Cardiac resynchronization therapy following Carillon® annuloplasty device for symptomatic heart failure and functional mitral regurgitation: a case report

Background  Symptomatic patients with significant left ventricular systolic dysfunction (LVSD) require a tailored treatment approach. Both functional mitral regurgitation (FMR) and left bundle branch block (LBBB) can develop, contributing to clinical deterioration, and worse prognosis despite optimal medical therapy (OMT). Case summary  We report the case of a symptomatic 60-year-old man on OMT with LVSD and significant FMR. His symptoms and FMR initially improved following transvenous mitral annuloplasty using the Carillon® Mitral Contour System® annuloplasty device. However, he subsequently developed LBBB with associated reduction in exercise capacity, for which he underwent cardiac resynchronization therapy, and ensuing symptom improvement and stabilization. Discussion  Our case describes how targeted device interventions can be combined synergistically to optimize patient symptoms

Bilan et perspectives du programme de surveillance épidémiologique des troubles musculo-squelettiques

Le programme pilote de surveillance épidémiologique des troubles musculo-squelettiques (TMS) développé dans la région des Pays de la Loire fêtera bientôt ses 10 ans. Ce programme a largement contribué à la mesure de ce problème majeur de santé au travail, mesure jusqu’alors essentiellement basée sur les statistiques de reconnaissance en maladie professionnelle; de même, il a contribué à la mise en visibilité dans le débat social du poids des facteurs professionnels dans leur survenue. Des pistes restent à explorer pour rendre cette surveillance plus efficiente et plusrégulière à l’échelon national. Par ailleurs, une réflexion est engagée sur la manière dont on peut traduire, pour les pouvoirs publics, les entreprises et le public, les résultats issus de l’épidémiologie de façon qu’ils puissent se les approprier à des fins de prévention. Car prévenir de façon durable les TMS et prendre en compte les situations de handicap des salariés souffrant de TMS est un impératif de santé au travail et de santé publique, sur lequel doivent se mobiliser tous les acteurs de la prévention des risques professionnels dans le cadre d’une politique structurée et coordonnée

The French Musculoskeletal Disorders Surveillance Program: Pays de la Loire network

Objectives: An epidemiological surveillance system for work-related musculoskeletal disorders (MSDs) was implemented in 2002 in France’s Pays de la Loire region to assess the incidence and prevalence of MSDs in the general and working populations, identify levels of exposure to occupational risk factors and investigate the proportion of cases attributable to work exposure.Methods: The program combines (1) surveillance of sentinel health events in the general population (carpal tunnel syndrome (CTS) was the sentinel event for upper limb MSDs), (2) assessment of the prevalence of the main upper limb MSDs and their risk factors in the workplace based on a network of occupational physicians and (3) registration of the notification of work-related diseases (WRDs). Results: 1168 incident cases of CTS were included over a 3 year period. The estimated incidence of CTS was 1.00 per 1000 person-years in those aged 20–59 years (0.60 in men and 1.40 in women). The incidence rate was higher in employed than unemployed persons in the year of diagnosis (0.6 per 1000 vs 0.3 in men and 1.7 vs 0.8 in women). The occupational physician network noted high prevalence rates: 11% of men and 15% of women had at least one of the six main upper limb clinically-diagnosed MSDs. The WRD survey showed that MSDs represented 65% of notified WRDs. Conclusion: The Pays de la Loire program plays a significant role in informing the authorities and the public about the state of current MSDs. It is planned to extend it to a routine national surveillance program

Effects of Individual and Work-related Factors on Incidence of Shoulder Pain in a Large Working Population

Objectives: The aim of this study was to assess the effects of individual and work-related factors on the incidence of shoulder pain in a large French working population. Methods: A total of 3,710 workers of a French region were randomly included in a cross-sectional study between 2002 and 2005. They completed a self-administered questionnaire about musculoskeletal symptoms, individual factors and exposure to work constraints. In 2007, 2,332 responded to a follow-up questionnaire. The Nordic questionnaire was used both times to assess shoulder pain during the preceding 7 days. Associations between incident shoulder pain and individual and work-related factors at baseline were studied by multivariate logistic regression for both genders. Results: A total of 946 men and 709 women without shoulder pain at baseline were eligible for the analyses. At follow-up, 105 men (11.1%) and 145 women (20.5%) reported shoulder pain. For men, age (OR 3.3, 95% CI, 1.7–6.5 for ≥50 yr), working with arms above the shoulder (1.5; 1.0–2.3) and high perceived physical exertion (1.6; 1.0–2.5) increased the risk of incident shoulder pain. For women, the factors associated with incident shoulder pain were age (2.9; 1.5–5.8 for ≥50 yr), obesity (2.5; 1.4–4.5), temporary employment (2.1; 1.1–3.7), high perceived physical exertion (2.2; 1.4–3.5) and low decision latitude (1.6; 1.0–2.3). Conclusion: Age was the strongest predictor of incident shoulder pain in both genders. BMI and biomechanical and psychosocial factors were also identified as risk factors, whereas no factor related to work organization remained in the final models

Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a vietnamese hospital with a first acute myocardial infarction

BACKGROUND: Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi. The objectives of this observational study were to examine sex differences in clinical characteristics, hospital management, in-hospital clinical complications, and mortality in patients hospitalized with an initial AMI. METHODS: The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. RESULTS: The average age of study patients was 66 years and one third were women. Women were older (70 vs. 64 years) and were more likely than men to have had hyperlipidemia previously diagnosed (10% vs. 2%). During hospitalization, women were less likely to have undergone percutaneous coronary intervention (PCI) compared with men (57% vs. 74%), and women were more likely to have developed heart failure compared with men (19% vs. 10%). Women experienced higher in-hospital case-fatality rates (CFRs) than men (13% vs. 4%) and these differences were attenuated after adjustment for age and history of hyperlipidemia (OR: 2.64; 95% CI: 1.01, 6.89), and receipt of PCI during hospitalization (OR: 2.09; 95% CI: 0.77, 5.09). CONCLUSIONS: Our pilot data suggest that among patients hospitalized with a first AMI in Hanoi, women experienced higher in-hospital CFRs than men. Full-scale surveillance of all Hanoi residents hospitalized with AMI at all Hanoi medical centers is needed to confirm these findings. More targeted and timely educational and treatment approaches for women appear warranted

Comparison of risk factors for shoulder pain and rotator cuff syndrome in the working population

BACKGROUND: To compare risk factors for shoulder pain without and with rotator cuff syndrome (RCS).METHODS: A total of 3,710 workers of a French region were randomly included in the cross-sectional study between 2002 and 2005. Personal and occupational risk factors were assessed during a physical examination and by a self-administered questionnaire. Multinomial logistic modeling was used for the following outcomes: no shoulder pain and no RCS (reference), shoulder pain without RCS (called "shoulder pain") and RCS, separately for men and women. RESULTS: The prevalence rates of "shoulder pain" for men and women were 28.0% and 31.1%, respectively, and the prevalence rates of RCS were 6.6% and 8.5%, respectively. In men, "shoulder pain" and RCS were associated with age, high-perceived physical exertion, and arm abduction. Automatic work pace and low supervisor support were associated with "shoulder pain," and high psychological demand and low skill discretion with RCS. In women, "shoulder pain" and RCS were associated with age, repetitiveness of tasks, and low supervisor support. High perceived physical exertion and exposure to cold temperatures were associated with "shoulder pain." CONCLUSIONS: Age was more strongly associated with RCS than with shoulder pain without RCS for both genders. Biomechanical and psychosocial factors were associated with "shoulder pain" and RCS and differed between genders

Personal, biomechanical, and psychosocial risk factors for rotator cuff syndrome in a working population

OBJECTIVE: Rotator cuff syndrome (RCS) is a major health problem among workers. The aim of the study was to examine the risk factors for RCS among workers exposed to various levels of shoulder constraints.METHODS: From 3710 workers, representative of a French region`s working population, trained occupational physicians diagnosed a total of 142 cases of RCS among men and 132 among women between 2002-2005. Diagnoses were established by standardized physical examination while personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between RCS and personal and work-related factors were analyzed for each gender using logistic regression modeling. RESULTS: The personal risk factors for RCS were age [odds ratio (OR) for 1-year increment 1.07, 95% confidence interval (95% CI) 1.05-1.09, among men and 1.08, 95% CI 1.06-1.10, among women] and diabetes mellitus (OR 2.9, 95% CI 1.0-8.6, among women). The work-related risk factors were (i) sustained or repeated arm abduction (≥ 2 hours/day) >90 degrees among men (OR 2.3, 95% CI 1.3-3.9) and >60 degrees among women (OR 1.8, 95% CI 1.0-3.2) or both conditions among men (OR 2.0, 95% CI 1.1-3.7) and women (OR 3.6, 95% CI 1.8-7.3); (ii) high repetitiveness of the task (≥ 4 hours/day) among men (OR 1.6, 95% CI 1.0-2.4) and women (OR 1.7, 95% CI 1.1-2.5); (iii) high perceived physical demand among men (OR 2.0, 95% CI 1.3-3.1); (iv) high psychological demand among men (OR 1.7, 95% CI 1.2-2.5); and (v) low decision authority among women (OR 1.5, 95% CI 1.0-2.3). CONCLUSION: Personal (ie, age) and work-related physical (ie, arm abduction) and psychosocial factors were associated with RCS for both genders in this working population