Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: A systematic review

Glatiramer acetate and interferon-beta are approved first-line disease-modifying treatments (DMTs) for multiple sclerosis (MS). DMTs can be associated with cutaneous adverse events, which may influence treatment adherence and patient quality of life. In this systematic review, we aimed to provide an overview of the clinical spectrum and the incidence of skin reactions associated with DMTs. A systematic literature search was performed up to May 2011 in Medline, Embase, and Cochrane databases without applying restrictions in study design, language, or publishing date. Eligible for inclusion were articles describing any skin reaction related to DMTs in MS patients. Selection of articles and data extraction were performed by two authors independently. One hundred and six articles were included, of which 41 (39%) were randomized controlled trials or cohort studies reporting incidences of mainly local injection-site reactions. A large number of patients had experienced some form of localized injection-site reaction: up to 90% for those using subcutaneous formulations and up to 33% for those using an intramuscular formulation. Sixty-five case-reports involving 106 MS patients described a wide spectrum of cutaneous adverse events, the most frequently reported being lipoatrophy, cutaneous necrosis and ulcers, and various immune-mediated inflammatory skin diseases. DMTs for MS are frequently associated with local injection-site reactions and a wide spectrum of generalized cutaneous adverse events, in particular, the subcutaneous formulations. Although some of the skin reactions may be severe and persistent, most of them are mild and do not require cessation of DMT

Influence de l'utilisation des commandes bimanuelles sur le risque de troubles musculo-squelettiques.

Dans le cadre de ses missions d'assistance pour la prévention des troubles musculo-squelettiques (TMS) du membre supérieur, l'INRS a été sollicité, à maintes reprises, pour étudier la possible relation entre l'utilisation des commandes bimanuelles et l'apparition de TMS. Cette question émanait de représentants des employeurs et des salariés et de CRAM. Par ailleurs, ces dernières années, les commandes bimanuelles ont fait l'objet d'une évolution technologique destinée, selon les fabricants, à réduire les TMS. Pourtant, les données bibliographiques documentant l'approche ergonomique des commandes bimanuelles, anciennes ou nouvelles, sont manquantes. Les commandes bimanuelles sont des dispositifs de sécurité permettant d'éloigner les mains de l'opérateur d'une zone dangereuse. Leur utilisation est toujours incluse dans une activité de travail globale. Par conséquent, l'étude de ce dispositif de commandes ne peut se faire sans analyser l'ensemble de l'activité de travail qui l'entoure et qui construit son contexte d'utilisation. L'étude a été conduite dans deux entreprises, permettant ainsi l'analyse de divers contextes d'utilisation et de plusieurs types de commandes bimanuelles. Les résultats montrent que les commandes bimanuelles peuvent être considérées comme un outil de travail, leur utilisation nécessitant en effet, un temps non négligeable, présentant ainsi une véritable action au sein du cycle de travail. L'utilisation des commandes bimanuelles ne semble pas être un facteur de risque de TMS, mis à part dans certains contextes particuliers. Cependant la présente étude ne permet pas de conclure définitivement sur la relation entre l'utilisation des commandes bimanuelles et l'apparition de TMS, mais elle dégage des pistes de réponses et de réflexions sur cette nouvelle demande

Determination of joint efforts in the human body during maximum ramp pushing efforts.

Determining with accuracy, the internal efforts in the human body is a great challenge in Biomechanics, particularly in Physical Therapy and Ergonomics. In this context, the present study develops a human body model that permits a non-invasive determination of the joint efforts produced by a seated subject performing maximum ramp pushing efforts. The joint interactions during these experiments are provided by a dynamic inverse model of the human body, using a symbolically generated recursive Newton-Euler formalism. The theoretical investigation is presented in two steps, with increasing complexity and relevance:The dynamic model confirms some previous studies of the effects of biomechanical factors on the performance of the task and is proposed as an accurate method for determining the joint efforts in dynamic contexts. Finally, this application is a preliminary benchmark case that will be extended to: *physical therapy, in order to analyse the joint and muscle efforts in various motion contexts, particularly for patients with fibromyalgia and patients with lumbar diseases; *accidentology, in order to analyse and simulate car occupant dynamics before a crash

Norms, Interests and Institutional Change

This paper provides a norms-based account of institutional change. It compares two cases of attempted change, one successful and one unsuccessful. The argument advanced is that norm-based change occurs when the norms are congruent with the perceived interests of the actors who have the power to take on the decision. Norms affect the process of institutional change not only by providing legitimacy to some forms of political action, but also by shaping the actors’ perception of their interests as well their strategies. It is argued that norms, in that sense, help political actors combine Max Weber's zweckrational (goal-orientated) and wertrational (value-orientated) categories of behaviour. Empirical evidence drawn from the context of the evolving European Union supports this argument