The aim of this study was to describe changes in employment and income following a diagnosis of occupational asthma, and to determine what factors might affect these changes.Two hundred and nine patients with occupational asthma were reviewed on average 3.1 yrs after the diagnosis had been made. They were contacted by telephone or were sent a self-administered questionnaire by post. Multiple logistic regression models were constructed to determine which variables were associated with loss of employment after the diagnosis.At the time of review, 44% of patients had left their previous job and 25% were currently unemployed. Remarkably, 32% remained exposed to the offending agents in the same job. Forty six percent of the patients had suffered a reduction of income (84% of those who had left their employer versus 19% of those still employed in the same company (p<0.001)). Claims for compensation, size of the company, level of education, and age at the time of diagnosis were significantly associated with a risk for becoming unemployed or having a new employer after the diagnosis of occupational asthma.Occupational asthma results in severe socioeconomic consequences. The French compensation system for occupational asthma should be revised, as the criteria currently used to determine compensation for this disease largely underestimate the social and occupational damages.

A hospital-based case-control study of the association between past occupational exposure to asbestos and pleural mesothelioma was carried out in five regions of France. Between 1987 and 1993, 405 cases and 387 controls were interviewed. The job histories of these subjects were evaluated by a group of experts for exposure to asbestos fibers according to probability, intensity, and frequency. A cumulative exposure index was calculated as the product of these three parameters and the duration of the exposed job, summed over the entire working life. Among men, the odds ratio increased with the probability of exposure and was 1.2 (95% confidence interval (CI) 0.8-1.9) for possible exposure and 3.6 (95% CI 2.4-5.3) for definite exposure. A dose-response relation was observed with the cumulative exposure index: The odds ratio increased from 1.2 (95% CI 0.8-1.8) for the lowest exposure category to 8.7 (95% CI 4.1-18.5) for the highest. Among women, the odds ratio for possible or definite exposure was 18.8 (95% CI 4.1-86.2). We found a clear dose-response relation between cumulative asbestos exposure and pleural mesothelioma in a population-based case-control study with retrospective assessment of exposure. A significant excess of mesothelioma was observed for levels of cumulative exposure that were probably far below the limits adopted in most industrial countries during the 1980s.

Aims: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. Methods: A total of 322 hairdressing apprentices and 277 office apprentices (controls) were studied. Two cross sectional surveys were conducted in 1994 and 1996/97 with longitudinal follow up for a subgroup of apprentices (191 hairdressing apprentices and 189 office apprentices). Results: In the initial phase, the prevalence of respiratory symptoms was significantly lower among hairdressing apprentices than among office apprentices. Lung function test results showed significantly higher values for hairdressing apprentices. Non-specific bronchial reactivity was similar in the two groups. In the final phase, results for respiratory symptoms were similar. The incidence of respiratory symptoms was not significantly different between hairdressing apprentices and office apprentices. Subjects who dropped out had lower values for FVC and FEV 1 in the initial phase than those who completed the final phase. There was a significant deterioration of FEV 1 and FEF 25-75% in hairdressing apprentices compared to office apprentices. There was a link between atopy and the incidence of most of the respiratory symptoms (day/night cough, wheezing, dyspnoea, mucosal hyperresponsiveness) and between smoking and the incidence of bronchial hyperreactivity. There was no significant correlation between change in lung function tests and specific hairdressing activities reported at the end of the apprenticeship or with environmental working conditions in hairdressing salons. Conclusions: Although a healthy worker effect can be suspected, results showed a significant deterioration of baseline values of lung function tests in the hairdressing apprentice group. However, no clear link was shown between change in lung function tests and specific parameters of occupational activities.

No abstract

M Me ea as su ur re em me en nt t o of f b br ro on nc ch hi ia al l r re es sp po on ns si iv ve en ne es ss s b by y f fo or rc ce ed d o os sc ci il ll la at ti io on n t te ec ch hn ni iq qu ue e i in n o oc cc cu up pa at ti io on na al l e ep pi id de em mi io ol lo og gy y Changes in resistance (∆R 0 %), frequency dependence of resistance (∆P) and resonant frequency (∆F%) determined by the FOT were compared to the ∆FEV 1 %. Receiver operating characteristic (ROC) curves were established to determine values of the changes in FOT parameters which corresponded to the best sensitivity and specificity for classifying the subjects as hyperresponsive or nonresponsive on the methacholine challenge test.Significant correlations were observed between ∆FEV 1 % and ∆R 0 %, ∆P and ∆F% respectively. The ROC curves showed the following cut-off values of FOT parameters to be the best values for classifying the subjects according to the presence or absence of 20% fall in FEV 1 : a 65% increase in R 0 (sensitivity 75%; specificity: 76%); a decrease of 65×10 -3 hPa·l -1 ·s 2 in P (sensitivity 58%; specificity 83%); a 50% increase in F (sensitivity 75%; specificity 62%).Our results suggest that the FOT is a useful test for assessment of bronchial hyperresponsiveness when compared to spirometry, and can be applied to epidemiological studies of a bronchial challenge test in normal active working populations.

These results confirm the links between life satisfaction and the factors generally recognized as its determinants. On the other hand, no effect of past occupational characteristics on life satisfaction long after retirement was shown.

Retrospective assessment of asbestos exposure--I. Case-control analysis in a study of lung cancer: efficiency of job-specific questionnaires and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S83-S95. In a lung cancer study in Northern Germany the asbestos exposure assessment obtained from detailed supplementary questionnaires (SQ) was compared to the assessment obtained by the application of two job exposure matrices (JEM) to the job history. The study includes 391 incident male cases and the same number of controls from the general population, matched by sex, age, and region. Almost 16% of the subjects are considered as never having been exposed to asbestos and 24% are classified as certainly exposed according to both of the JEM, the corresponding percentages of the SQ-method being 68% and 32%. Sixty percent are considered by the JEM as having an intermediate probability of exposure. In general, the agreement between the different methods is better when the exposure definition is restricted to definite exposures, the corresponding Kappa statistic being 0.67 for the comparison between both JEM and 0.44/0.39 between the JEM and the SQ. The positive agreement between SQ and JEM (reference) increases from 12% and 17% for subjects with low probability of exposure to 61% and 69% for those with definite exposures. A ranking according to cumulative exposure shows some dose-response relationship for each of the three methods with a smoking-adjusted OR in the highest category of 1.85 (95% CI: 1.01-3.38) for the SQ method and 2.47 (95% CI: 1.40-4.37) and 2.94 (95% CI: 1.73-4.99) for the two JEM. The results are discussed with reference to the conceptual differences between the methods and their potential scope in future studies.

A retrospective study was conducted to evaluate lung retention of particles containing cerium in subjects with and without previous occupational exposure to mineral dusts. Analytical transmission electron microscopy was performed on 459 samples of bronchoalveolar lavage (BAL) fluid and 75 samples of lung tissue. Study of the distribution of mineralogical species in human samples showed that particles containing cerium were encountered in less than 10% of subjects. The proportion of subjects with particles containing cerium in their biological samples was not different between controls and subjects with previous occupational exposure to fibrous or nonfibrous mineral dusts. This was considered as the background level of lung retention of cerium in the general population. By contrast, determination of the absolute concentration of particles containing cerium in BAL fluid and lung tissue samples showed that 1 2% (from BAL fluid) and 15% (from lung tissue) of subjects with previous exposure to mineral particles had high lung retention of particles containing cerium. This study is believed to be the first one in which lung retention of cerium was estimated in the general population.