Underreporting of musculoskeletal disorders in 10 regions in France in 2009

BACKGROUND: Underreporting of occupational diseases (OD) has been quantified, in particular in the United States, but little information is available in other countries. The aim of this study was to evaluate underreporting of musculoskeletal disorders (MSD) in France in 2009. METHODS: We calculated an indicator that approximated the underreporting rate of MSD in 10 regions of France. Two databases were used: data on OD compensated by insurance funding and data from the surveillance program for uncompensated work-related diseases. Analyses were performed for carpal tunnel syndrome (CTS) and elbow, shoulder, and lumbar spine MSD. RESULTS: The underreporting rate was estimated at 59% (range 52-64%) for CTS, 73% (range 67-79%) for elbow MSD, 69% (range 63-74%) for shoulder MSD, and 63% (range 50-76%) for lumbar spine MSD. CONCLUSIONS: This study revealed that MSD are substantially underreported in France, as in the United States, despite the differences in workers\u27 compensation systems

Des indicateurs en santé travail - Les troubles musculo-squelettiques du membre supérieur en France

France has sought to develop a series of indicators intended to monitor health trends at the national level. Since its creation in 1998, the Department of Occupational Health (DST) of the French Institute of Public Health Surveillance (InVS) has worked to develop monitoring programs, with the goal of producing such data regularly and thus improving our knowledge of occupational health risks. The data sources have expanded over time. In 2009, the DST established a program for the regular production of indicators intended to report the national workplace health situation and its trends over time. These indicators come from various sources and will be published regularly on the InVS website: www.invs.sante.fr. This third report covers musculoskeletal diseases of the upper limbs. This document summarizes data about their frequency in terms of prevalence and incidence, as well as about the frequency of exposures to the principal known risk factors, according to sex, age, occupational categories, and broad activity sectors. It also provides information about the proportion of these musculoskeletal diseases that are attributable to work, according to occupational categories and broad activity sectors, and about the scale of their under-reporting generally and as compensable occupational diseases. Finally, some questions enable us to put the results presented into perspective

Approche de la sous-déclaration des troubles musculo-squelettiques dans sept régions françaises en 2007

Introduction – Les troubles musculo-squelettiques (TMS) représentent la première maladie professionnelle (MP) indemnisée par le régime général de Sécurité sociale. Les statistiques du système de réparation des MP sont régulièrement critiquées en raison d’une sous-déclaration qui a été peu évaluée jusqu’à présent. L’objectif de cette étude était d’approcher la sous-déclaration des TMS de l’épaule, de la main-poignet-doigts et du rachis lombaire. Matériel-méthodes – Cette étude s’est appuyée sur les TMS reconnus en MP au régime général de Sécurité sociale et sur ceux signalés comme maladies à caractère professionnel (MCP) par un réseau de médecins du travail volontaires dans sept régions françaises en 2007. Un indicateur approchant le taux de sous-déclaration a été construit et analysé par sexe, âge et secteur d’activité. Résultats – L’indicateur de sous-déclaration était de 68% (fourchette de variation 63-72) pour les TMS de la main-poignet-doigts, 74% (fourchette de variation 69-78) pour ceux de l’épaule et 80% (fourchette de variation 72-89) pour le rachis lombaire. Il tendait à diminuer avec l’âge pour l’épaule et variait peu selon les secteurs d’activité. Discussion-conclusion – Cet indicateur constitue une approche permettant de mesurer l’importance du phénomène de sous-déclaration. La sous-déclaration plus importante des pathologies rachidiennes pourrait être liée au fait que la balance bénéfice (médico-social) / risque (pour l’emploi) est moins favorable que pour les autres localisations. Les résultats montrent également que la sous-déclaration est un phénomène largement répandu quels que soient les secteurs d’activité

Histological validation of diagnoses of thyroid cancer among adults in the registries of Belarus and the Ukraine

In order to evaluate the diagnostic reliability of the thyroid cancers listed in adult registries from the Ukraine and Belarus, a histological review was organised of 327 randomly selected thyroid carcinoma cases diagnosed between 1960 and 1999. A final diagnosis was reached at a 5-day consensus conference by six pathologists who met around a multiheaded microscope. The study concluded with a comparison between the final diagnosis and the initial diagnosis. The pathologists agreed with the initial diagnosis of malignancy in 286 cases (88%). A final diagnosis of papillary, follicular or medullary thyroid carcinoma was reached in 86, 4, and 6% of the cases respectively. In 2.8% of the cases reviewed, diagnostic discrepancies persisted. The percentage of agreement between the final diagnosis and the initial diagnosis was 93%, with a weighted κ-statistic of 0.61 (confidence interval 95% (CI 95%): [0.45-0.77]). In all, 89% of the 286 confirmed cancer cases were in agreement for the type of cancer, with a κ-statistic of 0.56 (CI95%: [0.43-0.69]). The level of agreement differed according to cancer categories, with concordance rates of 94, 40 and 33% for papillary, follicular and medullary thyroid carcinomas respectively. The low prevalence of follicular thyroid carcinomas in the adult population studied calls for further exploration. The discrepancies and classification difficulties encountered were analysed. © 2003 Cancer Research UK

Topiramate plus nortriptyline in the preventive treatment of migraine: a controlled study for nonresponders

A sizeable proportion of migraineurs in need of preventive therapy do not significantly benefit from monotherapy. The objective of the study is to conduct a randomized controlled trial testing whether combination therapy of topiramate and nortriptyline is useful in patients who had less than 50% decrease in headache frequency with the use of the single agents. Patients with episodic migraine were enrolled if they had less than 50% reduction in headache frequency after 8 weeks of using topiramate (TPM) (100 mg/day) or nortriptyline (NTP) (30 mg/day). They were randomized (blinded fashion) to have placebo added to their regimen, or to receive the second medication (combination therapy). Primary endpoint was decrease in number of headache days at 6 weeks, relative to baseline, comparing both groups. Secondary endpoint was proportion of patients with at least 50% reduction in headache frequency at 6 weeks relative to baseline. A total of 38 patients were randomized to receive combination therapy, while 30 continued on monotherapy (with placebo) (six drop outs in the combination group and three for each single drug group). For the primary endpoint, mean and standard deviation (SD) of reduction in headache frequency were 4.6 (1.9) for those in polytherapy, relative to 3.5 (2.3) for those in monotherapy. Differences were significant (p < 0.05]. Similarly, 78.3% of patients randomized to receive polytherapy had at least 50% headache reduction, as compared to 37% in monotherapy (p < 0.04). Finally we conclude that combination therapy (of TPM and NTP) is effective in patients with incomplete benefit using these agents in monotherapy

Acute treatment of migraine. Breaking the paradigm of monotherapy

BACKGROUND: Migraine is a highly prevalent disorder. The disability provoked by its attacks results in suffering as well as considerable economic and social losses. The objective of migraine acute treatment is to restore the patient to normal function as quickly and consistently as possible. There are numerous drugs available for this purpose and despite recent advances in the understanding of the mechanisms and different biological systems involved in migraine attacks, with the development of specific 5-HT agonists known as triptans, current options for acute migraine still stand below the ideal. DISCUSSION: Monotherapeutic approaches are the rule but up to one third of all patients discontinue their medications due to lack of efficacy, headache recurrence, cost and/or side effects. In addition, a rationale has been suggested for the development of polytherapeutic approaches, simultaneously aiming at some of the biological systems involved. This paper reviews the fundamentals for this changing approach as well as the evidence of its better efficacy. CONCLUSION: As a conclusion, most of the patients with a past history of not responding (no pain-free at 2 hours and/or no sustained pain-free at 24 hours) in at least 5 previous attacks should undergo a combination therapy suiting to their individual profile, which must include analgesics or non-steroidal anti-inflammatory agents plus a triptan or a gastro kinetic drug. The three-drug regimen may also be considered. In addition, changing the right moment to take it and the choice for formulations other than oral has also to be determined individually and clearly posted to the patient

Discussion on radon and leukemia risk in underground miners: Are working level months the most appropriate exposure parameter?

International audienc

Epidemiological response to a suspected excess of cancer among a group of workers exposed to multiple radiological and chemical hazards

OBJECTIVE—An excess of cancer was suspected by workers of the metallurgy department at the French Atomic Energy Commissariat (CEA) after several deaths from cancer were reported in 1983 and 1984. After a descriptive study performed by the CEA in 1985 the results of which were not conclusive enough to put an end to the controversy, the present cohort study was undertaken in 1989.
METHODS—As no specific exposure, or a precise cancer site was suspected, it was decided to include all subjects who had worked at the metallurgy department for at least 1 year between 1950 and 1968. The cohort was followed up to 31 December 1990. Individual occupational exposures were determined retrospectively for each year from 1950 to 1990, both qualitatively (annual job, and hazard records, and assistance from former workers) and quantitatively (for external radiation). On the basis of these exposures, three types of occupational tasks were identified: handling of chemicals, radionuclides, and external radiation. Standardised mortality ratios (SMRs) were calculated to estimate the risk of death, and the existence of an association between risk of cancer and each of the three tasks was tested.
RESULTS—The cohort included 356 workers, followed up for an average of 30 years (total of 10 820 person-years). The number of deaths from all causes and from all cancer sites were respectively 44( )and 21. No excess of cancer deaths was found for the study period (SMR 0.77), nor was there a peak in 1983-4. The risk of death from all cancer sites increased with the duration of exposure to chemicals.
CONCLUSION—The results do not justify the workers' impression of an excess of cancer. They suggest, however, that the duration of work at some tasks that involved handling chemicals may be an indicator of risk of cancer. Communication to the workers during the study played an important part in reducing their concern, contributing to their better understanding of the results.


Keywords: epidemiology; cancer; mortality; cluster; occupational exposure