[Agricultural occupational health and social security]. / Fonctionnement de la Santé-Sécurité au travail en agriculture.

The Mutualité Sociale Agricole (MSA) is the French social security agency for all agricultural wage earners and non-wage earners. It is the second French social security scheme after the general scheme, providing coverage for wage earners in commerce and industry. The MSA covers the whole spectrum of benefits (recovery, illness, family, retirement, occupational injury and disease) within a unique business window. The management of the MSA is overseen by elected representatives, thus creating a unique social democracy in the world of social security. Among the services managed by the MSA, occupational health and safety hold an original position: the MSA is indeed the only social security agency dealing with occupational health. 350 occupational physicians and 250 prevention consultants work in a multidisciplinary environment for the benefit of agricultural wage earners, as well as farmers, since the MSA implemented in 2002 an occupational risk prevention scheme for farmers.

Changes in osteoarthritis management by general practitioners in the COX2-inhibitor era-concomitant gastroprotective therapy.

OBJECTIVES: Two selective COX2 inhibitors, rofecoxib and celecoxib, were introduced on the French market in 2000. We evaluated their use in the treatment of osteoarthritis by general practitioners, with special attention to concomitant prescription of gastroprotective agents. MATERIAL AND METHODS: The Thales Epidemiology Observatory is a medical database compiled by a representative sample of 1000 general practitioners in France. We examined the data collected during the year before and the year after the introduction of rofecoxib and celecoxib on the French market (November 1999-October 2001). During each of the 2 years of the study period, about 200,000 visits for 70,000 patients were entered into the database. RESULTS: COX2 inhibitors were prescribed at a rapidly increasing rate during the second year, when they accounted for 38% of the prescription volume for nonsteroidal antiinflammatory drugs (NSAIDs) and 25% of prescribed medication costs. In some patients, COX2 inhibitors were substituted for nonselective NSAIDs, and in others they were used as first-line NSAID therapy. On average over the 2-year study period, 22.1% of prescriptions for conventional NSAIDs included a prescription for a gastroprotective agent; this proportion increased from 18.6% in November 1999 to 24.8% in October 2001. Among prescriptions for COX2 inhibitors, 17.5% included a gastroprotective agent. CONCLUSION: General practitioners have been prompt to use COX2 inhibitors in the treatment of osteoarthritis. However, they have not decreased their use of concomitant gastroprotective treatment. Thus, they seem aware that proof of a lower long-term risk of gastrointestinal toxicity with COX2 inhibitors is lacking, and that elderly patients such as those with osteoarthritis are at high risk for gastrointestinal side effects of NSAIDs.