How French subjects describe well-being from food and eating habits? Development, item reduction and scoring definition of the Well-Being related to Food Questionnaire (Well-BFQ©).

Providing well-being and maintaining good health are main objectives subjects seek from diet. This manuscript describes the development and preliminary validation of an instrument assessing well-being associated with food and eating habits in a general healthy population. Qualitative data from 12 groups of discussion (102 subjects) conducted with healthy subjects were used to develop the core of the Well-being related to Food Questionnaire (Well-BFQ). Twelve other groups of discussion with subjects with joint (n = 34), digestive (n = 32) or repetitive infection complaints (n = 30) were performed to develop items specific to these complaints. Five main themes emerged from the discussions and formed the modular backbone of the questionnaire: "Grocery shopping", "Cooking", "Dining places", "Commensality", "Eating and drinking". Each module has a common structure: items about subject's food behavior and items about immediate and short-term benefits. An additional theme - "Eating habits and health" - assesses subjects' beliefs about expected benefits of food and eating habits on health, disease prevention and protection, and quality of ageing. A preliminary validation was conducted with 444 subjects with balanced diet; non-balanced diet; and standard diet. The structure of the questionnaire was further determined using principal component analyses exploratory factor analyses, with confirmation of the sub-sections food behaviors, immediate benefits (pleasure, security, relaxation), direct short-term benefits (digestion and satiety, energy and psychology), and deferred long-term benefits (eating habits and health). Thirty-three subscales and 14 single items were further defined. Confirmatory analyses confirmed the structure, with overall moderate to excellent convergent and divergent validity and internal consistency reliability. The Well-BFQ is a unique, modular tool that comprehensively assesses the full picture of well-being related to food and eating habits in the general population.

Evaluation of the pain in varicose vein surgery under tumescent local anaesthesia using sodium bicarbonate as excipient without any intravenous sedation.

OBJECTIVE: In order to simplify varicose vein surgery, we studied the possibility of tumescent local anaesthesia (TLA) using sodium bicarbonate 1.4% as excipient without any intravenous sedation. METHODS: For three months, 215 patients were included in two centres for ambulatory varicose vein surgery performed without any intravenous sedation. Clinical results and pain were evaluated according to the type and duration of surgery. RESULTS: Mean perioperative pain was evaluated at 2.7 on a visual scale (0-10). In 91% of the cases, surgery was deemed to be slightly painful. Preoperative pain was not linked to the technical means of surgery but to the psychological and organizational environment of the centre. CONCLUSIONS: In many of the cases, varicose vein surgery could be performed under TLA without any intravenous sedation. Ambulatory varicose vein surgery without any intravenous sedation could be highly cost-effective.

[Assessment of workload in pediatric emergency units due to acute gastroenteritis during the epidemic season in France]. / Evaluation de la charge de travail induite aux urgences pédiatriques par les gastroentérites aiguës en période épidémique.

OBJECTIVE: The aim of this study was to assess the burden of medical and paramedical activities related to the management of acute gastroenteritis (AGE) cases in France. METHODS: An observational, multicenter study was carried out in 23 French pediatric emergency units. Each unit was requested to include the first 25 children less than five years of age, consulting for AGE during the epidemic season. RESULTS: A total of 443 children was included between January and April 2007. The median age was 13 months. Symptoms had been persisting for an average of 2.7 days, and 60.7% of patients had already consulted. In 62.6% of cases, oral rehydration solution (ORS) had been prescribed. The median waiting time in the EU was 15 minutes. The median time spent by a health care professional with a child was 55 minutes (30 minutes for paramedical care and 25 minutes for medical care). The length of these visits increased significantly (p<0.0001) if children presented with signs of dehydration or behavioral changes. The child's age had no significant impact. Rehydration in the EU was 70% oral rehydration, 16% parenteral rehydration (8% were combined). Among the children, 37% were discharged after consultation in the EU, 39% after observation, and 24% were hospitalized. 90% of the children who were given a prescription on discharge were prescribed at least one ORS (n=333). CONCLUSION: The time spent by a health care professional with a child presenting with acute gastroenteritis could cause organizational problems during an epidemic outbreak.

[Economic evaluation of acute paediatric rotavirus gastroenteritis in France]. / Evaluation du coût de la prise en charge pédiatrique des gastroentérites aiguës à rotavirus.

BACKGROUND: Acute paediatric rotavirus gastroenteritis (RVGE) is the leading cause of paediatric gastroenteritis worldwide. The objective of the study was to assess the average cost of a RVGE episode in children between 0 and 5 years in France. METHOD: An epidemiological study performed in Dijon provided the amount of resources used in the case of a RVGE episode. Their evaluation was based on current national local tariffs. Three different care settings were included: RVGE cases taken in charge only by community health care providers, RVGE cases leading to an emergency visit without hospitalisation, and cases leading to hospitalisation. This evaluation considered direct and indirect costs. RESULTS: Ninety-nine children with rotavirus gastroenteritis were included in the epidemiological study, 30 patients after hospitalisation, 50 patients in emergency departments, and 19 were included by physicians. The average French social security costs for one episode of rotavirus gastroenteritis was 1,270 euro for hospitalised cases, 80 euro for emergency cases and 34 euro for community health care cases. The part of costs not reimbursed by the social security was mainly due to loss of productivity. It amounted to 287, 254 and 255 euro for emergency visit cases, hospitalised cases and community health care respectively. CONCLUSION: This cost of disease study demonstrated that paediatric rotavirus gastroenteritis results in high expenditures for the French social security as well as for society. The implementation of a vaccination programme would reduce the economic burden of gastroenteritis disease in France.

Analysis of ambulatory heart failure management and its incidence on one-year survival.

AIM: To assess in a daily practice survey one-year survival in a cohort of patients with heart failure (HF) according to their clinical profiles and the way they were managed by cardiologists. METHODS AND RESULTS: A prospective observational survey was conducted in 1941 patients with HF followed up for one year. Results show high rates of prescription for ACE inhibitors, indicating that cardiologists take into account international recommendations. ACE inhibitors are prescribed at dosage levels approaching those recommended by the guidelines. However, beta-blocker prescription still shows a significant deficit and the prescribed doses are much lower than those currently recommended. The multifactorial modeling analysis showed that global heart failure (P=0.004), advanced NYHA class (P<0.001), renal failure (P<0.001) were predictive of poor outcome whereas an increased survival likelihood was observed in patients given ACE-inhibitor/beta-blocker combination compared with beta-blocker alone or ACE-inhibitor alone. CONCLUSION: The results from this study should enhance the prescription of ACE inhibitors and beta-blockers at effective doses in compliance with the guidelines. They also suggest that a synergic positive effect of the combination of these two therapeutic classes is observed in real life situations.

Decision analysis for the assessment of a record linkage procedure: application to a perinatal network.

OBJECTIVES: According to European legislation, we must develop computer software allowing the linkage of medical records previously rendered anonymous. Some of them, like AUTOMATCH, are used in daily practice either to gather medical files in epidemiologic studies or for clinical purpose. In the first situation, the aim is to avoid homonymous errors, and in the second one, synonymous errors. The objective of this work is to study the effect of different parameters (number of identification variables, phonetic treatments of names, direct or probabilistic linkage procedure) on the reliability of the linkage in order to determine which strategy is the best according to the purpose of the linkage. METHODS: The assessment of the Burgundy Perinatal Network requires the linking of discharge abstracts of mothers and neonates, collected in all the hospitals of the region. Those data are used to compare direct and probabilistic linkage, using different parameterization strategies. RESULTS: If the linkage has to be performed in real time, so that no validation of indecisions generated by probabilistic linkage is possible, probabilistic linkage using three variables without any phonetic treatment seems to be the most appropriate approach, combined with a direct linkage using four variables applied to non-conclusive links. If a validation of indecisions is possible in an epidemiological study, probabilistic linkage using five variables, with a phonetic treatment adapted to the local language has to be preferred. For medical purpose, it should be combined with a direct linkage with four or five variables. CONCLUSION: This paper reveals that the time and money available to manage indecision as well as the purpose of the linkage are of paramount importance for choosing a linkage strategy.

Assessment of cetirizine, an antihistamine, to prevent cutaneous reactions to nevirapine therapy: results of the viramune-zyrtec double-blind, placebo-controlled trial.

We conducted a 12-week, multicenter, randomized, double-blind, placebo-controlled trial of cetirizine to assess the ability of antihistamines to prevent nevirapine-associated rash in patients infected with human immunodeficiency virus type 1. Patients initiating treatment with nevirapine were randomized to receive either cetirizine, 10 mg q.d. (104 patients), or placebo (96 patients) during the first 6 weeks of therapy. Rash occurred in 22 (11%) of 200 patients; 10 (9.6%) were in the cetirizine group and 12 (12.5%) were in the placebo group (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.31-1.81; P=.5). Five of 22 rashes were cases of hypersensitivity syndrome. The rate of nevirapine discontinuation due to rash was similar in the 2 groups (7.7% and 6.25% in the cetirizine and placebo groups, respectively; P=.4). Multivariate analysis showed no treatment-group effect but indicated that age >40 years (OR, 3.83; 95% CI, 1.4-10.46; P=.008) was associated with an increased risk of rash. Cetirizine has no preventive effect on nevirapine-associated rash.

[Assessment of the discriminating power of identifiers for record linkage]. / Estimation de la valeur discriminante des traits d'identification utilisés pour le rapprochement des données d'un patient.

BACKGROUND: To reconstruct a patient's medical history, one has often to combine information from different sources, whatever the context of this reconstitution: epidemiological studies or health care. As a linkage using less informative identifiers could lead to linkage errors, it is essential to quantify the information associated to each identifier. METHODS: The aim of this study was to estimate the discriminating power of different identifiers which could be used in a record linkage process based on the means of the likelihood ratio proposed by Jaro as a probabilistic record linkage method. Six identifiers were considered: date of birth, maiden name, usual last name, first and second christian names and the gender. Two types of phonetic treatment were taken into account: the Soundex and a phonetic treatment adapted to the French language. Three situations were considered: 1) and 2) linkage of the data collected during two consecutive years in a university hospital (CHU de Dijon; 100000x100000 records) and a Paris hospital (50000x50000 records), 3) linkage of two files obtained through a healthcare network (Burgundy Perinatal Network; 200x2500 records). RESULTS: Whatever the situation, this work showed the interest of three identifiers when linking data concerning a same patient. The date of birth had the best discriminating power followed by the first and the last names. Including a poorly discriminating identifier like gender did not improve the results. Moreover, adding a second Christian name, often missing, increased linkage errors. On the contrary, it seemed that using a phonetic treatment adapted to the French language could slightly improve the results of linkage in comparison to Soundex. CONCLUSION: Whatever the method used, it seems necessary to improve the quality of identifier collection, in particular of the date of birth and of the first and last names as it could make the linkage of data obtained from different sources easier. Further research is needed to estimate the discriminating power of other identifiers (birth place and parents identifiers).

Law and standards faced to market rules in health information security.

This paper presents the main differences existing in the elaboration process of law and standard and analyses their potential conflicts. It also describes the respective force of law and standards in three main areas: legal threat versus financial threat, conflict versus cooperation and finally their respective position faced to oligarchic power.

Pharmaco-epidemiology of the treatment of chronic venous insufficiency in general medicine.

BACKGROUND: A report is presented of a multicenter pharmaco-epidemiological study on chronic venous insufficiency conducted in France on 5043 patients. METHODS: It was based on a questionnaire that included the demographic characteristics of the patients, their risk factors for venous disease, history of venous insufficiency, physical and functional symptoms, and clinical stage according to the CEAP classification, as well as modalities of treatment and professional practice of the participating doctors. The various treatment modalities (phlebotonics, compression stockings, sclerotherapy and surgery) were related to the stage of the venous insufficiency and to the satisfaction expressed by the patients. RESULTS: The results of the study showed a minimum annual sick leave rate of 7.2%. CONCLUSIONS: In conclusion, this study brings to the fore the change in treatment modalities for venous insufficiency according to its severity stage, principally as regards medico-economics.

A virtual intranet and data-warehousing for healthcare co-operation.

As patient's medical data is disseminated in different health structures, developing a medical or epidemiological patient-oriented data warehouse has some specific requirements compared to intra healthcare structure data-warehousing projects. The difference is that the healthcare structures implicated in a patient-oriented data warehouse project require some considerations about the confidentiality of the patient data and of the activities of healthcare structures. Building a data-warehousing system at a regional level, for example in cancerology, requires the participation of all concerned health structures, as well as different health professionals. The heterogeneity of sources medical data of has to be taken into account for choosing between several organizational configurations of the data warehousing system. In top of data warehousing, we propose a concept of Virtual Intranet, which provides a solution to the problem of medical information security arising from heterogeneous sources.

[Hepavir, the first observational study of one cohort of patients treated with alpha-2a interferon, monotherapy. Evaluation of asthenia and its social consequences]. / Hépavir, première étude observationnelle d'une cohorte de malades traités par interféron alpha-2a en monothérapie. Evaluation de l'asthénie et de ses répercussions sociales.

OBJECTIVES: The aim of this observational study in patients with chronic hepatitis C and treated with interferon alpha-2a was to assess 1) monitoring in everyday practice, 2) the acceptability of treatment and 3) the intensity of fatigue. METHODS: Three hundred and fifty four patients were enrolled by physicians in both teaching and general hospitals, or private practice. Before treatment, clinical, epidemiological, and virological data were collected as well as a self-evaluation of fatigue using a visual analogic scale. Clinical follow-up was assessed every 3 months during treatment and 6 months after the end of treatment and included an evaluation of fatigue and the number of workdays missed due to sickness. RESULTS: Two hundred and nineteen men and 135 women, mean age 45 +/- 13, were included. The epidemiological, histological and virological features of this group were similar to those patients usually treated for chronic hepatitis C. Before treatment, the mean measurement of fatigue was 41 on a scale from 0 (perfect form) to 100 (exhausted). Fatigue was unrelated to age, source of infection, biological activity, or histological score. It worsened in patients who stopped interferon after 3 or 6 months, but was stable in patients who continued treatment for 12 months. Fatigue decreased after the end of treatment and was unrelated to treatment response. The need to stop work was strongly related to the intensity of fatigue and the number of workdays missed due to sickness represented nearly two months out of three in 25% of active patients during the first quarter and in 15% of patients thereafter. 61% of patients self-injected interferon (mainly previous drug users) whereas 30% of patients used nurse care throughout treatment. CONCLUSION: This study not only provides a realistic evaluation of fatigue in patients with chronic hepatitis C, before, during and after treatment, but also highlights its social and economic consequences. It shows the need for further cost-effectiveness studies on new therapeutic strategies using combined treatments.

How to ensure data security of an epidemiological follow-up: quality assessment of an anonymous record linkage procedure.

A computerised record hash coding and linkage procedure is proposed to allow the chaining of medical information within the framework of epidemiological follow-up. Before their extraction, files are rendered anonymous using a one-way hash coding based on the standard hash algorithm (SHA) function, in order to respect the legislation on data privacy and security. To avoid dictionary attacks. two keys have been added to SHA coding. Once rendered anonymous, the linkage of patient information can be accomplished by means of a statistical model, taking into account several identification variables. Quality assessment of this anonymous record linkage procedure shows a specificity of 100% and a sensitivity of 95%.

Psychosocial and occupational impact of chronic low back pain.

UNLABELLED: The significant psychosocial and occupational impact of low back pain is a risk factor for chronicization but remains difficult to be evaluated. METHODS: A cross-sectional study of acute and chronic low back pain patients managed by 1282 physicians was conducted using an 85-item questionnaire. Most items were composed of multiple or binary clauses. A semi quantitative six-point scale was used to evaluate effects of the pain on family and personal life. A total of 2741 completed questionnaires were sent in. The present study was conducted on the 1072 questionnaires completed for "active" (as opposed to retired) patients with chronic low back pain. Mean age was 44 years. RESULTS AND DISCUSSION: As compared to the general population, there were fewer blue-collar workers, executives, and skilled professionals and more intermediate professions (34% versus 19% according to an INSEE survey, p < 0.001). Twelve per cent of patients were able either to change jobs or to find lighter duties in their current job, but a similar proportion were completely incapacitated or awaiting a job modification. Significant negative effects on everyday life were reported by 80% of patients, on emotional life by 58%, and on sexual activity by 46%. Most patients had reduced their leisure and household activities. Psychological disorders were noted in 75% of patients. On the day of the visit, two-thirds of patients were given a prescription for analgesics, nonsteroidal antiinflammatory drugs, and/or muscle relaxants, whereas only 34% received advice regarding their diet and life style and only 4% were sent to a back school. Despite significant effects on everyday and personal experiences associated with an increased risk of chronicization, treatments given to low back pain patients consist mainly of symptomatic medication.

[Medico-economic aspects of the management of perennial allergic rhinitis in general medicine]. / Aspects médico-économiques de la prise encharge des rhinites allergiques perannuelles en médecine générale.

A cross sectorial epidemiologic study was conducted in daily medical practice on the cost of perannual rhinitis. This study on 2033 patients shows per consultation the following costs. Medical fees: 130 +/- 45 francs, pharmaceutical expenses: 141 +/- 59 francs, biological and imaging: 109 +/- 174 francs. The indirect costs link to the absent days are evaluated at 776 francs. This rhinitis costs 1156 francs or 380 francs according the fact that the patient stops working or not. The extrapolation of these results to the french population shows 3.42 billions francs for the direct costs and 6 billions for the indirect costs. By comparison to this total amount, medical and pharmaceutical expenses represent only 11.7% and 12.7%.

[Sclerotherapy section of incompetent short saphenous veins: indications, technique, results]. / Section sclérothérapie des saphènes internes incontinentes. Indications, technique, résultats.

UNLABELLED: Sclerotherapy section of the long consists of a combination of ligations, with section and injection of the proximal and distal segment of the long saphenous vein. This technique is performed under local anesthesia 10 centimeters from the saphenofemoral junction and can be performed as an outpatient procedure. MATERIALS AND METHODS: Inclusion criteria are incompetent long saphenous vein diameter over 9 millimeters in older patients whose Duplex-scan examination eliminated other leaking points such as anterior or posterior tributaries or the junction, reflux coming from superficial iliac circonflex veins or from vulvo-pudendal varicose veins. Our study concerned 75 patients. 78 limbs were operated, 72 were reviewed after 1 year and 65 after 3 years. RESULTS: 66 of the 72 limbs (91.6%) had an incompressibility without flux or reflux at the sapheno-femoral junction level after 1 year and 59 of the 65 limbs (90.8%) after 3 years. Sclerosis with incompressibility without flux or reflux was observed in the lower third of the thigh in 51 of the 72 limbs (70.8%) after 1 year and in 40 of the 65 limbs (61.5%) after 3 years, without any clinically detectable underlying varicose recurrence. DISCUSSION: This technique is ambulatory and economic and ensures control of sapheno-femoral junction reflux. In the majority of reflux cases, the reflux observed in the lower third of the thigh is related to a Hunter perforanting vein that can feed an underlying varicose network. They were treated by ultrasound-guided ossifying injection. CONCLUSION: The indications for this technique are incompetence of the sapheno-femoral junction in older patients with trophic disorders, allowing effective treatment of the source of the reflux with rapid healing of underlying trophic disorders.

The use of personal health information for controlling the costs of delivering health care: does the end justify the means?

With the increasing costs of medical care many countries are seeking ways of controlling costs. Two approaches are discussed; the accounting control of costs and the medicalised control of costs. The former provides a very blunt and insensitive instrument while the latter can support best practice and reduce unnecessary examinations. However, the medicalised approach requires limited access to the patients' medical files thus breaching the medical secret. The paper discusses the strict controls necessary to make this approach work in an acceptable fashion.

Nursing and medical care of pressure ulcers in hospitals in France.

The prevalence of pressure ulcers in hospitals in France is given, and the anatomical location of these ulcers is explored. The importance of establishing accurate stages for these wounds is also emphasized. Four methods of cost-effectiveness analysis are proposed and described: analysis of one case; analysis of one ward; analysis of care time; and analysis of one tetraplegic young man.

The emergence of international telemedicine: no ready-made solutions exist.

Sending images to the far end of the world and establishing a diagnosis that may save one human life is a technological success which is very extremely gratifying, scientifically. But it's only the first, though essential, stage towards developing an international telemedicine network. The difficulties of conforming the telemedicine network to technical standards, administrative regulations, and existent national and supranational legislations are presented in this paper; there are often no ready-made solutions to these problems.