Performance accuracy, advantages and limitations of a store-and-forward teledermatology platform developed for general practitioners: A retrospective study of 298 cases.

BACKGROUND: Store-and-forward (SAF) tele-dermatology (TD) platforms could help promote coordination between hospital and general practitioners (GPs). However, very little data exists on the performance accuracy and opinions of GPs participating in this type of project in France. METHODS: We report on the diagnostic and management plan accuracy of an SAF-TD platform developed for neighbouring GPs around our hospital compared with routine face-to-face (FTF) dermatological consultation in our department. We also compared the accuracy of SAF-TD with that of the participating GPs. Lastly, we collected feedback from GPs after their participation in this project. RESULTS: Overall, 298 patients were included by 58 GPs between November 2016 and January 2020, of whom 169 (57%) were female, and with a median age of 44.5 years (range 0-96). The diagnostic accuracy of TD was 62% (n=184/298) for the initial hypothesis and 80% (n=239/298) for aggregated diagnostic accuracy. Management plan accuracy for TD was 81% (n=225/277). At least 43% of consultations (n=127/298) met the criteria for preventable consultation. Diagnostic accuracy for the initial hypothesis was significantly lower for GPs than for TD (Odd Ratio [OR]=0.34; 95% Confidence Interval [95% CI]: 0.20-0.56; p<0.0001), as was management plan accuracy (OR=0.23; 95% CI: 0.10-0.46; p<0.0001). Among the responding GPs, 78% (n=29) reported very high satisfaction and 97% would consider integrating this type of programme in their long-term practice, but they highlighted the time-consuming nature of the platform (46%) and the lack of financial compensation (44%). CONCLUSION: SAF-TD in coordination with GPs seems safe and efficient in the management of outpatients, and enjoys a high satisfaction rate among GPs, despite its time-consuming nature and the lack of financial compensation. Healthcare policy should promote financial participation to help the expansion of TD.

FUrTIHF: French urinary tract infections in healthcare facilities - five-year historic cohort (2014-2018).

BACKGROUND: Urinary tract infections (UTIs) are common and diverse. Even when not severe, UTIs regularly lead to hospitalization, but their hospital burden remains unknown. This study aimed to estimate the national incidence of hospitalized UTIs in France. METHODS: A historic five-year cohort of adult patients hospitalized with UTIs in France was extracted from the medico-administrative databases using an ICD-10 code algorithm built by a multidisciplinary team. The performance parameters were estimated blindly, by reviewing 1122 cases, using medical reports as the gold standard, giving a global predictive positive value of 70.4% (95% confidence interval 66.6-74.1). The national incidence of UTIs was then estimated. RESULTS: A total of 2,083,973 patients with UTIs were hospitalized over the period, giving an adjusted incidence rate of ∼900 cases/100,000 inhabitants, stable over the period, higher in females and increasing with age; 1.2% were device-associated UTIs. Unspecific acute cystitis represented almost two-thirds of cases (63.5%); followed by pyelonephritis (23.6%) and prostatitis (12.4%). More than three-quarters of patients had at least one comorbid condition (76.8%). CONCLUSIONS: This national cohort study is the first to date to estimate the incidence of UTI-related hospitalizations in France. UTIs represent a substantial burden of care. Further analysis will provide data for more informed goal-of-care discussions targeting each type of UTI, their management and outcomes.

Speciation study of aluminium in beverages by Competitive Ligand Exchange-Adsorptive Stripping Voltammetry.

Competitive Ligand Exchange-Adsorptive Stripping Voltammetry (CLE-AdSV) was used for determining the speciation of aluminium in commonly consumed beverages (water, tea, infusion, coffee, orange juice, tomato juice, beer and red wine). Aluminium determination involves the adsorption of Al-complexes with the ligand cupferron onto a hanging mercury drop electrode. All samples were studied at pH 6.5 with an accumulation step at -0.60 V (all potential values in the paper are given versus the Ag/AgCl, [KCl]=3 M reference electrode) during 60 s, and a final cupferron concentration of 4 × 10(-4)M. These conditions were used to establish (i) the concentration of electro-labile aluminium, (ii) the range of ligand concentrations and (iii) the conditional stability constants of beverage samples using titration procedures. The results based on Ruzic plots were compared to computer simulation with Visual MINTEQ. This comparison suggests that labile monomeric Al-forms and soluble organic complexes of low molecular weight can be quantified by the CLE-AdSV procedure. Overall the relative uncertainties on the determination of the electro-active Al fraction and the complexing parameters, i.e., concentration and conditional stability constant of natural ligands in the samples, are less than 15%. Thanks to these results, information on Al bioavailability in beverages was collected and discussed. This study also illustrates the value of computer simulations when complex, time-consuming voltammetric techniques are applied.

[Impact of endocrine disrupting chemicals on birth outcomes]. / Effets des perturbateurs endocriniens sur les marqueurs de la périnatalité

BACKGROUND: Endocrine disruptors are ubiquitous chemicals contaminants in the environment, wildlife, and humans. Their adverse effects on reproduction are well-documented. There is growing evidence that they can contribute to the current emergence of chronic diseases. OBJECTIVES: Our aim is to assess the relationships between endocrine disruptors and the neonatal health outcomes. METHODS: Two persons have independently reviewed Medline and Toxline databases about the following pollutants: bisphenol A, phthalates, parabens, brominated flame retardants and perfluorinated compounds. Only the human epidemiological studies, in general population with an abstract available, published between 2007 January the 1st and 2011 December the 31st, were analysed. The quality of each study was assessed with the Strobe score. RESULTS: Twenty-five out of 680 studies were included in the analysis. All pollutants were widely detected in maternal and new borns samples. Most of the studies have shown associations between bisphenol A, brominated flame retardants and perfluorinated compounds and lower birth weight. The effects on gestational age were less documented and have shown no clear connection. Results for phthalates were more ambiguous. Only one non-instructive study was found on parabens. DISCUSSION: Due to the inherent methological bias on endocrine disruptors research, further additional studies on environmental health must be investigated. It seems necessary to adopt preventive health measures first for vulnerable population.

[Indoor air quality and adult asthma]. / Pollution de l'air intérieur et asthme chez l'adulte.

INTRODUCTION: Asthma is a chronic inflammatory disease of the airways. The recent increase in its global prevalence suggests a possible role of environmental factors such as indoor air pollution. In 2000, according to the Institute Of Medicine, there was insufficient evidence to determine whether or not an association existed between high priority indoor air pollutants, listed by the French Indoor Air Quality Observatory, and asthma. The objective of this paper is to describe the current state of knowledge on the links between exposure to high priority indoor air pollutants and exacerbations of adult asthma. METHOD: A review of the Medline database has been undertaken of the following pollutants: formaldehyde, benzene, acetaldehyde, volatile organic compounds, particles (PM2.5, PM10) and diethylhexyl-phthalate. The studies were classified by type and source of pollutant. RESULTS: Twenty-three studies were included in the analysis. Most of the observational studies have shown an association between pollutants (by type and source) and adult asthma. The best documented pollutants were formaldehyde and volatile organic compounds. No studies were found on acetaldehyde and diethylhexyl-phthalate. CONCLUSION: The analysis of the literature is complicated on account of the difficulty of comparing different studies. However, since the synthesis performed in 2000, the existence of a link between chemical indoor air pollutants and increased respiratory symptoms appears to be reinforced. It seems necessary to adopt preventive health measures while pursuing scientific research on this topic.

[Assessment of educational benefits in 73 hypertensive patients by telephone survey at distance of HTA Vasc educational program]. / Évaluation des acquis éducatifs de 73 patients hypertendus par enquête téléphonique à distance du programme HTA Vasc.

UNLABELLED: HTA Vasc offers an approved educational program for hypertensive patients at high cardiovascular risk (CVR). METHOD: A telephone survey (December 2011-July 2012) evaluated the benefits of different workshops "my treatment", "my blood pressure" and "my nutrition", more than 6 months after the end of the program. The follow-up data (TS) were compared to inclusion data (T0) and to final data (TF) in 73 hypertensive patients. RESULTS: The follow-up period was 6 to 31 months. The number of hypertensive controlled patients [blood pressure (BP)<140/90 mmHg] increased from 55.4% to 75.4% (P=0.0158) in TF, which remained over time. The practice of physical activity increased from 47.9% (T0) to 79.5% (TS) (P=0.001). The follow-up period of 18 months or more was associated with a tendency to weight gain (P=0.0059) and with a decline in physical activity [89.7% (<18 months) to 67.5% (≥ 18 months) (P=0.0198)]. The practice of self-measurement BP increased from 41.1% (T0) to 71.2% (TS) (P<0.0001); knowledge of the "rule of three" increased from 6.8% (T0) to 74% (TS) (P<0.0001). CONCLUSION: An educational support contributes to a better long-term BP control. The motivation for lifestyle rules decreases with time. The implementation of a structured motivational follow-up could maintain the lifestyle motivation at these CVR patients.

Prevalence of breastfeeding in industrialized countries.

BACKGROUND: Given the benefits of breastfeeding (BF), healthcare institutions recommend that a child should be breastfed for the first 6 months of its life. This study provides a review of BF as a function of socioeconomic criteria in various industrialized countries. METHODS: A review was carried out between 1st January 1998 and 1st March 2009, using Medline and the Public Health Database. The papers were selected independently by two persons, using a methodological grid designed to evaluate the quality of the studies. From 1126 initially selected papers, 26 from 16 different countries were retained for further analysis. RESULTS: The prevalence of exclusive BF initiation was the highest in Norway, Denmark, and Japan with, respectively, 99, 98.7, and 98.3%. This prevalence was the lowest in the United Kingdom, the United States, and France with, respectively, 70, 69.5, and 62.6%. Women who breastfeed less were most commonly found to be young, single, from a low socioeconomic group, or with a low level of education. Women from immigrant population groups breastfed more than the native-born population during their pregnancy. CONCLUSION: Knowledge of the sociodemographic distribution of women who breastfeed is essential for the definition of preventive policies, which are needed to reduce health-related social inequalities. An in-depth analysis of existing primary healthcare programs would allow new strategies to be defined.

Comparative and functional genomic analyses of iron transport and regulation in Leptospira spp.

The spirochetes of the Leptospira genus contain saprophytic and pathogenic members, the latter being responsible for leptospirosis. Despite the recent sequencing of the genome of the pathogen L. interrogans, the slow growth of these bacteria, their virulence in humans, and a lack of genetic tools make it difficult to work with these pathogens. In contrast, the development of numerous genetic tools for the saprophyte L. biflexa enables its use as a model bacterium. Leptospira spp. require iron for growth. In this work, we show that Leptospira spp. can acquire iron from different sources, including siderophores. A comparative genome analysis of iron uptake systems and their regulation in the saprophyte L. biflexa and the pathogen L. interrogans is presented in this study. Our data indicated that, for instance, L. biflexa and L. interrogans contain 8 and 12 genes, respectively, whose products share homology with proteins that have been shown to be TonB-dependent receptors. We show that some genes involved in iron uptake were differentially expressed in response to iron. In addition, we were able to disrupt several putative genes involved in iron acquisition systems or iron regulation in L. biflexa. Comparative genomics, in combination with gene inactivation, gives us significant functional information on iron homeostasis in Leptospira spp.

Voltammetric procedure for trace metal analysis in polluted natural waters using homemade bare gold-disk microelectrodes.

Voltammetric procedures for trace metals analysis in polluted natural waters using homemade bare gold-disk microelectrodes of 25- and 125-microm diameters have been determined. In filtered seawater samples, square wave anodic stripping voltammetry (SWASV) with a frequency of 25 Hz is applied for analysis, whereas in unfiltered contaminated river samples, differential pulse anodic stripping voltammetry (DPASV) gave more reliable results. The peak potentials of the determined trace metals are shifted to more positive values compared to mercury drop or mercury-coated electrodes, with Zn always displaying 2 peaks, and Pb and Cd inversing their positions. For a deposition step of 120 s at -1.1 V, without stirring, the 25-microm gold-disk microelectrode has a linear response for Cd, Cu, Mn, Pb and Zn from 0.2 microg L(-1) (1 microg L(-1) for Mn) to 20 microg L(-1) (30 microg L(-1) for Zn, Pb and 80 microg L(-1) for Mn). Under the same analytical conditions, the 125-microm gold-disk microelectrode shows linear behaviour for Cd, Cu, Pb and Zn from 1 microg L(-1) (5 microg L(-1) for Cd) to 100 microg L(-1) (200 microg L(-1) for Pb). The sensitivity of the 25-microm electrode varied for different analytes from 0.23 (+/-0.5%, Mn) to 4.83 (+/-0.9%, Pb) nA L micromol(-1), and sensitivity of the 125-microm electrode varied from 1.48 (+/-0.7%, Zn) to 58.53 (+/-1.1%, Pb nA L micromol(-1). These microelectrodes have been validated for natural sample analysis by use in an on-site system to monitor Cu, Pb and Zn labile concentrations in the Deûle River (France), polluted by industrial activities. First results obtained on sediment core issued from the same location have shown the ability of this type of microelectrode for in situ measurements of Pb and Mn concentrations in anoxic sediments.

Collaborative consensus for optimized multilocus sequence typing of Candida albicans.

A panel of 86 different Candida albicans isolates was subjected to multilocus sequence typing (MLST) in two laboratories to obtain sequence data for 10 published housekeeping gene fragments. Analysis of data for all possible combinations of five, six, seven, eight, and nine of the fragments showed that a set comprising the fragments AAT1a, ACC1, ADP1, MPIb, SYA1, VPS13, and ZWF1b was the smallest that yielded 86 unique diploid sequence types for the 86 isolates. This set is recommended for future MLST with C. albicans.

Pressor responses to endothelin-1 in normotensive and spontaneously hypertensive rats.

In freely moving rats, endothelin-1 (0.0135-4.5 nmol/kg) administered as an intravenous bolus injection, produced an immediate, short-lasting, dose-related fall in blood pressure followed by a long-lasting, dose-related increase in blood pressure. There was a higher sensitivity in the pressor responses to endothelin-1, in spontaneously hypertensive (SH) rats (ED(50) = 0.11 +/- 0.02 and 0.28 +/- 0.02 nmol/kg, in SH and normotensive rats, respectively), but no change in the maximal pressor effect of endothelin-1 in SH rats. In rat isolated aorta, endothelin-1 induced a greater vasocontractile effect in SH rats than in normotensive rats. In both rat strains, removal of the endothelium did not change the concentration-effect curves obtained in endothelium-intact preparations. These data add further support to the hypothesis that endothelin-1 could play a role in genetic hypertension, at least in the maintenance of high blood pressure.