Neuropathic pain in patients with chronic leg ulcers.

BACKGROUND: Leg ulcers are a frequent and often painful disorder. This pain is not always correctly evaluated and relieved. OBJECTIVES: The aim of this prospective study is to assess the contribution of neuropathic pain in leg ulcers. METHODS: A visual analog scale and the DN4 questionnaire were fulfilled by 81 patients with leg ulcers. RESULTS: Of the patients with leg ulcers, 58% (n = 47) had a positive DN4 score. No predictive factor leading to neuropathic pain was found. The aetiology of the ulcers did not influence the DN4 score. CONCLUSIONS: This high prevalence of neuropathic pain in leg ulcers might be explained by an impairment of peripheral nerves due to ischaemia. This study also highlights the difficulty to relieve pain in chronic wounds; 16 patients had an analogous visual scale above 7. These results should encourage practitioners to regularly screen for neuropathic pain and to initiate appropriate treatment if necessary.

[Microbiological evaluation of cystoscope reprocessing at Brest university hospital from January 2007 through December 2014]. / Évaluation microbiologique de la désinfection des cystoscopes souples au CHRU de Brest de janvier 2007 à décembre 2014.

PURPOSE: Flexible cystoscopes are high temperature sensitive devices that must undergo high-level disinfection according to Spaulding classification. The objective of this study is to provide epidemiological data on the monitoring of microbiological quality of cystoscopes used in a teaching hospital, in order to determine the compliance rate of disinfection and to describe the main identified microorganisms. MATERIAL: Prospective study of all the results of microbiological samples taken for 8 years at the Brest teaching hospital. The analysis results were interpreted according to the ministerial recommendations. RESULTS: During the study, 87 microbiological tests were performed. The rate of non-compliant samples was 19.5% (17/87). This rate reached 24.5% (12/49) of the programmed controls. The microorganisms identified were present in small amounts, corresponding mainly to bacteria from the environment. CONCLUSION: The rate of non-compliance of the microbiological tests performed on cystoscopes is relatively high (19.5%), but the infectious risk seems limited. Hidden microorganisms are present in small quantities and identified germs are not known to be responsible for urinary tract infections. Educating professionals responsible for cystoscopes reprocessing and conducting regular audits may help to ensure a good level of cystoscope disinfection.

[Incidence of skin and non-skin cancers in Afro-Caribbean renal transplant recipients: Guadeloupe data from 2004 to 2011]. / Incidence des cancers cutanés et non cutanés chez les transplantés rénaux afro-caribéens : données guadeloupéennes de 2004 à 2011.

BACKGROUND: Cancer is the main complication of transplantation surgery. The literature concerning renal transplant recipients among the Afro-Caribbean population is scant. The aim of this study was to determine the incidence of cancer in these patients, with the secondary objective being to identify predisposing factors for cancer. PATIENTS AND METHODS: This was an epidemiological and retrospective study that included all Guadeloupians of phototype V-VI undergoing renal transplantation from 01/01/2004 to 31/12/2011. Skin cancer screening was performed before transplantation and during an annual dermatological consultation following transplantation. Screening for non-cutaneous cancers was guided by clinical symptoms or by the results of the screening examinations recommended in the current guidelines. At the study time-point (31/12/2011), all patients were examined by a dermatologist. RESULTS: One hundred and two patients were included : 42 women and 60 men (mean age: 52.1±11.6 years at transplantation). Eight cancers were diagnosed. The cumulative incidence of cancer was 7.8% at 3 years. Three factors were associated with more rapid onset of cancer: personal history or familial history of cancer, and genital lesion induced by HPV. CONCLUSION: Our results suggest a low incidence of cancer in Afro-Caribbean renal transplant patients. Personal or family history of cancer and HPV-induced genital lesions would appear to accelerate the onset of cancer in this population.

[Update of the 2013 consensus conference "Management of the preoperative risk of infection"]. / Mise à jour 2013 de la conférence de consensus « Gestion préopératoire du risque infectieux ¼

UNLABELLED: The surgical site infections (SSI) are rare adverse events that may have severe consequences in terms of morbidity, mortality and costs. Guidelines on the preparation of the patient can reduce the risk of SSI. Previous guidelines were published in 2004. MATERIAL: A steering committee and a group of experts were established after seeking professional societies that had participated in the previous guidelines. The working group has defined the objectives of revising and retained two main themes: skin preparation and nasal decolonization of patients with Staphylococcus aureus. We chose to report only the work done on the patient skin preparation. The working group relied on the method of recommendation for clinical practice of the High Authority for Health (HAS). The GRADE approach was used to analyze the articles published since 2004. RESULTS: It is recommended to perform a preoperative shower but when does not matter. The use of a simple soap seems sufficient. Shampoo does not seem essential nor removal of varnish in the field of urology. Impregnated fabrics, adhesives fields and bacteriological insulating films are of little use to reduce the risk of infection. The depilation is not routinely required. It is recommended to perform a cleansing on contaminated skin. The use of an alcohol antiseptic is preferred, the successive application of two different antiseptics range is possible. CONCLUSIONS: The updated guidelines on the patient skin preparation before urological surgery was necessary. It changed some guidelines that should appear in our daily practice.

Bed bug infestation in a French university hospital: control strategy, financial impact and perspectives.

BACKGROUND: With the increase in international travel and development of insecticide resistance, a re-emergence of the bed bug has been observed since the 2000s and it is becoming a worldwide public health problem. Hospitals and other medical settings have not been spared, while the cases reported remain limited. However, there are no specific recommendations for the healthcare settings in the literature. AIM: To report our experience of a bed bug infestation in a medical unit, in the French University Hospital Centre of Brest, caused by the admission of a patient carrier in October 2020. We described the practical methods used to control bed bugs infestation, evaluated the cost of this episode and created a specific procedure to take care of at-risk patients or known carriers of bed bugs. FINDINGS: The decision to close the unit for global treatment was taken after the investigations using a sniffer dog revealed that four rooms were infested. The closure lasted 24 days. We estimated the total cost of the infestation to be approximately US$400,000. No other wave of infestation occurred. We created a specific protocol of care for patients who were known carriers or at risk of carriage of bed bugs to graduate a strategy of control. CONCLUSION: Bed bug infestations in health facilities have a major impact on the care of patients and relevant economic consequences. Prevention and education policies are an essential starting point to respond to the scale of the phenomenon.

[Microbiological investigation of endoscopes at Brest Hospital over a period from 2007 to 2009]. / Contrôles microbiologiques des endoscopes au centre hospitalier régional de Brest du 1(er) janvier 2007 au 31 décembre 2009.

OBJECTIVES: The aim of this study is to evaluate the quality of disinfection of endoscopes at Brest hospital over a period from 2007 to 2009. PATIENTS AND METHODS: Retrospective study of microbiological investigations of endoscopes done at Brest hospital from 2007 to 2009. The interpretation of the microbiological investigations is based on the recommendations of the Comité technique national des infections nosocomiales et infections liées aux soins (CTINILS) of 2007. RESULTS: Most of the controls realized over the period deal with gastroenterological endoscopes (63.4 %) and bronchial endoscopes (21.8 %). Most of the controls (66.8 %) are conformed to the target level. Only 26.7 % of the controls get the level of action. Globally, the rate of level of action significantly increases (p=0.004) from 2007 (21.2 %) to 2009 (35.6 %). This increase is relatively important in gastroenterology endoscopy (46.8 % in 2009 versus 24.1 % in 2007) whereas the rate decreases in bronchial endoscopy (14.8 % in 2009 versus 25.9 % in 2007). In gastroenterological endoscopy, rates vary with the type of endoscopes and the context of controls, but there is no significant difference between manual disinfection and automated disinfection. The most frequent germ found in gastroenterological and bronchial endoscopies is Pseudomonas aeruginosa. CONCLUSION: Our results show that it is very difficult to insure a perfect disinfection of endoscopes. Difficulties met are certainly related with the complexity of the endoscopes and of the techniques of disinfection. Infections of patients are very infrequent in endoscopy, which takes the question of the pertinence of the threshold used for microbiological investigations.

[The scourge of vaccine tampering]. / Le fléau de la falsification des vaccins.

Fake vaccine trafficking is a recent but growing phenomenon, which represents a severe threat to public health. During the Covid-19 pandemic, Covid vaccines have been a prime target for traffickers, but all types of vaccines are falsified by profit-hungry criminals.The consequences of falsification on global health are serious: decline in vaccination coverage, loss of control of epidemics claiming yet more victims, resurgence of diseases that been under control. Fake vaccines also fuel the mistrust of populations towards science and towards the authorities.In order to tackle this scourge, a general and coordinated mobilization of all actors concerned is urgently needed: health professionals, political decision-makers, police and customs forces, judges and prosecutors, without forgetting the crucial awareness-raising of public opinion.

Study on the transfusion representation by nurses and midwives at the university hospital of Brest.

INTRODUCTION: Every day, large numbers of patients benefit from effective transfusion substitution therapy, through transfusion procedures that are generally safe and reliable. This care practice is complex, due to its history through the ages, ethical aspects linked to the donation of blood from one human to another, and the procedures and protocols linked to it. Nurses are a key link in the transfusion chain and are directly affected by the procedures implemented to limit transfusion risks. In this research study, we studied the nurses' and midwives' representations of transfusion, to evaluate their possible effects on transfusion practices. METHODOLOGY: With the aid of the various actors involved in transfusion, we developed and tested a questionnaire, which was then sent to 690 professionals in 69 care units. RESULTS: In total, 491 questionnaires were analyzed, corresponding to a response rate of 71%. The data collected revealed a strong feeling of responsibility among the healthcare staff questioned, with great attention paid to transfusion safety. The risk to the patient is very much taken into account by these professionals, who consider transfusion to be a healthcare practice unlike any other, generating a certain stress that affected all those questioned, regardless of the number of years they had been in practice, but was tempered by knowledge. CONCLUSION: This survey shows that nurses and midwives are very aware of the risks of transfusion to the patient, and that they take these risks into account with the same diligence throughout their careers. It would be useful to carry out semi-directed interviews to refine some of these results further.

Pulvinar and pubic cartilage measurements to refine universal ultrasound screening for developmental dysplasia of the hip: Data from 1896 infant hips.

PURPOSE: Screening modalities for Developmental Dysplasia of the Hip (DDH) and indications for treatment of mild forms remain controversial. Ultrasound (US) measurement of the pubofemoral distance (PFD > 6 mm, composed of the pubic cartilage and the pulvinar) can avoid late diagnoses of DDH. A thick pubic cartilage may nevertheless lead to false positives. The purpose of this study was to establish standard measurements of pubic cartilage and pulvinar, through universal US screening, to lower false positive results and thus any overtreatment. METHODS: This is a single-center observational prospective study conducted from December 2016 to January 2018, on infants who underwent universal US screening for DDH. The only inclusion criterion was an adjusted age between 4 and 12 weeks when US was realized. PFD measurement was made using the Couture and Tréguier method. In addition, thicknesses of pubic cartilage and pulvinar were measured on the same US section, in millimeters. RESULTS: Nine hundred and forty-eight patients, representing 1896 hips, were included. The average value of pubic cartilage thickness was 1.25 mm ±â€¯0.58 mm, with an upper threshold of 2.39 mm (+1.96σ). The average value of pulvinar thickness was 2.67 mm ±â€¯0.78 mm, with an upper threshold of 4.20 mm (+1.96σ). We found high inter-observer reproducibility in pubic cartilage measurements. CONCLUSION: Systematic measurements of pubic cartilage and pulvinar may refine therapeutic decision by identifying false positives. Patients with increased PFD due to a thick pubic cartilage >2,39 mm, without an associated pulvinar enlargement (<4,20 mm), could be therefore only monitored and not overtreated.

Wearing of face masks by healthcare workers during COVID-19 lockdown: what did the public observe through the French media?

Wearing a face mask is a major issue in the fight against the spread of the COVID-19 pandemic. The French general population widely started to wear this personal protective equipment usually dedicated to healthcare workers, without being educated to its correct use. People base their behaviour on what they see in the media. However, we observed that mask wearing of healthcare workers published in the media during the pandemic only conformed to good practice guidelines in 70.8% of the photographs collected on some of the main French information websites. Health authorities should communicate widely regarding the good practices for mask wearing in the general population.

COVID-19-associated shortage of alcohol-based hand rubs, face masks, medical gloves, and gowns: proposal for a risk-adapted approach to ensure patient and healthcare worker safety.

The coronavirus disease 2019 (COVID-19) pandemic has caused a huge demand for alcohol-based hand rubs, medical gloves, face masks, and gowns in healthcare and from the public. More and more hospitals face a serious shortage of these articles. We propose a risk-adapted approach to ensure adequate patient and healthcare worker safety for as long as possible.

Prion disease and recommended procedures for flexible endoscope reprocessing - a review of policies worldwide and proposal for a simplified approach.

Several guidelines recommend specific treatments for endoscopes, procedures of quarantine for endoscopes, or additional treatments for the endoscope washer disinfector (EWD) in suspected or confirmed cases of Creutzfeldt-Jakob disease (CJD) or variant CJD (vCJD) but vary in many details. This study therefore reviewed guidelines on reprocessing flexible endoscopes after use in patients with suspected or confirmed prion disease. In addition, a literature search was performed in Medline on prion, CJD, vCJD, chemical inactivation, transmission healthcare, epidemiology healthcare, concentration tissue human and endoscope. Thus far, no case of CJD or vCJD transmitted by flexible endoscope has been reported. In animals it has been shown that oral uptake of 0.1-5 g of bovine spongiform encephalopathy (BSE)-infected brain homogenate is necessary for transmission. The maximum prion concentration in other tissues (e.g., terminal ileum) is at least 100-fold lower. Automated cleaning of endoscopes alone results in very low total residual protein ≤5.6 mg per duodenoscopes. Recommendations vary between countries, sometimes with additional cleaning, use of alkaline cleaners, no use of cleaners with fixative properties, use of disinfectants without fixative properties or single-use disinfectants. Sodium hydroxide (1 M) and sodium hypochlorite (10,000 and 25,000 mg/L) are very effective in preventing transmission via contaminated wires implanted into animal brains, but their relevance for endoscopes is questionable. Based on circumstantial evidence, it is proposed to consider validated reprocessing as appropriate in the case of delayed suspected prion disease when immediate bedside cleaning, routine use of alkaline cleaners, no fixative agents anywhere prior to disinfection and single use brushes and cleaning solutions can be assured.

Investigation of Stenotrophomonas maltophilia epidemiology in a French cystic fibrosis center.

BACKGROUND: Stenotrophomonas maltophilia is an emerging opportunistic pathogen. The increasing incidence is of particular concern in patients with cystic fibrosis (CF). Since 2012, the Western France has witnessed high annual prevalence of S. maltophilia colonization/infection. This retrospective cohort study investigated the epidemiology of S. maltophilia emergence in the CF center of Roscoff, Western France, a region of high prevalence of CF in Europe. METHODS: All CF patients with S. maltophilia isolated in respiratory samples between December 2013 and February 2017 were included. For each patient the colonization status with S. maltophilia was determined. The epidemiological and microbiological characteristics collected were compared between colonization statuses. RESULTS: S. maltophilia was isolated in 90 patients (42 males, 48 females). Mean age at first colonization was 24.4±13.5 years. Annual prevalence since 2013 was high (16-17.9%), but stable. This high prevalence is mainly due to a high rate of intermittent colonization. Only 2.8% of CF patients showed chronic colonization, with significantly more frequent co-colonization by methicillin-susceptible Staphylococcus aureus (P<0.0001) and Pseudomonas aeruginosa (P<0.05). During chronic colonization, S. maltophilia acquired resistance to cotrimoxazole and ß-lactams. Interestingly, there were cases of decolonization. CONCLUSION: This is the first epidemiological report of S. maltophilia in a French CF center. Prevalence was stable but above the national average. Most cases were intermittent; chronic colonization was rare.

[Serological study carried out in Cambodia during a tetanus vaccination in adults]. / Résultats d'une enquê te sérologique réalisée au Cambodge lors d'une vaccination antit ténique des adultes.

In 1997, the Ministry of Health tested the feasibility and serological activity of a two-dose vaccine at one year interval within a catch-up tetanus immunization programme in a rural population. In the district of Angkor Thom in the Siem Reap province (15,000 inhabitants), a team of nurses and administrative clerks travelling by motorcycle, conducted between February 1998 and February 1999 an EPI and tetanus immunization of the whole population gathered in meeting points. In 132 childbearing age female volunteers, 49 following a two-dose schedule at one year interval, and 70 following a WHO three-dose schedule, with two doses at one month interval and a booster dose one year later tetanus antibodies have been measured before vaccination, one year after the first dose or the two first doses, and six months after the second or third dose of vaccine. 129 male volunteers of the same age were also recruited in the serological study following only the two-dose schedule. The titration was done first with monoantigen ELISA, then with mouse seroneutralisation, the reference method for measuring tetanus seroprotection. Only 148 (57%) volunteers completely attended the serological study Compared to seroneutralisation, sensitivity for seroprotection with ELISA was 89% (CI95%: 85%-94%) and specificity 84% (CI95%: 81%-89%). The coverage of the general population vaccinated with two doses, in both sexes and in all age-groups, increased on average from 5% to 70%. The three-dose schedule gave significantly more protection than the two-dose schedule in women tested with seroneutralisation. On a first sample in those with no protective antibodies and testifying they had not been vaccinated before, 51% of these volunteers after one dose and 93% after two doses acquired protective antibodies. On first sample, 52% of female volunteers had protective antibodies in seroneutralisation, against 11.7% in men. 14% of subjects tested in ELISA and 6.8% tested in seroneutralisation showed in a second sample a decrease in titres, although they had received a tetanus vaccine. For unprotected volunteers on first sample and testifying they had not been vaccinated before, neither age nor past chronic cutaneous lesions or cows living around their houses, two possible sources of contact with CI. tetani, increased significantly seroconversion. Only female volunteers were significantly more seroconverting (81%) compared to men of same age (51%) (RR: 1.60, CI95%: I. 17-2.18) suggesting a memory bias in women supposed to be vaccinated by EPI. 30% of volunteers in ELISA and 14% in seroneutralisation showed spontaneous protecting antibodies in the first sample without having any document or memory of a past tetanus vaccination. Tested by seroneutralisation, no relation was to be found for having spontaneous antibodies with past chronic cutaneous lesions and cows living around their houses. Only the eldest (35-45 y.o.) female volunteers showed significantly more spontaneous antibodies (RR: 3.83, CIs%: 1.74-8.2) than men in the same age-group. A memory bias may be found also in this female age-group. Good serological response should encourage implementation of a catch-up tetanus vaccination in this country considering the large number of unprotected adults, mainly male adults. Due to problems with notification and recalling past vaccinations, only a prospective study in an unimmunized large cohort, studying all possible factors of tetanus toxin neutralisation, could confirm the existence and cause of spontaneous antibodies. Excluding vaccination in at-risk population for such a study would be however ethically unacceptable.

[Eradication of infectious diseases by vaccination]. / L'éradication des maladies infectieuses par la vaccination.

Vaccination can achieve global eradication of transmissible diseases presenting certain features, i.e., low incidence of inapparent forms, existence of a single stable pathogen, strictly human reservoir, inter-human transmission involving no vector, and availability of an effective well-tolerated low-cost vaccine. After the triumphant eradication of smallpox demonstrated the feasibility of universal immunization, the WHO launched a vaccination program against poliomyelitis. Although total eradication of poliomyelitis has proven to be a more difficult challenge, it will likely be achieved provided that necessary funding is provided and that the government commitment in affected countries is strong. No other global eradication programs are currently planned even though there are several potentially eradicable diseases including measles and rubella. These two diseases have practically been eliminated in industrialized countries. In developing countries, WHO objectives now call for controlling measles by vaccination to reduce fatalities and attempting to eliminate neonatal tetanus that was, until only recently, a major cause of newborn mortality.

[Prevalence of teenage sleeping disorders]. / Troubles du sommeil chez les lycéens : prévalence et facteurs associés.

Teenage sleeping disorders can have short- and long-term consequences such as learning disorders, accidents, depression, and type 2 diabetes. OBJECTIVE: To assess the prevalence of sleeping disorders in high school students in the southwest of Brittany (Finistère), France. To search for family and social factors causing these disorders and drug use. METHOD: Observational multicenter study that took place in May, 2015, asking high school students to anonymously complete a questionnaire during school time. A variable was created: sleep disorders (TrS+) when teenagers responded "often" or "very often" to at least one of the six questions concerning sleeping disorders. RESULTS: The prevalence of TrS+ was 73 % (4170/5556). These teenagers had difficulty falling asleep (36 %), woke up during the night (33 %), or had nightmares (10 %). Their sleep routine was disrupted (35 %), they did not feel rested the following day (49 %): 9 % were late for class related to their sleeping disorders. TrS+ were more recurrent among females (OR: 2.64; P<0.0001). A negative atmosphere in high school (OR: 2.64; P<0.0001), tobacco use (>10 cigarettes per a day) (OR: 2.39; P<0.0001), alcohol (OR: 1.4, P=0.009), marijuana (<1 time per day; OR: 2.05; P=0.009), and time spent using a computer or watching television (>8h per a day; OR: 2.7; P<0.0001) had an impact on their sleep quality. Ten percent of TrS+ individuals consume medications and 9 % cannabis to help them fall asleep. CONCLUSION: Technology, drugs, and well-being at school have an impact on sleep quality. Screening of teenagers with sleeping disorders and information programs for teenagers must be provided by the teaching and medical staff.

[Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003]. / Taux de couverture vaccinale contre la grippe en France: analyse démographique transversale des saisons 2001-2002 et 2002-2003.

INTRODUCTION: Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field. RESULTS: Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%). CONCLUSION: Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

A comparative approach to the French medical missions in Brazil and in sub-Saharan Africa before the Second World War.

Franco-Brazilian cooperation in the field of microbiology and tropical diseases dates back to the onset of those disciplines. Physicians were sent over by France, namely Marchoux, Simond and Salimbeni from 1901 to 1905 to study yellow fever, and Emile Brumpt from 1913 to 1914 to teach parasitology. These missions brought in some important results. After confirming that the yellow fever agent was a filterable virus and that Stegomya (Aedes) its only vector, Simond and Marchoux clarified the biology of the mosquito and showed that sexual transmission of the virus could occur. They also set up different measures for the control of yellow fever outbreaks which Oswaldo Cruz was inspired by for his campaign against yellow fever. Emile Brumpt implemented the teaching of parasitology at the Faculty of Medicine in São Paulo and contributed to human American trypanosomiasis by defining the transmission of the disease and the cycle of the parasite responsible for it. He also developed the technique known as xenodiagnosis. Simond and Marchoux's works on yellow fever found an immediate application in French colonies, particularly in sub-Saharan Africa. However, the fight against large African endemics such as sleeping sickness, the other human trypanosomiases, could not have been carried out successfully without the contribution of mobile teams following Eugène Jamot's initiative in addition to the permanent centres which characterized the French colonial system.

[Blood pressure control after a one year follow-up in high risk subject screened in occupational medicine]. / Contrôle de la pression artérielle après un suivi d'un an chez des sujets ia haut risque cardiovasculaire dépistés en médecine du travail.

OBJECTIVE: To identify factors predicting the success or the failure of intervention on blood pressure in a population estimated at high risks. METHODS: The program "Coeur 2001" has analysed the absolute cardiovascular risk (ACVR Framingham) in 107 371 voluntary French railways employees. In the company, were considered at high risk (HR), subjects for whom risk was > or = to the 95th percentile of the distribution of the observed ACVR by age range: ACVR > or = 4.5% before 35 years, 12% between 35 and 45 years and 19% beyond 45 years, i.e. a total of 4 190 subjects. These subjects were warned about their risk and advised to choose and consult a physician. A two-year follow up was planned. Identical data (risk factors, ACVR, type of management and therapies) were collected during the first consultation with the occupational physician (T0), one year later (T1) and two years later (T2). RESULTS: Our work concerned 2376 employees at HR, consulting at T1. At T1, 54% of subjects were in the hight risk group (SHR) [48% when BP at T1 was < 140/90 mmHg and 62% when the BP was > or = 140/90 mmHg]. The mean decrease of the systolic BP (SBP) was 4 mmHg in the whole sample, 7.7 mmHg in subjects with normalised ACVR, and it remained stable in the group still at HR (-0.7 mmHg). At T0, blood pressure (BP) was > or = 140/90 mmHg in 55.8% of the patients and 38.4 at T1. This high BP was associated with higher frequency of diabetes (14 vs 7%) and overweight (BMI > or =30 kg/m2; 32.8 vs 19.7%). The percentage of treated hypertensive subjects had increased from 35 to 62% but one third of uncontrolled hypertensive subjects was treated by mono therapies at T1. CONCLUSION: To keep BP under control is a difficult task in routine medicine. At T1, despite a more aggressive treatment, 38% of subjects at high risk were still hypertensive subjects.