Serge Fanello

Active epidemiological surveillance of musculoskeletal disorders in a shoe factory.

Aims: (1) To evaluate an active method of surveillance of musculoskeletal disorders (MSDs). (2) To compare different criteria for deciding whether or not a work situation could be considered at high risk of MSDs in a large, modern shoe factory. Methods: A total of 253 blue collar workers were interviewed and examined by the same physician in 1996; 191 of them were re-examined in 1997. Risk factors of MSDs were assessed for each worker by standardised job site work analysis. Prevalence and incidence rates of carpal tunnel syndrome, rotator cuff syndrome, and tension neck syndrome were calculated for each of the nine main types of work situation. Different criteria used to assess situations with high risk of MSDs were compared. Results: On the basis of prevalence data, three types of work situation were detected to be at high risk of MSDs: cutting, sewing, and assembly preparation. The three types of work situations identified on the basis of incidence data (sewing preparation, mechanised assembling, and finishing) were different from those identified by prevalence data. At least one recognised risk factor for MSDs was identified for all groups of work situations. The ergonomic risk could be considered as serious for the four types of work situation having the highest ergonomic scores (sewing, assembly preparation, pasting, and cutting). Conclusion: The results of the health surveillance method depend largely on the definition of the criteria used to define the risk of MSDs. The criteria based on incidence data are more valid than those based on prevalence data. Health and risk factor surveillance must be combined to predict the risk of MSDs in the company. However, exposure assessment plays a greater role in determining the priorities for ergonomic intervention.

Conséquences de l’obésité maternelle sur le déroulement du travail et l’accouchement: À l’exclusion des autres pathologies pouvant modifier la prise en charge obstétricale

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 2 - p. 109-114

Multidisciplinary Intensive Functional Restoration Versus Outpatient Active Physiotherapy in Chronic Low Back Pain A Randomized Controlled Trial

Study Design. Randomized parallel group comparative trial with a 1-year follow-up period. Objective. To compare in a population of patients with chronic low back pain, the effectiveness of a functional restoration program (FRP), including intensive physical training and a multidisciplinary approach, with an outpatient active physiotherapy program at 1-year follow-up. Summary of Background Data. Controlled studies conducted in the United States and in Northern Europe showed a benefit of FRPs, especially on return to work. Randomized studies have compared these programs with standard care. A previously reported study presented the effectiveness at 6 months of both functional restoration and active physiotherapy, with a significantly greater reduction of sick-leave days for functional restoration. Methods. A total of 132 patients with low back pain were randomized to either FRP (68 patients) or active individual therapy (64 patients). One patient did not complete the FRP; 19 patients were lost to follow-up (4 in the FRP group and 15 in the active individual treatment group). The number of sick-leave days in 2 years before the program was similar in both groups (180 ± 135.1 days in active individual treatment vs. 185 ± 149.8 days in FRP, P = 0.847). Results. In both groups, at 1-year follow-up, intensity of pain, flexibility, trunk muscle endurance, Dallas daily activities and work and leisure scores, and number of sick-leave days were significantly improved compared with baseline. The number of sick-leave days was significantly lower in the FRP group. Conclusion. Both programs are efficient in reducing disability and sick-leave days. The FRP is significantly more effective in reducing sick-leave days. Further analysis is required to determine if this overweighs the difference in costs of both programs.

Venous thrombosis in immunocompetent patients with acute cytomegalovirus infection: a complication that may be underestimated

In the present study, we retrospectively studied clinical and laboratory findings associated with cytomegalovirus (CMV) infection in immunocompetent patients. We focused on severe CMV infection. Among 38 patients, five had a severe form of infection: one had meningitis, one had symptomatic thrombocytopenia and three had venous thromboses with pulmonary embolism, a rarely described complication. CMV-induced thrombosis has been reported in immunocompromised patients such as transplant recipients and patients with AIDS. Recent case reports have also described thrombotic phenomena in immunocompetent patients with CMV infection. Our study suggests that venous thrombosis during acute CMV infection is an underestimated complication.

Return to work of 87 severely impaired low back pain patients two years after a program of intensive functional restoration

UNLABELLED Return to work is the main long-term objective of rehabilitation programs for patients with chronic low back pain (LBP). OBJECTIVES Evaluation of work status and number of sick leaves in 87 severely impaired LBP patients 2 years after a functional restoration program. PATIENTS AND METHODS Open prospective study. POPULATION 87 chronic LBP patients. INTERVENTION multidisciplinary functional restoration program. Ergonomic advice on the workplace was performed for 53 patients. OUTCOME work status and number of sick leaves due to LBP. RESULTS The characteristics of the 26 patients lost to follow-up did not differ significantly from the rest of the population before the program. In the 61 remaining patients, 48 (78%) were at work at 2 years, 43 full-time and 22 at the same job. Nineteen worked in a different environment. Sick leaves were reduced by 60% compared to the 2 years prior to the program: 128 days (+/-200 days) versus 329 days (+/-179 days); p<0.005. CONCLUSION Sick leaves remained significantly reduced and the number of workers who were at work significantly increased at 2 years after an intensive program.

Management of low back pain in primary care prior to multidisciplinary functional restoration: a retrospective study of 72 patients.

OBJECTIVE Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. METHODS A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. RESULTS Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the studys follow-up period. CONCLUSION The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.

Information prénatale sur l'allaitement maternel : enquête en Pays de Loire.

OBJECTIVES The main aim of this study was to evaluate how well expectant mothers were informed on breastfeeding by healthcare professionals. The secondary objective was to determine the factors associated with the initiation of breastfeeding. POPULATION AND METHODS The survey was conducted in a group of 500 women who had delivered at the Angers Hospital (France), based on a questionnaire filled out by the postpartum women during their hospital stay. RESULTS The rate of breastfeeding was 61.2%. More than a quarter (26.9%) of the women did not receive any prenatal breastfeeding information. The survey showed that 77.8% of the women had been informed of breastfeeding advantages for infants and 51.5% of breastfeeding advantages for themselves. Only 27.5% had received the advice of exclusive breastfeeding for 6months. Only 5.2% had been informed of the uselessness of breast preparation during pregnancy and a minority had been informed of correct and incorrect breastfeeding contraindications. Only 15.4% of fathers had been involved in a discussion on infant feeding practices during prenatal consultations. Only 4.8% of the women had come to prenatal classes on breastfeeding with a relative. The maternal factors positively associated with breastfeeding initiation were age between 25 and 34 years, non-French origin, a high socioeconomic status, being married, having been breastfed, and having previous experience with breastfeeding. Breastfeeding initiation was negatively associated with maternal smoking. All the factors concerning prenatal breastfeeding information in women were associated with the choice of breastfeeding. CONCLUSION This study pointed out the populations at risk of not breastfeeding. Breastfeeding information given to pregnant women by healthcare professionals may influence them on whether or not they choose to breastfeed their newborn. However, this survey showed that women are insufficiently informed on prenatal breastfeeding. Therefore, prenatal breastfeeding information should be improved.

Botulisme alimentaire, prévention et traitement

Points essentials ● Les Etats-Unis et l’Europe s’accordent sur le fait que le principal traitement du botulisme est fonde sur des mesures symptomatiques et tout particulierement sur la ventilation assistee lorsqu’il existe une atteinte des fonctions respiratoires. ● Les avis divergent concernant le traitement specifique qu’est le serum antibotulique : utilise systematiquement aux Etats-Unis et frequemment dans de nombreux pays d’Europe, mais pas en France en dehors de quelques cas. La determination de l’aliment contaminant est un element essentiel pour limiter l’extension de la maladie. La reduction du delai de declaration ainsi que l’identification et la correction de mauvaises pratiques culinaires permettraient de diminuer le nombre de cas de botulisme.

Botulisme, un diagnostic clinique

Points essentials ● Le botulisme alimentaire resulte de l’action d’une neurotoxine produite par une bacterie anaerobie sporulee appelee Clostridium botulinum. ● Le mode de contamination s’effectue par la consommation d’aliments, prealablement contamines par la neurotoxine. ● Apres une periode d’incubation variant de 2 heures a 8 jours, la symptomatologie debute par des troubles digestifs. Secondairement, apparait une paralysie des paires crâniennes se traduisant typiquement par une diplopie, une dysphagie, une dysphonie, une mydriase areactive et un ptosis. ● L’evolution des troubles moteurs se fait de maniere descendante avec une possible atteinte des muscles respiratoires necessitant alors des mesures de reanimation avec parfois une ventilation assistee. ● Le diagnostic de botulisme est clinique. L’identification de la toxine botulique dans le sang ou les selles du patient ou dans l’aliment contaminant confirme le diagnostic.

Botulisme alimentaire, aspects épidémiologiques

Points essentials ● Avec une moyenne de 30 cas recenses par an, la France est, apres l’Italie, au deuxieme rang des pays europeens en terme d’incidence du botulisme. ● Les aliments d’origine commerciale, de fabrication artisanale ou industrielle, sont de plus en plus souvent impliques dans la genese de foyers de botulisme. De plus, les nouveaux modes de conservation des aliments (sous vide, refrigeres, etc.) permettent le developpement des Clostridii. ● La diversification des risques liee a la nature des produits en cause et aux nouveaux modes de conservation, associee a l’elargissement des echanges commerciaux, font craindre la survenue de foyers d’etendue internationale.