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BACKGROUND: Mental distress at work is a complex multifactorial phenomenon liable to impact health and personal life. OBJECTIVE: To assess the proportion of general practice consultations for mental distress at work and determine how general practitioners (GPs) manage these patients and the factors leading to consultation. METHODS: The frequency of consultations for mental distress at work was assessed on a self-administered questionnaire sent to the general practitioners (GPs) of the Loire administrative Département (France). Information on factors leading to consultation on management was obtained by a self-administered questionnaire in a sample of GPs and patients. RESULTS: Twenty-two patients were included by 16 GPs. 27% of patients were referred to an occupational physician. The frequency of consultations for mental distress at work was about 2%. Patients may wait several weeks or months before consulting, although a majority reported an impact on family life and health. A triggering event was often present, but no work accident procedure was undertaken. CONCLUSION: This study highlights the importance of better identifying adverse experience of working conditions and impaired mental health and reporting this to an occupational physician who can undertake preventive measures. Communication between occupational physician, employee and GP needs to be improved.

To compare the cesarean section rate before and after the introduction of an expectant management protocol in patients with abnormally progressing first-stage labor.A prospective monocentric cohort study performed between January 2012 and July 2016.267 patients were included, 97 in the control group and 170 in the study group. The number of cesarean sections decreased from 86 % to 45 % (p0.001). The number of instrumental extractions increased from 8.3% to 29.4% (p0.001). The number of postpartum hemorrhages increased from 5.2% to 18% (p0.01). No differences in the rates of perineal lesions, neonatal pHa below 7.10, and shoulder dystocia were observed.The expectant management in patients with labor arrest in the first stage was associated with a decrease in the number of cesarean sections, at the cost of an increase in instrumental extractions and postpartum hemorrhages.

Our objective was to improve the accuracy of bacteria and resistance coding in a hospital case mix database. Data sources consisted of 50,074 files on bacteriological susceptibility tests transmitted with the HPRIM protocol from laboratory management system to electronic health record of the University hospital of Saint Etienne in July 2017. An algorithm was implemented to detect susceptibility tests containing information corresponding to codes whose addition in the case mix database was susceptible to increase the severity level of a diagnosis related group. Among 132 hospital stays fulfilling the conditions, 27 were lacking bacteria and/or resistance codes, and the tariff was increased for 9 stays, with earnings of €54,612. Analyzing Antimicrobial susceptibility tests helps to improve clinical coding and optimize the financial gain.

The primary objective of this study was to compare lengths of stay since ERAS program implementation. We also evaluated ERAS protocol compliance, compared the outpatient rate, the complication rate and the readmission rate within 30 days after surgery and performed a satisfaction study.This is a monocentric comparative study with a historical control group, performed in the gynecological surgery department of the University Hospital of Saint-Etienne. We compared a group of patients who underwent surgery in 2016, before the implementation of ERAS program, with a group of patients who underwent surgery from July 2021 to July 2022, for whom ERAS program was applied.187 patients were included in this study, including 84 patients in the historical group before ERAS and 103 in the group with ERAS. Considering all approaches, the average length of stay decreased by 2 days (p0.0001). Considering minimally invasive surgery, the outpatient rate increased from 5% to 50% (p0.0001) and complication rate decreased from 23 to 11% (p=0,04). The readmissions rate was similar. Satisfaction score for patients managed with ERAS program was 8.9/10.The implementation of ERAS program in gynecological oncology surgery allowed a reduction in length of stay, with a high outpatient rate, decreasing complications in case of minimally invasive surgery, without increasing the readmission rate, and was associated with good patient satisfaction.

Introduction : Les illustrations du carnet de sante vehiculent des messages de prevention ; elles peuvent ne pas etre comprises ou seulement partiellement. L’objectif principal de notre etude est de decrire la comprehensibilite des illustrations de la rubrique – conseils aux parents de jeunes enfants – du carnet de sante et d’en chercher les determinants.Methodes : Une enquete transversale a ete realisee aupres d’un echantillon de 80 parents d’enfants de moins de six ans residant dans deux departements francais. Chaque parent etait interroge selon un questionnaire semi-dirige sur leurs donnees sociodemographiques puis sur chacune des 11 illustrations du carnet de sante. Le critere de jugement principal etait le nombre d’items corrects par rapport au nombre de messages attendus par illustration. L’analyse descriptive de l’echantillon a ete suivie d’une analyse multivariee par regression logistique.Resultats : Les illustrations « bebe pleure », « syndrome du bebe secoue », « securite du nourrisson dans la voiture », « depistage des troubles visuels » et « depistage des troubles auditifs » ne sont pas comprises par plus de 60 % des parents. Etre le pere ou ne pas savoir lire le francais augmentent significativement le risque de ne pas trouver six des items de prevention attendus.Conclusion : Les illustrations du carnet de sante de l’enfant francais, qui vehiculent pourtant des messages de prevention essentiels, ne sont pas accessibles a tous les parents. Medecins generalistes et pediatres ont l’opportunite d’aider au decryptage des illustrations et sont des acteurs importants de l’education a la sante.

In prolonged pregnancies, the risks of neonatal morbidity and mortality are increased. The aim of this trial was to assess the benefits of maternal information about fetal movement (FM) counting on neonatal outcomes in prolonged pregnancy. It was a prospective, single center, randomized, open-label study conducted from October 2019 to March 2022. Intention-to-treat analyses were performed on 278 patients randomized into two 1:1 groups (control group and FM counting group). The primary outcome was a composite score of neonatal morbidity (presence of two of the following items: fetal heart rate abnormality at delivery, Apgar score of

French child health record books contain preventive care illustrations, which may not always be fully understood. The aim of this study was to describe the degree to which illustrations may be understood in the parent advice section of the French child health record, and to determine the factors associated with poor understanding by young parents.A cross sectional survey was conducted on a sample of 80 parents of children aged 6 or younger from two French areas. Each parent was interviewed following a semi-structured questionnaire that incorporated social and demographic factors and questions about each of the eleven illustrations. The main outcome was the number of correct answers compared to number of expected answers. The data univariate analysis was followed by a multivariate analysis.The illustrations of "crying baby", "shaken baby syndrome", "baby car safety", "vision deficiency screening" or "hearing deficiency screening" are misunderstood by more than 60% of the parents. Being a father or being unable to read French significantly increased the risk of not finding 6 of the expected prevention items.The meaning of illustrations from the French child health record is not accessible to every parent despite the fact that they convey important reminders on preventive care. Family physicians and specialist pediatricians should seize opportunities to enhance preventive care education within medical consultations.

Author(s): Abensur Vuillaume, Laure; Ferreira, Joao Pedro; Asseray, Nathalie; Trombert-Paviot, Beatrice; Montassier, Emmanuel; Legrand, Matthieu; Girerd, Nicolas; Boivin, Jean-Marc; Chouihed, Tahar; Rossignol, Patrick | Abstract: BackgroundPotassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described.AimsThis study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness.MethodsPost-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete self-medication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed.ResultsA total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemial4mmol/L(n = 620, 49.9%), normokalemia 4-5mmol/L(n = 549, 44.2%) and hyperkalemia g5mmol/L(n = 73, 0,6%). The proportion of patients with a kalemial3.5mmol/L was 8% (n = 101). Renal insufficiency (OR [95% CI] = 3.56[1.94-6.52], p-value l0.001) and hemoglobin l12g/dl (OR [95% CI] = 2.62[1.50-4.60], p-value = 0.001) were associated with hyperkalemia. Female sex (OR [95% CI] = 1.31[1.03-1.66], p-value = 0.029), age l45years (OR [95% CI] = 1.69 [1.20-2.37], p-value = 0.002) and the use of thiazide diuretics (OR [95% CI] = 2.04 [1.28-3.32], p-value = 0.003), were associated with hypokalemial4mmol/l. Two patients died in the ED and 629 (52.7%) were hospitalized. Hypokalemia l3.5mmol/L was independently associated with increased odds of hospitalization or death (OR [95% CI] = 1.47 [1.00-2.15], p-value = 0.048).ConclusionsHypokalemia is frequently found in the ED and was associated with worse outcomes in a low-risk ED population.

This study consists of a retrospective study including 71 childhood leukemia survivors (36 females) treated with allo-HSCT 12 Gy fractionated total body irradiation (fTBI) conditioning, with a median age of 25.0 y at time of follow-up and a median delay of 14.8 y since the graft. The recovery ratio was 90%. The number of severe late-effects was specified for each patient: 21 with growth deficiency (final height162.5 cm for 12/35 men and152.0 cm for 9/36 women - Growth deficiency was correlated to young age at the time of the allograft); 5 with sclerodermic chronic graft vs. host disease; 9 with osteonecrosis; risk of impaired fertility for 25 women and 28 men (only 2 women had a child); 8 with diabetes; 5 with pulmonary late-effects including 1 death; 5 with chronic renal insufficiency including 1 death; 2 with cardiac late-effects; 2 with arterial high blood pressure; 11 (8 women) declared 14 subsequent cancers (7 with thyroid carcinomas, 3 with multiple squamous cell carcinomas, 2 with epidermoïdis carcinomas of the tongue or the lip, 1 with bone sarcoma, and 1 with carcinoma of the breast); 6 with chelating treatments of hemochromatosis; 14 with important educational underachievement; 11 with depression at adult age; 1 with hepatitis B virus infection; 4 with other severe late-effects, including 2 with blindness. The average number of severe late-effects was 2.3 with a positive correlation according to delay from fTBI (

World Health Organization recommends the implementation of alternatives to full-time hospitalizations. Psychiatric home-care has known a worldwide development in the last 20 years. The psychiatric mobile team for social and medico-social institutions in Saint-Etienne, France, (Equipe mobile d'intervention en établissements Sociaux et Médico-sociaux, ESMS) aims to support professionals from medico-social housing institutions (MSHI) in order to maintain people in housing. The objective of the study was to evaluate the efficiency of home-based interventions to reduce hospitalizations and improve collaboration between psychiatric hospital facilities and MSHI. We used a pre-post study design. A same cohort of patients living in a MSHI one year before intervention and one year after implementation of the ESMS was studied. Hospitalizations were compared between the two periods. A survey was conducted for qualitative evaluation among professionals in MHSI. Sixty-three patients were included. Most patients suffered from psychotic disorders (71%). We found a significant decrease in the mean number of admissions per year from 2,06 to 1,48 (Wilcoxon signed rank test; df64; p = 0,01). Mobile-team interventions included answering phone calls, home visits, coordination meetings, or clinical interviews with patients in inpatient and outpatient services, with an average of 9,3 interventions per patient (SD = 11,4). ESMS was evaluated as "essential" for 73% of 11 professionals from MSHI who answered the questionnaire in May 2017. Assertive Community Treatment and Crisis Resolution Teams are the most studied home-care models in psychiatry. Our results tend to show the efficiency of mobile-team interventions in MSHI, to enhance partnerships.

OBJECTIVE We aim to identify cardiovascular risk factors in firefighters of Loire (French district) with a high cardiovascular risk and report results of a screening program using exercise tests. METHODS A retrospective descriptive study was performed in a cohort of 158 career and 400 volunteer firefighters with a high cardiovascular risk who had undergone an exercise test. RESULTS Five hundred fifty-eight exercise tests and cardiovascular profiles were analyzed. Prevalence was 18% for high blood pressure, 19% for dyslipidemia, and 48% for overweight. Exercise tests were positive in 91 cases (16.3%): sensitivity, 53%; specificity, 74%. Risk of onset of a predictive event was higher in the high-risk group: odds ratio, 3.2 (95% confidence interval 2.0 to 5.1). There were more events on exercise test in volunteer firefighters. CONCLUSION Prevalence of cardiovascular risk factors in the cohort of firefighters was acceptable in comparison to French general population and other firefighters' cohort. Physical training of volunteer firefighters needs reinforcing.

We evaluated the satisfaction of adult survivors of childhood cancers and their general practitioners (GP) after a long-term consultation.The first Long-term Follow-up Study in Oncology (SALTO1) is a prospective cohort study of survivors of childhood cancers (except leukemia) diagnosed between 1987 and 1992 in the Rhône-Alpes and Auvergne regions of France. Of the 481 patients eligible for the study, 150 participated in a long-term consultation with a pediatric oncologist and an internist, after which survivors and their GPs received long-term plans and recommendations based on consultation findings. A year after the consultation, survivors and their GPs assessed their satisfaction with the process.Of the 150 survivor participants in the long-term follow-up, 120 (80%) completed the satisfaction form, with 107 (89%) reporting satisfaction. Forty-eight (32%) expressed strengthening their follow-up as a consequence of the consultation. Of the 79 survivors sent recommendations, 76 (96%) reported reading them, most (n = 68; 86%) found them useful, and 56 (71%) followed recommendations. Of the 107 GPs of the survivors, 82 (77%) conceded having been poorly informed about long-term complications for their patients after chemotherapy, and 93 (88%) appreciated having a hospital contact available for these patients.The long-term consultations ultimately enhanced medical follow-up of survivor participants, improving knowledge of both patients and family physicians regarding the patients' early disease, its treatments, and possible concerns, and offering consultative resources of medical specialists. The levels of participation of survivors and their physicians and reported satisfaction encourage the adoption of such consultations throughout France.

Firefighters' activities increase the risk of sudden cardiac events. The main objective of this study was to describe the Loire firefighters' cardiovascular risk factors according to their cardiovascular risk and to their professional status. A retrospective study of the entire population of firefighters of the Loire department was conducted. Risk factors derived from the data collected during the occupational health follow-up medical examinations were described and the cardiovascular risk was assessed for 417 firefighters. The most frequent cardiovascular risk factors were: overweight and obesity (62.1%), high blood pressure (27.8%) and active smoking (16,1%). There were no significant differences between career firefighters and volunteers. The prevalence of risk factors for cardiovascular diseases is less than in the general population. Obesity remains the most common risk factor, especially among firefighters with high cardiovascular risk.