Descriptive study of the parkinsonian population in the north of France: Epidemiological analysis and healthcare consumption.

BACKGROUND: The "neurodegenerative diseases plan" under elaboration for the Hauts-de-France region requires better knowledge of the patient population and care pathways. In France, the prevalence of Parkinson's disease (PD) has been estimated from cohorts to be about 1-3 per 1000 inhabitants, but exhaustive data are scarce for the general population. The purpose of this study was to evaluate the prevalence of PD in the Hauts-de-France region and to assess PD-related healthcare consumption. METHOD: A descriptive study was conducted to identify the parkinsonian population in the Hauts-de-France region (including the administrative districts of Pas-de-Calais and Picardie) for the year 2014. Parkinsonian patients were identified from health insurance fund reimbursement data using the following criteria: (i) reimbursement for a PD-specific medication; (ii) attribution of long-duration disease status coded as PD; (iii) hospital stay with PD diagnosis in the standard discharge report contained in the French medico-economic database on hospital activity (PMSI). RESULTS: The raw prevalence of PD in the region was 5.03 per 1000 inhabitants aged 20 years and older. The standardized prevalence by health territory ranged from 4.0 to 9.0 per 1000 inhabitants aged 20 years and older. During the 1-year study period, 33.5% of patients had a neurology consultation, 57.1% attended a physiotherapy session, and 7.7% received speech therapy. Most of patients (79.6%) were treated with levodopa, sometimes in combination with a catechol-O-methyl transferase inhibitor (14.4%). Dopaminergic agonists were prescribed in 33.5% of cases. A neuroleptic was prescribed for 6.9% of the population (clozapine for 25.9%). CONCLUSION: The prevalence of PD is high in the Hauts-de-France region with a heterogeneous distribution by health territory. Neurology consultations were attended by a minority of patients in 2014. This work provides perspectives for necessary improvement in specialized care for this disease, both in terms of follow-up consultations and home care.

[Perinatal mortality and quality of clinical management in the Aurore network from 2005 to 2011. Implementation of morbidity and mortality conferences]. / Mortalité périnatale et qualité des prises en charge au sein du réseau Aurore de 2005 à 2011. Mise en place des réunions de morbi-mortalité au sein du réseau.

OBJECTIVES: Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. METHODS: Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. RESULTS: The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4‰ vs. 6,4‰, P<0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P<0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P<0.03) and in type 3 maternities compared to type 1 and 2 maternities (P<0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. CONCLUSION: Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators.

[Intervention of psychological and ethical professionals of human science in obstetrical morbidity and mortality conferences]. / L'intervention des sciences humaines en psychologie et en éthique dans les revues de morbi-mortalité en obstétrique.

OBJECTIVE: To identify the defence mechanisms manifested by medical staff which could disturb the decision making, revealed by professionals of human science (PHS) in morbidity and mortality conferences (MMC). MATERIALS AND METHODS: Application of two methods of psychological intervention in MMC, conducted between March 1st, 2009 and November 30, 2010, in 20 randomized maternity among five perinatal networks: the method of inter-active problem solving targeted at the functioning of the teams and the method for developing professional practice centred on individual. The data collection was realized during analyse of case in MMC, with note-taking by two pair PHS. The oral expressions of RMM' participant were secondarily re-written, analyzed and classed by theme. RESULTS: Fifty-four MMC were performed. The mechanisms of defence have been identified by PHS intervention in MMC: denial of situation, pact of denegation, rift and overprotection. They were be identified by two PHS intervention methods, this consolidates these results. This intervention began staff medical to transformation at different level, in particular to improve the capacity of cooperation. CONCLUSION: The identification of the mechanisms of defence in MMC enables staff medical to improve communication and quality relationship between healthcare professionals. This could constitute an actual factor of practices improvement. However, complementary studies must be performed to confirm this hypothesis.

Streptococcus pneumoniae vaccinal coverage in hospitalized elderly patients in France.

BACKGROUND: In France, there is little data on vaccinal coverage in elderly people at risk for invasive pneumococcal infections (IPI). OBJECTIVE: The study objective was to assess the pneumococcal vaccination coverage and traceability in hospitalized elderly people (>75 years of age). METHOD: A multicentric point prevalence survey was made on volunteers over 75 years of age, hospitalized in internal medicine, geriatrics, and infectious diseases units. RESULTS: Nine hundred and three patients in 63 units of 28 hospitals were included (mean 85 years of age) in the study between April and May 2011. Ten percent (93/903) were vaccinated against the pneumococcus. Thirty-eight percent of the patients had at least one risk factor for IPI and 20.5% of these had been vaccinated. There was a traceability back-up in 59% of the cases. Vaccination was not considered by the hospital for 83% of patients with IPI risk factor but not vaccinated (task delegated to the family physician in 50% of the cases). CONCLUSION: Vaccination coverage against the pneumococcus in France is very low in hospitalized patients over 75 years of age even though more than one out of three presents at least one risk factor for IPI. The rate of traceability is also poor. Hospitalization should be an opportunity to offer pneumococcal vaccination to elderly patients at risk for IPI in France because of unclear recommendations for elderly individuals and lack of political will to improve vaccination coverage.

[Assessment of mortality morbidity conference in obstetrics: literature review]. / Évaluation de l'impact des revues de morbi-mortalité en obstétrique: revue de la littérature.

OBJECTIVES: To assess this effectiveness of morbi-mortality conference (MMC) in improving quality of care. MATERIALS AND METHODS: A review was carried out by searching Medline, Pascal and Cochrane databases, Google scholar and websites of French obstetrics professional societies, until July 2011. Search terms included morbidity, mortality, conference, and obstetrics. The eligible reports of assessment of MMC in obstetrics have been analysed by four reviewers with a standardized form. RESULTS: Among 319 records identified, four observational studies published between 2009 and 2011 were included. The objective of these MMC was students' training (n=2), quality of care improvement (n=1), or both (n=1). The MMC organization was heterogeneous. The impact of MMC was assessed using qualitative (n=2), semi-quantitative (n=1) or quantitative (n=1) method. None of these studies showed a significant impact of MMC on students' training or quality of care. CONCLUSION: Available evidence is insufficient to evaluate the effectiveness of MMC in improving quality of obstetrics care.

Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in France.

BACKGROUND: In France obstetric haemorrhage is the leading cause of maternal death. The aim of this study was to evaluate if the management of postpartum haemorrhage at individual maternity units followed guidelines established by the Aurore Network. METHODS: A descriptive study was carried out in 16 maternity units of the Aurore network between October 2004 and September 2005. Cases and data were prospectively identified and collected. RESULTS: Postpartum haemorrhage occurred in 1144 of 21 350 deliveries, an overall incidence of 5.4+/-0.3%. Of these, 316 cases were rated as severe. Diagnosis was clinical in 82.5% of severe cases and 77.5% of non-severe cases; the remainder were detected by postpartum laboratory tests. Uterotonic agents were given prophylactically to 46.7% of the 896 patients following vaginal delivery. In cases in which postpartum haemorrhage was due to uterine atony, 83.1% of women underwent examination of the uterine cavity and 96.3% received oxytocin, which proved therapeutic. Sulprostone was administered to 39.5% cases of persistent postpartum haemorrhage. A uterotonic was given prophylactically to 85.4% of the 247 patients at caesarean delivery. Oxytocin was therapeutic in 94.8% of cases of uterine atony. Sulprostone was administered in 84.4% of cases of persistent postpartum haemorrhage. CONCLUSION: The regional guidelines issued by the Aurore network were only partially followed. More effective guideline dissemination and implementation is required to improve the prevention and management of confirmed haemorrhage.

[Which future for Rhône-Alpes area obstetrical units? Thoughts of demography survey on Rhône-Alpes area obstetricians]. / Quel avenir pour les maternités de la région Rhône-Alpes? Réflexions à propos d'une enquête démographique réalisée auprès des obstétriciens de la région Rhône-Alpes.

OBJECTIVE: To describe the demography of obstetricians who practice an obstetrical activity and to forecast the needs of practitioners at five and 10years in Rhône-Alpes area. MATERIAL AND METHOD: Descriptive survey on 58maternities of Rhône-Alpes area in 2007. RESULTS: A total of 56maternities provided sufficient data. It was found that 321obstetricians actually had an obstetrical activity (deliveries, maternity ward). The average age of obstetricians was 40,9years for those practicing in teaching hospitals, 50,4years in other public hospitals and 52,6years in private settings. The needs in obstetricians for Rhône-Alpes area are expected to be 80 in five years and 150 in 10years. Considering the number of young obstetricians who choose obstetrical practice, the lack of obstetricians is expected to be 55 in five years and 100 in 10years. CONCLUSION: It's urgent to take measures to increase the number of student in gynaecology and obstetrics stream and to encourage junior obstetrician to choose obstetrical activity.

[Food allergy in the child: an exploratory study on the impact of the elimination diet on food neophobia]. / Impact du régime d'éviction sur la néophobie dans le cadre d'une allergie alimentaire chez l'enfant : étude exploratoire.

OBJECTIVES: This study was designed to analyse the impact of an elimination diet in children with food allergy, and its perception by their parents on the later reticence of children to test unknown foods, food neophobia. METHODS: The degree of food neophobia of children having outgrown their allergy (mean age, 7 years 2 months) was compared to that of a sibling (9 years 5 months) using a standardized scale and a questionnaire of food friendliness. Parents were also asked to fill in a questionnaire on the disease and its burden on the family. RESULTS: Children having outgrown their allergy are more reluctant to test new foods than their non-allergic brother or sister, as shown by their scoring on the food neophobia scale and the number of unknown foods following the cure of the disease. Two factors increase the level of food neophobia, the distressing effect and the duration of the period elapsed until the diagnosis was made, as well as the distressing effect and the lack of variety in the meal preparation. CONCLUSION: Food neophobia, a normal phase between 2 and 10 years, is worsened by the elimination diet required by food allergy, especially in case of late diagnosis and when the time elapsed before diagnosis and the preparation of meals were perceived as difficult to bear.

Medical and social differences between French and migrant patients consulting for the first time for HIV infection.

The objectives of the study were to describe the medical and social characteristics of patients consulting for the first time after diagnosis of HIV-infection and to compare the medical and social characteristics between French and migrant patients. From 1 January 2001 to 31 December 2002, all consecutive adults consulting for the first time for HIV infection in two HIV outpatient clinics located in the western suburb of Paris, agreed to an interview based on an administered questionnaire regarding their medical and socioeconomic characteristics. Of the 203 patients (98 women, 105 men), one-third (n=70) was of French nationality. Delay (+/-SD) in access to HIV outpatient clinic after diagnosis was shorter in migrant than in French patients, respectively 7.6+/-29.6 months (median=0.5, range=0 to 196.6) and 23.8+/-51.4 months (median=0.9, range=0 to 199.7); p=0.005. There was no significant difference in the medical characteristics between the two groups of patients on their first consultation. However, most of the migrants were living in very poor socio-economic conditions with minimal resources thus sometimes delaying initiation of HAART. The development of social facilities for HIV-positive migrants should be a public health priority.

Dual-probe pH monitoring for the assessment of gastroesophageal reflux in the course of chronic hoarseness in children.

The purpose of our study was to assess gastroesophageal reflux (GER) by dual-probe pH monitoring in children suffering from chronic hoarseness for more than six months. Seventeen children (aged between 2 and 12 years, 10 boys and 7 girls) were enrolled. All children underwent a laryngoscopy and a 24-hour dual-probe pH monitoring. At both sensor, distal and proximal esophageal, a pathological GER was defined as the presence of episodes of acid reflux with pH < 4 during a fraction of the total recording time greater than 5.2 percent. The computer considered the child was supine when asleep and upright when awake. Laryngoscopy revealed interarytenoid erythema and/or edema with vocal cord nodules or granulomas in 13 cases (76.4%), isolated vocal nodules or granulomas in three cases (17.6%) and a normal appearance in one case (5.8%). At both sensors, the majority of refluxes occurred when the child was upright, as analyzed by the percentage of time the intra-esophageal pH was below four (% time pH < 4), number of refluxes, reflux episodes/hour and longest reflux episode, p < 0.05 between upright and supine for each parameter. The median total % time pH < 4 on the proximal and distal probes was respectively 1.62 percent (95% CI 1.50-3.79) and 11.49 percent (95% CI 8.81-27.17), p < 0.0003. Among the 17 hoarse children, a pathological GER was observed in 12 (70.5%) at the distal sensor and in three (17.5%) at both sensors. Among the 16 hoarse children with abnormal findings on laryngoscopy, two (12.5%) had diagnosed pathological GER at the proximal and 11 (68.7%) at the distal sensor. The only child with normal findings on laryngoscopy exhibited a pathological GER at both sensors. Our results suggest that chronic hoarseness is associated with a pathological GER. The majority of these documented refluxes occurred when the child was awake.

A two-center study evaluating the hemodynamic and pharmacodynamic effects of cisatracurium and vecuronium in patients undergoing coronary artery bypass surgery.

OBJECTIVE: To determine the hemodynamic and pharmacodynamic effects of rapid bolus administration of cisatracurium compared with vecuronium. DESIGN: A randomized, prospective, double-blind study. SETTING: Tertiary-care university hospitals. PARTICIPANTS: Seventy-nine adult patients with diagnosed coronary artery disease (CAD). INTERVENTION: Elective coronary artery bypass graft surgery (CABG). MEASUREMENTS AND MAIN RESULTS: Patients were randomly divided into four groups. Patients received a rapid bolus of two or four times the 95% peak depression of twitch (ED95) of either cisatracurium (groups 1 and 2) or vecuronium (groups 3 and 4). Three minutes after a midazolam induction, all patients received a rapid bolus administration of either study drug. Maintenance of anesthesia was with a standardized propofol-sufentanil-oxygen anesthetic. Patients were monitored with radial and pulmonary artery catheters and electromyography. End points of the study were hemodynamic stability at induction, after bolus administration of study drugs, and after intubation; the quality of intubating conditions; drug interventions to correct hemodynamic instability; the onset, duration, and recovery of neuromuscular function; and drug cost. Mean arterial pressure (MAP) and heart rate (HR) decreased in a similar proportion in all four groups after induction while, following study drug administration, MAP and HR did not change significantly. Both cisatracurium groups required more boluses to maintain neuromuscular block, but spontaneous recovery rates were faster. Both agents, but cisatracurium to a lesser degree, showed increased duration with repeated maintenance doses. Both agents afforded good to excellent intubating conditions, but the cost of cisatracurium was significantly less. CONCLUSION: The authors conclude there is no evidence of a hemodynamic difference between the two neuromuscular blocking drugs (NMBDs). There are some clinical and cost advantages in favor of cisatracurium.

Magnesium deficiency-dependent audiogenic seizures (MDDASs) in adult mice: a nutritional model for discriminatory screening of anticonvulsant drugs and original assessment of neuroprotection properties.

A great many animal models for audiogenic seizures have been described. The extent to which these models may provide insight into neuroscience fields such as abnormal locomotor behavior (wild running), seizures and anticonvulsants, and neuroinsults and neuroprotectors is examined here by our study of magnesium deficiency-dependent audiogenic seizures (MDDASs) in adult mice. MDDASs were induced in all of the eight tested adult murine strains and are presented as a sequence of four successive components (latency, wild running, convulsion, and recovery phase periods). Compared with several classic seizure tests, the nutritional MDDAS model responded to low doses of prototype antiepileptic drugs (AEDs), including phenytoin (PHT), carbamazepine (CBZ), phenobarbital (PB), valproic acid (VPA), ethosuximide (ESM), and diazepam (DZP). Modulation by AEDs of the four components of MDDAS indicated that this seizure test was discriminatory, distinguishing between phenytoinergic (PHT, CBZ), GABAergic (PB, VPA, DZP), and ethosuximide (ESM) compounds. Suitability of the MDDAS test for evaluation of neuroprotective compounds was also examined: it showed partial (melatonin) and complete (WEB2170, an anti-PAF agent) reduction of recovery phase by non-anticonvulsant doses of test compounds. These neuroprotective responses were compared with neuroprotective potentials determined in a model of neonatal cerebral injury induced by focal injection of ibotenate (a glutamate analog). WEB2170 and melatonin reduced the size of lesions in white matter, but only WEB2170 protected cortical plate against ibotenate-induced lesions. In addition to the original neuroprotective behavior of WEB2170, studies on the neuroprotectors also supported GABAergic anticonvulsant activity of melatonin in the MDDAS test.

Assessment of the arterial tonometer (N-CAT) for the continuous blood pressure measurement in rapid atrial fibrillation.

The N-CAT is a newly developed arterial tonometer (TBP) able to determine systolic, diastolic and mean arterial blood pressures continuously and noninvasively. The aim of this study was to evaluate the accuracy and reliability of TBP relative to directly measured invasive blood pressure (IBP) in ten haemodynamically stable postoperative cardiac patients who were in rapid atrial fibrillation (HR > or = 100 bpm). There were differences between TBP and IBP for systolic (-1.7 mmHg) and diastolic (+0.9 mmHg) values but not for the mean arterial blood pressures. The N-CAT was able to follow blood pressure changes closely and demonstrated an average systolic, diastolic and mean bias (+/-SD) of -1.71 +/- 4.6, 0.99 +/- 4.6 and 0.33 +/- 4.2 mmHg, respectively. Although these biases are within the required standards for equivalency for noninvasive blood pressure to invasively determined blood pressure, approximately 20% of the readings were > +/- 10 mmHg while only 5% were > +/- 20 mmHg. Moreover, there were occasional discrepancies of sufficient magnitude and duration which may limit the clinical usefulness of the N-CAT in patients in whom continuous and accurate blood pressure measurement is required.