qwl and occupational risks : risks at work and health ......ankle foot 1. carpal tunnel syndrome 2....
TRANSCRIPT
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QWL and occupational risks : risks at work and health
inequalities
Yves Roquelaure 1,2
1. Inserm U1085 – Equipe ESTER, Université d’Angers, France2. Service de pathologie professionnelle et santé au travail, CHU Angers, France
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I. QWL and work intensification• Globalization of the economy
• Technological revolution (new technologies of information)
• Major changes in work organization and management practices– Rationalization of the work process (lean management, new public policies)– Downsizing, subcontracting, – Flexibility of employment
• Increased job insecurity and temporary employment
• Ageing of the workforce (in many countries)
Work intensificationHow to promote sustainable working conditions throughout
working life? 2
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Evolution of occupational exposure
o Persistent traditional exposure physical and chemical constraints
o Increased time and psychosocial pressures
o Increase of psychosocial constraints at work
o Cumulative exposure on blue-collar and low grade white-collar workers
3
Cumulative industrial and market constrains
48,0
55,759,5
64,3 65,4
1991 1998 2005 2013 2016
N E E D T O C H A N G E T A S K F O R A N O T H E R I N E M E R G E N C Y
Enquêtes Conditions de travail, DARES
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4
0% 20% 40% 60% 80% 100%
Senior civil servants
Higher managerial clerical & com.…
Employed engineers and technical…
Schoolteachers and related
Interm. Health and social service…
Intermediate clerical and admin. civil…
Intermediate sales and service…
Technicians (except tertiary sector)
Supervisors, foremen
Lower occupational civil servants
policemen and soldiers
Clerical occupations
Trade employees
Carers
Skilled workers in the industry
Skilled workers in crafts
Drivers
Handling and storage skilled workers
Unskilled workers in the industry
Unskilled workers in crafts
Farm workers and equivalent
Whole
0 1 2 ou +
Work-related exposures to physical factors: a source of inequalities in health
Source: Roquelaure et al; Arthritis Rheum 2006
• Exposure to biomechanical factors according to occupation in the Pays de la Loire region (European consensus criteria)
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5
Exposure to carcinogens (%)
Accumulation of exposure to physical, chemical and psychosocial constraints according to the occupational category
French SUMER 2010 survey (DARES)
Enquête SUMER 2010, 47,983 travailleurs actifs
Y Roquelaure – Travail et Santé - Colloque Constances - 9-10 novembre 2017
Accumulation of work-related constrains (%) (biomecanical, chemical, organizational)
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Work intensification du travail and work disability
0.7% in 1960 to 5.3% in 2010 / active populationSource Vallat (2002)
Disability (all causes) 1960-2010 (USA) Disability for low back pain1955-1990 (UK)
6
Working days loss (millions/an)
Y Roquelaure – Travail et Santé - Colloque Constances - 9-10 novembre 2017
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7
Population fraction of sickness absence attributable to work factors – GAZEL cohort 1995-2001(Melchior et al, Am J Pub Health, 2005)
Y Roquelaure – Travail et Santé - Colloque Constances - 9-10 novembre 2017
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Physical/chemical/ergonomic occupational exposures and healthy life expectancy in the GAZEL cohort(Platts et al, Occup Environ Med 2016)
8
Y Roquelaure – Travail et Santé - Colloque Constances - 9-10 novembre 2017
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48 762
42 535
38 740
12 948
0
5 000
10 000
15 000
20 000
25 000
30 000
35 000
40 000
45 000
50 000
55 000
60 000
20002001200220032004200520062007200820092010201120122013201420152016
Total MP RGSS
Total TMS RGSS (Tableaux 57, 69, 79, 97 et 98)
Total TMS Tableau 57 RGSS
Total TMS Tableau 57 épaule RGSS
Révision du paragraphe A du tableau 57 relatif à
l'épaule
II. Occupational diseases: 2000-2016Epidemics of Overuse syndromes
- Musculoskeletal disorders (1990-2000’)- Mental health disorders (2000-2010’)
←
9(Source CNAMTS, 2017)
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Work-related Musculoskeletal Disorders (WR-MSDs)
• Work-related Musculoskeletal Disorders
• Umbrella term for soft tissue disorders related to occupational overuse– Repetition strain injuries (RSI)– Cumulative trauma disorders (CTS)– Overuse syndromes, …
• Painful conditions– Pain (focal, regional, multiple)– Tendinopathy– Nerve entrapment (CTS)– Vascular disorders (Raynaud’s syndrome)
• Multifactorial origin in relation with overuse duringworking activities
• Major occupational health problem– Industrialized countries and emerging countries (globalization)– High impact on working capacities and employability– High socioeconomic costs
1010
Bernardino RamazziniDe Morbis Artificum Diatriba,
1713
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11
WR-MSDs : a major occupational health problem
WR-MSDs (EWCS survey, 2010)
• Most common declared work-related symptoms in Europe
• Backache: 25%• Muscular pain: 23%
• High exposure to risk factors for MSDs• Repetitive movements: 62% • painful positions: 46% • Carrying/moving loads: 36%
• All sectors involved• Agriculture ++• Construction ++
Occupational Diseases (EU, 2005)
EODS: European Occupational Diseases Statistics , obligatory list
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Occupational diseases: musculoskeletal disorders of the upper extremity (compensation table 57, 69), knees (table 79) and low back (table 97, 98)(2015)
Shoulder
Low backElbow
WristHand
Knee
AnkleFoot
1. Carpal tunnel syndrome2. Shoulder tendinitis (rotator cuff syndrome)3. Epicondylitis
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WR-MSDs compensated as occupational diseases in the French agriculture (MSA)
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French regional disparities in compensation
of UE-MSDs (2015)
Pays de la Loire region:
- 5.5% of the French
population
- 1.3 M salaried workers,
- socioeconomic structure
similar to that of France
Frequency index
= number of UE-MSDs (Table
57) compensated for 1 000
workers
France: IF = 4.3
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15
Epidemiology of MSDs in the Pays de la Loire region• Pays de la Loire region
– 1,100,000 workers
– 5,5% of France
• Prevalence of UE-MSDs: 12.4%– Shoulder tendinopathy 7.1%
– Lateral epicondylitis 3.0 %
– CTS and wrist-hand MSDs 4.1 %
• Workers with UE-MSDs: ~120,000– Shoulder tendinopathy ~70,000
– Lateral epicondylitis ~30,000
– CTS and wrist-hand MSDs ~40,000
InVS source: Pays de la Loire MSD network; données redressées par calage sur marge (référence recensement INSEE)
The European Clinical Practice Guidelines enable occupational doctors to track down early signs of musculoskeletal disorders (MSDs) of upper limbs. To facilitate the handover of the procedure and to help and guide the doctors through its implementation, the INRS and the InVS have produced a series of videos detailing the operations to be done.
SALTSA. Videos to help the diagnosis of UE-MSDs
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Self-questionnaire (MSDs): Constances cohort
• Nordic style questionnaire on symptoms (preceding 12 months and 7 days)
• Musculoskeletal disorders and treatment
16
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17
Prévalence of persistent pain: Constances cohort(Carton et al. BEH 25 octobre 2016; n° 35-36)
Y Roquelaure – Académie Nationale de Médecine 27-02-2018
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18
Activity
Physical- Maintain a static posture to grasp - Repeat cutting movements- Move with the production line, …
Psychological- Assess the turkey’s condition- Collect as much meat as possible- Assess space- Schedule knife sharpening, …
Social- Help co-workers to complete the
cutting- Inform her co-workers of the
breasts’ condition, …
II. Multiple dimensions of the work activities
From N Vézina, UQAM, Canada
Turkey breast boningMs Walch
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DURATION (time constraints)
effort repetitiveness extremepostures
STRAINS
FUNCTIONAL CAPACITIES
RISK
Health Status (RCS)Age
GenderExperienceSkills
Shoulder strainsLoad handled Deltoid force
(with arm abducted). 0 N . 320 N. 5 N . 960 N. 10 N . 1,600 N
Functional capacities. Reference population ? . Reference level: shoulder strength ?. Reference time exposure ? Cumulative load with gradual reduction of the tissue tolerance limitArmstrong et al., 1986; Cnockaert et al, 1993; Chaffin et al, 2007
Biomechanical models of WR-MSDsSoft tissue « strains / functional capacities» imbalance model
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20
WR-risk factors for MSDsShoulder tendinopathy• Repetition• Posture• Force• Stress• Work organisation
Carpal tunnel syndrome• Repetition• Posture• Force• Vibration• Work organisation
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Self-questionnaire (Biomechanical exposure): Constances cohort
21
. Protocol of the Pays de la Loire study
. Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders.. Sluiter JK, RestKM, Frings-Dresen MH. Scand. J. Work. Environ. Health . 2001;27 Suppl 1:1–102.
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Biomechanical exposure : Constances cohort (men)
22
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Y Roquelaure – 201523
Paradox of dentist workstation ergonomics
• Improvement of the anthropometryof the workstation
• Advances in equipment ergonomics
• Work rationalization– Focus on productive tasks (treatments)– Increase of professional gestures
– Fewer breaks/ position changes
– High scapular postural load
– Long use of motor units without break
– Musculoskeletal overexertion due to a staticposture
– Trapezius Myalgia
• One of the most exposed professions to MSD...
23Thorn et al. (2002)
Winkel & Weestgaard, 2007
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The psychosocial dimension of MSDs
Y Roquelaure - 2014 24
Intensity of the pain (in black) - unpleasant aspect of the pain (in white).
Charest et al, 1991
A painful experience with similar pain intensity …
Relationships between MSDs and psychosocial factors:
• Epidemiology: Bongers, 2006; Kausto , 2010; Krause, 2010; Hauke, 2011, Lang, 2012• Psychophysiology: Hagg et al, 1991; Johansson et al, 2003; Madeleine et al, 2010
• Work psychology: Sauter et Swanson, 1996; Pezé, 1998; Dejours, 2005; Clot, 2012
during the delivery Finger crush with a hammer Slap in the face
Vis
ual
an
alo
gic
scal
e
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Biomechanical factors
Individual bio-psycho-social characteristics and resources
Psychosocial factors
25
Biopsychosocial risk model for WR-MSDs
StressMSDs
Beyond biomechanics: personal and occupational psychosocial risk factors for WR-MSDs:
• Epidemiology: Bongers, 2006; Kausto , 2010; Krause, 2010; Hauke, 2011, Lang, 2012• Psychophysiology: Hagg et al, 1991; Johansson et al, 2003; Madeleine et al, 2010
• Work psychology: Sauter et Swanson, 1996; Pezé, 1998; Dejours, 2005; Clot, 2012
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“MSDs, a symptom of rigidity of organizations that want to be flexible” (F Hubault, 1998)
Organizational and ergonomic models of WR-MSDs
Biomechanicalstrains
Stress
Insufficient operational
leeway
WR-MSDs
Gesture perturbation
Caroly et al., 2007
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Adapted from N Vézina, UQAM
Conditions and means(organizational conditions, tools and
technologies, physical environment)
Experience, skills, know-how
Task and work demands(quantity and quality)
Social environment(managers, supervisors,
co-workers)
Differences between work prescribed and actually performed
Production (goods, services)
adjustments of operating strategies
operational leeway
Physical, psychological and mental strains
Variability
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Concept of “operational leeway”
• Formal and informal activity– undertaken by workers - performing constant operating
readjustments - to cope with the task variability– “Intelligence of the task” recognized for craftwork but
underestimated for industrial work (de Montmollin, 1990)– Hidden form of “added value” provided by workers to achieved
production and increase reliability of the production system.
• “Space of freedom” (P. Falzon, 2013)– available or constructed by workers to elaborate alternative
strategies and ways of working according to their skills,knowledge and values in order to achieve production targets,while reducing psychological, mental and physical strains andavoiding negative health effects”.
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Y Roquelaure - 201529
D’après Assunçao & Laville (1996)
Experienced
women with MSDExperienced men
without MSD
Inexperienced
men without MSD
Unofficial forms of support in institutional catering
Support for physical demands
Support for know-how demands
Cooperation and collective operational leewayProportion of employees reporting they have
tiring or painful postures at work, in 2005, in %
Proportion of employees judging they can
get help from their colleagues if they ask for it, in 2005, in %
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French COSALI cohort : increased risk of CTS for workers in temporary work and those working with colleagues in temporary work (Rigouin et al IAOEH 2013; Petit et al Appl Ergon 2015)
3. Productivity loss
4. Increased work demand for experienced workers
5. Increased absenteeism of experienced workers
6. Experienced workers replaced by temporary workers
1. Skills and know-how of experienced workers not officially recognized
2. Temporary workers without sufficient skills and know-how to cope with the complex task
Management practices and risk of WR-MSDs: counterproductive effects of temporary work
From Franchi et al, 1995
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Direct determinants of MS strains
Shoulder tendinopathy related to turkey boning
. Biomechanical constraints
. Psychosocial stress
. Individual characteristics
Indirect determinants at company level
. Industrial process
. Technical organization
. Commodities (ex. meat for barbecue)
. Managerial practices
. Human resources
. …
. Work station design
. Equipment
. rate of production (ex. production line for meat for barbecue)
. Social relationships with…. Direct supervisor. Colleagues, . ..
Indirect determinants at workstation level
Indirect determinants at market/ society levels
. Poultry industry vertical integration
. Consumer demand (ex. barbecue)
. Distributor, retail, grocery demand
. Veterinary regulation
. Trade regulation
. …
“Relationships between week end weather forecast and workers Thursday work demand”
1
2
3
4
Economic, organizational and managerial dimensions of WR-MSDs: Vertical integration of the industry and the chain of determinants of WR-MSDs
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Biomechanical factors
Individual bio-psycho-social characteristics and resources
Psychosocial factors
32
StressMSDs
WORK ORGANISATION (work situation level)Technical Organizational Human resources
ORGANISATION & MANAGEMENT PRACTICES (company level)Technical Organizational Human resources
Economic environment Social and political environments
Multidimensional model of occupational health (MSDs)
Roquelaure Safety Health Work 2016;7: 171-4
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Psychological
demand
Supervisor
social support
Co-workers
social support
Decision
authority
Skills discretion
industrial work
rate constraints
Market work rate
constrains
(public/customer’
s demand)
Biomechanical
strains
High perceived
workload
Work with arm
over shoulder
level
Work with arm
abducted
Perceived
stress
at follow-up
Shoulder pain
at follow-up
BMIAge≥40
Shoulder MSDs, work-related psychosocial and organizational factors: recent epidemiological findings
COSALI cohort: Men (n=840) (Epi-Prev-TMS; Santé publique France)
Bodin J, Garlantézec R, Costet N, Descatha A, Viel JF, Roquelaure Y. Risk factors for shoulder pain in a cohort of French workers: A Structural Equation Model. Am J Epidemiol. 2018;187(2):206-213. 33
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Demande
psychologique
Supervisor social
support
Co-workers
social support
Decision
authority
Skills
discretion
Work rate due to
industrial
constraints
Work rate due to
external demand
(public, customer)
Biomechanical
strain
High perceived
workload
Work with arm
over shoulder
level
Work with arm
abducted
Perceived
stress at follow
up
Shoulder pain
at follow-up
Shoulder MSDs, work-related psychosocial and organizational factors: recent epidemiological findings
COSALI cohort: Men (n=840) (Epi-Prev-TMS; Santé publique France
Bodin J, Garlantézec R, Costet N, Descatha A, Viel JF, Roquelaure Y. Risk factors for shoulder pain in a cohort of French workers: A Structural Equation Model. Am J Epidemiol. 2018;187(2):206-213. 34
+
+
+
++
+
-
-+
Psychological
demand
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Occupational, social and economic consequences
– Major source of inequalities in health
• Higher risk for blue collar workers and few qualified white collar workers
• Higher risk for women and ageing workers
– Main source of sick leave and wok disability
– High direct and indirect costs for individuals, companies and Society
3535
Fear and avoidance to work
Motivation loss
Shoulder pain at work
Permanentshoulder pain
Shoulder tendinopathy
Work and social disability
Loss of productivity
Return/stay at work issues
Time
Impact of WR-MSDs
Sickleave
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OD 57 cost (2013): 57A (shoulder): 64,000 e – 57C (wrist): 9 000 e
Average duration of sick leave for MSD acknowledged as Occupational Disease (source: CRPRP Bretagne 2012)
Economical stakes according to injured body part:
Shoulder:o Average sick leave: 300 dayso Average cost: 50,000€
Elbow:o Average sick leave: 170 dayso Average cost: 17,000€
Wrist:o Average sick leave: 150 dayso Average cost: 12,000€
Lumbar spine:o Average sick leave: 330 dayso Average cost: 76,000€
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Low back-pain and extended disability: The contribution of Québec Task Force (1986)
0%
10%
20%
30%
40%
50%
60%
70%
80%
< 1 mois 1 à 3 mois 3 à 6 mois > 6 MOIS
Layout of compensations according to the duration of work absence
pourcentage des coûts
pourcentage des cas
7,4 % of the casescause
70 % of costs.
$
$
$
Spitzer, W.O. (1986). Rapport du groupe de travail sur les aspects cliniques des affections vertébrales. IRSST
$
$
Acute Subacute Chronic
TIME
Return to work: 40% after 6 months, 20% after 1 year and 0 after 2 years
< 1 month 1 to 3 months 3 to 6 months > 6 months
Percentage of cases
Percentage of costs
Distribution of compensation costs according to the duration of work absence
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Intermittent pain
Chronic pain at work
MSD “disease”Situation incapacity
Difficulty to perform job tasks
Work disability
Impossible job retention
Absenteeism
Permanent pain
Etiological factors: biomechanical, psychosocial et organizational
Prognostic factors: biomechanical, psychosocial (individual and work-related) et organizational
Risk factors for work disability : biomechanical, psychosocial (individual and work-related) et organizational
MSDs: from pain work disability
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• Multifactorial origin Multidimensional approach of the prevention of MSDs
• Global and systemic assessment of risk factors/determinants
1. Biomechanical factors job station level
2. Psychosocial / stress factors job and work situation levels
3. Organizational factors work situation and company levels
4. Socioeconomic factorsmarket and Society levels
III. Integrated prevention of WR-MSDs
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Biomechanical model– Technical approach– Ergonomics of workstation /equipment– biomechanical exposure Targeting an hypothetical operating range
at low/acceptable risk of MSDs
Bio-psycho-social model– Psychological approach– Intervention regarding social relationships
and stress factors– Individual intervention of return to work– Physical / psychological reconditioning
Ergonomic model– Systemic approach– Intervention regarding workstation, work
organization and management practices– Participatory ergonomic intervention – Individual / collective empowerment 40
Risk models of WR-MSDs should be combined to achieve multi-level integrated prevention
• Primordial prevention– Intrinsic prevention at
source (ex. ‘Machine’ UE Directive )
• Primary prevention – Limit the incidence of MSDs– Lowering danger / exposure
• Secondary prevention– Early diagnosis and
appropriate management of (sub)acute MSDs
• Tertiary prevention– Rehabilitation of chronic
MSDs to prevent incapacity and work disability
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1. Participatory interventions on factors modifiable by interventions in the working environment (health protection)
• Primordial/primay prevention & secundary/tertiary prevention• Integrated prevention
2. Participatory interventions on medical , lifestyle, social and cultural factors that can be modified within the community (health promotion)
• Education and health promotion• Global prevention « public/occupational health » (WHO, WHA60-26, 2007; NIOSH Total
workers health, 2012)
3. Improvement of the occupational health system• Effectiveness of occupational health services• Early diagnosis of work disability• Coordination of preventive / curative interventions
4. Sustainable prevention policies41
Global and integrated prevention of WR-MSDs
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Global and integrated prevention: the NIOSH Total
Workers Health® model
Integrated intervention: “A strategic and operational coordination of policies, programs & practices designed to simultaneously prevent work-related injuries & illnesses & enhance overall workforce health & well‐being”• Coordination and linkage of separate policies, practices & programs• Continuum of approaches (Sorensen et al. J Occup Environ Med 2013; 55(12):S12-S18.)
Preventive impact on work-related disorders : ? (Feltner et al. Ann Intern Med 2016)
www.centerforworkhealth.sph.harvard.edu
G. Sorensen (Symposium Total Workers Health, 2014)
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CONSTANCESA population-based cohort of 200,000 adults
for research and public health information in FranceMarcel Goldberg & Marie Zins
Population-based Cohorts Unit – UMS 11 INSERM
Yves Roquelaure
Coronel Institute AMC Amsterdam 6-8 December 2016
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Objectives
• Main objectives1. Building an open research infrastructure based on a large general-
purpose population-based cohort
2. Providing information on the health of the French population
• Specific focus• Aging & chronic diseases
• Social determinants of health and social inequalities
• Occupational and environmental factors
• Women’s health
• Biological, genetic and environment interactions
45
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General Design
46
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Sample
• Randomly sampled on age, gender,
SES
• Aged 18-69 years at enrollment
• Size : 200,000 subjects
• Random cohort of 400,000 non-
participants (control of selection
effects)
•Enrolment
• In Health Screening Centers (HSCs)
in different regions of France
47
Setting
-
Recruitment and enrolment
• Random drawing of eligible subjects in the national Retirement Fund database and mailed invitations to participate
• Signature of the consent form
• Health examination in the HSCs
• Questionnaires
– Health & Lifestyle
– Job History
– Women’s Health
– Working Conditions and Occupational Exposures
• Biobank
• Quality assurance program
4848
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CES Pilote 2012 2013 2014 2015 2016 2017 Total
Angoulême 443 1 005 1 084 1 697 1 560 136 5 925
Auxerre 272 90 362
Bordeaux 348 330 1 235 1 358 1 959 2 115 219 7 564
Caen 752 251 1 003
Haut Rhin 1 984 113 1 098
Le Mans 696 286 982
Lille 525 541 1 533 1 723 2 455 2 303 232 9 312
Lyon 351 1 098 1 772 2 619 2 495 261 8 596
Marseille 573 998 1 188 1 436 1 593 200 5 988
Nancy 229 1 051 1 609 2 612 2 885 302 8 688
Nîmes 214 648 783 1 067 1 055 116 3 883
Orléans 302 862 1 001 1 343 1 390 121 5 019
Paris-CPAM 1 080 2 271 2 742 3 519 3 444 358 13 414
Paris-IPC 244 1 134 2 403 2 406 2 497 305 8 989
Pau 751 657 827 1 359 1 348 1 361 136 6 439
Poitiers 308 649 798 1 403 1 095 116 4 369
Rennes 435 722 1 093 1 419 1 645 1 629 200 7 143
Saint-Brieuc 464 607 1 336 1 733 1 881 2 045 240 8 306
Saint-Nazaire 399 660 756 838 1 116 118 3 887
Toulouse 486 659 1 320 1 840 1 914 1 987 203 8 409
Tours 515 749 1 649 2 013 1 676 1 732 90 8 424
Total 3524 8 408 19 369 25 581 31 819 35 006 4 093 127 800 49
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Follow-up
• Questionnaires
– Annual self-questionnaire (at home; paper or Internet)
• Health examination in the HSCs
– Every 5 years
• Annual linkage to national administrative databases including the whole French population
– Health data: ”SNIIRAM” (pharmaceutical and health-care expenditures, hospital discharges)
– Professional and social data: National Retirement Fund (”CNAV”)
– Causes of death: national death register (“CépiDc-INSERM”)
50
-
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 …
Inclusion• Questionnaires à domicile et au centre d’examen
de santé (CES)• Examens au CES
Suivi « actif »• Auto-questionnaire annuel• Examens au CES tous les 5 ans
Suivi « passif »Extractions annuelles de bases de données nationales : • Sniiram (jusqu’à 3 ans avant inclusion) : Système national d'information inter-régimes de l'Assurance maladie• CépiDC : Centre d'épidémiologie sur les causes médicales de décès• Cnav : Caisse nationale d’assurance vieillesse
51
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Main data collected (1)
• Sociodemographic characteristics– Professional status, education, individual and household income, marital status, household
composition, social status of parents and spouse
– Life events, social network and psychological support
– Professional and social trajectory, including jobs, SES, periods of unemployment, sick leaves… (questionnaire, linkage to the CNAV database)
– Social security coverage
• Lifestyle– Tobacco & e-cigarette, alcohol, cannabis, eating habits, physical activity, sexual orientation
• Occupational factors– Exposure to chemicals, biomechanical, biological and psychosocial factors (questionnaire,
linkage to the JEMs developed by the Occupational Health Dpt of the French Agency for Public Health)
• Environment– Prospective collection of residential addresses and geocoding (linkage to environmental
databases: outdoor pollution, contextual indices: urbanization, deprivation index…); retrospective collection and geocoding for the OCAPOL project
52
-
53
-
• Health data (1)
– HSC examination
• Personal and family medical history (MD examination)
• Anthropometry (weight, height, waist-hip ratio, waist size), vision, hearing, spirometry, electrocardiogram, blood pressure, basic biology (blood count, glucose, total cholesterol, HDL cholesterol, ALT, creatinine, triglycerides, micro albumin, Gamma GT)
• For subjects 45 years old and over
– Cognitive function: Mini Mental State Examination (MMSE), Digit Symbol Substitution Test (DSST), Free and Cued Selective Reminding Test with Immediate Recall (FCSRT-IR), Trail Making Test, Verbal Fluency
– Physical function: Standing Balance Test, Walking Speed, Handgrip Strength Test and Finger-Tapping Test
54
Main data collected (2)
-
Main data collected (3)Health data (2)
– Questionnaires
• Self-reported health scales (perceived health, quality of life, mental health), pathologies (incident and prevalent diseases, limitations, disability, fractures)
• Women’s health: treatment of menopause, osteoporosis, benign breast disease, endometriosis and chronic pelvic pain, infertility and reproductive period, sexual and sexually transmitted diseases
– Extracted from the national administrative health databases (“SNIIRAM”)
• Healthcare utilization and management: visits to health professionals, drugs and other prescriptions, hospitalization data
• “Long-term diseases” (i.e. severe chronic diseases; ICD-10 codes)
• Sick leaves, handicaps, disabilities and injuries
• Hospital discharges: pathology (ICD-10 codes), medical and technical procedures
• Cause of death (CépiDc-INSERM)
55
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Biobank
• Collection of biosamples – Basic program: serum, plasma (Lithium Heparin), plasma (EDTA), whole blood,
urine
– Due to current shortage of funding, collected for only half of the subjects (n=100,000), with 20 aliquots
• Ambitions for growth depending on additional funding– Basic program for the whole cohort (n=200,000) with a larger number of
aliquots
– Optional programs (on subsets of participants depending on specific funding)
• Washed erythrocytes, RNA, proteins, mononuclear cells
• Feces, sperm, saliva, hair, nails
Implementation of the biobank will start in 2017
56
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Chronic diseasesAsthma-COPD overlap syndromeBlood inflammatory patterns and asthmaBody composition and respiratory diseasesChronic airflow limitation and accelerated lung function declineDepression and addictionDepression and cardiovascular diseasesDepression and socio-professional trajectoriesDepression over the lifespanDyspnea in respiratory diseasesHIV-associated neurocognitive disorders Mental health and homosexual behavior Obstructive lung disease and HIVRisk and protective factors for Parkinson’s disease
Heath care, Prevention, Screening, TreatmentsBreast and cervical cancer screening among diabetic and obese women Early screening of cirrhosis complicationsConsumption and seeking care in obese subjects Evaluation of long-lasting exposure to osteoporosis treatment Infertility, course and treatmentCare pathway and quality of primary careWaiting times for access to care
Women’s healthChronic pelvic painGestational DiabetesManagement of menopause Screening for cervical cancer and contraceptionSexual activity in diabetic womenUrinary incontinence
First applications for ancillary studies (1)
Observation, surveillanceBlood pressure Observatory in FrancePrevalence and determinants of visual impairments Surveillance of chronic respiratory diseasesSurveillance of diabetes
57
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First applications for ancillary studies (2)
Aging•Adiposity and inflammation in relation to cognitive
and motor function
•Analysis of big data in ageing
•Ascertainment of dementia cases
•Drugs and cognitive ageing
•Establishment of normative scores for standard
cognitive scores
•Frailty in the elderly
•Impact of professional retirement on cognitive
performances
•Individual and contextual proxies of cognitive
reserve
•Role of vascular risk factors in ageing phenotypes
•Working life occupation and cognitive ageing
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Occupational and environmental risksAir pollution and rhinitisArduous working conditions and agingCleaning agents and irritants and asthmaCOMETT-Cohort Observatory MSDsCOSET – Cohorts for occupational risks surveillanceCOSMOS France – Cohort of mobile phone users in FranceDisinfectants Use among Nurses and Type II Diabetes MellitusOccupational risks among teachers and researchersJob-exposure matrix for biomechanical factors Night work and ischemic heart diseaseChronic exposure to air pollution and cancerSurveillance of chronic respiratory diseases in relation to workWork organization and maintaining employment
MethodsPrevalence estimation using data from individual surveys and administrative databases
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Thank you for your attention!
Happiness at work
If it can be deduced from
employer costs !
Why not ?
web site : www.ester.univ-angers.fr
http://www.ester.univ-angers.fr/