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Ding M, Lawson C, Johnson C, Rich-Edwards J, Gaskins AJ, Boiano J, Henn S, Rocheleau C, Chavarro JE. Occupational exposure to high-level disinfectants and risk of miscarriage among nurses. Occup Environ Med 2021; 78:731-737. [PMID: 34039757 DOI: 10.1136/oemed-2020-107297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the association of occupational exposure to high-level disinfectants (HLDs) with risk of miscarriage among nurses. METHODS Our study included women who enrolled in the Nurses' Health Study 3 (2010-2020) and had at least one pregnancy during follow-up. Occupational exposure to HLDs was self-reported at baseline. Every 6 months, a follow-up questionnaire was sent to participants asking for detailed information on pregnancies. We used a discrete-time Cox model to calculate the HRs and 95% CIs of miscarriage according to exposure to HLDs. RESULTS Our study included 2579 nurses with a median of 5.6 years of follow-up (range: 1-9 years), and we documented 768 (19%) cases of miscarriage among 3974 pregnancies. Compared with women with no HLD exposure, the HRs of miscarriage were 1.08 (95% CI: 0.87 to 1.34) for past users and 0.84 (95% CI: 0.68 to 1.04) for HLD users. Compared with women with no HLD exposure, duration, frequency, and type of HLD and use of exposure controls were not associated with risk of miscarriage. When restricting to pregnancies that occurred within 12 months of HLD use, occupational exposure to unspecified types of HLD was significantly associated with higher risk of miscarriage (HR=1.78; 95% CI: 1.08 to 2.93). CONCLUSIONS We observed no associations between occupational use of HLDs and miscarriage, except when we restricted to pregnancies occurring within 12 months of assessed baseline exposure. Given the observational design and limited sample size, results should be interpreted cautiously.
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Affiliation(s)
- Ming Ding
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christina Lawson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Candice Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Janet Rich-Edwards
- Connors Center for Women's Health and Gender Biology and Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey Jane Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jim Boiano
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Scott Henn
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Carissa Rocheleau
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
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Dumas O, Gaskins AJ, Boggs KM, Henn SA, Le Moual N, Varraso R, Chavarro JE, Camargo CA. Occupational use of high-level disinfectants and asthma incidence in early- to mid-career female nurses: a prospective cohort study. Occup Environ Med 2021; 78:244-247. [PMID: 33452037 DOI: 10.1136/oemed-2020-106793] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/30/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Occupational use of disinfectants among healthcare workers has been associated with asthma. However, most studies are cross-sectional, and longitudinal studies are not entirely consistent. To limit the healthy worker effect, it is important to conduct studies among early- to mid-career workers. We investigated the prospective association between use of disinfectants and asthma incidence in a large cohort of early- to mid-career female nurses. METHODS The Nurses' Health Study 3 is an ongoing, prospective, internet-based cohort of female nurses in the USA and Canada (2010-present). Analyses included 17 280 participants without a history of asthma at study entry (mean age: 34 years) and who had completed ≥1 follow-up questionnaire (sent every 6 months). Occupational use of high-level disinfectants (HLDs) was evaluated by questionnaire. We examined the association between HLD use and asthma development, adjusted for age, race, ethnicity, smoking status and body mass index. RESULTS During 67 392 person-years of follow-up, 391 nurses reported incident clinician-diagnosed asthma. Compared with nurses who reported ≤5 years of HLD use (89%), those with >5 years of HLD use (11%) had increased risk of incident asthma (adjusted HR (95% CI), 1.39 (1.04 to 1.86)). The risk of incident asthma was elevated but not statistically significant in those reporting >5 years of HLD use and current use of ≥2 products (1.72 (0.88 to 3.34)); asthma risk was significantly elevated in women with >5 years of HLD use but no current use (1.46 (1.00 to 2.12)). CONCLUSIONS Occupational use of HLDs was prospectively associated with increased asthma incidence in early- to mid-career nurses.
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Affiliation(s)
- Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Audrey J Gaskins
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Krislyn M Boggs
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Scott A Henn
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Raphäelle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Jorge E Chavarro
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Departments of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Carlos A Camargo
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Departments of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Henrotin JB, Béringuier H, Groupe de Travail de L'étude GaT-Hospi GDTDLGH. [Working at the hospital during pregnancy: A descriptive national cross-sectional study in France]. SANTE PUBLIQUE 2020; 31:611-621. [PMID: 33124787 DOI: 10.3917/spub.195.0611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of the article is to describe the follow-up of pregnancies at work and occupational exposure to potential risks for pregnancy. METHODS A descriptive cross-sectional study was performed from April 1, 2017 to October 31, 2017 in the occupational health departments of French hospitals. After delivery and at the time of returning to work, 1,165 eligible workers were interviewed by occupational health physicians (OHPs). Socio-demographic information was self-reported. Occupational exposures were assessed by an OHP. Birth weight, gestational age, and sick leaves were also collected. RESULTS Among recruited workers, 51.8% were exposed to more than 5 occupational hazards. Biological and physical hazards were the most common hazards at the workplace. Note that heavy lifting ≥ 15 kg concerned 9.5% of workers. Only 20.1% of workers had a specific "pregnancy at work" medical visit with OHP during pregnancy; 26.8% benefited from workstation adjustments. In contrast, the level of sick leaves was high (86.7%). CONCLUSIONS Our data suggest that pregnant workers in hospitals must be strictly supervised.
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Dumas O, Le Moual N. Damaging effects of household cleaning products on the lungs. Expert Rev Respir Med 2019; 14:1-4. [PMID: 31682770 DOI: 10.1080/17476348.2020.1689123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Orianne Dumas
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Nicole Le Moual
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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Nassan FL, Lawson CC, Gaskins AJ, Johnson CY, Boiano JM, Rich‐Edwards JW, Chavarro JE. Administration of antineoplastic drugs and fecundity in female nurses. Am J Ind Med 2019; 62:672-679. [PMID: 31219624 DOI: 10.1002/ajim.23015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND We examined the association between the administration of antineoplastic drugs (AD) and fecundity among female nurses. METHODS AD administration and use of exposure controls (EC) such as gloves, gowns, and needleless systems were self-reported at baseline among 2649 participants of the Nurses' Health Study 3, who were actively attempting pregnancy. Every 6 months thereafter, the nurses reported the current duration of their pregnancy attempt. Multivariable accelerated failure time models were used to estimate time ratios (TR) and 95% confidence intervals (CI) adjusted for age, race, body mass index, smoking, marital status, hours of work, and other occupational risk factors. RESULTS Mean (standard deviation) age and BMI at baseline were 30.7 years (4.7) and 26.0 kg/m2 (6.4). Forty-one percent of nurses reported ever administering AD; 30% only in the past and 11% currently. The former administration of AD (TR = 1.02, 95% CI, 0.93-1.12) was unrelated to the ongoing duration of pregnancy attempt. Among nurses currently administering AD, those who had administered AD for 6 years and above had a 27% (95% CI, 6%-53%) longer duration of pregnancy attempt than nurses who never handled ADs in unadjusted analyses. This difference disappeared in multivariable analyses (TR = 1.01, 95% CI, 0.85-1.21). 93% (n = 270) of the nurses currently administering ADs reported consistent use of EC. These nurses had a similar median duration of pregnancy attempt to those who never handled AD (TR = 1.00, 95% CI, 0.87-1.15). CONCLUSIONS Administration of ADs did not appear to have an impact on fecundity in a cohort of nurses planning for pregnancy with a high prevalence of consistent ECs. Our results may not be generalizable to women who are less compliant with PPE use or with less availability to ECs. Therefore, it is possible that we did not observe an association between occupational exposure to AD and reduced fecundity because of lower exposure due to the more prevalent use of effective ECs.
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Affiliation(s)
- Feiby L. Nassan
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBoston Massachusetts
- Department of NutritionHarvard T. H. Chan School of Public HealthBoston Massachusetts
| | - Christina C. Lawson
- Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthCincinnati Ohio
| | - Audrey J. Gaskins
- Department of NutritionHarvard T. H. Chan School of Public HealthBoston Massachusetts
- Channing Division of Network MedicineHarvard Medical School and Brigham and Women's HospitalBoston Massachusetts
| | - Candice Y. Johnson
- Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthCincinnati Ohio
| | - James M. Boiano
- Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthCincinnati Ohio
| | - Janet W. Rich‐Edwards
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBoston Massachusetts
- Channing Division of Network MedicineHarvard Medical School and Brigham and Women's HospitalBoston Massachusetts
- Department of Medicine, Connors Center for Women's Health and Gender BiologyBrigham and Women's Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Jorge E. Chavarro
- Department of NutritionHarvard T. H. Chan School of Public HealthBoston Massachusetts
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBoston Massachusetts
- Channing Division of Network MedicineHarvard Medical School and Brigham and Women's HospitalBoston Massachusetts
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Quinot C, Amsellem-Dubourget S, Temam S, Sevin E, Barreto C, Tackin A, Félicité J, Lyon-Caen S, Siroux V, Girard R, Descatha A, Le Moual N, Dumas O. Development of a bar code-based exposure assessment method to evaluate occupational exposure to disinfectants and cleaning products: a pilot study. Occup Environ Med 2018; 75:668-674. [PMID: 29760172 DOI: 10.1136/oemed-2017-104793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/27/2018] [Accepted: 04/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Healthcare workers are highly exposed to various types of disinfectants and cleaning products. Assessment of exposure to these products remains a challenge. We aimed to investigate the feasibility of a method, based on a smartphone application and bar codes, to improve occupational exposure assessment among hospital/cleaning workers in epidemiological studies. METHODS A database of disinfectants and cleaning products used in French hospitals, including their names, bar codes and composition, was developed using several sources: ProdHyBase (a database of disinfectants managed by hospital hygiene experts), and specific regulatory agencies and industrial websites. A smartphone application has been created to scan bar codes of products and fill a short questionnaire. The application was tested in a French hospital. The ease of use and the ability to record information through this new approach were estimated. RESULTS The method was tested in a French hospital (7 units, 14 participants). Through the application, 126 records (one record referred to one product entered by one participant/unit) were registered, majority of which were liquids (55.5%) or sprays (23.8%); 20.6% were used to clean surfaces and 15.9% to clean toilets. Workers used mostly products with alcohol and quaternary ammonium compounds (>90% with weekly use), followed by hypochlorite bleach and hydrogen peroxide (28.6%). For most records, information was available on the name (93.7%) and bar code (77.0%). Information on product compounds was available for all products and recorded in the database. CONCLUSION This innovative and easy-to-use method could help to improve the assessment of occupational exposure to disinfectants/cleaning products in epidemiological studies.
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Affiliation(s)
- Catherine Quinot
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France
| | | | - Sofia Temam
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France.,Faculty of Medicine, University Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - Christine Barreto
- ProdHyBase, CClin Sud-Est, Saint-Genis-Laval, France.,ProdHyBase, Unit of Hygiene and Epidemiology, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Arzu Tackin
- AP-HP UVSQ, Equipe opérationnelle d'hygiène hospitalière, University Hospital of Poincaré, Garches, France
| | | | - Sarah Lyon-Caen
- INSERM, CNRS, Université Grenoble Alpes, U1209, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble (La Tronche), France
| | - Valérie Siroux
- INSERM, CNRS, Université Grenoble Alpes, U1209, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble (La Tronche), France
| | - Raphaële Girard
- ProdHyBase, Unit of Hygiene and Epidemiology, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Alexis Descatha
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France.,AP-HP UVSQ, Occupational Health Unit/Population-Based Epidemiological Cohorts Unit, UMS 011, University Hospital of Poincaré, Garches, France
| | - Nicole Le Moual
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France
| | - Orianne Dumas
- INSERM, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U1168, F-94807, Villejuif, France.,UVSQ, UMR-S 1168, University Versailles St-Quentin-en-Yvelines, F-78180, Montigny le Bretonneux, France
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