Éditeur(s) : HAL CCSD BMJ Publishing Group
Résumé : International audience
OBJECTIVES: The time from the prenatal period through early childhood is an important window of vulnerability for the developing immune and respiratory systems, both sensitive to environmental chemicals such as solvents. This study sought to examine the effects of solvent exposure during the prenatal and postnatal periods on wheezing, eczema and food allergies in early childhood. METHODS: This study, based on the PELAGIE cohort, included 1505 mother-child pairs with measurements of prenatal and postnatal solvent exposures and data on wheezing, eczema or food allergies. The maternal occupation reported at inclusion, in early pregnancy allowed us to define prenatal occupational solvent exposure (by three specific job-exposure matrices). Data on prenatal and postnatal domestic solvent exposure, that is exposure to products that contain solvents, were obtained from self-administered questionnaires, once at inclusion and again when the child was 2 years old. Outcome data was collected at the 2-year follow-up. Associations between exposures and outcomes were estimated by logistic regression models, after adjustment for potential confounders. RESULTS: No association was observed between prenatal exposure to solvents and the outcomes studied. Postnatal exposure was associated with an increased risk of wheezing (OR=1.80 (95% CI 1.25 to 2.59)) which persisted after adjustment for prenatal exposure. No significant association was observed with eczema or food allergies. CONCLUSIONS: Postnatal exposure to solvent-containing products in the home may increase the risk of wheezing in early childhood. Follow-up studies are needed to determine if the health effects observed at age 2 persist at later ages.
ISSN: 1351-0711

hal-01063913
https://hal.archives-ouvertes.fr/hal-01063913
DOI : 10.1136/oemed-2013-102036
PUBMED : 24996679

Éditeur(s) : HAL CCSD Lippincott, Williams & Wilkins
Résumé : International audience
ISSN: 1044-3983

hal-00875759
https://hal.archives-ouvertes.fr/hal-00875759
DOI : 10.1097/EDE.0b013e3182a79ac7
PUBMED : 24077003

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
Exposure to solvents during pregnancy has long been suspected to increase the risk of congenital malformations. Glutathione S-transferases (GSTs) are enzymes essential for the detoxification of various chemicals. Our objective here was to assess whether GST polymorphisms might modify the association between maternal solvent exposure and the risk of birth defects. A prospective cohort included 3421 pregnant women in Brittany, France (2002-2006). Occupational exposure to solvents was assessed from a job-exposure matrix. Congenital malformations were diagnosed among livebirths, stillbirths, and medical pregnancy terminations. Using a nested case-control design, 32 babies with major birth defects were compared to 348 normal births for babies' cord blood genotypes (at GSTT1 and GSTM1) and maternal occupational solvent exposure. Logistic models were used to adjust for potential confounders. The risk of major defects increased significantly in women with solvent exposure (20% of controls and 34% of cases). Frequencies of the null genotype of both the GSTT1 and GSTM1 genes were similar among controls and cases. There was a significantly increased risk of birth defects in GSTM1 not-null cord-blood genotype in pregnancies exposed to solvents (odds ratio [OR], 1.0 for not-null, not-exposed; OR, 4.0 for not-null, exposed; 95% confidence interval [CI], 1.4-11.2; OR, 1.6 for null, not-exposed; 95% CI, 0.6-3.9; OR, 1.0 for null, exposed; 95% CI, 0.2-4.7; p = 0.05). This nested case-control study suggests that the child's GSTM1 genotype modifies the risk of major birth defects among offspring of solvent-exposed women. Replication and additional investigations are necessary to confirm and elucidate these findings.
ISSN: 1542-0752

hal-00875957
https://hal.archives-ouvertes.fr/hal-00875957
DOI : 10.1002/bdra.23018
PUBMED : 22570144

Éditeur(s) : HAL CCSD
Résumé : International audience
OBJECTIVE: A better understanding of the perception of the rehabilitative and medical care's by persons with cerebral palsy (CP) and their families may help in providing better adherence to these cares. The main objective of this study was to assess overall satisfaction, self-perception of effectiveness and tolerance of the rehabilitative and medical cares in individuals with CP. MATERIAL AND METHODS: This was a cross-sectional questionnaire-based study. A total of 950 questionnaires were sent to French Britain children and adults with CP. Perceived effectiveness and tolerance were evaluated for each types of care using a Likert scale from 1 to 7 and overall satisfaction by a visual analog scale. Comparison of means and uni-and-multivariate analyzes for correlation analysis were carried out. RESULTS: A total of 512 (53.9%) questionnaires were analyzed; 230 (44.9%) were children and 54% were walkers (GMFCS I, II or III). The overall satisfaction was 6.83/10 (SD 2.21). Orthoptic, orthosis and physical therapy were reported to be the most effective cares (5.34/5.30/5.29) while botulinum toxins, intrathecal baclofen, and speech therapy the least effective (4.42/4.52/5.02). Intrathecal baclofen, orthosis and botulinum toxin were the less well-tolerated therapies (4.75/5.11/5.28). Antiepileptic drugs were reported to be the most effective and best-tolerated drug contrary to analgesics. Overall, satisfaction was inversely correlated to the GMFCS in the multivariate analysis (P=0.013). The perceived effectiveness of occupational therapy, botulinum toxin injections and physiotherapy are inversely related to GMFCS in the univariate analyzes. The tolerance and effectiveness of the orthosis have a positive correlation with the GMFCS in the uni-and-multivariate analyzes. DISCUSSION/CONCLUSION: This study shows a good overall satisfaction on medical and paramedical care but highlights a large discrepancy between user self-perception and evidence base medicine. More communication about the therapies between professionals and individuals with cerebral palsy is needed and comparing opinions of patients and their families to literature can give us the keys to improve communication around these therapies.
Annals of Physical and Rehabilitation Medicine

hal-01477212
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01477212
DOI : 10.1016/j.rehab.2016.07.014
PUBMED : 27676935

Éditeur(s) : HAL CCSD
Résumé : National audience
L’objectif était d’identifier des formes d’organisation du travail et d’étudier leur association avec les douleurs de l’épaule et le syndrome de la coiffe des rotateurs (SCR) chez les salariés, à partir des données du programme de surveillance épidémiologique des troubles musculo-squelettiques mis en œuvre dans les Pays de la Loire.
16ème colloque de l'ADEREST
Lyon, France

hal-01301201
https://hal.archives-ouvertes.fr/hal-01301201
DOI : 10.1016/j.admp.2015.04.036

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : National audience
ISSN: 0755-4982

hal-01128003
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01128003
DOI : 10.1016/j.lpm.2014.06.042
PUBMED : 25639624

Éditeur(s) : HAL CCSD BMJ Publishing Group
Résumé : International audience
We read with interest the report by Desrosiers et al 1 on the association between maternal occupational exposure to organic solvents and some birth defects. Their case-control study examined occupational exposure to three classes of solvents (chlorinated, aromatic and Stoddard) and found one association--between neural tube defects (mainly spinal bifida) and maternal occupational exposure to chlorinated solvents, but no association with the other solvent classes or with oral clefts. In their discussion, the authors noted that previous findings on maternal occupational exposure to solvents and oral clefts were from European, mainly French, populations and they hypothesised that the inconsistency between their results and these previous studies might be due to different exposure profiles (eg, intensity and solvent formulation). Although this explanation is plausible, another explanation must be discussed: differences in the definition of exposure. Our research team conducted four of the five studies with positive results cited by Desrosiers et al.2-5 All four were population based and included, in addition to the solvent classes considered by Desrosiers et al, oxygenated solvents, for example, alcohols or glycol ethers. Exposure limited to only oxygenated solvents appears to be very frequent among working women: more than half of the solvent exposure group in Chevrier et al 4 were exposed only to that solvent class. Because previous studies found an increased risk of oral clefts to be associated principally with that specific exposure, failure to consider this association could explain the negative findings for oral clefts. Moreover, women who were exposed only to oxygenated solvents are included in the reference ('non-exposed') group here, which would result in underestimating associations with chlorinated and petroleum solvents. For both these reasons, we believe that the failure to consider oxygenated solvents led to underestimating the risk estimates for oral clefts.
ISSN: 1351-0711

hal-00875943
https://hal.archives-ouvertes.fr/hal-00875943
DOI : 10.1136/oemed-2012-100999
PUBMED : 22843438

Éditeur(s) : HAL CCSD BMJ Publishing Group
Résumé : International audience
OBJECTIVES: To compare the quality of life (QoL) in three groups of workers suffering or not from shoulder pain (SP) lasting more than one month during the preceding 12 months. METHOD: Between 2002-2005, 3710 workers were randomly included in a French surveillance system of work-related musculoskeletal disorders. In 2007, 2332 responded to a follow-up questionnaire, 2049 were still active. Workers completed the Nordic Questionnaire to assess SP and the SF-36 for QoL. Three groups were defined according to health status at follow-up: Group 1: workers without SP (men: 87.9%; women: 79.2%) Group 2: workers with SP without neck, elbow and hand/wrist pain lasting more than one month during the preceding 12 months (men: 4.2%; women: 6.0%) Group 3: workers with SP and neck, elbow or hand/wrist pain lasting more than one month during the preceding 12 months (men 7.9%; women 14.8%) The mean scores of SF-36 were compared with Kruskall-Wallis test and post-hoc comparisons were performed. Analyses were stratified by gender. RESULTS: Workers in group 2 had lower scores of physical health compared to workers in group 1, whatever the gender. Workers in group 3 had lower scores of physical and mental health compared to workers in group 1. Two dimensions of mental health in men and the four dimensions of physical health and one dimension of mental health in women had lower scores in group 3 compared to group 2. CONCLUSIONS: Workers with SP and upper-limb pain have poorer QoL compared to workers without SP and workers with SP without upper-limb pain.
ISSN: 1351-0711

hal-01063898
https://hal.archives-ouvertes.fr/hal-01063898
DOI : 10.1136/oemed-2014-102362.258

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
o abstract
ISSN: 0735-1097

hal-01446568
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01446568
DOI : 10.1016/j.jacc.2016.09.036
PUBMED : 27970295

Éditeur(s) : HAL CCSD BMJ Publishing Group
Résumé : International audience
OBJECTIVES: Many women who work during pregnancy are occupationally exposed to toxicants. The developing central nervous system is highly vulnerable to neurotoxicants such as solvents. Although the neurotoxicity of solvents to adults is well established, very few studies have examined their effects on children's behaviour following prenatal exposure. METHODS: Women from the Perturbateurs endocriniens: Étude Longitudinale sur les Anomalies de la Grossesse, l'Infertilité et l'Enfance (PELAGIE) mother-child cohort (including 3005 working women) were recruited in Brittany (France) between 2002 and 2006, at the beginning of pregnancy, to assess occupational exposure to solvents at that time. Child behaviour was documented at age 2 by mothers (n=1278) assessing components of attention deficit/hyperactivity, aggression, opposition and emotionality. We used a multiple linear regression analysis to evaluate the association between occupational solvent exposure and children's behaviour. Complementary sensitivity analyses allowed us to handle missing data, due mostly to attrition. RESULTS: 20% of women reported occasional exposure and 31% regular exposure to solvents. Children prenatally exposed were more likely to have higher scores of attention deficit/hyperactivity and aggression, and dose-response relations were observed. CONCLUSIONS: The dose-response effect and the high prevalence of children potentially exposed to solvents from their mother's workplace exposure underline the public health relevance of this result. Our results should be replicated in further studies designed to identify which solvents are most deleterious and to assess child behaviour at school age.
ISSN: 1351-0711

inserm-00795043
http://www.hal.inserm.fr/inserm-00795043
http://www.hal.inserm.fr/inserm-00795043/document
http://www.hal.inserm.fr/inserm-00795043/file/Occupationnal_solvent_exposure_child_behavior_HAL.pdf
DOI : 10.1136/oemed-2012-100892

Éditeur(s) : HAL CCSD
Résumé : International audience
Reply: We thank Keelan and colleagues for their letter questioning the accuracy of testosterone measurement in cord blood obtained by immunoassay methods...
Human Reproduction

hal-01560277
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01560277
DOI : 10.1093/humrep/dex076
PUBMED : 28453619

Éditeur(s) : HAL CCSD Lippincott, Williams & Wilkins
Résumé : International audience
BACKGROUND: Exposure to solvents during pregnancy has long been suspected of increasing the risk of congenital malformations, but the lack of prospective assessment of specific solvent exposures has prevented definitive conclusions. METHODS: In a cohort of 3421 pregnant women in Brittany (2002-2006), occupational solvent exposure was assessed from self-report during pregnancy and from a job-exposure matrix. Congenital malformations were diagnosed among live births, stillbirths, and medical pregnancy terminations. In a nested case-control sample, urinary concentrations of 10 metabolites of glycol ethers and chlorinated solvents were measured in maternal samples collected during early pregnancy (n = 79 cases, 580 controls). RESULTS: Dose-response trends linked occupational solvent exposure (both self-reported and based on a job-exposure matrix) to the risk of major congenital malformations--especially oral clefts, urinary tract malformations, and male genital malformations. Detection of some glycol ether metabolites and trichloroacetic acid in urine was associated with increased risks of oral clefts and of urinary tract and limb defects. CONCLUSIONS: This prospective study, using three independent methods of exposure assessment, suggests several specific associations between solvent exposure during early pregnancy and congenital malformations. Results based on urinary biomarkers, although limited by small numbers, identify work situations that require further investigation.
ISSN: 1044-3983

hal-00875918
https://hal.archives-ouvertes.fr/hal-00875918
DOI : 10.1097/EDE.0b013e31826c2bd8
PUBMED : 23007043

Éditeur(s) : HAL CCSD
Résumé : International audience
o abstract
ICOH Congress
Séoul, South Korea

hal-01302745
https://hal.archives-ouvertes.fr/hal-01302745

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
Background: Health care workers (HCWs) are occupationally exposed to various hazards, some associated with adverse pregnancy outcomes in previous reviews. This systematic review aims at synthesizing the recent literature on occupational exposures among HCWs related to fetal death, congenital anomalies, and fertility disorders. Methods: We searched the Medline database from 2000 to 2015 for articles about all potential occupational exposures of women and men working in this sector. Results: We retained 32 studies, most of them (n = 30) among women HCWs. Studies based on job title reported excess risks of some congenital anomalies (especially nervous and musculoskeletal systems) among HCWs compared to non-HCWs but no evidence about fetal death. Excess risks associated with specific exposures includes reports of some congenital anomalies forwomenexposed to anesthetic gases. Exposure to some sterilizing agents and, with less evidence, to antineoplastic drugs and to ionizing radiation, is associated with increased risks of miscarriage but not stillbirth. Strenuous work schedules appear to be associated with fertility disorders, but the evidence is limited. Only a few studies have been published since 2000 about non-ionizing radiation, or about fertility disorders related to chemical or physical agents, or about male HCWs. Conclusions: Despite the establishment of recommendations to limit exposures of HCWs, some excess risks of adverse pregnancy outcomes are still reported and need to be explained.
ISSN: 0271-3586

hal-01560148
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01560148
DOI : 10.1002/ajim.22711
PUBMED : 28514021

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
IntroductionFever is associated with a poor outcome in severely brain-injured patients, and its control is one of the therapies used in this condition. But, fever suppression may promote infection, and severely brain-injured patients are frequently exposed to infectious diseases, particularly ventilator-associated pneumonia (VAP). Therefore, we designed a study to explore the role of a fever control protocol in VAP development during neuro-intensive care.MethodsAn observational study was performed on severely brain-injured patients hospitalized in a university ICU. The primary goal was to assess whether fever control was a risk factor for VAP in a prospective cohort in which a fever control protocol was applied and in a historical control group. Moreover, the density of VAP incidence was compared between the two groups. The statistical analysis was based on a competing risk model multivariate analysis.ResultsThe study included 189 brain-injured patients (intervention group, n¿=¿98, and historical control group, n¿=¿91). The use of a fever control protocol was an independent risk factor for VAP (hazard ratio 2.73, 95% confidence interval [1.38, 5.38; P¿=¿0.005]). There was a significant increase in the incidence of VAP in patients treated with a fever control protocol (26.1 versus 12.5 VAP cases per 1000 days of mechanical ventilation). In cases in which a fever control protocol was applied for >3 days, we observed a higher rate of VAP in comparison with the rate among patients treated for ¿3 days.ConclusionFever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for >3 days.
ISSN: 1364-8535

hal-01118640
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118640
PUBMED : 25498970
DOI : 10.1186/s13054-014-0689-4
PUBMEDCENTRAL : PMC4279880

Éditeur(s) : HAL CCSD National Institute of Environmental Health Sciences
Résumé : International audience
Background: Glycol ethers (GE) are widely used organic solvents. Despite the potential neurotoxicity of several families of organic solvents, little is known about the impact of GE on the neurodevelopment of infants and children. Objectives: We investigated the relation between urinary concentrations of GE metabolites in pregnant women and neurocognitive abilities in their 6-year-old children in the PELAGIE mother-child cohort. Methods: Five GE metabolites were measured in first morning void urine samples of 204 French pregnant women in early pregnancy (<19 weeks of gestation). Psychologists assessed the neurocognitive abilities of their 6-year-old children with the Wechsler Intelligence Scale for Children IV (WISC) and the Developmental Neuropsychological Assessment (NEPSY). We analyzed the results with linear (WISC) and Poisson regression models (NEPSY), adjusted for potential confounders, including child's stimulation at home. Results: GE metabolites were detected in 90-100% of maternal urine samples. The WISC Verbal Comprehension score was significantly lower for children with the highest tertile of urinary phenoxyacetic acid (PhAA) [beta (third vs. first tertile)=-6.53; 95% CI: -11.44, -1.62]. Similarly, the NEPSY Design Copying subtest score was lower in those with the highest tertile of urinary ethoxyacetic acid (EAA) [beta (third vs. first tertile)=-0.11; 95% CI: -0.21, 0.00]. The other GE metabolites we studied were not significantly associated with WISC or NEPSY scores. Conclusions: Prenatal urine concentrations of two GE metabolites were associated with lower WISC Verbal Comprehension Index scores and NEPSY Design Copying subscale scores, respectively, at age 6 years. PhAA is the primary metabolite of 2-phenoxyethanol (EGPhE), which is commonly found in cosmetics, and precursors of EAA are frequently used in cleaning agents. Additional research is needed to confirm our findings and further explore potential effects of prenatal GE exposures on neurocognitive performance in children.
ISSN: 0091-6765

hal-01519256
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01519256
DOI : 10.1289/EHP39
PUBMED : 27740510

Éditeur(s) : HAL CCSD
Résumé : International audience
Letter to the Editor
Infection Control and Hospital Epidemiology

hal-01269911
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01269911
DOI : 10.1017/ice.2016.6
PUBMED : 26818822

Éditeur(s) : HAL CCSD
Résumé : International audience
The aim was to identify patterns of work organization characteristics using data from epidemiological surveillance program of musculoskeletal disorders (MSD) implemented in the Pays de la Loire region between 2002 and 2005. A total of 3710 workers were included and completed a administered questionnaire including 16 organizational variables. Ascendant hierarchical clustering (AHC) of organizational variables and AHC of workers had identified five patterns of work organization characteristics: technical constraints and weak decision latitude; internal/external demand and mean decision latitude; weak pace constraints and mean decision latitude; internal/external demand and high decision latitude; weak pace constraints and high decision latitude. Relationships with MSD diagnosed by occupational physicians were then studied.
The specific health programs (SHP) are one of the four mechanisms of prevention planned by the Health and Safety at work Law in the province of Quebec. If the Law appoints only a responsible doctor, it is in reality Health at work teams (HWT) that develop these SHP. In this communication, based on the model of the working situation and the diagram of inter professional practices of collaboration, we study the practices of inter professional collaboration (CIP) in the HWT. The observed practices vary between independent practices, in parallel, of consultation, of dialogue and in shared services. Formalization of the teams, coordination of communication, leadership, respect and professional identities influence particularly the practices of CIP.
L’objectif était d’identifier des patterns de caractéristiques d'organisation du travail à partir des données du programme de surveillance épidémiologique des troubles musculo-squelettiques (TMS) mis en œuvre dans les Pays de la Loire entre 2002 et 2005. Au total, 3 710 salariés ont été inclus et ont répondu à un questionnaire comportant notamment 16 variables organisationnelles. Une classification ascendante hiérarchique (CAH) des variables organisationnelles puis une CAH des salariés ont permis d’identifier cinq patterns de caractéristiques d’organisation du travail : contraintes techniques et faible latitude décisionnelle ; demande interne/externe et latitude décisionnelle moyenne ; faibles contraintes de rythme et latitude décisionnelle moyenne ; demande externe/interne et forte latitude décisionnelle ; faibles contraintes de rythme et forte latitude décisionnelle. Les associations avec les TMS diagnostiqués par des médecins du travail ont ensuite été étudiées.
Actes du 50ème congrès de la Société d'Ergonomie de Langue Française
Paris, France

halshs-01307785
https://halshs.archives-ouvertes.fr/halshs-01307785

Éditeur(s) : HAL CCSD National Institute of Environmental Health Sciences
Résumé : International audience
BACKGROUND: Glycol ethers are present in a wide range of occupational and domestic products. Animal studies have suggested that some of them may affect ovarian function. OBJECTIVE: To study the relation between women's exposure to glycol ethers and time to pregnancy. METHODS: Urine from randomly selected women in the PELAGIE mother-child cohort who had samples collected before 19 weeks of gestation was tested to measure eight glycol ether metabolites by chromatography coupled to mass spectrometry. Time to pregnancy was collected at the beginning of the pregnancy by asking women how many months they took to conceive. Associations between metabolite levels and time to pregnancy were estimated in 519 women with complete data using discrete-time Cox proportional hazards models to adjust for potential confounders. RESULTS: Glycol ether metabolites were detected in 6% (for ethoxyacetic acid) to 93% (for phenoxyacetic and butoxyacetic acids) of urine samples. Phenoxyacetic acid was the only metabolite with a statistically significant association with longer time to pregnancy (fecundability OR 0.82; 95% CI: 0.63, 1.06 for the second and third quartile combined; fecundability OR 0.70; 95% CI: 0.52, 0.95 for a fourth-quartile (≥1.38 mg/L) vs. first-quartile concentration (<0.14 mg/L)). This association remained stable after multiple sensitivity analyses. CONCLUSION: Phenoxyacetic acid, which was present in most of the urine samples tested in our study, was associated with increased time to pregnancy. This metabolite and its main parent compound, 2-phenoxyethanol, are plausible causes of decreased fecundability, but may also be surrogates for potential co-exposures frequently present in cosmetics.
ISSN: 0091-6765

hal-00866023
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00866023
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00866023/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00866023/file/Urinary_Glycol_Ether-accepted.pdf
DOI : 10.1289/ehp.1206103

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
AIM: To describe the amount of medical and paramedical involvement in a sample of Breton children with cerebral palsy as a function of the Gross Motor Function Classification System (GMFCS). MATERIALS AND METHODS: This is a transversal descriptive study. All children with cerebral palsy in Brittany were eligible. Parents who accepted to participate were asked to fill in a questionnaire regarding medical and paramedical involvement with their child. RESULTS: One hundred and thirty-three parents participated. 40.6% of the children were level I on the GMFCS, 20.3% II, 12.03% III, 13.53% IV and 13.53% were level V. Thirty-nine percent of the children took at least one medication (of which 43% were antiepileptic drugs). 33.1% of the children had received at least one injection of botulinum toxin within the year. Forty-four percent used a mobility aid. Eighty-five percent of the children had at least one orthotic device, most often a night ankle-foot orthosis. The median number of rehabilitation sessions per week was 3.85 [0.5-11.5]. The frequency and type of sessions were mostly related to the GMFCS level. CONCLUSION: This study reports high levels of medical and paramedical involvement. Studies must attempt to define optimal practice.
ISSN: 1877-0657

hal-00876456
https://hal.archives-ouvertes.fr/hal-00876456
PUBMED : 23312436
DOI : 10.1016/j.rehab.2012.11.003