Search

Resume Objectifs Developper et valider ImpactChimio, un outil de recueil specifique des interventions pharmaceutiques realisees au sein des Unites de Reconstitution des Chimiotherapies. Methodes Une intervention pharmaceutique est definie par un type d’intervention effectue au regard d’un probleme rencontre. ImpactChimio est base sur la grille Act-IP® (SFPC) et developpe selon la methode Delphi en 2 phases : monocentrique retrospective (analyse des interventions pharmaceutiques realisees sur 1 an) et multicentrique prospective pour evaluer la robustesse (interventions pharmaceutiques en vie reelle) et la reproductibilite (analyse de 50 interventions pharmaceutiques par des pharmaciens naifs et non naifs de l’outil). Resultats L’elaboration de l’outil version 1 decoule de l’analyse de 412 interventions pharmaceutiques. Pour sa validation, 196 interventions pharmaceutiques ont ete renseignees par 6 centres pendant 5 mois. Les modifications ont ete integrees aux nouvelles versions de l’outil (version 2 puis version 3). Six pharmaciens naifs et 6 non naifs ont ensuite teste la reproductibilite en reclassant 50 interventions pharmaceutiques selectionnees dans version 3. Au total, 136 divergences ont ete retrouvees (11,3 %) sur 1200 reponses : 66 concernaient le probleme rencontre, 70 le type d’intervention. Aucune difference statistiquement significative n’a ete trouvee entre les pharmaciens naifs ou non. Conclusions ImpactChimio est le premier outil de recueil specifique des interventions pharmaceutiques realisees en Unites de Reconstitution des Chimiotherapies, developpe de maniere robuste en s’appuyant sur une methode type Delphi. Il permet de valoriser l’activite d’analyse et peut servir a securiser les processus et identifier des axes de formation pour les equipes.

Research on the use of bio-based material rather than fossil fuel-based synthetic polymers is of considerable value due to the increasing interest in biodegradable and ecofriendly products. This paper describes an in-depth analysis of the effect of cellulose nanocrystals (CNC), a promising nanomaterial filler derived from cellulosic biomass, on the mechanical properties of rubber latex thin sheets. Sheets of styrene butadiene rubber (SBR) and its bio-based alternative, natural rubber (NR) were tested and compared. Percolation of CNC was studied within the rubber matrices, where the tear strength, water permeability, and water absorption increased due to the formation of a continuous network of CNC within the polymer thin sheets. The rubber nanocomposites were resistant to tear propagation, caused by increased tortuosity along the tear path brought about by CNC dispersion and filler network formation. The CNC reinforcement yielded thin sheets that were much stronger and more durable than their non-reinforced counterparts. Additionally, the increased water uptake of the sheets could aid in the biodegradation of the polymer. Thus, CNC is found to be an excellent functional filler in rubber sheets, where its formation of a percolating network significantly improved their properties.

Résumé Position du problème L’épidémie de Covid-19 du printemps 2020 a fortement affecté le système de soins. Le confinement et les risques d'exposition au coronavirus ont incité les patients à modifier leur recours aux soins. L'objectif était de partager un retour d'expérience sur la mise en place d'un dispositif de surveillance en temps réel de l'activité des médecins libéraux de la région Provence-Alpes-Côte d'Azur, et de l’évolution des remboursements de médicaments prescrits aux assurés du régime général pour le diabète, pour des troubles de la santé mentale et pour certains vaccins. Méthodes Les données ont été extraites à partir des bases régionales de l'Assurance maladie pour les années 2019 et 2020. Elles ont permis de construire des indicateurs en date de soins pour le régime général stricto sensu, calculés de façon hebdomadaire, à partir de la semaine 2. Résultats On constate une chute d'activité des médecins libéraux lors du confinement (-23 % pour les médecins généralistes ; -46 % pour les spécialistes), suivie d'un quasi retour à la normale par la suite. Dans le même temps, les téléconsultations ont connu un véritable essor : elles ont constitué 30 % des actes des médecins libéraux au plus fort de la crise. Le début du confinement a été marqué par un pic d'approvisionnement en médicaments, tandis que la vaccination a fortement diminué (-39 % concernant le vaccin contre la rougeole, les oreillons et la rubéole chez les enfants de moins de 5 ans ; -54 % pour le vaccin contre les papillomavirus humains chez les filles de 10-14 ans). Conclusion L’épidémie de Covid-19 risque d'entraîner d'autres conséquences sanitaires que celles directement imputables à la Covid-19 elle-même. Le renoncement aux soins pourrait causer des retards de soins fortement préjudiciables aux individus et à la collectivité. Ces questions inquiètent les autorités publiques, qui mettent en place des actions visant à inciter les patients à se soigner sans tarder. Mais la crise liée à la Covid-19 a aussi créé des opportunités, telles que le déploiement de la téléconsultation et de la téléexpertise. Bien que partiels, les indicateurs mis en œuvre peuvent permettre aux décideurs publics d’être réactifs et de mettre en place certaines actions afin de répondre aux besoins de santé des populations.

Resume Position du probleme L’epidemie de COVID-19 du printemps 2020 a fortement affecte le systeme de soins. Le confinement et les risques d’exposition au coronavirus ont incite les patients a modifier leur recours aux soins. L’objectif etait de partager un retour d’experience sur la mise en place d’un dispositif de surveillance en temps reel de l’activite des medecins liberaux de la region Provence-Alpes-Cote d’Azur, et de l’evolution des remboursements de medicaments prescrits aux assures du regime general pour le diabete, pour des troubles de la sante mentale et pour certains vaccins. Methodes Les donnees ont ete extraites a partir des bases regionales de l’Assurance maladie pour les annees 2019 et 2020. Elles ont permis de construire des indicateurs en date de soins pour le regime general stricto sensu, calcules de facon hebdomadaire, a partir de la semaine 2. Resultats On constate une chute d’activite des medecins liberaux lors du confinement (−23 % pour les medecins generalistes ; −46 % pour les specialistes), suivie d’un quasi retour a la normale par la suite. Dans le meme temps, les teleconsultations ont connu un veritable essor : elles ont constitue 30 % des actes des medecins liberaux au plus fort de la crise. Le debut du confinement a ete marque par un pic d’approvisionnement en medicaments, tandis que la vaccination a fortement diminue (−39 % concernant le vaccin contre la rougeole, les oreillons et la rubeole chez les enfants âges de moins de 5 ans ; −54 % pour le vaccin contre les papillomavirus humains chez les filles âgees de 10–14 ans). Conclusion L’epidemie de COVID-19 risque d’entrainer d’autres consequences sanitaires que celles directement imputables a la COVID-19 elle-meme. Le renoncement aux soins pourrait causer des retards de soins fortement prejudiciables aux individus et a la collectivite. Ces questions inquietent les autorites publiques, qui mettent en place des actions visant a inciter les patients a se soigner sans tarder. Mais la crise liee a la COVID-19 a aussi cree des opportunites, telles que le deploiement de la teleconsultation et de la tele-expertise. Bien que partiels, les indicateurs mis en œuvre peuvent permettre aux decideurs publics d’etre reactifs et de mettre en place certaines actions afin de repondre aux besoins de sante des populations.

Summary Introduction Cancer patients use complementary and alternative medicines (CAM) to improve their well-being. Little is known about real risks. Objective To highlight 3 different types of axes: 1/cancer patients’ perceptions concerning CAM; 2/misinformation/miscommunication about CAM; 3/CAM toxicity (direct toxicity, CAM-anticancer drugs, CAM-cancer interactions). Method A questionnaire was proposed to cancer patients for 2 months. The CAM toxicity was analyzed if patients documented their drugs and CAM. Results Eighty-five patients responded: 72/85 were taking ≥ 1 CAM. In total, 95% patients were satisfied. There was an increasing CAM intake after cancer diagnosis. One hundred and seventeen different CAM were identified (63 herbs, 24 essential oils, 28 food supplements, 2 homeopathic specialities). Only 30/85 were aware CAM could interact with anticancer drugs. No other type of risk was perceived. Information sources: 43/85 Internet, 38/85 general practitioner, 38/85 community pharmacist, 32/85 entourage, 25/85 other patients, 22/85 oncologist. In total, 81.3% questioned healthcare professionals (HCP) about CAM. Twelve patients noticed HCP lacked knowledge regarding CAM. The toxicity analysis was carried out for 24 patients who consumed 1 to 24 CAM. In total, 133 CAM were reported, including 87 different CAM. For only 43 CAM/87, studies were found. All patients presented ≥1 risk: 14 at risk of CAM-cancer interactions, 15 of CAM-anticancer drug interactions, 21 of CAM direct toxicities. Conclusion Many CAM are used by patients. The diagnosis of cancer favors their use. The risks are manifold: low perception of risk that can be induced by CAM, diverse and insecure sources of information and many potential toxicities that are not scientifically documented.

To develop and validate prospectively a specific tool for pharmaceutical interventions performed in centralized cytotoxic preparation units.A pharmaceutical intervention is defined as a type of intervention performed in relation to a problem encountered. ImpactChimio is derived from the Act-IP® (SFPC) tool. The initial version (version 1) was developed from the pharmaceutical interventions collected over 1 year by the pilot centre. Its validation was carried out by the Delphi method via a prospective multicentric collection to assess its robustness (real life pharmaceutical interventions) and reproducibility (50 pharmaceutical interventions classified by pharmacists naive or not to the tool and study of classification divergences).The development of the tool (version 1) was based on the analysis of 412 pharmaceutical interventions. For its validation, 196 pharmaceutical interventions were provided by 6 centers for 5 months. The changes have been incorporated into the new versions of the tool (version 2 and version 3). Six naive and six non-naive pharmacists then tested reproducibility by reclassifying 50 selected pharmaceutical interventions into version 3. A total of 136 discrepancies (11.3 %) were found out of 1200 responses: 66 related to the problem encountered and 70 to the type of intervention. No statistically significant differences were found between naive and non-naive pharmacists.ImpactChimio is the first pharmaceutical interventions' specific tool for centralized cytotoxic preparation units, developed and validated by a multicentric study using the Delphi method. It makes possible to enhance the value of the analysis activity and to identify training areas for the teams.

Issue/problem Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events. Description of the problem In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area. Results Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017. Lessons These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices. Key messages A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.

Issue/problem Local public health actors often need to identify public health priorities in their territories to guide public health policy and/or action. Description of the problem The Southeastern Health Regional Observatory (ORS Paca) has been developing since 2006 a health information system for Southeastern France (SIRSéPACA). The objective of this mapping tool is to give access to regional and local public health actors to public health indicators for various population groups and geographical scales (municipality, districts...) within the region. Results Indicators are displayed under the format of maps and tables on the following topics: morbidity, mortality, health social, economic or environmental determinants. Indicators are constructed using national and regional databases (open or accessible through agreements). SIRSéPACA is in free access (www.sirsepaca.org) and regularly updated. A function allows the users to obtain a portrait for a defined geographical area and to obtain in one click a description of various indicators (socio-economic and demographic characteristics, mortality and morbidity causes, health care and prevention, environmental health). Indicators for a given territory can be compared to the regional average (or another area). SIRSéPACA is regularly used to provide a description of the main public health characteristics of territories (“territorial diagnose”), e.g. to help health professionals intending to set up of a multidisciplinary group practice designing their project. Lessons Trainings on how to use the tool, interpret the maps produced, and about territorial diagnoses implementation are regularly done. We are also developing a similar tool for all French regions for the Ministry of Health. Key messages SIRSéPACA facilitates access to and overview of a lot of indicators and data for local public health actors. This regional experience has been expanded to national level.

This paper reports the use of cellulose nanocrystals (CNCs) and nanoclays as reinforcing fillers in starch ester (StE) films. The StE was prepared by a one-step homogenous esterification reaction to obtain a degree of substituted hydroxyl moieties of 2.8. StE films with varying concentrations (0, 0.5 wt.%, 1.5 wt.%, 3 wt.%, and 5 wt.%) of CNC and nanoclay were then fabricated using a solvent casting process and characterized using scanning electron microscopy, optical spectrometry, water absorbance, water vapor permeability, mechanical tests, and simulated compostability studies. The SEM images for the CNC-filled composites revealed aggregates of CNC in the matrix, while nanoclay showed a homogeneous dispersion. Although no apparent visible change in transparency was observed for all filled films, a decrease in light transmission was revealed by optical density measurements. The incorporation of the nanofillers improved the yield strength of the starch-ester films significantly. This improvement in the tensile strength was as much as 112 % and 173 % for 5 wt. % of CNC and 5 wt.% of nanoclay, respectively. No hydrolysis was observed for StE under the simulated composting conditions over six months. Compared to the unfilled StE films, the reinforced films showed a reduction in weight approximately equal to the amount of the filler, with a maximum degradation of 8.9 wt.% for the 5 wt. % nanoclay filled StE films.

The adhesion properties of Staphylococcus aureus on palladium–cobalt (Pd–Co) alloy nanostructures with various cross-sectional geometries have been characterised. They include solid core, hollow, c-shaped, and x-shaped pillars. These pillars have unique funnel-shaped geometric features on the top surfaces with average included angles between ∼142o and ∼149o. The success rates of cell attachment on these pillar tops were quantified by using field emission scanning electron microscopy techniques. Results show the Staphylococcus aureus attachment rates of Pd–Co solid core, hollow, and x-shaped pillars are statistically indistinguishable with success rate up to 82%. X-shaped pillars have the lowest attachment rate among the four geometries of 46 ± 5%.

National guidelines recommend oral vancomycin for severe Clostridium difficile infection (CDI) based on results from recent clinical trials demonstrating improved clinical outcomes. However, real-world data to support these clinical trials are scant.To compare treatment patterns and patient outcomes of those treated for CDI before and after implementation of a severity-based CDI treatment policy at a tertiary teaching hospital.This study evaluated adult patients with a positive C. difficile toxin before and after implementation of a policy where patients with severe CDI given metronidazole were switched to oral vancomycin unless contra-indicated. Patients were stratified according to disease severity using a modified published severity score. Treatment patterns based on CDI severity and rates of refractory CDI were assessed.In total, 256 patients with CDI (mean age 66 years, standard deviation 17, 52% female) were evaluated (before implementation: N = 144; after implementation: N = 112). Use of oral vancomycin for severe CDI increased significantly from 14% (N = 8) to 91% (N = 48) following implementation of the policy (P0.0001). Refractory disease in patients with severe CDI decreased significantly from 37% to 15% following implementation of the policy (P = 0.035). No significant differences were noted among patients with mild to moderate CDI.A severity-based CDI treatment policy at a tertiary teaching hospital increased the use of oral vancomycin and was associated with decreased rates of refractory CDI.

Background This study conducted in the region of Provence-Alpes-Cote d’Azur (PACA) sought to assess the feasibility of constructing and using indicators of potentially inappropriate prescriptions for the elderly from health insurance reimbursement data. We present and discuss different indicators of inappropriate prescriptions for people aged 70 years or older (at-risk prescriptions, dangerous or at-risk coprescriptions, absence of necessary coprescriptions) and reports their prevalence in PACA. Methods The indicators were constructed from the French list of inappropriate prescriptions, national agency guidelines, and the advice of experts in the field. The indicators selected were applied to the databases of the PACA Salaried Workers’ Health Insurance Fund for 2008 for all recipients aged 70 years or older and compared according to age, sex, chronic disease status, and, after standardization for age and sex, according to district of residence. Results In January 2009, 500,904 recipients aged 70 years or older were identified in the data base of the Salaried Workers’ Health Insurance Fund, 60.8% of whom were women and 52.1% of whom had approved coverage for a chronic disease. The potentially inappropriate prescriptions most frequently observed here, in decreasing order, were: prescription of an NSAID without the coprescription of gastric protection (28.1%); long-term benzodiazepine treatment (21.5%); prescription of long half-life benzodiazepine (14.9%), and long-term treatment with NSAIDs (11.6%). Overall, the prevalence of each increased significantly with age and was higher among women and people with chronic diseases. Significant variations were also observed between the different districts of PACA. Conclusion Our results confirm that a substantial proportion of elderly people receive potentially inappropriate prescriptions. They also suggest that health insurance reimbursement data could be used in some prescription domains for monitoring trends in the potentially inappropriate prescriptions in the populations of various territories, provided that specific limitations are considered.

Background Since 2001, the French hospital stay databases ( Programme de medicalisation des systemes d’information, PMSI ) have included a unique and anonymous identifier in order to cross-link discharge abstracts from a given patient, within and across hospitals. These data could be used to estimate prevalence for some diseases at a territorial level provided that linkage quality is good enough. Few morbidity data are available at this scale. This study analyzes the link between linkage quality and hospitalization rates in three French regions (Picardy, Brittany and Provence-Alpes-Cote d’Azur–Paca). Methods We studied short stays in medicine-chirurgical-obstetrical units for the 2004–2005 period (all stays, and stays with mention of cancer or asthma). To study linkage quality, the percentage of linkable stays (no error during the production of the anonymous identifier) was calculated at regional and territorial levels (areas used by regional health authorities). The interquartile range (IQR = third quartile – first quartile) of the percentage of linkable stays was calculated and the link between this percentage and standardized rates of people hospitalized at least once in 2004 or 2005 tested by Spearman correlation coefficients. Results For all stays, percentages of linkable stays were 94.4%, 96.6% and 97.0% in Picardy, Paca and Brittany respectively in 2004–2005. Geographical variation at the territorial level was higher in Picardy (IQR between 4 and 6) than in the two other regions (IQR between 1 and 2). The percentage of linkable stays was positively and significantly associated with the hospitalization rate for all stays and those with mention of cancer in Picardy only. Conclusion According to these results, PMSI data earlier than 2006 should be used with precaution; linkage quality should be analyzed before making geographical or time comparisons of hospitalization rates. Comparisons cannot always be made. Other studies should be carried out in other regions, and to analyze recent trends in linkage quality.

Background To provide feedback on the initial market authorization of rimonabant, a drug to be used under strict guidelines, we conducted a study with information from the National health insurance reimbursements database for southeastern France. The aims of this study were to: (1) describe the characteristics of subjects who have had one rimonabant prescription reimbursed; (2) study the frequency of prescriptions that did not comply with reimbursement criteria; (3) study the frequency of prescriptions for patients simultaneously treated with antidepressants; and (4) analyse the factors associated with both types of prescription (patient and prescriber characteristics). Methods Using the database of drug reimbursements maintained by the southeastern France general health insurance fund, we studied the characteristics of outpatients with at least one reimbursement for rimonabant, compared them to the rest of the population, and analysed compliance with the indications, contraindications, and regulations for rimonabant prescription with multivariate logistic regressions. Results A total of 10,510 beneficiaries (0.28%) had at least one rimonabant reimbursement. Among them, 55.7% were treated for diabetes. For at least 62.4% of rimonabant beneficiaries, the reimbursement regulations were not respected: this was significantly more frequent among women less than 57 years old, subjects with no chronic diseases, and when the prescriber was not an endocrinologist; 11.4% of rimonabant beneficiaries also received an antidepressant treatment. Conclusion Despite the specific status of rimonabant regarding its reimbursement modalities, these results suggest that some prescribers get around reimbursement instructions and that a significant percentage of prescriptions did not respect an important contraindication. Tools to follow up the prescriptions of new drugs with strict guidelines for use should be developed and physicians should be better informed and trained regarding specific prescription regulations.

BACKGROUND Data derived from Health Insurance databases are very useful for health observation. These data are however still underused, particularly for small local areas. This may be partly explained by the lack of reliable data on the number of insured people. Recent simplification of the Repertoire national interregimes de l'assurance-maladie (RNIAM) indicator (French register of health insurance) gives the opportunity to improve the usefulness of these databases. This indicator specifies the beneficiaries' status towards the General Health Insurance Fund. This study aimed to select the population of beneficiaries, which could be most adequately used to calculate health indicators based on these data. METHODS Data were collected from the outpatient database of the Southeastern France General Health Fund. We compared beneficiaries' characteristics according to the RNIAM indicator, calculated the annual unadjusted and age-adjusted regional and local prevalence of diabetes mellitus in two different populations: the whole initial beneficiaries database, and the population of "effective" beneficiaries (persons whose reimbursements were effectively managed by the General Health Insurance). RESULTS The initial database included 4,817,871 beneficiaries. Almost 80% were in the "effective" population, 14% had left the General Health Insurance, or Southeastern France, and 4% were doubles. The annual unadjusted prevalence of diabetes mellitus was 3.31% in the initial database, and more than 20% higher when calculated among "effective" beneficiaries. Impact on aged-adjusted prevalence was less important (+9% at regional level), but the increase varied from 6 to 42% for the small local areas. Impact was much higher on age and gender specific rates. CONCLUSION When Health Insurance databases are used to calculate health indicators at various geographical levels, only "effective" beneficiaries should be selected. The methodology for determining health indicators might be improved by updating databases (e.g. the date of the RNIAM indicator last update should be added).

The hardening and embrittlement of Reactor Pressure Vessel (RPV) steels is of great concern in the actual nuclear power plant life assessment. This embrittlement is caused by irradiation-induced damage, like vacancies, interstitials, solutes and their clusters. Fe-Cu binary alloys are often used to mimic the behaviour of such steels. Their study allows identifying some of the defects responsible of the hardening, especially when compared to pure iron or C-micro-alloyed iron. Owing to their self-seeking and selective trapping, positrons are used to determine the nature of these defects. Recently, at SCK·CEN, a new Positron Annihilation Spectroscopy (PAS) setup has been built, calibrated and optimized to measure the Coincidence Doppler Broadening (CDB) and Lifetime (LT) of neutron irradiated materials. This set-up has been used to measure the CDB and LT of n-irradiated pure Fe and Fe–Cu alloys. It is found that the clustering of Cu take place at the very early stages of irradiation using the CDB while LT measurement are showing much more vacancy clustering for low Cu alloys than in the higher ones. Increasing the neutron dose up to 1.3 × 1020 n/m2, allows the follow up of the kinetic of Cu and V-clustering especially in Fe-Cu alloys. It is found that both copper and carbon decrease the size of vacancy-cluster, when added to iron. (© 2007 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Resume Position du probleme Dans le cadre de la mise en place et du suivi des politiques territoriales de sante en France, il serait utile de disposer d’indicateurs sur la prevalence de l’asthme a un niveau territorial fin. A partir des bases de donnees de remboursement de l’assurance-maladie de la region Provence-Alpes-Cote d’Azur (PACA), cette etude vise a (1) comparer la prevalence des troubles asthmatiformes mesuree a partir de trois indicateurs differents ; (2) etudier les variations de ces indicateurs en fonction des caracteristiques sociodemographiques des individus ; (3) verifier si ces indicateurs sont equivalents pour etudier les disparites geographiques de la prevalence des troubles asthmatiformes au niveau infraregional. Methodes L’etude a ete realisee aupres des beneficiaires du regime general stricto sensu de l’assurance-maladie âges de 18–44 ans residant en PACA en 2010 (n = 1 371 816). A partir des remboursements de « medicaments pour syndromes obstructifs des voies aeriennes » (classe therapeutique R03), trois indicateurs ont ete construits pour mesurer la prevalence des troubles asthmatiformes : ≥ 1, ≥ 2 et ≥ 3 remboursement(s) en 2010. Les facteurs sociodemographiques associes a chacun des indicateurs et leurs variations geographiques a l’echelle des espaces de sante de proximite (ESP) ont ete etudies a l’aide de modeles de regression logistique multiniveaux tenant compte de la structure hierarchique des donnees. Resultats La prevalence brute des troubles asthmatiformes variait de 2,6 a 8,4 % selon l’indicateur utilise. Quel que soit l’indicateur, la prevalence augmentait avec l’âge et etait plus elevee chez les femmes que chez les hommes et chez les personnes beneficiant de la couverture maladie universelle complementaire. La prevalence variait significativement entre les ESP de la region. Les territoires presentant les prevalences les plus elevees etaient les memes quel que soit l’indicateur. Conclusion Les indicateurs construits a partir des donnees de remboursement de l’assurance-maladie peuvent etre utiles pour identifier les territoires ou la prevalence des troubles asthmatiformes est particulierement elevee. Ils pourraient contribuer a initier une reflexion sur les problematiques sante–environnement a un niveau local.

In the framework of the European project PERFECT, dealing with the modelling of irradiated material behaviour, well controlled irradiations have been performed at 300 °C for doses ranging from 0.025 to 0.2 dpa. At this stage, four model-alloys (Fe, Fe–C, Fe–0.1 wt%Cu, Fe–0.3 wt%Cu) have been investigated by Coincidence Doppler Broadening of positron annihilation radiation (CDBAR), a well established tool for studying defects in materials. The results demonstrate the effect of Cu on the matrix damage accumulation under neutron irradiation.

Data on asthma prevalence at a small-area level would be useful to set up and monitor French local public health policies. This study, based on drug reimbursement databases in southeastern France, aimed to (1) compare asthma-like disorders prevalence estimated by using three different indicators; (2) study sociodemographic characteristics associated with these indicators; (3) verify whether these indicators are equivalent to study geographical disparities of the asthma-like disorders prevalence at a small-area level.The study was conducted among the beneficiaries of the National Health Insurance Fund aged 18-44 years residing in southeastern France in 2010 (n=1,371,816). Using data on asthma drugs reimbursements (therapeutic class R03), we built three indicators to assess asthma-like disorders prevalence: at least 1, 2 or 3 purchase(s) in 2010. We analyzed sociodemographic characteristics associated with these indicators, and their geographical disparities at a small-area level using multilevel logistic regression models.The crude asthma-like disorders prevalence varied between 2.6 % and 8.4 % depending on the indicator. It increased with age, was higher for women than for men, and among low-income people for all three indicators. We measured significant geographical disparities. Areas with high prevalence rates were the same regardless of the indicator.The indicators built in this study can be useful to identify high prevalence areas. They could contribute to launch discussion on environmental health issues at the local level.

Background: Although risk factors for torsade de pointes (TdP) are known, identifying hospitalized patients at greatest risk for QTcP who should receive cardiac monitoring is poorly defined. Objectives: Describe the prevalence of risk for TdP in patients and associations between risk factors and QTc prolongation (QTcP) at a tertiary teaching hospital. Methods: This retrospective analysis assessed physiological and pharmacological risk factors for TdP of adult patients receiving ≥1 QTc-prolonging medications (QTcMed) during hospitalization. The QTcMeds were stratified by risk for causing TdP (probable, possible, and conditional). Baseline electrocardiograms (ECGs) were assessed for QTcP associated with risk for TdP. Results: During a 6-month period, 12 401 (51%) hospitalizations received ≥1 QTcMed. A baseline ECG was obtained for 2381 (19%) patients. A total of 386 (16%) patients with a baseline ECG were found to have QTcP. Significant associations for QTcP were found with the following physiological risk factors: female ( P = .021), left-ventricular ejection fraction

The precursors to fluorozirconate glass, which were tested, are volatile β-diketonate complexes. They have all been prepared and characterized (elemental analysis, infrared (IR), nuclear magnetic resonance (NMR), X-ray diffraction, and thermogravimetric analysis (TGA)). La(DPM) 3 , Al(DPM) 3 and Na(HPM), [DPM(H): 2,2,6,6-tetramethyl-3,5-heptanedione, HPM(H): 1,1,1,2,2,3,3-heptafluoro-7,7-dimethyl-4,6-octanedione] are thermally stable, whereas Zr(DPM) 3 Cl and Ba(HPM) 2 are not; Zr(DPM) 4 is not volatile enough at the chemical vapour deposition (CVD) reaction temperature. Deposition of AlF 3 , LaF 3 and NaF fluorides has been performed by vapour phase reaction of their precursors with HF or NF 3 . Starting from an equimolar mixture of the three complexes, a non-homogeneous amorphous material which combines these three fluorides has been deposited. Scanning electron microscope analysis showed carbon impurities

This study conducted in the region of Provence-Alpes-Côte d'Azur (PACA) sought to assess the feasibility of constructing and using indicators of potentially inappropriate prescriptions for the elderly from health insurance reimbursement data. We present and discuss different indicators of inappropriate prescriptions for people aged 70 years or older (at-risk prescriptions, dangerous or at-risk coprescriptions, absence of necessary coprescriptions) and reports their prevalence in PACA.The indicators were constructed from the French list of inappropriate prescriptions, national agency guidelines, and the advice of experts in the field. The indicators selected were applied to the databases of the PACA Salaried Workers' Health Insurance Fund for 2008 for all recipients aged 70 years or older and compared according to age, sex, chronic disease status, and, after standardization for age and sex, according to district of residence.In January 2009, 500,904 recipients aged 70 years or older were identified in the data base of the Salaried Workers' Health Insurance Fund, 60.8% of whom were women and 52.1% of whom had approved coverage for a chronic disease. The potentially inappropriate prescriptions most frequently observed here, in decreasing order, were: prescription of an NSAID without the coprescription of gastric protection (28.1%); long-term benzodiazepine treatment (21.5%); prescription of long half-life benzodiazepine (14.9%), and long-term treatment with NSAIDs (11.6%). Overall, the prevalence of each increased significantly with age and was higher among women and people with chronic diseases. Significant variations were also observed between the different districts of PACA.Our results confirm that a substantial proportion of elderly people receive potentially inappropriate prescriptions. They also suggest that health insurance reimbursement data could be used in some prescription domains for monitoring trends in the potentially inappropriate prescriptions in the populations of various territories, provided that specific limitations are considered.

Aim This study estimated geographical variations in the prevalence of treated diabetes (TD) at the small-area level in Southeastern France to determine whether or not the characteristics of these areas (in particular, socioeconomic status or “SES”) are associated with TD independent of person-level factors. Methods The study used drug reimbursement data for 2008 from the General Health Insurance Scheme in Southeastern France for beneficiaries aged 18 years or over. TD patients were defined as those to whom oral antidiabetic drugs or insulin had been dispensed at least three times within the year. Area (canton) characteristics associated with the prevalence of TD were studied using multilevel Poisson regression. Results In 2008, the crude prevalence of TD in adults in Southeastern France was 5.14%. In addition, TD prevalence was significantly higher in the more deprived and population-dense cantons independent of person-level factors (age, gender, low SES). Conclusion This study found a positive association between area deprivation and TD, and adds further evidence to the scanty data so far available on this topic. This finding should contribute to pinpointing priority action areas for programmes of diabetes prevention. However, more research is needed to further elucidate the mechanism(s) linking area deprivation and diabetes.

Since 2001, the French hospital stay databases (Programme de médicalisation des systèmes d'information, PMSI) have included a unique and anonymous identifier in order to cross-link discharge abstracts from a given patient, within and across hospitals. These data could be used to estimate prevalence for some diseases at a territorial level provided that linkage quality is good enough. Few morbidity data are available at this scale. This study analyzes the link between linkage quality and hospitalization rates in three French regions (Picardy, Brittany and Provence-Alpes-Côte d'Azur-Paca).We studied short stays in medicine-chirurgical-obstetrical units for the 2004-2005 period (all stays, and stays with mention of cancer or asthma). To study linkage quality, the percentage of linkable stays (no error during the production of the anonymous identifier) was calculated at regional and territorial levels (areas used by regional health authorities). The interquartile range (IQR=third quartile-first quartile) of the percentage of linkable stays was calculated and the link between this percentage and standardized rates of people hospitalized at least once in 2004 or 2005 tested by Spearman correlation coefficients.For all stays, percentages of linkable stays were 94.4%, 96.6% and 97.0% in Picardy, Paca and Brittany respectively in 2004-2005. Geographical variation at the territorial level was higher in Picardy (IQR between 4 and 6) than in the two other regions (IQR between 1 and 2). The percentage of linkable stays was positively and significantly associated with the hospitalization rate for all stays and those with mention of cancer in Picardy only.According to these results, PMSI data earlier than 2006 should be used with precaution; linkage quality should be analyzed before making geographical or time comparisons of hospitalization rates. Comparisons cannot always be made. Other studies should be carried out in other regions, and to analyze recent trends in linkage quality.

Data derived from Health Insurance databases are very useful for health observation. These data are however still underused, particularly for small local areas. This may be partly explained by the lack of reliable data on the number of insured people. Recent simplification of the Répertoire national interrégimes de l'assurance-maladie (RNIAM) indicator (French register of health insurance) gives the opportunity to improve the usefulness of these databases. This indicator specifies the beneficiaries' status towards the General Health Insurance Fund. This study aimed to select the population of beneficiaries, which could be most adequately used to calculate health indicators based on these data.Data were collected from the outpatient database of the Southeastern France General Health Fund. We compared beneficiaries' characteristics according to the RNIAM indicator, calculated the annual unadjusted and age-adjusted regional and local prevalence of diabetes mellitus in two different populations: the whole initial beneficiaries database, and the population of "effective" beneficiaries (persons whose reimbursements were effectively managed by the General Health Insurance).The initial database included 4,817,871 beneficiaries. Almost 80% were in the "effective" population, 14% had left the General Health Insurance, or Southeastern France, and 4% were doubles. The annual unadjusted prevalence of diabetes mellitus was 3.31% in the initial database, and more than 20% higher when calculated among "effective" beneficiaries. Impact on aged-adjusted prevalence was less important (+9% at regional level), but the increase varied from 6 to 42% for the small local areas. Impact was much higher on age and gender specific rates.When Health Insurance databases are used to calculate health indicators at various geographical levels, only "effective" beneficiaries should be selected. The methodology for determining health indicators might be improved by updating databases (e.g. the date of the RNIAM indicator last update should be added).

The structure of [ZrCl(C 11 H 19 O 2 ) 3 ] has been solved from single-crystal X-ray diffraction data. Monomolecular units are associated two-dimensionally by intermolecular hydrogen bonds.

Background The preparation in advance of anticancer drugs can decrease the waiting time of patients in oncology day units. Purpose To establish a system of phoning patients before their session (D-1 call) to cheque their availability. A year after its deployment, we evaluated the impact of this plan. Materials and Methods The oncologist and a nurse call patients one day before their appointment. The prescriptions are validated when the patient’s condition permits it in the light of the patient’s biological assessment, done in an outside medical analysis laboratory, and an interview using a standardised questionnaire. After pharmaceutical validation, anticancer drugs are prepared in the afternoon for the next day. Indicators of routine monitoring were defined. Results A median of 13 patients with 23 planned day-hospital appointments were called the day before their appointment. An oncologist validated the treatment of 45% of the patients on D-1 and 95% of the cancer treatments were delivered on D1 before 9:00 am. The total time the patients spent in the unit was reduced from 273 minutes to 242 minutes after our plan was adopted. The average time between the end of the medical consultation and the start of the treatment went down from 79 minutes before the D-1 call to 52 minutes. In addition, 2/3 of patients received the treatment only 30 minutes after seeing their doctor. Finally, fewer than 2% of anticipated preparations were not administered. Conclusions The D-1 call requires significant effort, but it enables us to improve the organisation of care in the oncology day unit and the preparation of the anticancer drugs by the pharmacy’s production unit. The workload is more even throughout the day and is not stressful for the staff. All of this contributes to making the system safer. We are hoping to extend the D-1 call to the oncology week unit and evaluate patient satisfaction. No conflict of interest.

Alveolar proteinosis is a rare disease. We report a case occurring in a patient who smoked and was a facade plasterer who was treated with repeated pulmonary lavage. A mineral analysis of the lavage fluid recovered a significant amount of silica and iron oxide confirming the massive exposure of the patient to these minerals. The favourable outcome over the next 7 years was associated as regards respiratory function, with a progressive improvement in lung volumes and pulmonary output and of CO diffusion capacity, as regards broncho-alveolar lavage there was a regular increase in the cellularity and finally as regards CT scanning (at high resolution) there was a progressive clearing of the alveolar opacities only leaving the persistent opacities in the interstitium.

The authors report three cases of abnormal chest radiography mimicking mediastinal masses. These radiographic findings were unrelated to any pathology, were discovered in asymptomatic patients, and must be considered consequences of unusually narrow thoracic inlets. Mean and standard deviations of the anteroposterior diameter of the superior mediastinum are given. Computed tomography of the chest yielded valuable diagnostic information and made it possible to exclude mediastinal masses.

Two babies with severe cardiac failure caused by a large arteriovenous malformation of the vein of Galen were evaluated with 2-dimensional ultrasound, pulsed and colour Doppler techniques. In both cases similar findings were recorded: dilated right cardiac chambers with high cardiac output in superior vena cava and ascending aorta; retrograde diastolic flow in descending aorta and continuous forward flow in arch arteries reflecting low resistance to flow in cerebral arteries; recirculation of microbubbles through the superior vena cava after passage unchanged through the cerebral malformation following contrast injection of saline into a peripheral vein or an arterial umbilical line. In addition, colour Doppler study of the brain clearly showed the malformation and the dilated straight sinus. Arteriovenous malformation of the vein of Galen can be noninvasively and easily detected by ultrasound studies of the heart and the brain.

A systematic evaluation of the anatomic relationships of the segmental bronchi, arteries, and veins of 107 right and 113 left lower lobes was made from CT scans of patients with normal chest radiographs. The classic taxonomies of Boyden and Jackson and Huber were used for nomenclature. Identification of individual structures was based primarily on careful analysis of contiguous CT slices. The frequency of identification of each of the major segmental bronchi and their corresponding arteries was established, and variations in the number and position of arteries were recorded at four transverse levels on the right side and three levels on the left side. The segmental venous tributaries of the inferior pulmonary vein were also identified. Although there is considerable constancy in the anatomy of the lower lobe segments, variation from the dominant pattern occurred in as many as 20% of cases. Sometimes major segmental bronchi were not identified and presumably varied in their origin. The segmental arteries may be single, duplicate, or even triplicate. Within the segments, the arteries generally lie toward the lung periphery relative to their corresponding bronchi, thus being anterior, lateral, or posterior. The segmental veins generally lie central to their bronchi, thus being posterior, medial, or anterior. Knowledge of prevailing patterns and variant appearances of the lower-lobe vascular structures can be helpful in interpreting CT scans. Such knowledge is a prerequisite for the identification of pulmonary nodules in the vicinity of vascular structures and the recognition of intersegmental lymph nodes and aberrant vessels.

Among the long-term complications that jeopardize bilateral aorto-femoral prostheses, the development of a false aneurysm on the aortic suture line, is indeed one of the most severe. Its frequency, approximately 1 p. cent of cases, is probably underestimated, since its diagnosis, with usual exploration methods, is difficult. The nuclear magnetic resonance (NMR) examination is here particularly indicated and, when in doubt, must be systematically requested, especially in the presence of a false aneurysm of the femoral suture line.

A case of intrarenal malignant pheochromocytoma, closely resembling hypernephroma radiologically, is presented. This tumor with 2 other pulmonary masses, recurred 12 years after ablation of an adrenal pheochromocytoma and extended into the inferior vena cava.

The authors report three cases of abdominal lipomatosis, presenting as an abdominal mass. The problems of diagnosis caused by this rare entity are discussed. The value of the CT scan is emphasized. Indeed, only this examination is able to give all the informations necessary for the diagnosis. Ultrasonography seems to be particularly useful in the assessment of the evolution of this disease, especially for the study of the urinary complications. Before apparition of these complications, no treatment is required.

The authors report a case of Caroli's disease, localized in the left hepatic lobe without any associated abnormality. Preoperative diagnosis of such localized forms is actually possible by the use of non invasive methods, especially computed tomography. This diagnosis is important leading to a curative surgical treatment.