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Points essentiels La nausee est une sensation commune. Elle est ressentie par le sujet comme un etat susceptible d’evoluer vers un vomissement. Cependant beaucoup de nausees se maintiennent sans etre suivies de vomissements. Les nausees peuvent etre isolees ou accompagner un tableau clinique. Certaines situations s’accompagnent frequemment de nausees comme les vertiges, les migraines, le mal des transports, la grossesse, des affections digestives aigues ou chroniques, des etats anxieux. En dehors d’un contexte pathologique connu, les nausees doivent faire l’objet d’une enquete etiopathogenique. Lorsqu’elles sont accompagnees de vomissements et de signes generaux – en particulier d’une fievre –, les nausees doivent faire d’abord eliminer une pathologie potentiellement grave (hypertension intracrânienne, meningite, occlusion…). La survenue des nausees retentit sur la qualite de vie du sujet. Les nausees peuvent limiter la concentration et les activites professionnelles. De nombreux patients ne traitent pas leurs nausees privilegiant le repos et l’attente de la resolution des symptomes. En l’absence de signes de gravite la prise d’un traitement sans prescription medicale peut s’envisager (recommandation ANSM 2008), surtout lorsqu’il s’agit de crises recidivantes dont la cause est identifiee. Les substances pharmacologiques ayant des effets anti-nauseeux sont nombreuses. Si l’approche etiologique est essentielle et parfois suffisante, le soulagement symptomatique peut etre facilitee par certains agents avec des nausees moins intenses et de duree plus breve, notamment par l’utilisation des antihistaminiques, des anticholinergiques et des derives des phenothiazines.

Nausea is a common feeling felt by the subject as a state likely to evolve into vomiting. However a lot of nausea is maintained without being followed by vomiting. Nausea can be isolated or accompanied by a clinical picture. Some situations are often accompanied by nausea like dizziness, migraines, transport sickness, pregnancy, acute or chronic digestive disorders or anxious state. Outside of a know pathological context, there must be an etiologic investigation. When they are accompanied by vomiting and general signs - especially a fever - nausea must first eliminate a potentially serious disease (intracranial hypertension, meningitis, occlusion…). Nausea resounds on the patient's quality of life, they can decrease concentration and professional activities. Many patients do not treat nausea and use rest and waiting for the resolution of symptoms. In the absence of signs of gravity taking a treatment without a medical prescription can be considered (recommendation ANSM 2008) especially for recurrent crisis whose cause can be precisely identified. They are many pharmacological substances with antinausea effects. If the etiological approach is essential and sometimes sufficient, symptomatic relief can be helped by some agents with less intense nausea and shorter duration especially by using of antihistaminics, anticholinergic agents and derivatives of phenothiazines.

Background Drug de-escalation is considered in Crohn’s disease patients in sustained remission on optimized infliximab treatment. Aim We built a model to evaluate the magnitude of cost savings in patients’ disease course with or without drug de-escalation guided by infliximab trough levels. Methods We designed 4 virtual cohorts (P1–P4) of 10,000 patients in clinical remission on optimized infliximab treatment followed for 2 years. P1: no drug de-escalation — 10 mg/kg/8 weeks; P2: drug de-escalation from 10 mg/kg/8 weeks to 5 mg/kg/8 weeks according to trough levels; P3: no drug de-escalation — 10 mg/kg/6 weeks; and P4: drug de-escalation from 10 mg/kg/6 weeks to 10 mg/kg/8 weeks according to trough levels. For P2 and P4 cohorts, drug de-escalation was decided if trough levels were ≥7 μg/mL and no de-escalation if trough levels were Results The cost differences when comparing P1 versus P2 and P3 versus P4 were 7.6% and 4.6%, respectively, corresponding to costs savings of €30.5 millions and €20.3 million for 10,000 patients. Conclusion Over a 2-year period, infliximab de-escalation according to trough levels led to cost saving of about 6%, corresponding to around €25.4 million.

Objectifs : Malgre l’existence de recommandations pratiques pour le traitement de la gonarthrose, des discordances dans leur application par les cliniciens et par les patients ont ete constatees, entrainant des resultats incomplets. Les donnees de la litterature montrent que la simple diffusion de recommandations therapeutiques n’entraine pas l’adhesion. La recherche suggere que les obstacles a leur mise en application devraient etre identifies et explicitees afin d’ameliorer l’adhesion. Le but de cette etude a ete d’identifier les obstacles a l’utilisation des recommandations concernant le traitement conservateur de la gonarthrose tant de la part des patients, que des medecins generalistes et des kinesitherapeutes. Methode : Apres avoir effectue une revue systematique des resultats et des recommandations de la litterature, douze recommandations therapeutiques principales ont ete elaborees sur quatre themes : medicaments, exercices physiques, autogestion, activites professionnelles. Des groupes de discussion ont ete formes comprenant des patients souffrant de gonarthrose, des medecins generalistes et des kinesitherapeutes, dans le but d’etablir les obstacles a la mise en application de ces recommandations. Resultats : Les patients et les medecins generalistes sont apparus comme generalement fatalistes concernant la gonarthrose, alors que les kinesitherapeutes etaient plus positifs vis-a-vis de l’amelioration a long terme de la gonarthrose. Pour les traitements medicamenteux, des discordances ont ete mises a jour entre les recommandations et l’opinion des cliniciens. Tant les patients que les medecins generalistes ont semble ambivalents vis-a-vis des exercices physiques et de l’activite physique, reconnaissant leur utilite mais les identifiant dans le meme temps comme des causes possibles de gonarthrose. Les patients et les medecins generalistes ont semble considerer l’amaigrissement comme un objectif particulierement difficile a realiser. Conclusion : Des obstacles specifiques a la mise en pratique de chaque recommandation du traitement de la gonarthrose pour chacun des groupes de sujets concernes ont ete identifies. Nous avons elabore des recommandations pour combattre ces obstacles. Les resultats de cette etude peuvent etre utilises pour developper des strategies de mise en application afin de surmonter les obstacles identifies, dans le but de faciliter l’utilisation des recommandations et d’ameliorer l’evolution de la gonarthrose. Niveau de preuve : non adapte

OBJECTIVES: Despite the availability of practice guidelines for the management of knee osteoarthritis, inadequacies in practices of clinicians and patients have been found, leading to suboptimal outcomes. Literature has shown that simply disseminating management recommendations does not lead to adherence. Research suggests that barriers to use should be identified and addressed to improve adherence. The objective of this study was to identify barriers to use of conservative management recommendations for knee osteoarthritis by patients, general practitioners and physiotherapists. METHODS: Following systematic reviews of evidence and guidelines, 12 key management recommendations were elaborated on four themes: medication, exercise, self-management and occupation. Focus groups were separately done with patients with knee osteoarthritis, general practitioners and physiotherapists to assess barriers to the use of recommendations. RESULTS: Patients and general practitioners appeared generally fatalistic with regards to knee osteoarthritis, with physiotherapists being more positive regarding long-term improvement of knee osteoarthritis. For medication, discrepancies were found between recommendations and views of clinicians. Both patients and general practitioners appeared ambivalent towards exercise and activity, recognizing its usefulness but identifying it at the same time as a cause of knee osteoarthritis. Patients and general practitioners appeared to consider weight loss particularly difficult. DISCUSSION/CONCLUSIONS: Barriers specific to each knee osteoarthritis management recommendation and stakeholder group were identified. Recommendations to address these barriers were elaborated. Results of this study can be used to develop implementation strategies to overcome identified barriers, with the goal of facilitating the use of guideline recommendations and improving outcomes.

Background & Aims Little is known about the magnitude of the risk of anal and rectal cancer in patients with anal and/or perineal Crohn's disease. We aimed to assess the risk of anal and rectal cancer in patients with Crohn's perianal disease followed up in the Cancers Et Surrisque Associe aux Maladies Inflammatoires Intestinales En France (CESAME) cohort. Methods We collected data from 19,486 patients with inflammatory bowel disease (IBD) enrolled in the observational CESAME study in France, from May 2004 through June 2005; 14.9% of participants had past or current anal and/or perianal Crohn's disease. Subjects were followed up for a median time of 35 months (interquartile range, 29–40 mo). To identify risk factors for anal cancer in the total CESAME population, we performed a case-control study in which participants were matched for age and sex. Results Among the total IBD population, 8 patients developed anal cancer and 14 patients developed rectal cancer. In the subgroup of 2911 patients with past or current anal and/or perianal Crohn's lesions at cohort entry, 2 developed anal squamous-cell carcinoma, 3 developed perianal fistula–related adenocarcinoma, and 6 developed rectal cancer. The corresponding incidence rates were 0.26 per 1000 patient-years for anal squamous-cell carcinoma, 0.38 per 1000 patient-years for perianal fistula–related adenocarcinoma, and 0.77 per 1000 patient-years for rectal cancer. Among the 16,575 patients with ulcerative colitis or Crohn's disease without anal or perianal lesions, the incidence rate of anal cancer was 0.08 per 1000 patient-years and of rectal cancer was 0.21 per 1000 patient-years. Among factors tested by univariate conditional regression (IBD subtype, disease duration, exposure to immune-suppressive therapy, presence of past or current anal and/or perianal lesions), the presence of past or current anal and/or perianal lesions at cohort entry was the only factor significantly associated with development of anal cancer (odds ratio, 11.2; 95% CI, 1.18-551.51; P = .03). Conclusions In an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn's disease have a high risk of anal cancer, including perianal fistula–related cancer, and a high risk of rectal cancer.

Resume Objectif Elaborer un score diagnostique de la poussee congestive de gonarthrose et valider sa sensibilite, sa specificite. Methodes Deux bases de donnees epidemiologiques issues respectivement d’une etude en medecine generale et d’une etude en rhumatologie, construites selon la meme methodologie et dans lesquelles les patients etaient classes par les medecins comme presentant ou non une poussee d’arthrose de genou, ont ete utilisees. La premiere a servi a l’elaboration du score diagnostique et la seconde a tester sa validite ; le diagnostic des rhumatologues etant considere comme le diagnostic de reference. Resultats Parmi les 6085 patients de la base epidemiologique de medecine generale, 52,3 % presentaient une poussee d’arthrose du genou. L’identification des caracteristiques influencant significativement le classement des patients en poussee de gonarthrose a ete conduite par une analyse en regression logistique. Le score a ete elabore en attribuant 0 en l’absence des caracteristiques cliniques et une ponderation indexee sur leur odds ratio lorsqu’elles etaient presentes : soit 1 pour derouillage matinal superieur a 20 minutes, 2 pour des douleurs provoquant des reveils nocturnes, 2 pour un epanchement intra-articulaire, 3 pour une boiterie, 3 pour un gonflement articulaire et 3 pour une augmentation de la chaleur locale. Le score varie ainsi de 0 a 14. Une courbe ROC a permis d’identifier 7 comme valeur seuil a partir de laquelle le diagnostic de poussee d’arthrose semblait pouvoir etre retenu. Cette formule et ce seuil ont ete appliques aux donnees issues de la base des rhumatologues. Le classement des patients en poussee ou non d’arthrose selon le score a ete compare au diagnostic porte par les rhumatologues. Les resultats font apparaitre 274 (46,4 %) patients classes en poussee d’arthrose par le score et 270 (45,7 %) par les rhumatologues, une sensibilite de 87,0 %, une specificite de 87,9 %, une valeur predictive positive de 85,8 % et une valeur predictive negative de 89,0 %. L’indice de Youden est a 0,75. Conclusion Une valeur superieure ou egale a 7 obtenue au score diagnostique de poussee d’arthrose etabli par cette etude apparait etre bien correlee au diagnostic clinique des rhumatologues. Le Knee Osteoarthritis Flare-Ups Score (KOFUS) pourrait constituer une mesure objective pour apprehender de maniere standardisee le diagnostic de poussee d’arthrose du genou, notamment dans le cadre des criteres d’inclusion des essais therapeutiques.

AIM: In patients with acute gastroenteritis, general behaviour of patients as well as medical care remain poorly documented. The aim of this work was to determine clinical and demographic characteristics, reason for visiting a doctor, and medical care in adult patients with acute gastroenteritis. METHODS: During the winter epidemic peak of acute diarrhea, 2,217 general practitioners filled in standardized clinical observations of 17,273 patients (mean age 40 yrs) with acute gastroenteritis. RESULTS: There were abdominal pain, nausea, and vomiting in respectively 72%, 53% and 43% of patients. Thirty one percent of patients had fever. Nausea and vomiting were more frequently observed in younger patients (15-25 yrs) than in older ones. More severe diarrhea more frequent nausea, vomiting and abdominal pain (p

Background : The use of pharmacokinetics is associated with cost savings in anti-tumor necrosis factor (anti-TNF) therapy, but the long-term cost savings in a large cohort of Crohn’s disease (CD) patients are unknown. Aim : The goal of this study was to compare the cost of anti-TNF therapy in two cohorts of CD patients losing response to infliximab, one using a test-based strategy and one an empirical dose escalation. Methods : We used a selected mathematical model to describe the trajectories of CD patients based on a discrete event system. This design allowed us to track over a given period a double cohort of patients who moved randomly and asynchronously from one state to another, while keeping all the information on their entire trajectory. Both cohorts were modeled using state diagram parameters where transition probabilities from one state to another are derived from literature data. Costs were estimated based on the French health care system. Results : Cost savings among the 10,000 CD patients using a test-based strategy were €131,300,293 at 5 years. At 5 years the mean cost saving was €13,130 per patient. The direct cost of the test had no impact on the results until the cost per test reached €2,000. Conclusions : A test-based strategy leads to major cost savings related to anti-TNF therapy in CD. Keywords: infliximab; pharmacokinetics; adalimumab; Crohn’s disease; cost saving (Published: 30 October 2015) Citation: Journal of Market Access & Health Policy 2015, 3 : 29229 - http://dx.doi.org/10.3402/jmahp.v3.29229

Resume Objectifs Le but de cette etude etait de rechercher si un laxatif de lest (psyllium) et un medicament favorisant l’exoneration (Eductyl ® ) avaient une action synergique dans le traitement de la constipation. Methodes Vingt sujets temoins et 20 malades souffrant de constipation chronique ont ete inclus dans une etude randomisee, controlee, en cross-over. L’etude s’est deroulee en 4 periodes successives de 2 semaines chacune : pre-inclusion, puis traitement par les 3 traitements suivants : psyllium, Eductyl ® et Eductyl ® -psyllium. Une mesure du temps de transit colique etait realisee en fin de chaque periode therapeutique. Durant chacune des 4 periodes du test, un auto-questionnaire etait rempli quotidiennement pour evaluer la variation des parametres utilises pour le diagnostic de constipation. Resultats Sous traitement par Eductyl ® ou Eductyl ® -psyllium, une amelioration clinique evaluee par l’augmentation de la frequence des selles, la diminution du pourcentage de selles dures, de la sensation d’evacuation incomplete et de la necessite de pousser fortement lors de l’exoneration etait observee chez les malades constipes. Cette amelioration etait associee a une diminution du temps de transit colique total et segmentaire. Le psyllium ne modifiait pas significativement ces parametres. L’effet des 2 produits n’etait pas synergique. Conclusions Le traitement par Eductyl ® est plus efficace que le traitement par psyllium seul. Il n’y a pas d’effet synergique des 2 produits.

Acute low back pain is a very common reason for general practitioner visits. Objective. – To evaluate practices among French general practitioners regarding the prescription of bed rest in patients with low back pain. Methods. – 2000 general practitioners were to include the first three patients presenting within the first 3 d of onset of acute low back pain without nerve root pain. The characteristics of the pain, social and demographic characteristics of the patients, and treatments prescribed by the physicians were recorded. Results. – 5355 patients were included, of whom more than half had a history of one or more episodes of low back pain. The mean pain severity score on a 100-mm visual analog scale was 57.2 ± 22.7 mm. Bed rest was recommended to 27.6% of the patients, for a mean duration of 4.4 d. Patients to whom bed rest was recommended were significantly more likely than the other patients to have chronic low back pain (32.1% vs. 26.5%) and received a greater number of medications. Bed rest was associated with significantly poorer outcomes in the multivariable analysis adjusting for confounding factors. Conclusion. – Recommendations to avoid bed rest in patients with acute low back pain are widely followed in France. Furthermore, our results confirm that bed rest is associated with poorer outcomes.

Resume La lombalgie aigue constitue un motif tres frequent de consultation en medecine generale. Objectif. – L'objectif de cette enquete francaise etait de recueillir les donnees concernant la prescription de repos au lit en pratique de ville. Cette enquete a ete realisee aupres de 2000 medecins generalistes devant inclure a la date de l'enquete les 3 premiers patients lombalgiques. Les patients devaient souffrir de lombalgie aigue sans irradiation, de moins de 3 j et consulter pour la premiere fois pour cet episode. Les caracteristiques de la lombalgie, les caracteristiques sociodemographiques des patients et les prescriptions du medecin etaient recueillies. Resultats. – Cinq mille trois cent cinquante-cinq patients ont ete inclus. Plus de la moitie des patients avait deja eu un ou plusieurs episodes lombalgiques. L’intensite de la douleur lombaire moyenne sur EVA etait de 57,2 ± 22,7 mm. La prescription d'un repos au lit a ete recommandee a 27,6 % des patients. La duree moyenne de cette prescription etait de 4,4 j. Le groupe des patients ayant eu une prescription de repos au lit comportait un pourcentage significativement plus eleve de patients lombalgiques chroniques compare au groupe sans repos au lit (32,1 vs 26,5 %). Les prescriptions medicamenteuses etaient plus importantes dans le groupe avec repos au lit. Conclusion. – L'evolution de la lombalgie etait significativement plus favorable dans le groupe sans repos au lit. Les resultats de cette enquete confirment que les recommandations d'eviter le repos au lit dans la lombalgie aigue sont appliquees en France a la majorite des patients lombalgiques, ainsi que l’effet deletere du repos au lit dans l’evolution de la lombalgie aigue.

International audience; BACKGROUND: Dyschezia is a defecatory disorder that places a heavy burden on a patient's quality of life. Biofeedback is the recommended treatment in most cases. OBJECTIVE: The objective of our study was to test whether a CO2-releasing suppository for patients with dyschezia could be effective in improving biofeedback training results. DESIGN: A randomized, double-blind, multicenter, placebo-controlled study was conducted in patients (18-75 years of age) with dyschezia defined according to the modified Rome III criteria. Patients were randomly assigned to either a CO2-releasing suppository or placebo suppository once per day for 21 days. SETTINGS: This was a multicenter trial. PATIENTS: A total of 122 patients were randomly assigned (62 intervention group and 60 placebo group). MAIN OUTCOME MEASURES: The primary end point was the change from day 0 to day 21 in intensity of symptoms on the basis of a self-assessed dyschezia using a visual analog scale (range, 0-100). Analyses were performed using intention-to-treat principles. RESULTS: A greater reduction from baseline to day 21 in symptom visual analog scale score was observed in the intervention group (-41.3 mm) than in the control group (-22.3 mm). Some secondary efficacy parameters improved more in the intervention group, including the percentage of patients who improved 50%, symptom intensity over 21 days, stool stains on underwear or pads, and need to practice manual maneuvers to facilitate defecation at day 21. At day 21, rectal sensitivity in the intervention group (31.4 mL) was lower than in the control group (39.1 mL). LIMITATIONS: There was a lower number of patients recruited than planned by the protocol. The sponsor stopped the trial before the inclusion of 306 participants, with no intermediate analysis. In addition, the main analysis conducted on the full analysis set population could have led to a statistical bias. CONCLUSIONS: The results of this multicenter trial demonstrate the added benefits of a CO2-releasing suppository in patients with dyschezia who were treated by anorectal biofeedback training.

Constipation has a significant impact on quality of life. Aim of this study was to evaluate the safety and the efficacy for relieving dyschezia symptoms of a CO2-releasing suppository in a randomized, placebo-controlled, clinical trial.Fifty-three office-based primary care physicians and 24 gastroenterologists conducted the study in France, between November 2010 and January 2012. Patients (aged 18-75 years) with dyschezia were eligible. Patients were randomly allocated a once-a-day suppository (CO2-releasing suppository or placebo) for 21 days. Primary endpoint was the change, from Day 0 to Day 21, in the intensity of discomfort related to dyschezia based on a self-assessed 0-100 visual analogue scale.A total of 323 patients were randomized, i.e. 166 into the intervention group and 157 into the placebo group. Co-variance analysis showed a greater reduction in discomfort visual analogue scale score in the intervention group (-34.5mm; standard error of the mean: 1.8mm) than in the placebo group (-26.2mm; standard error of the mean: 1.9 mm; p0.001). The greater efficacy of the CO2-releasing suppository was confirmed for all secondary efficacy parameters. No significant side effects for either treatment were observed.A CO2-releasing suppository is more effective than a placebo for the relief of symptoms of dyschezia. This efficacy is associated with a good safety profile.

Background: Motivation has long been emphasized as the most important determinant of action. However, there is a substantial gap between people's goals and their attainment. Patients may be motivated and yet unable to take action if their volitional competencies are insufficient. One of the important tasks of volition is goal-maintenance. Research has stressed the importance of a volitional tool, the implementation intentions. Implementation intentions indicate where, when, and how the action leading to the goal will be performed. Forming implementation intentions favours the execution of goal-directed efforts, and reinforces the relationship between intentions and behaviours. Results from various studies clearly suggest that volitional competencies and implementation intentions could play a role in low back pain (LBP) patients. However, there is at present no questionnaire allowing assessing the capacity of implementation intentions of physical activities in LBP patients. Methods/Design. This study will develop such a questionnaire, using a 3-step approach. A first qualitative step to build categories and generate items; 30 patients suffering chronic LBP will be invited to participate in semi-structured interviews; verbatim and derived items will then be submitted to a panel of experts, using a Delphi method; a second quantitative step to examine the properties of items, and determine the factorial structure of the questionnaire; 100 patients suffering chronic LBP will be recruited to respond to this phase; and third, preliminary psychometric analyses (item-scale correlations, construct validity, reliability); 180 chronic LBP patients will be recruited for this phase of the study. The relationships between implementation intentions and variables affecting physical activity on chronic LBP patients, i.e. pain, physical capacities, fear-avoidance beliefs, kinesiophobia, work status, and level of physical activity will be considered. Discussion. Developing a questionnaire to assess implementation intentions would allow investigating the role of these intentions in the transition from acute to chronic LBP. The results of this study should contribute to the understanding of the psychological processes at stake in the development of chronic LBP, and in particular to the identification of factors eventually favouring patients' participation in and adherence to active physical treatments. © 2011 Mathy et al; licensee BioMed Central Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective To develop a diagnostic score for knee osteoarthritis flare-ups and to evaluate its sensitivity and specificity. Methods We used two epidemiological databases built using the same methodology. One database was from a general-practice study and served to develop the score, whereas the other was from a rheumatology study and served to validate the score. Physicians determined the flare-up status of each patient. The rheumatologist diagnosis was the reference standard. Logistic regression was performed to identify factors significantly associated with having a flare-up. Results Of the 6085 patients in the general-practice database, 52.3% had a knee osteoarthritis flare-up. The score was built by assigning points to features that were present, with a weighting system based on the odds ratio of each feature for having a flare-up (0, feature absent; 1, morning stiffness for longer than 20 min; 2, pain causing nocturnal awakenings and knee effusion; 3, limping, joint swelling, and increased warmth over the knee). The score could range from 0 to 14. The receiver-operating characteristic curve showed that 7 was the best cutoff for diagnosing a flare-up. In the rheumatologist database, the numbers of patients having a flare-up were 274 (46.4%) based on the score and 270 (45.7%) based on the rheumatologist diagnosis. Sensitivity of the score was 87.0%, specificity 87.9%, positive predictive value 85.8%, and negative predictive value 89.0%. The Youden index was 0.75. Conclusion A score equal to or greater than 7 points correlated well with a rheumatologist diagnosis of flare-up. Our score may constitute a valid objective criterion for standardizing the diagnosis of knee osteoarthritis flare-up, most notably when screening patients for inclusion in therapeutic trials.

To describe the age standardised prevalence of symptomatic osteoarthritis (OA) in a nationwide cross sectional survey of 10 412 patients in France, and their functional and work limitations.Cases in the survey were compared with their expected counterpart by age, gender, and occupational groupings using data from the 1998 French National Survey on Health Impairment and Disability.Women represented 66.2% of the sample; mean age was 66.2 years. One third of patients had OA of the knee, 16% of the hip, and 12% of the hand; a third had multiple joint OA. Peak prevalence of symptomatic OA was in the 60-69 year category in women and in the 70-79 year category in men. Agricultural workers showed a significant excess prevalence of OA, with an observed to expected (O/E) ratio of 1.7 in women and 2.3 in men. Linear trends in prevalences between white collar, "mixed" collar, and blue collar workers were also significant, with odds ratios respectively of 1.0, 2.9, and 2.6 in women and 1.0, 1.2, and 1.7 in men. Specific excess prevalence was found in women among housekeepers (O/E 4.4), and in men among unskilled labour workers (O/E 10.3) and truck drivers (O/E 6.7). Total work disability was highest among blue collar workers and partial disability among agricultural workers.Results contribute to the mounting evidence that OA is potentially aetiologically linked to occupation in a sizeable segment of the population and that OA can no longer be considered an inevitable disease of ageing.

Introduction La prise en charge du syndrome de l’intestin irritable (SII) represente une part importante de l’activite du gastroenterologue. La place des traitements alternatifs y est mal connue. L’objectif de cette enquete nationale etait d’evaluer pour la premiere fois le recours a ces therapeutiques et le niveau de satisfaction des patients. Patients et Methodes Les patients inclus etaient adultes et consultaient un gastroenterologue pour un SII. Un questionnaire medical precisait la symptomatologie et les traitements medicamenteux ou alternatifs. Un auto-questionnaire patient anonyme portait sur les professionnels de sante consultes, l’information recue et le niveau de satisfaction vis-a-vis des traitements. Parmi les 790 gastroenterologues sollicites, 644 (81,5 %) ont participe a cette enquete menee de mars a septembre 2008. 2 933 paires de questionnaires medecin-patient etaient analysables. Resultats Les patients etaient en majorite des femmes (72 %), etaient âges de 52 ± 16 ans et souffraient d’un SII depuis 10 ± 11 ans. Il s’agissait d’un nouveau patient pour le gastroenterologue dans 37 % des cas. 82 % des patients estimaient avoir recu l’information souhaitee sur leur SII. Parmi les symptomes les plus frequemment observes on notait : douleur : 91 %, ballonnements : 62 %, constipation : 37 %, epigastralgies : 22 %). Sur une echelle visuelle analogique allant de 0 a 10 le niveau de satisfaction generale des patients sur leur prise en charge etait de 5,1 ± 2,5 et 28 % avaient un niveau de satisfaction ≤ 3. Vis-a-vis du traitement medicamenteux traditionnel, le niveau de satisfaction etait de 4,9 ± 2,4 et 31 % des patients avaient un niveau de satisfaction ≤ 3. 20 % des patients avaient eu recours au cours des 12 derniers mois a un ou plusieurs traitements alternatifs (13 % selon les medecins, p Conclusion Au cours du SII, plus de 80 % des patients considerent leur niveau d’information comme satisfaisant. Les gastroenterologues sous-estiment le recours de leurs patients a des traitements alternatifs. Ce recours est lie a l’anciennete du SII, l’alternance diarrhee-constipation, les ballonnements et l’anxiete-depression. Ces diverses therapeutiques alternatives ne donnent pas un niveau de satisfaction superieur aux traitements traditionnels.

Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument – the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed.

SummaryBackground Whether aminosalicylates or thiopurines reduce the risk of colorectal cancer (CRC) in inflammatory bowel (IBD) disease is controversial. Aim To assess simultaneously the chemopreventive effect of aminosalicylates or thiopurines in a case–control study nested in the CESAME observational cohort that enrolled consecutive patients with IBD between May 2004 and June 2005. Patients were followed up to December 2007. Methods Study population comprised 144 case patients who developed CRC from the diagnosis of IBD (65 and 79 cases diagnosed, respectively, before and from 2004, starting year of the prospective observational period of CESAME) and 286 controls matched for gender, age, IBD subtype and year of diagnosis, and cumulative extent of colitis. Exposure to aminosalicylates or thiopurines was defined by an exposure to the treatment during the year of the diagnosis of cancer. The propensity of receiving 5-ASA and thiopurines was quantified by a composite score taking into account patient and IBD characteristics. The role of aminosalicylates or thiopurines was assessed by multivariate analysis. Propensity scores and the history of primary sclerosing cholangitis were entered into the multivariate model for adjustment. Results By multivariate analysis adjusted for propensity, a significant protective effect of exposure to drugs during the year of cancer was found for aminosalicylates (OR = 0.587, 95% CI: 0.367–0.937, P = 0.0257), but not for thiopurines (OR = 0.762, 95% CI: 0.432–1.343, P = 0.3468). Conclusion In a case–control study nested in the CESAME cohort, a significant decrease in the risk of colorectal cancer in IBD was associated with exposure to aminosalicylates, not to thiopurines.