néanmoins, les limites majeures de cette étude sont le faible nombre de répondants et le suivi n'excédant pas 12 mois.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Inaptitude médicale et handicap au CHU de Bordeaux (état des lieux pour l'année 2008)

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Evaluation des risques professionnels au C.H.U.de Bordeaux

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Protocole d’aide à la décision pour la reconnaissance des affections péri-articulaires du membre supérieur provoquées par certains gestes et postures de travail

National audienc

Arch Mal Prof Environ

Malgré les efforts réalisés en prévention pour réduire l’exposition professionnelle aux médicaments anticancéreux (MAC), ce problème reste d’actualité. La littérature à ce sujet pointe le besoin de caractériser et d’évaluer les risques et les dangers et de former les professionnels. Grâce à l’ergotoxicologie, mêlant des prélèvements d’essuyages de mains et des entretiens d’autoconfrontation, nous chercherons à savoir comment la poly-exposition et les moyens de protection associés se manifestent dans l’activité des soignants. Les essuyages de mains, réalisés avant/après des actions déterminées comme potentiellement exposantes, montrent la présence de MAC sur l’ensemble des prélèvements (n = 20). La molécule manipulée le jour du prélèvement ne se retrouve que sur 25 % des prélèvements. Deux prélèvements (sur 9) montrent une augmentation du niveau de contamination des mains après une action potentiellement exposante. Les données d’entretiens montrent que malgré le manque de formation, les soignants sont capables d’identifier des sources et des espaces d’exposition potentielle. Nos résultats ne montrent qu’une partie de l’énigme de l’exposition aux MAC et ne permettent pas, encore, de la caractériser. Néanmoins, ils montrent des déterminants de la contamination à différents niveaux de l’activité qu’il reste à approfondir. Aussi, nos résultats nous laissent penser que, par nos méthodes, les soignants sont rentrés dans une « zone potentielle de développement », où une partie de leurs connaissances sur les risques biologiques pourraient leur servir de ressources pour mieux gérer le risque chimique et penser une prévention propre aux spécificités des MAC. En effet, au vu, des voies d’exposition et des modes de transmission des contaminations aux risques biologiques, les actions de protection développées pour ce risque pourraient permettre l’élaboration d’une nouvelle forme d’intervention pour les MAC. Cette dernière considèrerait les soignants comme agissant face aux poly-expositions et producteurs de leurs actions de protection, qui vont au-delà des équipements de protection prescrits.Despite preventive efforts to reduce occupational exposure to antineoplastic drugs (ADs), the problem remains. The literature on the subject points to the need to characterize, assess and train professionals. In this article, using ergotoxicology as a tool, we will look at how multiple exposures to multiple nuisances and the associated protective measures arise in the work of healthcare workers, by means of hand -wiping samples and self -confrontation interviews. Hand wiping carried out before and after actions identified as potentially exposing, revealed the presence of ADs in all samples (n = 20). The compound handled on the sampling day was found in only 25% of the samples. Only two samples (out of 9) showed an increase in the level of hand contamination after a potentially exposing action. Although these data have helped to reveal part of the enigma of exposure to ADs, they do not yet allow us to characterize it. Nonetheless, our methods have enabled us to identify the determinants of contamination at different activity levels, which still need to be examined in greater depth in the rest of the prevention project. The interview data show that, despite a lack of training, carers can identify potential sources and areas of exposure. Our results lead us to believe that our methods have enabled carers to enter a "zone of proximal development", where their knowledge of biological risks could serve as a resource for better chemical risk management. These data also show that carers take action on a daily basis in the face of multiple exposures, and produce protective measures that go beyond the prescribed protective equipment. Given the routes of exposure and modes of transmission of biological risk contamination, the protective actions developed for this risk could contribute to the development of a new form of intervention for ADs.Innovation and Transformation for Prevention Activity of Professional Risk

Measles outbreak linked to insufficient vaccination coverage in Nouvelle-Aquitaine Region, France, October 2017 to July 2018

International audienc

Urine biomonitoring of occupational exposure to methotrexate using a highly sensitive UHPLC-MS/MS method in MRM(3) mode

Methotrexate (MTX) is widely used as antineoplastic drug (AD) and as an immunosuppressive. As a result, many healthcare professionals are exposed to this drug which is classified as dangerous to handle due to its reproductive toxicity in humans. Since the 1990 s, cases of internal contamination of professionals handling this molecule have been reported in the literature and even recently MTX was detected in the urine of professionals. To date, there is no toxicological reference value for occupational exposure to MTX. Given the toxicity of this molecule, the internal contamination of professionals must be reduced and kept as low as possible according to the ALARA principle (as low as reasonably achievable). The aim of this work was to develop an UHPLC-MS/MS method in MRM (Multiple Reaction Monitoring) and MRM(3) modes for routine application in MTX occupational biomonitoring. Good linearity (r greater than 0.997), precision (CV < 15 %), and accuracy (94.97-97.80% of the nominal value in MRM mode; 105.90-112.25% in MRM(3) mode) were achieved. This method is reliable with high specificity and high sensitivity especially in MRM(3) mode and has better LOD and LLOQ (1 ng/L and 2.5 ng/L) than published methods to date. The MRM(3) mode increases the signal-to-noise ratio compared to the MRM mode. It was then applied routinely for the biological monitoring of healthcare professionals exposed to methotrexate. One hundred and seventeen urine samples from 93 healthcare professionals occupationally exposed to methotrexate were analyzed. Fifteen healthcare professionals (16.1 %) were found to be contaminated with methotrexate. Urine concentration levels ranged from 2.5 to 380 ng/L with a median value of 8.9 ng/L. Such efficient analytical tool is essential for the routine biological monitoring of healthcare professionals exposed to methotrexate. It also enables the traceability of occupational exposure to this molecule and the evaluation of the effectiveness of preventive measures such as individual and collective protective equipment

Analyst

5-Fluorouracil (5-FU) is one of the most widely used antineoplastic drugs handled by healthcare professionals (HCP). To monitor occupational exposure to 5-FU, a highly sensitive ESI-UHPLC-MS/MS method was developed for the assay of its main human metabolite, alpha-fluoro-beta-alanine (FBAL), in urine. After a derivatization step, solid phase extraction was used for the urine. Good linearity (r > 0.996), precision (CV < 14.76%), and accuracy (bias < 12.16%) were achieved. The lower limit of quantification (LOQ), 20 pg ml-1, is the lowest one published to date. Seven urine samples from 73 HCP exposed to 5FU were positive for FBAL, indicating 5FU contamination (9.6%). FBAL urine concentrations ranged from 25 to 301 pg ml-1. Such an efficient analytical tool combining high specificity with high sensitivity is essential for the reliable detection and routine biological monitoring of healthcare professionals occupationally exposed to this widely used antineoplastic drug. This method allows biomonitoring of occupational exposure to 5-fluorouracil in a routine manner, with the aim of assessing the effectiveness of collective and individual protective measures