Impact of perinatal environmental health education intervention on exposure to endocrine disruptors during pregnancy-PREVED study: study protocol for a randomized controlled trial.

BACKGROUND: The suspected or actual effects on health of endocrine-disrupting chemicals (EDC) and their ubiquitous presence in everyday life justify the implementation of health promotion interventions. These interventions should ideally be applied during critical windows like pregnancy. Perinatal environmental health education interventions may help to reduce EDC exposure during pregnancy. METHODS/DESIGN: PREVED (Pregnancy, PreVention, Endocrine Disruptors) is an open-label randomized controlled trial assessing the impact of environmental health education intervention on EDC exposure during pregnancy. Inclusion, consent, and randomization take place during the first trimester. The participants are randomly allocated into three groups: (i) control group (information leaflet on EDCs), (ii) intervention group in neutral location (information leaflet and workshops in a meeting room), and (iii) intervention group in contextualized location (information leaflet and workshops in a real apartment). Workshops are organized between the second and third trimesters of pregnancy. Main outcome is the percentage of participants who reported consuming manufactured/industrial food. Secondary outcomes are as follows: (i) psycho-social dimensions, (ii) EDC concentrations in urine, (iii) EDC concentration in colostrum, and (iv) percentage of participants who reported consuming paraben-free personal care products. DISCUSSION: PREVED is a ground-breaking intervention research project dedicated to perinatal environmental health education that aims to identify pollutant sources in daily life and to offer accessible and realistic alternative solutions, by promoting the sharing of know-how and experience in a positive and non-alarmist approach. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03233984 (current status: ongoing). Retrospectively registered on 31 July 2017 ( https://clinicaltrials.gov/ct2/show/NCT03233984 ) because when the first participant was enrolled in this non-drug intervention, ClinicalTrials.gov was centered in therapeutic trials. The World Health Organization Trial Registration Data Set is in Additional file 1.

Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France.

To combat the COVID-19 pandemic, many European countries have developed a public health strategy involving the use of digital contact tracing (DCT) applications to improve timely tracking and contact tracing of COVID-19 cases. France's independent COVID-19 Control and Society Connection Council (CCL) was established by law in May 2020 to issue advice and recommendations on the national epidemic digital systems. In this paper, we present the recommendations by the CCL, with the objective to increase the uptake and utility of French DCT applications. As the country's most vulnerable population has been subjected to greater virus exposure, a stronger impact of the lockdown, and less access to preventive and health care services, the CCL is particularly aware of health inequalities. The French DCT app TousAntiCovid had been downloaded by 13.6 million users (ie, 20% of the French population) in March 2021. To promote the use of DCT apps, the CCL has recommended that communication about the app's individual and collective objectives be increased. The CCL has also recommended the introduction of clear, simple, accessible, incentivizing, noncoercive information within the digital tools. In addition, the CCL has recommended improving public health policies to address the needs of the underprivileged. The CCL calls for promoting population empowerment with the use of digital tools, improving public health culture for decision-makers dealing with health determinants, taking social considerations into account, and incorporating community participation.

Comparison of the Effect on Fetal Growth of a Mixture of Atrazine and Nitrates in Drinking Water and of Active Tobacco Exposure during Pregnancy.

Active tobacco exposure during pregnancy is a known determinant of fetal growth. Nitrates and atrazine metabolites in drinking water may affect fetal growth as a mixture of endocrine disruptors (ED). We aimed to determine whether EDC have an additional effect on fetal growth compared to active tobacco exposure. A historic cohort study was carried out with a sample stratified with regard to the maternity unit, drinking water exposure, and year of birth. The women included were living in Deux-Sèvres, had given birth between 2005 and 2010 in three selected maternity units, and ultrasound data were available in their obstetrical records. Mixed linear models were used to analyze fetal weight evolution from the second trimester to the time of birth according to drinking water exposure to EDC mixture and active tobacco exposure. We included 558 mother-neonate couples, of whom 9% were exposed to high doses of the mixture and 21% to active tobacco smoking. There was no difference in fetal weight evolution according to drinking water mixture exposure (0.97 g; 95% CI [-3.01; 4.94]). We could not show a supplementary effect of mixture exposure in drinking-water on fetal growth as compared to active tobacco exposure. Further research is needed, using more precise methods to estimate EDC exposure.

Perinatal Environmental Health Education Intervention to Reduce Exposure to Endocrine Disruptors: The PREVED Project.

Environmental health promotion interventions may reduce endocrine disruptor (ED) exposure. The PREVED (PREgnancy, preVention, Endocrine Disruptors) project was developed to improve knowledge, to enhance risk perception, and to change exposure behavior. Our objective was to present the phases of the PREVED project using the RE-AIM method. PREVED intervention consisted of three workshops during pregnancy. Reach, adoption, and implementation phases were assessed with qualitative studies. Efficacy study consisted of a three-arm randomized controlled trial (RCT) on 268 pregnant women: (i) control group (leaflet), (ii) intervention group in neutral location, (iii) intervention group in contextualized location. The main outcome was the percentage evolution of participants who reported consuming canned food. Secondary outcomes were evolution of psycho-social scores, evolution of ED presence in urine, and ED presence in colostrum. The intervention adoption was centered on upper-privileged women, but implementation assessment showed that key features (highly practical intervention) seemed to be carried out and had initiated some behavior changes. A total of 268 pregnant women participated in the intervention and 230 in a randomized controlled trial (control group: 86 and intervention groups: 172). We found no significant differences in consumption of canned food and in percentage of women having a decrease of bisphenol A or parabens in urine, but we found a significant increase in the evolution of risk perception score and overall psychosocial score in intervention groups (respectively: +15.73 control versus +21.03 intervention, p = 0.003 and +12.39 versus +16.20, p = 0.02). We found a significant difference in percentage of women with butylparaben detection between control group and intervention groups (13% versus 3%, p = 0.03). PREVED intervention is the first intervention research dedicated to perinatal environmental health education in France. By sharing know-how/experience in a positive non-alarmist approach, it improved risk perception, which is key to behavior change, aiming to reduce perinatal ED exposure. Including women in precarious situations remains a major issue.

How to Educate Pregnant Women about Endocrine Disruptors?

Background: Despite mediatization, only half of pregnant women are informed about endocrine disruptors (EDs). We wished to inquire about appropriate environmental health education procedures during pregnancy: Who, when, and how? Methods: The question stems from a comprehensive population health intervention research project. It includes qualitative studies aimed at constructing an educational program in environmental health and an accompanying assessment tool. The validation of a customized questionnaire (PREVED© for Pregnancy Prevention Endocrine Disruptors) about the knowledge, attitudes, and practices (KAP) of pregnant women regarding exposure to EDs was carried out in a quantitative study. Results: Health education by a prenatal professional with communication skills should take place as early as possible, during the preconception period or early pregnancy, as part of individual consultation or group workshops. In order to customize the discourse and to develop women's empowerment, concomitant presentation of the risks by the products used in each room and of previous solutions is recommended. Conclusion: Appropriate health education procedures on EDs should be done at every contact but taking the KAP of pregnant women into account first. We propose all educational actions should be accompanied by questioning of the KAP of pregnant women; for example, with questions from the PREVED© questionnaire.

Simultaneous determination of bisphenol A and its chlorinated derivatives in human plasma: Development, validation and application of a UHPLC-MS/MS method.

Bisphenol A (BPA) is a well-known ubiquitous chemical found in polycarbonate, polysulfone and epoxy resins, used in mass production for many consumer products. BPA exhibits endocrine disruptor properties that can potentially induce adverse health effects. In aquatic environments, it can react with chlorine to produce chlorinated derivatives (ClxBPAs). ClxBPAs exhibit oestrogenic activity 10 to 105 times higher than BPA itself. Assessing human exposure to endocrine disrupting chemicals is mandatory to assess health risk. Blood, as well as urine matrix, are commonly used to perform human biomonitoring. We therefore developed, fully validated and applied a method based on Ultra High Performance Liquid Chromatography couples to a Triple Quad Mass Spectrometer to determine BPA, monochlorobisphenol A (MCBPA), dichlorobisphenol A (DCBPA), trichlorobisphenol A (TCBPA) and tetrachlorobisphenol A (TTCBPA) in human blood plasma. The European Medicines Agency guidelines for bioanalytical method validation have been applied. Precision and trueness of the method were <15% at medium and high levels of quality control and <20% at the limits of quantification (LOQs). The LOQs were settled at 0.1 ng/mL for BPA, 0.02 ng/mL for TTCBPA and 0.005 ng/mL for MCBPA, DCBPA, and TCBPA. The analytical method was applied to ten patients suffering from end stage renal disease. BPA was quantified in all ten patients while MCBPA, DCBPA and TTCBPA were determined in three and TCBPA in four. In conclusion, we have successfully developed a highly sensitive method to determine BPA and ClxBPAs in human plasma. Thanks to this method, for the first time, we could demonstrate ClxBPAs occurrence in human blood.

Environmental Health Knowledge, Attitudes, and Practices of French Prenatal Professionals Working with a Socially Underprivileged Population: A Qualitative Study.

: Introduction: As environmental health knowledge of population is associated with social economic status, the objective of this study was to determine environmental health knowledge, attitudes, and practices of French prenatal professionals working with a socially underprivileged population. MATERIAL AND METHODS: A focus group with eleven prenatal professionals working with socially underprivileged population was carried out in France in 2015. Content analysis of verbatim explanation was conducted with choice-of-subject categories carried out according to the triangulation principle, and topic trees were generated and applied. RESULTS: The professionals have non-specialized experimental knowledge of emergent risks and were essentially preoccupied by infectious biological risks. In practice, however, they became increasingly cognizant of emergent risks. Their educational practices take cultural context into account but educational tools with imagination and affectivity have to be developed in order to reach socially underprivileged population. DISCUSSION: Professionals are often sensitized to the field of environmental health in their apprehension of polluted biological environments, which they associate with social contexts and behavioral factors. In this study, we recommend adapted training programs and updated professional guidelines in view of reducing prenatal emergent risk exposures and social inequalities of health.

Bisphenol A, Chlorinated Derivatives of Bisphenol A and Occurrence of Myocardial Infarction in Patients with Type 2 Diabetes: Nested Case-Control Studies in Two European Cohorts.

A positive association between Bisphenol A (BPA) exposure and coronary heart disease has been shown, but not in patients with type 2 diabetes (T2D). During the treatment of drinking water, chlorination leads to the formation of chlorinated derivatives of Bisphenol A (ClxBPA), that have higher estrogenic activity than BPA. No evidence exists for a relationship between exposure to ClxBPA and myocardial infarction in patients with T2D. The objective of this study was to evaluate the relationship between exposure to BPA, ClxBPA and the occurrence of myocardial infarction (MI) in patients with T2D. Two nested case-control studies in two independent European cohorts were performed. Each case with incident MI during follow-up was matched to one control on age, sex, and personal cardiovascular history in the same cohort. Association between baseline urine concentrations of BPA and of ClxBPA and incident MI was determined. Exposure to BPA was 31% in the ESTHER cohort and 18% in the SURDIAGENE cohort. In a meta-analysis of the two studies, occurrence of MI was significantly associated with urine BPA detection: adjusted OR = 1.97 (1.05-3.70), p = 0.04. Exposure to ClxBPA significantly differed in the SURDIAGENE and ESTHER studies: 24% and 8%, respectively (p = 0.0003). It was very strongly associated with MI in the SURDIAGENE cohort with an adjusted odds ratio (OR) of 14.15 (2.77-72.40) but this association was not replicated in the ESTHER study: adjusted OR: 0.17 (0.02-1.23). Whether these results may be explained by different water chlorination processes in France and Germany, resulting in different ClxBPA exposure levels, requires further investigation.

Determinants of Risk Perception Related to Exposure to Endocrine Disruptors during Pregnancy: A Qualitative and Quantitative Study on French Women.

Endocrine disruptors (EDCs) are known as environmental exposure factors. However, they are rarely reported by health professionals in clinical practice, particularly during pregnancy, even though they are associated with many deleterious consequences. The objectives of this study were to estimate the risk perception of pregnant women related to EDC exposure and to evaluate its determinants. A qualitative study based on the Health Belief Model was carried out through interviews of pregnant women and focus group with perinatal, environmental health and prevention professionals in 2015 in the city of Poitiers, France. Then, determinants of risk perception were included in a questionnaire administered to 300 women in the perinatal period through a quantitative study. Scores were subsequently calculated. Perception of EDC risk was defined as perceived severity for different stages of the infant's development and perceived susceptibility to EDC exposure. The determinants reported in the qualitative study were: age, strong maternal figure, socio-professional category, level of knowledge, and involuntariness of exposure. Age and level of knowledge were confirmed in our statistical model as determinants. Mean score of EDC risk perception was 55.0 ± 18.3 on 100 points. Our study should guide healthcare providers when advising pregnant women about EDC and environmental exposure. Our score for perceived EDC risk and assessment of its known determinants may help to assess the impact and the relevance of prevention programs dedicated to reducing exposure to EDC during pregnancy.

Endocrine Disruptors and Pregnancy: Knowledge, Attitudes and Prevention Behaviors of French Women.

Endocrine disrupting chemicals (EDC) are environmental exposure factors that are rarely reported in clinical practice, particularly during pregnancy. This study aimed to describe women's knowledge, attitudes and behaviors towards EDC exposure. A study was conducted in the French Department of Vienne between 2014 and 2016 and comprised semi-structured interviews with pregnant women, a focus group of professionals in perinatology and environmental health, and the administration of a psychosocial questionnaire comprising scores in 300 pregnant or in postpartum period women. The mean score of knowledge was 42.9 ± 9.8 out of 100 (from 13.5 to 75.7). Exposure attitude was determined by risk perception. Mean level of cues to action to reduce their EDC exposure was estimated at 56.9 ± 22.5 out of 100 (from 0 to 100). Anxiety was significantly increased after the questionnaire. Anxiety about EDC was associated with a high score of knowledge (OR = 2.30, 95% CI (1.12-4.71)) and with no pregnancy anxiety (OR = 0.57, 95% CI (0.34-0.95)). Our findings suggest that healthcare providers should consider pregnant women's knowledge and perceptions, possibilities of action, and be careful not to increase their anxiety when advising them about EDC and environmental exposure.

Validation of a probe for assessing deconjugation of glucuronide and sulfate phase II metabolites assayed through LC-MS/MS in biological matrices.

LC-MS/MS has been proposed in various areas such as Therapeutic Drug Monitoring (TDM), Human Biomonitoring (HBM), disease diagnosis, clinical toxicology and doping control to identify and quantify chemical parents and their metabolites in biological matrices. To determine the total content of a xenobiotic (unconjugated+conjugated forms), an enzymatic hydrolysis step is required. Most studies in the literature have not controlled the effectiveness of the deconjugation process because no method has been described for that purpose. Therefore the aim of this study was to develop and validate a deconjugation probe using a LC-MS/MS method. In order to estimate deconjugation using ß-glucuronidase and/or sulfatase, 4-methyl-umbelliferone (MU) and its conjugates were used as markers. Glucuronidase/sulfatase was added to plasma or urine spiked with 4-methylumbelliferyl-ß-d-glucuronide (MUG) and 4-methylumbelliferyl sulfate (MUS) and umbelliferone, which was used as the internal standard. After incubation at 37°C during 90min, MU appears as a result of the deconjugation of MUG and MUS. The concentrations of the 3 markers were determined using LC-MS/MS. Trueness and precision of the LC-MS/MS method were determined by quality control analysis at three different levels of concentration covering the whole range of calibration. In both matrices, the analytical method allows quantification of the different compounds, with good linearity, trueness and precision and negligible matrix effects. The method was applied with success to deconjugation assay using active glucuronidase/sulfatase in plasma and urine. The probe developed in this study allows to ensure that enzymatic preparation is working properly in the frame of a quality system.

Association between Exposure to Endocrine Disruptors in Drinking Water and Preterm Birth, Taking Neighborhood Deprivation into Account: A Historic Cohort Study.

BACKGROUND: The relationship between preterm birth (PTB) and endocrine disruptor exposure in drinking-water has only occasionally been studied. The objective of this work was to investigate the relation between exposure to atrazine metabolites, or atrazine/nitrate mixtures, in drinking-water during pregnancy and prevalence of PTB neonates, while taking neighborhood deprivation into account. METHOD: A historic cohort study in Deux-Sèvres, France, between 2005 and 2010 with a multiple imputation model for data of exposure to atrazine metabolites and a logistic regression were carried out. RESULTS: We included 13,654 mother/neonate pairs living in 279 different census districts. The prevalence of PTB was 4%. Average atrazine metabolite concentration was 0.019 ± 0.009 (0.014-0.080) µg/L and 39% of mothers lived in less deprived areas. The individual data were associated with risk of PTB. The risk of PTB when exposed to highest concentration of atrazine metabolite adjusted for confounders, was ORa 1.625 95% CI [0.975; 2.710]. Taking, or not, neighborhood deprivation into account did not change the result. Exposure to atrazine/nitrate mixtures remained non-significant. CONCLUSIONS: Even if we took neighborhood deprivation into account, we could not show a significant relationship between exposure to atrazine metabolites, or mixtures, in drinking-water during the second trimester of pregnancy and PTB.

Estimating drinking-water ingestion and dermal contact with water in a French population of pregnant women: the EDDS cohort study.

The aim of the present study, a part of the Endocrine Disruptor Deux-Sèvres (EDDS) cohort study, was to estimate water-use habits of pregnant French women. The study population consisted of 132 pregnant women living in Deux-Sèvres (France) in 2012-2013, in areas where drinking water is exclusively produced by surface water. Drinking-water data included ingested water (tap, bottled and filtered) and ingestion place (home, work and elsewhere). Dermal contact with water included showering, bathing, swimming, spa use, hand-washing and other water activities. Data were collected through face-to-face interviews at second and third trimesters of pregnancy with a 1-day-recall questionnaire. Intertrimestral differences in water-use habits were assessed. Predictors of water ingestion and duration of dermal contact with water were assessed with multiple linear regressions. At the second trimester of pregnancy, the mean total drinking-water ingestion was 1.8±0.6 l per day (mean and SD), 71% of which was tap water. Total drinking-water ingestion was not different between both trimesters but ingestion place differed. Dermal contact with water estimate was 188±118 and 173±92 min/week at second and third trimesters, respectively. Smoking increased water ingestion 777 ml/day 95% CI (171-1384). Duration of dermal contact in spring was 30 min/week 95% CI (13-48) higher than in winter. Obese women spend 26 min/week 95% CI (2-50) more showering than women with recommended weight. Our estimates of pregnant French women's exposure to water will help researchers to better assess water pollutant risks.

Bisphenol a and its chlorinated derivatives in human colostrum.

The health effects related to bisphenol A (BPA) and its exposure sources have undergone extensive investigation, but no consensus has been reached. Hitherto, the major source of human BPA exposure considered in the literature remains food-contact material. However, the chlorine present in drinking water may react with BPA to form chlorinated derivatives (ClxBPA), which have indeed been shown to have a heightened level of estrogenic activity. In this study, we have evaluated colostrum concentrations of BPA and ClxBPA in order to confirm our hypothesis according to which BPA water contamination leads to ClxBPA human exposure. BPA and its ClxBPA were assessed through online solid-phase extraction coupled to ultra high-performance liquid chromatography tandem mass spectrometry (SPE-UPLC-MS/MS) using the isotope dilution method in the colostrums of 21 women who had completed a water exposure questionnaire. BPA was detected in 19 colostrums and its ClxBPA in 21 colostrums. Mean concentrations were 1.87 ± 1.38 ng mL(-1) (n = 19) for BPA, 1.87 ± 1.23 ng mL(-1) (n = 7) and 1.56 ± 0.74 (n = 18) ng mL(-1) for 2,2'-Cl2BPA and 2,6-Cl2BPA, respectively, and 0.68 ng mL(-1) (n = 1) for trichloro-BPA. These findings confirm our hypothesis that ClxBPA should be taken into account in human health risk assessment.

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

Bisphenol A is a widespread industrial chemical which over the past decade has demonstrated its toxicity as an endocrine disruptor. Chlorine present in drinking water may react with bisphenol A to form chlorinated derivatives, which have demonstrated a heightened level of estrogenic activity. In this work, we have comprehensively validated a method using on-line SPE-UPLC-MS/MS and isotope dilution quantification to measure bisphenol A and its chlorinated derivatives in human breast milk according to accepted guidelines. Deutered bisphenol A was used as internal standard. The matrix calibration curve ranged from 0.40 to 6.40 ng/mL for each of the target compounds and provided good linearity (r²>0.99).This method was precise (the intra and inter-day coefficient of variation was <20% at two different concentrations (0.40 and 3.20 ng/mL) and accurate (recovery ranged from 81% to 119%). The limits of detection obtained for BPA and its chlorinated derivatives ranged from 0.01 to 0.09 ng/mL. The limit of quantification for all the compounds validated at 0.40 ng/mL when using 500 µL of milk was found to be suitable for the concentration existing in real samples. The analytical method developed in this study is in accordance with the requirements applicable to biomonitoring of BPA and its chlorinated derivatives in human breast milk.

Quantification of bisphenol A, 353-nonylphenol and their chlorinated derivatives in drinking water treatment plants.

Bisphenol A (BPA) and nonylphenols (NP) are of major concern to public health due to their high potential for human exposure and to their demonstrated toxicity (endocrine disruptor effect). A limited number of studies have shown that BPA and NP are present in drinking water. The chlorinated derivatives that may be formed during the chlorination step in drinking water treatment plants (DWTP) exhibit a higher level of estrogenic activity than their parent compounds. The aim of this study was to investigate BPA, 353NP, and their chlorinated derivative concentrations using an accurate and reproducible method of quantification. This method was applied to both surface and treated water samples from eight French DWTPs producing from surface water. Solid-phase extraction followed by liquid chromatography-tandem mass spectrometry was developed in order to quantify target compounds from water samples. The limits of detection ranged from 0.3 to 2.3 ng/L for BPA and chlorinated BPA and from 1.4 to 63.0 ng/L for 353NP and chlorinated 353NP. BPA and 353NP were found in most analyzed water samples, at a level ranging from 2.0 to 29.7 ng/L and from 0 to 124.9 ng/L, respectively. In most of DWTPs a decrease of BPA and 353NP was observed between surface water and treated water (36.6 to 78.9 % and 2.2 to 100.0 % for BPA and 353NP, respectively). Neither chlorinated BPA nor chlorinated 353NP was detected. Even though BPA and 353NP have been largely removed in the DWTPs studied, they have not been completely eliminated, and drinking water may consequently remain a source of human exposure.

Improving perinatal Group B streptococcus screening with process indicators.

RATIONALE: Group B streptococcus (GBS) neonatal infection can be prevented by screening pregnant women for GBS colonization from the 34th to the 38th week of gestation, as has been recommended in France since 2001. We assessed guideline adherence among midwives and obstetricians. METHODS: From 2006 to 2008, new and mandatory GBS data were added to the obstetric database. We merged the latter with a bacteriological database and a paediatric database and defined process indicators for pregnant women who delivered from the 37th week of gestation in the hospital of Poitiers and for neonates hospitalized for a GBS infection from 2006 to 2008. RESULTS: We abstracted 5997 pregnant women (1942 in 2006, 1975 in 2007 and 2080 in 2008) and 84 neonates (17 in 2006, 32 in 2007 and 35 in 2008). GBS pregnancy colonization prevalence was 15%, 13% and 18% respectively. Availability of GBS screening status was stable (96%, P = 0.15). The rate of GBS screening during pregnancy increased significantly (86% to 90%, P = 0.002). Percentage of correct-term screening increased significantly (89% to 96%, P < 0.001). Percentage of women who received intra-partum antibiotic prophylaxis decreased significantly (84% to 70%, P = 0.001). Percentage of women who received correct intra-partum antibiotic prophylaxis was stable (75%, P = 0.65). Percentage of neonates whose mother had been correctly screened but negative was 77%, 67% and 68% respectively (P = 0.61). CONCLUSION: Our mandatory database entailed guideline adherence over a short lapse of time and resulted in a significant increase of the screening rate at the correct term. However, circumstances where neonates are infected still remain. Screening test performance needs to be re-evaluated.

[Adequacy between prescriptions and CHADS(2) score recommendations in geriatric patients]. / Adéquation entre les prescriptions réalisées et les recommandations CHADS(2) dans un service de gériatrie.

UNLABELLED: Atrial fibrillation (AF) is a major risk factor for stroke. Thromboprophylaxis with anticoagulant reduces the incidence of stroke and is warranted by the CHADS(2) recommendations when score ≥2. But such therapy remains underused particularly among elderly patients. The aim of our study was to evaluate the adequacy between prescriptions and CHADS(2) recommendations in geriatric hospitalised patients with AF. METHOD: retrospective study set in the Geriatrics Department of the University hospital of Poitiers (France), of patients >75 y with AF, between July and December 2009. The description of the patients taken into the count: epidemiological data, functional daily activities (score GIR), cognitive assessment, antithrombotic treatment, and evaluation of the CHADS(2) and HEMORR(2)HAGES scores. RESULTS: in this study161 hospitalisations were analysed, mean age of the patients was 87.4 ±â€Š5.4 years. Antithrombotic treatment was prescribed in 84% of cases. The overall conformity to CHADS(2) recommendations was 44%. Most of hospitalisations (88.9%) included patients with CHADS(2) score ≥2. Non-conformity rate was up to 60% in this group with 5 significant variables: MMSE score <26 (OR: 3.17 [95%IC: 1.23-8.17]), high risk of bleeding (2.88 [1.28-6.47]), dementia (2.46 [1.01-5.95]), functional impairment (GIR score ≤4) (2.43 [1.23-4.84]) and history of fall (2.42 [1.13-5.17]). Still, the variables explained only 19% of the non-conform prescriptions and no variable was significantly relevant on multivariate analysis. DISCUSSION: our study show 56% of prescriptions that are non-conform to CHADS(2) recommendations, particularly in the elderly with a predictive embolic score ≥ 2. Antithrombotic treatment seems to be all the less conform as patients appear to be more vunerable. Due to the new score CHA(2)DS(2)-VASc, physicians really have to discuss the benefit-risk balance at an individual level.