Objectives Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical students is more effective in improving knowledge, satisfaction and a positive attitude towards OH than non-case-based textbook learning. Methods Participants, 141 second year medical students, were randomised to either case-based e-learning or text-based learning. Outcome measures were knowledge, satisfaction and attitude towards OH, measured at baseline, directly after the intervention, after 1 week and at 3-month follow-up. Results Of the 141 participants, 130 (92%) completed the questionnaires at short-term follow-up and 41 (29%) at 3-month follow-up. At short-term follow-up, intervention and control groups did not show a significant difference in knowledge nor satisfaction but attitude towards OH was significantly more negative in the intervention group (F¼4.041, p¼0.047). At 3-month follow-up, there were no significant differences between intervention and control groups for knowledge, satisfaction and attitude. Conclusions We found a significant decrease in favourable attitude during the internship in the experimental group compared with the control group. There were no significant differences in knowledge or satisfaction between case-based e-learning and textbased learning. The attitude towards OH should be further investigated as an outcome of educational programmes.

Background:The etiology of the central nervous system (CNS) tumors remains largely unknown. The role of pesticide exposure has been suggested by several epidemiological studies, but with no de nitive conclusion. Objective: To analyze associations between occupational pesticide exposure and primary CNS tumors in adults in the CERENAT study. Methods: CERENAT is a multicenter case-control study conducted in France in [2004][2005][2006]. Data about occupational pesticide uses -in and outside agriculturewere collected during detailed face-to-face interviews and reviewed by experts for consistency and exposure assignment. Odds ratios (ORs) and 95% con dence intervals ( 95% CI) were estimated with conditional logistic regression.Results: A total of 596 cases (273 gliomas, 218 meningiomas, 105 others) and 1 192 age-and sex-matched controls selected in the general population were analyzed. Direct and indirect exposures to pesticides in agriculture were respectively assigned to 125 (7.0%) and 629 (35.2%) individuals and exposure outside agriculture to 146 (8.2%) individuals. For overall agricultural exposure, we observed no increase in risk for all brain tumors (OR=1.04, 0.69-1.57) and a slight increase for gliomas (OR=1.37, 0.79-2.39). Risks for gliomas were higher when considering agricultural exposure for more than 10 years (OR=2.22, 0.94-2.24) and signi cantly trebled in open eld agriculture (OR=3.58, 1.20-0.70). Increases in risk were also observed in non-agricultural exposures, especially in green space workers who were directly exposed (OR=1.89, 0.82-4.39), and these were statistically signi cant for those exposed for over 10 years (OR=2.84, 1.15-6.99).Discussion: These data support some previous ndings regarding the potential role of occupational exposures to pesticides in CNS tumors, both inside and outside agriculture.

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Background: The etiology of the central nervous system (CNS) tumors remains largely unknown. The role of pesticide exposure has been suggested by several epidemiological studies, but with no definitive conclusion. Objective: To analyze associations between occupational pesticide exposure and primary CNS tumors in adults in the CERENAT study. Methods: CERENAT is a multicenter case-control study conducted in France in 2004-2006. Data about occupational pesticide uses - in and outside agriculture - were collected during detailed face-to-face interviews and reviewed by experts for consistency and exposure assignment. Odds ratios (ORs) and 95% confidence intervals (95%CI) were estimated with conditional logistic regression. Results: A total of 596 cases (273 gliomas, 218 meningiomas, 105 others) and 1 192 age- and sex-matched controls selected in the general population were analyzed. Direct and indirect exposures to pesticides in agriculture were respectively assigned to 125 (7.0%) and 629 (35.2%) individuals and exposure outside agriculture to 146 (8.2%) individuals. For overall agricultural exposure, we observed no increase in risk for all brain tumors (OR=1.04, 0.69-1.57) and a slight increase for gliomas (OR=1.37, 0.79-2.39). Risks for gliomas were higher when considering agricultural exposure for more than 10 years (OR=2.22, 0.94-2.24) and significantly trebled in open field agriculture (OR=3.58, 1.20-0.70). Increases in risk were also observed in non-agricultural exposures, especially in green space workers who were directly exposed (OR=1.89, 0.82-4.39), and these were statistically significant for those exposed for over 10 years (OR=2.84, 1.15-6.99). Discussion: These data support some previous findings regarding the potential role of occupational exposures to pesticides in CNS tumors, both inside and outside agriculture.