Occupational Epidemiology Division
This division conducts epidemiological studies aimed at highlighting deteriorations in health and occupational injuries due to working environments, occupational exposures to substances, or psychosocial factors. The studies carried out examine respiratory and cardiovascular pathologies, allergies, cancers, musculoskeletal disorders, reproductive disorders, disorders related to psychosocial factors, or occupational injuries. The division also conducts evaluative studies. The various studies can require appropriate statistics methods to be developed internally.
Occupational exposure to chemical agents
In the context of his occupational activity, nearly one in three workers is exposed to chemical agents in France. These exposures can cause diseases. The aim of epidemiological studies is to investigate the possible relationships between occupational exposures to these chemical agents and the risk of disease. However, in order to prevent diseases whose diagnosis is established several decades after exposure, the Division focuses on preclinical alterations as potential indicators of early effects before clinical manifestations may occur. These biomarkers studied are mainly markers of oxidative stress, inflammation and antioxidant activities, cardiovascular biomarkers, genotoxicity, and epigenetic markers. They are measured in different biological matrices: for examples, in blood or urine to examine systemic effects of exposure, exhaled breath condensate and exhaled breath to study local effects and exposure at target organ level e.g. the lungs. Linking these markers with atmospheric exposure measurements and exposure biomarkers will help to better understand the physiopathological mechanisms that occur before the onset of diseases and thus to optimize actions to prevent occupational risks.
Currently, early effect markers are investigated among workers exposed to metalworking fluids and among workers handling engineered nanomaterials.
The Division is also interested in endocrine disruptors. These are chemical substances or mixtures of natural or artificial origin which interfere with the hormonal system. They can have harmful effects on health. The epidemiological studies carried out concern the study of possible effects on reproduction or on the cardiovascular system …
© Gael Kerbaol - INRS
Publications
- Clerc-Urmès I, Grzebyk M, Hédelin G. Net survival estimation with stns. Stata Journal 2014; 14,1: 87-102.
- Clerc-Urmès I, Grzebyk M, Hédelin G. CENSUR working survival group (2017). flexrsurv: An R package for relative survival analysis. R package version 1.4.2, https://CRAN.R-project.org/package=flexrsurv.
Linking exposures related to the work organisation and Occupational Safety & Health (OSH)
How the work and the workplace are structured is crucial for the prevention of occupational risks. Work organizational characteristics include the structure and organization of the companies (working hours, pace of work, methods of management) but also their internal policies (prevention, training, human resources). These characteristics as well as the resulting working situations (strain / resources) may have negative or positive consequences on OSH (depression, well-being, musculoskeletal disorders, occupational injuries, etc.).
The Division carries out studies designed to quantify the relationship between these different factors, particularly those involving collective modifiable dimensions, and OSH. Studies take place in different workplaces (e.g. call-centres) or are designed to explore a specific aspect of work (e.g. night work) in voluntary companies. Some studies are based on existing data from large existing surveys (e.g. the Working Conditions Survey, carried out by the direction of the animation of research, studies and statistics, French Ministry of Labour) or cohorts (e.g. CONSTANCES carried out by the unit UMS 011, INSERM). This type of approach allows the exploration of the link between work determinants and rare health events.
The results are used to establish recommendations for good prevention practices, promote prevention measures for the workers with specific working conditions, or highlight organizational factors that could be implemented in order to promote healthy workplace.
© Gael Kerbaol - INRS
Publications
- Boini S, Kolopp M, Grzebyk M, Hédelin G, Chouanière D. Is the effect of work psychosocial exposure on depressive and anxiety disorders short-term, lagged or cumulative? (Submitted)
- Hella F, Radauceanu A, Atain-kouadio JJ, Payet R, Colin R. Multidisciplinary approach applied to activity analysis within a dynamic setting: driving light vehicles for postal delivery of mail and parcels. Pistes 2018; 20-2:10.4000/pistes.5733. (Article in English and French).
- Boini S, Chouanière D, Colin R, Wild P. Relationships between organizational workplace characteristics and perceived workplace strain in call-centers in France. Am J Ind Med 2013; 56(11):1317-28.
Health effects associated with occupational exposure to biological agents
Biological agents are ubiquitous in the environment, including the worksites. Moreover, they can be intentionally used in processes as in biotechnologies, waste treatments, etc. …They can present several risks for the health, due to their pathogenic, inflammatory, allergenic and/or carcinogenic potential properties. In contrast with chemical agents, there is no mandatory value for the biological agents. Epidemiological studies can provide knowledge about dose-response relationships and help the thinking on these mandatory values. Respiratory health effects are measured with standardized questionnaires, functional investigations such as spirometry, and measures of biomarkers such as fractional exhaled nitric oxide, in association with measures of airborne occupational exposure to these agents or their products (endotoxins, mycotoxins).
© Gael Kerbaol - INRS
Publications
- Duquenne P, Simon X, Demange V, Harper M, Wild P. Endotoxin deposits on the inner surfaces of closed-face cassettes during bioaerosol sampling: a field investigation at composting facilities. Annals of Occupational Hygiene 2015, May; 59(4):504-13.
- Demange V, Barrera C, Laboissiere A, Duquenne P, Simon X, Million I, Reboux G, Grzebyk M. Effects of plant features on symptoms and airway inflammation in compost workers followed over 18 months. Arch Environ Occup Health 2019; 18:1-10.
Evaluation of OSH prevention interventions or programs
Occupational evaluative epidemiology may investigate the functioning and the impact of prevention interventions or programs on workers’ health. The gold standard used to demonstrate the causal effectiveness of an intervention is the double-blind randomized controlled trial, an experimental methodology commonly used in clinical trials. In the area of OSH prevention, the interventions to be evaluated are complex and this methodology is not always possible. Quasi-experimental studies or even observational studies can be used, but the causal interpretation of the results has to be careful. As an illustration of observational evaluation study, the Division carried out a prospective cohort study in order to determine the effect of OSH education during formal schooling on the incidence of workplace injuries in young people starting their careers. The results suggest the relevance of integrating OSH in all trainings, with an approach mostly broader than the specific risks related to future jobs.
The division participated in a multidisciplinary project aimed at proposing an alternative method for the evaluation of complex interventions. This project, in collaboration with the agency for the improvement of working conditions (ANACT) and academic experts, led to an original and innovative book and a guide for the evaluation of the results of prevention interventions in the field of musculoskeletal disorders and psychosocial risks.
Publications
- Boini S, Colin R, Grzebyk M. Effect of occupational safety and health education received during schooling on the incidence of workplace injuries in the first 2 years of occupational life: a prospective study. BMJ Open 2017; 7:e015100.
- EVALIA: Guide for evaluating the interventions of prevention related to psychosocial risks or musculoskeletal disorders. (French guide). Available at https://www.inrs.fr/actualites/anact-inrs-guide-rps-tms.html; https://www.anact.fr/guide-devaluation-des-interventions-de-prevention-des-rps-tms
Development of methods and tools in occupational epidemiology
The Division is involved in methodological developments in order to accommodate existing methods to the specificities of occupational epidemiology and to contribute to the larger set of methods.
Net survival analysis aimed at studying the occurrence of health events in a specific population compared to a reference population for which rate tables exist. Applied in occupational epidemiology, it makes it possible to analyze the potential relationships between occupational exposures and health events after causes external to occupational activities are ruled out. The division is involved in developing specific methods to account for selection biases such as the "healthy worker effect".
The relationship between occupational exposures over a long period of work and health can be complex, not fully accounted for by the simple calculation of cumulative intensity or average exposure. This is the case when a latency period is at work and more generally when the effect of an exposure occurring at a given date takes place several years after with intensity depending on the time shift. The Division is involved in developing methods for sorting out timing and intensity of exposure in the relationship between exposure and health.
These methodological developments materialize through computer programs that are made available to scientific community.
Publications
- Clerc-Urmès I, Grzebyk M, Hédelin G. Net survival estimation with stns. Stata Journal 2014; 14,1: 87-102.
- Clerc-Urmès I, Grzebyk M, Hédelin G. CENSUR working survival group (2017). flexrsurv: An R package for relative survival analysis. R package version 1.4.2, https://CRAN.R-project.org/package=flexrsurv.