[The social to the test, the test of the social. Or the art of accommodating patients' social position in preventive work in general medicine]. / Le social à l'épreuve, l'épreuve du social. Ou l'art d'accommoder la position sociale des patients dans le travail préventif en médecine générale.

AIM: This article examines the way in which private general practitioners take into account the social position of their patients in their preventive work. METHODS: After a review of the main normative constructs supposed to equip the general practitioners to grasp the social dimension of their practice, the article used two surveys on the provision of preventive care, one epidemiological (PrevQuanti) and the other sociological (PrevQuali). RESULTS: Deontology, training and recommendations make it difficult to shape the social dimensions of health that pratitioners have to deal with. The PrevQuanti survey, however, revealed that the provision of preventive care is subject to almost systematic but variable social gradients. The analysis, based on the PrevQuali interview study, makes the ways in which pratitioners mobilise the social position of their patients and whether or not they adapt to it. CONCLUSION: The positionings of general practitioners can be modelled in a typology of six postures between which some oscillate.

The risk of postoperative complications and functional impairment after multimodality treatment for limb and trunk wall soft-tissue sarcoma: Long term results from a monocentric series.

BACKGROUND AND OBJECTIVES: Conservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives. METHODS: A retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012. Predictive factors for postoperative complications and functional impairment were tested in a multivariate analysis. RESULTS: 728 patients were operated (resection R0: 68%). Neoadjuvant chemotherapy (NAC) was given to 28%, postoperative radiotherapy to 70% of patients. Median follow-up was 103 months. At five years, overall survival was 80% and local recurrences 11%. Major postoperative complications occurred in 8% and functional impairment in 13% of the patients. Independent predictive factors for postoperative complications were American Society of Anesthesiologist classes 2 and 3 (OR: 2.3, CI: 1.2-4.5 and 4.0 CI: 1.7-9.3), tumor size >80 mm (OR: 2.5, CI: 1.3-4.9), tumor site (trunk wall/lower limb, OR: 4.1, CI: 1.3-13.6) and multifocal/multicompartmental spread (OR: 2, CI: 1.1-3.6). Independent predictive factors for function impairment were postoperative complications (OR: 5.3, CI: 2.8-10.1), NAC (OR: 3.6, CI: 2.2-5.8), and bone or neurovascular involvement (OR 3.3, CI 2.0-5.3), whereas Early Rehabilitation after Surgery (ERAS) improved outcome (OR: 0.5, CI: 0.3-0.9). CONCLUSION: Postoperative complications induced functional impairment. They may be reduced by acting on comorbidity factors and careful tumor evaluation prior to surgery. Furthermore, ERAS measures improved function.

[Gynaecologic follow up, physicians involved and cervical smears: An accumulation of social disparities]. / Suivi gynécologique, médecin impliqué et dépistage du cancer du col utérin : une accumulation de disparités sociales.

OBJECTIVES: This study analysed how social disparities are built in the health process leading to the achievement of cervical smears. MATERIALS AND METHODS: A cross-sectional study included women over 40 years eligible for cervical cancer screening and recruited randomly in the patient base of 52 volunteer general practitioners (GP). Judgement criteria were (1) the existence of a gynaecological follow up, (2) provided by a GP (versus gynaecologist), and (3) the "up to date" status for the cervical smear. Occupational class, education, and perceived financial condition evaluated social position. RESULTS: Among 1092 women (participation 74%), 86% had a gynaecological follow up. It was associated with a higher social position and to more "up to date" status. The follow up was performed by the GP for 10% of the patients who mainly had a lower social position. The "up to date" status was more prevalent when the follow up was done by the gynaecologist than by a GP but was socially differentiated. CONCLUSION: Having a gynaecological follow up, especially by a gynaecologist, improved cervical screening but social inequalities were linked to its achievement at every part of this process.

[Vaccination against hepatitis B in children: survey on knowledge, opinions, and practices of general practitioners in Île-de-France in 2009]. / Vaccination des nourrissons contre l'hépatite B: connaissances, opinions et pratiques des médecins généralistes de l'Est parisien en 2009.

Vaccination against hepatitis B in infants has been recommended since 1994. However, the WHO target of eradicating the disease in Europe is compromised due to less than 50% coverage in France. A telephone survey conducted in the first quarter of 2009 on 300 general practitioners (GPs) randomly selected in 3 departments in eastern Île-de-France was used to study the knowledge, reported practices, and opinions on the vaccine in infants and the impact of the hexavalent vaccine's reimbursement. Two hundred and nine GPs agreed to answer. Among those taking care of infants (180), 74.4% reported offering them the vaccine. The GPs who did not practice complementary and alternative medicine (CAM), who knew of the reimbursement of the hexavalent and the recommendations, and who practiced in the suburbs rather than in Paris offered to vaccinate infants more frequently. Among GPs taking care of infants, 40.5% reported they had changed their practice since the reimbursement of the hexavalent vaccine. More than a quarter of GPs (26.2%) were opposed to the vaccination against hepatitis B in infants. They were older, practiced CAM more frequently, and were less familiar with the recommendations. Among the respondents, 79% had encountered the fear of side effects from the parents and among them 17.7% did not insist or postponed the discussion. In conclusion, in 2009, over a quarter of GPs were refractory to the vaccination proposal in infants but the hexavalent vaccine seems to have a significant impact on practices.

Do social inequalities in cervical cancer screening persist among patients who use primary care? The Paris Prevention in General Practice survey.

OBJECTIVE: Social inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize social inequalities among women consulting general practitioners with a wide range of social position indicators. METHODS: In 2005-06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50-69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels). RESULTS: The rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03-1.41), social network (1.52, 95% CI: 1.18-1.94), financial difficulties (1.42, 95% CI: 1.07-1.88), neighborhood safety (2.15, 95% CI: 1.10-4.20), and allocations (3.34, 95% CI: 1.12-9.96). CONCLUSIONS: Even among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.

[Factors associated with the lack of proposition for HIV-AIDS and hepatitis B and C screening to underprivileged immigrants]. / Facteurs liés à l'absence de proposition de dépistage du VIH-sida et des hépatites B et C aux immigrés en situation de précarité

BACKGROUND: Underprivileged immigrants from endemic areas cumulate risk factors for infections by HIV-AIDS and hepatitis B and C. Free primary care consultations are available to them in the four health centers of the city of Paris. The objective of our study was to identify socio-demographic and medical factors related to the lack of screening proposition for HIV-AIDS and hepatitis B and C to new immigrant patients in these centers in 2003. METHODS: For each disease, the absence of screening proposition was analyzed according to geographical origin, length of stay in France, type of accommodation, type of health insurance and symptom motivating the encounter in logistic mixed models adjusted on sex and age. RESULTS: About 500 patients were included in the analysis. Three-quarters of them were male and from Sub-Saharan Africa. They were 36years old on average. Half of them lived in shelters for homeless or immigrants. Their median stay lasted two years. They rarely came for screening (1%), sometimes for asthenia (6%) and two-thirds of them for uro-genito-digestive signs. The results were similar for the three screenings. The lack of screening proposition was about 45% and varied significantly between physicians. Factors significantly associated with the lack of screening proposition were: coming from non-Sub-Saharan Africa (especially from North Africa and Middle East; OR=1.7 to 3.6) and having a health insurance (OR=2.4 to 2.6) regardless of the disease; being a female (OR=2.0 to 2.3) in the case of hepatitis; and having a length of stay in France greater than or equal to five years (OR=1.9) for hepatitis B. CONCLUSIONS: Our results should encourage practitioners to provide more screening to underprivileged immigrants and draws attention to immigrants from non-Sub-Saharan origin and those with health insurance. Factors that might explain doctor and gender-related variability observed in hepatitis are highlighted.

Thermo-mechanical processing of sugar beet pulp. III. Study of extruded films improvement with various plasticizers and cross-linkers.

Thermoplastic sugar beet pulp (thermo-mechanical processing was discussed in previous studies) was formed into film strips by extrusion. Film tensile properties are discussed according to the molecular structure of external plasticizer. Sorbitol, fructose and adipic acid have a marked antiplasticizing effect, while urea and xylitol gave higher ultimate tensile stress than glycerol for a comparable strain at break. Xylitol can be considered as the best plasticizer with UTS and EL of, respectively, 4.9 MPa and 11.3% and water absorption (85% RH, 25 degrees C) was less than 25%. Glycidyl methacrylate was directly used in the extrusion process as cross-linker. In high humidity atmosphere (97% RH, 25 degrees C), film water absorption was then kept under 40% while tensile strength and strain were improved of 50% and with a 30 min UV post-treatment the mass gain in absorption was even less than 30% after 5 days.

New natural injection-moldable composite material from sunflower oil cake.

Through a twin-screw extrusion process the native structure of sunflower oil cake was completely transformed (globular protein denaturation/texturization and husk fiber defibration) into a simpler matrix-fiber structure, as could be seen on SEM micrographs. Further chemical reduction of protein disulfide bridges greatly reduced the melt viscosity of the moistened composite that it could be injection-molded. The molded specimens were tested and their tensile and flexural properties and water absorption calculated. Their water resistance appeared to be particularly high, and could be enhanced further after a thermal treatment (N2, 200 degrees C). The proteic matrix seemed to behave like a natural thermoset resin. Sunflower oil cake could be used without any additives to make biodegradable, water resistant and exceptionally cheap materials.

Extraction of sunflower oil by twin screw extruder: screw configuration and operating condition effects.

The objective of this study was to investigate the screw configuration allowing oil extraction from sunflower seeds with a twin-screw extruder. Experiments were conducted using a co-rotating twin-screw extruder. Five screw profiles were examined to define the best performance (oil extraction yield, specific mechanical energy and oil quality) by studying the influence of operating conditions, barrel temperature, screw speed and feed rate. Generally, the position and spacing between two reversed screw elements affected oil extraction yield. An increase of oil extraction yield was observed as the reversed screw elements were moved with increased spacing between two elements and with smaller pitch elements. In addition, oil extraction yield increased as barrel temperature, screw speed and feed rate were decreased. Highest oil extraction yield (85%) with best cake meal quality (residual oil content lower than 13%) was obtained under operating conditions of 120 degrees C, 75 rpm and 19 kg/h. Furthermore, the operating parameters influenced energy input. A decrease in barrel temperature and feed rate followed by an increase in screw speed increased energy input, particularly specific mechanical energy input. Effect of the operating parameters on oil quality was less important. In all experiments tested, the oil quality was very good. The acid value was below 2 mg of KOH/g of oil and total phosphorus content was low, below 100 mg/kg.

Magneto-optical evidence for a gapped fermi surface in underdoped YBa2Cu3O6+x.

The infrared (900-1100 cm(-1)) Faraday rotation and circular dichroism are measured in the normal state of underdoped High T(c) superconductors and used to study the magnetotransport. YBa2Cu3O6+x thin films are investigated in the temperature range 10-300 K in magnetic fields up to 8 T and as a function of oxygen concentration. A dramatic increase of the Hall frequency is observed for underdoped samples, which is not consistent with the approach to a Mott transition but is consistent with a partial gapping of the Fermi surface as predicted in density wave models.

Spectral measurement of the Hall angle response in normal state cuprate superconductors.

We measure the temperature and frequency dependence of the complex Hall angle for normal state YBa(2)Cu(3)O(7) films from dc to far-infrared frequencies (20-250 cm(-1)) using a new modulated polarization technique. We determine that the functional dependence of the Hall angle on scattering does not fit the expected Lorentzian response. We find spectral evidence supporting models of the Hall effect where the scattering Gamma(H) is linear in T, suggesting that a single relaxation rate, linear in temperature, governs transport in the cuprates.

Isolation and characterisation of hemicelluloses from sunflower hulls.

The hemicelluloses extracted from sunflower hulls by repeated alternating oxidative and alkaline treatments were purified by precipitation with Cetavlon and then ion-exchange chromatography on DEAE-trisacryl. The resulting fractions were examined by hydrolysis, methylation, GLC-MS, and NMR spectroscopy. The hemicelluloses are of the glucuronoxylan type with the following structure -->4)-beta-D-Xylp-(1-->4)-[4-O-Me-alpha-D-GlcpA-(1-->2)]-bet a-D-Xylp-(1-->. The polysaccharides differed in the amount of branching; the ratio of the main fraction 4-O-MeGlcA:Xyl was 1:8-9.