Emmanuel Fort

Functional outcome after road-crash injury: Description of the ESPARR victims cohort and 6-month follow-up results

OBJECTIVE It is essential to know about the long-term consequences of road crashes involving corporal injury in order to adopt relevant public health measures. METHODS The ESPARR cohort comprises 1168 road-crash victims, aged 16 or over, managed in hospitals in the Rhône administrative départment (France). It is based on the Registry of Road Traffic Casualties, which has been collecting exhaustive data since 1995. Two groups are monitored: mild to moderate (M-AIS 1 or 2) and severe (M-AIS > or =3). Patients were interviewed at the point of primary care, between 1 October 2004 and 31 July 2006. 6 months later, their state of health and presence of pain were compared. Multivariate analysis (logistic regression) was performed to identify factors related to residual pain. RESULTS Adults of the cohort were compared to the road crash population as a whole recorded over the same period in the same area. At 6 months post-accident, only 31.9% of victims deemed their health status to have entirely returned to normal; 63.8% of mild to moderate and 89.2% of severe cases reported residual pain, but neither pain frequency nor intensity correlated with M-AIS. Residual pain was related to lower limb injuries (OR=1.6; 95% CI=1.1-2.4). After adjustment, pain was essentially related to age, seriousness of the lesions and a stay in a rehabilitation unit. CONCLUSION The ESPARR cohort provides a unique opportunity in France to describe the trajectory of a road crash victim, in terms both of care and rehabilitation and of resumption of work and personal activity.

Predictive factors of chronic post-traumatic stress disorder 6 months after a road traffic accident

BACKGROUND This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. METHODS The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhône area administrative département. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. RESULTS 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥ 44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR=0.4; 0.2-0.9). CONCLUSION Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users.

Return to work following road accidents: Factors associated with late work resumption

OBJECTIVE To analyse factors associated with late return to work in road accident victims. MATERIALS AND METHODS The ESPARR cohort comprises road accident victims monitored over time from initiation of hospital care. A total of 608 ESPARR cohort subjects were working at the time of their accident and answered questionnaires at 6 months and/or 1 year. For each level of overall severity of injury (Maximum - Abbreviated Injury Scale (M-AIS) 1, 2, 3 and 4-5), a time-off-work threshold was defined, beyond which the subject was deemed to be a late returner; 179 subjects were considered to be late in returning to work, while 402 showed a normal pattern of return. Logistic regression identified factors associated with late return. RESULTS Type of journey, overall injury severity and intention to press charges emerged as factors predictive of late return to work on the basis of the data collected at inclusion alone. After adjustment, pain (odds ratio (OR): 2.6; 95% confidence interval (95% CI) 1.0-6.7) and physical sequelae (OR: 3.8; 95% CI 1.7-8.3) at 6 months and the fact of pressing charges (OR: 2.6; 95% CI 1.2-5.5) remained significantly linked with late return to work. CONCLUSION Impaired health status at 6 months after the initial accident (in the form of persistent pain and physical sequelae) is a determining factor delaying return to work following a road traffic accident.

Diseases, consumption of medicines and responsibility for a road crash: A case-control study

UNLABELLED The role of medical conditions in crashes is a topic of public debate. Some studies suggest that there has been a reduction in road traffic crashes subsequent to the medical restrictions introduced on drivers with medical deficiencies. As in todays society the car is an important factor for independence and socialization, it seems important to consider whether diseases or consumption of drugs increase the risk of causing a road crash in comparison to well-known major crash risk factors. A case-control study was conducted (733 injured drivers). The cases were subjects who were partly or totally responsible for their crash. The 304 controls were the non-responsible drivers. Diseases and medicine consumption were analyzed using logistic regression models. Cases were characterized by a higher percentage of young men. They were more frequently affected by fatigue, as were subjects who had consumed alcohol. A higher risk in subjects suffering from hypertension is observed (adjusted odds ratio [adjOR]=3.82; 95%CI=[1.42-10.24]). An association between antidepressant consumption and responsibility appeared (adjOR=3.61; 95%CI=[1.30-10.03]). CONCLUSION Medical factors associated with responsibility were arterial hypertension and antidepressant consumption. Other medical conditions do not seem to play a preponderant role comparing to individual behaviours.

Occupational Risk Factors for Upper-limb and Neck Musculoskeletal Disorder among Health-care Staff in Nursing Homes for the Elderly in France

This study investigated the relation between working conditions, in terms of physical and psychological demand, and upper-limb and neck musculoskeletal disorders (ULNMD) in female staff working in direct contact with the elderly in nursing homes. A cross-sectional survey was conducted in 105 nursing homes in France. Data on nursing-home working conditions were collected by questionnaire from occupational physicians and by self-administered questionnaire from staff. Psychosocial demand at work was assessed on Siegrist’s questionnaire and ULNMD on the Nordic questionnaire. 2,328 employees were included: 628 housekeepers, 1,372 nursing assistants and 328 nurses. During the previous 12 months, 50% of the subjects (1,160) had presented with a musculoskeletal complaint concerning the neck, 38% (881) the shoulders, 10% (246) the elbows and 22% (520) the wrists. 9% (219) reported effort/reward imbalance on the 2004 Siegrist questionnaire and 42% were in a situation of over-commitment. ULNMD complaints were associated not only with physical occupational factors but also with psychosocial factors (effort/reward imbalance and over-commitment), both before and after adjustment on individual and occupational factors. Prospective studies are needed to clarify the causal role of occupational, including, organizational, psychosocial factors in ULNMD outcomes. Preventive approaches should take account of both physical and psychosocial occupational factors.

Psychoactive substances consumption in French fishermen and merchant seamen

ObjectivesThe aim of this study is to assess tobacco consumption, nicotine dependence as diagnosed by Fagerström test, alcohol consumption, alcohol dependence as diagnosed by CAGE questionnaire and drug consumption in French seamen. Results are presented according to job category: fishermen and merchant seamen.MethodsFrench seamen were recruited from a stratified survey of 19 ports in France. Subjects completed a questionnaire during their annual medical check-up. The questionnaire covered demographic and professional items, tobacco, alcohol and drug consumption behaviour. Nicotine and alcohol dependence were, respectively, assessed by the Fagerström Test for Nicotine Dependence (FTND) and a French version of the CAGE questionnaire. A urine test was used to detect cannabis derivatives.ResultsPrevalence rates for current smoking and daily alcohol consumption were higher in fishermen than merchant seamen. The prevalence of nicotine dependence on FTND was likewise higher in fisherman smokers, who also showed more intense smoking behaviour. The category of seamen did not correlate with alcohol addiction, but differences in alcohol-related behaviour emerged between fishermen and merchant seamen. Prevalence of cannabis and other drug use was higher in merchant seamen, although the two categories of seaman did not differ with respect to recent use of cannabis. Demographic factors cannot fully explain these differences, as multivariate analysis showed significantly greater risks in marine fisheries.ConclusionsAlcohol and tobacco consumption are a major public health problem for seafarers. Fishermen seem to be more liable to high consumption. Working conditions may explain these differences.

Driving Behaviors and On-Duty Road Accidents: A French Case-Control Study

Objectives: A case-control study was carried out to identify driving behaviors associated with the risk of on-duty road accident and to compare driving behaviors according to the type of journey (on duty, commuting, and private) for on-duty road accident victims. Methods: Cases were recruited from the Rhône Road Trauma Registry between January 2004 and October 2005 and were on duty at the time of the accident. Control subjects were recruited from the electoral rolls of the case subjects’ constituencies of residence. Cases’ and controls’ driving behavior data were collected by self-administered questionnaire. A logistic regression was performed to identify behavioral risk factors for on-duty road accidents, taking into account age, sex, place of residence, road accident risk exposure, socio-occupational category, and type of road user. A second analysis focused specifically on the case subjects, comparing their self-assessed usual behaviors according to the type of journey. Results: Significant factors for multivariate analysis of on-duty road accidents were female gender, history of on-duty road accidents during the previous 10 years, severe time pressure at work, and driving a vehicle not belonging to the driver. On-duty road accident victims reported behavioral risk factors more frequently in relation to driving for work than driving for private reasons or commuting: nonsystematic seat belt use, cell phone use at least once daily while driving, and history of accidents with injury during the previous 10 years. Conclusions: This study provides knowledge on behavioral risk factors for on-duty road accidents and differences in behavior according to the type of journey for subjects who have been on-duty road accident victims. These results will be useful for the design of on-duty road risk prevention.

Risk factors for work-related stress and subjective hardship in health-care staff in nursing homes for the elderly: A cross-sectional study

Risk factors for work‐related stress and subjective hardship in health‐care staff in nursing homes for the elderly: A cross‐sectional study: Carole Pélissier, et al. Université Lyon 1, UMRESTTE (Joint unit IFSTTAR/UCLB), France

Prevalence of drug use in French seamen

The main objective of the present study is to determine the prevalence of lifetime use and use in the past 30 days of narcotics in French seamen and to assess factors correlated with positive urine test in seamen as a whole. A stratified survey conducted in 19 French ports collected 1,928 self-administered questionnaires on cigarette, alcohol and narcotics consumption. Seafarers were randomly selected and interviewed during their annual seafaring aptitude consultation. Only the 1847 male respondents were included in analysis. Nearly half of the seamen had tried cannabis at some point in their life, and 16% were users in the past 30 days. Lifetime use of certain other illegal drugs (cocaine, heroin, hallucinogenic mushrooms, poppers and ecstasy) was non-negligible, but cocaine and heroin were the only ones showing exceptional prevalence of consumption over the previous 30 days. Lifetime use of drugs was non-negligible among seamen. Prevalence of recent cannabis use was elevated. Recent consumption as indicated by positive urine test correlated with age group, family situation, occupational category, geographical area, young age of first alcohol consumption and experimentation with other drugs.

Impaired mental well-being and psychosocial risk: a cross-sectional study in female nursing home direct staff.

Objectives The present study sought to quantify the impaired mental well-being and psychosocial stress experienced by nursing home staff and to determine the relationship between impaired mental well-being assessed on the 12-item General Health Questionnaire (GHQ-12) and exposure to psychosocial stress assessed on Siegrists effort/reward and overcommitment model. Methods A transverse study was conducted in France on 2471 female employees in 105 nursing homes for the elderly. Personal and occupational data were collected by questionnaire for 668 housekeepers, 1454 nursing assistants and 349 nurses. Results 36.8% of participants (n=896) showed impaired mental well-being, 42.7% (n=1039) overcommitment and 9% (n=224) effort/reward imbalance. Overcommitment (prevalence ratio (PR)=1.27; 95% CI (1.21 to 1.34)) and effort–reward imbalance (PR=1.19; 95% CI (1.12 to 1.27)) were significantly associated with presence of impaired mental well-being after adjustment for personal factors (age and private life events). Taking effort and reward levels into account, the frequency of impaired mental well-being was highest in case of exposure to great extrinsic effort and low rewards of any type: esteem, PR=3.53, 95% CI (3.06 to 4.08); earnings, PR=3.48, 95% CI (2.99 to 4.06); or job security, PR=3.30, 95% CI (2.88 to 3.78). Participants in situations of overcommitment and of effort/reward imbalance were at the highest risk of impaired mental well-being: PR=3.86, 95% CI (3.42 to 4.35). Conclusions Several changes in nursing home organisation can be suggested to reduce staff exposure to factors of psychosocial stress. Qualitative studies of the relation between impaired mental well-being and psychosocial stress in nursing home staff could guide prevention of impaired mental well-being at work.