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Background & Aims: Mother-to-child (MTC) hepatitis B virus (HBV) transmission has been mainly studied in Asia. The geographical origins of women and HBV genotypes differ in Europe. The aims were to determine the rate and risk factors of MTC HBV transmission from women with high HBV DNA loads in a maternity hospital in Paris, France., Methods: Retrospective study of HIV-negative, HBs Ag-positive pregnant women with HBV DNA loads above 5 Log10 I.U/ml who were not given lamivudine or tenofovirDF during pregnancy between 2004 and 2011., Results: Among 11 417 pregnant women, 437 (4%) showed a positive HBs Ag. Among these women, 52 had HBV DNA loads above 5 Log10 I.U/ml: 41, 10 and 1 born in Asia, sub-Saharan Africa and Europe respectively. Among the 52 women, 40 were eligible for the analysis: no antiviral therapy during pregnancy; children over 9 months old. Twenty-eight (70%) women were assessed, corresponding to 41 childbirths. Eleven children (27%) had positive HBs Ag, 14 (34%) had positive HBc and HBs Ab, 16 (39%) had positive HBs Ab only. The risk of having positive HBs Ag, according to maternal HBV DNA loads, was 14% for HBV DNA loads less or equal to 8 Log10 I.U/ml, 42% for HBV DNA loads over 8 Log10 I.U/ml, P = 0.04, but not related to the women's origin, HBV genotype., Conclusions: This study confirms that serovaccination does not fully protect newborns from MTC HBV transmission, when maternal HBV DNA loads exceed 5 Log10 I.U/ml, regardless of the women's origin or HBV genotype., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: We wondered whether pregnant women with social handicap benefited from readmissions which could have been prevented, and if there was a selection of patients?, Patients and Method: This is a retrospective study of 127 pregnant women with social handicap having given natural childbirth in a public health establishment. The research was based on analysis of data from DRG's (PMSI), legislation and other documents., Results: Between mid March 2007 and mid June 2009, 27 of the 127 pregnant women with social handicap have benefited from 35 readmissions. There were 171.5 ± 255.1 days between readmissions. There was no second readmission on the same day for the same patient. According to the criteria of the Appropriateness Evaluation Protocol (AEPf), none of the readmissions were considered avoidable. No parturient was readmitted for non-medical reasons. Readmitted patients presented low to severe social handicaps and had 79.6 % more coded diagnosis compared to their first hospitalization. This service plays its public service role to fight against social exclusion., Discussion and Conclusion: This pilot study provides encouraging results but also underlines the limits of our approach. We nevertheless wished to explore whether this low resource intensive initiative could make interesting indicators emerge, which seems to be the case., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Context: The objective of our study was to estimate the impact of the precariousness on the quality of the care in antenatal diagnosis of the patients followed to Lariboisière (Parisian service of gynaecology obstetrics situated in a district of the capital discriminated socially) over a period of 3 months., Patients: All the patients undergoing a prenatal diagnosis consultation in Lariboisière Hospital between February and April 2008. Patients were split in two groups according to their precariousness (economic or psychosocial) or not. Criteria studied were: initial purpose of the prenatal consultation, quality of the first trimester ultrasound exam, access to the integral calculus in Down Syndrome detection, lateness of care between the diagnosis and the prenatal consultation. The second part of this analysis was to evaluate if precariousness was associated with organizational problem in prenatal diagnosis., Results: Fifty-nine patients were included: 29 (49%) were identified as being in a precariousness situation. The initial purpose of the consultation was the same in the two groups. Precariousness was associated to organizational problems for the prenatal diagnosis consultation (72 vs. 47%, P=0.004). Thirty-five patients (59%) have met organizational problems for the prenatal diagnosis consultation. Were associated to organizational problems: precariousness (60% vs. 33%, P=0.04), low education level (86 vs. 54%, P=0.007) and single mother (23% vs. 0%, P=0.001)., Conclusion: This work shows the negative impact of precariousness on the prenatal diagnosis. Prevention may improve the information and the quality of care given to these patients., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objectives: This paper considers the specific administrative procedures set up by managers of public healthcare establishments and those responsible for health and welfare policies to care for low-income pregnant women for whom 100% of the "price per act" (T2A) is refunded. What are the limitations and what improvements can be suggested?, Patients and Method: The results are based on an analysis of data from semi-structured interviews, legislation and documents., Results: The State, health insurance systems, public health establishments, local authorities, charities and outpatient services are involved in handling low-income parturients in different services and different establishments, both locally and regionally. A health and welfare policy comprising specific, coordinated actions and measures has been developed. The T2A "price per act" system may threaten its survival: the limited number of front-line facilities is often saturated and demand is increasing, treatment is often reduced to reactive management leading to unwanted readmissions, ethics are sometimes called into question and there is a risk of patient selection., Discussion and Conclusion: This pilot study provided some encouraging information but also indicated the limitations of the approach adopted. However, it was still of interest to see whether it was possible to use this approach, which did not require considerable resources, to reveal useful markers. This appeared to be the case. Regional Health Agencies (ARS) and local authorities could support the system. Additional funding is needed., (Copyright © 2011. Published by Elsevier SAS.)

Aim: Assess the degree of satisfaction of medical students regarding their teaching of gynaecology and obstetrics at the medical faculty of Paris-VII in 2008-2009. The aim is to improve the quality of teaching and learning tools mainly with a view to preparing for the national examination competition., Materials and Methods: This is an observational study on a cohort of 116 students enrolled in 3rd year of graduate medical education, Faculty Paris-VII Denis-Diderot, who was asked to respond anonymously to a questionnaire of satisfaction comprising 13 questions., Results: Participation in course organized by the faculty is 62%. Ninety-three percent of students are enrolled in private lessons to prepare the national examination competition. Eighty-one percent of students believe that teaching private courses is better than the courses offered by the faculty. Sixty-two percent of students consider a medium (Internet or CD-ROM). Quality could replace traditional media's theory of education. Ninety percent of students use as a main working the same book sold in commerce. Among them, 98.2% considered that the external training is useful in the preparation of the national examination competition., Discussion: It seems that teaching traditional academic lectures of gynaecology and obstetrics is not the preferred method of teaching students in 5th year of medicine. They prefer the education provided by the private preparedness at national examination competition, in the form of clinical cases, even if the courses offered by the faculty try to adapt in this form. The book remains the primary medium of work, but many students believe that a computer could replace or supplement the traditional media. The internship hospital services in gynaecology and obstetrics compulsory Paris-VII seems helpful in learning the specialty including in the context of the national examination class., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)