This paper notes that a careful case definition of workers with previous history of low-back pain (LBP) is needed to better characterize sub-groups based on their recurrences profile. Workers with highly recurrent LBP may require a stepped secondary prevention in order to prevent recurrences and sick leave. The value of a workplace component reducing physical and psychosocial risks in secondary prevention of LBP must be explored.

Health outcomes showed that influenza disease burden in young French children is similar to that observed in North America. An active vaccination strategy would have strongly reduced the burden of influenza and lowered antibiotic use. Continuous efforts are needed to reach requirements of our influenza vaccination policy.

This randomized tandem trial showed lower adenoma miss rates and higher adenoma detection rates for the newer 190 colonoscopes compared with the 160/5 series. These results suggest that it takes multiple improvements, such as those implemented over 2 instrument generations, before an effect on adenoma (miss) rate can be observed. (Study registration number: ISRCTN 2010-A01256-33.).

Our results confirm the high prevalence of influenza-related morbidity in infants during the epidemic peak. One child in three consulting to the pediatric emergency room had a virologically confirmed influenza infection regardless of the body temperature. Every fifth child with influenza was admitted to hospital, which corresponds to an admission rate of 237 per 100 000 children 0 to 11 months of age.

BackgroundOptimal sedation and analgesia is a challenge in paediatric intensive care units (PICU) because of difficulties in scoring systems and specific metabolism inducing tolerance and withdrawal. Excessive sedation is associated with prolonged mechanical ventilation and hospitalisation. Adult and paediatric data suggest that goal-directed sedation algorithms reduce the duration of mechanical ventilation. We implemented a nurse-driven sedation protocol in a PICU and evaluated its impact.MethodsWe conducted a before and after protocol implementation study in a population of children aged 0–18 years who required mechanical ventilation for at least 24 h between January 2013 and March 2015. After the protocol implementation in January 2014, nurses managed analgesia and sedation following an algorithm that included the COMFORT behaviour scale (COMFORT-B). Duration of mechanical ventilation was the primary outcome; secondary outcomes were total doses and duration of medications, PICU length of stay, incidence of ventilator-associated pneumonia, and occurrence of withdrawal symptoms. Pre–post analysis followed with segmented regression analysis of interrupted time series was used to assess the effect of protocol.ResultsA total of 200 children were analysed, including 107 before implementation and 93 children after implementation of the protocol. After implementation of the protocol, the total number of COMFORT-B scores per day of mechanical ventilation significantly increased from 3.9 ± 2.5 times during the pre-implementation period to 6.6 ± 3.5 times during the post-implementation period (p < 10−3). Mean duration of mechanical ventilation tended to be lower in the post-implementation period (8.3 ± 7.3 vs 6.6 ± 5.6 days, p = 0.094), but changes in either the trend per trimester from pre-implementation to post-implementation (p = 0.933) or the immediate change after implementation (p = 0.923) were not significant with segmented regression analysis. No significant change between pre- and post-implementation was shown for total dose of sedatives, withdrawal symptoms, agitation episodes, or unplanned endotracheal extubations.ConclusionsThese results were promising and suggested that implementation of a nurse-driven sedation protocol in a PICU was feasible. Evaluation of sedation and analgesia was better after the protocol implementation; duration of mechanical ventilation and occurrence of withdrawal symptoms tended to be reduced.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0256-7) contains supplementary material, which is available to authorized users.

No abstract

Objective: Narrow-Band Imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect oesophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than than that of Lugol chromoendoscopy in expert centres, remains to be established in current practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of oesophageal SCC and high-grade dysplasia (HGD) in current practice (including tertiary care centres, local hospitals, and private clinics). Trial Design: Prospective randomised multicentre trial including consecutive patients with previous or current SCC of the upper aerodigestive tract addressed for gastroscopy. Patients included were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI exam was performed after white light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. Results: 334 patients with previous history of SCC were included and analysed in intention-to-tret from 15 French institutions between March 2011 and December 2015. In a per-patient analysis, sensitivity, specificity, positive and negative likelihood values were respectively 100%, 66.0%, 21.2%, and 100% for Lugol chromoendoscopy vs. 100%, 79.9%, 37.5%, and 100% for NBI. NBI specificity was greater than Lugol chromoendoscopy (p=0.0023). Conclusions: As previously demonstrated in expert centres, NBI is more specific than Lugol in current gastroenterology practice for the detection of early SCC but combined approaches with both NBI and lugol could improve the detection of squamous neoplasia.

Background: To investigate how poor pre-gestational pulmonary function influenced pregnancy outcome and clinical status evolution in women with cystic fibrosis. Methods: Pregnancies in women without lung transplantation with a first delivery reported to the French cystic fibrosis registry between 20 0 0 and 2012 were identified. Pregnancy outcomes and clinical trends (body mass index-BMI, and pulmonary function) over a 4-year follow-up in women with poor pregestational pulmonary function, defined as forced expiratory volume (FEV 1) ≤ 50%, were compared to those in women with FEV 1 ˃ 50%. Results: A total of 149 women had a first delivery and 36 (24.2%) of these had pre-gestational FEV 1 ≤ 50%. There was no significant difference in age or frequency of assisted conception between the 2 groups. The rate of cesarean section was significantly higher in women with FEV 1 ≤ 50% (43.7% vs. 21.1%, p = .01). The frequency of preterm birth did not differ significantly between the two groups, but median infant birthweight was significantly lower in women with FEV 1 ≤ 50% (2705 g; range: 650-3700 vs. 3044 g; range: 1590-3860, p = .003). Despite significantly lower FEV 1 and BMI the year before pregnancy for women with poor pulmonary function, the decline in these parameters during the study period did not differ significantly between the two groups. Conclusion: Poor pre-gestational pulmonary function in women with cystic fibrosis was associated with a higher rate of cesarean section and a clinically significant impact on fetal growth, but was not associated with more important pulmonary and nutritional decline over the study period.