[Breast cancer in Finistère, France: epidemiological description and tendencies over a 10-year period (2000-2009) according to pathology data]. / Épidémiologie des cancers du sein dans le Finistère entre 2000 et 2009 à partir d'une base de données anatomopathologiques.

UNLABELLED: The aim of this study was the description of breast carcinoma over a 10-year period according to pathology data. METHOD: Descriptive epidemiological study based on data collection of pathological code ADICAP (injury, organ, and applied technical), histological, hormonal, node and administrative data. From January 1st 2000 to December 31st 2009, 6186 women living in Finistère have had a diagnosis of invasive breast carcinoma. The incidence rate involved from 125 per 100,000 women to 136 in 2009. Average age to the first diagnosis was 61.4 ± 13.6; class of age with the more important incidence rate was for the 50-74 years old. The different histological subtypes varied over the period (P<0.0001). Tumour's size was notified for more than 75% in the whole period of the study. The average size evolved significantly over the period (P<0.0001 from 23.5mm [± 18.4] in 2000 to 21.02 [± 16.2] in 2009, particularly after 2003 [P<0.0002]). The grade status (SBR, MSBR and Elston Ellis) showed a trend to the gravity decrease over the period (respectively P=0.03 [r(2)=-0,04]; P<0.0001 [r(2)=-0.10]; P<0.0001 [r(2)=-0.08]). CONCLUSION: Our results confirm the interest of pathology database for the description of invasive breast cancer.

A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial.

OBJECTIVES: To assess the impact of a hygiene-encouragement program on reducing infection rates (primary end point) by 5%. DESIGN: A cluster randomized study was carried out over a 5-month period. SETTINGS AND PARTICIPANTS: Fifty nursing homes (NHs) with 4345 beds in France were randomly assigned by stratified-block randomization to either a multicomponent intervention (25 NHs) or an assessment only (25 NHs). INTERVENTION: The multicomponent intervention was targeted to caregivers and consisted of implementing a bundle of infection prevention consensual measures. Interactive educational meetings using a slideshow were organized at the intervention NHs. The NHs were also provided with color posters emphasizing hand hygiene and a kit that included hygienic products such as alcoholic-based hand sanitizers. Knowledge surveys were performed periodically and served as reminders. MEASUREMENTS: The primary end point was the total infection rate (urinary, respiratory, and gastrointestinal infections) in those infection cases classified either as definite or probable. Analyses corresponded to the underlying design and were performed according to the intention-to-treat principle. This study was registered (#NCT01069497). RESULTS: Forty-seven NHs (4515 residents) were included and followed. The incidence rate of the first episode of infection was 2.11 per 1000 resident-days in the interventional group and 2.15 per 1000 resident-days in the control group; however, the difference between the groups did not reach statistical significance in either the unadjusted (Hazard Ratio [HR] = 1.00 [95% confidence interval (CI) 0.89-1.13]; P = .93]) or the adjusted (HR = 0.99 [95% CI 0.87-1.12]; P = .86]) analysis. CONCLUSION: Disentangling the impact of this type of intervention involving behavioral change in routine practice in caregivers from the prevailing environmental and contextual determinants is often complicated and confusing to interpret the results.

French healthcare workers in geriatric healthcare settings staunchly opposed to influenza vaccination: the VESTA study.

The observational diagnosis phase of the VESTA study was aimed to determine the composite profiles of vaccinated/non-vaccinated HCWs by analyzing reasons to accept/decline influenza vaccination. Between June and September 2005, 2485 HCWs (female: 82.9%; nursing auxiliaries: 42.1%; vaccination coverage: 23.4%) from 53 French geriatric HCSs were included in the study. Cluster analysis determined 3 composite profiles: HCWs for whom information programs on vaccination can be useful (59%), HCWs staunchly opposed to vaccination (36%), and skeptical HCWs (5%). Qualitative analysis provided some aspects of influenza vaccine reluctance. Effective programs would be multidimensional and target the most susceptible group.

Assessment of healthcare worker influenza vaccination program in French geriatric wards: a cluster-randomized controlled trial.

BACKGROUND AND AIMS: The French institute for study of geriatric infection risk (ORIG) has run a multiphase multicenter study (VESTA) to develop and implement active programs promoting healthcare worker (HCW) influenza vaccination. The present article reports results after implementation of the first active program. METHOD: A cluster-randomized controlled trial was conducted from December 1 to December 15, 2005, and a total of 43 geriatric wards (3646 HCWs) were randomly assigned to two clusters. The program cluster (24 wards; 1918 HCWs) received the active program whereas no action was taken in the control cluster (19 wards; 1728 HCWs). The program was educational; its objective was to convince HCWs to be vaccinated by giving them topdown scientific information and developing a sense of altruism. Data from 1201 HCWs (63%) from the program cluster and 1144 HCWs (66%) from the control cluster were collected. RESULTS: The program failed to increase the HCW influenza vaccination rate (program: 34%; control: 32%; p>0.05), but won the faithfulness of vaccinated HCWs (5% vs 8% HCWs quitted vaccination; p<0.05). CONCLUSIONS: Resistance to active influenza vaccination programs was found. Future active programs will have to restore a climate of confidence between sources of knowledge and HCWs and promote "self-protection" in contrast with the protection of elderly people.

Surveillance for surgical site infection (SSI) after neurosurgery: influence of the US or Brest (France) National Nosocomial Infection Surveillance risk index on SSI rates.

A total of 5,628 neurosurgical patients were observed in France to assess the occurrence of surgical site infection (SSI). Their risk of SSI was defined by calculating both the US National Nosocomial Infection Surveillance and the Brest National Nosocomial Infection Surveillance risk indexes. This study compares SSI rates stratified according to either the US or Brest (France) National Nosocomial Infection Surveillance risk index. The SSI rates were correlated with National Nosocomial Infection Surveillance data involving only local operation durations.

Risk factors for neurosurgical site infections: an 18-month prospective survey.

OBJECT: The purpose of this study was to determine the incidence rate and risk factors of surgical site infections (SSIs) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class. METHODS: The authors undertook an exhaustive 18-month prospective survey including patients who underwent neurosurgery. In particular, a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant, and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant. The Centers for Disease Control definition of SSI was used. Univariate and multivariate analyses were conducted; all dependent variables found in univariate analysis were entered in the multiple regression model. A stepwise multiple logistic regression method was used. RESULTS: Of the 844 patients studied, 35 SSIs were diagnosed, yielding an incidence rate of 4.1% (95% confidence interval 3.6-4.5). Independent predictive risk factors for infection were cerebrospinal fluid leakage, external shunt, Altemeier class, and further neurosurgery. A lack of antibiotic prophylaxis was not found to be a risk factor. CONCLUSIONS: Infection risk factors occur mainly during the postoperative period.

Comparative analysis of 75th percentile durations for neurosurgical procedures in France and in US National Noscomial Infection Surveillance System data .

The duration of surgical procedures and the 75th percentiles of those durations are considered in calculation of the US National Nosocomial Infection Surveillance (NNIS) system risk index score. To compare the durations of neurosurgical procedures in a hospital in western France with the durations in the NNIS data, 6,136 neurosurgical patients were followed up to determine surgical site infection rates. The surgical site infection rate was 1.9%, and the 75th percentile durations were lower than those in the NNIS data. The values from the NNIS data are thus inadequate for this neurosurgical center.

Influenza and pneumococcal vaccine coverages in geriatric health care settings in france.

BACKGROUND: Annual immunization with influenza vaccine is effective in preventing influenza-associated mortality and morbidity in the elderly. Pneumococcal vaccination is also considered as an effective strategy to decrease pneumococcal-associated diseases and mortality, particularly in the geriatric health care setting. However, in France, influenza and pneumococcal vaccination coverage in senior citizens living in long-term care facilities has not been comprehensively evaluated. OBJECTIVES: A prospective multicenter study was conducted to measure influenza and pneumococcal vaccine coverage and to assess the existence of local recommendations and the reasons for reluctance to immunize patients in geriatric health care settings in France. Two questionnaires were developed: the initial questionnaire to record the demographic characteristics of patients in health care facilities and to note influenza and pneumococcal vaccine coverage, and a second questionnaire, sent to all responders in June 2003, to record the number and causes of death (December 2002 to April 2003). Questions about the reasons for non-vaccination were added to all settings which had pneumococcal or influenza vaccination coverages below the median levels in the first query. RESULTS: 105 health care facilities measuring vaccine coverage in 7,882 elderly patients participated in the study. Of 105 units, 9 were acute care units (n = 203 patients), 22 rehabilitation care units (n = 923), 68 long-term care facilities (n = 6,458), and 6 nursing homes (n = 315). The median and mean age of patients was 83 (SD 3.5) years. Influenza and pneumococcal vaccine rates were 87.7% (median 90%, range 0-100%) and 21.9% (median 2.8%, range 0-100%), respectively. There were significant differences between the type of setting and wide variability. There was no correlation between vaccine coverage and local recommendations. Mortality was 15.2% and was negatively correlated with influenza vaccine. The reasons for non-vaccination evaluated in 20 units differed for influenza and pneumococcal vaccine. CONCLUSION: Influenza vaccine coverage is high in long-term care settings but not in other settings. Pneumococcal vaccine coverage is very low in most settings, in part because of the lack of positive recommendations in France. Annual vaccination records are needed and should be a goal for the National Health Care Department. In addition, reasons for failure to administer both vaccines should be precisely evaluated on large populations to improve vaccination coverage.

Influenza vaccine coverage for healthcare workers in geriatric settings in France.

BACKGROUND AND AIMS: Because of a relative lack of efficiency of influenza vaccine in the elderly population, influenza outbreaks in geriatric healthcare settings are probable, despite high influenza vaccination rates in patients. Nosocomial influenza outbreaks, more probably related to healthcare workers, have also been reported. Therefore, vaccination of healthcare workers is considered to be an important preventive policy, to decrease the in-hospital influenza burden during the viral circulation period. METHODS: This multicenter study measured influenza vaccine coverage of Health Care Worker in 102 geriatric healthcare settings (acute care, rehabilitation care, long-term care) by a first questionnaire. A second questionnaire assessed main factors associated with vaccine acceptance. RESULTS: 102 geriatric healthcare settings (20%) answered the first questionnaire. Vaccine coverage for physicians (n=187), nurses (n=631) and nurse assistants (n=1487) were 48.4%, 30.5% and 27.9%, respectively. Vaccination rates were correlated between occupational categories according to healthcare settings. Vaccination rates were significantly lower in acute care settings compared with rehabilitation and long-term care settings. Local recommendations was reported for 29.9%, but was not correlated with vaccine coverage. The second questionnaire showed that lack of motivation and knowledge, and organizational problems were the three main reasons for reluctance to be vaccinated. CONCLUSIONS: In French geriatric settings, influenza vaccine coverage of healthcare workers is low and highly variable, according to the type of healthcare setting. A group effect was found between occupational categories. However, the reasons for non-acceptance need further evaluation to improve HCW influenza vaccine coverage.