A Randomized, Placebo-Controlled Study of High-Dose Baclofen in Alcohol-Dependent Patients-The ALPADIR Study.

AIMS: Alcohol dependence is a major public health issue with a need for new pharmacological treatments. The ALPADIR study assessed the efficacy and safety of baclofen at the target dose of 180 mg/day for the maintenance of abstinence and the reduction in alcohol consumption in alcohol-dependent patients. METHODS: Three hundred and twenty adult patients (158 baclofen and 162 placebo) were randomized after alcohol detoxification. After a 7-week titration, the maintenance dose was provided for 17 weeks, then progressively decreased over 2 weeks before stopping. RESULTS: The percentage of abstinent patients during 20 consecutive weeks (primary endpoint) was low (baclofen: 11.9%; placebo: 10.5%) and not significantly different between groups (OR 1.20; 95%CI: 0.58 to 2.50; P = 0.618). A reduction in alcohol consumption was observed from month 1 in both groups, but the difference of 10.9 g/day at month 6 between groups, in favour of baclofen, was not statistically significant (P = 0.095). In a subgroup of patients with high drinking risk level at baseline, the reduction was greater with a difference at month 6 of 15.6 g/day between groups in favour of baclofen (P = 0.089). The craving assessed with Obsessive-Compulsive Drinking Scale significantly decreased in the baclofen group (P = 0.017). No major safety concern was observed. CONCLUSIONS: This study did not demonstrate the superiority of baclofen in the maintenance of abstinence at the target dose of 180 mg/day. A tendency towards a reduction in alcohol consumption and a significantly decreased craving were observed in favour of baclofen. SHORT SUMMARY: Baclofen was assessed versus placebo for maintenance of abstinence and reduction in alcohol consumption in alcohol-dependent patients. This study did not demonstrate the superiority of baclofen in the maintenance of abstinence. A tendency towards a reduction in alcohol consumption and a significantly decreased craving were observed in favour of baclofen.

[Preventing addictive practices in the workplace thanks to occupational health services]. / Prévenir les pratiques addictives en milieu professionnel grâce aux services de santé au travail.

The workplace can be concerned by all types and all levels of addictive practices: consumption of alcohol or psychoactive substances, work addiction, internet addiction and technology addiction. Addictions can be related to multiple factors, both within and outside the workplace. With the employer, responsible for occupational health and safety, the multidisciplinary team of the inter-company occupational health service must today implement a collective and global prevention policy with regard to addictions, in addition to the traditional follow-up.

Surveillance program of neck and upper limb musculoskeletal disorders: assessment over a 4 year period in a large company.

OBJECTIVE: A company-wide surveillance program for musculoskeletal disorders (MSDs) based on the assessment of health and risk factors was implemented between 1996 and 2000 in a large shoe factory. The study aimed to compare the results of the surveillance program in 1996 and 1997 with the occurrence of MSDs in 2000. METHODS: A health and ergonomic assessment of workstations was performed for 253 workers in 1996. Of these, 166 were examined again in both 1997 and 2000. A set of criteria was used to predict whether or not a job category could be predicted to have a potentially high risk of MSDs in 1996 and 1997 and the results were compared with the incidence rate of MSDs in the job category in 2000. RESULTS: The criteria based on prevalence data in 1996 were unable to detect the job categories characterized by the occurrence of MSDs in 2000. The criterion based on an incidence rate >1% in 1997 was sensitive and specific. The agreement between the ranking of the job categories according to incidence rate of MSDs in 1997 and 2000 was good (rho=0.57, P=0.11). Agreement of the prediction based on ergonomic exposure was lower than that based on incidence data. CONCLUSION: The efficacy of the surveillance program to predict on a collective basis the job categories in which numerous cases of MSDs occurred in 2000 depended on the decision criteria used. The criteria based on the incidence of MSDs were more reliable to predict the risk of MSDs than those based on prevalence data or on exposure assessment. Because exposure assessment plays a greater role in determining the priorities for ergonomic intervention, surveillance of health and exposure must nevertheless be combined to predict the risk of MSDs in the plant in the short and middle terms.

Biomechanical strains on the hand-wrist system during grapevine pruning.

OBJECTIVES: In order to understand the high prevalence of musculoskeletal disorders of the hand among vineyard workers, we conducted a study to evaluate biomechanical strains on the hand-wrist system during grapevine pruning. METHODS: Surface electromyography (sEMG) activity of the right flexor digitorum muscle and wrist posture were analysed in six healthy vineyard workers using the same hand-powered pruning shears during grapevine pruning. RESULTS: The biomechanical strains on the hand-wrist system were high during grapevine pruning. Mean sEMG activity during pruning was high [23.5% (standard error of the mean (SEM): 0.4) in the maximal voluntary handgrip contraction (MVC)], as was the mean cutting frequency per minute (38; range=24-48). Approximately 14% of cuts were performed with the wrist in extreme flexion/extension (F/E) (>60% of the maximum range). Numerous cuts required moderate (20%-40% of the maximum range) or extreme (>50% of the maximum range) ulnar deviation (17% and 12% of cuts, respectively). Approximately 18% of cuts required both high muscular activity (sEMG >15% MVC) and extreme ulnar/radial (U/R) deviation of the wrist (>50% of the maximum range). CONCLUSION: Pruning imposes high biomechanical strains on the hand-wrist system in view of the repetitiveness of the task. The magnitude of physical exposure during pruning explains the high prevalence of hand disorders among vineyard workers. The use of ergonomic pruning shears is advised to lower force exertion and to reduce the frequency of awkward wrist postures during pruning.