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Grimaldi-Bensouda L, Le Heuzey JY, Davy JM, Touze E, Leys D, Benichou J, Ferrieres J, Abenhaim L. P3619Comparative patterns of use of non-vitamin K antagonist oral anticoagulants and risk of haemorrhage in real life. The Stroke Prevention and Anticoagulants (SPA) study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J.-Y. Le Heuzey
- European Hospital Georges Pompidou, Cardiologie, Paris, France
| | - J.-M. Davy
- University Hospital of Montpellier, Département de Cardiologie et Maladies Vasculaires, Montpellier, France
| | - E. Touze
- Université de Caen Normandie, Unité neurovasculaire, Caen, France
| | - D. Leys
- Université de Lille; Inserm U 1171; CHU Lille, Lille, France, Lille, France
| | - J. Benichou
- University Hospital of Rouen, Unité de biostatistiques et méthodologie, Fédération de la recherche, Rouen, France
| | - J. Ferrieres
- Faculté de Médecine de l'Université de Toulouse, Cardiologie, Toulouse, France
| | - L. Abenhaim
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Grimaldi-Bensouda L, Le Heuzey JY, Ferrieres J, Leys D, Davy JM, Martinez M, Smadja D, Ellie E, Sablot D, Nighoghossian N, Benichou J, Touze E, Abenhaim L. P3595Non-valvular atrial fibrillation, anticoagulants and stroke: the stroke prevention and anticoagulants (SPA) case-control study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - J.-Y. Le Heuzey
- European Hospital Georges Pompidou, Cardiologie, Paris, France
| | - J. Ferrieres
- Faculté de Médecine du l'Université de Toulouse, Hôpital Rangueil, TSA 50032, Cardiologie, Toulouse, France
| | - D. Leys
- Université de Lille; Inserm U 1171; CHU Lille, Lille, France
| | - J.-M. Davy
- University Hospital of Montpellier, Département de Cardiologie et Maladies Vasculaires, Montpellier, France
| | - M. Martinez
- Centre Hospitalier de Dax, Service de Neurologie-Unité Neurovasculaire, Dax, France
| | - D. Smadja
- Hospital Sud-Francilien, Neurologie, Corbeil-Essonnes, France
| | - E. Ellie
- Centre Hospitalier de la Côte Basque, Service de neurologie, Bayonne, France
| | - D. Sablot
- Centre Hospitalier de Perpignan, Service de neurologie, Perpignan, France
| | - N. Nighoghossian
- Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Unité de Neurologie vasculaire, Bron, France
| | - J. Benichou
- University Hospital of Rouen, Unité de biostatistiques et méthodologie, Fédération de la recherche, Rouen, France
| | - E. Touze
- Université de Caen Normandie, Unité neurovasculaire, Caen, France
| | - L. Abenhaim
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nordon C, Karcher H, Pichler F, Abenhaim L. Efficacy, Effectiveness and the "Efficacy-To-Effectiveness Gap": Review of the Current State of Play and Perspectives. First Results From the Imi Getreal Consortium. Value Health 2014; 17:A586. [PMID: 27201991 DOI: 10.1016/j.jval.2014.08.1998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - F Pichler
- Eli Lilly and Company, Windlesham, Surrey, UK
| | - L Abenhaim
- London School of Hygiene and Tropical Medicine, London, UK
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Grimaldi-Bensouda L, Guillemot D, Godeau B, Bénichou J, Lebrun-Frenay C, Papeix C, Labauge P, Berquin P, Penfornis A, Benhamou PY, Nicolino M, Simon A, Viallard JF, Costedoat-Chalumeau N, Courcoux MF, Pondarré C, Hilliquin P, Chatelus E, Foltz V, Guillaume S, Rossignol M, Abenhaim L. Autoimmune disorders and quadrivalent human papillomavirus vaccination of young female subjects. J Intern Med 2014; 275:398-408. [PMID: 24206418 DOI: 10.1111/joim.12155] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to investigate whether the quadrivalent human papillomavirus (HPV) vaccine Gardasil is associated with a change in the risk of autoimmune disorders (ADs) in young female subjects. DESIGN Systematic case-control study of incident ADs associated with quadrivalent HPV vaccination in young women across France. PARTICIPANTS AND SETTING A total of 113 specialised centres recruited (from December 2007 to April 2011) females aged 14-26 years with incident cases of six types of ADs: idiopathic thrombocytopenic purpura (ITP), central demyelination/multiple sclerosis (MS), Guillain-Barré syndrome, connective tissue disorders (systemic lupus erythematosus, rheumatoid arthritis/juvenile arthritis), type 1 diabetes mellitus and autoimmune thyroiditis. Control subjects matched to cases were recruited from general practice. ANALYSIS Multivariate conditional logistic regression analysis; factors included age, geographical origin, smoking, alcohol consumption, use of oral contraceptive(s) or vaccine(s) other than Gardasil received within 24 months before the index date and personal/family history of ADs. RESULTS Overall, 211 definite cases of ADs were matched to 875 controls. The adjusted odds ratio (OR) for any quadrivalent HPV vaccine use was 0.9 [95% confidence interval (CI) 0.5-1.5]. The individual ORs were 1.0 (95% CI 0.4-2.6) for ITP, 0.3 (95% CI 0.1-0.9) for MS, 0.8 (95% CI 0.3-2.4) for connective disorders and 1.2 (95% CI 0.4-3.6) for type 1 diabetes. No exposure to HPV vaccine was observed in cases with either Guillain-Barré syndrome or thyroiditis. CONCLUSIONS No evidence of an increase in the risk of the studied ADs was observable following vaccination with Gardasil within the time periods studied. There was insufficient statistical power to allow conclusions to be drawn regarding individual ADs.
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Affiliation(s)
- L Grimaldi-Bensouda
- LA-SER, Paris, France; Conservatoire National des Arts et Métiers (CNAM), Paris, France
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Grimaldi-Bensouda L, Alpérovitch A, Aubrun E, Danchin N, Rossignol M, Abenhaim L, Richette P. Impact of allopurinol on risk of myocardial infarction. Ann Rheum Dis 2014; 74:836-42. [PMID: 24395556 DOI: 10.1136/annrheumdis-2012-202972] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/14/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Gout therapy includes xanthine oxidase inhibitors (XOI) and colchicine, which have both been associated with decreased cardiovascular risk. However, their effects on major cardiac events, such as myocardial infarction (MI), need to be investigated further. OBJECTIVES To investigate whether XOIs and colchicine are associated with decreased risk of MI. METHODS This case-control study compared patients with first-ever MI and matched controls. Cases were recruited from the Pharmacoepidemiological General Research on MI registry. Controls were selected from a referent population (n=8444) from general practice settings. RESULTS The study sample consisted of 2277 MI patients and 4849 matched controls. Use of allopurinol was reported by 3.1% of cases and 3.8 of controls, and 1.1% of cases and controls used colchicine. The adjusted OR (95% CI) for MI with allopurinol use was 0.80 (0.59 to 1.09). When using less stringent matching criteria that allowed for inclusion of 2593 cases and 5185 controls, the adjusted OR was 0.73 (0.54 to 0.99). Similar results were found on analysis by sex and hypertension status. Colchicine used was not associated with a decreased risk of MI (aOR=1.17 (0.70 to 1.93)). CONCLUSIONS Allopurinol may be associated with a reduced risk of MI. No decreased risk of MI was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect.
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Affiliation(s)
- L Grimaldi-Bensouda
- LA-SER, Paris, France Conservatoire National des Arts & Métiers, Paris, France INSERM/Pasteur Institute, Paris, France
| | - A Alpérovitch
- Inserm U708-Neuroepidemiology, Bordeaux, France Université Bordeaux-Segalen, Bordeaux, France
| | | | - N Danchin
- Coronary disease unit, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris and Paris-Descartes University, Paris, France
| | - M Rossignol
- LA-SER, Centre for Risk Research, Montreal, Canada Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - L Abenhaim
- Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, UK LA-SER Europe Ltd, London, UK
| | - P Richette
- Université Paris 7, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, Cedex 10, France Inserm U1132, Hôpital Lariboisière, Paris, Cedex 10, France
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Rossignol M, Bégaud B, Engel P, Avouac B, Lert F, Rouillon F, Bénichou J, Massol J, Duru G, Magnier AM, Guillemot D, Grimaldi-Bensouda L, Abenhaim L. PC0006 Impact of physician preferences for homeopathic or conventional medicines on patients with muskuloskeltal disorders: Results from the EPI3-MSD cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Grimaldi-Bensouda L, Viallard JF, Aubrun E, Leighton P, Fain O, Ruel M, Machet L, Le Guern V, Kone-Paut I, Abenhaim L, Costedoat-Chalumeau N. La vaccination est-elle associée au risque de survenue d’un lupus systémique ? Résultat d’une étude prospective multicentrique cas–témoins utilisant le registre PGRx-Lupus. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Grimaldi-Bensouda L, Michel M, Viallard JF, Adoue D, Magy-Bertrand N, Khellaf M, Morin AS, Leighton P, Aubrun E, Alperovitch A, Abenhaim L, Godeau B. La vaccination est-elle associée au risque de survenue d’un purpura thrombopénique immunologique chez l’adulte ? Résultat d’une étude prospective multicentrique cas-témoins utilisant le registre PTI-PGRx. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grimaldi-Bensouda L, Rossignol M, Danchin N, Steg PG, Bessede G, Ovize M, Cottin Y, Autret-Leca E, Benichou J, Abenhaim L. Risk of ST versus non-ST elevation myocardial infarction associated with non-steroidal anti-inflammatory drugs. Heart 2011; 97:1834-40. [DOI: 10.1136/hrt.2011.222448] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Grimaldi-Bensouda L, Rouillon F, Astruc B, Rossignol M, Benichou J, Falissard B, Thibaut F, Limosin F, Beaufils B, Vaiva G, Verdoux H, Moride Y, Abenhaim L, Rasul F. Reduced risk of hospitalisation with risperidone long-acting injectable. Results of the french cohort for the general study of schizophrenia (CGS). Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionMedication non-adherence is a significant risk factor for rehospitalisation in schizophrenia patients. Delayed release formulations like R-LAI may reduce rehospitalisation.ObjectivesTo examine the association between R-LAI use and hospitalisation in schizophrenia patients.AimsTo assess the effect of R-LAI, compared to non-use and use of other antipsychotic drugs, on the risk of hospitalization in real-life settings.MethodThe CGS study recruited schizophrenia patients from 177 public and private wards of psychiatric hospitals across France. Inclusion criteria were schizophrenia (DSM-IV), age 15–65 years, ambulatory/hospitalised for < 93 days at entry. Patients were followed up to 12 months for antipsychotic use and hospitalisation. The recruitment was stratified for long-acting second generation antipsychotic use. Multivariate Poisson regression adjusted for confounding with propensity scores and allowing for autocorrelation was used to estimate relative rates of hospitalisation.ResultsOf 2092 eligible patients, 1859 were included. Their mean age was 38.1 ± 11.1 years, 68.6% were male and 37.8% were hospitalised for < 93 days at entry. A total of 1659 patients (89.2%) were followed up for 12 months, accumulating 933 hospital stays (53.0 per 100 person-years). Compared to other schizophrenia patients, patients on R-LAI were younger, had more often a history of previous hospitalisation for equivalent severity, living conditions and other characteristics. The adjusted relative rate of hospitalisation for R-LAI use against non-use was 0.66 [95% CI 0.46–0.96], and 0.53 [95% CI 0.32–0.88] against long-acting first generation antipsychotics.ConclusionsUse of R-LAI was associated with lower rates of hospitalization compared to non-use of R-LAI.
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Grimaldi-Bensouda L, Khellaf M, Viallard JF, Adoue D, Hacini M, Magy-Bertrand N, Morin AS, Pan-Petesh B, Michel M, Abenhaim L, Godeau B. Epidémiologie du purpura thrombopénique immunologique de l’adulte en France. À propos d’une étude multicentrique prospective portant sur 171 malades. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Grimaldi-Bensouda L, Marty M, Pollak M, Cameron D, Riddle M, Charbonnel B, Barnett AH, Boffetta P, Boivin JF, Evans M, Rossignol M, Benichou J, Abenhaim L. The international study of insulin and cancer. Lancet 2010; 376:769-70. [PMID: 20816540 DOI: 10.1016/s0140-6736(10)61374-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Bensouda-Grimaldi L, Rossigno M, Abenhaim L. PGRx : Un programme francocanadien de surveillance et d’évaluation pharmacoépidémiologique des facteurs de risque de maladies rares. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bensouda-Grimaldi L, Rossignol M, Danchin N, David B, Autret-Leca E, Abenhaim L. Risque d’infarctus du myocarde (IDM) associé à une utilisation récente, chronique ou après arrêt d’AINS traditionnels. Étude cas–témoins. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kahn SR, M'Lan CE, Lamping DL, Kurz X, Bérard A, Abenhaim L. The influence of venous thromboembolism on quality of life and severity of chronic venous disease. J Thromb Haemost 2004; 2:2146-51. [PMID: 15613019 DOI: 10.1111/j.1538-7836.2004.00957.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is not known whether burden-of-illness differs in chronic venous disease patients with prior venous thromboembolism compared with patients with other forms of chronic venous disease. OBJECTIVE To compare severity of disease and quality of life in chronic venous disease patients with and without prior venous thromboembolism. PATIENTS AND METHODS The VEINES Study population is an international cohort of 1531 outpatients with chronic venous disease in Belgium, France, Italy and Canada. Clinical severity of chronic venous disease graded using the seven-category 'CEAP' scale, and quality of life using standardized generic (SF-36) and venous disease-specific (VEINES-QOL/Sym) questionnaires were compared in patients with and without venous thromboembolism. Multivariable analyses with adjustment for known confounders were used to examine associations between venous thromboembolism and quality of life. RESULTS One hundred and fifty-one (10%) patients had prior venous thromboembolism. These patients had more severe chronic venous disease than those without venous thromboembolism (P <0.0001), including a higher frequency of healed or active ulcers (29% vs. 7%, respectively). Multivariable analyses controlling for age, sex, country, education, body mass index, years of chronic venous disease and comorbid conditions demonstrated that prior venous thromboembolism was an independent predictor of poorer generic quality of life (SF-36 Mental Component Summary score, P=0.047; SF-36 Physical Component Summary score, P=0.012) and venous disease-specific quality of life (VEINES-QOL, P = 0.0002; VEINES-Sym, P=0.009). CONCLUSIONS Disease severity is worse and quality of life poorer in chronic venous disease patients with prior venous thromboembolism compared with patients with other forms of chronic venous disease. Our findings support the need for further research of interventions to prevent and treat the long-term complications of venous thromboembolism.
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Affiliation(s)
- S R Kahn
- Center for Clinical Epidemiology & Community Studies, Jewish General Hospital, Montreal, Canada.
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Abstract
Exogenous substances such as the appetite suppressant fenfluramine are known to be causally related to the development of pulmonary arterial hypertension (PAH). In these cases, the clinical course as well as the pulmonary vascular disease pathologically is indistinguishable from idiopathic PAH. Other exogenous substances, such as amphetamines, cocaine, and meta-amphetamines, have been considered to be potential risk factors for inducing PAH. SOPHIA (the study of pulmonary hypertension in America), in addition to confirming previous reports of a causal association between the appetite suppressant fenfluramine and PAH, unexpectedly found a significantly increased risk for the development of PAH with exposure to over-the-counter antiobesity agents containing phenylpropanolamine. The first case is reported of fatal PAH in a child heavily treated with cold remedies containing phenylpropanolamine, which, in addition to the results of SOPHIA, strengthens the hypothesis that phenylpropanolamine is a risk factor for the development of PAH.
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Affiliation(s)
- R J Barst
- Columbia University College of Physicians & Surgeons, New York, New York, USA.
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Abenhaim L, Moore N, Bégaud B. The role of pharmacoepidemiology in pharmacovigilance: a conference at the 6th ESOP Meeting, Budapest, 28 September 1998. Pharmacoepidemiol Drug Saf 2004; 8 Suppl 1:S1-7. [PMID: 15073881 DOI: 10.1002/(sici)1099-1557(199904)8:1+3.3.co;2-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- L Abenhaim
- Department of Pharmacology, Université Victor Segalen, Bordeaux, France
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Sift R, van Staa TP, Abenhaim L, Ebner D. A study of the longitudinal utilization and switching-patterns of non-steroidal anti-inflammatory drugs using a pharmacy based approach. Pharmacoepidemiol Drug Saf 2004; 6:263-8. [PMID: 15073777 DOI: 10.1002/(sici)1099-1557(199707)6:4<263::aid-pds286>3.0.co;2-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The extent of the heterogeneity of drug utilization among NSAID users has not been extensively studied. We studied the longitudinal prescribing and switching patterns of NSAID users in a 1-year follow-up study in four German pharmacies. The study population consisted of 526 persons with an average age of 57 years. We observed that the legend duration of prescription increased with age; 14.3 days for patients aged 44 or younger to 25.1 days for persons 75 years or older, and was dependent on disease chronicity; 16.0 days for acutely ill persons compared to 23.9 days for chronic patients. The average legend duration also varied between different types of NSAIDs, from 18.0 days for ibuprofen to 29.1 days for tiaprofen. Switching from one type of NSAID to another proved to be related to the legend duration of prescription and patient characteristics such as compliance with NSAID therapy, duration of the disease and the effectiveness (poor tolerability or insufficient effect) of the NSAID therapy reported by the patients 4 weeks after recruitment. We conclude that NSAID users cannot be viewed as an homogeneous group of patients with respect to exposure time to the drug. This heterogeneity should be considered in the exposure definition, the 'time-window' design of observational studies dealing with risk comparisons in particular.
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Affiliation(s)
- R Sift
- Medical Department, Ciba-Geigy, 4002 Basel, Switzerland
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Abenhaim L. [Progress against cancer!]. Rev Epidemiol Sante Publique 2003; 51:1-2. [PMID: 12684577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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Wolfson C, Perrault A, Moride Y, Esdaile JM, Abenhaim L, Momoli F. A case-control analysis of nonsteroidal anti-inflammatory drugs and Alzheimer's disease: are they protective? Neuroepidemiology 2002; 21:81-6. [PMID: 11901277 DOI: 10.1159/000048621] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In many studies of nonsteroidal anti-inflammatory drugs (NSAIDs) and Alzheimer's disease (AD), the exposure to NSAIDs was concurrent with AD or based on self (or surrogate) report. We conducted a case-control analysis of the Québec participants in the Canadian Study of Health and Aging who received a diagnosis of AD (cases) or were found to be cognitively unimpaired on screening (controls). Information on drug use was obtained from the Québec Provincial Pharmaceutical Services Database. There was no significant difference in the proportion of cases and controls who had received any NSAID prescriptions in the 3 years prior to the onset of symptoms of dementia; amongst NSAID users, there was no difference in mean dose or duration. Our findings, using a measure of drug use prior to symptom onset and not subject to recall bias, do not support a protective effect for NSAIDs.
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Affiliation(s)
- C Wolfson
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Que., Canada.
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Kurz X, Lamping DL, Kahn SR, Baccaglini U, Zuccarelli F, Spreafico G, Abenhaim L. Do varicose veins affect quality of life? Results of an international population-based study. J Vasc Surg 2001; 34:641-8. [PMID: 11668318 DOI: 10.1067/mva.2001.117333] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study assessed the impact of varicose veins (VV) on quality of life (QOL) and patient-reported symptoms. METHODS A cross-sectional population-based study was held in 166 general practices and 116 specialist clinics for venous disorders of the leg in Belgium, Canada (Quebec), France, and Italy. Study subjects included a sample of 259 reference patients without VV (CEAP class 0 or 1) and 1054 patients with VV who were classified as having VV alone (367; 34.8%), VV with edema (125; 11.9%), VV with skin changes (431; 40.9%), VV with healed ulcer (100; 9.5%), and VV with active ulcer (31; 2.9%). The main outcome measure was generic and disease-specific QOL, as measured by means of the Short-Form Health Survey-36 (SF-36) and the VEINES-QOL scale, and patient-reported symptoms as measured by the VEINES-SYM scale. RESULTS In patients with VV, age-standardized mean SF-36 physical (PCS) and mental (MCS) scores were 45.6 and 46.1 in men and 44.2 and 43.2 in women, respectively, compared with population norms of 50. PCS scores decreased according to increasing severity of concomitant venous disease, with the lowest mean scores of 37.3 and 35.5 found in patients with VV and active ulcer. However, adjusted analyses showed no statistically significant differences between patients with VV alone and patients without VV for PCS (0.0), MCS (1.0), VEINES-QOL (-0.1), or VEINES-SYM (0.0) scores. In comparison with patients without VV, the largest differences were seen in patients with VV and edema (PCS, VEINES-QOL, and VEINES-SYM score differences of -1.8, -2.5, and -2.9, respectively) and in patients with VV and ulceration (differences of -3.3, -3.4, and -2.7, respectively). The high prevalence of major symptoms of venous disorders in patients in CEAP class 0 or 1 being treated for venous disorders (76.1% of patients had heaviness, aching legs, or swelling) might have contributed to the impairment of QOL in the reference group. CONCLUSION Results indicate that impairment in physical QOL in patients with VV is associated with concomitant venous disease, rather than the presence of VV per se. Findings concerning QOL in patients with VV can only be reliably interpreted when concomitant venous disease is taken into account. In patients with VV alone, the objectives of cosmetic improvement and the improvement of QOL should be considered separately.
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Affiliation(s)
- X Kurz
- Department of Pharmacology, University of Liege, Belgium
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Abstract
A previous history and earlier onset of low back pain are associated with chronic low back pain in adults, implying that prevention in adolescence may have a positive impact in adulthood. The study objectives were to determine the incidence of low back pain in a cohort of adolescents and to ascertain risk factors. A cohort of 502 high school students in Montreal, Canada, was evaluated during 1995-1996 at three separate times, 6 months apart. The outcome was low back pain occurrence at a frequency of at least once a week in the previous 6 months. Of the 377 adolescents who did not complain of low back pain at the initial evaluation, 65 developed low back pain over the year (cumulative incidence, 17 percent). Risk factors associated with development of low back pain were high growth (odds ratio = 3.09; 95 percent confidence interval (CI): 1.53, 6.01), smoking (odds ratio = 2.20; 95% CI: 1.38, 3.50), tight quadriceps femoris (odds ratio = 1.02; 95% CI: 1.00, 1.05), tight hamstrings (odds ratio = 1.04; 95% CI: 1.01, 1.06), and working during the school year (odds ratio = 1.33; 95% CI: 1.03, 1.71). Modifying such risk factors as smoking and poor leg flexibility may potentially serve to prevent the development of low back pain in adolescents.
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Affiliation(s)
- D E Feldman
- Centre for Clinical Epidemiology and Community Studies, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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Abstract
AIMS The objective of this study was to estimate the number of fractures attributed to oral corticosteroid use. METHODS Information was obtained from the General Practice Research Database which contains medical records of general practitioners in the UK. The total number of corticosteroid-related fractures during a course of treatment was estimated using the formula for attributable risk among the exposed. RESULTS A total of 244 235 patients was prescribed an oral corticosteroid. The rate of hip fractures increased exponentially with age in both males and females. The excess number of hip fracture cases among females aged 85 years or older using 7.5 mg prednisolone per day or more was 1.4 cases per 100 patients per year. About 47% of all hip and 72% of all vertebral fractures that occurred can be attributed to oral corticosteroid use. Among 10 000 female users of higher doses, 99.7 nonvertebral, 31.6 hip and 45.8 vertebral fractures can be attributed to use of oral corticosteroids. CONCLUSIONS The targeting of high-risk patients will be important for implementing preventative strategies in a cost-effective manner.
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Affiliation(s)
- T P van Staa
- Department of Pharmacoepidemiology and Pharmacotherapy, University of Utrecht, Sorbonnelaan 16, Utrecht, The Netherlands
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Abstract
PURPOSE Estrogen has been found to increase the risk of deep vein thrombosis (DVT), which is associated with venous ulcers. A matched case-control study was therefore performed to quantify the effect of hormone replacement therapy (HRT) on the occurrence of venous ulcers of the lower limbs. METHODS Women presenting to a participating vascular surgery department between January and December 1997 with a first open venous ulcer served as cases. Controls were sampled among women with sub-acute conditions such as skin problems, cold, headache/migraine, sore throat and mild ear infections, and were matched on referral site and age (+/- 5 years). Subjects were eligible for this study if they were postmenopausal, and excluded if they had non-palpable pedal pulse or any chronic active diseases. The study consisted of an interviewer-administered risk factor questionnaire. Conditional multivariate logistic regression analyses were performed adjusting for history of DVT and unbalanced distributions in important covariates. RESULTS Forty-four cases and 80 matched controls were recruited. The mean age of participants was 64 years. HRT users were significantly thinner (27% with body mass index (BMI = (kg/height (m2)) > or = 27 vs. 41%, p = 0.04) and less likely to have a history of DVT (12 vs. 33%, p = 0.02) and varicose veins (VV) (52 vs. 69%, p = 0.04) than non-users. A matched univariate logistic regression analysis was performed to quantify the effect of HRT on venous ulcers and generated an odds ratio (OR) of 0.14 with 95% confidence interval of (0.04, 0.49)95%: adjusting for prior DVT resulted in an OR of 0.29 (0.09, 0.93)95%. When adjusting for BMI, history of VV, exercise, education, and smoking, the OR observed was 0.03 (0.01, 0.13)95%: further adjustment for prior DVT gave an OR estimate of 0.06 (0.01, 0.50)95%CI. CONCLUSIONS Our study demonstrates that HRT has a protective effect on the occurrence of venous ulcers of the lower limbs. Adjusting for prior DVT moves the estimate closer to the null. DVT is a strong contraindication for HRT and therefore must be considered in order to eliminate confounding by contraindication.
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Affiliation(s)
- A Bérard
- Montefiore Medical Center, Albert Einstein College of Medicine, Departments of Emergency Medicine and of Epidemiology, Bronx, NY, USA.
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Shrier I, Ehrmann-Feldman D, Rossignol M, Abenhaim L. Risk factors for development of lower limb pain in adolescents. J Rheumatol 2001; 28:604-9. [PMID: 11296967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Although many clinicians believe high growth leads to inflexibility, which may lead to lower extremity pain, the only prospective data suggest growth is unrelated to flexibility. However, it is still possible that growth and/or flexibility are related to pain even if they are not related to each other. We investigated the incidence of leg pain in adolescents to determine whether high growth spurt and/or poor flexibility are risk factors for the development of lower extremity pain. METHODS Repeated measures, prospective cohort study of urban high school students aged 12-18. Subjects were measured at baseline and at 6 and 12 months for flexibility of hamstrings and quadriceps and with the sit-and-reach test. Participants completed a detailed questionnaire on recreational activity, occupational activities, psychosocial variables, and musculoskeletal pain. RESULTS Poor hamstring flexibility (odds ratio 0.99, confidence interval 0.97-1.01), poor quadriceps flexibility (OR 1.01, CI 0.99-1.03), poor sit-and-reach flexibility (OR 0.99, CI 0.99-1.01), and growth (OR 0.93, CI 0.50-1.71) were not related to the development of lower extremity pain. There was an association between lower extremity pain and occupational activities (OR 2.08, CI 1.45-2.98) and poor mental health (per 1 SD change, OR 1.41, CI 1.19-1.67). CONCLUSION Neither growth nor flexibility is related to the development of lower extremity pain in adolescents. A poor mental health score and occupational activities may be associated with the development of lower extremity pain.
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Affiliation(s)
- I Shrier
- Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada.
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Loisel P, Gosselin L, Durand P, Lemaire J, Poitras S, Abenhaim L. Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain. Appl Ergon 2001; 32:53-60. [PMID: 11209832 DOI: 10.1016/s0003-6870(00)00038-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper describes a participatory ergonomics program aimed at early return to regular work of workers suffering from subacute occupational back pain and assesses the perceptions of the participants on the implementation of ergonomic solutions in the workplace. The participatory ergonomics program was used in the rehabilitation of workers suffering from subacute back pain for more than 6 weeks, a program that was associated with an increased rate of return to work. The perceptions of the participatory ergonomics participants were assessed 6 months after completion of the ergonomic intervention through a questionnaire sent to employer representatives, union representatives and injured workers of participating workplaces. About half of the ergonomic solutions were implemented according to the perception of the participants, with a substantial agreement between respondents.
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Affiliation(s)
- P Loisel
- Department of Surgery, Université de Sherbrooke, Québec, Canada.
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Abstract
OBJECTIVE This study examined the effects of daily and cumulative oral corticosteroid doses on the risk of fractures. METHODS Information was obtained from the General Practice Research Database, which contains medical records of general practitioners in England and Wales. The study included 244 235 oral corticosteroid users and 244 235 controls. RESULTS Patients taking higher doses (at least 7. 5 mg daily of prednisolone or equivalent) had significantly increased risks of non-vertebral fracture [relative rate (RR)=1.44, 95% confidence interval (CI) 1.34-1.54], hip fracture (RR=2.21, 95% CI 1.85-2.64) and vertebral fracture (RR=2.83, 95% CI 2.35-2.40) relative to patients using oral corticosteroids at lower doses (less than 2.5 mg per day). Fracture risk was also elevated among people with higher cumulative exposure to oral corticosteroids over the study period, but this effect was almost wholly removed by adjustment for daily dose, age, gender and other confounding variables. CONCLUSIONS These findings suggest that the adverse skeletal effects of oral corticosteroids manifest rapidly and are related to daily dose. The level of previous exposure to oral corticosteroids was not a strong determinant of the risk of fracture. Preventive measures against corticosteroid-induced osteoporosis should therefore be instituted as soon after the commencement of glucocorticoid therapy as possible.
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Affiliation(s)
- T P van Staa
- Department of Pharmacoepidemiology and Pharmacotherapy, University of Utrecht, Sorbonnelaan 16, Utrecht, The Netherlands
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Abenhaim L, Penaud P, D'Autume C, Slonimsky A, Dab W. [The mission of the Director General of the Ministry of Health]. Sante Publique 2000; 12:393-403. [PMID: 11142198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
In France, the health and solidarity department of Employment and solidarity Ministry have just been re-organised. The Directory General of the department of Health is experiencing a complete revision of its functions and organisation. This article presents the public health context which has been taken into account for this new organisation and explains its main principles and strategic orientations. The new organisation chart is clarified. It is made up by two departments and seven under-directions. Up to now, control and administrative supervision were predominant among Health General Direction functions. They are now oriented to administrate missions prioritizing the function of health doctrines' elaboration, of programmation, animation and coordination. As the guarantor of sanitary security, the Health General Direction has also to impulse a new partnership which does not only include health professional, social and health organisation and the economic actors: citizen in general and service users in particular have to be included to promote health democracy.
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Marrie RA, Wolfson C, Sturkenboom MC, Gout O, Heinzlef O, Roullet E, Abenhaim L. Multiple sclerosis and antecedent infections: a case-control study. Neurology 2000; 54:2307-10. [PMID: 10881258 DOI: 10.1212/wnl.54.12.2307] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine whether there is an excess of respiratory tract infections in the 5-week, 3-month, and 12-month periods before MS symptom onset and if there is an association between MS and a history of infectious mononucleosis (IM). BACKGROUND The etiology of MS remains unknown, but infection is frequently suggested as a putative etiologic agent. Epidemiologic studies have produced inconsistent evidence for an etiologic role of respiratory tract infections (RTI) and IM in MS. METHODS The authors performed a case-control study using the General Practice Research Database from the United Kingdom. There were 225 subjects with definite or probable MS, and 900 controls matched for age, sex, and physician practice. Using computerized patient records, the authors compared the mean rates of RTI per patient in the 5-week, 3-month, and 12-month periods before the date of onset of the first symptoms compatible with MS (index date). They also compared histories of IM. RESULTS In all periods, an increased frequency of RTI was associated with a significantly increased risk of MS. A history of IM was associated with greater than five times the risk of MS (OR = 5.5 [95% CI 1.5 to 19.7]). CONCLUSIONS These results support an association between a history of IM and subsequent MS. Respiratory tract infections may precipitate disease onset.
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Affiliation(s)
- R A Marrie
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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32
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Abstract
Treatment with oral corticosteroids is known to decrease bone density but there are few data on the attendant risk of fracture and on the reversibility of this risk after cessation of therapy. A retrospective cohort study was conducted in a general medical practice setting in the United Kingdom (using data from the General Practice Research Database [GPRD]). For each oral corticosteroid user aged 18 years or older, a control patient was selected randomly, who was matched by age, sex, and medical practice. The study comprised 244,235 oral corticosteroid users and 244,235 controls. The average age was 57.1 years in the oral corticosteroid cohort and 56.9 years in the control cohort. In both cohorts 58.6% were female. The most frequent indication for treatment was respiratory disease (40%). The relative rate of nonvertebral fracture during oral corticosteroid treatment was 1.33 (95% confidence interval [CI], 1.29-1.38), that of hip fracture 1.61 (1.47-1.76), that of forearm fracture 1.09 (1.01-1.17), and that of vertebral fracture 2.60 (2.31-2.92). A dose dependence of fracture risk was observed. With a standardized daily dose of less than 2.5 mg prednisolone, hip fracture risk was 0.99 (0.82-1.20) relative to control, rising to 1.77 (1.55-2.02) at daily doses of 2.5-7.5 mg, and 2.27 (1.94-2.66) at doses of 7.5 mg or greater. For vertebral fracture, the relative rates were 1.55 (1.20-2.01), 2.59 (2.16-3.10), and 5.18 (4.25-6.31), respectively. All fracture risks declined toward baseline rapidly after cessation of oral corticosteroid treatment. These results quantify the increased fracture risk during oral corticosteroid therapy, with greater effects on the hip and spine than forearm. They also suggest a rapid offset of this increased fracture risk on cessation of therapy, which has implications for the use of preventative agents against bone loss in patients at highest risk.
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Abstract
In this review, we critically assess the literature on the incidence of postphlebitic syndrome, risk factors for its occurrence, available therapeutic options, and its effects on quality of life. As well, we describe available tools to measure postphlebitic syndrome. Recent prospective studies indicate that postphlebitic syndrome, a chronic, potentially disabling condition characterized by leg swelling, pain, venous ectasia, and skin induration, is established by 1 year after deep vein thrombosis (DVT) in 17% to 50% of patients. The only prospectively identified risk factor for its occurrence is recurrent ipsilateral DVT. In the sole randomized study available, daily use of elastic compression stockings after proximal DVT reduced the incidence of postphlebitic syndrome by 50%. Treatment options for established postphlebitic syndrome are limited, but include compression stockings and intermittent compressive therapy with an extremity pump for severe cases. To date, quality of life after DVT has received little attention in the literature. The recent development of the VEINES-QOL questionnaire, a validated venous-disease-specific measure of quality of life, should encourage researchers to include quality of life as a routine outcome measure after DVT. There is no criterion standard for the diagnosis of postphlebitic syndrome, but a validated clinical scoring system does exist. More research on postphlebitic syndrome is needed to enable us to provide DVT patients with comprehensive, evidence-based information regarding their long-term prognosis, to help quantify the prevalence and health care burden of postphlebitic syndrome, and by identifying predictors of poor outcome, to develop new preventive strategies in patients at risk of developing this condition.
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Affiliation(s)
- S R Kahn
- Center for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada.
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Rich S, Rubin L, Walker AM, Schneeweiss S, Abenhaim L. Anorexigens and pulmonary hypertension in the United States: results from the surveillance of North American pulmonary hypertension. Chest 2000; 117:870-4. [PMID: 10713017 DOI: 10.1378/chest.117.3.870] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The use of appetite suppressants in Europe has been associated with the development of primary pulmonary hypertension (PPH). Recently, fenfluramine appetite suppressants became widely used in the United States but were withdrawn in September 1997 because of concerns over adverse effects. MATERIALS AND METHODS We conducted a prospective surveillance study on patients diagnosed with pulmonary hypertension at 12 large referral centers in North America. Data collected on patients seen from September 1, 1996, to December 31, 1997, included the cause of the pulmonary hypertension and its severity. Patients with no identifiable cause of pulmonary hypertension were classed as PPH. A history of drug exposure also was taken with special attention on the use of antidepressants, anorexigens, and amphetamines. RESULTS Five hundred seventy-nine patients were studied, 205 with PPH and 374 with pulmonary hypertension from other causes (secondary pulmonary hypertension [SPH]). The use of anorexigens was common in both groups. However, of the medications surveyed, only the fenfluramines had a significant preferential association with PPH as compared with SPH (adjusted odds ratio for use > 6 months, 7.5; 95% confidence interval, 1.7 to 32.4). The association was stronger with longer duration of use when compared to shorter duration of use and was more pronounced in recent users than in remote users. An unexpectedly high (11.4%) number of patients with SPH had used anorexigens. CONCLUSION The magnitude of the association with PPH, the increase of association with increasing duration of use, and the specificity for fenfluramines are consistent with previous studies indicating that fenfluramines are causally related to PPH. The high prevalence of anorexigen use in patients with SPH also raises the possibility that these drugs precipitate pulmonary hypertension in patients with underlying conditions associated with SPH.
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Affiliation(s)
- S Rich
- Section of Cardiology, Rush Medical College, Chicago, IL 60612-3824,
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Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, Charlot J, Dreiser RL, Legrand E, Rozenberg S, Vautravers P. The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine (Phila Pa 1976) 2000; 25:1S-33S. [PMID: 10707404 DOI: 10.1097/00007632-200002151-00001] [Citation(s) in RCA: 280] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- L Abenhaim
- Montreal Department of Public Health, Quebec, Canada
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Abstract
Administration of oral corticosteroids is associated with the development of osteoporosis and an increased risk of fractures. However, the size of the treated sub-population who would benefit from preventive therapy remains uncertain. The objective of this study was to investigate the usage pattern of oral corticosteroids in a large sample representative of the general population in England and Wales. Information was obtained from the General Practice Research Database (GPRD) which contains medical records of general practitioners. Oral corticosteroid users were patients aged 18 years or older who received one or more prescriptions for oral corticosteroids. Over 1.6 million oral corticosteroid prescriptions were issued to the cohort of 244 235 oral corticosteroid users. At any point in time, oral corticosteroids were being used by 0.9% of the total adult GPRD population. The highest use (2.5%) was by people between 70 and 79 years of age. Respiratory disease was the most frequently recorded indication for oral corticosteroid treatment (40%). Patients with arthropathies were most likely to use long-term, continuous treatment, and patients with chronic obstructive pulmonary disease least likely (19.3% and 6.1%, respectively, used oral corticosteroids for more than 2 years). The overall use of bone-active medication (oestrogens, bisphosphonates, vitamin D, and calcitonin) during oral corticosteroid treatment was low (between 4.0% and 5.5%). The current population in the UK at risk of developing corticosteroid-induced fractures might be as large as 350 000. Identification of these patients will be important for implementing preventive strategies in a cost-effective manner.
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Couty E, Abenhaim L. [Letter DGS/DH dated November 18, 1999 on the treatment of paranesthetic malignant hyperthermia (MH)]. Ann Fr Anesth Reanim 2000; 19:Fi45-6. [PMID: 10730184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Rossignol M, Abenhaim L, Séguin P, Neveu A, Collet JP, Ducruet T, Shapiro S. Coordination of primary health care for back pain. A randomized controlled trial. Spine (Phila Pa 1976) 2000; 25:251-8; discussion 258-9. [PMID: 10685491 DOI: 10.1097/00007632-200001150-00018] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized controlled trial comparing usual care with a program for the coordination of primary health care (CORE) for the treatment of subacute low-back pain patients. OBJECTIVES To measure the effectiveness of the CORE program as a mean for implementing clinical practice guidelines for low-back pain in an urban community. SUMMARY OF BACKGROUND DATA Clinical practice guidelines have been developed for primary care physicians and patients on the clinical management of low-back pain. The implementation of the guidelines in a large community is difficult with the multiplicity of medical and nonmedical back care providers and products. The CORE program was designed to make the guidelines fit in this complex environment. METHODS One hundred ten workers compensated for low-back pain for 4 to 8 weeks in metropolitan Montreal were randomized in two groups: usual care (N = 56) and the CORE program (N = 54). Coordination of primary health care was performed by two primary care physicians and a nurse in liaison with the treating physicians, and included a complete examination, recommendations for the clinical management, and support to carry out the recommendations. All workers were followed for 6 months. Back pain and functional status were assessed at baseline, 3 months, and 6 months. RESULTS In the 6-month follow-up, the CORE group returned to work 6.6 days (standard error = 8.9) quicker than the control group, a difference that was not statistically significant. However, the CORE group showed a sustained improvement in pain and functional status with two-fold differences at the end of the 6 months of follow-up. This represented nine points on the Oswestry scale (P = 0.02) and 12 points on the Quebec Back Pain Disability Scale (P = 0.01). The CORE group also used three times less specialized imaging tests of the spine at 3 months (P < 0.01) and exercised twice as much at 6 months (P < 0.05) than the controls. CONCLUSIONS The therapeutic results for workers with low-back pain could be improved by implementing the clinical practice guidelines with primary care physicians in a large community, without delaying the return to work. The CORE intervention for back pain patients is highly relevant to primary care practice. It is simple in its application, flexible to accommodate physicians' and- patients' preferences in health care, and it is effective on patients' clinical outcome.
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Affiliation(s)
- M Rossignol
- Montreal Department of Public Health, Quebec, Canada.
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39
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Van Staa TP, Abenhaim L, Cooper C, Zhang B, Leufkens HGM. The use of a large pharmacoepidemiological database to study exposure to oral corticosteroids and risk of fractures: validation of study population and results. Pharmacoepidemiol Drug Saf 2000; 9:359-66. [DOI: 10.1002/1099-1557(200009/10)9:5<359::aid-pds507>3.0.co;2-e] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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40
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Abstract
STUDY DESIGN A prospective, repeated-measures cohort design with high school students from Montreal, Canada. OBJECTIVES To determine whether smoking was a risk factor for the development of low back pain or other musculoskeletal pain in a cohort of adolescents. SUMMARY OF BACKGROUND DATA Smoking has been associated with low back pain in adults. Many adolescents smoke, and the prevalence of low back pain in this age group is 30%. A history of low back pain is predictive of future problems. METHODS A total of 502 students from grades 7 to 9 were assessed from 3 schools. Data were collected at 3 times: at the beginning of the study, at 6 months, and at the end of a 12-month period. Students responded to a questionnaire addressing musculoskeletal health and life-style factors, which included smoking. Measurements of height, weight, trunk and leg flexibility, and trunk strength were obtained. Low back pain occurring at a frequency of at least once a week in the past 6 months was defined as the outcome. Multivariate methods were used to model the repeated-measures dichotomous outcome as a function of smoking and other covariates. RESULTS Smokers experienced low back pain more than nonsmokers (odds ratio, 2.4; 95% confidence interval, 1.3-6.0). There was also a dose-response relationship between amount smoked and development of low back pain. Smokers tended to experience more upper limb or lower limb pain than nonsmokers, although this result was not significant. CONCLUSIONS Smoking was found to increase the risk for low back pain in this cohort of adolescents.
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Affiliation(s)
- L Abenhaim
- McGill University, Montreal, Quebec, Canada
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Collet JP, Sharpe C, Belzile E, Boivin JF, Hanley J, Abenhaim L. Colorectal cancer prevention by non-steroidal anti-inflammatory drugs: effects of dosage and timing. Br J Cancer 1999; 81:62-8. [PMID: 10487613 PMCID: PMC2374346 DOI: 10.1038/sj.bjc.6690651] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Epidemiological studies show that non-steroidal anti-inflammatory drugs (NSAIDs) reduce colorectal cancer incidence. We measured the rate ratio for colorectal adenocarcinoma according to dosage and the timing of exposure by means of a case-control study, nested in a non-concurrent cohort linkage study, using the population of beneficiaries of the Saskatchewan Prescription Drug Plan from 1981 to 1995 with no history of cancer since 1970 as the source population. Four controls per case, matched on age and gender and alive when the case was diagnosed, were randomly selected. Dispensing rates, calculated over successive time periods, characterized NSAID exposure. We accrued 3844 cases of colon cancer and 1971 cases of rectal cancer. For colon cancer a significant trend towards a decreasing rate ratio was associated with increasing exposure during the 6 months preceding diagnosis (P-trend = 0.002). For both cancers, significant trends were associated with exposure 11-15 years before diagnosis (colon: P-trend = 0.01; rectum: P-trend = 0.0001). At the highest exposure levels the rate ratio for colon cancer was 0.57 (95% confidence interval (CI) 0.36-0.89); for rectal cancer it was 0.26 (95% CI 0.11-0.61). No protection was associated with exposure during other periods. The timing of NSAID use must be considered in planning intervention trials to prevent colorectal cancer. There may be a 10-year delay before any preventive effect will appear.
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Affiliation(s)
- J P Collet
- Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Canada
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Kurz X, Kahn SR, Abenhaim L, Clement D, Norgren L, Baccaglini U, Berard A, Cooke JP, Cornu-Thenard A, Depairon M, Dormandy JA, Durand-Zaleski I, Fowkes GR, Lamping DL, Partsch H, Scurr JH, Zuccarelli F. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. INT ANGIOL 1999; 18:83-102. [PMID: 10424364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND To critically review the classification, epidemiology, outcomes, diagnosis and treatment of chronic venous disorders of the leg (CVDL), to issue evidence-based recommendations, and to identify areas requiring further research. METHODS Articles identified by an extensive literature search were scored by members of an international task force. Only those articles with a moderate or strong rating for internal validity were retained. RESULTS A scoring system weighing CVDL severity according to the probability of ulcer occurrence is proposed. Epidemiological data on the frequency of CVDL and its risk factors are reviewed. The following items are evaluated: costs associated with treatment; clinical outcomes related to CVDL and its treatment; available generic and disease-specific measures of quality of life; diagnostic procedures used to detect venous reflux; and efficacy of available treatments. CONCLUSIONS CVDL is an important public health problem, based on its prevalence, cost and impact on quality of life. High-priority areas for research on CVDL are identified.
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Affiliation(s)
- X Kurz
- Department of Pharmacology, University of Liege, Belgium
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44
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Kahn SR, Joseph L, Abenhaim L, Leclerc JR. Clinical prediction of deep vein thrombosis in patients with leg symptoms. Thromb Haemost 1999; 81:353-7. [PMID: 10102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Symptoms and clinical signs individually are inaccurate for the diagnosis of DVT. However, when assessing patients with leg symptoms, clinicians have access to additional information, such as whether or not DVT risk factors are present that could improve the accuracy of clinical judgment. The purpose of this study was to identify which clinical variables best predict DVT, and to use these variables to create a clinical prediction index for DVT. We studied 271 university hospital patients with a first episode of symptomatic, clinically suspected DVT. The prevalence of DVT was 27%, of which 71% were proximal. At baseline, information was collected on demographic features, comorbidity, and symptoms and signs. A Bayesian model selection strategy was used to estimate the logistic regression model that best predicted DVT. Male sex [OR = 2.8 (1.5, 5.1)], orthopedic surgery [OR = 5.4 (2.2, 13.6)], warmth [OR = 2.1 (1.2, 3.9)] and superficial venous dilation on exam [OR = 2.9 (1.4, 5.7)] were independent predictors of DVT. Using the model, a clinical prediction index that categorized patients into different levels of DVT risk was created, and was useful in a theoretical strategy aimed to limit the need for contrast venography in patients with suspected DVT, such that 96% of study patients could have avoided contrast venography. This index should be evaluated prospectively in other patient populations.
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Affiliation(s)
- S R Kahn
- Center for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada
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Abstract
OBJECTIVE To determine whether adolescent growth is associated with a decrease in flexibility. DESIGN Longitudinal cohort study of urban high school students. MAIN OUTCOME MEASURES Flexibility of hamstring muscles (popliteal angle), quadriceps muscles (quadriceps angle), lumbar extensor muscles (Schober test), and combined lower extremity-trunk muscles (Sit and Reach test). RESULTS There was no relation between growth and changes in flexibility for the lumbar flexor muscles, hamstring muscles, or muscles involved in the Sit and Reach test. Although there was a slight decrease in flexibility of the quadriceps muscle with increases in growth, the very low r2adj value (0.01-0.06) strongly suggests that growth plays only a small role in determining the flexibility of individuals. CONCLUSION These results strongly suggest that growth is not a cause of decreased flexibility during the peripubescent period.
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Affiliation(s)
- D Feldman
- Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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46
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van Staa TP, Leufkens H, Abenhaim L, Cooper C. Postmarketing surveillance of the safety of cyclic etidronate. Pharmacotherapy 1998; 18:1121-8. [PMID: 9758324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
To evaluate the safety of cyclic etidronate in routine clinical practice, we obtained information from 550 general practices in the United Kingdom that provide the medical records to the General Practice Research Database. A group of 7977 patients taking cyclic etidronate and two age-, gender-, and practice-matched control groups, one with osteoporosis and one without, were analyzed. For the group taking cyclic etidronate, the average age was 71.6 years and follow-up was 10,328 person-years. Conditions that do not induce osteoporosis generally occurred in these patients at a rate comparable to that in the control groups. The incidence of osteomalacia was low and comparable between patients taking cyclic etidronate and controls with osteoporosis. No medically significant increases in frequency were observed among patients taking cyclic etidronate for a broad group of diseases that may potentially be induced by exposure to the drug. These data support the favorable risk:benefit ratio of cyclic etidronate.
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Affiliation(s)
- T P van Staa
- Procter & Gamble Pharmaceuticals, Staines, United Kingdom
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47
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Loisel P, Poitras S, Lemaire J, Durand P, Southière A, Abenhaim L. Is work status of low back pain patients best described by an automated device or by a questionnaire? Spine (Phila Pa 1976) 1998; 23:1588-94; discussion 1595. [PMID: 9682315 DOI: 10.1097/00007632-199807150-00015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study of patients with subacute occupational back pain. OBJECTIVES To study the relation between a marketed opto-electric device measuring trunk kinematics, a widely used specific functional capacity questionnaire, and work status in back pain patients, and to assess the responsiveness to change in work status of the opto-electric device and the questionnaire. SUMMARY OF BACKGROUND DATA Several instruments have been developed to evaluate the functional capacities of patients with back pain, but the relation between these instruments and work status has rarely been studied. METHODS The relation between the opto-electric device, the questionnaire, and work status in patients with back pain was evaluated. The study population was a prospective cohort of patients with subacute back pain who were absent from regular work for more than 4 weeks. All data were compiled blindly on the same day, at study entry (4 weeks after work accident), and at 12, 24, and 52 weeks after the work accident. The validity of the questionnaire and opto-electric device scores was assessed with partial correlation analyses, standardized response mean, logistic regression analyses, and receiver operating characteristics curves. RESULTS The correlation between the questionnaire and opto-electric device scores was low. The questionnaire scores were significantly related to work status, but the opto-electric device scores were not. The questionnaire was responsive to change in work status, whereas the opto-electric device was not. CONCLUSIONS The opto-electric device scores were not related to either functional capacity scores (questionnaire) or work status in patients with low back pain, and the opto-electric device was not responsive to change in work status. Conversely, the questionnaire was related to work status and was responsive to change in work status.
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Bérard A, Kurz X, Zuccarelli F, Ducros JJ, Abenhaim L. Reliability study of the Leg-O-Meter, an improved tape measure device, in patients with chronic venous insufficiency of the leg. VEINES Group.(Venous Insufficiency Epidemiologic and Economic Study). Angiology 1998; 49:169-73. [PMID: 9523538 DOI: 10.1177/000331979804900301] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to evaluate the inter-rater reliability of the Leg-O-Meter, an instrument designed to measure the ankle or calf circumference. The Leg-O-Meter consists of a tape measure fixed to a stand attached to a small board on which the patient is in standing position. For this study the tape measure of the Leg-O-Meter was fixed at 10 cm from the board in order to standardize all measurements. Informed consent to participate in the study was obtained from 39 patients consulting the phlebology clinic of Hôpital St-Michel, Paris, France. Participants were asked to enter a closed room where four independent and blinded observers consecutively took measurements of both legs with the Leg-O-Meter. The order of the observers was randomized between patients. Under the assumption of a two-way random effects model an intraclass correlation coefficient (ICC) was used to determine the reliability or reproducibility of a measure with the Leg-O-Meter. The overall reliability coefficient calculated by the ICC for the right and left leg were estimated at 97.09% [95.52%;100%]95% and 97.08% [95.86%;100%]95%, respectively. The authors conclude that the Leg-O-Meter gives a standardized and reliable measure of the circumference of the ankle. Furthermore, it is not invasive or costly.
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Affiliation(s)
- A Bérard
- Centre for Clinical Epidemiology and Community Studies, SMBD-Jewish General Hospital, McGill University, Montreal, QC, Canada
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Abstract
This study examined the effects of cyclical etidronate, when used in routine clinical practice, on the prevention of fracture. Information was obtained from 550 general practices in the UK that provide their medical records to the General Practice Research Database. A total of 7977 patients taking cyclical etidronate treatment and 7977 age-, sex- and practice-matched control patients with a diagnosis of osteoporosis were analysed. People taking cyclical etidronate had a significantly reduced risk of non-vertebral fracture (by 20%) and of hip fracture (by 34%) relative to the osteoporosis control patients. The relative risk of non-vertebral fracture was 0.80 (95% confidence interval 0.70-0.92), that of hip fracture 0.66 (0.51-0.85) and that of wrist fracture 0.81 (0.58-1.14). When fracture incidence rates were compared between the two groups, the rate of non-vertebral, hip and wrist fracture decreased significantly (P < 0.05) with increasing etidronate exposure. The results of this study complement and extend clinical observations supporting the anti-fracture efficacy of cyclical etidronate therapy.
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Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L, Simard R, Turcotte J, Lemaire J. A population-based, randomized clinical trial on back pain management. Spine (Phila Pa 1976) 1997; 22:2911-8. [PMID: 9431627 DOI: 10.1097/00007632-199712150-00014] [Citation(s) in RCA: 268] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Population-based randomized clinical trial. OBJECTIVES To develop and test a model of management of subacute back pain, to prevent prolonged disability. SUMMARY OF BACKGROUND DATA The present management of back pain seems inadequate, and development of innovative models has been urged. METHODS A model for the treatment of subacute work-related back pain has been developed and evaluated in a population-based randomized clinical trial. Workers (n = 130) from eligible workplaces in the Sherbrooke area (N = 31), who had been absent from work for more than 4 weeks for back pain, were randomized, based on their workplace, in one of four treatment groups: usual care, clinical intervention, occupational intervention, and full intervention (a combination of the last two). The duration of absence from regular work and from any work was evaluated using survival analysis. Functional status and pain were compared at study entry and after 1 year of follow-up. RESULTS The full intervention group returned to regular work 2.41 times faster than the usual care intervention group (95% confidence interval 1.19-4.89; P < 0.01). The specific effect of the occupational intervention accounted for the most important part of this result, with a rate ratio of return to regular work of 1.91 (95% confidence interval = 1.18-3.10; P < 0.01). Pain and disability scales demonstrated either a statistically significant reduction or a trend toward reduction in the three intervention groups, compared with the trend in the usual care intervention group. CONCLUSIONS Close association of occupational intervention with clinical care is of primary importance in impeding progression toward chronicity of low back pain.
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Affiliation(s)
- P Loisel
- Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park Université de Sherbrooke, Québec, Canada
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