Added value of an intensive multidisciplinary functional rehabilitation programme for chronic low back pain patients.

BACKGROUND: Several treatments exist for chronic low back pain (cLBP) patients although none has shown superiority. Among group treatments, muscle reconditioning programmes (MRPs) are the most commonly used. Multidisciplinary functional rehabilitation programmes (MFRPs) are an alternative. OBJECTIVE: To compare a MFRP with a MRP as few studies compare these treatments METHODS: This was a prospective, nonrandomised, controlled study comparing cLBP patients participating in a MRP or MFRP in an outpatient setting. The predetermined primary outcome measure was the daily life activity subscale (DLA) of the Dallas Pain Questionnaire (DPQ) within one year after the end of the treatment. RESULTS: Twenty-one patients were included in the MRP and 24 in the MFRP. At inclusion, the groups were similar in terms of age (mean 40 years), sex (50%-60% males), sick leave duration (mean 6.0 months, standard deviation (SD) 4.4 months) and follow up (mean 9.0 months, SD 2.0 months). The DLA score decreased from 59.5% (SD 16.9) to 44.8% (SD 25.4), p <0.01, in the MFRP and from 62.3 (SD 20.3) to 58.8 (SD 20.7), p = 0.3, in the MRP. The between-groups difference at follow-up was 13.8, p = 0.05, and the difference in the mean improvement was -11.5 (5.9), p = 0.058. Seventy-eight percent of MFRP patients versus 47 % in the MRP group returned to work (p = 0.08). DISCUSSION: In a population of highly disabled cLBP patients, MFRP seems more effective in increasing function and return to work. Interpretation is limited by the small population included and by the type of trial. CONCLUSION: Randomised studies are needed to confirm these results and explore the cost-effectiveness of MFRP.

Chlamydia trachomatis infection in males in a juvenile detention facility in Switzerland.

QUESTIONS UNDER STUDY: Young offenders represent a group for which Chlamydia trachomatis infection screening is recommended in the US. In the absence of local epidemiological data it is difficult to assess whether such recommendations apply to the Swiss context. Our aim was to obtain local prevalence data for Chlamydia trachomatis infection among young male offenders as a basis for screening strategies in Swiss juvenile detention centres. METHODS: This cross-sectional study was conducted in a juvenile detention facility in Geneva, Switzerland. Adolescent males aged 15-18 years admitted to the detention facility were invited to participate during a consultation with a nurse conducted within 48 hours of admission. Participants were asked to provide a first void urine sample for PCR detection of Chlamydia trachomatis infection and to complete a questionnaire on reproductive health behaviours. RESULTS: 72 males were considered for participation in the study. 13 were excluded (mainly due to the language barrier or a shorter than 3 days' stay in the facility) and 9 (15%) declined participation. Not being sexually active was the most common reason for declining participation. Most participants originated from Switzerland or the European Union and 68% reported having ≥2 sexual partners in the past year. Only one participant (18 years, asymptomatic) had Chlamydia trachomatis infection (2%; 95%CI: 0-6%). CONCLUSIONS: This study does not support screening for Chlamydia trachomatis among young offenders admitted to detention centres in Switzerland. Studies in other European detention centres should document the extent to which our findings are generalisable to the European context.

[General internal medicine: important articles about ambulatory care published in 2010]. / Médecine interne générale: articles importants pour la pratique ambulatoire en 2010.

This review of articles published in 2010 covers the new role of dabigatran in atrial fibrillation, the lack of efficacy on pain of chondroïtine/ glucosamine in knee arthrosis, the risk of thrombosis with antipsychotics, the increase cardiovascular risk in case of migraine with aura and the insufficient prescription of adjuvant chemotherapy in elderly with colon cancer. Authors also highlight public health topics such as the association of poor oral hygiene and increased cardiovascular risk, the positive effect of opioid substitution therapy by primary care practitioners on mortality, the high frequency of prenatal violence on pregnant women and the negative impact of financial constraint on the risk of hospitalization.

Chlamydia trachomatis infection in a Swiss prison: a cross sectional study.

BACKGROUND: Chlamydia trachomatis infection (CTI) is the most frequent sexually transmitted infection in Switzerland and its prevalence in correctional settings is currently unknown. The aim of this study was to determine the prevalence of CTI and associated risk factors in a population of inmates aged 18-35 years. METHODS: Inmates attending the health care unit of the largest Swiss remand prison from June 2008 to May 2009 were invited to participate in this cross-sectional study. All participants completed a questionnaire and provided a first-void urine specimen for CTI testing based on a PCR assay. Univariate and multivariate logistic regression analyses were used to assess risk factors associated with CTI. RESULTS: 214 male and 20 female inmates agreed to participate. Overall CTI prevalence was 6.5% in men (95% CI 3.2; 9.9) and 10% (95%CI 0; 23.1) in women. None of the following possible risk factors analysed were significantly correlated to CTI: age, origin, education, religion, number of sexual partners, iv drug use, subjective health status and uro-genital symptoms. CONCLUSION: CTI prevalence in the largest Swiss prison was two to six times higher than in the general population but similar to other European prison settings. This result should raise our awareness that this population is at particularly high risk for sexually transmitted infections and motivate a widespread surveillance of prison CT prevalence. We hesitate to consider systematic screening because evidence is still lacking in relation to the benefits of screening in males. Local cost effectiveness studies would highly contribute to a correct decision concerning implementation of screening.