Exposition des professionnels médicaux aux rayonnements ionisants et risque de cancer

Les expositions aux rayonnements ionisants (RI) à forte dose ont été reconnues comme facteur de risque de cancers (1). Les effets à long terme des rayonnements ionisants à faibles et moyennes doses restent débattus. De nombreuses études épidémiologiques portant sur le suivi des survivants des bombardements d’Hiroshima et de Nagasaki et sur le suivi des travailleurs exposés aux RI ont montré des augmentations de risque de cancer et de pathologies cardiovasculaires (2). Les professionnels de santé, notamment les radiologues, ont été les premières populations de travailleurs étudiées en raison des fortes expositions professionnelles qui prévalaient de la fin des années 1890 au début du XXème siècle. Suite à la mise en place du système de radioprotection, les doses reçues ont considérablement diminué, passant de 100 mSv par an au début du XXème siècle à moins de 5 mSv par an dans les années 1980 chez les manipulateurs de radiologie (3). Au cours des trente dernières années, le développement rapide de nouvelles techniques d’imagerie diagnostique, interventionnelle et scintigraphique, utilisant des RI, a entrainé une nouvelle augmentation de l’exposition aux RI chez certains professionnels de santé. Si ces nouvelles techniques permettent un bénéfice médical certain pour les patients, il est nécessaire d’évaluer l’impact de ces expositions chroniques sur les personnels médicaux exposés aux RI qui constituent une part importante de l’ensemble des travailleurs exposés aux RI (63 % des travailleurs français en 2013) (4). Dans ce contexte, deux articles ont été publiés récemment : l’un porte sur une étude américaine évaluant le risque de cancer chez les manipulateurs de radiologie effectuant des procédures interventionnelles guidées par fluoroscopie ; l’autre porte sur l’association entre exposition aux RI et incidence de cancers chez les personnels médicaux chinois exposés aux RI.

Source: Baysson, Hélène. (2017). Bulletin de veille scientifique (31).
http://bvs.mag.anses.fr/sites/default/files/BVS-mg-031-Baysson.pdf

Case-control study on occupational exposure to extremely low-frequency electromagnetic fields and glioma risk

Background: Exposure to extremely low-frequency electromagnetic fields (ELF-EMF) was in 2002 classified as a possible human carcinogen, Group 2B, by the International Agency for Research on Cancer at WHO.
Methods: Life time occupations were assessed in case-control studies during 1997-2003 and 2007-2009. An ELF-EMF Job-Exposure Matrix was used for associating occupations with ELF exposure (μT). Cumulative exposure (μT-years), average exposure (μT), and maximum exposed job (μT) were calculated.
Results: Cumulative exposure gave for astrocytoma grade IV (glioblastoma multiforme) in the time window 1-14 years odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.4-2.6, p linear trend <0.001, and in the time window 15+ years OR = 0.9, 95%CI = 0.6-1.3, p linear trend = 0.44 in the highest exposure categories 2.75+ and 6.59+ μT years, respectively.
Conclusion: An increased risk in late stage (promotion/progression) of astrocytoma grade IV for occupational ELF-EMF exposure was found.

Source: Carlberg, M., Koppel, T., Ahonen, M., & Hardell, L. (2017). American journal of industrial medicine.
http://dx.doi.org/10.1002/ajim.22707

Guide pour la prophylaxie et le suivi après une exposition au VIH, au VHB et au VHC

Ce document constitue une mise à jour du Guide pour la prophylaxie après une exposition au VIH, au VHB et au VHC dans un contexte non professionnel et du Guide pour une prophylaxie postexposition (PPE) à des liquides biologiques dans le contexte du travail édités par le ministère de la Santé et des Services sociaux en 2010 et en 2011 respectivement. Il est le résultat du fusionnement de ces deux publications.

Source: http://asstsas.qc.ca/msss-guide-pour-la-prophylaxie-et-le-suivi-apres-une-exposition-au-vih-au-vhb-et-au-vhc-0

Appraisal of levels and patterns of occupational exposure to 1,3-butadiene

Levels and extents of occupational exposures to 1,3-butadiene are not yet extensively evaluated. The present study is the first Italian study that evaluated exposure to 1,3-butadiene basing on a large sample of measurements and using several statistical analysis methods to identify high-risk exposure situations. The present study also intends to contribute to raise public awareness about occupational exposure levels to 1,3-butadiene.

Source: Scarselli A, Corfiati M, Di Marzi D, Iavicoli S. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3644

Chromosomal aberrations, sister chromatid exchanges, and micronuclei in lymphocytes of oncology department personnel handling anti-neoplastic drugs

Objective: Concern exists regarding the possible hazards to the personnel handling anti-neoplastic drugs. The purpose of the present study was to assess the genotoxicity induced by anti-neoplastic agents in oncology department personnel. Materials and methods: To do this, the frequency of chromosomal aberrations (CAs) induced in peripheral blood lymphocytes was assessed at G0 phase of the cell cycle using metaphase analysis, cytokinesis block-micronucleus (MN) assay and sister chromatid exchange (SCE) assay. These cytogenetic end points were measured among 71 nurses in oncology department and 10 drugstore personnel handling and preparing anti-neoplastic drugs. The results were compared to those of 74 matched nurses for age and sex not exposed to any anti-neoplastic agents. Results: There was no significant difference between the age of study subjects and control group (p > 0.05). The results showed that the mean frequency of cytogenetic damages in terms of CAs [chromatid breaks (p = 0.01), chromosome breaks (p = 0.005), total CAs (p = 0.001)], MN formation (p = 0.001), and SCE (p = 0.004) in lymphocytes of personnel handling anti-neoplastic drugs were significantly higher than those in control unexposed group. Conclusion: Results of the present study demonstrate the cytogenetic damage in peripheral blood lymphocytes of oncology department personnel. Suitable training and proper knowledge when handling anti-neoplastic drugs are emphasized to avoid potential health hazards caused by cytostatic agents.

Source: Mahmoodi, Majid, Soleyman-Jahi, Saeed, Zendehdel, Kazem, Mozdarani, Hossein, Azimi, Cyrus, Farzanfar, Farideh,... Rezaei, Nima. (2017). Drug and Chemical Toxicology, 40(2), 235-240. http://dx.doi.org/10.1080/01480545.2016.1209678

Occupational exposure to extremely low-frequency magnetic fields and risk for central nervous system disease

An update of a Danish cohort study among utility workers
Purpose: Evidence of whether exposure to extremely low-frequency magnetic fields (ELF-MF) is related to central nervous system diseases is inconsistent. This study updates a previous study of the incidence of such diseases in a large cohort of Danish utility workers by almost doubling the period of follow-up.
Methods: We investigated the risks for dementia, motor neurone disease, Parkinson disease, multiple sclerosis and epilepsy among 32,006 men employed at the 99 utility companies that supplied Denmark with electricity during the period 1900–1993. Cases were identified in the Danish National Patient Registry and the cohort was followed during 1982–2010. Exposure was estimated from a job-exposure matrix based on company records of job title and area of work and cohort members were allocated to one of three categories (<0.1, 0.1–0.99 and ≥1.0 µT).
Results: For dementia, multiple sclerosis and epilepsy the incidence rate ratios (IRR) were close to unity, but higher for motor neurone disease [IRR 1.24, 95% confidence interval (CI) 0.86–1.79] and lower for Parkinson disease (IRR 0.81, 95% CI 0.67–0.97) among workers exposed to ≥0.1 µT compared with the Danish population. For the highest level of exposure (≥1.0 µT), IRRs of 1.44, 1.78, 1.40 and 1.34 were observed for dementia, motor neurone disease, multiple sclerosis and epilepsy, respectively.
Conclusions: We observed elevated risks of dementia, motor neurone disease, multiple sclerosis and epilepsy and lower risks of Parkinson disease in relation to exposure to ELF-MF in a large cohort of utility employees.

Source: Pedersen, C., Poulsen, A. H., Rod, N. H., Frei, P., Hansen, J., Grell, K., ... & Johansen, C. (2017). International Archives of Occupational and Environmental Health, 1-10.
http://dx.doi.org/10.1007/s00420-017-1224-0

Interim Guidance for Managing Occupational Exposures to Zika Virus for Healthcare Personnel

Zika virus is primarily spread by the bite of an infected Aedes species mosquito. Sexual and maternal-fetal transmission have also been well described. Transmission via transfusion of blood products has been reported in Brazil, but to date, transmission of Zika virus via blood transfusion has not been reported in the United States. There is currently no clinical evidence that Zika virus is transmitted through the air.
In June 2016, there was a report of possible Zika virus transmission from an infected person to a family member in the United States; the exact mechanism of transmission and whether transmission occurred in the home or in a healthcare setting are unclear. There have been no reports of transmission of Zika virus from infected patients to healthcare personnel (HCP) or to other patients in healthcare settings. However, transmission related to occupational exposure to Zika virus has occurred in laboratory workers, including one in 2016 in which a research laboratorian became infected via a needlestick injury.

Source: https://www.cdc.gov/zika/hc-providers/infection-control/managing-occupational-exposures.html

Mesures de prévention et contrôle des infections pour la gestion des cas et des contacts d’oreillons en milieu de soins

Une éclosion de cas d’oreillons est survenue chez des résidents en médecine d’un centre hospitalier universitaire du Québec à l’automne 2016. Le cas source avait acquis son infection lors d’un séjour à l’extérieur du Canada et demeure dans une autre région sociosanitaire. Des cas se sont retrouvés dans plusieurs milieux de soins au Québec.
Selon les données recueillies lors des enquêtes épidémiologiques auprès des cas, la transmission semble être survenue directement entre les résidents en médecine, possiblement lors d’activités sociales plutôt que lors de prestations de soins.
Devant cette situation, la Direction générale de la santé publique (DGSP) du ministère de la Santé et des Services sociaux (MSSS) a demandé au Comité sur les infections nosocomiales du Québec (CINQ) de l’Institut national de santé publique du Québec (INSPQ) de produire un avis sur les mesures particulières de prévention et contrôle des infections (PCI) à mettre en place. Le présent document répond à ces préoccupations.

Source: https://www.inspq.qc.ca/sites/default/files/publications/2245_prevention_controle_infections_oreillons_milieu_soins.pdf

Establishing a policy framework for the primary prevention of occupational cancer

A proposal based on a prospective health policy analysis
Background: Despite our knowledge of the causes of cancer, millions of workers are involuntarily exposed to a wide range of known and suspected carcinogens in the workplace. To address this issue from a policy perspective, we developed a policy framework based on a prospective health policy analysis. Use of the framework was demonstrated for developing policies to prevent cancers associated with diesel engine exhaust (DEE), asbestos, and shift work, three occupational carcinogens with global reach and large cancer impact.
Methods: An environmental scan of existing prospective health policy analyses was conducted to select and describe our framework parameters. These parameters were augmented by considerations unique to occupational cancer. Policy-related resources, predominantly from Canada, were used to demonstrate how the framework can be applied to cancers associated with DEE, asbestos, and shift work.
Results: The parameters of the framework were: problem statement, context, jurisdictional evidence, primary prevention policy options, and key policy players and their attributes. Applying the framework to the three selected carcinogens illustrated multiple avenues for primary prevention, including establishing an occupational exposure limit for DEE, banning asbestos, and improving shift schedules. The framework emphasized the need for leadership by employers and government.
Conclusion: To our knowledge, this is the first proposal for a comprehensive policy framework dedicated to the primary prevention of occupational cancer. The framework can be adapted and applied by key policy players in Canada and other countries as a guide of what parameters to consider when developing policies to protect workers' health.

Source: Veglia, A., Pahwa, M., & Demers, P. A. (2017). Safety and Health at Work, 8(1), 29-35.
http://doi.org/10.1016/j.shaw.2016.07.001

Behaviour of chemical respiratory allergens in novel predictive methods for skin sensitisation

Asthma resulting from sensitisation of the respiratory tract to chemicals is an important occupational health issue, presenting many toxicological challenges. Most importantly there are no recognised predictive methods for respiratory allergens. Nevertheless, it has been found that all known chemical respiratory allergens elicit positive responses in assays for skin sensitising chemicals. Thus, chemicals failing to induce a positive response in skin sensitisation assays such as the local lymph node assay (LLNA) lack not only skin sensitising activity, but also the potential to cause respiratory sensitisation. However, it is unclear whether it will be possible to regard chemicals that are negative in in vitro skin sensitisation tests also as lacking respiratory sensitising activity. To address this, the behaviour of chemical respiratory allergens in the LLNA and in recently validated non-animal tests for skin sensitisation have been examined. Most chemical respiratory allergens are positive in one or more newly validated non-animal test methods, although the situation varies between individual assays. The use of an integrated testing strategy could provide a basis for recognition of most respiratory sensitising chemicals. However, a more complete picture of the performance characteristics of such tests is required before specific recommendations can be made.

Source: Basketter, D., Poole, A., & Kimber, I. (2017). Regulatory Toxicology and Pharmacology.
http://doi.org/10.1016/j.yrtph.2017.03.002

History of knowledge and evolution of occupational health and regulatory aspects of asbestos exposure science: 1900–1975

The understanding by industrial hygienists of the hazards of asbestos and appropriate ways to characterize and control exposure has evolved over the years. Here, a detailed analysis of the evolution of industrial hygiene practices regarding asbestos and its health risks, from the early 1900s until the advent of the national occupational health and safety regulatory structure currently in place in the US (early-to-mid 1970s) is presented. While industrial hygienists recognized in the early 1900s that chronic and high-level exposures to airborne concentrations of asbestos could pose a serious health hazard, it was not until the mid-1950s that the carcinogenic nature of asbestos began to be characterized and widespread concern followed. With the introduction of the membrane filter sampling method in the late 1960s and early 1970s, asbestos sampling and exposure assessment capabilities advanced to a degree which allowed industrial hygienists to more precisely characterize the exposure–response relationship. The ability of industrial hygienists, analytical chemists, toxicologists, and physicians to more accurately define this relationship was instrumental to the scientific community's ability to establish Occupational Exposure Levels (OELs) for asbestos. These early developments set the stage for decades of additional study on asbestos exposure potential and risk of disease. This was followed by the application of engineering controls and improved respiratory protection which, over the years, saved thousands of lives. This paper represents a state-of-the-art review of the knowledge of asbestos within the industrial hygiene community from about 1900 to 1975.

Source: Barlow, C. A., Sahmel, J., Paustenbach, D. J., & Henshaw, J. L. (2017). Critical Reviews in Toxicology, 1-31.
http://dx.doi.org/10.1080/10408444.2016.1258391

Fire Simulation and Cardiovascular Health in Firefighters

Background: Rates of myocardial infarction in firefighters are increased during fire suppression duties, and are likely to reflect a combination of factors including extreme physical exertion and heat exposure. We assessed the effects of simulated fire suppression on measures of cardiovascular health in healthy firefighters.
Methods: In an open-label randomized crossover study, 19 healthy firefighters (age, 41±7 years; 16 males) performed a standardized training exercise in a fire simulation facility or light duties for 20 minutes. After each exposure, ex vivo thrombus formation, fibrinolysis, platelet activation, and forearm blood flow in response to intra-arterial infusions of endothelial-dependent and -independent vasodilators were measured.
Results: After fire simulation training, core temperature increased (1.0±0.1°C) and weight reduced (0.46±0.14 kg, P<0.001 for both). In comparison with control, exposure to fire simulation increased thrombus formation under low-shear (73±14%) and high-shear (66±14%) conditions (P<0.001 for both) and increased platelet-monocyte binding (7±10%, P=0.03). There was a dose-dependent increase in forearm blood flow with all vasodilators (P<0.001), which was attenuated by fire simulation in response to acetylcholine (P=0.01) and sodium nitroprusside (P=0.004). This was associated with a rise in fibrinolytic capacity, asymptomatic myocardial ischemia, and an increase in plasma cardiac troponin I concentrations (1.4 [0.8–2.5] versus 3.0 [1.7–6.4] ng/L, P=0.010).
Conclusions: Exposure to extreme heat and physical exertion during fire suppression activates platelets, increases thrombus formation, impairs vascular function, and promotes myocardial ischemia and injury in healthy firefighters. Our findings provide pathogenic mechanisms to explain the association between fire suppression activity and acute myocardial infarction in firefighters.

Source: Hunter, A. L., Shah, A. S., Langrish, J. P., Raftis, J. B., Lucking, A. J., Brittan, M., ... & Graveling, R. (2017). Circulation135(14), 1284-1295.
https://doi.org/10.1161/CIRCULATIONAHA.116.025711

Parkinson’s disease and occupational exposures

A systematic literature review and meta-analyses
Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of relevant risk factors for Parkinson's disease.
Methods: Our search identified 103 original publications on associations between work and Parkinson's disease. GRADE guidelines were used to ensure high scientific quality, and reliable guidelines were applied to classify the papers. Of the 103 articles, 47 fulfilled good scientific standards while 56 were methodologically deficient and thus excluded from our meta-analyses.
Results: A total of 23 publications concerned work exposure to pesticides. The weighted relative risk estimate was 1.67 (95% confidence interval 1.42–1.97). A funnel plot and bias test indicated that some publication bias concerning smaller studies might have been present. The risk estimate was not influenced by study design (case–control, cohort, or cross-sectional study) or gender. Higher estimates were found when there was a hereditary taint or onset below age 60. Studies on exposure to metals or electromagnetic fields did not show increased risk.
Conclusions: Using an elaborated quality protocol, there is now strong evidence that exposure to any pesticide involves a ≥50% increased risk for developing Parkinson's disease.

Source: Gunnarsson, L. G., & Bodin, L. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3641

La chimie en quête d'alternatives

Lors de toute démarche de prévention du risque chimique, lorsque celui-ci n'a pu être évité ou supprimé, la substitution des produits chimiques dangereux au profit d'autres produits ou de procédés moins dangereux doit être envisagée. Pour autant, elle se heurte bien souvent à des réalités complexes. Une démarche de substitution se conçoit comme un véritable projet. Elle nécessite la mise en commun de compétences internes et externes à l'entreprise, depuis l'analyse préalable jusqu'à la mise en oeuvre de solutions et à l'évaluation de leurs conséquences.

Source: https://kiosque.inrs.fr/alyas/view/news/lettre/114/html#suite

Epigenetics and chemical risk management in the workplace

Ce guide présente une introduction complète à l'épigénétique, la science émergente des mécanismes biologiques dans l'ADN qui peuvent modifier notre activité génétique sans changer le code génétique lui-même. La connaissance de l'épigénétique est importante pour les travailleurs car elle pourrait apporter des preuves rétrospectives d'exposition à des agents chimiques (néfastes) et permettre l'identification précoce des substances chimiques dangereuses sur les lieux de travail.

Source: http://www.etui.org/fr/Publications2/Guides/Epigenetics-and-chemical-risk-management-in-the-workplace

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