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International audience; BACKGROUND: Addressing chronic low back pain (cLBP) from the point of view of representation allows better understanding the behaviors associated with it and thus improve its medical and socio-occupational management. The Quebec Questionnaire of Representations related to Work Disability (QRWoD) proposes an evaluation of 9 dimensions of the cLBP-related representation. OBJECTIVE: To translate and adapt the QRoWD to French language and assess its validity and reliability in French cLBP workers on prolonged sick leave. METHODS: A prospective study was conducted from March 2017 to April 2018 in the Department of occupational health of the University Hospital of Angers, France. The QRWoD is a self-administered questionnaire (87 items) which assesses Identity, Acute/Chronic duration, Consequences, Personal Control, Treatment Control, Cyclical Timeline, Coherence, Emotional Representation and Causes dimensions. The Internal consistency (Cronbach's alpha) and the convergent validity (Pearson correlations) in comparison to validated instruments for each dimension were assed. RESULTS: Fifty French workers (29 men, 43 +/- 9.1 years, 293.6 +/- 173.0 days of work absence) were included. The internal consistency (all alpha > 0.7) and the convergent validity (all r(2) > 0.25, p < 0.01) of each dimension were very satisfactory except for the Cyclical Timeline dimension. CONCLUSIONS: The French version of the QRoWD seems to be valid and relevant among the target population.

International audience

Resume La lombalgie est un probleme majeur de sante publique dans les pays occidentaux. Le caractere benin de la lombalgie contraste regulierement avec son retentissement sur la qualite de vie du fait de son caractere volontiers recidivant et de sa potentielle evolution vers la chronicite, stade auquel elle s’accompagne regulierement d’une restriction de participation sociale et professionnelle. La pratique d’une activite physique (AP) reguliere et d’exercices physiques (EP) est essentielle pour la prise en charge de la lombalgie et la prevention des recidives. L’AP est ainsi recommandee a tous les stades de la lombalgie. Or, la douleur, les croyances erronees et les comportements inappropries vis-a-vis de la douleur font regulierement obstacles a la pratique d’une AP. Selon le modele biopsychosocial, la lombalgie chronique est liee a un ensemble de facteurs qui rendent sa prise en charge complexe. Ce constat a conduit a la mise en place de programmes multidisciplinaires de reentrainement a l’effort comprenant une prise en charge des composantes physique, psycho-comportementale et socioprofessionnelle de la lombalgie chronique. La composante reeducative des programmes comprend classiquement des exercices de renforcement musculaire et d’etirement, des activites aerobies et de stabilisation rachidienne. Les autres aspects de la prise en charge incluent l’amelioration des parametres psychosociaux et comportementaux via notamment les therapies cognitives et comportementales et l’education therapeutique du patient. Enfin, la plupart des programmes proposent egalement une evaluation et un accompagnement socioprofessionnel en vue d’ameliorer le retour au travail ou le maintien en emploi. L’approche multidisciplinaire de la prise en charge de la lombalgie chronique a montre son efficacite, notamment en termes d’incapacite fonctionnelle et d’intensite de la douleur alors que les effets concernant l’absenteisme et le retour au travail sont plus heterogenes. Favoriser les comportements actifs et l’autonomie des patients au decours de la prise en charge supervisee, sur le long terme, est un enjeu crucial. Cela necessite donc, d’une part, de prendre en compte la preference du patient pour le choix de l’AP et des EP, mais egalement de mettre l’accent sur les strategies motivationnelles.

ObjectiveCold environments are a potential risk factor for stroke. The aim of this study was to investigate the association between performing work tasks in cold environments and the occurrence of a first stroke event.MethodsFrom the French population-based cohort CONSTANCES (‘Cohorte des consultants des Centres d'examens de santé’ in French), we collected data from baseline questionnaires along with medical interviews on cardiovascular risk factors and reported exposure to cold temperatures (ResultsThere were 160 782 participants and 224 strokes (168 ischaemic and 76 haemorrhagic) included in our study. No significant increase in stroke was found for working in cold environments; the adjusted OR for often or almost always exposed was 1.14 (95% CI 0.46 to 2.84).ConclusionsThis study did not reveal a significant excess risk of stroke for occupational exposures to low temperatures. Further studies are needed to better assess the effect of preventive measures and very low temperature on occurrence of cardiovascular diseases.

National audience; The risk factors for hematological malignancies, in particular lymphoid malignancies, are still poorly understood today. A certain number of risk factors of occupational origin have been the subject of scientific studies since the 1980s. We offer, in this mini-review, a synthesis of data from the literature dealing with risk factors for lymphomas linked to professional exposure. Pesticides and organic solvents have been the most studied and the farming profession seems to be the most affected. We detail here the main pesticides in question. Hair dyes, ultraviolet and ionizing radiations have also been the subject of epidemiological studies. Many of these studies, however, have limitations and biases, and call for caution in interpreting their results and conclusions. Finally, it is recalled that the occurrence of lymphoma linked to an occupational exposure recognized as potentially favorable may be the subject of a request for recognition as an occupational disease, under certain conditions.

Resume Introduction Le sentiment d’efficacite personnelle a retourner au travail est un determinant psychologique majeur du retour au travail de patients diagnostiques d’un cancer. Cependant, les investigations francaises dans ce domaine ne prennent pas en compte cette dimension en raison de l’absence d’outil adapte a son evaluation. L’objectif de cette etude etait de proposer une traduction et adaptation francaise du « Return to Work Self-Efficacy’ scale – 11 items » (RTWSE-11), valide en neerlandais dans sa version originale. Methodes Apres les etapes de traduction/contre-traduction, completees par des reunions de consensus d’experts, des entretiens ont ete menes aupres de treize patients diagnostiques d’un cancer afin de mesurer le degre de clarte, simplicite et ambiguite des differents elements de la version francaise du RTWSE-11. Resultats Les principales modifications inherentes a l’adaptation francaise du RTWSE-11 ont concerne la reformulation des modalites de l’echelle de Likert et l’inversion de trois items negatifs en items positifs. Discussion La traduction et adaptation francaise du RTWSE-11 ont ete particulierement fideles aux aspects semantiques, idiomatiques, fonctionnelles, experientielles, conceptuelles et operationnelles de la version originale. Les travaux a venir pourront des lors se concentrer sur l’evaluation psychometrique du questionnaire. Toutefois, cet outil peut d’ores et deja etre utilise en pratique clinique afin d’etablir une premiere evaluation des capacites des patients diagnostiques d’un cancer a retourner au travail.

Over the last few years, an increasing number of agricultural R&D actors have sought to discover and get to know farmers’ practices that they consider as innovative, unconventional, or promising. We refer to these approaches, all of which aim to support the design of farming systems, as ‘farmer innovation tracking’. There is still a lack of knowledge, however, about the specificities of the approaches adopted to track innovations and how they contribute to design processes. To explore these questions, we studied 14 initiatives in France led by actors from different R&D networks. We analysed the data collected using agronomy and design science concepts. Three outcomes emerge from this work. (1) We shed light on the common features of innovation tracking. We outline five stages that structure all the approaches: formulating an innovation tracking project, unearthing innovations, learning about them, analysing them, and generating agronomic content. (2) We characterize six contributions of farmer innovation tracking to design processes: giving rise to creative anomalies, shedding light on systemic mechanisms to fuel design processes on other farms, uncovering research questions, stimulating design in orphan fields of innovation, circulating innovation concepts, and connecting farmer-designers with each other. (3) Finally, we highlight three tracking strategies: the targeted tracking of proven practices, the targeted tracking of innovations under development, and the exploratory tracking of proven practices. This article is the first to propose a theorization of the farmer innovation tracking approaches, thus enriching the agronomic foundations supporting farming system design. The purpose of our paper is not to provide a turnkey method, but to highlight concepts, mechanisms, and points of reference for actors who might wish to develop farmer innovation tracking in different contexts in the future. By revealing their contributions to design processes, this article seeks to contribute to the institutionalization of innovation tracking.

Introduction Young patients with idiopathic aplastic anemia (AA) respond better to immunosuppressive therapy (IST) but the long-term outcome is suboptimal with non-response in 30% of patients as well as significant risks of relapse, ciclosporine (CSA) dependence and clonal evolution. Excellent results of up-front unrelated donor (UD) hematopoietic stem cell transplantation (HSCT) have been reported in a cohort of 29 children with idiopathic AA using an Alemtuzumab-based regimen, with low Graft versus Host Disease (GvHD) rates and only 1 death (Dufour C, BJH 2015). We took advantage of the SAAWP registry of the European Blood and Marrow Transplantation (EBMT) to analyze the outcomes of 65 young patients who received up-front UD HSCT in Europe. Methods : Patients who had received an UD HSCT for AA, between 2010 and 2018, registered in the SAAWP registry were included. Patients who had received IST (CSA or anti-thymocyte globulin (ATG)) before HSCT, cord blood, haplo-identical transplant were excluded as well as patients suffering from congenital bone marrow disorders. The primary endpoint was overall survival (OS) at 2 years. Secondary endpoints were GVHD-free/relapse-free survival (GRFS) - defined at 2 years as being alive, engrafted without acute GVHD grade III-IV, and extensive chronic GVHD during follow-up. Results : Sixty-five patients were included between 2010 and 2018; median age was 16 years old (9-26). Time to HSCT was 6.5 months (IQR 3.6-11.7). Thirty-nine patients were transplanted from a matched unrelated donor (at least 8/8 HLA matched), 11 patients had mismatched UD (HLA data missing for 14 patients). The two-year overall survival rate was 92% (95% CI, 85-99%) (figure 1,A) with a median follow-up of 32 months (25-43). Main cause of death was infection (2 out of 5 deaths). Failure occurred in 8% (1-15%) of the patients. Acute GVHD grade II-IV was observed in 13% (5-22%) of the patients and Grade III and IV happened for two patients (3%). Chronic GVHD at 2 years occurred for 12% (4-21%) of the patients, with no extensive case. GRFS was 87% (77-96%) at 2-years (Figure 1, B). In our cohort, 57 patients received in vivo T cell depletion using either ATG (n=33, 60%) or anti-lymphocyte globulin (n=4, 7%) or alemtuzumab (n=20, 30%). Due to low rate of events happening during outcome, no risk factor analysis could be driven. Conclusion: In this retrospective cohort of 65 patients with idiopathic aplastic anemia, up-front UD transplantation leads to promising results, confirming previous studies on a smaller cohort of patients. Moreover, we did not find any difference according to in vivo T-cell depletion type, suggesting excellent results are not exclusively related to alemtuzumab-based regimen. Because of obvious limitation related to retrospective studies, unreported events and information bias cannot be excluded. Prospective trials are on their way in the United States and in Europe to formally confirm upfront UD transplantation as standard of care for pediatric patients with idiopathic aplastic anemia. Disclosures Rambaldi: Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company). Research grant from Amgen Inc.; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company). Advisory board and speaker fees from Pfizer.; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support from Gilead.; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support of parent study and funding of editorial support. Received travel support., Research Funding; University of Milan: Current Employment; BMS/Celgene: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Astellas: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Sanofi: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Omeros: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company). Griškevičius:Novartis: Research Funding. Dalle:Sanofi-Genzyme: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Orchard: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Medac: Consultancy, Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria; Bellicum: Consultancy, Honoraria; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; AbbVie Pharmacyclics: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; bluebird bio: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Risitano:Pfizer: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Alnylam: Research Funding; Alexion: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amyndas: Consultancy; Samsung: Membership on an entity's Board of Directors or advisory committees; RA pharma: Research Funding; Biocryst: Membership on an entity's Board of Directors or advisory committees; Apellis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Achillion: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Jazz: Speakers Bureau. Peffault De Latour:Apellis: Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Research Funding; Alexion Pharmaceuticals Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

Beta thalassemia major (βTM) is the most common inherited hemoglobinopathy. Management essentially focuses on preventing and treating complications. Conventional treatment is based on a regular blood transfusion program, and chelation therapy. Management essentially focuses on preventing and treating complications. Severe complications of βTM are very rarely seen in children in Europe. In the context of the migrant crisis, pediatricians will be confronted with the challenge of managing severe complicated βTM. We report the case of 2 Syrian 10-year-old twin girls who arrived to France with numerous and severe complications of βTM: hemochromatosis, alloimmunization, hypopituitarism, osteopenia… Their clinical management, which led to successful vital and functional improvement, is reported in this article.

Intra-articular injection of drug depots is considered as a therapeutic strategy for the treatment of osteoarthritis. In this study, we designed an in vitro assay in a previously described bioreactor system to evaluate the uptake of a small molecule drug mimic as a function of drug clearance by the synovium and compressive load. Bromophenol blue (BPB) loaded hydrogels were placed on top of bovine articular cartilage explants and were compressed in a dual flow bioreactor. As a control, BPB was directly injected in the bioreactor compartment mimicking the synovial fluid. Subsequently, diffusion coefficients of the dye were estimated based on Fick's law. Mimicking synovial clearance revealed that dye penetration of BPB when released from a drug delivery system placed on top of a cartilage explant was enhanced compared to direct injection of BPB into a simulated synovial fluid. Furthermore, we show the synergistic effect of the amount of load and the frequency on drug uptake by the cartilage. In the described model, we have shown that, under compressive load, drug delivery from a depot was beneficial over conventional intra-articular drug administration. The assay mimics the complexity of the knee joint in several key aspects, which results in a more close representation of the expected drug outcome. In this study, we have evaluated the penetration of a model small molecule drug into articular cartilage under compressive conditions, and future development will focus on incorporating synovial(-like) fluid, synovium, and bone to increase the predictive potential of the assay further.

Resume Objectif Determiner comment les employeurs percevaient les salaries en situation de souffrance psychique liee au travail dans leur entreprise. Methode Une etude qualitative par entretiens individuels semi-diriges a ete menee entre janvier et novembre 2017. Chaque entretien a fait l’objet d’un double codage avant analyse thematique de maniere inductive au fil des entretiens. Resultats L’etude a porte sur 15 entretiens aupres d’employeurs ou de directeurs des ressources humaines d’entreprises allant de 5 a 900 salaries, localisees en France dans le Maine et Loire, la Sarthe et la Charente. Cette etude a fait apparaitre de nombreuses interrogations et incomprehensions de la part des employeurs concernant les origines et les facteurs de risque de souffrance psychique au travail avec notamment la tendance a considerer les facteurs prives comme des facteurs de risque psychosociaux. Les employeurs ont decrit une mise a l’epreuve de la relation avec leurs salaries par l’apparition d’un sentiment de mefiance, d’injustice et d’une perte de confiance. Les actions des employeurs etaient limitees par un defaut de formation sur les risques psychosociaux, par le sentiment de manque de possibilite d’agir sur la part privee et par les enjeux economiques. Conclusion L’ensemble des incomprehensions des employeurs a semble compliquer les situations de souffrance psychique au travail avec une degradation secondaire des relations employeur/salarie et etre parfois a l’origine d’une volonte de separation. L’etude a permis de montrer, dans certains cas, une non-reconnaissance de la souffrance psychique du salarie par son employeur. Il pourrait etre interessant de mener des etudes sur les impacts de cette non-reconnaissance dans les situations de souffrance psychique au travail.

Introduction L’utilisation des technologies de l’information et de la communication dans le secteur médical s’est brutalement développée depuis le début de la pandémie liée au SARS-CoV-2 afin d’assurer la continuité des soins et limiter la propagation du virus. Sur le modèle des téléconsultations, la télérééducation (kinésithérapie et activité physique adaptée (APA) à distance) a été mise en place pour la prise en charge des patients ayant une incapacité physique et/ou cognitive. Dans le contexte sanitaire, cette pratique, initialement réservée aux pathologies lourdes, s’est secondairement étendue à d’autres affections. L’objectif de cette étude était d’évaluer l’intérêt de la télérééducation dans le cadre d’un programme de réentraînement à l’effort (RAE) chez les patients lombalgiques chroniques. Patients et méthodes . Etude rétrospective, mono centrique, menée auprès des patients présentant une lombalgie chronique commune, inclus dans un programme de RAE entre juin 2020 et juin 2021, au Centre de médecine physique et réadaptation d’Angers. Le programme était réparti sur 5 semaines (5 ½ journées/semaine de rééducation en présentiel) et comprenait 20 h de kinésithérapie, 19 h d’ergothérapie, 17 h d’APA et 17 h d’éducation thérapeutique du patient (ETP). Un suivi psychologique (présentiel) et/ou diététique (télé-consultations) pouvaient être mis en place, si besoin. Des activités de télérééducation (1 h de kinésithérapie + 1 h d’APA/semaine, sur la même demi-journée) ont été proposées de manière systématique, à partir de la 3ème semaine du programme. Une évaluation de la douleur (EVA), du syndrome de déconditionnement à l’effort (distance doigt-sol, élévation des membres inférieurs, distance talon-fesse, tests de Ito et de Sorensen, nombre de squat en 45 sec.), du retentissement de la douleur et de l’incapacité liées à la lombalgie (échelle HAD, questionnaires Dallas et FABQ) et de la qualité de vie (SF-36) a été réalisée à l’inclusion (T0) et à la fin du programme (T5). L’acceptation, la faisabilité, l’assiduité et la satisfaction des patients ont été recueillies à distance. Résultats La comparaison des résultats obtenus chez les patients ayant participé et n’ayant pas participé à la télérééducation seront présentés lors du congrès. Discussion Outre les limites matérielles (manque de matériel, problèmes de connexion), la télérééducation peut être un frein à la mise place de la relation thérapeutique et se heurte parfois à des croyances préalables (volonté d’être examiné et touché). La télérééducation présente en revanche de nombreux avantages, notamment en termes de gain de temps, de réduction des déplacements et des coûts, et permet ainsi d’améliorer la qualité de vie. Elle permet également d’améliorer la motivation et l’autonomisation (auto-efficacité) du patient. Conclusion La télérééducation ne doit sans doute pas être considérée comme une modalité de soin à part entière, mais plutôt comme un complément aux prises en charge conventionnelles pour améliorer l’accessibilité aux soins, la réduction des coûts, le suivi et l’observance.

Resume Objectif La recuperation acceleree apres chirurgie (RAAC) a pour objectif de reduire la duree d’hospitalisation tout en garantissant la qualite des soins. Cette etude a evalue l’implantation et le deploiement de ce dispositif organisationnel a travers deux dimensions : 1-la description des modalites de deploiement ; 2-l’identification de facteurs structurants. Methodes Nous avons procede par etude de cas aupres de 4 etablissements et avons eu recours a une methodologie qualitative (entretiens, observations, analyse documentaire). L’ensemble des donnees collectees a ete analyse par analyse de contenu. Resultats L’implantation de la RAAC depend du contexte et a des modalites de deploiement (institutionnelles, organisationnelles et professionnelles) variables d’un etablissement a un autre. Pour autant, des facteurs structurants conditionnent la reussite de l’implantation de ces programmes. Conclusion L’implantation de la RAAC repose sur plusieurs dimensions structurantes, qui ne peuvent etre standardisees et qu’il importe d’activer de maniere concomitante.

We have read with great interest the two editorials by Burdorf et al: "The COVID-19 pandemic: one year later - an occupational perspective" (1) and "The COVID-19 (Coronavirus) pandemic: consequences for occupational health" (2). The authors highlight the importance of the societal consequences of the outbreak and changes in the world of work to manage occupational health. The key points identified - such as individual socio-economic factors, psychological effects and occupations with highest risk of contamination - modify return-to-work approaches. It is estimated that around 800 million people of working age worldwide were living with disabilities before the SARS-CoV-2 pandemic. In early January 2021, the cumulative COVID-19 hospitalisation rate reached 207.4/100 000 (18-49-year-olds) and 505.7/100 000 (50-64-year-olds), respectively, in the United States (3). In France, the hospitalisation rate was 411.5/100 000 across all ages (4). A recent cohort study of working-age men who were hospitalised for COVID-19 highlighted the long-term health consequences of such a disease (5). The SARS-CoV-2 pandemic creates new challenges for occupational health, shifting attention away from return-to-work after health problems to resuming work during an outbreak, dealing with lockdown, and taking special account of workers with vulnerabilities (6, 7). We recommend considering three different aspects of occupational medicine during a pandemic. Firstly, for most workers at high-risk of severe COVID-19, the issues of work disability and resuming work had never occurred before the epidemic. Recommendations such as physical and social distancing and wearing a facemask are highly advisable to protect against infection but may not be enough to enable some individuals to resume work. Therefore, decision-making requires individual comprehensive assessments of the underlying medical condition, the SARS-CoV-2 contamination risk associated with either regular work or teleworking, and vaccination opportunities. The second situation concerns workers who have suffered from COVID-19. Preliminary studies suggest that long recovery duration is related to high severity (7), but this is still a matter of debate for patients suffering from "long COVID-19" (5, 8, 9), a condition for which the long-term effects remain unknown. Any long-running recovery must be considered to be a potential sign of long COVID-19. These long-lasting syndromes occur among patients with severe symptoms but have also been reported independently of acute phase severity, hospitalisation and receiving medical oxygen (8, 9). Researchers worldwide are currently investigating such syndromes. Strategies promoting return to work for these workers will need to be implemented and could be similar to programmes developed for other chronic conditions. Moreover, numerous more serious sequelae following critical illness suggest the need for enhanced support by rehabilitation and occupational health specialists. Finally, the consequences of the epidemic must be evaluated over time for people who suffered from functional limitations before COVID-19 as their physical and mental condition may be modified by the epidemic and, specifically, the consequences of lockdown (10). In all of these situations, medical, social, financial and working contexts are key elements. In addition to a medical assessment, the use of scales such as the Work Ability Index (WAI) (11) or the Work Productivity and Activity Impairment (WPAI) (12) can help perform long-term follow-up and provide information about work capacity and workload. It also gives a "back to basics" perspective, urging politicians to move towards a `decent-work-for-all` policy, as advocated by the United Nation`s Sustainable Development Goal (SDG) 8, which the WHO has endorsed (13). References 1. Burdorf A, Porru F, Rugulies R. The COVID-19 pandemic: one year later - an occupational perspective. Scand J Work Environ Health - online first. https://doi.org/10.5271/sjweh.3956 2. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020;46(3):229-230. https://doi:org/10.5271/sjweh.3893. 3. COVID-19 Hospitalizations [Internet]. Available from: https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html 4. COVID-19 in France, vaccine and allergy management in occupational setting. Descatha A et al. Arch Mal Prof Environ 2021. Accepted for publication. 5. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397(10270):220-32 https://doi.org/10.1016/S0140-6736(20)32656-8 6. Shaw WS, Main CJ, Findley PA, Collie A, Kristman VL, Gross DP. Opening the Workplace After COVID-19: What Lessons Can be Learned from Return-to-Work Research? J Occup Rehabil. 2020;30(3):299-302. https://doi.org/10.1007/s10926-020-09908-9 7. Taylor T, Das R, Mueller K, Pransky G, Christian J, Orford R, et al. Safely Returning America to Work: Part I: General Guidance for Employers. J Occup Environ Med. 2020;62(9):771-9. https://doi.org/10.1097/JOM.0000000000001984 8. Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-5. https://doi.org/10.1001/jama.2020.12603 9. Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. MMWR Morb Mortal Wkly. 2020;69(30):993-8. https://doi.org/10.15585/mmwr.mm6930e1 10. Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14(5):965-7. https://doi.org/10.1016/j.dsx.2020.06.042 11. Tuomi K. Eleven-year follow-up of aging workers. Scand J Work Environ Health. 1997;23(1):1-71. 12. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics. 1993;4(5):353-65. https://doi.org/10.2165/00019053-199304050-00006 13. Organization WH. Health in the 2030 agenda for sustainable development. Sixty-Ninth World Health Assembly. Document A. 2016, p69.

Sir, On the 6th of April, the WHO provided guidance about personal protective equipment (PPE) for healthcare workers (HCWs) in healthcare settings areas that have reported cases of COVID-19, stating that HCWs working in settings where aerosol-generating procedures were performed should wear a particulate respirator (N95 or FFP2), whereas in their previous recommendations, such masks were restricted to those who actually performed such procedures. This a step forward, although insufficient, towards the recognition of aerosol transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its consequences in terms of PPE choice. COVID-19 has been considered as a droplet transmitted disease by WHO, which means that it can be prevented using surgical masks and hand hygiene. However, there is now increasing evidence …

International audience

Objective This paper presents the stages of development of an occupational biomechanical exposure matrix and preliminary reliability and validity indicators. Methods The expertise-based job exposure matrix, called "MADE" (for "difficult physical conditions and job matrix"), was developed from the French and international classification of jobs for 17 biomechanical exposures. Three pairs of investigators independently rate the frequency and intensity of exposure of each job from 0 to 5; discordant scores within pairs (mean difference >20% for each biomechanical exposure considered) were discussed collectively. Reliability was assessed by the difference between the initial ratings, the number of revised jobs, and the correlation between the two classifications (with transcoding). Validity was studied by correlating variables similar to those from existing United States and Danish matrices. Results The difference between the mean scores of the pairs was considered to be "fair" (less than one point). Of the 51 paired results studied (17 exposures - 3 pairs of investigators), four coefficients were found to be less than 0.6, and 14 were between 0.6 and 0.7. Forty-nine of the 1,169 job categories were reviewed. Correlation coefficients between the initial classification and transcoding were greater than 0.7. Correlation coefficients between the French, United States and Danish MEE variables were fair to good. Conclusion An expertise-based job exposure matrix with fairly reliable indicators has been developed, opening up the prospects to improve certain some fields of public health, at both national and international levels.

International audience; Objectives - To assess the attitudes and beliefs of physiotherapists (PTs) regarding the management of chronic LBP and to investigate the factors which influence them. Methods - A cross-sectional study conducted in the French Loire Valley region by a questionnaire sent to the private PTs between June and September 2014. Demographic data and modalities of practices were collected in association with the Pain Attitudes and Beliefs Scale (PABS) which is a specific self-administered questionnaire designed to assess the "biomedical" or "behavioral" (i.e., biopsychosocial) management orientation of PTs toward chronic LBP. Results - One hundred and sixty-eight of the 704 PTs entirely completed the questionnaire (63% of men, 58% >40 years of age) of whom 15 were involved in a LBP care network. A higher biomechanical score was observed with a higher age and lower with full-time employment, less than 20 years of length of practice and a recent LBP-specific training (p

International audience; Purpose Understanding and treating musculoskeletal disorders (MSDs) requires coordination between the numerous healthcare professionals involved, including occupational physicians (OPs), general practitioners (GPs) and social insurance physicians (SIPs). The main objective of this study was to assess communication between OPs, GPs and SIPs in the management of MSDs. Methods This is a qualitative study in the form of semi-structured interviews with OPs in the French region of Brittany. The interviews were conducted until data saturation was achieved. The interviews were fully coded and analysed thematically using NVivo® software. Results The interviews were carried out among 17 OPs from companies and external occupational healthcare services who treated employees from various activity sectors. Different communication channels were used depending on the interlocutor, though they were mainly contacted by mail or phone. Most of the communication passed through the patient, either verbally or in writing. No major failure was detected in communication between the various types of practitioners, but instances of communication were influenced by various factors such as differences in perception, representation and objectives, as well as by how well the physicians knew each other. A number of instances of non-communication were found. Conclusion This study showed that patients play a key role in the interactions between different practitioners. It also revealed that different types of professional relationships depend on the objectives of the various interlocutors, which in turn vary according to their roles and competences.

Resume Objectifs Evaluer l’interet du depistage systematique des cancers nasosinusiens par nasofibroscopie chez les salaries et les retraites exposes aux poussieres de bois et promouvoir le suivi post-professionnel. Methodes Etude longitudinale, realisee entre 2007 et 2014, dans les trois services de sante au travail de Maine-et-Loire, chez les salaries et retraites exposes de maniere continue ou fractionnee aux poussieres de bois pendant plus de 20 ans. Comparaison de 2 modalites de depistage du cancer nasosinusien : interrogatoire annuel oriente par le medecin du travail ; interrogatoire annuel oriente et nasofibroscopie bisannuelle. L’apport de la nasofibroscopie etait considere comme positif en cas de diagnostic d’une tumeur a un stade precoce (≤ T2) non depistee par la recherche de signes cliniques d’appel a l’interrogatoire seul. La realisation des suivis post-professionnels a egalement ete evaluee. Resultats Sept cent quatre-vingt-quinze salaries (753 hommes ; duree d’exposition moyenne = 29 ans) ont ete inclus. Aucun cancer nasosinusien n’a ete depiste. Des symptomes unilateraux ont ete rapportes chez 130 salaries, a l’interrogatoire. Parmi les 1403 nasofibroscopies realisees, 254 etaient pathologiques, dont 7 % associees a un symptome clinique a l’interrogatoire. L’examen etait considere comme peu ou pas douloureux dans 90 % des cas. Le suivi post-professionnel a ete realise chez 30 des 37 retraites, inclus dans l’etude en tant que salaries. Conclusion La faisabilite de la nasofibroscopie en tant qu’examen de depistage est validee. L’interet de la nasofibroscopie bisannuelle systematique n’a pas ete etabli etant donne l’absence de cas depiste et la taille de l’effectif inclus. Des criteres plus selectifs de la population a suivre et l’implication des medecins traitants dans la demarche pourraient permettre d’optimiser l’efficience et la rentabilite du depistage et du suivi chez les professionnels du bois.