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Introduction La persistance d’une detresse psychique consecutive a un accident de la route a des repercussions humaines, economiques et sociales. L’objectif de notre etude est d’estimer les facteurs socioprofessionnels et medicaux associes a une detresse psychique cinq ans apres un accident corporel. Methode Six cent quatre-vingt-onze sujets sur 1168 sujets accidentes de la route participant a une etude prospective (la cohorte ESPARR) ont repondu a des questionnaires standardises a un an et cinq ans apres l’accident. L’evaluation des caracteristiques socioprofessionnelles, des sequelles physiques, des sequelles psychiques, de la douleur et de la qualite de vie percue s’est appuyee sur l’utilisation d’outils valides. Les analyses univariees ponderees en fonction du niveau de gravite puis multivariees (modele de regression logistique) ont permis de rechercher des associations significatives entre la detresse psychique cinq ans apres l’accident de la route et des facteurs medicaux et socioprofessionnels initiaux, a un an et a cinq ans de l’accident. Resultats Cent soixante-huit participants (24 %) expriment une detresse psychique cinq ans apres l’accident de la voie publique. Apres ajustement sur plusieurs facteurs, la detresse psychique a cinq ans de l’accident est associee a des facteurs socioeconomiques (genre, niveau d’etude), et a des symptomes deja observes un an apres l’accident (difficultes de concentration, symptomes d’anxiete) et a une alteration de la qualite de vie. A cinq ans de l’accident, la detresse psychique est associee a la presence de sequelles psycho-cognitives, a la presence de sequelles rachidiennes, a l’absence de retour au travail, a une insatisfaction de l’etat de sante percu, et a une alteration de la qualite de vie. Conclusion Suite a un accident de la route, la mise en œuvre d’une prise en charge medicale physique et psychique adaptee, et un reperage precoce des pathologies psychiques, pourraient contribuer a reduire la detresse psychique chronique.

Objectifs Le risque routier est la premiere cause d’accidents mortels du travail. Ces accidents lies a des vehicules diminuent moins que les autres accidents du travail et presentent une gravite particuliere. L’exposition des salaries a ce risque s’accroit en raison de l’augmentation des distances parcourues pour se rendre au travail. Dans le secteur hospitalier, les changements de l’organisation (postes de 12 h) peuvent induire une plus grande fatigue et pourraient representer un facteur de risque des accidents de trajet. Cette etude vise, d’une part, a decrire l’incidence des accidents de trajet pour l’ensemble de la population non medicale et des sages-femmes et par categories professionnelles, a suivre son evolution sur 5 annees, et d’autre part, a rechercher les facteurs de risque chez les soignants, dans le cadre de leur emploi (rythmes de travail). Methodes Une etude cas-temoins a ete realisee a partir des donnees sur les accidents de trajet extraites du logiciel de sante au travail ; les temoins ont ete tires au sort a partir du fichier du personnel (appariement sur sexe et âge). Une analyse en regression logistique conditionnelle a permis d’identifier les facteurs de risque d’accidents de trajet. Resultats Si 78 % des accidents concernent un usager de voiture, 16 % surviennent avec un deux-roues, et 4 % en tant que pieton. Le taux d’incidence moyenne est de 443 accidents pour 100 000 salaries, sans difference selon le sexe. Il varie selon le grade, allant de 234 accidents pour les infirmieres anesthesistes, de bloc et les sages-femmes a 628 accidents pour les agents de service. L’etude cas temoins (358 cas et 1280 temoins) a montre un risque accru en lien avec les km parcourus. Apres ajustement sur ce facteur, le risque est plus eleve pour les agents de service par rapport aux administratifs OR (IC95 %) : 1,9 (1,11–3,25). Les accidents surviennent plus frequemment au retour de jour de repos. Les horaires de nuit ne sont pas associes a un sur-risque d’accident. Discussion/Conclusions Pour la periode 2012–2016, le registre du Rhone des accidents de la route retrouve une incidence annuelle moyenne des victimes d’un accident de trajet toutes gravites de 127 pour 100 000, soit 3 fois moins que l’incidence moyenne dans notre population. Les differents rythmes de travail ne semblent pas associes a un risque d’accident de trajet. La distance et l’inactivite la veille sont des facteurs de risque, tout comme l’appartenance a certaines categories de personnels.

We reviewed the comments on our publication sent by S.M.J. Mortazavi and would like to clarify some of the concerns from this reader, especially those due to misunderstanding of our study methods.

Resume Avec le developpement et le deploiement des nouvelles technologies sans fil depuis une vingtaine d’annees, un nombre croissant de systemes de communication et d’interconnexions entre objets utilisent les ondes electromagnetiques dans le domaine des radiofrequences. Ainsi, il existe de nombreuses sources de radiofrequences dans notre environnement quotidien (telephone mobile, antennes relais, Wi-Fi, etc.). Parmi celles-ci, le telephone mobile est de loin la principale source d’exposition. Concernant la question des effets sanitaires des radiofrequences, il n’est pas possible aujourd’hui d’etablir un lien de causalite entre les quelques effets biologiques decrits et d’eventuels effets sur la sante qui en resulteraient. Le risque de gliome n’est, quant a lui, pas significativement modifie par l’utilisation des telephones mobiles en population generale pour des durees d’observation de moins de 15 ans. Cependant, les donnees disponibles actuellement ne permettent pas d’exclure, parmi les utilisateurs « intensifs », une augmentation d’incidence faible des gliomes ou un risque qui se manifesterait pour des durees d’induction superieures a 15 ans. Face aux incertitudes qui entourent l’evaluation des risques lies aux radiofrequences, certaines personnes souhaitant reduire leurs expositions se dotent de dispositifs « anti-ondes ». Cependant, l’efficacite des dispositifs dits « anti-ondes » est loin d’etre etablie, leur usage pourrait meme etre contre-productif. Afin de maitriser les niveaux d’exposition aux radiofrequences, l’ANSES recommande aux utilisateurs intensifs de telephonie mobile de privilegier des telephones mobiles affichant un faible niveau de DAS et d’utiliser un kit mains-libres.

OBJECTIVE: The variety and extent of impairments occurring after traumatic brain injury vary according to the nature and severity of the lesions. In order to better understand their interactions and long-term outcome, we have studied and compared the cognitive and neurobehavioral profile one year post onset of patients with and without traumatic brain injury in a cohort of motor vehicle accident victims. METHOD: The study population is composed of 207 seriously injured persons from the ESPARR cohort. This cohort, which has been followed up in time, consists in 1168 motor vehicle accident victims (aged 16 years or more) with injuries with all degrees of severity. Inclusion criteria were: living in Rhone county, victim of a traffic accident having involved at least one wheel-conducted vehicle and having occurred in Rhone county, alive at the time of arrival in hospital and having presented in one of the different ER facilities of the county. The cohort's representativeness regarding social and geographic criteria and the specificities of the accidents were ensured by the specific targeting of recruitment. Deficits and impairments were assessed one year after the accident using the Neurobehavioral Rating Scale - Revised and the Trail-Making Test. Within our seriously injured group, based on the Glasgow Score, the presence of neurological deficits, aggravation of neurological condition in the first 72hours and/or abnormal cerebral imaging, we identified three categories: (i) moderate/severe traumatic brain injury (n=48), (ii) mild traumatic brain injury (n=89), and (iii) severely injured but without traumatic brain injury (n=70). RESULTS: The most frequently observed symptoms were anxiety, irritability, memory and attention impairments, depressive mood and emotional lability. While depressive mood and irritability were observed with similar frequency in all three groups, memory and attention impairments, anxiety and reduced initiative were more specific to traumatic brain injury whereas executive disorders were associated with moderate/severe traumatic brain injury. DISCUSSION-CONCLUSION: The presence and the initial severity of a traumatic brain injury condition the nature and frequency of residual effects after one year. Some impairments such as irritability, which is generally associated with traumatic brain injury, do not appear to be specific to this population, nor does depressive mood. Substantial interactions between cognitive, affective and neurobehavioral disorders have been highlighted. Language: en

Objective The aim of the present study was to describe the consequences of a road accident in adults, taking account of the type of road user, and to determine predictive factors for consequences at 2 years. Design Prospective follow-up study. Methods The cohort was composed of 1168 victims of road traffic accidents, aged ≥16 years. Two years after the accident, 912 victims completed a self-administered questionnaire. Weighted logistic regression models were implemented to compare casualties still reporting impact related to the accident versus those reporting no residual impact. Five outcomes were analysed: unrecovered health status, impact on occupation or studies, on familial or affective life, on leisure or sport activities and but also the financial difficulties related to the accident. Results 46.1% of respondents were motorised four-wheel users, 29.6% motorised two-wheel (including quad) users, 13.3% pedestrians (including inline skate and push scooter users) and 11.1% cyclists. 53.3% reported unrecovered health status, 32.0% persisting impact on occupation or studies, 25.2% on familial or affective life, 46.9% on leisure or sport activities and 20.2% still had accident-related financial difficulties. Type of user, adjusted on age and gender, was linked to unrecovered health status and to impact on leisure or sport activities. When global severity (as measured by NISS) was integrated in the previous model, type of user was also associated with impact on occupation or studies. Type of user was further associated with impact on occupation or studies and on leisure or sport activities when global severity and the sociodemographic data obtained at inclusion were taken into account. It was not, however, related to any of the outcomes studied here, when the models focused on the injured body region. Finally, type of road user did not seem, on the various predictive models, to be related to financial difficulties due to the accident or to impact on familial or affective life. Conclusions Overall, victims were affected by their accident even 2 years after it occurred. The severity of lesions induced by the accident was the main predictive factor. However, considering lesion as intermediary factors between the accident and the recovery status at 2 year post-accident, impact on health status was lower for cyclists than M4W users or M2W users.

Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged /=3) and lower limb injury (AIS>1) were associated with incomplete recovery of health status: weighted odds ratio (ORw), 4.3 [95% confidence interval (95% CI), 1.3-14.6] and ORw, 6.5 [95% CI, 1.9-21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r=0.46), especially body pain (r=0.48) and role/social-physical (r=0.50) and, to a lesser extent, quality of life psychosocial scores (r=0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.

Resume Contexte Ces dernieres annees, l’utilisation de plus en plus importante du telephone portable chez les adolescents et plus recemment chez les enfants, a suscite un interet considerable quant a de possibles effets sanitaires des ondes radiofrequences. L’etude MOBI-KIDS s’inscrit dans ce contexte : elle a pour objectif d’evaluer le risque potentiel de tumeur cerebrale chez l’enfant et l’adolescent lie a l’exposition aux champs electromagnetiques generes par les telephones mobiles et par d’autres sources d’exposition dans leur environnement. Methode L’etude MOBI-KIDS est une enquete epidemiologique internationale prospective de type cas/temoins. Sont consideres comme cas les sujets âges de 10 a 24 ans residant dans une des zones geographiques de l’etude et pour lesquels une tumeur cerebrale primitive incidente a ete diagnostiquee au cours de la periode d’etude. Pour chaque cas, 2 temoins apparies sur l’âge, le sexe et la zone geographique de residence sont recrutes parmi les patients hospitalises pour appendicite, pathologie frequente dans la tranche d’âge etudiee. Le recueil des donnees est realise par l’intermediaire d’un questionnaire detaille administre lors d’un entretien en face-a-face. Les releves des communications sont parallelement demandes aux operateurs avec le consentement des participants a l’etude. Discussion L’etude internationale MOBI-KIDS dans son ensemble, et notamment en France, represente une occasion unique d’analyser la relation entre le risque de tumeur cerebrale et l’exposition aux radiofrequences et aux extremement basses frequences emises par les telephones mobiles et par d’autres sources importantes d’exposition dans l’environnement des jeunes.

Objective: Reducing the rates of death, trauma and sequelae associated with road accidents is the prime goal of road safety authorities, and success requires having data on victims' outcomes in the long term. The present study examined the outcome of adult road accident victims one year after their accident. Design: A follow-up study. Methods: The cohort comprised 886 injured road-accident victims, aged ≥ 16 years, and living in the Rhône administrative Département, France (taken from the ESPARR Cohort). Data were collected on victim characteristics at the time of crash, and self-reported outcomes one year later. The population of respondents at the one-year questionnaire follow-up was divided into two categories according to injury severity, as mild-to-moderate (M.AIS

Summary Objective It is essential to know about the long-term consequences of road crashes involving corporal injury in order to adopt relevant public health measures. Methods The ESPARR cohort comprises 1168 road-crash victims, aged 16 or over, managed in hospitals in the Rhone administrative department (France). It is based on the Registry of Road Traffic Casualties, which has been collecting exhaustive data since 1995. Two groups are monitored: mild to moderate (M-AIS 1 or 2) and severe (M-AIS ≥3). Patients were interviewed at the point of primary care, between 1 October 2004 and 31 July 2006. 6 months later, their state of health and presence of pain were compared. Multivariate analysis (logistic regression) was performed to identify factors related to residual pain. Results Adults of the cohort were compared to the road crash population as a whole recorded over the same period in the same area. At 6 months post-accident, only 31.9% of victims deemed their health status to have entirely returned to normal; 63.8% of mild to moderate and 89.2% of severe cases reported residual pain, but neither pain frequency nor intensity correlated with M-AIS. Residual pain was related to lower limb injuries (OR = 1.6; 95% CI = 1.1–2.4). After adjustment, pain was essentially related to age, seriousness of the lesions and a stay in a rehabilitation unit. Conclusion The ESPARR cohort provides a unique opportunity in France to describe the trajectory of a road crash victim, in terms both of care and rehabilitation and of resumption of work and personal activity.

Background Use of cell phones has increased dramatically since 1992 when they were first introduced in France. Certain electromagnetic fields (at extremely low frequency) have been recognized as possibly carcinogenic by the International Agency for Research on Cancer. Given the use of radiofrequency technology in cell phones, the rapid increase in the number of cell phones has generated concerns about the existence of a potential health hazard. To evaluate the relationship between the use of cell phones and the development of tumors of the head, a multicentric international study (INTERPHONE), coordinated by the International Agency for Research on Cancer, was carried out in 13 countries. This publication reports the results of the French part of the INTERPHONE study. Methods INTERPHONE is a case-control study focused on tumors of the brain and central nervous system: gliomas, meningiomas and neuromas of cranial nerves. Eligible cases were men and women, residents of Paris or Lyon, aged 30–59, newly diagnosed with a first primary tumor between February 2001 and August 2003. The diagnoses were all either histologically confirmed or based upon unequivocal radiological images. Controls were matched for gender, age (± 5 years) and place of residence. They were randomly drawn from electoral rolls. Detailed information was collected for all subjects during a computer-assisted face-to-face interview. Conditional logistic regression was used to estimate the odds ratio (OR) for an association between the use of cell phones and risk of each type of cancer. Results Regular cell phone use was not associated with an increased risk of neuroma (OR = 0,92; 95% confidence interval = [0.53–1.59]), meningioma (OR = 0,74; 95% confidence interval = [0.43–1.28]) or glioma (OR = 1.15; 95% confidence interval = [0.65–2.05]). Although these results are not statistically significant, a general tendency was observed for an increased risk of glioma among the heaviest users: long-term users, heavy users, users with the largest numbers of telephones. Conclusion No significant increased risk for glioma, meningioma or neuroma was observed among cell phone users participating in Interphone. The statistical power of the study is limited, however. Our results, suggesting the possibility of an increased risk among the heaviest users, therefore need to be verified in the international INTERPHONE analyses.

OBJECTIVE: To identify socio-occupational and medical factors associated with non-return to work 3 years after severe road-accident injury. MATERIALS/PATIENTS AND METHODS: ESPARR is a prospective 5-year cohort of 1168 road-accident victims, aged over 16 years, in the Rhone administrative Departement of France. 141 (63.5%) of the 222 subjects with severe injury (maximal abbreviated Injury Scale>=3) in work at the time of the accident reported whether they had returned to work during the 3 years following the accident. Two groups were distinguished: those who had returned to work during the 3 years (n=113; 79.1%) and those who had not (n=28; 19.9%). The groups were compared on socio-occupational and accident-related medical factors at 3 years post-accident, by univariate analysis on Chi(2) or Fisher test, and multivariate analysis on a generalized linear model. RESULTS: Being separated, widowed or divorced at the time of the accident, initial head, face and lower-limb lesion severity, New injury severity score(3) 16, onset of post-traumatic stress disorder, persistence of intense pain and perceived poor quality of life and health status at 3 years post-accident emerged as factors associated with non-return to work on univariate analysis. On multivariate analysis, severity of initial head lesions, persistence of intense pain at 3 years and onset of post-traumatic stress disorder remained significant factors for non-return to work 3 years after severe road-accident injury. DISCUSSION/CONCLUSION: Chronic pain and post-traumatic stress disorder appeared in this study to be the main factors on which action could be taken. Early adapted treatment of these factors could facilitate return to work in victims of severe injury.Copyright © 2016. Published by Elsevier Masson SAS. Language: en

Introduction S’il est connu que le traumatisme crânien (TC) joue sur la qualite de vie (QdV) du blesse, son evolution dans le temps est peu etudiee. L’objectif de notre etude etait d’evaluer l’evolution de la QdV durant cinq annees suivant un TC. Methodologie Nous avons utilise le « WhoQol-bref » pour evaluer la QdV des sujets de la cohorte ESPARR (957 victimes d’accident de la route ; TC = 22,7 %) 1, 3 et 5 ans apres l’accident. Chacun des six scores derivant de cet outil variait de 4 a 20. Le TC a ete entre comme variable explicative dans les modeles. Des analyses par classes latentes ont ete realisees afin d’identifier les trajectoires concernant chaque score et etablir les associations entre chaque trajectoire et le TC. Resultats La qualite de vie des TC etait significativement alteree par rapport aux autres blesses. Deux trajectoires ont ete determinees pour le score global et pour les scores des domaines mental, social et environnemental ; trois trajectoires ont ete definies pour le score de sante globale et pour le score du domaine physique. Les traumatises crâniens ont plus de chances d’appartenir a la trajectoire basse pour la QdV globale (OR = 2,2 ; 1,3–3,9), le domaine physique (OR = 2,1 ; 1,3–3,5) et le domaine social (OR = 2,2 ; 1,3–3,5) et d’appartenir a la trajectoire moyenne pour la sante globale (OR = 2,0 ; 1,2–3,4). Discussion Nos resultats soulignent la necessite d’accroitre les efforts pour ameliorer la qualite de vie des traumatises crâniens, dans toutes ses dimensions.

PURPOSE: To quantitatively assess the impact of selection bias caused by nonparticipation in a multinational case-control study of mobile phone use and brain tumor. METHODS: Non-response questionnaires (NRQ) were completed by a sub-set of nonparticipants. Selection bias factors were calculated based on the prevalence of mobile phone use reported by nonparticipants with NRQ data, and on scenarios of hypothetical exposure prevalence for other nonparticipants. RESULTS: Regular mobile phone use was reported less frequently by controls and cases who completed the NRQ (controls, 56%; cases, 50%) than by those who completed the full interview (controls, 69%; cases, 66%). This relationship was consistent across study centers, sex, and age groups. Lower education and more recent start of mobile phone use were associated with refusal to participate. Bias factors varied between 0.87 and 0.92 in the most plausible scenarios. CONCLUSIONS: Refusal to participate in brain tumor case-control studies seems to be related to less prevalent use of mobile phones, and this could result in a downward bias of around 10% in odds ratios for regular mobile phone use. The use of simple selection bias estimation methods in case-control studies can give important insights into the extent of any bias, even when nonparticipant information is incomplete.

Objectifs Les conséquences d’un accident de la route sont variées, cependant peu d’études ont pris en compte leur aspect multidimensionnel. Notre objectif est d’analyser cet aspect et de déterminer les facteurs prédisant le devenir à un an des victimes d’accident de la route. Méthodes L’analyse a porté sur 616 victimes d’accident de la route de la cohorte ESPARR, de 16 ans et plus, qui ont complété un an après l’accident, un questionnaire sur leur état de santé, leur statut familial, social, émotionnel, financier. Par une mise en ½uvre conjointe d’analyse des correspondances multiples et de classification ascendante hiérarchique, ces sujets sont classés dans des groupes homogènes en fonction des conséquences observées à un an. Ces groupes sont ensuite comparés sur leur qualité de vie à un an (WHOQol-Bref). Les facteurs prédictifs d’appartenir à un groupe sont analysés à partir de modèles de régression logistique multinomiale pondérée. Résultats Cinq groupes de victimes ont été identifiés : dans le groupe 1 les sujets ont une bonne récupération ; les sujets du groupe 2 ont des conséquences physiques uniquement ; les sujets des 3 autres groupes ont des conséquences multiples (physiques, sociales, environnementales). Des différences significatives entre les groupes apparaissent en matière de statut familial, de fragilité socioéconomique initiale, de gravité des lésions initiales, et du territoire anatomique des lésions (thorax, colonne, membres inférieurs). La qualité de vie est dégradée dans les groupes présentant des conséquences multiples. Outre la gravité initiale, la fragilité socioéconomique est un élément prédisant le fait d’être dans un groupe vivant de multiples conséquences. Conclusions Un an après l’accident, les victimes subissent encore de multiples conséquences en termes de santé physique, mais aussi mentale, dans leur vie sociale et leur environnement quotidien, conséquences qui peuvent être prédites tant par des caractéristiques accidentelles que par des facteurs socioéconomiques.

Introduction L’usage du velo est encourage pour ses effets benefiques sur la sante face aux objectifs de developpement durable et de lutte contre la sedentarite. Neanmoins cette pratique comporte des risques ; on estime qu’un cycliste a huit fois plus de chances d’etre blesse qu’un automobiliste par heure passee sur la route. La majorite des etudes analyse des donnees policieres, fortement biaisees, et minimise le risque d’accident seul tout en surevaluant celui de collision avec autrui. Methode Nous utilisons une source medicale, peu biaise : le Registre des accidents du Rhone. Les 3300 cyclistes blesses a velo en 2009–2011 ont ete invites a remplir un questionnaire, 1078 (42 %) ont repondu. L’objectif principal est l’exploitation d’une typologie des configurations d’accidents cyclistes construite a partir des questionnaires. Les methodes de classification adoptees pour sa construction et les ACM utilisees pour en verifier la pertinence sont presentees. Resultats La typologie comporte 17 types d’accident, la taille des groupes est de 39 a 110 individus. Les variables les plus discriminantes pour la construction sont : le type de trajet (utilitaire, loisir et sportif), avoir une collision ou eviter un antagoniste, etre dans une situation de conflit de trajectoire et signaler un objet sur son chemin. Ces variables se retrouvent dans les ACM. Chacune des 17 configurations est caracterisable par un ensemble de facteurs d’accidents principaux et secondaires. Conclusion Cette etude permet de se focaliser sur differents types d’usagers accidentes lors d’un trajet utilitaire (42 %) dont la moitie entre le domicile et travail, d’une pratique sportive (37 %) ou d’une balade (19 %).