Metastatic Melanoma in Young Child.

Pediatric melanoma is a rare cancer, especially in young children, and it remains a diagnostic challenge. We report a case of massively metastatic melanoma in young patient with an atypical clinical and biological presentation and with no risk factors.

Effects of COVID-19 lockdown on low back pain intensity in chronic low back pain patients: results of the multicenter CONFI-LOMB study.

PURPOSE: The COVID-19 pandemic and the extended lockdown are associated with numerous changes in behavior and lifestyles. The objective was to assess the impact of the first lockdown on LBP course among chronic LBP patients. METHODS: Descriptive and analytical, cross-sectional, multicenter study, conducted by questionnaire from mid-May to end of June 2020 among patients treated for chronic LBP in 6 French and 1 Swiss center. Collected data concerned changes in LBP intensity during lockdown, lockdown experience, physical activity (PA) practice and sedentary lifestyle prior and during lockdown, recourse to care, consumption of psychoactive substances for LBP, and professional activity and its conditions during lockdown. RESULTS: 360 participants (58.6% women, 52.1 ± 13.4 years) were included of which 65% were active (63% keep on working of which 54% teleworked). LBP got worse in 41.1%, mean VAS went from 49.5 ± 21.6 before to 53.5 ± 22.4 during lockdown (p < 0.001) and needed increase of treatment by 29% but very few people increased their consumption psychoactive substances for analgesia. Half of participants had well-experienced lockdown. Findings revealed a significant decrease in PA and increase of sedentary during lockdown (p < 0.0001). Good experience of lockdown was associated with LBP improvement (OR = 0.6 [0.3-0.9]) and decrease of PA with LBP worsening (OR = 1.9 [1.1-3.2]). Teleworking was also associated with LBP worsening. Gender, age, or BMI did not influence LBP course. CONCLUSION: These findings indicate that chronic LBP people suffered from increase in self-perceived LBP during lockdown and help to better understand the factors associated with their condition.

Major Issues of Care in Thalassemia Major Children Refugees.

Beta thalassemia major (ßTM) is the most common inherited hemoglobinopathy. Management essentially focuses on preventing and treating complications. Conventional treatment is based on a regular blood transfusion program, and chelation therapy. Management essentially focuses on preventing and treating complications. Severe complications of ßTM are very rarely seen in children in Europe. In the context of the migrant crisis, pediatricians will be confronted with the challenge of managing severe complicated ßTM. We report the case of 2 Syrian 10-year-old twin girls who arrived to France with numerous and severe complications of ßTM: hemochromatosis, alloimmunization, hypopituitarism, osteopenia… Their clinical management, which led to successful vital and functional improvement, is reported in this article.

Functional incapacity related to rotator cuff syndrome in workers. Is it influenced by social characteristics and medical management?

STUDY DESIGN: Survey. INTRODUCTION: Rotator cuff syndrome (RCS) is one of the most common musculoskeletal disorders reported in workers. The functional incapacity related to RCS may vary according to the sociodemographic context and to the medical management. PURPOSE OF THE STUDY: The purpose of this is to analyze the RCS-related functional incapacity assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires in workers according to their sociodemographic characteristics and the use of care. METHODS: A cross-sectional study was carried out on a French sample of workers diagnosed with RCS. The DASH and DASH-work scores were studied according to the sociodemographic factors, musculoskeletal symptoms, and RCS medical management during the preceding 12 months. RESULTS: Two hundred seven workers who suffered from RCS filled out the questionnaire of which 80% were still working. The DASH score was significantly higher in women (24.0 vs 17.4; P < .01; effect size (d) = 0.39), in patients over the age of 50 years (23.6 vs 11.3; P < .005) and in case of another upper limb musculoskeletal disorder (P < .0001; d ≥ 0.4). The DASH and DASH-work scores were significantly higher in case of use of care for RCS (P < .005; d > 0.6). DISCUSSION: The demographic factors and the RCS medical management influenced the overall incapacity assessed by the DASH questionnaire. Work incapacity was more especially related to the use of care for RCS. CONCLUSION: The sociodemographic and medical parameters added to other established predictors could help guide clinicians in managing their patients.

Risk factors for episodic neck pain in workers: a 5-year prospective study of a general working population.

PURPOSE: Development of neck pain (NP) in workers has a multifactorial etiology and depends on both individual and workplace factors. The aim of this study was to investigate risk factors for episodic NP in a large diverse sample of active workers. METHODS: A prospective study based on the surveillance program implemented by the French Public Health Agency in the Loire Valley region. Between 2002 and 2005, 3710 workers were included. Between 2007 and 2010, 2332 workers responded to a follow-up questionnaire which assessed: (1) musculoskeletal symptoms (Nordic questionnaire) and (2) individual and work-related risk factors. Associations between episodic NP in 2007 (i.e., free subjects at baseline and who suffered at least 8 days during the preceding 12 months) and individual and work-related risk factors at baseline were studied using logistic regression modeling, stratified by sex. RESULTS: Among the 1510 workers (914 men, 596 women) still active at follow-up, 10.4% (8.4-12.4) of men and 14.6% (11.8-17.4) of women declared episodic NP. Among men, work pace dependence of guests or permanent hierarchical controls were risk factors of NP [OR = 1.8 (1.1-2.8) and OR = 2.1 (1.3-3.3), respectively]. Among women, the combination of sustained/repeated arm abduction with high physical perceived exertion was the strongest risk factor for NP [OR = 3.5 (1.7-7.2)]; age and paced work were also predictors for NP in women. CONCLUSIONS: NP results from complex relationships between individual and work-related variables. High physical workload, awkward postures, and poor organizational environment together with age differently predicted episodic NP according to the sex.

Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS. METHODS: Surgical CTS were assessed using regional hospital discharge records for persons aged 20-59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors. RESULTS: A limited proportion of CTS were work-related in the region's population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137-2212] CTS, of which 906 [450-1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46-153], 81 [58-111] and 159 [114-223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). CONCLUSION: The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

Interprofessional Communication Concerning Work-Related Musculoskeletal Disorders: A Qualitative Study.

Purpose Understanding and treating musculoskeletal disorders (MSDs) requires coordination between the numerous healthcare professionals involved, including occupational physicians (OPs), general practitioners (GPs) and social insurance physicians (SIPs). The main objective of this study was to assess communication between OPs, GPs and SIPs in the management of MSDs. Methods This is a qualitative study in the form of semi-structured interviews with OPs in the French region of Brittany. The interviews were conducted until data saturation was achieved. The interviews were fully coded and analysed thematically using NVivo® software. Results The interviews were carried out among 17 OPs from companies and external occupational healthcare services who treated employees from various activity sectors. Different communication channels were used depending on the interlocutor, though they were mainly contacted by mail or phone. Most of the communication passed through the patient, either verbally or in writing. No major failure was detected in communication between the various types of practitioners, but instances of communication were influenced by various factors such as differences in perception, representation and objectives, as well as by how well the physicians knew each other. A number of instances of non-communication were found. Conclusion This study showed that patients play a key role in the interactions between different practitioners. It also revealed that different types of professional relationships depend on the objectives of the various interlocutors, which in turn vary according to their roles and competences.

Return to work after rehabilitation in chronic low back pain workers. Does the interprofessional collaboration work?

The objective of this study was to assess the workplace information collected and shared between professionals of the centers and occupational health professionals during functional restoration programs intended to chronic low back pain patients. A descriptive study carried out by a questionnaire sent to the French rehabilitation centers offering a functional restoration program. Data collection focused on the kinds of professionals involved in programs, professionals who approach work issues, work analysis, social and occupational information collected, existence of a specific work rehabilitation program, frequency of and methods for sharing information with occupational health professionals. Occupational information was mostly collected at inclusion during an individual interview by the rehabilitation physicians, social workers, and occupational therapists. Workplace environment was the most poorly discussed aspect. A minority of centers adapted their programs regarding these information. Information sharing with occupational physicians was mostly through the patient and was influenced by the presence of an ergonomist or of an occupational physician in the team. The study found poor interest about work environment and that the cooperation between practitioners in disability management remains limited. The various practitioners' cultures and interests may be a brake on cooperation and exchange of information.

[Development of "MADE", a French Job exposure matrix for evaluation of biomechanical exposure]. / Développement d?une matrice emplois-expositions française (« MADE ¼) pour l'évaluation des contraintes biomécaniques.

OBJECTIVE: This paper presents the stages of development of an occupational biomechanical exposure matrix and preliminary reliability and validity indicators. METHODS: The expertise-based job exposure matrix, called "MADE" (for "difficult physical conditions and job matrix"), was developed from the French and international classification of jobs for 17 biomechanical exposures. Three pairs of investigators independently rate the frequency and intensity of exposure of each job from 0 to 5; discordant scores within pairs (mean difference >20% for each biomechanical exposure considered) were discussed collectively. Reliability was assessed by the difference between the initial ratings, the number of revised jobs, and the correlation between the two classifications (with transcoding). Validity was studied by correlating variables similar to those from existing United States and Danish matrices. RESULTS: The difference between the mean scores of the pairs was considered to be "fair" (less than one point). Of the 51 paired results studied (17 exposures - 3 pairs of investigators), four coefficients were found to be less than 0.6, and 14 were between 0.6 and 0.7. Forty-nine of the 1,169 job categories were reviewed. Correlation coefficients between the initial classification and transcoding were greater than 0.7. Correlation coefficients between the French, United States and Danish MEE variables were fair to good. CONCLUSION: An expertise-based job exposure matrix with fairly reliable indicators has been developed, opening up the prospects to improve certain some fields of public health, at both national and international levels.

[Musculoskeletal disorders: how to recognize them as occupational diseas]. / Troubles musculo-squelettiques : comment les reconnaître en maladie professionnelle ?

Musculoskeletal disorders: how to recognize them as occupational disease? Musculoskeletal disorders can be recognized as occupational diseases. The declaration of an occupational disease is the responsibility of the victim. The doctor has the duty to inform his patient about the advantages and disadvantages related to this declaration which are related to the medical and socio-professional situation of each patient. In parallel, the intervention of the occupational physician can support the return to and the staying at work of the patient-worker.

Troubles musculo-squelettiques : comment les reconnaître en maladie professionnelle ? Les troubles musculo-squelettiques peuvent être reconnus au titre de la maladie professionnelle. La déclaration d'une maladie professionnelle incombe à la victime. Le médecin a le devoir d'informer son patient sur les avantages et inconvénients liés à cette déclaration qui sont liés à la situation médicale et socioprofessionnelle de chaque patient. En parallèle, l'intervention du médecin du travail peut favoriser le retour au travail et le maintien en emploi du patient-travailleur.

[Work-related musculoskeletal disorders]. / Troubles musculo-squelettiques liés au travail.

Work-related musculoskeletal disorders. Upper-limb musculoskeletal disorders are painful conditions related to the overuse of periarticular soft tissues. The main musculoskeletal disorders are rotator cuff tendinopathy, epicondylalgia, carpal tunnel syndrome and non-specific pain. Musculoskeletal disorders affect millions of European workers and represent the first problem of health at work in the European Union. They testify to the intensification of working conditions affecting a growing number of workers in the industry and services sectors. Their impact in terms of pain and disruption of career, but also economic costs, make them a priority of health at work. They are multifactorial disorders associated with individual and occupational (biomechanical, psychosocial and factors related to work organization) risk factors. Prevention requires a global and integrated approach focusing on the reduction of the exposure to working constraints, early diagnosis and management and, if necessary, an intervention of stay at work.

Troubles musculo-squelettiques liés au travail. Les troubles musculo-squelettiques du membre supérieur regroupent des affections douloureuses en lien avec l'hypersollicitation des tissus mous périarticulaires. Les principaux sont les tendinopathies de la coiffe des rotateurs de l'épaule, les épicondylalgies, le syndrome du canal carpien et les syndromes douloureux non spécifiques. Ils affectent des millions de travailleurs européens et représentent le premier problème de santé au travail dans l'Union européenne. Ils témoignent de l'intensification des conditions de travail qui affecte un nombre croissant de travailleurs de l'industrie et des services. Leur répercussion en termes de souffrance et d'interruption des parcours professionnels, mais aussi de coûts économiques, en font une priorité de santé au travail. Les troubles musculo-squelettiques sont des maladies multifactorielles faisant intervenir des facteurs de susceptibilité individuelle et des facteurs professionnels, non seulement biomécaniques mais aussi psychosociaux et organisationnels au travail. Leur prévention nécessite une approche globale et intégrée, privilégiant la réduction des risques à la source par une action en milieu de travail, le dépistage et la prise en charge précoce des travailleurs et, si nécessaire, une intervention de maintien en emploi.

Efficiency of three treatment strategies on occupational and quality of life impairments for chronic low back pain patients: is the multidisciplinary approach the key feature to success?

OBJECTIVE: To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach. METHODS: A monocentric randomized controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) intensive and multidisciplinary program conducted in a rehabilitation center; (ii) less intensive outpatient program conducted by a trained private physiotherapist; (iii) mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an "intention to treat" approach: Number of days' sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires. RESULTS: A total of 159 patients (58.9% men, 41.5 ± 10.3 years old, median duration of sick leave = 221.0 days (127.5-319.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. There was no significant difference for the evolution of participants' quality of life, social ability, and personal beliefs between the three groups. CONCLUSION: This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care. CLINICAL TRIAL REGISTRATION: NCT02030171.

Exploratory study of the implications of research on the use of smart connected devices for prevention: a scoping review.

BACKGROUND: Smart devices and mobile applications are now an integral part of all aspects of everyday life. They are particularly numerous in the field of health, contributing to the movement called ehealth. What is the potential role of these devices as prevention supports? The purpose of this article is to provide an exploratory analysis of the use, efficacy and contribution to conventional prevention strategies. METHODS: To address this issue, we conducted a scoping-review on the basis of 105 publications from the fields of medicine and human sciences. RESULTS: Three dimensions of the use of smart devices in the field of health were identified: 1/a quantification tool allowing the users to measure their activities; 2/a tool of self-positioning in the community; 3/an interface between the medical world and the population, modifying the hierarchy of knowledge. However, few published studies have investigated the determinants of the efficacy of these devices and their impact on individual behaviours and professional health practices. CONCLUSION: Based on the hypothesis of possible integration of these devices in prevention policies, it would be interesting to investigate two research issues: how and under what psycho-socio-environmental conditions can smart devices contribute to the adoption of positive health behaviours? To what degree does the use of smart devices modify the health care professional-patient relationship? Finding answers to these questions could help to define the real place of these devices in prevention strategies by determining their complementarity with respect to other prevention strategies, and the conditions of their efficacy on behaviours and inequalities.

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.