[Diagnosis and management of alcohol-use disorders]. / Diagnostic et prise en charge des troubles de l'usage d'alcool: données récentes.

With the publication of the DSM-5, the alcoholic disease becomes Alcohol-use disorders taking into account dependence and damages according to a gradient of severity. This conceptual evolution should improve the screening of people affected by this chronic and progressive disease associated with a heavy impact on morbidity and mortality. This identification is provided by the clinical interview and examination. Its sensitivity can be improved by questionnaires and biological markers. Damage and related pathologies have to be systematically revealed. In this context, the MoCA test allows the early detection of cognitive disorders. Care management aims for a change in consumption and consists in supporting the patient in his/her approach. Care management should be personalized, appropriated to the patient's informed choice and graded according to disorders' severity. This includes a psychosocial intervention which can be associated with drugs. Abstinence is no longer the only alternative: decreasing consumption with the aim of regulation has been shown interesting in the reduction of harmful consumption. When therapeutic withdrawal turns out to be necessary, use of a treatment should not be systematic. If necessary, benzodiazepines remain the first-line treatment with a limited duration of prescription. According to his/her profile, the patient can receive a long-term treatment to help to maintain abstinence, prevent relapse or reduce consumption. There is evidence that identifying and involving patients in their care significantly improve their health. Effective treatments are available for treating alcohol-use disorders. However, only a relatively small number of patients receive specific management appropriated to their needs and according to concrete goals.

[Exposure to psychosocial stressors at work in the Pays de la Loire region in 2002]. / Exposition au stress psychosocial chez les salariés des Pays de la Loire en 2002.

OBJECTIVE: An epidemiological surveillance system of work-related musculoskeletal disorders of the upper limb (MSDs) was implemented in 2002 in the Pays de la Loire region to assess the prevalence of the MSDs and their biomechanical and psychosocial risk factors in the working population. We will report here only the results concerning the exposure to psychosocial stress in the work environment. According to the Karasek "demand-autonomy" model, high psychological work demands may increase risk of ill health, particularly if there is a low level of decision latitude for the employees and low social support by the hierarchy or colleagues. METHODS: In 2002, 68 out a total of 400 occupational physicians volunteered to participate in the surveillance program and included 1 495 workers (895 men, 600 women) representative of the region's workforce. Work history and work environment were assessed by a self-administered questionnaire before the compulsory annual visit of occupational physicians. Exposure to psychosocial stress at work was assessed with the Job Content Questionnaire (JCQ) developed by Karasek. The three scales of decision latitude, social support and psychological demands were calculated using Karasek's recommendations. RESULTS: The mean scores of psychological demands, decision latitude and social support were 69.3 +/- 12.7; 22.3 +/- 3.2; 24.0 +/- 3.5, respectively. No differences were observed according to gender and age. A third of the workers were exposed to high psychological demands at work and most of them (61%) had little decision latitude to cope with work constraints. About 28% of workers suffered from a lack of social support from their colleagues or supervisors. Overall, about 17% of workers were exposed to a situation of "Job strain" (ie a combination of a high level of psychological demands and a low level of decision latitude) and 7% were exposed to a situation of "Job strain" with social isolation ("Job strain" with low social support). The situations of "Job strain", associated or not with a low level of social support, were particularly frequent in industries with taylorized work organisation, like the food industry and automobile industry, and in services characterised by strong merchant constrains, such as trade and cleaning services, for example. The frequency of "Job strain", with or without social isolation, was almost double in temporary workers. DISCUSSION: This study confirms that in a representative sample of workers, the exposure to occupational stress is not limited to managers and professionals, but concerns also a large number of employees and blue-collar workers of the public and private sectors. In general, the strongly qualified occupations are characterised by a high level of psychological demands, but individuals have large decision latitude to cope, which allows them to develop their capacities. The less qualified occupations are generally less confronted with a high level of mental demands than the managers and professionals. However, these individuals do not have enough decision latitude to cope with psychological demands which could lead to a high level of "Job strain", notably in the case of lack of social support from the supervisors and the colleagues. CONCLUSION: The study shows that the exposure to occupational stress is not limited to managers and professionals, but also concerns numerous employees and blue-collar workers. The determinants of work strain differ depending on occupations and this should be taken into consideration when implementing prevention programs for stress at work.

Work status after workers' compensation claims for upper limb musculoskeletal disorders.

AIM: To provide information on employment status after workers' compensation (WC) claims for musculoskeletal disorders of the limbs (MSDs). METHODS: Two-year follow up of the workers who filed a WC claim for MSDs in 1996 in the Pays de la Loire region. Of the 701 eligible workers, 514 workers (70%) participated. Information was requested by means of a mailed questionnaire about the characteristics of the MSDs and job status at the time of the WC claim and two years later. RESULTS: Two years after the WC claim, 65% of the claimants had returned to work in the same company, often without any ergonomic improvement, 12% had retired or had left employment voluntarily, and 18% had been dismissed. The risk of dismissal was associated with three factors: being older than 45 years, having two or more MSDs at claim, and working in the cleaning services sector.

Active epidemiological surveillance of musculoskeletal disorders in a shoe factory.

AIMS: (1) To evaluate an active method of surveillance of musculoskeletal disorders (MSDs). (2) To compare different criteria for deciding whether or not a work situation could be considered at high risk of MSDs in a large, modern shoe factory. METHODS: A total of 253 blue collar workers were interviewed and examined by the same physician in 1996; 191 of them were re-examined in 1997. Risk factors of MSDs were assessed for each worker by standardised job site work analysis. Prevalence and incidence rates of carpal tunnel syndrome, rotator cuff syndrome, and tension neck syndrome were calculated for each of the nine main types of work situation. Different criteria used to assess situations with high risk of MSDs were compared. RESULTS: On the basis of prevalence data, three types of work situation were detected to be at high risk of MSDs: cutting, sewing, and assembly preparation. The three types of work situations identified on the basis of incidence data (sewing preparation, mechanised assembling, and finishing) were different from those identified by prevalence data. At least one recognised risk factor for MSDs was identified for all groups of work situations. The ergonomic risk could be considered as serious for the four types of work situation having the highest ergonomic scores (sewing, assembly preparation, pasting, and cutting). CONCLUSION: The results of the health surveillance method depend largely on the definition of the criteria used to define the risk of MSDs. The criteria based on incidence data are more valid than those based on prevalence data. Health and risk factor surveillance must be combined to predict the risk of MSDs in the company. However, exposure assessment plays a greater role in determining the priorities for ergonomic intervention.

Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory.

The study was conducted to assess the prevalence and incidence of carpal tunnel syndrome (CTS) in a large modern footwear factory and to identify factors predictive of CTS. To this end, 199 workers were examined in 1996, and 162 of them were re-examined in 1997. Ergonomic and psychosocial risk factors of CTS were assessed by workpost analysis and self-administered questionnaire. The prevalence of CTS at baseline in 1996 and in 1997 was 16.6% (95%CI: 11.4-21.7) and 11.7% (95%CI: 6.7-16.8), respectively. The incidence rate of CTS in 1997 was 11.7% (95%CI: 6.7-7.8). No specific type of job performance was associated with CTS. Obesity (OR = 4.4; 95%CI: 1.1-17.1) and psychological distress at baseline (OR = 4.3; 95%CI: 1.0-18.6) were strongly predictive of CTS. Rapid trigger movements of the fingers were also predictive of CTS (OR = 3.8; 95%CI: 1.0-17.2). A strict control of thework by superiors was negatively associatedwith CTS (OR = 0.5; 95%CI: 0.2-1.3). The prevalence and incidence of CTS in this workforce were largely higher than in the general population and numerous industries. The study highlights the role of psychological distress in workers exposed to a high level of physical exposure and psychological demand.

Occupational risk factors for radial tunnel syndrome in industrial workers.

OBJECTIVES: The aim of the study was to evaluate both nonoccupational and occupational factors associated with radial tunnel syndrome (RTS) among industrial workers in 3 large plants. METHODS: Twenty-one cases of RTS were compared with 21 referents matched for gender, age, and plant. RTS was associated with carpal tunnel syndrome (CTS) in 9 cases. Past medical history, household activities, and ergonomic and organizational characteristics of the job were analyzed. RESULTS: The study found 3 occupational risk factors for RTS. Exertion of force of over 1 kg [odds ratio (OR) 9.1, 95% confidence interval (95% CI) 1.4-56.9] more than 10 times per hour was the main biomechanical risk factor. Prolonged static load applied to the hand during work was strongly associated with RTS (OR 5.9, 95% CI 1.2-29.9). Work posture with the elbow fully extended (0-45 degrees) was associated with RTS (OR 4.9, 95% CI 1.0-25.0). Full extension of the elbow, associated with a twisted posture of the forearm, stressed the radial nerve at the elbow. However, personal activities, household chores, and sport and leisure activities were not associated with RTS. CONCLUSIONS: The study confirms that RTS occurs in workers performing hard manual labor that requires forceful and repetitive movements involving elbow extension and forearm prosupination.

Occupational and personal risk factors for carpal tunnel syndrome in industrial workers.

OBJECTIVES: The purpose of the study was to evaluate both nonoccupational and occupational factors associated with carpal tunnel syndrome (CTS) in industrial workers. METHODS: Sixty-five workers with CTS were compared with 65 referents matched for gender, age, and plant. The medical history and household activities of the workers and the ergonomic and organizational characteristics of the job were analyzed. RESULTS: Exertion of force over 1 kg was associated with CTS [odds ratio (OR) 9.0]. Two risk factors were related to motion repetitiveness: length of the shortest elementary operation of < or = 10 s (OR 8.8) and lack of change in tasks or lack of breaks for at least 15% of the daily worktime (OR 6.0). No posture of the upper limb was associated with CTS. Workstation design involving the manual supply of the workers (OR 5.0) and the lack of job rotation (OR 6.3) were associated with CTS. The only personal factor associated with CTS was a parity of at least 3 (OR 3.2). There was a continuous increase in the odds ratio against the number of risk factors accumulated by the workers; the odds ratio thus ranged from 5.6 when 3 of the 6 risk factors were present to > or = 90 when 4, 5, or 6 risk factors were accumulated. CONCLUSIONS: The results were in agreement with a model for CTS which included 1 personal and 5 occupational risk factors. The number of risk factors cumulated by the workers seems to be a major determinant of CTS.