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

Low back pain around retirement age and physical occupational exposure during working life

<p>Abstract</p> <p>Background</p> <p>Physical occupational exposure is a risk factor for low back pain in workers but the long term effects of exposure remain unclear. As several countries consider increasing the retirement age, further information on this topic is relevant. This study aimed to describe the prevalence of low back pain among middle aged and aging individuals in the general French population according to physical occupational exposure and retirement status.</p> <p>Methods</p> <p>The study population originated from the French national survey 'Enquête décennale santé 2002'. Low back pain for more than 30 days within the previous twelve months (LBP) was assessed using a French version of the Nordic questionnaire. Occupational exposure was self assessed. Subjects were classified as "exposed" if they were currently or had previously been exposed to handling of heavy loads and/or to tiring postures. The weighted prevalence of LBP was computed separately for men and women, for active (aged 45-59) and retiree (aged 55-74), according to 5-year age group and past/present occupational exposure.</p> <p>Results</p> <p>For active men, the prevalence of LBP was significantly higher in those currently or previously exposed (n = 1051) compared with those never exposed (n = 1183), respectively over 20% versus less than 11%. Among retired men, the prevalence of LBP tended towards equivalence with increasing age among those previously exposed (n = 748) and those unexposed (n = 599).</p> <p>Patterns were quite similar for women with a higher prevalence in exposed active women (n = 741) compared to unexposed (n = 1260): around 25% versus 15%. Similarly, differences between previously exposed (n = 430) and unexposed (n = 489) retired women tended to reduce with age.</p> <p>Conclusion</p> <p>The prevalence of LBP in active workers was associated with occupational exposure. The link with past exposure among retirees decreased with age. These results should be considered for policies dealing with prevention at the workplace and retirement.</p

Adapter le parcours de soins prénatal par le repérage précoce d’un mal-être psychologique

International audienc

How French general practitioners adapt their care to patients with social difficulties?

International audienceObjective Several studies have shown the role of the primary care system in access to care and in reducing social inequalities in health. The objective of this study was to describe the practices of general practitioners (GPs) in taking into account the social environment of their patient, and the ways they adapted to social difficulties. Design Qualitative study comprising interviews and focus groups. Setting French primary care settings. Participants Twenty semistructured interviews and two focus groups were conducted with 33 GPs. Sessions were audio recorded, transcribed verbatim and analysed using thematic analysis. The reporting of findings was guided by consolidated criteria for reporting qualitative research. Result This study identified adaptations at three levels: in the individual management of patients (alert system, full involvement in prevention, better communication, prioritised additional examinations, financial facilities, help in administrative tasks), in the collective management of patients in an office (consultation without appointment, pay-for-performance indicators, medical staffs, multidisciplinary protocols, medical practice in group, medical student), and in the community management (patients description, cooperation with associations, public health sector and politics). Conclusion In France, GPs can take into account the social determinants of health in practice through simple or more complex actions

[Personal and occupational factors associated with low-back pain in a general working population in France].: low-back pain in working population in France

International audienceThis study showed strong associations between occupational exposures and persistent/recurrent low-back pain in a general working population in France. Targeting these exposures in prevention programs could be useful

Seeking care for lower back pain in the French population aged from 30 to 69: the results of the 2002-2003 Décennale Santé survey.

International audienceOBJECTIVES: To describe the frequency with which members of the French general population in the 30-to-69 age class sought care for lower back pain (LBP) from various healthcare professionals and to identify associated parameters. MATERIAL AND METHODS: Data were collected in the 2002-2003 Décennale Santé survey, which is representative of ordinary households in continental France. We assessed the frequency with which the 17,792 surveyed individuals sought care for LBP by considering consultations with healthcare professionals in general and consultations with general practitioners and physiotherapists in particular. RESULTS: Among the survey subjects, 4.5% reported that they had sought treatment for LBP from a healthcare professional at least once during the 2-month survey period. The decision to seek care was correlated with the characteristics of the LBP. The duration of the pain was associated with the frequency of all types of consultation studied here. Sociodemographic, economic and occupational risk factors were also involved. Consultation with a physiotherapist was related to income. CONCLUSION: These results from a representative sample of the French general population show that the factors associated with seeking treatment for LBP differ according to the type of healthcare professional consulted

Level of education and back pain in France: the role of demographic, lifestyle and physical work factors.

International audiencePURPOSE: To investigate the pathways from level of education to low back pain (LBP) in the adult population, especially concerning the role of physical working constraints, and personal factors (overweight, tobacco consumption, and tallness). METHODS: The study population consisted of 15,534 subjects from the National Health Survey, with data on LBP, level of education, personal factors, and physical working constraints. Logistic models for LBP (pain more than 30 days during the previous 12 months) were compared in order to check the consistency of the data with specific causal pathways. RESULTS: Low back pain was strongly associated with level of education. This association was almost completely explained if present or past exposure to tiring work postures and handling of heavy loads were taken into account. For men, the OR for "no diploma", adjusted only for age, was 1.75; it was 1.02 after additional adjustment on physical work factors. Personal factors played also a role, especially overweight for women. Among them, the OR associated with a body mass index = 27 or more was 1.58 after adjustment on all the other factors. CONCLUSIONS: In this national population the main pathways from education to LBP were through occupational exposure and lifestyle factors

Risk factors for rotator cuff syndrome and shoulder pain in the working population

International audienceThe 12-month prevalence of shoulder pain in the population of working age ranges between 7 and 47% 1 and for clinically-diagnosed rotator cuff syndrome (RCS) ranges between 2 and 7% 2-3. Information on the risk factors for shoulder disorders and clinically-diagnosed RCS in the working population would help policy makers to implement preventive intervention in the workplace. The surveillance program for musculoskeletal disorders implemented in the Pays de la Loire region by the French Institute for Public Health Surveillance between 2002 and 2004 provides the possibility of epidemiological analysis of the risk factors for unspecific shoulder pain and clinically-diagnosed RCS in a large study sample exposed to various levels of work-related constraints 3. The aim of this study was to describe associations between the personal and occupational risk factors for unspecific shoulder pain and RCS and to compare their relative importance in a large sample of workers representative of the regional working population. Methods This cross-sectional study included 3,710 workers (58% men and mean ± SD age 38.7 ± 10.3 years) between 2002 and 2004. Subjects with unspecific shoulder pain were defined as those who reported shoulder pain during the preceding 12 months, and RCS was diagnosed by 83 trained occupational physicians performing a standardized physical examination. Personal factors and medical history were collected during the physical examination. Exposure regarding work status and occupational risk factors were assessed with a self-administered questionnaire including information on the characteristics of the job and tasks, work organization, and the main potential risk factors for RCS. Psychosocial work factors were assessed according to the Karasek Job Content Questionnaire. Relationships between RCS and risk factors were studied by binary logistic regressions following a 3-stage process: • In stage 1, univariate analyses were performed with each of the potential explanatory variables as independent variables and RCS as the dependent variable. Non-significant variables (p > 0.20) were excluded from further analyses, with the exception of age and gender. • In stage 2, the independent variables not excluded in stage 1 were grouped into the five groups of potential determinants (personal factors, current occupational category and length of service in current job, factors related to work organization, postural and biomechanical constraints, and psychosocial factors at work). Backward multivariate logistic regression models were then performed for each group of variables, with age and gender forced into the models. Non-significant variables (p > 0.10) after this stage were excluded. • In stage 3, final multivariate logistic regression analyses were performed using all variables remaining after stage 2, and backward selection retained only significant variables at a p-level of 0.05. The same binary logistic regression modeling was performed for unspecific shoulder pain. Multinomial logistic regressions were then constructed to determine which factors were associated with shoulder pain and/or RCS. Three categories of outcome were defined: • No shoulder pain and no RCS (reference) • Shoulder pain alone • Shoulder pain with RCS The independent variables included in the model comprised all remaining variables of binary logistic regressions and only significant variables with a p-level at 0.05 were included in the final model. Results Prevalence of shoulder pain and RCS • 29.3% of workers had shoulder pain alone • 7.4% had shoulder pain with RCS A. Work-related risk factors for the incidence and recurrence of shoulder and neck complaints among nursing-home and elderly-care workers. Scand J Work Environ Health 2004;30(4):279-286. 2 Silverstein BA. Viikari-Juntura E. Fan ZJ. et al. Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Scand J Work Environ Health 2006;32(2):99-108. 3 Ha C, Roquelaure Y, Leclerc A, Touranchet A, Goldberg M, Imbernon E. The French Musculoskeletal Disorders Surveillance Program: Pays de la Loire Network. Occup Environ Med 2009;66:471-9. (a) Reference group: n=2,217 (b) Equality of two odds ratios (Shoulder pain alone / Shoulder pain with RCS): *: p<0.05, **: p<0.01,***: p<0.001. (c) RPE Borg scale ≥ 13 A strong relationship was observed between age and RCS and, to a lesser extent, with shoulder pain. The ORs were significantly higher for shoulder pain with RCS than for shoulder pain alone for each age group. Female gender, the coexistence of clinically-diagnosed epicondylitis and carpal tunnel syndrome were associated with shoulder pain and RCS. No association was observed with overweight or obesity. Work pace dependent on an automatic rate was associated only with shoulder pain. A dose-response relationship was found with daily exposure to the high repetitiveness of tasks, with ORs ranging from 1.1 to 1.3 for shoulder pain and 0.9 to 1.9 for RCS. The differences between ORs for shoulder pain with and without RCS were significant only for repetitiveness of tasks for more than 4 hours per day. High physical demand was associated with shoulder pain and RCS. Moderate arm abduction (between 60°and 90°) for 2 hours or more per day was associated with shoulder pain alone whereas greater abduction (over 90°) was related to shoulder pain with RCS. The combination of sustained or repeated arm abduction over 60°and 90°was associated with shoulder pain and RCS. The ORs for abduction over 90°and the combination of moderate abduction and greater abduction were significantly higher among workers with RCS. Examination of exposure to psychosocial factors at work revealed that low supervisor support was related to shoulder pain and RCS. Conclusion This study showed that personal and work-related biomechanical and psychosocial factors were associated with both shoulder pain and RCS. Factors related to work organization were only associated with shoulder pain. The relative importance of age was greater than that of work-related risk factors for both disorders and it was more strongly associated with RCS than with shoulder pain. However, most personal factors are less modifiable or preventable than work-related factors, and the latter should therefore be an important target for strategies aimed at the prevention of RCS and shoulder pain in the working population. Risk factors for shoulder pain and RCS The final multinomial logistic models highlighted 9 personal, organizational, biomechanical and psychosocial risk factors (Table). OR 95% CI OR 95% CI Women 1.3 [1.1-1.5] 1.4 [1.1-1.9] NS Age < 35 1

Caractéristiques socio-démographiques et médicales influençant les qualités attribuées au bon médecin : Perspectives pour la formation à la relation médecin-patient

Contexte : La satisfaction du patient, au sein d’une relation médecin-malade de qualité, améliore son observance, son adhésion thérapeutique et in fine son état de santé. L’objectif de cette étude était d’analyser les facteurs influençant les qualités attribuées par les patients au bon médecin. Méthode : Enquête transversale sous la forme d’un questionnaire téléphonique, élaboré après une étude pilote, auprès de patients majeurs. Douze qualités attribuées au bon médecin dans les domaines médicaux, relationnels, éthiques ou organisationnels ont été étudiées. Des facteurs d’ordre sociodémographiques, liés au parcours médical ou à l’état de santé des patients ont été pris en compte. Une déclaration à la CNIL a été déposée. Les analyses descriptives, univariées et multivariées ont été réalisées à l’aide du logiciel SAS 9.1. Résultats : Sur 1246 appels téléphoniques, 302 patients ont été inclus. La capacité à réaliser un bon diagnostic, l’écoute et l’intégrité du médecin étaient les qualités les plus citées. La présence d’une maladie chronique était associée à des exigences d’écoute et de qualités relationnelles accrues, selon un gradient de sévérité de la maladie et après ajustement multivarié. D’autres facteurs sociodémographiques ou liés à l’expérience médicale du patient semblaient influer sur les qualités attendues du bon médecin. Conclusion : Ces résultats soulignent l’importance des qualités relationnelles dans la relation médecin malade. Celles-ci sont à promouvoir et à enrichir tout au long du cursus médical et de la carrière de soignant