Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys.

International audienceINTRODUCTION: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP. OBJECTIVE: To estimate the prevalence of LBP in the French population aged 30 to 64 years. MATERIALS AND METHODS: The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented. RESULTS: More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age. DISCUSSION-CONCLUSION: The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used

The CONSTANCES cohort: an open epidemiological laboratory

<p>Abstract</p> <p>Background</p> <p>Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an "open epidemiologic laboratory" accessible to the epidemiologic research community. Although designed as a "general-purpose" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging.</p> <p>Methods/Design</p> <p>The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death.</p> <p>To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants will be set up and followed through the same national databases as participants.</p> <p>A field-pilot was performed in 2010 in seven HSCs, which included about 3,500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data.</p> <p>Discussion</p> <p>The constitution of the full eligible sample is planned during the last trimester of 2010, and the cohort will be launched at the beginning of 2011.</p

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

Etude des facteurs prédictifs de douleur chronique et d'incapacité chez des patients en activité professionnelle ayant des antécédents de lombalgie

Il s'agit d'une étude sur les facteurs prédictifs de passage à la lombalgie chronique dans une population en activité professionnelle. Après un rappel de quelques définitions (douleur, incapacité, chronicité) et une revue des facteurs de risque de lombalgie chronique, nous présentons un modèle prédictif de la lombalgie chronique en milieu professionnel basé sur les données d'une étude longitudinale. Deux définitions différentes de la lombalgie chronique ont été considérées, l'une axée sur la durée de la douleur et l'autre sur la récurrence de l'arrêt de travail. Un outil de prédiction pour la lombalgie quotidienne est proposé pour une utilisation en routine. Enfin, les interventions efficaces sur le retour au travail ont également été explorées à travers une revue de la littérature. Les résultats de notre travail devraient permettre de prédire parmi des sujets lombalgiques, ceux qui risquent d'évoluer vers une pathologie chronique invalidante.This study concerns the predictive risk factors of chronic low back pain (CLBP). After having defined some concepts (pain, disability, chronicity) and proposed a review on CLBP risk factors, we presented a study, which main objective was to propose a predictive model for chronic low back pain in an occupational setting. Two different dimensions of CLBP were studied : pain duration and recurrent sick leave. A predictive tool for daily LBP is developed for a routine use. Finally, a rewiew on the efficiency of some interventions on return to work was performed. Our results could help to predict among low back pain sufferers, those who will have a disabling CLBP.PARIS5-BU Saints-Pères (751062109) / SudocSudocFranceF

Abstract 219: What factors influence the decision to refer patients to a stroke center in an Emergency Medical Service Dispatch Center?

Introduction: Recent findings recommend fibrinolysis for ischemic stroke patients with no age limit and when onset of symptoms is less than 6 hours before treatment. The aim of this study was to identify the factors that influence the decision to refer to a stroke center (SC) in an Emergency Medical Service Dispatch Center (EMS). Methods: A prospective study was implemented in an EMS located in Paris area, from 10/02/2011 to 01/06/2013. Dispatchers initiated 1319 calls with a suspicion of stroke, and transferred them to a Medical Doctor (MD) that took the final decision to refer or not to a SC. Age, gender, socio-economic status of residential area, delay from onset of symptoms to call were first compared at bivariate level. The final analysis was based on backward stepwise logistic regression model with the referral to SC as dependent variable. The [[Unable to Display Character: &amp;#64257;]]nal model included factors associated with referral to a SC at a p level of 0.10. A p value of less than 0.05 was accepted as significant. Results: bivariate comparisons showed younger age, call location and short delay from onset to call as significantly associated with referral to a SC (table 1). In the logistic regression model only age and short delay from onset to call remained associated with the referral to a SC. Women tended to less benefit from SC, but with no statistical significance (table 2). Conclusion: in our study 26% of callers were referred to a SC, age and delay influenced this decision. Enforced implementation of recent recommendations and standard training in stroke recognition will improve EMS pathways to SC. </jats:p

The pathophysiology of “happy” hypoglycemia

Abstract Background Hypoglycemia usually includes various neurological symptoms, which are the consequence of neuroglycopenia. When it is severe, it is associated with altered mental status, even coma. Case presentation We report the case of a patient with severe hypoglycemia, completely asymptomatic, due to the increase of lactate production in response to tissue hypoperfusion following a hemorrhagic shock. This illustrates that lactate can substitute glucose as an energy substrate for the brain. It is also a reminder that this metabolite, despite its bad reputation maintained by its role as a marker of severity in critical care patients, has a fundamental role in our metabolism. Conclusions Following the example of the “happy hypoxemia” recently reported in the literature describing asymptomatic hypoxemia in COVID-19 patients, we describe a case of “happy hypoglycemia.” </jats:sec

Abstract 218: Do mass media campaigns about stroke influence the number of calls to Emergency Medical Services Dispatch Center?

Introduction: Raising public awareness of stroke warning signs has been attempted in several places. Studies show that stroke recognition by the public is challenging and efficiency of mass media campaigns remains uncertain. In France, national mass media campaigns have been launched since 2002, including FAST warning signs (http://www.strokeassociation.org). End October 2011, a campaign was launched with radio and TV spots. In fall 2012, radio spots were broadcasted during 10-days and were later followed by other media such as TV and press. Each campaign cost 1.5M$. Influence of these campaigns on the number of calls to Emergency Medical Services dispatch center (EMS) was evaluated during these periods in an EMS, located in Paris area and serving an urban population of 1.5 Million inhabitants. Methods: Data concern 1258 calls to EMS for stroke collected from 10/2/2011 to 11/23/2012. Number of calls was analyzed for this time period, with a specific focus on the 2 campaign periods. In addition, patients’ socio-economic profile and delay from symptoms’ onset to call were compared 1 month before and 1 month after these 2 campaigns. Results: More calls occurred during the 1 st campaign, with a rapid normalization of calls afterwards, whereas the 2 nd campaign did not increase number of calls (figure 1). In 2011 more males called EMS after the campaign but with no significant difference. In 2012, younger people called more, but with no difference in gender or residential area. The patients did not call earlier after both campaigns (table 1). Conclusion: These 2 campaigns had no impact on the amount of calls. Moreeffort should be made on patients’ education and a new strategy to reach target population must be clearly defined. </jats:p