Students perceived stress in academic programs: consequences for its management.

BACKGROUND: Academic stress contributes to the deterioration of the students' quality of life. Psychological determinants involved in the stress process, trait anxiety and coping, have been neglected when assessing the role of academic programs in stress. This study aimed at determining whether academic programs are associated with a high level of perceived stress above and beyond potential personal and environmental risk factors, as well as coping strategies. METHODS: A cross-sectional survey was conducted in 2009 among third-year medical (total n=170, participants 88%), dental (n=63, 94%), psychology (n=331, 61%) and sports sciences (n=312, 55%) students in Montpellier (France). The stress level experienced during the last 2months, trait anxiety and coping strategies were appraised. Substance use, psychological care, and stress triggers were also collected using a self-administered questionnaire. RESULTS: Compared with medicine and after adjusting for gender and age, only the sports program was associated with a lower perceived stress risk: adjusted odds ratio: 0.54 [95% Confidence interval: 0.30; 0.99]. Substantial reductions in perceived stress risks were observed in science students after additional adjustments for non-academic stress triggers, substance use, psychological care (adjusted odds ratio: 0.20 [95% Confidence interval: 0.09; 0.41]), and also for trait anxiety and coping strategies (adjusted odds ratio: 0.23 [95% Confidence interval: 0.10; 0.54]). Compared with medicine and after these additional adjustments, psychology had a significantly lower perceived stress risk (0.34 [0.18; 0.64]; 0.40 [0.19; 0.86], respectively), dentistry had a similar risk (0.82 [0.35; 1.91]; 0.53 [0.20; 1.43], respectively). CONCLUSION: Sports and psychology programs had a lower perceived stress risk compared with medicine. Personal and environmental risk factors and coping strategies modified the association between academic program and perceived stress. Developing efficient coping strategies in students and improving academic environment could contribute to prevent the potential deleterious consequences of stress.

[Trends in hospital admissions for asthma in France, 1998-2002]. / Evolution des hospitalisations pour asthme en France métropolitaine, 1998-2002.

BACKGROUND: As the quality of asthma care influences hospital admission rates, we described hospitalizations for asthma and studied trends in admission rates in France from 1998 to 2002. METHODS: Using data from the French hospital information system, admissions for asthma were defined by the J45 or J46 codes (ICD-10) as primary diagnosis, and admissions for acute respiratory failure (ARF) associated with asthma by the J96.0 code as primary diagnosis and the J45 or J46 codes as an associated diagnosis. Annual rates of admission adjusted for age and sex were calculated. RESULTS: During the study period, the adjusted asthma admission rate decreased by 5% per year (from 10.8/10,000 in 1998 to 8.6/10,000 in 2002). A significant decrease was observed in children aged 10-14 years (-5%/year) and in older people (from -7%/year in 15-19 years old to -9%/year in people aged 50 years or more), whereas no significant decrease was seen in youngest children (-2%/year in children aged 0-1 or 5-9 years, +0.1%/year in those aged 2-4 years). Although not statistically significant, an increase in admission rate for ARF associated with asthma was observed (+5%/year). CONCLUSION: Admission rates for asthma decreased between 1998 and 2002 in people aged 10 years and older. However, changes in coding practices or admission policies cannot be excluded and the extent to which the observed trends reflect changes in preventive care among patients with asthma remains to be assessed.

Measuring agreement for ordered ratings in 3 x 3 tables.

OBJECTIVES: When two raters consider a qualitative variable ordered according to three categories, the qualitative agreement is commonly assessed with a symmetrically weighted kappa statistic. However, these statistics can present paradoxes, since they may be insensitive to variations of either complete agreements or disagreements. METHODS: Agreement may be summarized by the relative amounts of complete agreements, partial and maximal disagreements beyond chance. Fixing the marginal totals and the trace, we computed symmetrically weighted kappa statistics and we developed a new statistic for qualitative agreements. Data sets from the literature were used to illustrate the methods. RESULTS: We show that agreement may be better assessed with the unweighted kappa index, kappa(c), and a new statistic zeta, which assesses the excess of maximal disagreements with respect to the partial ones, and does not depend on a particular weighting system. When zeta is equal to zero, maximal and partial disagreements beyond chance are equal. With its estimated large sample variance, we compared the values of two contingency tables. CONCLUSIONS: The (kappa(c), zeta) pair is sensitive to variations in agreements and/or disagreements and enables locating the difference between two qualitative agreements. The qualitative agreement is better with increasing values of kappa(c) and zeta.

[Sensitization to powdered latex gloves: prevalence in hospital employees]. / Sensibilisation aux gants en latex poudrés: une prévalence élevée chez le personnel hospitalier.

INTRODUCTION: The prevalence of latex allergies in industrial countries has skyrocketed since the 1980s. Between 2.6 and 22% of hospital workers are diagnosed with latex allergy, which has been recognized as an occupational hazard in France since 1997. AIM: To assess the prevalence of latex allergy among Montpellier University Hospital Center staff. METHODS: From 1999 to 2002, we interviewed and conducted skin-prick tests on 537 hospital staff members from different departments and with different degrees of exposure to airborne latex allergens. RESULTS: Symptoms while using natural-rubber latex gloves (most often contact dermatitis) were reported by 88 (16.4%) staff members. Overall work-related allergic symptoms included rhinitis, reported by 65 (12.1%), contact urticaria by 28 (5.2%), and bronchial symptoms by 16 (1.1%). In all, sensitization to latex was identified in 7.1% of our staff, and this percentage was higher (11.3%) in units where latex gloves were used more often. Sensitization was associated with high latex exposure and atopy. CONCLUSION: This high rate of latex sensitization and the risk factors are similar to those already published. Based on this study, we have eliminated powdered latex gloves, as have many other hospitals.

Morpho-semantic analysis and translation of medical compound terms.

This paper describes an automatic procedure for morphosemantic analysis and translation of compound medical terms. This analysis is of interest for the automatic indexation of medical discharge reports and summaries. Since words with the suffix -osis may have many different semantic interpretations, such -osis forms are taken as examples for a general method that avoids the difficulties in interpreting medical terms as reported in other studies.

[Measurement of the sus-hepatic pressure gradient in differential diagnosis of chronic persistent or active hepatitis]. / Mesure du gradient de pression sus-hépatique pour le diagnostic différentiel des hépatites chroniques persistantes ou actives.

The value of the hepatic venous pressure gradient, measured during a transjugular liver biopsy procedure, was evaluated in the differential diagnosis of chronic persistent versus active hepatitis. The diagnosis of chronic persistent or active hepatitis was carried out according to classical clinical, biological, and above all pathological criteria. Patients with chronic active hepatitis were divided in to subgroups according to the degree of aggressivity and the presence of cirrhosis. Of the 70 patients studied, 13 had a gradient lower than 0.79 kPa, and all had chronic persistent hepatitis; 48 patients had a gradient higher than 0.93 kPa, they all had a chronic active hepatitis. For the 9 remaining patients, the gradient was between 0.79 and 0.93 kPa, 3 had persistent hepatitis, and 6 had active hepatitis. There was no significant variation of the gradient according to aggressivity in the subgroups of chronic active hepatitis. The gradient separated clearly chronic active hepatitis with or without cirrhosis. The measurement of the hepatic venous pressure gradient allows to differentiate between chronic persistent versus active hepatitis in 87 p. 100 of cases. This simple procedure offers a quick clue to diagnosis before obtaining histologic results.

[Cost-effectiveness of epilepsy surgery in a cohort of patients with medically intractable partial epilepsy--preliminary results]. / Evaluation médico-économique de la chirurgie des épilepsies partielles pharmaco-résistantes de l'adulte. Etude coût-efficacité--résultats préliminaires.

OBJECTIVE: Patients with medically intractable epilepsy are potential candidates for surgery if the epileptogenic tissue is localized and resectable. Surgical therapy can eliminate seizures but is very expensive. We followed a prospective adult cohort of intractable epileptic patients in order to perform a cost-effectiveness analysis. POPULATION AND METHODS: Adult patients with a suspected partial medically intractable and operable epilepsy were eligible for evaluation, explorations and/or surgery. Clinical and economical data were collected at the inclusion and every 6 months over at least two years. Two patient groups were analyzed: some underwent a surgery, others did not. Clinical data were compared between both groups. As the data collection was not yet complete, we compared the surgery to a continuation of the preoperative medical management in a cost-effectiveness analysis. Direct medical and nonmedical costs were evaluated according to a societal perspective. The effectiveness was defined as one year without seizure. We assessed the incremental cost-effectiveness ratio (ICER) for the first two years after the surgery. We also modeled long-term costs and effectiveness and extrapolated the results over the patients' lifetime with a Markov model. We computed the ICER and performed a sensitivity analysis. Indirect costs were measured in physical units and intangible costs were assessed with quality-of-life measures (QOLIE-31, SEALS). Data were compared before and after surgery. RESULTS: Among the 286 patients included, 119 did not enter in the analysis: 7 were not eligible, 44 not operable, 31 did not present a follow-up, 37 still underwent exams. Finally, 89 underwent a surgical treatment, and 78 were medically treated. Disease was more severe in surgical patients than in medical patients: seizures frequency, depressive disorders and cognitive impairment were greater. One year after the surgery, 83% patients were seizure free. During the year before inclusion and the year after surgery, direct costs were mainly due to hospitalization. During the second year after surgery, the cost of antiepileptic drugs predominated. One additional year without seizure costs 23 531 euro one year after surgery and 9533 euro two years after surgery. In a long-term perspective, the surgery became cost-effective between 7 and 8 years after the surgery. CONCLUSION: Surgical therapy is a cost-effective treatment in a middle-term even without indirect costs consideration.

[Contribution of kidney echography to upper urinary tract infection in pregnancy]. / Apport de l'échographie rénale dans les infections urinaires hautes au cours de la grossesse.

The authors carried out a prospective study and also looked at the literature in order to assess the contribution ultrasound makes in the diagnosis of the aetiology of upper urinary tract infections in pregnancy. They studied two matched series (patients and controls). They note that ultrasound is reliable in the aetiological diagnosis of upper urinary tract infections without complications and they discuss its place and the contribution it can make as compared with more invasive investigations of infections of the upper urinary tract in pregnancy (such as I.V.U. and C.T. scanning).

[Recklinghausen's disease and vascular complications during pregnancy]. / Maladie de Recklinghausen et complications vasculaires au cours de la grossesse.

Von Recklinghausen's neurofibromatosis is an illness that quite often has visceral and neurological side-effects (the former in turn as its side-effects on the blood vessels). Although the patients' fertility is maintained the numbers of spontaneous abortions, of premature births and of perinatal mortality are raised. In fact one of the principal effects of this disease on pregnancy is on the blood vessels, giving rise to hypertension and to a drop in the circulation through the placenta, which in turn has well-known consequences. These are: intra-uterine growth retardation, chronic fetal distress and premature labour. As far as vascular aneurysms are concerned, they constitute an indication for termination of pregnancy. We here give a case history of the condition drawing attention yet once more to the need for a multidisciplinary care of the pregnancy in women who have neurofibromatosis.

[Evaluation of the clinical and biologic means of assessing fetal prognosis in pregnancy toxemias. Apropos of 223 cases]. / Evaluation des moyens cliniques et biologiques d'appréciation du pronostic foetal dans la toxémie gravidique. A propos de 223 observations.

Two hundred and twenty-three cases notes of patients with toxaemia of pregnancy were analysed in order to try to establish the ability to predict through clinical and biological assessments of the mother the prognosis for the fetus. Statistical analysis methods were chosen to work out the classification of the parameters and to lead to an index of severity that could be established by a multifactorial discriminating analysis. This study confirms that there is an inversion in the circadian rhythm of arterial blood pressure, with an increase in the evening and at night. It shows how bad prognostically blood pressure instability is. On the other hand oedema of the legs is of no significance. Contrary to the view that has been held for a long time, an increase in weight is directly proportional to fetal parameters. As far as parameters are concerned as a whole (both clinical and biological) a rise in blood urea is more discriminating at every stage of the illness and precedes an increase in the platelet count, the changes in creatinine clearance and night blood pressure. Maternal changes are better correlated with fetal variability before the 35th week of the pregnancy whereas after that date the prognostic value of these readings is of little importance.

[Management of persistent posterior occipital presentation. 253 extractions by forceps]. / Conduite à tenir devant une présentation en occipito-postérieure persistante. A propos de 253 extractions par forceps.

A retrospective study of the notes of 253 deliveries was carried out in the two maternity units attached to the University of Rennes between 1980 and 1985. This followed a review of the literature on delivery of babies presenting with a persistent occipito posterior position. Tarnier's forceps were used in each case with full rotation of the presenting part carried out or else delivery in the occipito posterior position. There were five cases of failed forceps. We have not been able to show that there was a significant statistical difference as far as the neonatal state of the babies was, because to the methods of delivery. On the other hand, there was a greater frequency of urinary-vaginal lesions after full rotation. We therefore suggest that a trial of forceps delivery should be carried out in the operating theatre when the optimal obstetrical conditions have been fulfilled, so long as the manoeuvres are carried out technically easily and so long as Caesarean section is resorted to if all the obstetrical conditions are not fulfilled, or if it seems difficult to deliver the baby with a forceps.

Compared effects of ATP vs adenosine on pulmonary circulation of COPD.

Pulmonary human vasomotor effects of purine nucleotides are unknown. We compared hemodynamic and gasometric effects of ATP vs ADO, using equimolar infusion rate, on 18 chronically hypoxemic COPD patients. ATP infusion (1 and 2 micro Mole per kilo over 20 min) induced pulmonary vasodilation, with a significant decrease of Ppa (-14% -p = 0.025), PVR (-26.6% p = 0.05) and PaO2 (-10.9% p = 0.025). No change was observed when ADO and control solvent were infused. The pulmonary vasodilator effect of infused ATP on COPD patients, seems to be independent of circulating ADO.

Effects of adenosine triphosphate on pulmonary circulation in chronic obstructive pulmonary disease. ATP: a pulmonary vasoregulator?

Extracellular adenosine triphosphate (ATP) has potent systemic vasodilator and endothelial-dependent relaxant effects on precontracted vessels. Pulmonary uptake and metabolism of ATP have been described, but experimental effects on pulmonary vessels remain controversial in animals. The effects of an intravenously administered infusion of ATP on pulmonary hemodynamic and gasometric data were assessed in 18 patients with stable chronic obstructive pulmonary disease (COPD). Low doses of ATP (successive rates, 1 and 2 mumol/kg body weight, each for 20 min) were infused in pulmonary hypertensive (H; n = 6) and nonhypertensive (N; n = 6) patients. They were compared with a control group (C; n = 6) that received only solvent, using ANOVA. During ATP infusion, a significant pulmonary vasodilation was demonstrated as simultaneous decreases reached, respectively, -14.2% (Group H; p less than 0.005) and -13.8% (Group N; p less than 0.001) for mean pulmonary artery pressure (Ppa), and -31.7% (H; p less than 0.05) and -20.7% (N; p less than 0.01) for pulmonary vascular resistances (PVR), associated with some worsening of hypoxemia: -6.9% (H; p less than 0.01) and -11.8% (n; p less than 0.005). After ATP withdrawal, significant rebound of these data (above baseline values) reached +10.9% (H; p less than 0.05) and +4.4% (N; p less than 0.05) for Ppa and +24.9% (H; p less than 0.05) and +10.2% (N; p = NS) for PVR. At the low infusion rate used, ATP appeared to be a well-tolerated, short-acting, selective pulmonary vasolidating compound in patients with COPD, but therapeutic use remains premature.