Objectives To depict the present situation regarding ENM-workers medical and epidemiological surv... more Objectives To depict the present situation regarding ENM-workers medical and epidemiological surveillances in France and discuss its advancement. Methods During 2008-2010 the InVS conducted an exploratory study based on in site visits of French facilities using/producing ENM with aim to explore the ENM exposure circumstances, ENM-workers medical surveillance and other epi-surveillance development prerequisites. This "field" information was completed with systematic scientific and statutory bibliography reviews and discussions within two working groups. One included scientists from the French Institute for Public Health Research (IReSP) and focused the epi-surveillance development aspects, while another included physicians from the Occupational medical inspection department at the Ministry of Labour and focused medical surveillance aspects. Results Since neither epidemiologic nor individual medical surveillance existed specifically for ENM-workers despite a likelihood of exposure in some facilities, InVS developed a protocol for an integrated surveillance system of French workers potentially exposed to ENM. It consists of a multi-step methodology starting with an ENM-exposure registry. ENM-workers will be identified using a 3-level approach: 1-selection of companies concerned with ENM exposure (based on questionnaire and compulsory declaration), 2-in site exposure assessment and identification of the job/tasks with ENM exposure (based on jobexposure-matrix construction, further supplemented with measurements), and 3-registration of ENM-workers (based on inclusion criteria and additional self-questionnaire). The registration is planned for three years focusing two ENM, carbon nanotubes and nano-TiO 2. The two corresponding prospective cohorts will pursue epidemiologic surveillance objectives and serve as a basis for performing cross-sectional/panel studies with specific research objectives. Conclusion The French ENM-workers surveillance is actively developing. Companies and workers inclusion questionnaires are designed and protocol is operational for starting in early 2013, after approval from national ethical committees (still awaited). The results coming from the first six-month operation should be informative in terms of data quality, numbers of facilities and workers with ENM-exposure likelihood.
Objectives To identify dose-response relationship between lung cancer incidence and cumulative ex... more Objectives To identify dose-response relationship between lung cancer incidence and cumulative exposure to the main occupational carcinogens as assessed by experts making use of an initial algorithmic exposure assessment within the two-phase design. Methods A population-based case-control study including 246 cases and 531 controls was conducted in NorthEastern France. Detailed occupational and personal risk factors were obtained in face-to-face interviews based on a task-based questionnaire and a series of job-specific questionnaires. In the conceptual framework of a two-phase design, cumulative expert-based exposure scores were obtained in a subset of 215 cases and 269 controls stratified on smoking and a prior algorithmic exposure assessment. The cases and controls included in the expert assessment were chosen in order to over-sample rare exposure categories. The data were analysed using logistic regression models adapted to two-phase data. This analysis makes use of the subset of subjects with expert assessments but also of the initial data set from which the subset was sampled. Results Expert based cumulative exposure scores were lower than the corresponding algorithmic scores. The correlation between algorithmic and expert-assessed cumulative exposure scores were high for asbestos (r = 0.80) but less so for crystalline silica (CS) (r = 0.60) and polycyclic aromatic hydrocarbons-PAH (r = 0.56). We identified significant dose-response relationships (DRR) for asbestos, CS and Diesel Motor Exhaust (DME) with significant ORs exceeding 2 in the respective highest tertiles of cumulative exposure. The dose-response relationship with PAH was borderline significant but the OR in the highest tertile was 1.96 (95%CI [1.11-3.46]). All DRRs were steeper when using expert-based scores than when using algorithmic scores. Conclusion Dose-response relationships between lung cancer incidence and cumulative exposure scores could be identified based on expert-assessment in a subset of cases and controls chosen to be informative in the framework of a two-phase design.
Objectives To depict the present situation regarding ENM-workers medical and epidemiological surv... more Objectives To depict the present situation regarding ENM-workers medical and epidemiological surveillances in France and discuss its advancement. Methods During 2008-2010 the InVS conducted an exploratory study based on in site visits of French facilities using/producing ENM with aim to explore the ENM exposure circumstances, ENM-workers medical surveillance and other epi-surveillance development prerequisites. This "field" information was completed with systematic scientific and statutory bibliography reviews and discussions within two working groups. One included scientists from the French Institute for Public Health Research (IReSP) and focused the epi-surveillance development aspects, while another included physicians from the Occupational medical inspection department at the Ministry of Labour and focused medical surveillance aspects. Results Since neither epidemiologic nor individual medical surveillance existed specifically for ENM-workers despite a likelihood of exposure in some facilities, InVS developed a protocol for an integrated surveillance system of French workers potentially exposed to ENM. It consists of a multi-step methodology starting with an ENM-exposure registry. ENM-workers will be identified using a 3-level approach: 1-selection of companies concerned with ENM exposure (based on questionnaire and compulsory declaration), 2-in site exposure assessment and identification of the job/tasks with ENM exposure (based on jobexposure-matrix construction, further supplemented with measurements), and 3-registration of ENM-workers (based on inclusion criteria and additional self-questionnaire). The registration is planned for three years focusing two ENM, carbon nanotubes and nano-TiO 2. The two corresponding prospective cohorts will pursue epidemiologic surveillance objectives and serve as a basis for performing cross-sectional/panel studies with specific research objectives. Conclusion The French ENM-workers surveillance is actively developing. Companies and workers inclusion questionnaires are designed and protocol is operational for starting in early 2013, after approval from national ethical committees (still awaited). The results coming from the first six-month operation should be informative in terms of data quality, numbers of facilities and workers with ENM-exposure likelihood.
Objectives To identify dose-response relationship between lung cancer incidence and cumulative ex... more Objectives To identify dose-response relationship between lung cancer incidence and cumulative exposure to the main occupational carcinogens as assessed by experts making use of an initial algorithmic exposure assessment within the two-phase design. Methods A population-based case-control study including 246 cases and 531 controls was conducted in NorthEastern France. Detailed occupational and personal risk factors were obtained in face-to-face interviews based on a task-based questionnaire and a series of job-specific questionnaires. In the conceptual framework of a two-phase design, cumulative expert-based exposure scores were obtained in a subset of 215 cases and 269 controls stratified on smoking and a prior algorithmic exposure assessment. The cases and controls included in the expert assessment were chosen in order to over-sample rare exposure categories. The data were analysed using logistic regression models adapted to two-phase data. This analysis makes use of the subset of subjects with expert assessments but also of the initial data set from which the subset was sampled. Results Expert based cumulative exposure scores were lower than the corresponding algorithmic scores. The correlation between algorithmic and expert-assessed cumulative exposure scores were high for asbestos (r = 0.80) but less so for crystalline silica (CS) (r = 0.60) and polycyclic aromatic hydrocarbons-PAH (r = 0.56). We identified significant dose-response relationships (DRR) for asbestos, CS and Diesel Motor Exhaust (DME) with significant ORs exceeding 2 in the respective highest tertiles of cumulative exposure. The dose-response relationship with PAH was borderline significant but the OR in the highest tertile was 1.96 (95%CI [1.11-3.46]). All DRRs were steeper when using expert-based scores than when using algorithmic scores. Conclusion Dose-response relationships between lung cancer incidence and cumulative exposure scores could be identified based on expert-assessment in a subset of cases and controls chosen to be informative in the framework of a two-phase design.
Uploads
Papers by Ng Ng