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

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

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

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)

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)

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

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

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

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)

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

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

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

WR-MSDs compensated as occupational diseases in the French agriculture (MSA)

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

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

Self-questionnaire (MSDs): Constances cohort

• Nordic style questionnaire on symptoms (preceding 12 months and 7 days)

• Musculoskeletal disorders and treatment

16

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

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

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

20

WR-risk factors for MSDsShoulder tendinopathy• Repetition• Posture• Force• Stress• Work organisation

Carpal tunnel syndrome• Repetition• Posture• Force• Vibration• Work organisation

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.

Biomechanical exposure : Constances cohort (men)

22

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

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

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

“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

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

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”.

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 %

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

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

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

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

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

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

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€

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

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

• 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

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

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

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)

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

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

General Design

46

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

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

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

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

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

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

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

58

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

59

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/