189 Medical surveillance and epidemiologic studies of engineered nanomaterials (enm) workers in France
本文描述了法国对工程纳米材料工人的医学和流行病学监测现状，介绍了法国公共卫生监测所开发的综合监测系统，包括建立暴露登记册和前瞻性队列，旨在评估工人健康风险。
<h3>Objectives</h3> To depict the present situation regarding ENM-workers medical and epidemiological surveillances in France and discuss its advancement. <h3>Methods</h3> 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. <h3>Results</h3> 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 job-exposure-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<sub>2</sub>. 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. <h3>Conclusion</h3> 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.