BACKGROUND: A qualitative study was conducted in 2008 of occupational physicians (OPs) in south-eastern France to document their attitudes, opinions and practices on prevention and screening of occupational cancers. This was done to provide elements to prepare the questionnaire of a quantitative study in 2009. METHODS: Semi-structured interviews were conducted using a structured interview guide with 20 OPs. The data collected were subjected to an analysis of thematic content type. RESULTS: The analysis revealed that OPs face many difficulties when preventing occupational cancers. For most of OPs, these difficulties appeared related to "external factors": lack of involvement of employers and minimization of risks by employers and employees. Lack of time, overload and, for some OPs, perceived lack of independence towards employers, were also mentioned as barriers to cancer prevention. This study also suggested hypotheses related to OPs themselves (internal factors): perceived lack of effectiveness and, trend to minimize the risks of occupational cancer in their geographical area. Finally, the results suggest a significant heterogeneity of OPs' practices regarding occupational cancer screening. CONCLUSION: These results raise several hypotheses that will be addressed further in the quantitative survey. They warn about the difficulties of a profession that seems to encounter a demographic and identity crisis.

PURPOSE: Physicians can play an important role in the reporting of occupational diseases (ODs), which are still under-reported in many countries. We aimed to identify physicians' difficulties in recognizing and reporting ODs and to study the characteristics of the physicians that do report ODs. METHODS: We conducted a telephone study in 2006-2007 among general practitioners (GPs), pulmonologists and rheumatologists in south-eastern France, concerning their knowledge, attitudes and practice in occupational health. Simple and multiple logistic regressions were performed to study factors associated with the issue of medical certificates for the claim process. RESULTS: Three hundred and ninety-one GPs, 95 pulmonologists and 96 rheumatologists participated. GPs reported significantly less often than specialists that they questioned their patients on past occupational exposure. They more frequently reported difficulties in identifying the occupational origin of diseases, and lack of knowledge on the OD reporting system. Issue of medical certificates for OD reporting was significantly more frequent among specialists than among GPs, among physicians considering that ODs are a public health problem, among those acquainted with the forms required to establish certificates, using internet to obtain information, having trade union activities, or having contact with occupational physicians (OPs). CONCLUSION: Initial and continuing training should be developed to encourage physicians, in particular GPs, to question patients on their working conditions and to become better acquainted with claim procedures. Physicians should also be provided with tools for identification of ODs that are suited to their practices, and collaboration with OPs should be fostered.

Introduction Identifying patients with psychological stress at work (PSW) and managing them are complex tasks. We studied the frequency of PSW as perceived by general practitioners (GPs), their practices in such situations, and the factors associated with these perceptions and practices, especially drug prescription. Methods Cross-sectional telephone study of GPs in southeastern France with a questionnaire about knowledge, attitudes, behavior, and practices in occupational health. We explored the management of PSW with a case-vignette of a 45-year-old supermarket cashier consulting for psychological stress that he or she attributes to the job. Results In all, 391 GPs participated; 87.2% reported that they encountered PSW often in their practice. GPs reported that they would treat the case-vignette patient by prescribing anxiolytics (66.5%) or sick leaves (65.7%) or referral to an occupational physician (80.3%) or a mental health specialist (44.8%). A multiple logistic regression showed that GPs reported prescribing an anxiolytic most frequently for the vignette-patient when they saw a high number of patients daily, asked patients about working conditions, suggested a sick leave or a referral to a specialist to the case-vignette patient and perceived more obstacles to reporting an occupational disease. Conclusion Our study suggests that PSW is perceived by GPs as one of the principal work-related health problems and that in such situations, most GPs say they would prescribe drugs and sick leave and refer the patient to an occupational physician. Initial and continuing education programs and good practice guidelines would be useful to help them deal with these problems.

OBJECTIVES: To study the difficulties faced by general practitioners to detect and report asbestos-related cancers, focusing on the influence of patients' tobacco use, physicians' training and role perception. METHOD: Telephone survey conducted among 486 general practitioners and pulmonologists randomly selected in the French region of Provence-Alpes-Côte d'Azur, with: 1) a standardized questionnaire on their behaviors, attitudes and practices in the field of occupational health; 2) a clinical case (case vignette) about a lung cancer patient with occupational asbestos exposure. Two alternative versions of the clinical case varying only in the patient's smoking status were presented randomly to two subgroups of general practitioners and pulmonologists. The primary variable examined was the physician recommendation that the patient described in the vignette file an occupational disease claim. RESULTS: The response rate was 64.4% among general practitioners and 62.5% among pulmonologists. In multiple logistic regressions, the recommendation to file an occupational disease claim was significantly associated with specialty (OR = 4,46; 95% CI: 2.38-8.37 for pulmonologists versus general practitioners), patient's smoking status (OR = 3.15; 95% CI: 2.11-4.70, for non-smokers versus smokers), physician's workload (OR =1,8; 95% CI:1.17-2.88, for physicians examining less than 25 patients per day versus those examining more than 25) and role perception (OR = 2.00; 95% CI:1.22-3.27, for those who considered completing occupational disease medical certificates to be part of their role versus those who did not). CONCLUSION: For a certain number of physicians, tobacco use often over-shadows the role of environmental carcinogens in the development of cancers. Those responsible for initial and continuing medical education should give occupational health higher priority in their programs. Tools designed to help physicians detecting and managing occupational diseases should be developed and disseminated.

Despite an epidemic of muscular-skeletal disorders (MSD), they are underreported. We carried out a telephone survey of 391 general practitioners (GPs) and 96 rheumatologists in south-eastern France to study the barriers to physicians' reporting of occupational diseases (OD). We presented them with a case-study of a patient with work-related sciatica. 72% of GPs and 84% of rheumatologists did not recommend to report this OD, for the following reasons, respectively: hesitation due to the possible role of extraprofessional activities as the root cause (77%, 74%), preferably should be reported as an occupational accident (67%, 42%), acknowledgement that the reporting of this is the role of occupational physicians (60% et 60%) and fear of risk of loosing one's job (47%, 36%). Results of multiple regression analyses suggest that the lack of awareness of reporting procedures and the presumption of causality principle may be main barriers to reporting.

As a part of the HIV behavioural surveillance system in Switzerland, repeated cross-sectional surveys were conducted in 1993, 1994, 1996, 2000 and 2006 among attenders of all low threshold facilities (LTFs) with needle exchange programmes and/or supervised drug consumption rooms for injection or inhalation in Switzerland. Data were collected in each LTF over five consecutive days, using a questionnaire that was partly completed by an interviewer and partly self administered.

Studies suggest strong underreporting of occupational diseases in industrialized countries. We studied physician-related barriers to reporting of occupational sciatica (with herniated disk). We conducted a telephone survey of 391 general practitioners (GPs) and 96 rheumatologists in southeastern France with a standardized questionnaire and case-vignette of a patient with occupational sciatica. Our results show that 71% of GPs and 78% of rheumatologists would not recommend that the case-vignette patient file a workers' compensation claim, for the following reasons: possible role of nonwork-related activities (77%, 74%), should be reported as an occupational accident (67%, 42%), recommendation should be made by occupational physicians (60%, 60%), and risk of patient's losing his job (47%, 38%). Our results suggest that occupational sciatica is underreported in France. Physicians' lack of knowledge of reporting principles and procedures and their ethical dilemma regarding job loss may be barriers to reporting.

Background: Few data report remifentanil use in the neonatal population. We described here our experience with remifentanil-sevoflurane balanced anesthesia in neonates and children less than 2 years who underwent general anesthesia for abdominal surgery. Methods: We retrospectively studied the pattern of remifentanil infusion associated with sevoflurane inhalation in preterm neonates (PTN; n = 18)(born before 37 weeks of gestation and <45 weeks of postmenstrual age), full-term neonates (FTN; n = 21)(born after 37 weeks of gestation and less than 29 days old) and older children up to 2 years (CUT; n = 24). We recorded heart rate (HR), mean arterial pressure (MAP), mean remifentanil dose and sevoflurane concentration before incision and at 5, 10, 20, 30, 45, 60, 90, and 105 min after incision. Results: We observed that remifentanil doses used during surgery were lower in PTN than in both FTN and CUT and lower in FTN than in CUT. This was because of a progressive decrease in remifentanil dose during anesthesia in PTN and FTN. Conversely, remifentanil doses increased in CUT during anesthesia. Sevoflurane concentrations were higher in CUT group than in PTN and FTN groups. MAP and HR did not vary in the three groups during anesthesia. Conclusions: Remifentanil-sevoflurane anesthesia can be used for general anesthesia in neonates. We observed that anesthetists used lower doses of remifantanil and lower concentrations of sevoflurane in neonates compared with the older children.

OBJECTIVE:: To determine the effect of loss of ovarian function and mechanical loading (ie, inactivity) alone or in combination on bone mass and strength. DESIGN:: Mature (aged 6 mo) rats were ovariectomized to induce loss of ovarian function and bone. Hindlimb unloading (HLU) was used to determine the effect of mechanical unloading and reloading on bone mass and strength. Bone mass of the femur and tibia was determined using dual-energy x-ray absorptiometry. Femoral and tibial bone strength was determined by a three-point bending test and by a torsion test. RESULTS:: Ovariectomy (OVX) alone decreased total bone mineral density (BMD) in the femur (-5.5%, P = 0.03) and tibia (-7.3%, P = 0.01) compared with that for sham-operated animals. HLU alone for 4 weeks had no significant effect on bone. Together OVX/HLU accentuated BMD loss in the femur (-10.5%, P < 0.01) compared with that for sham-operated animals. The femur was more sensitive than the tibia to the combination of OVX/HLU, indicated by the reduction (-5.3%, P < 0.05) of total BMD below that achieved by OVX alone. Torsion tests showed that OVX/HLU but not OVX or HLU alone reduced bone strength. There was a correlation between lower femoral total BMD (r = 0.65, P < 0.001) and reduced torque strength. Bone loss did not continue during the 2 weeks of reloading. CONCLUSIONS:: OVX accompanied by mechanical unloading results in more rapid and severe bone loss than either OVX or unloading alone and therefore is associated with a greater likelihood of osteoporosis.

OBJECTIVES: To study physician barriers to workers' compensation claims for asbestos-related cancers, focusing on smokers' stigma and physicians' speciality and role perception. METHODS: Cross-sectional telephone study of 486 randomly-selected physicians: general practitioners (GPs) and pulmonologists in southeastern France. Standardised questionnaires explored their behaviour, attitudes and practices in the field of occupational health and their responses to a case-vignette about a lung cancer patient with long-term occupational asbestos exposure. Randomised subgroups of GPs and pulmonologists heard alternative versions varying only in the worker's smoking status. We studied factors associated with the recommendation that the case-vignette patient file a compensation claim with simple and multiple logistic regressions. RESULTS: The response rate was 64.4% among GPs and 62.5% among pulmonologists. Recommending the filing of an occupational disease claim was significantly associated in multiple logistic regressions with speciality (OR=4.46; 95%CI=2.38-8.37, for pulmonologists versus GPs), patient's smoking status (OR=3.15; 95%CI=2.11-4.70, for non-smokers versus smokers), physician's workload (OR=1.83; 95%CI= 1.17-2.88, for </=25 consultations per day versus >25), and role perception (OR=2.00; 95%CI=1.22-3.27, for those who considered completing occupational disease medical certificates to be part of their role versus those who did not). CONCLUSIONS: The results of this French study appear applicable to various countries and contexts. To make physicians and especially GPs more aware of occupational health and smoking stigma, officials and educators must give these topics higher priority during initial training and continuing medical education. Tools and equipment that take time constraints into account should be developed and disseminated to help physicians manage occupational diseases.