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Background Since the law of February 11, 2005, in France, the number of children with disabilities enrolled in ordinary schools has increased steadily. As a result, the amount of personal support provided by a special needs assistant (personal support) is also increasing. The aim of the study was to describe the diseases and impairments of disabled children aged 2–6, enrolled in mainstream schools and benefiting from personal support for schooling by special needs assistants in the Bouches-du-Rhone (France) in 2014. Methods A cross-sectional descriptive study was performed. Children included were benefiting from either an individual or shared personal support. Physicians from the territorial organization in charge of disability coded diseases and deficiencies using the International Classification of Diseases, 10th revision, and nomenclature inspired by the International Classification of Functioning, Disability and Health. Results Medical data were coded for 990 children out of 1260 of the total population. These young disabled children were most frequently children with pervasive developmental disorders (23.3%), lack of expected normal physiological development (19.9%), or mixed specific developmental disorders (13.5%), and most often had behavioral, personality, and relational skills disorders (61.8%), psychomotor function impairments (51.9%), or written or oral language learning impairment (43.2%). Finally, the two main types of impairments most represented among these children were psychological impairments (86.7%) and language and speech impairments (79.8%). The children were most often supported by an individual personal support (for one child only) than by a shared personal support (60% vs. 40%). They were mainly boys (almost 75%). Conclusion This study provides working guidelines for the management of health policies relating to disability at the territorial or even national level.

Research question Does fresh embryo transfer after IVF with or without intracytoplasmic sperm injection (ICSI) increase the small for gestational age (SGA) rate, and frozen embryo transfer (FET) after IVF with or without ICSI increase the large for gestational age (LGA) rate versus natural conception? Design Retrospective comparison of an exposed historical group/cohort involving singletons conceived after fresh embryo transfer and after FET with an unexposed group/cohort involving singletons conceived after a natural conception. Results A total of 1961 fresh embryo transfer babies and 366 FET babies were compared with 6981 natural conception babies. The SGA rate in fresh embryo transfer babies was not significantly different to natural conception babies (6.9% versus 6.8%, P = 0.856). This outcome was not influenced by the fresh embryo transfer (adjusted odds ratio [aOR] 1.0; 95% confidence interval [CI] 0.8–1.3), but rather by a low rate of multiparity (aOR 0.5; 95% CI 0.3–0.7), advanced maternal age (aOR 1.1; 95% CI 1.0–1.2), maternal underweight (aOR 1.5; 95% CI 1.1–2.1), maternal smoking or cessation during pregnancy (aOR 1.8; 95% CI 1.4–2.3), pre-existing hypertension (aOR 2.3; 95% CI 1.3–4.1) and pregnancy-induced hypertension (aOR 2.5; 95% CI 1.7–3.7). The LGA rate in FET babies was significantly different from natural conception babies (6.6% versus 3.2%, P = 0.012). This outcome was influenced by the transfer of frozen embryos (aOR 2.2; 95% CI 1.3–3.8) and by a high maternal weight (aOR 1.9; 95% CI 1.1–3.6). Conclusions Maternal background and obstetric parameters are more likely to influence the SGA rate than fresh embryo transfer conception. FET conception could be associated with an increase in LGA rate.

The literature presents conflicting results on the epigenetic effect of in vitro fertilization (IVF) on the short-term and mid-term growth of children. These contradictory results may be related to the use of heterogeneous methodologies and non-longitudinal data. The goal of this study was to compare the body mass index (BMI) of children conceived via IVF and spontaneous conception (SC) children, using longitudinal data from birth to 5 years.This study compared 118 singleton children born after in vitro fertilization, with or without intracytoplasmic sperm injection (ICSI), selected from a pre-existing single-center cohort to 320 SC children from the same geographic area. BMI and its evolution were analyzed using the mixed-effect model during three periods: before standing acquisition (from birth to 1 year of age), during standing acquisition, and the following period from 2 to 5 years of age.BMI means were not significantly different between groups regardless of the period, when adjusting for confounding factors related to parents, pregnancy, and children's characteristics and lifestyle. Nevertheless, during the standing acquisition period, children born after IVF-ICSI presented a less significant decrease in BMI (P0.05). In addition, for each period we identified influencing factors (maternal BMI, level of wealth indicator) associated with BMI.In the study population, the suspected epigenetic influence of IVF reported in the literature was not observed for BMI from birth to 5 years of age. Further investigations need to be conducted to determine if the suspected influence of IVF on adiposity could be expressed through other parameters.

Resume Objectif L’objectif principal de cette etude etait de determiner les raisons invoquees par les femmes ayant change ou suspendu leur methode de contraception en 2013. Quelle influence avait la controverse autour des estroprogestatifs (EP) de 3 e et 4 e generation de 2013 et l’avis de leur medecin ? Outre les modifications de methode contraceptive, percevaient-elles des consequences de la controverse sur leur mode de vie ? Ressentaient-elles un impact sur leur comportement vis-a-vis des professionnels de sante ? Methodes Une enquete a ete effectuee aupres de femmes en âge de procreer et domiciliees dans les Bouches-du-Rhone. Le recueil des donnees avait lieu entre le 4 novembre et le 16 decembre 2013. Etaient inclus les sujets de sexe feminin, d’âge compris entre 18 et 55 ans revolus. Les sujets etaient interroges par le biais d’un auto-questionnaire anonyme distribue dans le cadre d’officines pharmaceutiques. Le protocole prevoyait la construction de regroupements : les patientes declarant avoir pris connaissance de la controverse constituaient le groupe « expose », et les autres le groupe « non expose ». Il devait etre compare entre les deux groupes : le taux de sujets declarant avoir modifie ou suspendu leur contraception en 2013 et sans ou contre l’avis d’un medecin. Resultats L’echantillon comportait 988 sujets. L’âge moyen etait de 34 ans. Le niveau d’exposition aux debats mediatiques etait de 86,5 %. Parmi les femmes interrogees, 19,8 % etaient sous EP de 3 e ou 4 e generation en 2012, donc directement concernees par les debats et recommandations. Parmi les patientes, 38,5 % declaraient avoir realise une modification ou une suspension de leur contraception en 2013, et lorsqu’elles confirmaient avoir pris connaissance de la controverse, 40,1 % affirmaient avoir mene cette demarche sans ou contre l’avis d’un medecin. Cette proportion chutait a 18,2 % chez celles qui n’etaient pas au fait de la controverse. La mediatisation du sur-risque vasculaire n’etait pas plus evoquee chez les patientes ayant suspendu toute contraception medicale que chez les patientes declarant un simple changement de methode. Au total, 52,1 % des femmes ayant cesse leur contraception indiquaient que ce choix etait en partie le fait d’un changement dans leur sexualite ou vie reproductive. Ce motif n’etait invoque que chez 19,0 % des femmes ayant effectue un simple changement de methode contraceptive. Parmi les representations des femmes, la controverse faisait partie des raisons d’un changement de contraception dans 418 % des cas, tandis que l’avis d’un medecin n’entrait en jeu que chez 19,9 % des femmes. Il etait constate un recul de 11,0 % de la contraception orale entre 2012 et 2013, quasiment superposable a celui des EP oraux de 3 e et 4 e generation (10,6 %). En revanche, l’utilisation d’EP de 1 re et 2 e generation stagnait : leur hausse etait de 0,4 %. Au-dela de tout changement de contraception, 66,9 % des femmes exprimaient l’absence d’un impact quelconque de la controverse sur leur comportement. Parmi les femmes, 6,1 % temoignaient d’une perte de confiance en certains professionnels de sante. Conclusion Nous avons mis en evidence comment les patientes ayant change ou suspendu leur contraception au cours de l’annee 2013 placaient l’influence de l’affaire au premier rang des raisons de leur decision. Bien qu’un motif medical ait ete frequemment invoque, une femme sur cinq seulement estimait que l’avis de son medecin avait clairement contribue a son choix. L’influence des medias semblait empieter sur la relation medecin–patient, fondamentale a la qualite d’une prise en charge au long cours.

Background Emergency department (ED) utilization has increased for several decades. ED are becoming busier because of patients with no urgent problems, and their demand for service has resulted in overcrowding in ED. To resolve this problem, primary care units involving general practitioners have been established. The objective of this study is to assess provision of the shift to other health care facilities for no urgent ED patients, starting from entry to ED at the request of the triage nurse. Methods A cross-sectional study was conducted during a one-week period in the adult ED of La Conception Hospital in Marseilles, France. Only no urgent patients identified prospectively by the triage nurse were included. Information was gathered regarding the usual source of care, reason for the visit, care itinerary before presenting to the ED, patient's perception of emergency level, their willingness regarding a reorientation to another health care facility, accomplished actions, and type of discharge. Results Among 245 ED patients, 110 were identified as no urgent by the triage nurse, and 85 effectively answered questions for the purpose of this study. In 76.4% of the cases, the patients were self-referred to ED, however one-third had contacted a physician. The most common reasons provided for attending the ED were pain (55.3%), laboratory and radiographic investigations (37.6%), and difficulty in accessing the usual source of care (22.3%). The mean level of emergency perception was 10.6 ± 5.6 on a zero-twenty scale. Half of the patients presented for traumatology concerns. One-third had an additional examination, six received treatments, and none were hospitalized. Upon entry to ED, more than two-thirds of patients accepted the principle of reorientation to another health care facility. Two main factors linked with this decision were employment status (odds-ratio [OR] = 4.5; 95% confidence interval [CI] = 1.6–12.9) and the perceived emergency level (OR = 0.88; 95% CI = 0.8–0.9). Among patients who refused reorientation, 41 of them were able to pay an additional cost to receive care in the ED. Conclusion Alternative structures such as primary care units near the ED seem to be an appropriate response to meet the growing demand of no urgent patients. The success of providing this reorientation, however, could be determined by the working hours of the structures and the practice of certain technical skills.

The purpose of this study was to determine whether patients have a better level of information about colonoscopy and are more satisfied with medical care when they attend a dedicated consultation with a gastroenterologist prior to the procedure.We conducted a prospective study which compared "exposed" (E) and "non exposed" (NE) patients. In group E, information about colonoscopy was delivered by a gastroenterologist during a special consultation at least 24 hours before the procedure. In group NE, information was delivered in the usual manner. The patients' level of information was measured after colonoscopy and 3 months later.Thirteen patients were included in group E and 18 in group NE. The level of information was better in group E, 5.2 +/- 2.1 versus 3.3 +/- 2.1 (P0.04), as was satisfaction with medical care, 24.9 +/- 4.6 versus 23.0 +/- 5.1 (P0.03). The differences in information levels remained at 3 months.The information delivered during a dedicated precolonoscopy consultation increases assimilation of knowledge concerning the procedure and the patient's satisfaction with medical care.

Devant l'ampleur des investissements de l'industrie pharmaceutique et les risques financiers encourus par celle-ci, il est important pour les firmes pharmaceutiques de proteger au mieux leurs inventions par de multiples techniques et ce, pendant une longue periode. Les brevets appliques aux molecules sont un moyen de protection temporaire, a ces derniers brevets peuvent s'ajouter des brevets additionnels ou brevets secondaires. Enfin le certificat complementaire de protection constitue aussi un moyen juridique de protection des brevets de medicaments. Une autre methode, exclusive cette fois-ci de reference juridique, permet d'etendre la duree de protection des brevets de medicaments, c'est l'inversion chirale.

RESUME Le Haut Comite de la sante publique est remplace dans la loi du 4 mars 2002 par le Haut Conseil de la sante. Pendant ses dix annees d’activite, il a repondu a sa mission d’orienter la politique de sante a travers deux types de rapports. Les rapports triennaux (1994, 1998, 2002) ont dresse l’etat de sante de la France, montrant ses forces et ses faiblesses, proposant une analyse critique du systeme de sante. Les rapports thematiques etablis sur saisine du ministre ont oriente un grand nombre de textes reglementaires dans des domaines touchant a l’organisation des soins ou a la prevention. Au-dela de ces missions, la production du HCSP a egalement eu pour effet de diffuser la culture et les methodes de sante publique, dont la place en France demeure encore trop marginale.

Objective To investigate the impact of social inequalities on the risk of rehospitalization in the first year after discharge from the neonatal unit in a population of preterm-born children. Study design Preterm infants were included if they were born between 2006 and 2013 at ≤32 + 6 weeks of gestation and who received follow-up in a French regional medical network with a high level of healthcare. Socioeconomic context was estimated using a neighborhood-based socioeconomic deprivation index. Univariate and logistic regression analyses were used to identify risk factors associated with rehospitalization. Results For the 2325 children, the mean gestational age was 29 ± 2 weeks and the mean birth weight was 1315 ± 395 g. In the first year, 22% were rehospitalized (n = 589); respiratory diseases were the primary cause (44%). The multiple rehospitalization rate was 18%. Multivariable analysis showed that living in the most deprived neighborhoods (socioeconomic deprivation index of 5) was associated with overall rehospitalization (OR, 2.2; 95% CI, 1.5-3.6; P .001), and multiple rehospitalizations (OR, 2.5; 95% CI, 1.2-4.9; P .01); with socioeconomic deprivation index of 1 (least deprived) as reference. Deprivation was associated with all causes of hospitalization. Female sex ( P .001) and living in an urban area ( P = .001) were protective factors. Conclusions Despite regional routine follow-up for all children, rehospitalization after very preterm birth was higher for children living in deprived neighborhoods. Families' social circumstances need to be considered when evaluating the health consequences of very preterm birth.

Resume La mise en place du Guide de bonne exeution des analyses (GBEA) dans un etablissement public releve de la responsabilite partagee des biologistes et de l'administration. La demarche entreprise au sein de l'Assistance Publique Hopitaux de Marseille (AP-HM) a consister a federer, autour d'un systeme qualite unique dans sa conceptualisation, l'ensemble des efforts fournis par les 35 laboratoires de l'etablissement. Cet objectif d'harmonisation a necessite la creation d'un Comite de pilotage, l'elaboration d'un calendrier d'actions, l'encadrement methodologique de la demarche par un Comite d'execution et l'engagement formel des laboratoires garantissant la reussite du projet au terme des delais fixes. L'engagement de la Direction s'est traduit par sa participation a l'elaboration de procedures relevant de son domaine de competence directe (archives, maintenance, commandes, marches, etc.). La demarche au sein de l'AP-HM, commencee en juin 1997, devrait s'achever, conformement au calendrier d'action prevu, en janvier 1999. Au terme d'un an, l'etat d'avancement de la demarche est positif avec 13 des 17 procedures generales redigees par l'ensemble des laboratoires. Les principales difficultes recontrees relevant de facteurs humains, de contraintes liees aux principes de l'assurance qualite: surcharge de travail a moyens constants, passage d'une culture orale a une culture ecrite. La mobilisation des biologistes est tres encourageante, temoin d'une evolution culturelle integrant les concepts d'assurance qualite. La perennisation du systeme qualite necessite cependant que cet effort soit soutenu a long terme et que les dysfonctionnements qui ont ete identifies tout au long de la demarche soit corriges.

1. A statistically significant increased risk of schizophrenia for individuals born in winter has been reported. The increase risk is of the order of 5-15 percent. The seasonal effect is more marked among females. This winter birth effect suggests some environmental agents, probably a neuropathogen one, acting on the foetus. 2. The present study sought to test the environmental damage hypothesis by application of the family history of psychiatric disorder distinction to season of birth data divided according to sex and using a control population. 3. From computer records, all patients admitted to the psychiatric department of Marseilles Timone hospital between January 1984 and December 1989 who satisfied DSM III, DSM III R criteria for schizophrenia were identified. Patients were then classified into two groups: family history of psychiatric disorder versus no family history. Division according to the sex was carried on after two groups were formed. 4. The data show (I) a significant excess of births in the early months of the year (p0.05) for all patients with no family history of psychiatric disorder, (2) a significant excess of births for females (p0.05) with no family history. 5. These results provide indirect support for the neurodevelopmental theory of schizophrenia.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 29 juin 2016

In 1992, we conducted two prevalence surveys on hospital-acquired infections (HAIs) in a group of eight university affiliated hospitals with a total of 4462 acute care beds. Most of the intensive care units (ICUs) already had a prospective surveillance scheme. The need for HAI rates that could be estimated easily and economically led us to develop a prevalence survey by using a stratified sampling method. The units were distributed into four groups: ICU; clean surgery; other surgery; and medical. In each group a sample of units was randomly selected using different sampling fractions. The first survey was conducted in May and involved 1220 patients. The second survey in November included 1389 patients. The HAI rates in May and November were 8·6% (95% CI 7·4–9·8%) and 7·1% (95% CI 6–8·2%), respectively. This study allowed us to direct resources towards high risk units and clean surgical procedures. Based on the results, prospective surveillance was implemented in units of the clean surgery group.

Resume En 1992, deux enquetes de prevalence sur les infections nosocomiales ont ete realisees par une methode de sondage sur l'Assistance Publique de Marseille, une structure hospitaliere regroupant 4000 lits de court sejour. Les enquetes ont porte respectivement sur 42 % et 50 % des patients hospitalises. Le taux d'infections acquises a l'APM etait de 8,6 % et 7,1 % avec une precision de 1,2 % et 1,1 %. Cette etude a montre la faisabilite de ce type d'enquete et a permis une utilisation efficace des ressources pour etudier les services a haut risque d'infections. A partir des resultats obtenus une surveillance prospective a ete developpee dans certains services de soins intensifs et de chirurgie, pour completer le systeme de surveillance en incidence deja en place dans la majorite des services de reanimation.

This study analyzes the results of 457 carotid artery operations done in 416 patients by the same surgeon during a five-year period. A total of 27 central neurologic complications were observed, 14 were transient and 13 were permanent neurologic deficits, nine of which resulted in death. The causes of these accidents were: embolism (12), intolerance to clamping (7), carotid thrombosis (3), and reperfusion injury (2). In three cases no cause could be found. Preoperative predictive factors for these complications were analyzed statistically by multivariate analysis techniques. A high-risk group was identified, characterized by diffuse atherosclerotic disease and by the presence of a previous neurologic deficit. The prevention of neurologic complications in carotid surgery goes far beyond the controversy of whether or not a temporary inlying shunt should be used. In our opinion indications for shunting are limited. Neurologic complications can be prevented by maintaining awareness of certain temporary contraindications in patients with permanent neurologic deficits and by exacting operative techniques.