Impact of the COVID-19 pandemic on non-COVID-19 hospital mortality in patients with schizophrenia: a nationwide population-based cohort study.

It remains unknown to what degree resource prioritization toward SARS-CoV-2 (2019-nCoV) coronavirus (COVID-19) cases had disrupted usual acute care for non-COVID-19 patients, especially in the most vulnerable populations such as patients with schizophrenia. The objective was to establish whether the impact of the COVID-19 pandemic on non-COVID-19 hospital mortality and access to hospital care differed between patients with schizophrenia versus without severe mental disorder. We conducted a nationwide population-based cohort study of all non-COVID-19 acute hospitalizations in the pre-COVID-19 (March 1, 2019 through December 31, 2019) and COVID-19 (March 1, 2020 through December 31, 2020) periods in France. We divided the population into patients with schizophrenia and age/sex-matched patients without severe mental disorder (1:10). Using a difference-in-differences approach, we performed multivariate patient-level logistic regression models (adjusted odds ratio, aOR) with adjustment for complementary health insurance, smoking, alcohol and substance addiction, Charlson comorbidity score, origin of the patient, category of care, intensive care unit (ICU) care, major diagnosis groups and hospital characteristics. A total of 198,186 patients with schizophrenia were matched with 1,981,860 controls. The 90-day hospital mortality in patients with schizophrenia increased significantly more versus controls (aOR = 1.18; p < 0.001). This increased mortality was found for poisoning and injury (aOR = 1.26; p = 0.033), respiratory diseases (aOR = 1.19; p = 0.008) and for both surgery (aOR = 1.26; p = 0.008) and medical care settings (aOR = 1.16; p = 0.001). Significant changes in the case mix were noted with reduced admission in the ICU and for several somatic diseases including cancer, circulatory and digestive diseases and stroke for patients with schizophrenia compared to controls. These results suggest a greater deterioration in access to, effectiveness and safety of non-COVID-19 acute care in patients with schizophrenia compared to patients without severe mental disorders. These findings question hospitals' resilience pertaining to patient safety and underline the importance of developing specific strategies for vulnerable patients in anticipation of future public health emergencies.

Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy.

INTRODUCTION: Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated by using a strictly standardized lung-protective strategy. METHODS: This prospective epidemiologic study was done in all the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis. RESULTS: Ninety-eight (28.9%) patients had at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared with 74 (30.7%) of the 241 patients without VAP (P = 0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage device were protective. CONCLUSIONS: In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment.

Survey of caregiver opinions on the practicalities of family-centred care in intensive care units.

AIMS AND OBJECTIVES: To determine caregiver opinion on their intensive care unit's policies with regard to visiting hours, how families are informed and participate in patient care. BACKGROUND: Benefits of improving family access to the intensive care unit, information delivery and participation of families in care have been suggested. DESIGN: Survey of caregivers working in French-speaking intensive care units. METHODS: An e-mail invitation to complete an online, closed-ended questionnaire was issued to caregivers registered in the mailing list of the French society of intensive care. RESULTS: Caregivers (n = 731) working in 222 adult and 41 paediatric intensive care units completed the questionnaire. Unlike in paediatric intensive care units, 58% of adult intensive care unit had restricted visiting hours (< 4 hour). However, 63% of respondents would recommend extended visiting periods. A 24-hour policy existed in 7% of adult intensive care units; 10% of respondents from these intensive care units thought reducing visiting periods would be very useful or essential; 81% thought that a 24-hour policy contributed to improved relations with families; and only 9% thought that it was a hindrance to care. Over 90% of caregivers thought that families should be informed of patient progress in a designated room in the presence of the patient's nurse and that patient records should report family meetings. This policy was only implemented in half of the cases. Family participation in care procedures was strongly encouraged in only 0·5% of adult intensive care units. CONCLUSIONS: Intensive care unit caregivers are in favour of longer visiting hours, increased use of designated rooms for, and nurse participation in, meetings with families. Although caregivers do not associate families with care procedures, they considered that their presence during most interventions should be authorised. RELEVANCE TO CLINICAL PRACTICE: Our results could help in implementing intensive care unit policies concerning visiting hours, how families are informed and participate in patient care.

Patient characteristics and determinants of quality of life in an international population with multiple sclerosis: assessment using the MusiQoL and SF-36 questionnaires.

BACKGROUND: Multiple sclerosis (MS) can have psychological and socioeconomic consequences that affect patients' health-related quality of life (HRQoL) as much as physical disability. OBJECTIVE: To determine the clinical and sociodemographic factors affecting HRQoL in a large international study using the MS International QoL (MusiQoL) questionnaire. METHODS: Patients aged >18 years with a diagnosis of MS for >6 months or clinically isolated syndrome (CIS) were enrolled. Sociodemographic and clinical data were recorded, and patients completed the MusiQoL and 36-item short form (SF-36) health survey questionnaires. RESULTS: In total, 1992 patients from 15 countries were enrolled (mean [standard deviation] age: 42.3 [12.5] years; 70.5% women; 70.4% with relapsing-remitting MS). Multivariate multiple regression analyses identified lower educational level, higher Expanded Disability Status Scale (EDSS) score, cognitive impairment, being single and shorter time since last relapse as significant predictors of lower MusiQoL global index scores (p < 0.05). Older age, female sex, higher EDSS score, shorter time since last relapse and receiving current MS treatment were significant predictors of lower SF-36 physical component summary scores (p < 0.05). The SF-36 mental component summary score was linked to occupational status, inpatient/outpatient status, time since last relapse, and whether the patient was receiving MS treatment (p < 0.05). CONCLUSION: Sociodemographic and clinical factors are linked to HRQoL in patients with MS. Interventions that affect these factors might be expected to influence HRQoL.

Cognitive function and quality of life in multiple sclerosis patients: a cross-sectional study.

BACKGROUND: Nearly half of all patients diagnosed with multiple sclerosis (MS) will develop cognitive dysfunction. Studies highlighted from no/weak impact to a strong impact of cognitive impairment on quality of life (QoL). The aim of this study was to assess the impact of cognitive dysfunction on self-reported QoL in MS patients while considering key confounding factors. DESIGN: cross-sectional study. INCLUSION CRITERIA: MS patients of any disease subtype. DATA COLLECTION: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, disease duration); MS disability (Expanded Disability Status Scale, EDSS); depression (Beck Depression Inventory); fatigue (Modified Fatigue Impact Scale); QoL (SF36 and MusiQoL); and neuropsychological performance (Brief Repeatable Battery of Neuropsychological Tests, BRB-N). STATISTICAL ANALYSIS: multiple linear regressions (forward-stepwise selection). RESULTS: One hundred and twenty-four patients were enrolled. Performance on BRB-N subtests varied widely (6% to 70% abnormal). The BRB-N classified 37-78% of the patients as cognitively impaired, depending on the definition of cognitive impairment. No links were found between the MusiQoL index and cognitive subtests, whereas marital status, EDSS, and depression were found to be independent predictive factors. CONCLUSIONS: The present study demonstrated the weak and scarce association between cognitive impairment and QoL, when the key confounding factors were considered. These results need to be confirmed with larger samples and more accurate tests of cognitive function.

Validation of the spanish version of the Multiple Sclerosis International Quality of Life (Musiqol) questionnaire.

BACKGROUND: The Multiple Sclerosis International Quality Of Life (MusiQoL) questionnaire, a 31-item, multidimensional, self-administrated questionnaire that is available in 14 languages including Spanish, has been validated using a large international sample. We investigated the validity and reliability of the Spanish version of MusiQoL in Spain. METHODS: Consecutive patients with different types and severities of multiple sclerosis (MS) were recruited from 22 centres across Spain. All patients completed the MusiQoL questionnaire, the 36-Item Short Form (SF-36) health survey, and a symptoms checklist at baseline and 21 days later. External validity, internal consistency, reliability and reproducibility were tested. RESULTS: A total of 224 Spanish patients were evaluated. Dimensions of MusiQoL generally demonstrated a high internal consistency (Cronbach's alpha: 0.70-0.92 for all but two MusiQoL domain scores). External validity testing revealed that the MusiQoL index score correlated significantly with all SF-36 dimension scores (Pearson's correlation: 0.46-0.76), reproducibility was satisfactory (intraclass correlation coefficient: 0.60-0.91), acceptability was high, and the time taken to complete the 31-item questionnaire was reasonable (mean [standard deviation]: 9.8 [11.8] minutes). CONCLUSIONS: The Spanish version of the MusiQoL questionnaire appears to be a valid and reliable instrument for measuring quality of life in patients with MS in Spain and constitutes a useful instrument to measure health-related quality of life in the clinical setting.

Heath-related quality of life in thyroid cancer patients following radioiodine ablation.

BACKGROUND: There is limited information about the medium to long-term health-related quality of life (QOL) in thyroid cancer patients after initial therapy and the existing studies suffer from limitations. The aim of the study was to assess the determinants of medium-term QOL after the initial therapy. METHODS: Following a total thyroidectomy, 88 thyroid cancer patients received either rhTSH or hypothyroid-assisted radioiodine ablation (RRA) using 3.7 GBq (100 mCi) of radioiodine. QOL evaluation of the patients using the validated Functional Assessment of Chronic Illness & Therapy (FACIT) was performed at the time of inclusion (t0) and later at the 9-month post-RRA (t1). RESULTS: 83 patients were eligible for the final evaluation. Medium-term FACIT scores were not statistically different between t0 and t1 patients. All but one domain of the QOL score was similar between t0 and t1. Using a multivariate analysis, only age and immediate postoperative QOL scores were found to be determinants of the overall medium term 9-month QOL scores. Analysis showed that 'high QOL levels' (baseline and 9-month) and 'no depression', 'low anxiety levels', were associated with '<45 yrs', 'men', 'partner', and 'rhTSH stimulation'. CONCLUSIONS: The use of radioiodine ablation does not seem to affect the medium term QOL scores of patients. Medium-term QOL is mainly determined by pre-ablation QOL. The assessment of baseline QOL might be interesting to evaluate in order to adapt the treatment protocols, the preventive strategies, and medical information to patients for potentially improving their outcomes.

A social network analysis of healthcare professional relationships in a French hospital.

PURPOSE: This paper aims to describe relationships among healthcare professionals in a French public hospital using social network analysis (SNA) and to improve health service quality by strengthening health service management and leadership. DESIGN/METHODOLOGY/APPROACH: This study was based on a questionnaire sent to randomly selected French public hospital professionals and administrators. Network composition measures were obtained using a name generator. Analysis focused on three main indicators: "centrality", "prestige", and "clique participants". The SNA was carried out using UCINET and statistical analyses were performed with SPSS version 15.0. FINDINGS: A total of 104 questionnaires were returned and analysed. Centrality, prestige and clique indicators were highly correlated (all p-value were less than 0.01). Physicians had the highest scores for the three indicators. Older age (> or = 45 years) was associated with higher centrality and clique numbers scores. Transversal activity was associated with higher scores than other specific activities (hospitalisation, ambulatory care), except for emergency care. ORIGINALITY/VALUE: The paper shows how networks and SNA techniques provide novel and useful means to understand communication and collaboration between hospital professionals.

Validation of a French hospitalized patients' satisfaction questionnaire: the QSH-45.

OBJECTIVE: To develop a generic French self-administered instrument for measuring hospitalized patients' satisfaction based on the patient's point of view: the questionnaire for satisfaction of hospitalized (QSH) patients. DESIGN: The development was supervised by a steering committee and undertaken through three standard steps. Item generation was derived from 95 face-to-face interviews, performed in hospitalized patients and in patients scheduled to be admitted. The item reduction led to a 69-item questionnaire. The validation process was based on validity, reliability and some aspects of external validity. SETTING: Medical, surgical and obstetrical departments (n = 187) of public hospitals (n = 11) from different French regions (n = 3). PARTICIPANTS: Eligible patients were adult subjects hospitalized for at least 24 h. MAIN OUTCOME MEASURES: QSH, sociodemographic data, hospitalization department, visual analogue scales of satisfaction. RESULTS: The final version of QSH contained 45 items describing 9 dimensions, leading to 2 composite scores (staff and structure index). The factor structure accounted for 71% of the total variance. Internal consistency was satisfactory (item-internal consistency over 0.40; Cronbach's alpha coefficients ranged from 0.76 to 0.96). The scalability was satisfactory with inlier-sensitive fit (INFIT) statistics inside an acceptable range. Scores of dimensions were strongly positively correlated with visual analogue scale scores (all P < 0.001). External validity showed statistical associations between QSH scores and age or department. Participation rate was 91%. CONCLUSIONS: The availability of a reliable and valid French questionnaire concerning hospitalized patients' satisfaction, exclusively generated from patients' interviews, enables patient feedback to be incorporated in a continuous quality health-care improvement strategy.

Nutritional factors as predictors of response to radio-chemotherapy and survival in unresectable squamous head and neck carcinoma.

BACKGROUND AND PURPOSE: This study sought to evaluate nutritional prognostic factors before treatment in patients with unresectable head and neck cancer treated by concomitant radio-chemotherapy. METHODS AND MATERIALS: Seventy-two consecutive patients were treated. We studied the potential effects of CRP, Alb, preAlb, orosomucoid, weight, weight history, BMI, PINI, OPR and NRI on response to treatment, Event-Free Survival (EFS) and Overall Survival (OS). Effects of potential risk factors on OS and on EFS were analyzed by computing Kaplan-Meier estimates, and curves were compared using the log-rank test. RESULTS: All biological nutritional factors were statistically correlated with the response to radio-chemotherapy. In multivariate analysis, only CRP (p=0.004) remained statistically significant. A statistical correlation was found between Alb and EFS in multivariate analysis (p=0.04). The factors influencing OS in univariate analysis were Alb (p=0.008), CRP (p=0.004), orosomucoid (p=0.01) and NRI (p=0.01), response to radio-chemotherapy (p<0.001) and staging (p=0.04). In multivariate analysis, only the response to radio-chemotherapy (p<0.001) remained significant. CONCLUSIONS: This study illustrates the prognostic value of nutritional status. CRP and Alb may be useful in the assessment of advanced head and neck cancer patients at diagnosis and for stratifying patients taking part in randomized trials.

Quality of life impairment in hidradenitis suppurativa: a study of 61 cases.

OBJECTIVE: We sought to determine quality of life impairment in hidradenitis suppurativa. METHODS: Questionnaires were administered to 61 patients. RESULTS: Quality of life impact in hidradenitis was much greater than that of several other dermatologic conditions. LIMITATION: This hospital-based population may not be representative. CONCLUSION: Hidradenitis is one of the most distressing conditions observed in dermatology.

Assessment of acute ankle sprain with os subfibularein children.

Children commonly present with acute inversion injuries of the ankle. Radiographs occasionally show small fragments under the tip of the lateral malleolus. The purpose of our study was to clarify their origin. A prospective standardized clinical examination and a magnetic resonance imaging were carried out. Among the 116 included patients, seven of them showed an os subfibulare. They presented more pains on the lateral ankle area than the other children. We found also more injuries on the anterior talofibular ligament. The os subfibulare could be secondary to an accessory ossification but the lateral area of the ankle would be likely to be injured.

Cell adhesion molecules as a marker reflecting the reduction of endothelial activation induced by glucocorticoids.

In vitro, steroids down-regulate the expression of cell adhesion molecules (CAMs) in endothelial cells stimulated by lipopolysaccharide. Low-dose hydrocortisone is a new treatment of patients with septic shock, a state that is characterized by an endothelial injury. The aim of the present study was to investigate whether the plasma levels of soluble CAMs, reflecting in vivo endothelial activation, could be modulated in patients with septic shock treated by hydrocortisone. This was a prospective and observational study conducted in the intensive care unit at a university hospital. The subjects included 40 patients with septic shock (American College of Chest Physicians Consensus Conference/Society of Critical Care Medicine definition); 45 healthy blood donors served as controls. The patients receiving the standard care ("reference group") during the first 6 months were compared with the patients receiving the hydrocortisone therapy ("hydrocortisone group") for the next 6 months. Measurements of sCAMs were performed on days 1 and 3 of the disease. On day 1, sE-selectin, sP-selectin, sVCAM-1, and sICAM-1 were significantly elevated in patients with septic shock compared with healthy donors. sE-selectin levels significantly decreased between days 1 and 3 in the "hydrocortisone group," whereas there was no significant change in the "reference group". Surprisingly, sICAM-1 levels significantly increased between days 1 and 3 only in patients treated by hydrocortisone. No significant changes were observed for sP-selectin and sVCAM-1 levels in the two groups. In patients with septic shock, glucocorticoids differently affected the pattern of evolution of sCAMs, with sE-selectin being decreased and sICAM-1 being increased. Expression of sP-selectin and sVCAM-1 was not affected.

Hand antisepsis: evaluation of a sprayer system for alcohol distribution.

OBJECTIVE: To evaluate the usefulness of a new alcohol sprayer by comparing it with an individual bottle of alcohol. Patterns of use and perceptions among healthcare personnel were compared for the two products. DESIGN: Observational study recording the volume of alcohol used and the compliance rate (frequency of hand antisepsis per number of opportunities), and a survey of healthcare workers' perceptions of the different hand hygiene strategies. SETTING: A 20-bed medical unit in a public hospital in Marseille, France. PARTICIPANTS: Healthcare workers of an infectious disease unit INTERVENTIONS: Hand hygiene alcohol systems (sprayer vs individual bottle, 70% ethyl alcohol). RESULTS: The sprayer was used more frequently than the individual bottle (12.6 vs 9.7 hand washes per day). With the sprayer system, compliance was 91% for physicians, 28% for nurses, and 8% for housekeeping personnel. Alcohol hand antisepsis was preferred to washing hands with soap and water in low-risk situations such as simple entrance into a room (91% vs 36%; P < 10(-6)) or simple contact with a patient (69% vs 40; P < .005). The sprayer system was considered easier to use (95%), more hygienic (90%), and faster (92%), with a better tolerance than the individual bottle. CONCLUSION: The new alcohol sprayer should improve rapid hand antisepsis.

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

OBJECTIVE: To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). DESIGN AND SETTING: Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital. INTERVENTIONS: Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. MEASUREMENTS AND RESULTS: Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: sex female, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. CONCLUSIONS: In our study the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients removal of the bladder catheter must be performed as soon as possible.

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

OBJECTIVE: To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). DESIGN: Prospective cohort study. SETTING: Sixteen-bed polyvalent ICU in a French university hospital. INTERVENTIONS: Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. MAIN OUTCOME MEASURES: Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. RESULTS: The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: female sex, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. CONCLUSION: In our study, the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients, removal of the bladder catheter must be performed as soon as possible.

Contribution of nonspecific laboratory test to the diagnosis of malaria in febrile travelers returning from endemic areas: value of hypocholesterolemia.

BACKGROUND: The gold standard in diagnosis of malaria is microscopic detection of malaria parasites in thin blood smears. However, the sensitivity and specificity of blood smears depend mostly on the experience of the examiner. In the traveler returning from the tropics, diagnosis of malaria may be difficult when the parasitemia is low. In this circumstance any indicator that suggests the diagnosis of malaria is of great interest. The aim of this study is to determine the value of hypocholesterolemia to the diagnosis of imported malaria. METHOD: A retrospective case-control study was performed among hospitalized patients with fever returning from a malaria-endemic area, to compare the results of routine biological parameters of 129 malaria cases with those of 92 control patients. RESULTS: Multivariate analysis, using a logistic regression model demonstrates that hypocholesterolemia was the strongest parameter associated with malaria (adjusted odds ratio [OR]: 75.22, 95% confidence interval [CI] 4.60-1227.78) and the most specific (98%, 95% CI 0.95-1.0). The most sensitive abnormality was thrombocytopenia (82%, 95% CI-0.77 0.87). With a malaria prevalence of 52% in our population study, hypocholesterolemia has the strongest positive predictive value among routine biological parameters for malaria diagnosis (96%). The combination of hypocholesterolemia and thrombocytopenia was always associated with diagnosis of malaria in this study. CONCLUSION: These results show that hypocholesterolemia is significantly associated with malaria. Therefore, in the setting of negative thin and thick blood smears, the presence of hypocholesterolemia, particularly when it is combined with thrombocytopenia, in a febrile traveler returning from a malaria-endemic area, should prompt repetition and careful analysis of blood smears to avoid misdiagnosis.

Imported Dengue in French University Hospitals: a 6-year survey.

Dengue fever (DF) is a mosquito-transmitted acute disease caused by any of four dengue flavivirus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) which is becoming a major public health problem in intertropical areas.1 DF is increasingly observed in febrile travelers returning from tropical areas,2 especially those returning from the Caribbean islands and Southeast Asia, but it is rarely diagnosed in travelers returning from Africa.3-8 Diagnosis is often serologic, and in most cases is not confirmed; virus isolation remains exceptional. In a retrospective study of 44 cases of imported DF diagnosed in France, we found that the epidemiologic, clinical and diagnostic characteristics of these cases were similar to those reported in other previous published studies; diagnosis was carried out with serology, and no virus isolation was reported. To draw the attention of physicians from nonendemic areas to the possible occurrence of dengue infection in febrile travelers from all tropical countries, including those in Africa, and to reinforce recommendations required to establish diagnosis with certainty, we report herein a prospective study from 1998-1999 which we compiled with our previously published data.

Three-year follow-up of attitudes and smoking behaviour among hospital nurses following enactment of France's national smoke-free workplace law.

OBJECTIVE: This study evaluated among hospital nurses the smoking status, knowledge and attitudes regarding smoking cessation services, and smoking behaviour 3years after the implementation of smoke-free workplace law (decree no. 2006-1386). METHODS: A descriptive study was undertaken in a public referral hospital in the South of France. Between February and April 2010, a questionnaire was distributed to the nurses. Data on demographic information, smoking status, behaviour and attitudes regarding smoking addiction, and knowledge regarding smoking cessation services were collected. Changes in nurses' smoking habits were studied through a former study conducted in this hospital a year after the law had come into effect. RESULTS: Three years after the enactment of the smoking ban, 30% (30% in 2008) reported themselves as current smokers, 26% (25% in 2008) as ex-smokers and 44% (45% in 2008) as non-smokers. Among smokers, 72% (68% in 2008) declared they had decreased tobacco consumption during working hours and 50% (29% in 2008) daily cigarette consumption. The majority of nurses (88%) supported the smoke-free law. A higher percentage of smokers than non smokers have knowledge of smoking cessation services. The smoking prevalence among hospital nurses seemed to have remained constant between 2008 and 2010 despite a better compliance with the law. CONCLUSIONS: France's national smoke-free workplace law is associated with a reduction in tobacco consumption and exposure to second-hand smoke in nurses but not smoking prevalence. The other measures of the MPOWER package have to be reinforced.

The usefulness of factor XIII levels in Crohn's disease.

BACKGROUND AND AIMS: The assessment of inflammatory activity in Crohn's disease (CD) is challenging, and no specific laboratory marker is currently available. Several studies have reported decreased serum factor XIII levels in CD patients as a function of disease activity. We aimed to determine whether the factor XIII level could be a marker for the evolution of CD. METHODS: In this prospective, single-centre trial, 129 patients were included and categorised into two groups: functional bowel disorders (FBDs, n=42) and CD (n=86). The CD group was divided into two subgroups depending on disease activity, as defined by the Crohn's Disease Activity Index score: active disease (CDa, n=41) and disease remission (CDb, n=45). The factor XIII levels were evaluated for each patient. Serial factor XIII levels were evaluated in the patients within the CDa subgroup. RESULTS: The factor XIII levels were significantly different between the FBD (117.69%) and CD (101.89%) groups (p=0.009) but there was no significant difference between the CDa and CDb subgroups (99.04% vs 104.65%, p>0.05), and the levels did not vary during follow-up for the patients in the CDa subgroup. By multivariate analysis, factor XIII levels did not correlate with the time course of disease evolution, CRP, serum fibrin levels, platelet count, disease distribution within the bowel, or the presence of a fistulising form of CD. CONCLUSIONS: Our results confirm that factor XIII levels are decreased in CD patients but cannot be recommended as a marker for the disease activity.