Objective. Pyogenic vertebral osteomyelitis (PVO) are frequently misdiagnosed and patients often receive anti-inflammatory drugs for their back pain. We studied the impact of these medications. Methods. We performed a prospective study enrolling patients with PVO and categorized them depending on their drugs intake. Then, we compared diagnosis delay, clinical presentation at hospitalization, incidence of complications, and cure rate. Results. In total, 79 patients were included. Multivariate analysis found no correlation between anti-inflammatory drug intake and diagnosis delay, clinical presentation, complications, or outcome. Conclusion. Anti-inflammatory drugs intake does not affect diagnostic delay, severity at diagnosis, or complications of PVO.
In massive catastrophic events, occupational health practitioners are more and more frequently involved in the management of such situations. We aim to describe the multiple aspects of the role that occupational health practitioners might play, by focusing on the recent example of the Paris terrorist attack of November 2015. During and after the Paris attack, occupational practitioners, in collaboration with emergency and security professionals, were involved in psychological care, assembling information, follow-up, return-to-work, and improving in-company safety plans. Based on this experience and other industrial disasters, we distinguish three phases: the critical phase, the post-critical phase, and the anticipation phase. In the critical phase, the occupational practitioner cares for patients before the emergency professionals take charge, initiates the psychological management, and may also play an organizational role for company health aspects. In the post-critical phase, he or she would be involved in monitoring those affected by the events and participate in preventing, to the extent possible, posttraumatic stress disorder, helping victims in the return-to-work process, and improving procedures and organizing drills. In addition to their usual work of primary prevention, occupational practitioners should endeavor to improve preparedness in the anticipation phase, by taking part in contingency planning, training in first aid, and defining immediately applicable protocols. In conclusion, recent events have highlighted the essential role of occupational health services in anticipation of a crisis, management during the crisis, and follow-up.
crisis; occupational; management; health practitioner; terrorism
Urinary tract infection (UTI) among patients with neurogenic bladder is a major problem but its management is not well known. We studied the relationship between antibiotic regimen use and the cure rate of those infections among 112 patients with neurogenic bladder.
We studied a retrospective cohort of febrile UTI among patients with neurogenic bladder. Drug selection was left to the discretion of the treating physicians, in accordance with current guidelines. Patients were divided into 3 groups according to antibiotic treatment duration (<10 days, between 10 and 15 days, and >15 days). We analysed clinical and microbiogical cure rate one month after the end of antibiotic treatment.
The three groups of patients were similar, especially in terms of drug treatment (equal distribution). The cure rates were not significantly different (71.4 %, 54.2 %, and 57.1 %, respectively; p = 0.34). Moreover, there was no difference in cure rate between mono and dual therapy (44 % for monotherapy vs. 40 % for dual therapy; p = 0.71).
This descriptive study supports the efficacy of antimicrobial treatment duration of less than 10 days and the use of monotherapy to treat febrile UTI among patients with neurogenic bladder. A randomized control trial is required to confirm these data.
Antibiotic treatment duration; Neurogenic bladder; Urinary tract infection
To prospectively evaluate associations between self-reported physical work exposures and incident carpal tunnel syndrome (CTS).
Newly employed workers (n=1,107) underwent repeated nerve conduction studies (NCS), and periodic surveys on hand symptoms and physical work exposures including average daily duration of wrist bending, forearm rotation, finger pinching, using vibrating tools, finger/thumb pressing, forceful gripping, and lifting >2 pounds. Multiple logistic regression models examined relationships between peak, most recent, and time-weighted average exposures and incident CTS, adjusting for age, gender, and body mass index.
710 subjects (64.1%) completed follow-up NCS; 31 incident cases of CTS occurred over 3 year follow-up. All models describing lifting or forceful gripping exposures predicted future CTS. Vibrating tool use was predictive in some models.
Self-reported exposures showed consistent risks across different exposure models in this prospective study. Workers’ self-reported job demands can provide useful information for targeting work interventions.
carpal tunnel syndrome; physical work exposures; self-report; occupational health; prospective; longitudinal studies
Floor layers have high rates of musculoskeletal disorders yet few studies have examined their work exposures. This study used observational methods to describe physical exposures within floor laying tasks.
We analyzed 45 videos from 32 floor layers using Multimedia-Video Task Analysis software to determine the time in task, forces, postures, and repetitive hand movements for installation of four common flooring materials. We used the WISHA checklists to define exposure thresholds.
Most workers (91%) met the caution threshold for one or more exposures. Workers showed high exposures in multiple body parts with variability in exposures across tasks and for different materials. Prolonged exposures were seen for kneeling, poor neck and low back postures, and intermittent but frequent hand grip forces.
Floor layers experience prolonged awkward postures and high force physical exposures in multiple body parts, which probably contribute to their high rates of musculoskeletal disorders.
musculoskeletal disorders; observational assessment; construction trades
To describe the proportions of workers with upper extremity (UE) symptoms and work limitations due to symptoms in a newly hired working population over a 3-year study period and to describe transitions between various outcome states.
827 subjects completed repeat self-reported questionnaires including demographics, medical and work history, symptoms and work status. Outcomes of interest were UE symptoms and work limitations due to symptoms.
72% of workers reported symptoms at least once during the study, with 12% reporting persistent symptoms and 27% reporting fluctuating symptoms. 31% reported work limitations at least once, with 3% reporting consistent work limitations and 8% reporting fluctuating limitations.
UE symptoms and work limitations are common among workers and dynamic in their course. A better understanding of the natural course of symptoms is necessary for targeted interventions.
Carpal tunnel syndrome (CTS) affects about 1% of working-aged people and is the commonest cause of hand pain in manual workers. CTS is a clinical diagnosis and does not warrant any further investigation in the presence of mild and suggestive CTS. Although the recommended non-surgical management is still a matter of debate, nocturnal splinting or steroid injection are recommended in most countries, with strong to moderate level of evidence for short-term efficacy. Patients with an uncertain diagnosis or severe symptoms, should undergo nerve conduction studies with referral to a hand specialist.
carpal tunnel syndrome; primary care; manual workers; clinical review; pain
Musculoskeletal Disorders; MSD; models; Occupational; Practitioners
The persistence of knee pain (KP) and its relationship with occupational factors were investigated in two prospective cohorts of French workers: retirees of the Gazel cohort and workers in the Cosali cohort.
KP was defined according to the Nordic questionnaire (>1 day in the last year), and the information was extracted from two questionnaires in 2006 and 2012 for the Gazel cohort, and in 2002–2005 and 2007–2010 for the Cosali cohort. The personal and occupational factors and the severity of KP were measured at baseline. Of the 4590 members of the Gazel cohort with KP at baseline, 4140(90.2%) were followed up, as were 637(63.1%) members of the Cosali cohort. Logistic models were used to evaluate associations (ORs) between occupational exposure and the persistence of KP separately by sex, adjusted on indicators of severity of KP.
KP was no longer present at follow-up for 38.3% of Gazel men and 46.0% of Cosali men (33.4% of Gazel women and 50.6% of Cosali women). The persistence of KP in men was associated with carrying or handling heavy loads on univariate analyses and with kneeling on multivariate analyses, with ORs of 1.3(1.0-1.6) (Gazel) and 1.6(1.0-2.6) (Cosali). Climbing stairs was not significantly associated with the persistence of knee pain among men. The persistence of KP in women was not significantly associated with such occupational exposure.
This study highlights the role of occupational factors in the persistence of KP for men, in particular kneeling and handling/carrying loads.
Musculoskeletal pain; Occupational exposure; Persistence
To analyze relationships between physical occupational exposures, post-retirement shoulder/knee pain, and obesity.
9 415 male participants (aged 63–73 in 2012) from the French GAZEL cohort answered self-administered questionnaires in 2006 and 2012. Occupational exposures retrospectively assessed in 2006 included arm elevation and squatting (never, <10 years, ≥10 years). “Severe” shoulder and knee pain were defined as ≥5 on an 8-point scale. BMI was self-reported.
Mean BMI was 26.59 kg/m2 +/−3.5 in 2012. Long-term occupational exposure to arm elevation and squatting predicted severe shoulder and knee pain after retirement. Obesity (BMI≥30 kg/m2) was a risk factor for severe shoulder pain (adjusted OR 1.28; 95% CI 1.03, 1.90). Overweight (adjusted OR 1.71; 1.28,2.29) and obesity (adjusted OR 3.21; 1.90,5.41) were risk factors for severe knee pain. In stratified models, associations between long-term squatting and severe knee pain varied by BMI.
Obesity plays a role in relationships between occupational exposures and musculoskeletal pain. Further prospective studies should use BMI in analyses of musculoskeletal pain and occupational factors, and continue to clarify this relationship.
Although previous studies have related occupational exposure and epicondylitis, the evidence is moderate, and mostly based on cross-sectional studies. Suspected physical exposures were tested over a three year period in a large longitudinal cohort study of workers in the United States.
In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables.
Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral epicondylitis (6.9%), with 34 cases of lateral epicondylitis (4.9%), 30 cases of medial epicondylitis (4.3%), and 16 workers who had both. After adjusting for age, lack of social support, and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral epicondylitis (odds ratios 2.8 [1.2;6.2] and 3.6 [1.2;11.0] respectively in men and women).
Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved.
epicondylitis; observational study; occupational; risk factor; epidemiology
To evaluate predictors of hand symptoms and functional impairment after three years of follow-up among workers with different types of hand symptoms including carpal tunnel syndrome (CTS). Functional status and job limitations were also analyzed as key secondary objectives.
Cohort design of 3-years duration
Working population-based study
1107 newly employed workers without a pre-existing diagnosis of CTS. Subjects were categorized into four groups at baseline examination: no hand symptoms, any hand symptoms but not CTS (recurring symptoms in hands, wrist or fingers without neuropathic symptoms), any hand symptoms of CTS (neuropathic symptoms in the fingers and normal nerve conduction study), or confirmed CTS (CTS symptoms and abnormal nerve conduction study). Among workers with hand pain at baseline, subject and job characteristics were assessed as prognostic factors for outcomes, using bivariate and multivariate regression models.
Main outcome measure
The primary outcome assessed by questionnaire at 3 years was “severe hand pain” in the past 30 days.
At baseline, 155 workers (17.5% of 888 followed workers) reported hand symptoms, 21 had confirmed CTS. Presence of hand pain at baseline was a strong predictor of future hand pain and job impairment. Subjects with confirmed CTS at baseline were more likely to report severe hand pain, (adjusted prevalence ratios 1.98 [1.11 – 3.52]) and functional status impairment (adjusted prevalence ratios 3.37 [1.01 – 11.29]) than workers with other hand pain. Among subjects meeting our case definition for CTS at baseline, only 4 (19.1%) reported seeing a physician in the 3 year period.
Hand symptoms persisted among many workers after 3 year follow-up, especially among those with CTS, yet few symptomatic workers had seen a physician.
hand; pain; Carpal Tunnel Syndrome; functional status; work
Whereas accumulating evidence indicates close associations between rhinitis and asthma, little is known about the relationships between occupational rhinitis (OR) and occupational asthma (OA). This study analyses the prevalence of OR associated with OA, globally and according to the various causal agents, and investigates the temporal relationships between these two conditions.
Data on incident cases of OA (2008–2010) were collected through the French national occupational disease surveillance and prevention network, using a standardized form including information on occupation, causal agents, presence of OR, and respective dates of occurrence of rhinitis and asthma.
Among the 596 reported OA cases with latency period, 555 could be attributed to identified agents: high molecular weight (HMW) agents (n=174); low molecular weight (LMW) agents (n=381). Overall, OR was associated with OA in 324 (58.4%) cases. The frequency of association was significantly higher for HMW agents than for LMW agents (72.2% vs 51.5%, p<0.001). OR occurred before OA significantly more frequently for HMW agents than for LMW agents (p<0.01).
These results show that OR is frequently associated with OA, especially when HMW agents are involved. They are consistent with the hypothesis that OR, in conjunction with OA, is more likely to be caused by sensitizers that cause disease via IgE-mediated mechanisms and suggest that symptoms of OR should be taken into account in the medical surveillance of workers exposed to HMW agents.
Adult; Air Pollutants, Occupational; adverse effects; chemistry; Asthma, Occupational; epidemiology; etiology; Female; France; epidemiology; Humans; Incidence; Male; Middle Aged; Molecular Weight; Occupational Diseases; epidemiology; etiology; Occupations; statistics & numerical data; Odds Ratio; Prevalence; Rhinitis; epidemiology; etiology; occupational asthma; occupational rhinitis; high molecular weight; low molecular weight
Bullying; psychology; Humans; Mental Disorders; diagnosis; etiology; Occupational Diseases; diagnosis; etiology; Referral and Consultation; Stress, Psychological; diagnosis; etiology
Employee Performance Appraisal; methods; Faculty, Medical; Humans; Teaching
Assessment of workplace physical load is highly resource-intensive. This study tested whether a single-item measure asking individuals about perceived physical strain (PPS) at work was an acceptable proxy for physical load.
The study was conducted in a subset of GAZEL cohort (n=2612) undergoing assessment of exposure to 38 occupational biomechanical constraints (representing eight domains) in 1994. Test-retest reliability analyses compared PPS in 1994 and 1995. Validity analyses compared PPS in 1994 to concurrent strains assessed in the more extensive measure.
The measure showed adequate test-retest reliability. Within and across domains of physical load, linear relationships (p<0.0001) existed between n exposures and PPS. Domains considered more strenuous (carrying loads, pulling objects) showed the highest PPS.
PPS approximates physical load in absence of detailed measures. PPS could be used in non-occupational epidemiologic studies.
Analysis of Variance; Cohort Studies; Female; France; Humans; Male; Physical Exertion; Reproducibility of Results; Self Report; Workload
In view of the debate of factors in Dupuytren’s disease, we aimed to describe its relationship with certain occupational factors, alcohol intake and smoking.
The French GAZEL cohort (employees of Electricité de France and Gaz de France).
Participants of the cohort who answered a questionnaire in 2012, that is, 13 587 participants (73.7% of the questionnaire sent). In 2007, self-assessed lifetime occupational biomechanical exposure was recorded (carrying loads, manipulating a vibrating tool and climbing stairs), as well as alcohol intake, smoking and diabetes mellitus. Analyses were performed on high alcohol intake, smoking and duration of relevant work exposure, stratified by gender.
Primary and secondary outcome measures
From a specific question on Dupuytren’s disease assessed in 2012, the outcome measures were self-reported Dupuytren’s disease (yes/no) and disabling Dupuytren’s disease (including surgery).
A total of 10 017 men and 3570 women, aged 64–73 years, were included; the mean age for men was 68 years and for women was 65 years. Among men, the following were significantly associated with Dupuytren’s disease: age (OR 1.03 (1.00; 1.06)), diabetes (OR 1.31 (1.07; 1.60)), heavy drinking (OR 1.36 (1.10; 1.69)) and over 15 years of manipulating a vibrating tool at work (OR 1.52 (1.15; 2.02)); except for diabetes, the association with these factors was stronger for disabling Dupuytren’s disease (or surgery), with OR 1.07 (1.03; 1.11), 1.71 (1.25; 2.33) and 1.98(1.34; 2.91), respectively, for age, heavy drinking and over 15 years of manipulating a vibrating tool at work. Among the 3570 women included, 160 reported Dupuytren’s disease (4.5%). The number of cases in the group of women was too low to reach conclusions, although the findings seemed similar for age, diabetes and vibration exposure.
In this large French cohort study, Dupuytren’s disease in men was associated with high levels of alcohol consumption and exposure to hand-transmitted vibration. It is likely that the same applied to women.
EPIDEMIOLOGY; OCCUPATIONAL & INDUSTRIAL MEDICINE
Automobile mechanics have been exposed to asbestos in the past, mainly due to the presence of chrysotile asbestos in brakes and clutches. Despite the large number of automobile mechanics, little is known about the non-malignant respiratory diseases observed in this population. The aim of this retrospective multicenter study was to analyze the frequency of pleural and parenchymal abnormalities on HRCT in a population of automobile mechanics.
The study population consisted of 103 automobile mechanics with no other source of occupational exposure to asbestos, referred to three occupational health departments in the Paris area for systematic screening of asbestos–related diseases. All subjects were examined by HRCT and all images were reviewed separately by two independent readers, with further consensus in the case of disagreement. Multiple logistic regression models were constructed to investigate factors associated with pleural plaques.
Pleural plaques were observed in 5 cases (4.9%) and interstitial abnormalities consistent with asbestosis were observed in 1 case. After adjustment for age, smoking status, and a history of non-asbestos-related respiratory diseases, multiple logistic regression models showed a significant association between the duration of exposure to asbestos and pleural plaques.
The asbestos exposure experienced by automobile mechanics may lead to pleural plaques. The low prevalence of non-malignant asbestos-related diseases, using a very sensitive diagnostic tool, is in favor of a low cumulative exposure to asbestos in this population of workers.
Adult; Asbestos; toxicity; Automobiles; Female; Humans; Logistic Models; Lung Diseases; epidemiology; radiography; Male; Mechanics; Middle Aged; Occupational Diseases; epidemiology; radiography; Occupational Exposure; adverse effects; Paris; Pleural Diseases; epidemiology; radiography; Prevalence; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; methods; Young Adult; asbestos; pleural plaques; automobile mechanics; HRCT
Acute allergic reactions often occur in out-of-hospital settings, and
some of these reactions may cause death in the short term. However, initial
diagnosis, management and processing of acute allergic reactions by Medical
Emergency Dispatch Centres are not documented. We sought to describe acute
allergic reactions and their management by a Medical Emergency Dispatch
A prospective study was conducted from 20th August 2006 to 5th
November 2006 on incoming calls for acute allergic reactions to the Medical
Emergency Dispatch Centre for the Hauts de Seine (Paris
West suburb, France). The agreement between initial diagnosis (made by
dispatching physician) and final diagnosis (made by the physician who later
examined the patient), and between initial and final severity, were
evaluated using Cohen’s weighted Kappa coefficient.
210 calls were included. The diagnoses made by the dispatching
physician were: in 58.1% of cases urticaria, in 23.8%
angioedema, in 13.3% laryngeal edema, and in 1.9%
anaphylactic shock. The agreement between initial and final diagnoses was
evaluated by a kappa coefficient at 0.44 (CI 95%: 0.26–0.61)
and the agreement between initial and final severity was evaluated using a
kappa coefficient at 0.37 (CI 95%: 0.24–0.50).
We have highlighted only moderate agreement between the initial
severity assessed by the dispatching physician and the final severity
assessed by the physician later examining the patient. This demonstrates the
need to develop a tool for assessing severity of acute allergic reactions
for dispatching physicians in Medical Emergency Dispatch Centres.
Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Emergency Medical Services; organization & administration; Female; France; Humans; Hypersensitivity; diagnosis; Infant; Male; Middle Aged; Physician's Role; Prospective Studies; Severity of Illness Index; Young Adult; allergy; pre-hospital; clinical assessment; severity (other)
Physical examination is often used to screen workers for carpal tunnel syndrome (CTS). In a population of newly-hired workers, we evaluated the yield of such screening.
Our study population included 1108 newly-hired workers in diverse industries. Baseline data included a symptom questionnaire, physical exam, and bilateral nerve conduction testing of the median and ulnar nerves; individual results were not shared with the employer. We tested three outcomes: symptoms of CTS, abnormal median nerve conduction, and a case definition of CTS that required both symptoms and median neuropathy.
Of the exam measures used, only Semmes-Weinstein sensory testing had a sensitivity value above 31%. Positive predictive values were low, and likelihood ratios were all under 5.0 for positive testing and over 0.2 for negative testing.
Physical examination maneuvers have a low yield for the diagnosis of CTS in workplace surveillance programs and in post-offer, pre-placement screening programs.
Carpal Tunnel Syndrome; Post-offer pre-placement examinations; physical examination; screening; clinical epidemiology
In view of the debate about occupational factors in Dupuytren’s disease, the aim of this study was to describe the prevalence of the disease in men and its relationship with work exposure, and especially to distinguish heavy manual work with and without significant use of vibrating tools by using data from a surveillance program for musculoskeletal disorders.
This cross-sectional study was conducted in France between 2002 and 2004. Dupuytren’s disease was diagnosed clinically by one of the 83 occupational physicians involved in the program. Exposure in relation to work status and occupational risk factors was assessed with a self-administered questionnaire, and was categorized according to vibration exposure (defined as use of vibrating tools ≥2h/day), heavy manual work without vibration exposure [defined as use of hand tools ≥2h/day (use of vibrating tools ≥2h/day excluded) and Borg scale ≥15/20] and no form of such exposure. Bivariate and multivariate associations using logistic models were recorded in men and also in those with over 10 years at the same job.
Of the 2,161 men, 1.3% (n=27) suffered from Dupuytren’s disease (mean age 47.1+/−6.7 years). Heavy manual work without vibration exposure was significantly associated with the disease (adjusted odds ratio - aOR- 3.9[1.3;11.5]) adjusted on age and diabetes), as was the use of vibrating tools (aOR 5.1[2.1;12.2]). These associations remained significant among subjects with over 10 years at the same job, with increases in aOR of 6.1[1.5;25.0] and 10.7[3.4;34.6], respectively.
Despite the limited number of cases, occupational exposure, including both vibration exposure and heavy manual work without significant vibration exposure, was associated with Dupuytren’s disease.
Adult; Cross-Sectional Studies; Dupuytren Contracture; diagnosis; epidemiology; etiology; France; epidemiology; Humans; Logistic Models; Male; Middle Aged; Occupational Diseases; etiology; Occupational Exposure; adverse effects; Occupations; Population Surveillance; Prevalence; Questionnaires; Risk Factors; Vibration; adverse effects; Work; Dupuytren contracture; observational study; occupational factor; manual work; vibration exposure
Katz et al have published a standardized scoring system of hand diagrams for carpal tunnel syndrome. The purpose of this study was to quantitatively evaluate alternative scoring of the hand diagram for detection of carpal tunnel syndrome.
In a prospective study of 1107 workers, 221 workers with hand symptoms completed hand diagrams and electrodiagnostic testing for carpal tunnel syndrome. Scoring algorithms for the hand diagrams included the Katz rating; a median nerve digit score (0–2) with a maximum of 2 symptomatic digits of thumb, index, and long; and isolated digit scores (0–1) of thumb, index, or long. Intraclass correlation coefficients quantified inter-rater reliability. Sensitivity, specificity, and logistic regression analyses evaluated scoring systems performances ability to predict abnormal median nerve conduction.
One hundred ten (50%) subjects illustrated symptoms within the median nerve distribution. All scoring systems demonstrated substantial inter-rater reliability. “Classic” or “probable” Katz scores, median nerve digit score of 2, and positive long finger scores were significantly associated with abnormal median nerve distal sensory latency and median-ulnar difference. Abnormal distal motor latency was significantly associated with the median nerve digit score of 2 and positive long finger scores. Increasing Katz scores from “possible” to “probable” and “classic” were not associated with greater odds of electrodiagnostic abnormality. Positive long finger scores performed at least as well as the most rigorous scoring by Katz.
Symptoms diagramed within the median nerve distribution are associated with abnormal nerve conduction among workers. The median nerve digit score and the long finger score offer increased ease of use compared to the Katz method while maintaining similar performance characteristics. The long finger appears best suited for isolated digit scoring to predict abnormal median nerve conduction in a working population.
Carpal tunnel syndrome; Hand diagram; screening; scoring