Idiopathic Pulmonary Fibrosis: What do we Know about the Role of Occupational and Environmental Determinants? A Systematic Literature Review and Meta-Analysis

The objectives of this systematic review of original articles published up until August 2021 and meta-analyses were to identify the links between occupational and non-occupational environmental exposures, types of occupations and idiopathic pulmonary fibrosis (IPF). Sixteen selected case-control studies were qualified as good level with Newcastle-Ottawa quality assessment scale. Sensitivity analyses highlighted the role of choice of control group, tobacco adjustment and diagnostic tools. Significantly increased risks of IPF were observed (OR (95%CI): for metals (1.42(1.05-1.92)), wood (OR:1.32(1.02-1.71)), and general dust (OR:1.32(1.08-1.63)) exposures. Subgroup analyses found a significantly elevated risk for: hardwood (OR:1.75 (1.13-2.70)), organic dusts (OR:1.72 (1.20-2.46)) and pesticides (OR:2.30 (1.30-4.08)), while no significant change was noted for softwoods and solvents. Smoking adjustments: general dust (1.45 (1.04-2.03)/organic dust (2.5 (1.49-4.22)/metals (1.87 (1.16-3)/wood dust OR: 1.16 (0.86-1.61)/pesticide exposure 2.4 (0.84-6.9) were calculated. Among agricultural workers, the risk was also increased (OR:2.06 (1.02-4.16)). Few environmental data were available and no significant associations detected. Thus, these meta-analyses highlighted the role of some occupational exposures in IPF occurrence. A more accurate and thorough assessment of exposures over the entire working life as well as on the duration and intensity of exposure and complex of multi-pollutant exposure is needed in future research and clinical practice.

Matrice emplois-exposition pour le SARS-CoV-2 (COVID-19) : création de « Mat-O-Covid », validité et perspectives

L’évaluation de l’exposition est difficile pour le chercheur du domaine des risques professionnels. L’objectif du travail est de développer et de valider une matrice emplois-exposition (MEE) pour l’exposition professionnelle au SARS-CoV-2 appelée « Mat-O-Covid ». Grâce à un groupe d’expert français, la matrice a été développée pour tous les travailleurs sur la profession et les catégories socioprofessionnelles de 2003 (avec une passerelle de transcodage vers la Classification internationale type des professions de 2008) et un focus sur le secteur de soin et médicosocial. La moyenne des codages des experts a été utilisée comme estimation pour l’exposition « sujets » (collègues et/ou public) et « patients » pour le focus secteurs sanitaires, ainsi que la probabilité de prévention pour chaque. Les corrélations intraclasses ont été considérées comme bonnes à excellentes, sauf pour la prévention en santé. Comparées à la matrice américaine O*Net, l’évaluation a été considérée comme satisfaisante. En conclusion, une MEE « Mat-O-Covid » fournissant une probabilité d’exposition professionnelle au SARS-CoV-2 aura des implications pour la recherche et en santé publique, sous réserve de connaître ses limites et de poursuivre sa validation.

Professional drivers and cardiovascular risk: APPTIV cohort

Background

Professional drivers have a high risk of morbidity, including myocardial infarction. Bus, taxi and truck drivers have most often constituted the studied populations. However, if the transport sector faces road risk, 70% of employees in all activity sectors are exposed to this risk in France. Most often studied by the analysis of global working time, the real driving time and the distance travelled are rarely taken into account, whereas they are potentially modifiable factors.

Purpose

To assess the associations between exposure to road risk by taking into account driving time and the number of kilometers travelled professionally and certain cardiovascular risk factors, in different sectors of professional activity.

Method

Based on the APPTIV cohort, data from 984 men and women employees from 94 companies in France was collected from 2018 to 2019, during occupational health medical visits focused on road risk. The number of Kms / month (<400 (ref); <1600; ≥1600) and the duration of driving (hours / d <1 (ref); <4; ≥4) were studied according to the respective tertiles. A variable with 9 classes was created. Logistic regressions adjusted for age, gender and activity sectors were carried out to explain the associations with certain cardiovascular factors (Hypertension, overweight (≥25 kg/m2), obesity (30 kg/m2) Hypertriglyceridemia (≥1.7 mmol/l), Hypercholesterolemia, HypoHDLemia).

Results

The population studied came from 23.30% of the transport sector, 23.30% of the construction sector, 26.75 of the public administration and 4.78% of the trade sector. After adjustments, the estimated risks of hypertension according to the driving time or the number of km travelled are not significant. Driving between 1 and 4 hours and more than 4 hours per day increases the risk of obesity, by: OR: 1.85 (1.22–2.80); 1.85 (1.19–2.86), the risk of hypertriglyceridemia of 1.39 (1.0–1.95); 1.54 (1.09–2.18). Traveling more than 1600 km / m increases the risk of hypertriglyceridemia by 1.5. People driving between 400 and 1600 km / m with a driving time between 1 and 4 h / d or those covering more than 1600 km with long driving times (>4 h / d) have an estimated risk of obesity at 1.82 (1.05–3.14) and 1.87 (1.13–3.11) respectively. Those traveling over 1600 km / m with long driving times (>4 hrs / day) have a 1.5 times risk of hypertriglyceridemia.

Conclusion

Taking into account the number of hours of driving and the kilometers travelled professionally, this study highlighted some employee profiles with high cardiovascular risk, accessible to medical and professional prevention measures.

Funding Acknowledgement

Type of funding source: None

Cardio-vascular risk factors according to different profiles of night work and shift work

Background

The shift-night work concerns around 17% workers in our modern society with evident need of this type of organisation for productivity and economic reasons for the companies. if the impact of this global organisation pattern on cardiovascular disease or risk factors is more and more documented, it remains unclear which types of rotating or night work are really involved and which are the impact on cardiovascular risk of being exposed currently or in the past to these different types of shift-night work.

Purpose

To study possible relationships between arterial blood pressure, anthropometric markers, fasting biomarkers, and sleep disturbances, and different exposure profiles of night work and/or shift work.

Methods

A cross-sectional study was conducted among 65.126 workers aged 18–70 at baseline in the French random population-based Constances cohort. Four exposure groups were defined: (1) workers with current permanent night work, (2) current night shift workers 3x8, (3) day workers with past night and/or shift work, (4) day workers without night and/or shift work during their work history (reference group). Logistic regression models adjusted for age, sex, socio-economic position, and personal history of ischemic cardiovascular disease (CVD) were performed to assess associations between clinical risk markers for CVD at baseline and these exposure groups.

Results

Compared with the reference group, current and past night workers had a significant higher risk of obesity (Body Mass Index≥30). Permanent night workers had a significant higher risk of metabolic syndrome, mostly due to abdominal obesity, hypertriglyceridemia (>1.7 mmol/l) and low level of high density lipoprotein. Even if day workers with past night/shift work had no statistically significant over-risk of metabolic syndrome, they presented significantly higher risks for the same three criteria as observed for the permanent night workers. However, only hypertriglyceridemia was significantly more frequent among 3x8 workers. Among current night workers, 3x8 had a higher risk of sleep disturbances while permanent had not. Sleep disturbances over-risk was also observed among day workers with past night/shift work. No over-risk of hypertension, hypercholesterolemia, hyperglycemia, and elevated levels of gamma-glutamyl-transferase was observed among the three groups.

Conclusion

The results support the need for enhanced cardiovascular follow-up of workers exposed to night and/or shift work. However, it is also necessary to follow regularly and specifically current day workers with a past night and/or shift work history.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): INRS: institut National de Recherche et de Sécurité

Job stress and occupational status in a French cohort

BACKGROUND

The goal of this study was to examine a large, varied occupational French cohort for possible relationships between various dimensions of occupational stress, on the one hand, and the occupational status and socio-demographic characteristics of workers on the other.

METHODS

Data was taken from the first, cross-sectional phase of the VISAT study (aging, health, and work), which took place in 1996. Participants were randomly drawn from the patient lists of about one hundred occupational physicians in three regions of southern France. The current study concerned 2,768 wage earners born in 1944, 1954, or 1964. The material consisted of 59 questions aimed at assessing a broad set of working conditions, some of which were proxy measures of the dimensions described in the Karasek and Siegrist models.

RESULTS

From a principal component analysis, three main factors were extracted that accounted for 40% of the total variance. The first factor (a=0.79) included items that referred to the decision latitude in the Karasek model and items that referred to the reward dimension in the Siegrist model. The second factor (a=0.77) was made up of items tapping physical stressors, while the third factor (a=0.71) pooled items that corresponded fairly well to psychological demands in the Karasek model. Highly significant relationships (p<10(-4)) were found between the mean factor scores and both occupational status and educational level, with a lower occupational status and educational level being associated with greater lack of job control and rewards, higher physical stress, but lower psychological demands. Less job control and fewer rewards were also found to be greater in older workers (p<10(-3)) and females (p<10(-4)).

CONCLUSION

Our results thus confirm the existence of a strong association, in a French cohort, between occupational status and dimensions of job stress known to be associated with adverse health outcomes.

High-resolution computed tomography abnormalities in ex-insulators annually exposed to asbestos dust

BACKGROUND

characterize To the effects of high asbestos exposure during annual periods of insulation.

METHOD

170 ex-workers underwent clinical examination, spirometry, standard chest X-rays and high-resolution computed tomography (HRCT). Asbestos exposure was retrospectively assessed for latency, duration, and intensity.

RESULTS

Sixty-six percent of these workers were annually exposed to high concentrations of asbestos dust. Respiratory symptoms were mild. One hundred and nineteen subjects had pleural or pulmonary changes on HRCT, compatible with asbestos exposure. Localized pleural thickening was found in 113 subjects (66.5%); pulmonary nodules or lines in 35 (20.6%). The presence of pleural plaques was linked to intensity of asbestos exposure (P <.01), and length of employment (P <.05). Parenchymal lesions were related to intensity (P <.05) and duration of exposure (P <.05). Lung function of subjects with X-ray changes was not significantly altered.

CONCLUSIONS

Annual asbestos exposure led to a high prevalence of pleural plaques and to mild parenchymal anomalies.

[Cardiovascular risk factors and shift work in men living in Haute-Garonne, France]

OBJECTIVE

The goal of this study was to examine the relationship between shift work and cardiovascular risk factors in a cross sectional survey.

MATERIAL AND METHODS

2 610 men of the PRIME study, aged 50-60 years, residing in Haute-Garonne (France) and selected from health centers and various firms were screened. White-collar workers, retired and disabled men at the time of the study were excluded so the analysis was performed on a sample of 1,341 subjects. Work was categorized as day work (n = 1,161) and three types of shift work: 2 x 8 (n = 108), 3 x 8 (n = 41) and night (n = 31). A comparison of cardiovascular risk factors was performed in the different types of work.

RESULTS

Univariate analysis showed that systolic blood pressure was significantly higher among 2 x 8 workers (132.7 +/- 17.4 mmHg) than in other shift workers and day workers (126.9 +/- 15.1 mmHg). The same difference was observed for diastolic blood pressure. Plasma triglycerides were significantly higher among night workers (1.60 +/- 0.76 g/l) than among day workers (1.29 +/- 0.81 g/L). Logistic regression analysis showed that the risk of hypertension, defined as systolic (> or = 140 mmHg) and diastolic (> or = 90 mmHg) blood pressure and/or antihypertensive drug, was 2 times higher among 2 x 8 shift workers (OR: 2.14, 95% CI [1.42-3.23]) than among day workers after adjustment for BMI, alcohol and tobacco consumption and plasma triglyceride levels. The same result (OR: 1.99, 95% CI [1.28-3.12] was obtained with a different definition of hypertension (systolic > or = 160 mmHg and/or diastolic > or = 95 mmHg blood pressure and/or antihypertensive drug). Among night workers the risk of triglycerides > 2 g/L was higher (OR: 2.52, 95% CI [1.06-6.01] than among day workers. The risk of both hypertension (140/90 mmHg) and hypertriglyceridemia in comparison to day workers was (OR: 2.01, 95% CI [1.33-3.03]) and (OR: 2.44, 95% CI [1.14-5.21]) for 2 x 8 shift workers and night shift workers respectively.

CONCLUSION

The results of this study, putting into evidence a relationship between shift work, hypertension and high level of triglycerides, justify a careful screening by occupational physicians of cardiovascular risk factors among shift workers.