[Prevention of infective endocarditis: are recommendations about oral health procedures for high or moderate risk patients respected?]. / Prevention de l'endocardite infectieuse: les recommandations sur le suivi bucco-dentaire des populations à risque sont-elles appliquées?

BACKGROUND: Infective endocarditis (IE) is a rare but particularly serious disease. It frequently requires surgical treatment with cardiac valve replacement. In-hospital mortality is very high. The guidelines of the Society of Infectious Pathology of French Language (SPILF) for the prevention of infective endocarditis of at-risk patients were updated in 2002. They recommended a bi-annual oral health follow-up and antibiotic prophylaxis for invasive sequences of care for high-risk patients. The objective of the study was to assess the application of the guidelines. METHODS: Using databases and medical files of self-employed persons insured by compulsory national health insurance in the Alps, we studied from January 2001 to December 2002 the oral ambulatory follow-up of patients with permanent health insurance for valvular heart disease or congenital heart disease. RESULTS: Among the 260 patients with valvular heart disease or congenital heart disease, 125 (48.1%) presented medical claims for at least one dental treatment. Antibiotic prophylaxis was found in 15.8% of the invasive sequences of care for high-risk patients. The prescribed antibiotic was amoxicillin in 90% of the cases. CONCLUSION: Guidelines are seldom applied. Public and practitioner awareness should be improved to promote oral health: patients should regularly consult their dentist, and practitioners should follow the guidelines for the prevention of infective endocarditis.

[Relationship between in-hospital mortality rate and patient volume for total hip arthroplasty in the Rhône-Alpes public hospitals]. / Relation entre volume d'activité et mortalité intra-hospitalière après intervention pour pose de prothèse totale de hanche dans les établissements publics de la région Rhône-Alpes.

BACKGROUND: Comparisons between hospitals using surgical volume, among other criteria can be made using large hospital databases. A relationship between hospital volume and care results, particularly mortality, is assumed to justify the use of activity volume as a comparison criterion. We aimed to assess a relationship between hospital volume and mortality after total hip replacement using the data available in the French Diagnosis Related Groups (Programme de Médicalisation des Systèmes d'Information, PMSI). We also searched for a threshold associated with mortality. METHODS: We included all stays with a surgical procedure for total hip replacement in public hospitals in the Rhône-Alpes region in France in 1997 (n=5521). We examined the relationship between mortality and the number of procedures per hospital and assessed activity threshold using logistic regression. RESULTS: Using the number of procedures as the continuous variable, we observed a relationship with mortality (OR=0.94 [0.91; 0.96] for an increase in activity of 100 total hip replacements). We found no evidence of an activity threshold. The reason for performing total hip replacement (OR=6.36 [2.78; 14.55] for trauma compared with rheumatology diseases) and patient age (OR=1.76 [1.31; 2.36] for a 10-year increase in age) were strongly related to mortality. CONCLUSIONS: PMSI only collects in-hospital mortality, limiting the impact of our findings. The relationship between mortality and hospital volume is significant, but too small and consequently of little use. We found no activity threshold. It would be difficult to recommend surgical volume as a criterion for comparing hospitals.

[Prevention of post-transfusional malaria in France: a descriptive survey]. / Prévention du paludisme post-transfusionnel en France: enquête descriptive.

Due to an expansion in international travel, an increasing number of blood donors are at risk of exposure to malaria. Preventions of transfusional malaria is required by law in France. Acting as National Reference Center for Malarial Immunology we noticed that this regulation was not being respected by all blood banks. We conducted a questionnaire study concerning 181 blood banks to evaluate under which circumstances serological tests were requested, the policy employed in case of seropositivity, the cost of screening, and wishes concerning modification of the law. The response rate was 46.9%. We noticed a great variability in attitude: only 21% of blood banks followed the regulation; 63% added extra criteria to the law; 16% did not follow the regulation. Indirect immunofluorescence was the main method used by 91.5% of blood banks. However the specificity threshold fluctuated. The fate of the blood unit in case of seropositivity was variable (discard of blood bags, plasma fractionation, blood used). Centers who answered to questionnaire performed 2,513,687 blood donations during the survey. A serology was carried out in 2.6% of donations, and was positive in 9.4% of cases i.e. 0.24% of donations. The average cost of screening was 35 FF. The profit loss due to discard of positive blood was estimated at 1.7 million FF. for the duration of the survey and the blood banks studied. 99% of centers answering the questionnaire expressed desire for standardisation of screening method.

[Human salmonellosis and turtles in France]. / Salmonelloses humaines en rapport avec les tortues aquatiques dans le déparement de l'Isère.

Two immunosuppressed children were infected with Salmonella, due to turtles living in water. So we investigated the carriage of Salmonella among those animals. Among the 95 investigated animals, 10 were carrying Salmonella (Arizonae, Rissen, Pomona and Blockley). The water of 6 containers out of 20 contained Salmonella. Comparing our data to others in the litterature, we conclude that human salmonellosis, acquired from turtles are not, by now, a major problem in France. Nevertheless, a number of those animals are carrying Salmonella. So an epidemiological survey is necessary, and immunosuppressed patients should avoid contact with those animals.

[Economic benefit of using antibiotics prophylactically in cesarean sections with little risk of infection]. / Bénéfice économique de l'antibioprophylaxie dans les césariennes dépourvues de haut risque infectieux.

A randomised double trial was carried out in 266 women who had Caesarean without any high risk of infection in order to study the efficacy of prophylactic antibiotics given during the operation. One group received 1 gram of cefotetan when the cord was being clamped and the other had an injection of placebo under the self-same conditions. Apart from studying the clinical efficacy, evaluation of the economics of the treatment was carried out using, as parameters, the length of stay in hospital and the cost of the antibiotics which were prescribed after the operation. The following results were obtained: 75% of the Caesarean operations carried out in the Maternity Units of the University Regional Hospital Centre were without high risk of infection. Prophylactic antibiotics are proficient because they reduce post Caesarean morbidity due to: endometritis, superficial and deep abscesses and septicaemia. 12.5% in the group who had antibiotics developed infections as against 26% in the placebo group. Post Caesarean infections which required antibiotics cost on an average for each Caesarean 16 francs in the groups who received antibiotics as against 52 francs in the groups that received the placebo. Even including the cost of the antibiotics given prophylactically the costs of antibiotics (prophylactic and curative) was higher in the antibiotic group than in the placebo group. The length of hospital stay was significantly reduced in the group that received prophylactic antibiotics.

[Passive smoking respiratory risk. A quantitative synthesis of the literature]. / Tabagisme passif et risque respiratoire. Une synthèse quantitative de la littérature.

Fifty nine scientific papers had been published in english or french literature, by 1988, on the matter of respiratory health effects of environmental tobacco smoke exposure (ETS). Fifteen dealt with lung cancer. An original meta-analytical approach was used in order to assess the consistency of these results, where the quality of the papers contributes to the weighing scheme, along with the traditional precision parameters. Lung cancer studies converge towards a point estimate of the relative risk (RR) near 1.5, contrasting non smokers exposed during a long time to ETS (mostly at home) and non exposed non smokers (95% confidence interval = 1.3-1.6). Important methodological difficulties did not allow, to date, to show consistent dose-effect relationship with duration or intensity of exposure. Chronic infections of lower respiratory tract related to ETS have been frequently observed (RR = 1.3; 1.2-1.4) as well among adults as among children. Wheezing and asthma are likewise more frequent among children exposed to ETS at home (RR = 1.2; 1.1-1.4). A modest, although statistically significant decrease of Forced Expiratory Volume at One Second is associated with passive smoking among children (mean effect = -0.5%). Health risk related to passive smoking are much lower than those caused by active smoking. However, this hazard should not be underlooked, since ETS is universally present in everyday life and since anyone may be exposed, including children, the elderly and those who suffer from chronic respiratory diseases. Many research needs are underscored by this meta-analysis. It remains that the current state of knowledge on health risks associated with passive smoking warrants that strong preventive action, educative or statutory, be promoted.

[Can ambulatory blood pressure be assessed using 9 self-measurements?]. / Peut-on évaluer la charge tensionnelle d'activité avec 9 automesures?

This study compares the blood pressure (BP) levels, the variability and the circadian BP variation recorded in ambulatory (AM) and self measurement (SM) conditions. The BP is recorded every 15 min on the day time with an automatic device (Space-labs) in a population of 16 normotensive patients; the same day, each patient performs with an half automatic device (SEB) 9 self measurements between 8 am and 8 pm. The SM method provides significantly lower mean values: -3.9 mmHg and -3.1 mmHg for the Systolic and the Diastolic blood pressure (SBP and DBP) than the AM. The heart rate (HR) also is lower in SM than in AM (-6.5 cy/min). The BP variability is lower for the SBP and the HR in SM. The correlation between AM and SM hours means is poor. This study shows that the self measurement method provides a lower BP level and variability than the full ambulatory method and the hourly means variation are not assessed.

[Analysis of the risk of backache in the occupational environment]. / Analyse du risque lombalgique en milieu professionnel.

In a cross-sectional, and one year retrospective study low back pain risk was analysed in a sample of 1812 subjects stratified by five professions: nurses, industrial workers, truck drivers, construction workers and white collar workers. Data were collected by occupational physicians during annual systematic examinations. Relative risks were significantly higher in nurses and industrial worker occupations than in the control group of white collar employees. Multivariate analysis points out that heavy or light handling, bad postures, non-sitting jobs and exposure to vibration or inclemency are the prevalent occupational factors of low back pain. Housekeeping among females and gardening or odd jobs in males are less but significant extra-professional factors. Prevention should include instruction in lifting techniques and improvement in work conditions.

Comparative study of the efficacy of captopril at a single daily dose of 100 mg and at a twice daily dose of 50 mg by measuring ambulatory pressure over 24 hours.

Variations in blood pressure were investigated by an automatic, non-invasive ambulatory method in 9 subjects with essential hypertension. Recordings were made after 6 week periods during which captopril was taken either once or twice daily, in a double-blind cross-over study. Although the effects of captopril administration either once or twice daily were broadly similar, there was a significant decrease in diastolic blood pressure values on the once-daily regimen. These results suggests that treatment once a day can advantageously replace twice-daily treatment.