B cells in the pneumococcus-infected lung are heterogeneous and require CD4+ T cell help including CD40L to become resident memory B cells.

Recovery from respiratory pneumococcal infections generates lung-localized protection against heterotypic bacteria, mediated by resident memory lymphocytes. Optimal protection in mice requires re-exposure to pneumococcus within days of initial infection. Serial surface marker phenotyping of B cell populations in a model of pneumococcal heterotypic immunity revealed that bacterial re-exposure stimulates the immediate accumulation of dynamic and heterogeneous populations of B cells in the lung, and is essential for the establishment of lung resident memory B (BRM) cells. The B cells in the early wave were activated, proliferating locally, and associated with both CD4+ T cells and CXCL13. Antagonist- and antibody-mediated interventions were implemented during this early timeframe to demonstrate that lymphocyte recirculation, CD4+ cells, and CD40 ligand (CD40L) signaling were all needed for lung BRM cell establishment, whereas CXCL13 signaling was not. While most prominent as aggregates in the loose connective tissue of bronchovascular bundles, morphometry and live lung imaging analyses showed that lung BRM cells were equally numerous as single cells dispersed throughout the alveolar septae. We propose that CD40L signaling from antigen-stimulated CD4+ T cells in the infected lung is critical to establishment of local BRM cells, which subsequently protect the airways and parenchyma against future potential infections.

Two Cases of Acute Direct Oral Anticoagulant Overdose Without Adverse Effect.

We report 2 pediatric patients who had acute overdoses of the direct oral anticoagulants medications. Both patients were managed conservatively; neither required reversal agents or blood products nor had any major or minor bleeding events. With therapeutic usage of direct oral anticoagulants, routine coagulation studies typically are considered insufficient measures of anticoagulation and the preferred chromogenic anti-Factor Xa assay is recommended but not widely available. Using a routine hybrid heparin anti-Factor Xa assay, 1 patient demonstrated a strong linear correlation up to a serum rivaroxaban concentration of 940 ng/mL.

Case Report: Deutetrabenazine as an Adjunctive Treatment for Stuttering.

Childhood-Onset Fluency Disorder (Stuttering) is a neurodevelopmental disorder in which disturbances occur in the normal fluency and time patterning of speech. While the dopamine system has been well-described in its neurophysiology, there currently is no FDA-approved treatment for stuttering. Second-generation antipsychotics, which have been effective in the treatment of schizophrenia and bipolar disorder, act as dopamine D-2 receptor antagonists at the postsynaptic neuron and have been shown to reduce the symptoms of stuttering. However, the D-2 receptor antagonist and partial agonist agents carry the potential for metabolic side effects and can potentially lead to movement disorders. Deutetrabenazine, a VMAT-2 inhibitor indicated to treat hyperkinetic movement disorders, is a potential candidate in the treatment of stuttering, based on its mechanism of action in decreasing dopamine activity while not carrying the risk of metabolic adverse events.

Effect of a stepwise opioid-sparing analgesic protocol on in-hospital oxycodone use and discharge prescription after cesarean delivery.

INTRODUCTION: Opioid exposure during hospitalization for cesarean delivery increases the risk of new persistent opioid use. We studied the effectiveness of stepwise multimodal opioid-sparing analgesia in reducing oxycodone use during cesarean delivery hospitalization and prescriptions at discharge. METHODS: This retrospective cohort study analyzed electronic health records of consecutive cesarean delivery cases in four academic hospitals in a large metropolitan area, before and after implementation of a stepwise multimodal opioid-sparing analgesic computerized order set coupled with provider education. The primary outcome was the proportion of women not using any oxycodone during in-hospital stay ('non-oxycodone user'). In-hospital secondary outcomes were: (1) total in-hospital oxycodone dose among users, and (2) time to first oxycodone pill. Discharge secondary outcomes were: (1) proportion of oxycodone-free discharge prescription, and (2) number of oxycodone pills prescribed. RESULTS: The intervention was associated with a significant increase in the proportion of non-oxycodone users from 15% to 32% (17% difference; 95% CI 10 to 25), a decrease in total in-hospital oxycodone dose among users, and no change in the time to first oxycodone dose. The adjusted OR for being a non-oxycodone user associated with the intervention was 2.67 (95% CI 2.12 to 3.50). With the intervention, the proportion of oxycodone-free discharge prescription increased from 4.4% to 8.5% (4.1% difference; 95% CI 2.5 to 5.6) and the number of prescribed oxycodone pills decreased from 30 to 18 (-12 pills difference; 95% CI -11 to -13). CONCLUSIONS: Multimodal stepwise analgesia after cesarean delivery increases the proportion of oxycodone-free women during in-hospital stay and at discharge.

Poison control centers and alternative forms of communicating with the public: what's all the chatter about?

Context: Short messaging service (SMS or text messaging) allows for the exchange of electronic text messages. Online chatting refers to Internet-based transmission of messages for real-time conversation. Poison Control Centers (PCCs) in the United States communicate with the public primarily via telephone. However, people increasingly prefer the convenience of SMS and chatting. Our objective is to describe the use of SMS and chatting by PCCs in the United States. Methods: An electronic survey questionnaire was distributed to all 55 US poison control center members of the American Association of Poison Control Centers. The survey assessed protocols for SMS and chatting, inquiry volume, and staff satisfaction. Centers reporting use of SMS or chatting services were administered follow-up questions, which further documented SMS and chatting interfaces and startup and maintenance costs. Descriptive statistics were used to describe the data. No statistical analysis was performed. Results: Of the 55 PCCs, 51 (93%) responded to the survey, 6 (12%) of which currently use or formerly used SMS and/or chatting. Inquiry volume ranged from 0 to 1 per day for SMS and 0 to 20 per day for chats. Startup costs ranged from $0 to $25,000. The most beneficial aspect, reported by 4 of the 6 PCCs (66.6%), was providing an alternative contact for inquiries. Most SMS and chatting interactions were completed within 10 and 30 min, respectively. All six centers completed telephone interactions within 10 min. The most disadvantageous aspects, reported by 2 of the 6 PCCs (33.3%), were staff apprehension and interaction length. Technology, such as syncing with existing call queuing software and databases, presented the greatest barrier to implementation. Conclusions: A minority of PCCs in the United States use SMS and chatting. Further research may investigate the economic feasibility of these systems, if SMS and chatting effectively expands public access, and patient comfort in contacting PCCs.

Use of medical administrative data for the surveillance of psychotic disorders in France.

BACKGROUND: Psychotic disorders are among the most severe psychiatric disorders that have great effects on the individuals and the society. For surveillance of chronic low prevalence conditions such as psychotic disorders, medical administrative databases can be useful due to their large coverage of the population, their continuous availability and low costs with possibility of linkage between different databases. The aims of this study are to identify the population with psychotic disorders by different algorithms based on the French medical administrative data and examine the prevalence and characteristics of this population in 2014. METHODS: The health insurance system covers the entire population living in France and all reimbursements of ambulatory care in private practice are included in a national health insurance claim database, which can be linked with the national hospital discharge databases. Three algorithms were used to select most appropriately persons with psychotic disorders through data from hospital discharge databases, reimbursements for psychotropic medication and full insurance coverage for chronic and costly conditions. RESULTS: In France in 2014, estimates of the number of individuals with psychotic disorders were 469,587 (54.6% males) including 237,808 with schizophrenia (63.6% males). Of those, 77.0% with psychotic disorders and 70.8% with schizophrenia received exclusively ambulatory care. Prevalence rates of psychotic disorders were 7.4 per 1000 inhabitants (8.3 in males and 6.4 in females) and 3.8 per 1000 inhabitants (4.9 in males and 2.6 in females) for schizophrenia. Prevalence of psychotic disorders reached a maximum of 14 per 1000 in males between 35 and 49 years old then decreased with age while in females, the highest rate of 10 per 1000 was reached at age 50 without decrease with advancing age. No such plateau was observed in schizophrenia. DISCUSSION: This study is the first in France using an exhaustive sample of medical administrative data to derive prevalence rates for psychotic disorders. Although only individuals in contact with healthcare services were included, the rates were congruent with reported estimates from systematic reviews. The feasibility of this study will allow the implementation of a national surveillance of psychotic disorders essential for healthcare management and policy planning.

Forkhead box O3 (FoxO3) regulates kidney tubular autophagy following urinary tract obstruction.

Autophagy has been shown to be important for normal homeostasis and adaptation to stress in the kidney. Yet, the molecular mechanisms regulating renal epithelial autophagy are not fully understood. Here, we explored the role of the stress-responsive transcription factor forkhead box O3 (FoxO3) in mediating injury-induced proximal tubular autophagy in mice with unilateral ureteral obstruction (UUO). We show that following UUO, FoxO3 is activated and displays nuclear expression in the hypoxic proximal tubules exhibiting high levels of autophagy. Activation of FoxO3 by mutating phosphorylation sites to enhance its nuclear expression induces profound autophagy in cultured renal epithelial cells. Conversely, deleting FoxO3 in mice results in fewer numbers of autophagic cells in the proximal tubules and reduced ratio of the autophagy-related protein LC3-II/I in the kidney post-UUO. Interestingly, autophagic cells deficient in FoxO3 contain lower numbers of autophagic vesicles per cell. Analyses of individual cells treated with autophagic inhibitors to sequentially block the autophagic flux suggest that FoxO3 stimulates the formation of autophagosomes to increase autophagic capacity but has no significant effect on autophagosome-lysosome fusion or autolysosomal clearance. Furthermore, in kidneys with persistent UUO for 7 days, FoxO3 activation increases the abundance of mRNA and protein levels of the core autophagy-related (Atg) proteins including Ulk1, Beclin-1, Atg9A, Atg4B, and Bnip3, suggesting that FoxO3 may function to maintain components of the autophagic machinery that would otherwise be consumed during prolonged autophagy. Taken together, our findings indicate that FoxO3 activation can both induce and maintain autophagic activities in renal epithelial cells in response to injury from urinary tract obstruction.

An epidemiological surveillance network of lumbar disc surgery to help prevention of and compensation for low back pain.

BACKGROUND: In the context of the establishment of a new surveillance system, the aim was to assess the proportion of cases of lumbar disc surgery (LDS) attributable to work according to occupation category and industry sector. METHODS: The sociodemographic and socioeconomic data of 3150 inpatients living in a French region discharged in 2007-2008 from spine centers of the region following LDS were compared with those of the regional population. Occupational history was gathered using a mailed questionnaire. The attributable fraction of risk for exposed individuals (AFE) and population attributable fraction of risk (PAF) were calculated in relation to occupations and industries. RESULTS: Three occupational subcategories presented an AFE >50% for men (police and armed forces, unskilled agricultural and skilled craft blue-collar workers). There were eight subcategories for women, including material handlers and related equipment workers, and skilled industrial and unskilled agricultural blue-collar workers. The PAF for men was highest for construction and for women it was highest for wholesale and retail trades. CONCLUSION: The AFE and PAF are valuable for public policy. Although PAF could be used to help public health policy makers to implement preventive measures, the AFE could assist expert tribunals who take decisions about compensation for occupational diseases.

Incidence of Chronic and Other Knee Pain in Relation to Occupational Risk Factors in a Large Working Population.

OBJECTIVES: The aim of this study was to estimate the incidence of chronic and other knee pain (KP) in relation to occupational and personal risk factors among workers representative of a general working population. METHODS: Of 3710 workers in a French region included in a surveillance network for musculoskeletal disorders (2002-2005), 2332 completed a follow-up questionnaire in 2007-2009 (Cosali cohort). The questionnaires included questions on musculoskeletal symptoms, and personal and occupational exposure. Incident cases of KP in 2007-2009 (i.e. with KP at follow-up but not at baseline) were dichotomized into chronic KP (>30 days in the previous year) and other KP. Associations between incident KP and personal and occupational factors at baseline were studied separately according to sex using multinomial logistic regression. RESULTS: Of the 1616 respondents without KP at baseline, 122 (7.5%) reported chronic KP and 243 (15.0%) reported other KP. The incidence rate of chronic KP was estimated at 19.6 per 1000 worker-years (95% CI: 16.3-23.5). After adjustment for age and body mass index, significant associations were found between incident chronic KP and handling loads >4kg [odds ratio (OR) 2.1 (1.2-3.6) for men, OR 2.3 (1.1-5.0) for women] and kneeling >2h a day for men [OR 1.8 (1.0-3.0)]. CONCLUSIONS: This study highlights the high frequency of chronic KP in the working population and the role of occupational factors in its incidence, in particular those kneeling and handling loads.

Risk factors for carpal tunnel syndrome related to the work organization: a prospective surveillance study in a large working population.

The study aimed to determine the risk factors for incident carpal tunnel syndrome (CTS) in a large working population, with a special focus on factors related to work organization. In 2002-2005, 3710 workers were assessed and, in 2007-2010, 1611 were re-examined. At baseline all completed a self-administered questionnaire about personal/medical factors and work exposure. CTS symptoms and physical examination signs were assessed by a standardized medical examination at baseline and follow-up. The risk of "symptomatic CTS" was higher for women (OR = 2.9 [1.7-5.2]) and increased linearly with age (OR = 1.04 [1.00-1.07] for 1-year increment). Two work organizational factors remained in the multivariate risk model after adjustment for the personal/medical and biomechanical factors: payment on a piecework basis (OR = 2.0, 95% CI 1.1-3.5) and work pace dependent on automatic rate (OR = 1.9, 95% CI 0.9-4.1). Several factors related to work organization were associated with incident CTS after adjustment for potential confounders.

Biomechanical constraints remain major risk factors for low back pain. Results from a prospective cohort study in French male employees.

BACKGROUND CONTEXT: Low back pain (LBP) is a major public health problem, with a considerable impact on workers. PURPOSE: To model the risk of LBP in the male general working population. STUDY DESIGN/SETTING: Repeated cross-sectional surveys in a wide occupational setting. PATIENT SAMPLE: A random sample of 2,161 men working in various occupations in a French region participated in a first survey in 2002, and 1,313 of these (60.8%) participated in a second survey in 2007. OUTCOME MEASURE: The self-reported prevalence of LBP during the previous week in the second survey. METHODS: Twenty-one biomechanical, organizational, psychosocial, and individual factors were assessed in the first survey. The association between these potential risk factors and the prevalence of later LBP (in the second survey) was studied, using multistep logistic regression models. RESULTS: Three hundred ninety-four men reported LBP in the second survey (prevalence 30.0%). The final multivariate model highlighted four risk factors: frequent bending (odds ratio [OR], 1.45, 95% confidence interval [CI], 1.07-1.97 for bending forward only; and OR, 2.13, 95% CI, 1.52-3.00 for bending both forward and sideways), driving industrial vehicles (OR, 1.35; 95% CI, 1.00-1.81), working more hours than officially planned (OR, 1.38; 95% CI, 1.05-1.81), and reported low support from supervisors (OR, 1.35; 95% CI, 1.02-1.79). CONCLUSIONS: These results emphasize that biomechanical factors remain worth considering, even when psychosocial factors are taken into account, and provide a significant contribution to preventive strategies.

Long-term persistence of knee pain and occupational exposure in two large prospective cohorts of workers.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: This study highlights the role of occupational factors in the persistence of KP for men, in particular kneeling and handling/carrying loads.

[Difficulties of a longitudinal epidemiological follow-up study in French occupational medicine]. / Les difficultés d'un suivi epidémiologique longitudinal dans les services de santé au travail.

INTRODUCTION: This study was designed to describe the difficulties of epidemiological follow-up of employees by occupational health services. METHODS: This study was based on two transverse studies conducted by the Pays de la Loire musculoskeletal disorders (MSD) surveillance network. Eighty-three occupational health physicians included 3,710 employees between 2002 and 2005 and had to review them between 2007 and 2009. Thirteen of these physicians changed jobs and 7 changed geographical sector in the same occupational health service. RESULTS: Another 94 physicians were contacted and 85 agreed to participate in the network. The follow-up rate was 43%: 1,044 employees were reviewed by the physician who saw them on inclusion and 567 employees were reviewed by another physician of the network. The other employees were distributed as follows: 25% were lost to follow-up and their occupational status remained unknown; 23% were still employed with an identified occupational health physician but had not attended a medical visit during the follow-up study; 5% had left the occupational health surveillance system. Only 23 employees refused to participate in the follow-up and 105 employees had a physician who refused to participate. DISCUSSION: There is therefore a considerable mobility of occupational health physicians, which interfered with follow-up despite their good mobilization and a high percentage of employee are lost to follow-up after having left their jobs. More appropriate systems must be set up to follow populations of employees, such as new collaborations with general practitioners.

Incidence and risk factors for thoracic spine pain in the working population: the French Pays de la Loire study.

OBJECTIVE: To examine the incidence and risk factors for incident thoracic spine pain (TSP) in workers representative of a French region's working population. METHODS: In this prospective study, 3,710 workers were assessed in 2002-2005, and 2,332 (62.9%) of them were reassessed in 2007-2010. TSP was assessed by a self-administered Nordic questionnaire at baseline and at followup. At baseline, all participants completed a self-administered questionnaire on personal factors and work exposure. A total of 1,886 subjects (1,124 men and 762 women) without TSP at baseline were eligible for analysis. Associations between incident TSP and risk factors at baseline were analyzed by multivariate logistic regression. RESULTS: The incidence rate of TSP was 5.2 (95% confidence interval [95% CI] 3.9-6.6) per 100 men and 10.0 (95% CI 7.8-12.1) per 100 women. TSP was often associated with low back pain and neck pain. TSP in men was associated with age (odds ratios [ORs] ranging from 2.6 [95% CI 0.95-7.1] at 30-39 years to 6.0 [95% CI 2.1-17.3] at ≥50 years), being tall (OR 2.2 [95% CI 1.2-3.9]), frequent/sustained trunk bending (OR 3.0 [95% CI 1.5-6.1]), lack of recovery period or change in the task (OR 2.0 [95% CI 1.2-3.6]), and driving vehicles (OR 2.8 [95% CI 1.4-5.5]). Being overweight or obese was associated with lower risk (OR 0.5 [95% CI 0.3-0.96]). TSP in women was associated with high perceived physical workload (OR 1.9 [95% CI 1.1-3.3]), after adjustment for confounding variables. CONCLUSION: The risk model of TSP combined personal and work-related organizational and physical factors. Trunk bending appeared to be a strong independent predictor of TSP in this working population.

Natural course of rotator cuff syndrome in a French working population.

BACKGROUND: The aim was to assess the persistence of rotator cuff syndrome (RCS) in workers and to study associations with personal and work-related factors, job change, exposure change and treatment. METHODS: At baseline, 274 workers suffered from RCS, of whom 150 were followed up. Three groups were constituted: (1) a RCS recovery group, (2) a shoulder pain without RCS group, and (3) a RCS without recovery group. We studied the differences between groups (1) and (3) because of the low number of workers in group (2). RESULTS: Recovery occurred in 61.5% of men and 51.4% of women. Factors related to work were associated with persistence of RCS in men whereas upper limb pain and absence of job rotation were associated with persistence of RCS in women. CONCLUSION: This descriptive study showed that a high percentage of workers recovered and several personal and work-related factors were associated with persistent RCS. Larger prospective studies are needed to confirm these results.

Personal, biomechanical, organizational and psychosocial risk factors for neck disorders in a working population.

OBJECTIVES: The aim of the study was to assess both personal and occupational risk factors for non-specific neck disorder (ND) in a representative working population characterized by various levels of exposure to work-related constraints. ND during the preceding 7 days was assessed in 3,710 workers surveyed by 83 occupational physicians between 2002 and 2005. Personal risk factors and work exposure were assessed by a standardized examination and a self-administered questionnaire. Associations between ND and personal and occupational factors were analyzed using logistic regression modeling separately in men and in women. RESULTS: The personal risk factors for ND were age (OR for 1-year increment 1.02, 95% CI 1.01 to 1.03 in men and 1.03 [1.01-1.04] in women) and previous history of arthritis disease (OR 2.39 [1.17-4.91] in men and 3.95 [1.92-8.12] in women). The risk of ND increased with previous history or upper limb musculoskeletal disorders in men (OR 1.58 [1.17-2.13]) and decreased with BMI in women (OR for 1-kg/m(2) increment 0.96, [0.93-0.99]). The work-related risk factors of ND were sustained or repeated arm abduction (OR 2.08 [1.35-3.21] in men and 2.22 [1.27-3.86] in women) and neck flexion (OR 1.64 [1.26-2.12] in women). Work pace dependent on customers (OR 1.42 [1.10-1.83]) and psychological demand of the task (OR 1.49 [1.15-1.92]) increased the risk of ND in men. Work pace dependent on quantified targets (OR 1.37 [1.05-1.79]) and low supervisor support (OR 1.68 [1.30-2.17]) increased the risk of ND in women. This study highlighted the multifactorial nature of ND.

Organizational and psychosocial risk factors for carpal tunnel syndrome: a cross-sectional study of French workers.

PURPOSE: The aim of the study was to examine the organizational and psychosocial risk factors for carpal tunnel syndrome (CTS) in workers exposed to various levels of work-related constraints, with a special focus on factors related to the work organization. METHODS: From 3,710 workers, representative of a French region's working population, trained occupational physicians diagnosed a total of 156 cases of CTS between 2002 and 2005. Diagnoses were established by standardized physical examination, while personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between CTS and personal and work-related factors were analyzed for each gender using logistic regression modeling. RESULTS: Among the factors related to work organization, working with temporary workers was associated with CTS for women (OR = 1.99, 95 % CI 1.23-3.25), but not for men. Task rotation during the job (OR = 2.45 95 % CI 1.41-4.24) and work pace dependent on quantified targets (OR = 1.93 95 % CI 1.08-3.46) were associated with CTS only for men. The work-related psychosocial factors highlighted by the logistic modeling were high psychological demand for women (OR = 1.90, 95 % CI 1.17-3.09) and low skill discretion (OR = 1.77, 95 % CI 1.01-3.11) for men. CONCLUSION: This study has identified some psychosocial factors and factors related to work organization associated with clinically diagnosed and symptom-only cases of CTS as well as personal and biomechanical factors. However, due to the cross-sectional design of the study, no causal conclusion could be drawn and longitudinal studies are necessary to confirm these results.

Work-related risk factors for incidence of lateral epicondylitis in a large working population.

OBJECTIVES: This study aims to estimate the association between repeated measures of occupational risk factors and the incidence of lateral epicondylitis in a large working population. METHODS: A total of 3710 workers in a French region were included in 2002-2005, and among them 1046 had a complete follow-up in 2007-2010. At both stages, occupational health physicians assessed the presence of lateral epicondylitis and workers self-reported their occupational exposures. Poisson models were performed to assess the incidence rate ratios (IRR) separately by sex using multiple imputed data. RESULTS: The annual incidence rate of lateral epicondylitis was estimated as 1.0 [95% confidence interval (95% CI) 0.7-1.3] per 100 workers among men and 0.9 (95% CI 0.6-1.3) among women. Workers aged >45 years had higher incidence than those aged <30 years (significant at 10%). Among men, high physical exertion combined with elbow flexion/extension or extreme wrist bending (>2 hours/day) was a risk factor, with an age-adjusted IRR of 3.2 (95% CI 1.5-6.4) for workers exposed at both questionnaires [3.3 (95% CI 1.4-7.6) among women]. CONCLUSIONS: This study highlights the importance of temporal dimensions for occupational risk factors on the incidence of lateral epicondylitis. Further research should evaluate the risk associated with the duration and repetition of occupational exposure on the incidence of lateral epicondylitis.

Employment and occupational outcomes of workers with musculoskeletal pain in a French region.

OBJECTIVES: To study the employment and occupational outcomes of workers who were diagnosed with upper limb musculoskeletal disorders (UL-MSDs) or had complained of upper limb musculoskeletal pain a few years before compared with workers who had no upper limb pain. METHODS: In 2002-2005, an epidemiological surveillance system was set up. Occupational physicians examined 3710 randomly selected workers. It focused on six UL-MSDs: rotator cuff syndrome, lateral epicondylitis, flexor-extensor peritendinitis of the hands and fingers, de Quervain's disease, carpal tunnel syndrome and ulnar tunnel syndrome. Three groups were constituted: a 'UL-MSD' group (workers with a clinically diagnosed UL-MSD at baseline, 13% of the cohort); a 'PAIN' group (workers with pain in the previous 7 days at baseline and without any clinically diagnosed form, 38%); and a 'HEALTHY' group (workers with no disorder or upper limb pain in the previous 7 days, 49%). They completed a questionnaire between 2007 and 2009. RESULTS: A total of 2332 responded. Fewer subjects were still in work in the 'UL-MSD' group (79.3%) than in the 'PAIN' (85.9%) and 'HEALTHY' (90.4%) groups, the difference remaining significant after adjusting for gender, age, occupational category, type of company and comorbidities. Of the subjects still in work, 24% had changed their work station in the same company in the 'PAIN' group compared with 19% in the 'HEALTHY' group and 21% in the 'UL-MSD' group. CONCLUSIONS: This study showed the impact of musculoskeletal pain on employment outcome and the difficulty of keeping workers with musculoskeletal problems at work.

Work-related risk factors for lateral epicondylitis and other cause of elbow pain in the working population.

BACKGROUND: This study was designed to assess the relationship between work-related combined physical and psychosocial factors and elbow disorders (lateral epicondylitis and non-specific disorders without lateral epicondylitis) in the working population. METHODS: A total of 3,710 workers (58% men) in a French region in 2002-2005 participated in physical examinations by occupational health physicians and assessed their personal factors and work exposure by self-administered questionnaire. Statistical associations between elbow disorders and risks factors were analyzed using multinomial logistic regression. RESULTS: A total of 389 (10.5%) workers had elbow pain without lateral epicondylitis and 90 (2.4%) workers had lateral epicondylitis. Age, body mass index (>25), and low social support (only for men) were significant risks factors. Hard perceived physical exertion combined with elbow flexion/extension (>2 hr/day) and wrist bending (>2 hr/day) was a strong significant risk factor for elbow pain and epicondylitis: among men, adjusted Odds Ratio (ORa) = 2.6 (1.9-3.7) and ORa = 5.6 (2.8-11.3), respectively; among women, ORa = 1.4 (0.9-2.2) and ORa = 2.9 (1.3-6.5). CONCLUSIONS: This study emphasizes the strength of the associations between combined physical exertion and elbow movements and lateral epicondylitis. Certain observed differences in associations with lateral epicondylitis and elbow pain only indicate the need for additional longitudinal studies on different stages of elbow disorders and known risk factors.