An overview of the literature on emerging pollutants: Chlorinated derivatives of Bisphenol A (ClxBPA).

CONTEXT: Bisphenol A (BPA) is a ubiquitous contaminant with endocrine-disrupting effects in mammals. During chlorination treatment of drinking water, aqueous BPA can react with chlorine to form chlorinated derivatives of BPA (mono, di, tri and tetra-chlorinated derivatives) or ClxBPA. OBJECTIVE: The aim of this study is to summarize and present the state of knowledge on human toxicological risk assessment of ClxBPA. MATERIALS AND METHODS: A search on ClxBPA in the PubMed database was performed based on studies published between 2002 and 2021. Forty-nine studies on chlorinated derivatives of BPA were found. Available information on their sources and levels of exposure, their effects, their possible mechanisms of action and their toxicokinetics data was extracted and presented. RESULTS: ClxBPA have been essentially detected in environmental aqueous media. There is evidence in toxicological and epidemiological studies that ClxBPA also have endocrine-disrupting capabilities. These emerging pollutants have been found in human urine, serum, breast milk, adipose and placental tissue and can constitute a risk to human health. However, in vitro and in vivo toxicokinetic data on ClxBPA are scarce and do not allow characterization of the disposition kinetics of these compounds. CONCLUSION: More research to assess their health risks, specifically in vulnerable populations, is needed. Some water chlorination processes are particularly hazardous, and it is important to evaluate their chlorination by-products from a public health perspective.

RNA polymerase II CTD S2P is dispensable for embryogenesis but mediates exit from developmental diapause in C. elegans.

Serine 2 phosphorylation (S2P) within the CTD of RNA polymerase II is considered a Cdk9/Cdk12-dependent mark required for 3'-end processing. However, the relevance of CTD S2P in metazoan development is unknown. We show that cdk-12 lesions or a full-length CTD S2A substitution results in an identical phenotype in Caenorhabditis elegans Embryogenesis occurs in the complete absence of S2P, but the hatched larvae arrest development, mimicking the diapause induced when hatching occurs in the absence of food. Genome-wide analyses indicate that when CTD S2P is inhibited, only a subset of growth-related genes is not properly expressed. These genes correspond to SL2 trans-spliced mRNAs located in position 2 and over within operons. We show that CDK-12 is required for maximal occupancy of cleavage stimulatory factor necessary for SL2 trans-splicing. We propose that CTD S2P functions as a gene-specific signaling mark ensuring the nutritional control of the C. elegans developmental program.

Reliable quantification of bisphenol A and its chlorinated derivatives in human urine using UPLC-MS/MS method.

Bisphenol A (BPA), a widespread man-made chemical classified as an endocrine disruptor, is increasingly considered as a major cause of concern for human health. Chlorine present in drinking water may react with BPA to form chlorinated derivatives (ClxBPA), which have demonstrated a heightened level of estrogenic activity. If many epidemiological studies report that more than 90% of people have detectable BPA levels in their urine, then no such study has been undertaken regarding ClxBPA. The purpose of this work is to propose a highly sensitive and accurate analytical method adapted to large-scale biomonitoring studies aimed at assessing exposure to BPA and ClxBPA through the use of human urine. To achieve this, we have comprehensively validated a method using salting-out assisted liquid/liquid extraction (SALLE) coupled to UPLC-MS/MS and isotope dilution quantification, to measure unconjugated BPA and ClxBPA in human urine according to the accepted guidelines. Deutered BPA as well as deutered 2,2'-DCBPA was used as internal standards. The matrix calibration curve ranged from 0.05 to 1.60 ng mL(-1) and from 0.5 to 16.0 ng mL(-1) for ClxBPA and BPA respectively, and provided good linearity (r²>0.99). This method was precise (the intra- and inter-day coefficients of variation were <20% at three different concentrations: 0.05 ng mL(-1), 0.2 ng mL(-1), 0.8 ng mL(-1) and 0.5 ng mL(-1), 2 ng mL(-1), 8 ng mL(-1) for ClxBPA and BPA, respectively) and accurate (bias ranged from -13% to +12%). The limit of quantification, validated at 0.05 ng mL(-1) and 0.5 ng mL(-1) for ClxBPA and BPA respectively when using 300 µL of urine, was found to be suitable for the concentration existing in real samples. The matrix effect and the BPA cross-contamination were also investigated in this study. The analytical method developed in this study is in accordance with the requirements applicable to biomonitoring of BPA and ClxBPA in human urine.

Does area deprivation modify the association between exposure to a nitrate and low-dose atrazine metabolite mixture in drinking water and small for gestational age? A historic cohort study.

Birth weight may be influenced by environmental and socio-economic factors that could interact. The main objective of our research was to investigate whether area deprivation may modify the association between drinking water exposure to a mixture of atrazine metabolites and nitrates during the second trimester of pregnancy and prevalence of small for gestational age (SGA) neonates. We conducted a historic cohort study in Deux-Sèvres, France between 2005 and 2010, using birth records, population census and regularly performed drinking water withdrawals at community water systems. Exposure to an atrazine metabolite/nitrate mixture in drinking water was divided into six classes according to the presence or absence of atrazine metabolites and to the terciles of nitrate concentrations in each trimester of pregnancy. We used a logistic regression to model the association between SGA and mixture exposure at the second trimester while taking into account the area deprivation measured by the Townsend index as an effect modifier and controlling for the usual confounders. We included 10,784 woman-neonate couples. The risk of SGA when exposed to second tercile of nitrate without atrazine metabolites was significantly greater in women living in less deprived areas (OR = 2.99; 95 % CI (1.14, 7.89)), whereas it was not significant in moderately and more deprived areas. One of the arguments used to explain this result is the presence of competing risk factors in poorer districts.

Does uncontrolled cardiac death for organ donation raise ethical questions? An opinion survey.

BACKGROUND: Organ donation after uncontrolled cardiac death raises complex ethical issues. We conducted a survey in a large hospital staff population, including caregivers and administrators, to determine their ethical viewpoints regarding organ donation after uncontrolled cardiac death. METHODS: Multicenter observational survey using a questionnaire, including information on the practical modalities of the procedure. Respondents were asked to answer 15 detailed ethical questions corresponding to different ethical issues raised in the literature. Ethical concerns was defined when respondents expressed ethical concerns in their answers to at least three of nine specifically selected ethical questions. RESULTS: One thousand one hundred ninety-six questionnaires were received, and 1057 could be analysed. According to our definition, 573 respondents out of 1057 (54%) had ethical concerns with regard to donation after cardiac death and 484 (46 %) had no ethical concerns. Physicians (55%) and particularly junior intensivists (65%) tended to have more ethical issues than nurses (52%) and hospital managers (37%). Junior intensivists had more ethical issues than senior intensivists (59%), emergency room physicians (46%) and transplant specialists (43%). CONCLUSION: Only 46% of hospital-based caregivers and managers appear to accept easily the legitimacy of organ donation after cardiac death. A significant number of respondents especially intensivists, expressed concerns over the dilemma between the interests of the individual and those of society. These results underline the need to better inform both healthcare professionals and the general population to help to the development of such procedure.

Drinking-water exposure to a mixture of nitrate and low-dose atrazine metabolites and small-for-gestational age (SGA) babies: a historic cohort study.

BACKGROUND: Groundwater, surface water and drinking water are contaminated by nitrates and atrazine, an herbicide. They are present as a mixture in drinking water and with their endocrine-disrupting activity, they may alter fetal growth. OBJECTIVES: To study an association between drinking-water atrazine metabolites/nitrate mixture exposure and small-for-gestational-age(SGA). METHODS: A historic cohort study based on birth records and drinking-water nitrate and pesticide measurements in Deux-Sèvres (France) between 2005 and 2009 was carried out. Exposure to drinking-water atrazine metabolites/nitrate mixture was divided into 6 classes according to the presence or absence of atrazine metabolites and to terciles of nitrate concentrations in each trimester of pregnancy. Regression analysis of SGA by mixture exposure at second trimester was subsequently conducted. RESULTS: We included 11,446 woman-neonate couples of whom 37.0% were exposed to pesticides, while 99.9% of the women were exposed to nitrates. Average nitrate concentration was from 0 to 63.30 mg/L. In the second trimester of pregnancy, the risk of SGA was different with mixture exposure when drinking-water atrazine metabolites, mainly 2 hydroxyatrazine and desethylatrazine, were present and nitrate dose exposure increased: compared to single first tercile of nitrate concentration exposure, single second tercile exposure OR was 1.74 CI 95% [1.10; 2.75] and atrazine metabolites presence in the third tercile of nitrate concentration exposure OR was 0.87 CI 95% [0.45;1.67]. CONCLUSIONS: It is possible that the association found at the second trimester of exposure with regard to birth weight may likewise be observed before birth, with regard to the estimated fetal weight, and that it might change in the event that the atrazine metabolites dose were higher or the nitrate dose lower. It would appear necessary to further explore the variability of effects.

Altered quality of life in Rendu-Osler-Weber disease related to recurrent epistaxis.

OBJECTIVES: Development and validation of an epistaxis-specific quality-of-life questionnaire (EQQoL) to evaluate the impact on quality of life of epistaxis, during hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN: Prospective clinical study using QoL instruments administered twice in HHT patients. PATIENTS AND METHODS: In total, 109 patients who had epistaxis and a clinical diagnosis of HHT according to Curacao criteria were included. Invoice of the questionnaire in 2004 and 2006 included SF-36, Jenkins` sleep scale and the new epistaxis-specific13-item EQQoL. RESULTS: EQQoL uptake rate was 98%, mean score 58/100 +- 27, and Cronbach alpha 0.96. EQQoL was sensitive to change with a strong correlation with the course of epistaxis. Factorial analysis showed that EQQoL was clearly distinct from SF-36 and Jenkins sleep scales. In stepwise multivariate ordinal logistic regression, frequency and duration of epistaxis were both associated with lower EQQoL. Conversely, visceral involvement and comorbidity had independent impact on SF-36 scores, but not on EQQoL. CONCLUSIONS: This new epistaxis-specific EQQoL questionnaire provides complementary information on the impact of HHT on patients quality of life relative to the SF-36 generic questionnaire. After international validation, the EQQoL might prove a useful tool for treatment evaluation.

[Survey on the medical mycology processes to the members of the French Society for Medical Mycology]. / Enquête sur les conditions analytiques d'un examen de mycologie médicale auprès des membres de la Société française de mycologie médicale.

AIM OF THE STUDY: The objective of the survey was to describe the practices of clinical laboratories in terms of cultures in medical mycology. We have implemented this project within the members of the French Society for Medical Mycology (SFMM) to evaluate the analytical processes of the mycological examination in our laboratories. This preliminary study would help to suggest the future French guidelines. MATERIALS AND METHODS: A questionnaire regarding the processing of mycology analysis was sent to the 227 members of the SFMM in 2009. The data involved 21 types of samples, direct microscopic examination with or without colouring and the reagents, the number of culture media, the types of media (Sabouraud, Sabouraud antibiotic, Sabouraud cycloheximide and chromogenic medium), temperature and duration of the incubation (days) and the existence of a first result before the end of the incubation period. The analytical processes were compared to an accredited laboratory according to EN ISO 15189. RESULTS: A great heterogeneity was observed in the 36 forms from 27 (75%) laboratories belonging to university hospitals among the 38 existing in France. As for deep samples, two microscopic exams were performed, only one was usually done. A more sensitive technique was preferred to the wet-mount for some samples. Routine samples are often inoculated on a chromogenic media. For deep samples two medium are inoculated (chromogenic media, Sabouraud and antibiotics). If the temperature of incubation is unique, 30°C was chosen. A temperature of 37°C was preferred for samples where Candida spp. is selected. When there are two temperatures of incubation, 27°C and 37°C were preferred. CONCLUSION: Each biologist can compare his proceedings to the other laboratories and to a laboratory already accredited. The question is to find the best strategies for each medical mycology specimen. They will aid the process of accreditation according to EN ISO 15189, which now applies in all laboratories in Europe.

[Evaluation of a fully integrated digital screening mammography program in the Vienne region]. / Evaluation du tout numérique dans le dépistage organisé du cancer du sein à travers une expérience dans le département de la Vienne.

PURPOSE: To evaluate a fully integrated digital screening mammography program (image acquisition, transfer and over-read). MATERIALS AND METHODS: between april 2005 and December 2007, two imaging sites were authorized by the Department of Health to use digital mammography units (Senographe 2000D and 2000DS, GEMS) for screening mammography. the initial interpretation was made on a workstation with accompanying digital films. The images were also transmitted via the internet on the same day for over-read on a workstation. In addition, a <> over-read was also performed from printed mammographic images using a viewbox. Differences in interpretation and BIRADS classification as well as economical considerations were analyzed between the types of interpretation setups. RESULTS: A total of 7008 screening mammograms were included. No significant problem was reported with regards to internet image transfers. No significant interpretation difference was noted related to the fully integrated digital imaging process. This technology could generate cost savings estimated in 2007 at 3.793/year (mailing fee). CONCLUSION: A fully integrated digital screening mammography program results in improved organisational processes and significant cost reductions without reduced diagnostic accuracy.

Use of a risk analysis method to improve care management for outlying inpatients in a university hospital.

OBJECTIVE: To improve the quality of care provided for inpatients outlying in inappropriate wards of a teaching hospital because of lack of vacant beds in appropriate specialty wards. METHODS: A multidisciplinary team consisting of hospital doctors, nurses and managers performed a prospective risk analysis of the process of care provided for outlying patients during their hospitalisation. The design of the study was Failure Modes, Effects and Criticality Analysis (FMECA). Failure modes were defined and classified according to their criticality, in order to identify priority actions for improvement. Criticality indices were calculated by multiplying occurrence, severity and detection scores. RESULTS: Measures for improvement indicated by the most critical failure modes were the identification of specialist doctors in appropriate specialty wards to be responsible for the care of outlying patients falling within their sphere of competence; the identification of a nurse coordinator in each department to improve communication between the emergency department, appropriate specialty wards and outlying wards; the standardisation of medical records throughout the whole hospital to ensure better traceability and access to information. CONCLUSIONS: Using FMECA, we were able to identify the most critical failure modes of the complex process of care provided for outlying patients and to suggest subsequent improvement measures. Follow-up indicators were defined to assess implementation.

The case for re-evaluating the upper limit value for selenium in drinking water in Europe.

Selenium is an essential trace element for life, which can be toxic for humans when intakes reach a certain amount. Therefore, since the margin between healthy intake and toxic intake is narrow, the selenium concentration of tap water is a parameter that must be monitored because of its potential for increased intake. The present work gives an overview of the different approaches used to calculate safe limits for selenium. As recommended by WHO, the guidelines for drinking water form the basis of national legislated standards for drinking water. Before setting a maximum acceptable level in drinking water, it is necessary to take into account the total intake of selenium in both food and beverage. The limit value of 10 microg l(-1) for drinking water laid down in the European regulations for all countries should be adapted depending on geographic area, as previously recommended by WHO.

[Application of detecting and taking overdispersion into account in Poisson regression model]. / Intérêt de la détection et de la prise en compte d'une surdispersion dans un modèle de Poisson: illustration à partir d'un exemple.

BACKGROUND: Researchers often use the Poisson regression model to analyze count data. Overdispersion can occur when a Poisson regression model is used, resulting in an underestimation of variance of the regression model parameters. Our objective was to take overdispersion into account and assess its impact with an illustration based on the data of a study investigating the relationship between use of the Internet to seek health information and number of primary care consultations. METHODS: Three methods, overdispersed Poisson, a robust estimator, and negative binomial regression, were performed to take overdispersion into account in explaining variation in the number (Y) of primary care consultations. We tested overdispersion in the Poisson regression model using the ratio of the sum of Pearson residuals over the number of degrees of freedom (chi(2)/df). We then fitted the three models and compared parameter estimation to the estimations given by Poisson regression model. RESULTS: Variance of the number of primary care consultations (Var[Y]=21.03) was greater than the mean (E[Y]=5.93) and the chi(2)/df ratio was 3.26, which confirmed overdispersion. Standard errors of the parameters varied greatly between the Poisson regression model and the three other regression models. Interpretation of estimates from two variables (using the Internet to seek health information and single parent family) would have changed according to the model retained, with significant levels of 0.06 and 0.002 (Poisson), 0.29 and 0.09 (overdispersed Poisson), 0.29 and 0.13 (use of a robust estimator) and 0.45 and 0.13 (negative binomial) respectively. CONCLUSION: Different methods exist to solve the problem of underestimating variance in the Poisson regression model when overdispersion is present. The negative binomial regression model seems to be particularly accurate because of its theorical distribution ; in addition this regression is easy to perform with ordinary statistical software packages.

[Hospital pathway of patients with breast cancer]. / Trajectoires hospitalières des patientes atteintes de cancer du sein en Poitou-Charentes.

Health care network should promote better quality, equity and care efficacy. On the subject of breast cancer, literature has shown inequality in care depending on geographical areas and health centres locations. This article illustrates a method of analysis of female non in situ non metastatic breast cancer patients hospital care pathway, from the 2002 and 2003 Poitou-Charentes' county Diagnosis Related Groups (DRG's) data bases. The treatments several phases are described along with their combination. The number of chemotherapy and radiotherapy sessions per patient are each analysed for comparison between Health Centres, Health Centres Status, and in view of the referentials recommendations. Several health pathways options are quantified: Mono/pluri Health Centres sites, inside/outside a geographical department, inside/outside Poitou-Charentes county. Nine hundred and nine patients hospital care pathways are described. Surgery was more often partial (66%), with Health Centres variation between 17 and 68%. Among the 308 patients who had chemotherapy, 78% received between 4 and 6 sessions, with variation per Health Centre between 65 and 90%. Radiotherapy is difficult to trace because of the Health Centres non systematic radiotherapy sessions linkage, and private Health Centres lack of information (no DRG's). 91% of identified radiotherapy benefiting patients had 25 to 35 sessions, in conformation with recommendations depending on the surgery performed with Health Centres variation ratio between 76 and 96%. Hospital care pathways options between two type of treatments were identified. 90% of the hospital care pathways took place in the same geographical department, and 30% took place in public Health Centres alone. Despite radiotherapy tractability limits, proper DRG's data collection allows the description of health pathways between Health Centres and allows health practice disparity identification. Using this tool, in accordance with the Cancer Plan, can therefore help health networks in evaluating care pathway in cancer and many other fields.

[Imogam rage prescription assessment in the rabies prophylaxis center of Poitiers]. / Evaluation de la pertinence de la prescription d'Imogam rage au centre antirabique de Poitiers.

OBJECTIVES: Imogam rage (IgR) prescriptions were assessed in the rabies prophylaxis centre of Poitiers (France). MATERIAL AND METHODS: All medical records closed between January 1 and June 1, 2005 were retrospectively analyzed. An infectious disease specialist examined the pertinence of IgR prescription according to WHO references adapted to the epidemiological situation by the Pasteur Institute French rabies center. The indicator used was the proportion of patients treated by IgR among all patients treated by vaccination or vaccination with IgR. RESULTS: During the study period, 69 medical records have bewereen analyzed: 48 (70%) patients were treated including 22 (46%) with IgR. Imogam rage indication was not appropriate for 21 (95%) patients (one contact with a rodent, 8 low gravity contact, 12 contacts with a French animal) that is to say 86 IgR vials. The direct cost was 8,032 euros. CONCLUSION: This assessment permitted to underline an overprescription of IgR, to adapt guidelines to the local situation, and to improve care quality by adaptating medical record files, improving the prescription decisional tree and the local guidelines, and improving the training of interns.

[Health behaviours of students at the University Institute of Technology in Poitiers]. / Comportements de santé des étudiants d'IUT de l'Iniversité de Poitiers.

Better knowledge and understanding of students' health attitudes and behaviours are necessary to more effectively plan targeted prevention strategies. A survey conducted among 617 students at the University Institute of Technology in Poitiers showed that although some indicators affirm good health (relationships with friends and family, appropriate contact with care providers in the health system and regular visits to prevention centres, sexual life, and sports and physical fitness), other indicators reveal a certain amount of suffering among the student population. Students reported suicidal thoughts, symptoms of poor well-being (fatigue, sleeping disorders, concentration problems, sadness or depression) and poor eating habits and/or eating disorders. Consumption of both legal and illegal products seems to be a means utilised to facilitate the social integration process for some students. Therefore, this underlines a significant challenge for prevention campaigns to develop an alternative role model, which promotes the image and profile of a healthy student, with a strong sense of self-esteem, who is well-integrated with his peers without having to engage in substance abuse.

[Information on organized screening for breast cancer: qualitative study of women and practitioners in the Poitou-Charentes county]. / Information sur le dépistage organisé du cancer du sein : étude qualitative auprès des femmes et des médecins en Poitou-Charentes.

SUMMARY: This study was an evaluation of communication campaigns for the organized breast cancer screening tests. Women and practitioners in Charente and Vienne departments were interviewed in order to evaluate the campaigns' impact in terms of information tools memorization, organized screening test knowledge and attitude towards screening. The study revealed general practitioner's difficulties in appropriating the breast cancer organized screening and incomplete procedures knowledge; the information given to women by practitioners was therefore incomplete. The evaluation found that women had diversified breast cancer screening information, but some had difficulties in beginning screening test procedure. These women need a local communication network through associations and institutions to be reassured, advised and guided during the procedure.

[Influence of smoking among family physicians on their practice of giving minimal smoking cessation advice]. / Influence du tabagisme des médecins généralistes sur leur pratique du conseil minimal d'aide à l'arrêt du tabac.

INTRODUCTION: The aim of the study was to establish whether family physicians are influenced by their own smoking habits when issuing prevention messages to patients who smoke. METHODS: 257 Family physicians of the Vienne Department answered a survey (participation rate: 70%) investigating their own smoking habits and how they approach patients who smoke. RESULTS: The prevalence of smoking among respondents was 26%; 30% were ex-smokers and 44% had never smoked. Regular smokers (16%) generally smoked 15 cigarettes a day and 49% were nicotine dependent--15% highly so. When consulting, 44% of doctors stated that they systematically addressed smoking habits and 41% declared that they gave minimal smoking cessation advice. Doctors who smoke were less prone to ask their patients whether they smoke (p = 0.036) and whether they had considered quitting (p = 0.045). Unlike those who didn't smoke or had quit smoking, doctors who smoke often believed that their smoking habits had no impact on their relationship with the patients or that it might even make communication with the patient easier (p < 0.0001). CONCLUSIONS: Family physicians' smoking habits have an impact on their interaction with patients who smoke. This must be taken into account in training sessions for smoking cessation.

[Diversity of bedside pretransfusion ABO compatibility devices in metropolitan France]. / La diversité des dispositifs de contrôle ultime pré-transfusionnel utilisés en France métropolitaine.

To prevent the occurrence of the ABO incidental incompatibility, the bedside pretransfusion ABO control is mandatory in France since 37 years. If the quality of the reagents is regularly controlled, no technical specification exists concerning the type of support. To describe the different types of devices used by the French hospitals, a brief questionnaire was sent, from December 2000 to March 2001, to each hemovigilance correspondent working in the 1782 hospitals with transfusion activity in 1999. Every participant had to send back the device used in his establishment. The rate of replies was 29.4%, varying from a region to another. The devices distributed by laboratories were the most used (67.4%) vs. 25.6% for the devices provided by the regional establishments of the French Establishment of Blood and 6.7% for the devices manufactured by hospitals. The presence in the region of a local office of the French Establishment of Blood providing some devices was the only factor determining the choice of the device type (p < 10(-8)). Almost half of the hospitals (46.8%) declared to have renewed their devices after 1996, most often in favor of a device provided by a laboratory (p < 10(-8)). We evaluated 30 different devices taking into account the general presentation, the available information on the device. The results of this survey showed a large disparity and heterogeneity in the quality of the devices used by the French hospitals in the context of a lack of standardization.

[Chronic renal failure in Poitou-Charentes: prevalence, structure adequacy, and patient satisfaction]. / Insuffisance rénale chronique en Poitou-Charentes: prévalence, adéquation des structures et satisfaction des patients.

The characteristics of the existing cases in the region, the adequacy of the structures with respect to the needs, and the satisfaction of patients undergoing dialysis have been analysed as part of an ongoing project for the development of a Regional Outline for Health Organisation in the Poitou-Charentes region of France. A cross-sectional survey was conducted in the haemodialysis units, dialysis facilities and patient associations in the region and bordering areas where patients were being treated. As of March 31, 2000, the prevalence of chronic renal failure was estimated to be 373 people per one million of the population. According to the nephrologist, the adequacy of the care structures was found to be satisfactory for 82% of the patients. The main reasons for non-adequacy were first, the lack of intermediate structures between centres and outpatient units; second, the patient's refusal to be referred to another structure; and finally, other medical, physical and intellectual factors. For 90% of patients, their treatment method corresponded to their choice of therapy. The lack of a nearby structure was equally recognised as a primary reason for dissatisfaction. It should be noted that 42% of the patients under 60 years old felt that they were either poorly or very poorly informed of their rights, the coverage and the treatment of this illness.

[Regional program to improve the quality of blood transfusions in hospitals: experience of the Poitou-Charentes region]. / Programme régional d'amélioration de la qualité transfusionnelle dans les établissements de santé: expérience de la région Poitou-Charentes.

In the Poitou-Charentes area, a regional pilot program was implemented over a two year-period to improve transfusion safety in public and private hospitals. This program consisted in: (i) an evaluation of the transfusion chain in hospitals; (ii) a regional program to guide hospitals in improving the quality process. Five workgroups were set up. Three persons in each hospital should participate in the workgroup: one representing the administration, one the medical staff and one the nursing staff. After a six months follow-up several hospitals were prompted to implement corrective and preventive measures to improve transfusion safety; (iii) a letter was regularly published to contribute to set-up a regional haemovigilance network. Such a quality improvement program revealed to be a relevant method to steer the changing blood transfusion process in hospitals.