Search

To evaluate the impact of systematic radiological review by breast specialist radiologist of malignant breast lesion imaging on the therapeutic management of patients.Data collection was performed for patients with histopathologically proved breast cancer or suspicious breast lesion on imaging realized out of our institution. Patients underwent systematic mammary and axillary ultrasound, imaging review and if necessary complementary mammographic images. We analyzed the number of additional breast biopsies and axillary lymph node fine needle aspiration (FNA) with their histopathological results. We assessed their impact by comparing the final surgical treatment to the one planned before review.Two hundred and seventeen patients were included, with a total of 230 BIRADS 0, 4, 5 or 6 breast lesions. Seventy-six additional breast core biopsies were realized, leading to diagnose 43 additional BIRADS 6 lesions (24 infiltrative carcinomas, 9 DCIS and 10 atypical lesions) in 30 patients (13.82%). Thirty-five additional lymph node FNA were realized with 12 metastatic nodes and 3 false negative samples. Imaging review lead to change surgical treatment in 59 patients (27.19%, P0.01) with modification in breast surgery in 37 patients, axillary surgery in 8 patients and both sites surgery in 12 patients.This study shows an impact of systematic radiological review by breast specialist radiologist in therapeutic management of patients treated for malignant breast lesion.

Intra dialytic hypotension is the most common complication in hemodialysis. However, isolated diastolic hypotension (IDH) in hemodialysis is asymptomatic and its detection requires repeated monitoring of blood pressure during dialysis sessions. To study this phenomenon, we conducted a prospective study over a period of 5 years in 45 chronic hemodialysis patients. The IDH, was noted in 42% at inclusion, and in 59,5% of the cases at the end of the study. IDH was associated with advanced age, female gender, high relative critical blood volume, cardiac arrhythmias and diastolic dysfunction of the left ventricle. IDH was also significantly associated with novel cardiovascular complications (P=0.004) and all-cause mortality (P=0.038). Isolated diastolic hypotension is a particularly common phenomenon in hemodialysis. Our data encourage in-depth reflection on this subject in hemodialysis. In addition, our study highlights the value of screening for IDH by close monitoring of hemodynamic parameters, and calls for personalized dialysis management based on the analysis of the demonstrated risk factors and on the study of the associated comorbidities.

To describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi.We conducted a prospective cohort survey over a 54 month-period, from March 1st, 2012 to September 30th 2015. Were included all patients with pulmonary embolism and having high or intermediate-high risk of death. Patients were divided into two groups according to whether cardiac Doppler-echography found a thrombus in the right chambers or not (ICT+ vs. ICT-). The survival curves for the patients were obtained using the software STATA.The prevalence of pulmonary embolism associated with right heart thrombi was 4% in our study. Thrombi were mobile, straight localization in all cases. The ICT+group was characterized by a significantly higher proportion of congestive heart and chronic lung disease. The proportion of patients' thrombolysis was significantly higher in the ICT-group. In the ICT+group, thrombolysis significantly reduced mortality giving a 30-day survival of 80% against 20% among patients receiving only heparin.Pulmonary embolism associated with right heart thrombi including the atrium are not exceptional. These patients are at high risk of early death. Thrombolysis is significantly improving the mortality of pulmonary embolism associated with right-sided heart thrombi.

Benefits of physical activity during cancer treatment are widely demonstrated, however, most of patients are not active enough. Several studies have analyzed the different variables that would affect the participation to physical activity programs. The aim of our study was to define profiles of patients who agree to participate in a physical activity program in the medical setting according to the hospital structure in which they receive their care, their past and present habits in sports and their temporal perspectives.Forty-six patients treated from two different hospitals (regional hospital denoted CLCC; and local hospital denoted CH), completed a survey consisting of a questionnaire on their past and present habits in physical activity, ZTPI and a demographic questionnaire. Patients could decide to participate or not in a physical activity program in the medical community. T-tests and ChiChiOur study points out that the past and present patient PA (physical activity) has no influence on their accession to a physical activity program, however the type of hospital providing patient care could influence their participation. These results should lead us to rethink about the different forms of communication made around the physical activity programs in medical contexts, and about different practical arrangements proposed according to each health facility.

Given the proposed changes to nutrition labelling in Canada and the dearth of research examining comprehension and use of nutrition facts tables (NFts) by adolescents and young adults, our objective was to experimentally test the efficacy of modifications to NFts on young Canadians' ability to interpret, compare and mathematically manipulate nutrition information in NFts on prepackaged food.An online survey was conducted among 2010 Canadians aged 16 to 24 years drawn from a consumer sample. Participants were randomized to view two NFts according to one of six experimental conditions, using a between-groups 2 x 3 factorial design: serving size (current NFt vs. standardized serving-sizes across similar products) x percent daily value (% DV) (current NFt vs. "low/med/high" descriptors vs. colour coding). The survey included seven performance tasks requiring participants to interpret, compare and mathematically manipulate nutrition information on NFts. Separate modified Poisson regression models were conducted for each of the three outcomes.The ability to compare two similar products was significantly enhanced in NFt conditions that included standardized serving-sizes (p ≤ .001 for all). Adding descriptors or colour coding of % DV next to calories and nutrients on NFts significantly improved participants' ability to correctly interpret % DV information (p ≤ .001 for all). Providing both standardized serving-sizes and descriptors of % DV had a modest effect on participants' ability to mathematically manipulate nutrition information to calculate the nutrient content of multiple servings of a product (relative ratio = 1.19; 95% confidence limit: 1.04-1.37).Standardizing serving-sizes and adding interpretive % DV information on NFts improved young Canadians' comprehension and use of nutrition information. Some caution should be exercised in generalizing these findings to all Canadian youth due to the sampling issues associated with the study population. Further research is needed to replicate this study in a more heterogeneous sample in Canada and across a range of food products and categories.Essai randomisé mesurant l’efficacité des modifications apportées au tableau de la valeur nutritive sur la compréhension et l’utilisation de l'information nutritionnelle par les adolescents et les jeunes adultes au Canada.Compte tenu des changements proposés à l’étiquetage nutritionnel au Canada et de la rareté des travaux de recherche portant sur la compréhension et l’utilisation des tableaux de la valeur nutritive (tVN) chez les adolescents et les jeunes adultes, notre objectif consistait à réaliser un essai expérimental pour déterminer si les modifications apportées au tVN permettaient d’améliorer efficacement la façon dont les jeunes Canadiens interprètent, comparent et manipulent, sur le plan mathématique, l’information nutritionnelle figurant dans le tVN de denrées préemballées.Une enquête en ligne a été menée auprès d’un échantillon de consommateurs composé de 2 010 Canadiens âgés de 16 à 24 ans. Nous avons réparti les participants de façon aléatoire en six groupes d’étude, et nous avons présenté à chacun des groupes deux des six tVN définis comme conditions expérimentales, selon un plan factoriel 2 x 3 : portion de référence (tVN actuel et portions de référence normalisées pour tous les produits similaires) x pourcentage de la valeur quotidienne (% VQ) (tVN actuel, ajout des descripteurs « faible/moyen/élevé » et ajout d’un code de couleurs). L’enquête comprenait sept tâches consistant à interpréter, comparer et manipuler, sur le plan mathématique, l’information nutritionnelle figurant dans les tVN. Des modèles de régression de Poisson modifiés ont été élaborés pour chacun des trois résultats.La capacité à comparer deux produits similaires s’est révélée significativement meilleure quand le tVN incluait une portion de référence normalisée (p ≤ 0,001 dans tous les cas). L’ajout de descripteurs ou d’un code de couleurs indiquant, sur le tVN, le % VQ pour les calories et les nutriments a amélioré de façon significative la capacité des participants à interpréter correctement l’information à propos de ce % VQ (p ≤ 0,001 dans tous les cas). Le fait de présenter aux participants des portions de référence normalisées et des descripteurs du % VQ a eu un effet modeste sur leur capacité à manipuler, sur le plan mathématique, l’information nutritionnelle pour calculer la valeur nutritive de plusieurs portions d’un produit (ratio relatif = 1,19; intervalle de confiance à 95 % : 1,04 à 1,37).La normalisation des portions de référence et l’ajout d’information sur l’interprétation du % VQ dans le tVN ont permis aux jeunes Canadiens de mieux comprendre et utiliser l’information nutritionnelle. Il faut néanmoins faire preuve de prudence avant de généraliser les résultats de l’enquête à l’ensemble des jeunes Canadiens en raison de l’échantillonnage de la population à l’étude. D’autres travaux de recherche sont nécessaires afin de reproduire cette étude au Canada avec un échantillon plus hétérogène, et en utilisant un éventail de produits alimentaires et de catégories d’aliments.

The purpose of this study was to compare the clinical characteristics of acne in adult women in France and in sub-Saharan Africa.Women aged 25 years and over consulting for acne in hospital dermatology departments in Créteil, Dakar and Bamako were included. The data collected concerned a health questionnaire, previous history of acne, clinical examination and use of skin lighteners. Patient characteristics were expressed as absolute numbers and percentages for qualitative variables and as means and standard deviations or medians, and first and third quartiles, for quantitative variables based on distribution.There was no significant difference between the groups in terms of body mass index, tobacco smoking, age at first period and use of contraceptives. The presence of a lozenge-shaped area of abdominal hyperpilosity was more common in women of dark phototype, with no other signs of hyperandrogenism being seen. Acne was more severe in Dakar and in Bamako than in Créteil. Post-inflammatory pigmentation and involvement of the cheeks and forehead occurred significantly more frequently in patients of dark phototype. Involvement of the chin was more common in light-skinned subjects. While none of the women not of African origin performed voluntary skin lightening, this practice was recorded in half of women of African origin in Créteil and in Africa.This study shows clinical differences in acne in adult women according to phototype and geographical zone.

Our study examined the barriers to treatment experienced by people with anxiety disorders (ADs) who had not received services for their problems. Recommendations to improve treatment access made by participants are reported.A web-based questionnaire on treatment accessibility for anxiety disorders was completed by 610 people living in Quebec reporting an anxiety problem. Chi-square tests were used to compare answers from people who received services (n = 151) with answers from people who had not (n = 434 ).Treatment wait times that were too long (X2 = 29.66, df = 1, P0.001 ), difficulties reaching a professional by phone (X2 = 13. 75, df = 1, P0.001 ), and geographical distance from service sites (X2 = 4.34, df = 1, P = 0.04) were obstacles that hindered participants who had not received the services they were seeking, more than those who had received services.Participant-reported barriers and recommendations highlight the need to increase access to health care professionals in terms of wait times, to train and inform primary care professionals about screening and treating ADs, and to develop psychotherapeutic services availability in the public health network.

The "Patients' rights and end-of-life care" act known as "Leonetti's Law" promulgated in 2005 has promoted the use of palliative care to avoid unreasonable obstinacy when life-sustaining treatment appears disproportionate. Very little is known about this new practice for newborns in French neonatal units.To describe and evaluate the practice of palliative care in the newborn (mode of entry, characteristics, and modalities) and its evolution over time.Ambispective observational study conducted in a level III neonatal center. We included all newborns presenting conditions for which palliative care was introduced. Quantitative and qualitative analyses of routinely collected data, recorded from medical and nursing charts. We compared the recorded data between periods P1 (2006-2007) and P2 (2008-2010) using the Chi(2) test to assess changes over time.A total of 93 newborns benefited from palliative care during the study period. The main medical conditions motivating palliative care initiation in the newborns were severe complications of prematurity (36/93, 39%), anoxic-ischemic encephalopathy (19/93, 20.5%), severe malformations (8/93, 8.5%), severe congenital heart disease (8/93, 8.5%), and other various etiologies (22/93, 23.5%). Both the number of newborns in palliative care/total number of births and the number of deaths after palliative care/total number of neonatal deaths remained stable. In case of prenatal diagnosis (n=31), there was an increase in the number of "palliative care from birth projects" (13/22 in P2 vs. 1/9 in P1, P=0.02). Collective meetings during the decision process were significantly more frequently reported in the infants' charts in P2 (48/59 in P2 vs. 18/34 in P1, P0.01). Withdrawing and withholding life-sustaining treatment and limiting procedures of care and/or procedures of surveillance/monitoring were more frequent in P2 as compared to P1, respectively 12/34 vs. 37/59 (P=0.02) and 14/34 vs. 39/59 (P=0.03). A titration of level III analgesics treatment was high in both periods and remained stable. However, a trend toward an increase of systematic pain evaluation over time was observed (81.6% in P2 vs. 64.5% in P1; P=0.085).A significant number of newborns affected by various pathologies undergo neonatal palliative care. Despite their recent introduction in neonatal medicine, palliative care practices have changed significantly. These practices are mostly in compliance with the "patients' rights and end-of-life care" act promulgated in France in 2005.

Summary The purpose of this study was to evaluate the effects of sandblasting on the initial shear bond strength (SBS) and on the bracket/adhesive failure mode of orthodontic brackets bonded on buccal and lingual enamel using a self-etching primer (SEP). The brackets were bonded using a SEP and composite resin on the buccal and lingual surfaces of 30 premolars with intact enamel and 30 premolars pretreated by sandblasting with 50 μm aluminum-oxide. Student's paired t-test was used to compare the groups for differences in SBS and a multiple Chi2 test was performed to compare the bond failure mode. It was shown that sandblasting increases significantly SBS of the SEP on the buccal surfaces but the increase on the lingual surfaces is not statistically significant. A comparison of the adhesive remnant index scores indicated that there was more residual adhesive remaining on the teeth that were treated by sandblasting than on the teeth with intact enamel. Besides, there is no statistical difference between SBS of the SEP on buccal and lingual surfaces with intact enamel. Therefore, we can conclude that sandblasting improves the bond between buccal and lingual enamel and resin ant that the SEP provides the same SBS on buccal and lingual intact surfaces.

Summary The aim of this exhaustive descriptive epidemiological study was to determine the clinical approach to be adopted by practitioners specializing exclusively in pediatric odontology and by orthodontists when confronted with decayed molars in children and adolescents. Material and method A questionnaire was sent out to all corresponding practitioners ( n = 2076). Six questions related to treatment decisions taken when faced with decayed permanent first molars (unfavorable short or middle-term prognosis) in patients needing, or not, orthodontic care. The Chi 2 test was used to compare responses. Results Thirty-eight per cent of pedodontists ( n = 38) and 12.5% ( n = 246) of orthodontists nswered the questionnaire. Faced with a permanent first molar with an unfavorable middle-term prognosis, 75.7% needed criteria to help them reach their treatment decision. In decreasing order of importance, these criteria were: presence of the third molar, patient motivation, inter-arch relationship, patient's oral hygiene, facial type, anterior jaw-teeth discrepancy and the number of molars to be extracted. Faced with a permanent first molar requiring extraction and when orthodontic treatment was not required, 31.7% of practitioners decided to close the maxillary space immediately as opposed to 13.4% who closed the space at the mandible. In the presence of a single decayed first molar, 68.7% of practitioners did not extract the antagonist or contralateral first molars. Conclusion These treatment decisions were not always unanimous and call for a combined approach between dental surgeon and orthodontist.

Summary Objectives The aim of this study was to compare bond failure and breakage rates of two types of bonded lingual orthodontic retainers (GFR and .0175” multistranded stainless steel wire [MST]) after a 6-year retention period. Subjects and methods Eighty-five young adults were randomly divided into two groups: 40 subjects received 48 GFR retainers (14 maxillary and 34 mandibular retainers), and 45 subjects received 50 MST retainers (18 maxillary and 32 mandibular retainers). A Fisher's exact test was performed in order to identify significant differences in the percentage of detachment and breakage of the retainers between the groups. Results The maxillary detachment rates were 21.42% for the GFR group and 22.22% for the MST group; the mandibular detachment rates were 11.76% for the GFR group and 15.62% for the MST group. The maxillary breakage rates were 7.14% for the GFR group and 16.66% for the MST group; the mandibular breakage rates were 8.82% for the GFR group and 15.62% for the MST group. The differences were not statistically significant. Conclusion GFR and multistranded stainless steel retainers showed similar results in terms of bond failure and breakage after 6 years of retention. The use of GFR retainers as a retention strategy should not be discouraged and could be considered a viable esthetic alternative to stainless steel wire retainers.

To analyse the factors influencing the time of admission of patients presenting an acute ischaemic stroke (AIS) to the emergency department.Between May 2006 and July 2007, all patients with suspected stroke admitted to the emergency department were included. Patients' characteristics and the nature and timing of the events following symptom detection were recorded in the emergency department. The symptoms observed, the person telephoning for help, the person or establishment contacted, the measures implemented (attendance of a physician, medical or paramedical intervention) and the means of transport to the hospital were noted. The overall population was analysed descriptively and patients admitted within 3 hours of symptom onset (group I) were compared with those admitted after a longer interval (group II). The final diagnosis of AIS was confirmed on patient discharge. The results were expressed as the mean (± SD) or median (interquartile range), Mann-Whitney and Chi(2) tests being used to analyse differences between the two groups (threshold of statistical significance: P0.05).Among the 678 patients admitted with suspected stroke, 536 were diagnosed as having experienced an AIS, 65 a haemorrhagic stroke, 3 a cerebral venous thrombosis and 74 an event other than an acute neurovascular event. The results therefore concern 536 patients (median age: 75 years), of whom 166 (31%, group I) were admitted within 3 hours of symptom onset and 370 after a longer interval (group II). The median time between symptom onset and the call for help was 15 min (1-26) in group I and 300 min (60-960) in group II (P0.0001). The median times to intervention of a physician (the patient's regular general practitioner, the physician on duty, or the SMUR [Mobile Emergency and Resuscitation Service] physician) ranged from 10 to 60 min. Median transport times ranged from 30 to 120 min depending on the type of transport employed. The two groups differed significantly with regard to intervention of a physician before admission to the emergency department (40% of patients in group I vs. 72% in group II, P0.0001), initial call to the emergency medical call centre ("15" in France) (42% vs. 17%, P0.001), presence of a relative or other person at the time of functional symptom onset (58% vs. 39%, P0.01), and immediate transport to hospital without medical intervention (49 vs. 11%). Finally, irrespective of the time to hospital admission, 12% of the patients studied were eligible for intravenous thrombolysis.In the event of a suspected stroke, these results favour contacting the emergency medical call centre and immediate transfer of the patient to an appropriate hospital establishment without waiting for prior medical intervention.

The survey appears in the setting of the politics of improvement for prevention of professional risks in hospital environment in Ivory Coast.To identify the influence factors of the coif of rotators pathology among dentist surgeons and to improve the preventive measures.It was a prospective case/witness survey type. It had for setting, public hospitals and private clinics in Abidjan.We enrolled two types of population (case/witness) comparable with the criteria's of age, sex, bodily mass indication (BMI) and laterality. The data have been collected on a standardized questionnaire named "Nordic questionnaire" and have been enriched. That informed on the bodily mass indication calculated according to the method: weight/T2 (m), on the epidemiological data and the specifics data of the shoulder and the coif of the rotators. The statistical tests have been done by the test of the Khi2 of Pearson, the test of T Student, the exact test of Fischer and the test of the gap reduces.The study included 100 cases and as many witnesses. The middle age of apparition of the tendinitis of the shoulder was of 38,83 years. Age, sex, bodily mass and professional experience didn't have any influence on the apparition of the lesion of the shoulder. The analysis of the results established that the professional seniority encourages the apparition of the lesion of the shoulder. The length on average some seniority is of 12,7 years with extremes of 2 and 30 years. This observation rests on the fact that the risks of intervening of musculo-skeletal unrests of the superior member is equal to the length of work (effort, repetitive acts and stance) returned to the functional capacities.The tendinitis of the shoulder, because of its importance must be recognized and repaired as an indemnisable professional disease.

This study's purpose was to demonstrate a relationship between growth of stroke volume measured on Diffusion-Weighted MRI (DWI) at admission (baseline) and 24 hours later (follow-up) and functional outcome at 90 days evaluated by the modified Rankin Scale (mRS).DWI infarct volumes were calculated, using an Analyze Software. Clinical outcomes were assessed at 90 days by the mRS. Univariate regression analysis was performed to assess the relationship between changes in DWI lesion volume and mRS less or equal to 1.Sixty-nine cases had serial DWI scans with a measurable lesion at baseline and follow-up. The median baseline National Institutes of Health Stroke Scale (NIHSS) was 10, 5 and 7 at 24 hours. At 90 days, the proportion of patients with Rankin less or equal to 1 was 51.7%. The average baseline volume was 19.7 cm(3) and average follow-up volume was 46.1 cm(3). For each 10 cm(3) of growth in DWI infarct volume, the odds ratio for a mRS less or equal to 1 was 10,1 (IC 95%, 3-33.9).The results of this study provide evidence of a significant inverse relationship between infarct growth measured by DWI and good functional clinical outcome at 90 days.

AB Background: Although many scholars have acknowledged the relationship between personal and work-related factors associated with job search and actual turnover, there is a lack of longitudinal designs that test this relationship empirically. Objectives: This longitudinal study examines specific determinant factors that differentiate between so-called "stayers" and "leavers" within the nursing profession and identifies risk factors for premature leaving by comparing nurses who have left their job or the nursing profession with nurses who stay. Methods: This cross-national exploratory European survey included 34,587 nurses (baseline measurement) working in 623 hospitals, nursing homes, and home care institutions and was composed of two measurements with a 1-year time interval. The final samples for the follow-up measurement included 14,016 stayers and 866 leavers. As regards the leavers, the participating nurses were asked to indicate to what extent personal and work-related factors had contributed to the decision to leave their healthcare institution. Results: Nurses' intent-to-leave scores were higher in the baseline measurement among those who left the organization during the following 12 months than those among nurses who stayed (24.0% vs. 13.5%). A majority of nurses (86.8%) left their profession voluntarily. Involuntary departure occurred more often in Eastern European countries. Nurses indicated that the reasons for leaving were (a) working conditions (e.g., relationship problems, emotional difficulties, time pressure and quality of care, dissatisfaction with use of one's competence and lack of autonomy, work schedule difficulties, and dissatisfaction with pay) and (b) family reasons (e.g., caring for relatives). For a considerable number of nurses, health reasons and the desire for continuing education added to their decision to leave. Discussion: Healthcare organizations should pay attention to preventive measures to protect labor market potential. Recommendations are made for human resource development in healthcare organizations and for further empirical research to better understand to what extent different policy systems across the European countries explain variance in outcomes

Anaemia is a public health problem in Morocco. To limit this problem, Morocco developed a national programme based on fortification of flour with electrolytic elemental iron. To evaluate the programme's impact on the prevalence of anaemia in children between 2 and 5 years, 4 surveys were conducted, between 2006 and 2008, throughout the country. The results showed a significant improvement in the mean rate of haemoglobin accompanied by a significant decrease in the prevalence of anaemia. This improvement appears to be the result of several mutually reinforcing actions in addition to the fortification of flour with iron, including the promotion of a diversified diet rich in micronutrients and the promotion of public health measures.

International audience; ObjectivesPseudoxanthoma elasticum (PXE) is an inherited metabolic disease characterized by elastic fiber fragmentation and calcification in the cutaneous, ophthalmologic, and vascular tissues. Cardiovascular manifestations such as peripheral arterial disease (PAD) are frequent in PXE. Because of the changes in the elastic properties and medial calcification of the arterial wall in PXE, the impact of the arterial remodeling on the ankle brachial index (ABI), a well-established diagnostic method for the detection and follow-up of PAD, remains to be determined in this disease. Methods This was a cross-sectional, comparative, open study, which took place at the PXE Consultation Center, University Hospital of Angers. The subjects were 53 patients (mean age, 49 ± 14 years; 35 females) with PXE clinically proven on the basis of established criteria (skin changes, angioid streaks, and skin biopsy). The ABI at rest, symptoms of intermittent claudication (IC), carotid intima-media thickness (IMT), carotid-femoral pulse wave velocity (c-f PWV), compliance (CC), and β stiffness index were measured in a single-center cohort. Results Forty-five percent of the PXE patients had an ABI ≤0.90, but only one patient had an ABI >1.40. IC was found in 23% of the patients with an ABI ≤0.90. There were no significant differences between the patients with a low and normal ABI in terms of IMT (P = .566) or β stiffness index (P = .194), but differences were significant for c-f PWV (P = .010) and CC (P = .011). Adjusted multivariate linear regression for the Framingham-Laurier score showed that patients with a low ABI had less compliant carotid arteries (B = 0.318, P = .039). Conclusions PAD detected by a low ABI is very frequent in PXE, although with limited prevalence of symptomatic claudication. Unexpectedly, ABI was low in such calcifying PAD and associated with lower CC, independently of atherosclerosis risk factors. These findings demonstrate that PXE represents a unique monogenic model of PAD in which the specific arterial wall remodeling could change the diagnostic value of the ABI to detect PAD.

Summary The aim of our study was to investigate the prevalence of temporomandibular dysfunction (TMD) during orthodontic treatment. Material and method: the study investigated all the patients receiving orthodontic treatment in the dentofacial orthopedic department in Casablanca in the course of the different stages of treatment over a 4-month period. We looked for a possible association between the presence of at least one sign of TMD, the Helkimo anamnesis index, the clinical Helkimo index and the following factors: age, gender, extractions, or not, of premolars, duration, type and stage of orthodontic treatment, molar and canine class, crowding, overjet, overbite and unilateral crossbite. Data were analysed using Epi-info 6.0.fr software. The analysis of the results was done using the Chi 2 test ( P Results and conclusion: no statistically significant association could be established between TMD and the various factors under investigation with the exception of the association between gender and the Helkimo anamnesis index, stage of treatment and the Helkimo anamnesis index and the Angle molar class and the Helkimo clinical index.

Dehydration is an important complication for sick children. The Clinical Dehydration Scale for children (CDS) measures dehydration based on 4 clinical signs: general appearance, eyes, saliva, and tears.To validate the association between the CDS and markers of dehydration in children aged 1 month to 5 years visiting emergency departments (EDs) for vomiting and/or diarrhea.An international prospective cohort study conducted in 3 university-affiliated EDs in 2009. Participants were a convenience sample of children aged 1-60 months presenting to the ED for acute vomiting and/or diarrhea. Following triage, a research nurse obtained informed consent and evaluated dehydration using the CDS. A few days after recovery, another research assistant weighed participants at home. The primary outcome was the percentage of dehydration calculated by the difference in weight at first evaluation and after recovery. Secondary outcomes included proportion of blood test measurements, intravenous use, hospitalization, and inter-rater agreement.During the study period, 264 children were recruited and data regarding weight and dehydration scores were complete for 219 (83%). According to the CDS, 88 had no dehydration, 159 some dehydration, and 15 moderate or severe dehydration. A Chi-square test showed a statistical association between CDS and weight gain, the occurrence of blood tests, intravenous rehydration, hospitalization, and abnormal plasmatic bicarbonate. Good inter-rater correlation was found among participants (linear weighted Kappa score of 0.65; (95% CI, 0.43-0.87).CDS categories correlate with markers of dehydration for young children complaining of vomiting and/or diarrhea in the ED.

For many years, the literature reported the key role of occlusal factors in the development of craniomandibular dysfunctions (CMD). In our study, we investigated the connections between the functional and morphological features of dental occlusion and CMDs in a population of students at the Casablanca Faculty of Dental Medicine, Morocco.Our study comprised a sample of 142 students from the Casablanca Faculty of Dental Medicine aged between 18 and 30 years. An information card was filled in providing general details, medical history, the clinical examination and an assessment of the orofacial functions. We looked for possible links between CMDs and the various malocclusions. The statistical test used was the Khi2 test under Epi-info 6.0 under MS Dos.There is no connection between craniomandibular dysfunctions and certain malocclusions in the student population at the Casablanca Faculty of Dental Medicine.

This article aims to validate the factorial structure of the perceived stress scale (PSS10) within the French working population. The analyses conducted confirmed the presence of two distinct factors, interpreted in terms of perceived work overload and perceived personal efficacy. Both factors presented good internal consistency and adequate validity of construct. The authors show and illustrate the predicted link between the two factors and the levels of anxiety and depression. Thus, the PSS 10 is a bi-dimensional scale with satisfactory psychometric proprieties. The results are discussed in the light of their theoretical and practical implications.

In the context of implementing hospital reforms, the objective of this work was to compare practice in relation to evidence-based guidelines and recommendations for good practice in diabetes screening and management. Laboratory test consumption was determined for patients hospitalized for diabetes in 2005 in three public hospitals (one civilian, two military) taking care of diabetic patients and performing related biological tests. For the 395 admissions in these three hospitals during 2005 [Diagnosis-related group (DRG) 10M02V "Diabetes, age 36 to 69 years without co-morbidity"], the average length of stay and the number of biological acts ["B"] performed were lower than those given by the French national health cost study scale and by the Montpellier University Hospital database. In terms of qualitative coherence between the guidelines for treatment and the recommendations, the total number of biological acts ["B"] is higher than if one were to strictly apply the good practice suggested by the French Health Authority. These three hospitals have and apply different guidelines for practice in the area of diabetes management. The implementation of reforms such as DRG-based payment scales may be an additional leverage to ensure that the recommendations of best practices are effective. Improved methods and tools for data collection and monitoring are essential, especially for estimating revenue and expenditure.

Resume Introduction Le score clinique de deshydratation pediatrique (SCD) mesure la deshydratation des enfants malades selon 4 criteres cliniques : apparence generale, yeux, salive, larmes. Objectif Valider la correlation entre le SCD et certains marqueurs de deshydratation pour des enfants de 1 a 60 mois visitant des urgences pour vomissements ou diarrhee. Methode Etude de cohorte prospective internationale menee dans 3 services d’urgence universitaires en 2009. Les participants provenaient d’un echantillon d’enfants de 1 a 60 mois consultants pour vomissements ou diarrhee. Suite au triage, une infirmiere de recherche a obtenu le consentement et evalue la deshydratation en utilisant le SCD. Apres retablissement, les participants ont ete peses a la maison par un assistant de recherche. La variable d’interet etait la deshydratation calculee par la difference entre le poids au recrutement et apres retablissement. Les prelevements sanguins, la rehydratation intraveineuse, l’hospitalisation et la reproductibilite ont ete mesures. Resultats Deux cent soixante-quatre enfants ont ete recrutes et 219 (83 %) avaient des donnees completes. Selon le SCD, 88 enfants n’etaient pas deshydrates, 159 avaient une deshydratation legere et 15 avaient une deshydratation moderee ou severe. Le test de Khi2 montrait une association significative entre le SCD et la reprise de poids, les prelevements sanguins, la rehydratation intraveineuse, l’hospitalisation et des valeurs anormales de bicarbonates plasmatiques. La correlation interobservateur etait bonne (score Kappa pondere de 0,65 [IC 95 % 0,43–0,87]). Conclusion Le SCD est un bon outil d’evaluation de la deshydratation pour les jeunes enfants presentant des diarrhees ou des vomissements.

Despite efforts to control human African trypanosomiasis (HAT) in the field, this infection remains prevalent in endemic or epidemic form in most of its traditional habitats. In the Democratic Republic of Congo (DRC), HAT has extended beyond rural areas to reach large cities such as Kinshasa. The objective of this study was to analyse the characteristics of trypanosomiasis patients (cases) in Kinshasa and to compare them to those of healthy controls. METHODS AND POPULATION OF STUDY: This case-control study allowed us to compare case patients and controls for some epidemiologic, clinical and sociodemographic characteristics. In all, 1764 people (588 case-patients and 1176 controls) were interviewed according to a structured questionnaire. Case-patients were infected with trypanosomiasis and entered the National Human African Trypanosomiasis Program (PNLTHA-DRC) from January 2004 through December 2005. Controls were matched for sex, age and residence to the corresponding case-patient, but had negative results from the Card Agglutination Trypanosomiasis Test (CATT-Test) whole-blood serologic analysis. Each patient was matched with two controls.Cases were identified in all 24 districts of Kinshasa, but were concentrated in the outskirts (outlying areas and southern expansion) and in rural areas. Overall, 25% (144/588) of case-patients lived in urbanized areas. People in the labour market (aged 20-49 years) were affected more often than others. HAT affected men and women equally. It also affected at higher rates people who moved around a lot and those who worked in rural or domestic activities, especially those in close contact with watercourses. Sleep disorders were the primary clinical sign (85%). Cervical adenopathies were observed frequently (66%). Fever was reported in 68% of case-patients. Most (73.5%) were diagnosed at a very advanced stage of infection (meningoencephalitic or neurological stage).These results highlight several modifiable or avoidable characteristics associated with HAT. Interventions on them might make it possible to reduce the morbidity and mortality rates associated with HAT and prevent wider extension of this disease.

Version 2 of accreditation, known as "certification" by 13 th August 2004 law, introduces assessment practices. The opportunity of introducing these practices, offers to the of introducing these practices, offers to the whole health professional members the possibility of using concretely in their practices, the results and knowledge issued in health taking care research. Registered in a dual approach (research and process quality), the research we have driven aimed to analyze the knowledge, the attitudes and the practices associated to the Léonetti Law Act (Act no 2005-370 from 22nd Apr 2005, in reference with patients' rights and the end of life), towards all kind of health professionals. 1770 of them, working at Toulouse Universitarian Hospital, have answered inquiries which included questions about professional knowledge (confidence person, advanced directives) as well as questions linked with professional practices (attitudes, behaviours, decisions taken ...). The results point out a certain consensus on professional practices: good knowledge about the notion of confidence person, changes in the replies rate about the discriminating variable "seniority", new emerging professional attitudes. This kind of research underlines the deep links between knowledge systems and the attitude requires around palliative care.

We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes.Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery.During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications.In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.

Prospective monocentric study to determine the feasibility, tolerability and diagnostic value of intravaginal contrast to assess female pelvic anatomy on MRI.Forty-nine consecutive women referred for MRI evaluation of the pelvis, irrespective of the indication, were included in this study. The MR imaging protocol consisted of axial and sagittal T2W images before and after intravaginal instillation of sterile US gel. Eight anatomical regions were analyzed and their visibility graded from 1 to 4 (1=excellent; 4=non-visualized) by 3 radiologists without and with intravaginal gel. The value of intravaginal gel was determined by calculating the difference in the visibility index for each anatomical region by the Wilcoxon and khi2 tests. Inter-observer agreement was also determined using the kappa test.Two women declined vaginal opacification resulting in an acceptance rate of 96%. The gel instillation procedure had a duration of less than 3 minutes on average and was well tolerated by all patients. Intravaginal gel allowed significantly improved visualization of all anatomical regions (p0.001); improvement between 0.5 and 2.5 points on average per anatomical region. Inter-observer agreement significantly improved after gel instillation increasing from 72% to 92%.Intravaginal instillation of US gel is simple, noninvasive, well-accepted and well-tolerated by patients. It increases visibility of pelvic anatomical structures with improved inter-observer agreement.

The chemotherapy of the metastatic breast cancer is characterized by the diversity of the treatment protocols and the utilisation of new expensive molecules posing the double problem of outcomes for the patients and financial effects for the hospitals. This survey describes the different chemotherapy treatments prescribed in the metastatic breast cancer and the direct costs supported by the hospitals according to the patient survival time. A cohort of 371 patients treated for a metastatic breast cancer was followed in three hospitals of the Rhone-Alpes region between 2001 and 2006. The detail of their different antineoplasic treatments, as well as the purchase cost of the drugs and their cost of hospital administration, the cost of the other hospital stays are presented in relation with the survival. The median survival time (35,8 months; CI 95%: [31.7-39.1]) since the first metastasis does not differ significantly according to the hospital. Ninety-three different chemotherapy protocols are observed combining from one to five molecules. Thirty-two different molecules are identified. In first line treatment, there is a significant difference in the use of the new molecules according to hospital (Chi(2) test; P10(-3)). The average cost of a chemotherapy treatment is 3,919 euro (+/- 8,069 euro), the higher cost is observed for trastuzumab (23,443 euro). The average time period before the beginning of a new chemotherapy line is 212 days (+/- 237 days) and the mean cost of hospital stay during this period is 3,903 euro (+/- 4,097 euro). If no impact of the chemotherapy treatment strategy is observed on the survival time of the patient, it is the opposite for the hospital treatment cost. These results are asking for a better control system of the authorization procedure of new molecules marketing and the harmonization of the practices.

Removing pediatric crystalline lens abnormalities has improved recently. Congenital cataract is the main cause.This retrospective study analyzed 121 eyes in children that were operated early at the Bordeaux Hospital (France) from 2000 to 2005, with no exclusion criterion. The Anova test and the Bartlett Chi2 test were used for the statistical analysis.This cohort mainly recruited congenital cataract with half of the population operated on at less than 1 year of age, including 41 before the age of 6 months. The mean age at surgery was 1.93 years (range, 9 days to 8.86 years). Seventy-nine eyes underwent primary intraocular lens implantation (78.8% for unilateral cataracts and 55.1% for bilateral cataract). The mean postoperative refraction was +1.94 D with a mean myopic shift of -1.22 D over 2.89 years of follow-up. Of the operated eyes, 64.7% improved 0.5 D or better, with a mean gain of 0.38. The final visual acuity (AVF) was 0.51. Before the age of 1 year, the mean AVF was 4.1/10 (range, 1/50 to 12/10). The mean AVF of the implanted eyes (5.4/10+/-4.2/10) was higher than those corrected by contact lenses (2/10+/-1.6/10) (p=0.024).Primary intraocular lens implantation provides significantly better AVF than aphakic contact lens-corrected eyes and provides better stabilization over time whatever the age.

Malaria is a common and frequently fatal disease in sub-Saharan Africa and children suffer the consequences of their family's erroneous therapeutic decisions.To assess knowledge, attitudes and practices related to malaria treatment and prevention among mothers of children younger than 5 years old.Cross-sectional survey conducted from July to September 2000, in Notsé (Togo) among a sample of 385 mothers of children aged younger than 5 years. Investigators completed environmental evaluation cards and used a questionnaire to interview mothers.Mothers' level of knowledge was qualified as high among 53% of the subjects, intermediate among 30%, and poor among 17%. It was associated with the mothers' level of education. All mothers considered malaria to be a serious disease; 79% said that they were favourable to drug use for malaria prevention in children; 81% preferred mosquito nets as the means of prevention; 94% of them preferred that their child receive modern medical treatment for malaria. Mothers' global practices for malaria prevention and treatment were qualified as good among 5%, intermediate among 23%, and poor among 73%. Practices were associated with educational and level of knowledge and inversely associated with the number of children she had.These results suggest that improved communication with the population and promotion of intra- and inter-sector collaborations and literacy in mothers, together with active participation by the population, might be useful measures for reaching the objectives of antimalaria program in Togo.

To determine the value of an angioplasty simulation to differentiate the users based on their level of experience. To determine the perceived usefulness of an angioplasty simulation program.Forty-six radiologists performed a renal angioplasty on a VIST simulator (Mentice Corporation, Gothenburg, Sweden); the procedure was completed by 41 radiologists. The radiologists were divided into two groups based on the level of experience. Quantitative variables analyzed included procedure duration time and fluoroscopy time. The radiologists then completed a questionnaire evaluating the simulation program.Radiologists with more than 2 years of clinical experience (n=14) performed the procedures faster (20.4 min vs 27.4 min, p0.01) using less fluoroscopy time (7.8 min vs 11.2 min, p0.05) than others. Radiologists performing more than 2 procedures per month (n=14) performed the procedures faster (19.4 min vs 27.9 min, p0.01) using less fluoroscopy time (7.4 min vs 11.3 min, p0.05) than other (n=27). The participating radiologists indicated that the simulation was realistic.Procedure duration time and duration of fluoroscopy were criteria able to differentiate the users based on their level of experience. The educational value of the simulation program was perceived as helpful by the users.

Should the palmar digital artery be repaired in the pedicular section of the finger? This repair is discussed in the case of a unilateral pedicular lesion on a vascularised finger, and often neglected in current surgical practice. The problem is knowing the role of a permeable artery in sensory recovery and cold intolerance. The author presents a retrospective study on palmar digital nerve reinnervation after section with or without palmar digital artery section. Artery permeability was studied by doppler ultrasonography. Forty nerves in 35 patients were studied after at least 3 years had passed. Twenty-five nerves were associated with a permeable artery, 15 with a non permeable artery. The functional result was evaluated with the Weber test (S2PD) and by the presence or absence of cold intolerance. This work demonstrates the statistically significant role of the palmar digital artery in sensitive recovery quality and cold intolerance appearance. Its permeability ensures a better sensitive result with an 8.84 mm S2PD versus 13.47 mm with a non permeable artery. The benefit of the systematic repair of palmar digital artery is thus demonstrated for the first time. This repair is all the more justified if local conditions are unfavorable, in particular in contuse wounds with associated lesions (tendinous or bone).

Clip migration occurs frequently in clinical practice (13-20%), irrespective of the approach. The purpose of this article is to suggest tricks in order to decrease clip migration and optimize presurgical localization.Retrospective study of breast macrobiopsy from a lateral approach performed between March 2003 and June 2004: 447 clips were placed. Sixty clips showed migration20 mm, due to the accordion effect in 59 cases (98.4%). These 59 procedures were analyzed to try and understand the underlying mechanisms of clip migration.From these 59 clips, more migrations were noted on CC compression (16.6%) compared to MLO compression (5.2%). This difference was statistically significant. Therefore, we promote the use of MLO compression. This incidence also allows optimal presurgical localization in case of clip migration, by placing the patient in the same position while modulating depth based on the extent of clip displacement.For quality purposes, it is imperative to know the clip position relative to the initial target. By using MLO compression from a lateral approach, it is possible to reduce clip migration and optimize future presurgical localization.

The diagnosis of herpes simplex virus (HSV) genital infection is primarily clinical. The primary indication for serodiagnosis is to detect seronegativity in pregnant women at risk of acquiring the HSV virus during the course of their pregnancy. In this study, two ELISA tests were compared for the detection of HSV infection among a population of 307 pregnant women followed at the maternity of a community-based hospital in France (Robert Ballanger hospital in the Seine-Saint-Denis department). The two tests compared were: Test Captia anti-HSV-1 and anti-HSV-2 specifics IgG of Trinity Biotech and the ELISA IgG HerpesSelect 1 and 2 of FOCUS Diagnostics distributed by Eurobio Courtaboeuf, France.Both tests results were similar in terms of population prevalence for HSV-1 and HSV-2 infections (respectively 86.64% and 85.99% for HSV-1; 17.59% and 15.31% for HSV-2). Whereas the prevalence of the HSV-1 virus was described in the literature as being superior to our current results, the prevalence of HSV-2 according to the results of both ELISA tests studied was similar to the one described in previous cohort studies.

In adult mental health, there are few practice guidelines for occupational therapists with regards to the assessment of driving capacities.This article describes a clinical approach, with regards to driving assessments, in adult mental health.A retrospective study was completed from a chart review of clients seen in occupational therapy, between 1999 and 2004, in the psychiatric out-patient clinic of a university-affiliated hospital.The occupational therapists are not offering road tests but results on the following tests discriminate those individuals considered safe or unsafe drivers: "Trail A" (p=0,0004), "Trail B" (p=0,0005), "Cognitive Behavioural Driver's Inventory" (p=0.006), "Continuous Performance Test" (p=0,001).Results on some psychometric measures have an impact on recommendations made by occupational therapists assessing driving capacities. Future studies should include road test performance of clients in adult mental health.

Provide a descriptive analysis of children admitted to a tertiary care pediatric emergency department (PED) for a nasal foreign body (NFB) and describe the current knowledge and management of such accidents.A retrospective study was conducted from January 2003 to May 2008, including all patients aged less than 15 years admitted for a NFB. The data collected were age, sex, geographic origin, time and day of admission, duration in PED, duration of NFB insertion, nostril location, symptoms and clinical signs, prehospital extraction attempts, facial x-ray, extraction mode, referral to an ENT specialist, progression, and complications. For statistical analysis, the data were entered in Microsoft Excel spreadsheets. The data were analyzed with StatView 5.1 (SAS Institute) and EpiInfo 6.04fr (VF, ENSP Epiconcept). In the descriptive analysis, the data are presented as mean values with standard deviation, median with extreme values or with 95% confidence intervals where appropriate, unless otherwise indicated. To compare qualitative variables, a chi(2) test (Mantel-Haenszel) was used and the two-tailed Fisher exact test if the expected value was 5 or less. Statistical significance was set at p0.05.A total of 388 patients were included (393 NFB). The annual mean number of cases was 68. The annual distribution showed a higher number in January, March, April, and October following Christmas, Easter and Halloween celebrations, totaling 40% of all NFB admissions. The sex-ratio was 0.95. Children aged less than 4 years accounted for 71% of the studied population. The mean age was 3.5+/-1.6 years (range, 1.4-13 years). The majority of accidents occurred at home (95%). The length of time spent in the PED was 78+/-57 min. The NFB duration of insertion was unknown in one-quarter of cases, present for less than 4 h in 65% of cases. No symptoms were described in most cases (88%). When symptoms were described, bleeding, pain or nasal discomfort, and foul nasal odor were the principal symptoms. The right nostril was the predominant location (60%). This difference tended to disappear in the group of children aged less than 4 years. Five children had bilateral NFB. Nonorganic compounds accounted for 80% of the NFB: plastic beads or balls (39%), plastic or toy parts (20%), stones or pebbles (11%), and paper (6%). The extraction was instrumental in 82% of cases, and 26% of patients were referred to an ENT specialist when PED attempts were unsuccessful. One child needed hospitalization for extraction under general anesthesia of two beads located deep in the same nostril. No complication occurred. Five children had repeated accidents within an average delay of 6 months.Often benign, this frequent accident can be serious in case of batteries or neodymium magnet insertion: the extraction becomes an emergency because of risks of nasal mucosa necrosis and/or nasal septum perforation. In other cases, positive pressure techniques (the parent's kiss or its variants) could be tried first in the emergency department or at home at the time of a call to emergency services before a medical visit.

To study prognostic factors of obliteration and risk factors of brain radiation necrosis in order to propose an algorithm for radiosurgery prescription for cerebral arteriovenous malformations (cAVM).One hundred and seventy-nine patients were analysed. Radiosurgery delivered 6 or 10 MV X-rays by arc therapy in 84% of cases, or by fixed field in 16% of cases using two different micro-multileaf collimators (micro-MLC). Follow-up consisted of screening radiation necrosis by MRI every 6 months, and assessing local control by arteriography every 2 years. Obliteration was defined as at least 95% reduction of cAVM volume. Cox proportional hazard model was used to evaluate the local control and the appearance of radiation necrosis over time.Local control rate was 82.7% with the mean follow-up of 3.1 years (0.5-11). Significant prognostic factors were: simple nidus (RR=2.8, p0.0001), number of embolizations before radiosurgery below 4 (RR=2.9, p0.0001), prescribed dose to the periphery of at least 18 Gy (RR=2, p=0.0002), nidus volume below8cm(3) (RR=1.9, p=0.0002), and number of table positions below six (RR=1.4, p=0.05). Radiation necrosis rate was 11.2% with a mean time to onset of 18 months. Significant predictive factors were: fixed field versus arc therapy (according to MLC RR=9.1, p0.0001, and RR=15.1, p=0.01), age below 30 years (RR=2.5, p=0.04), depth of cAVM greater than or equal to 7 cm (RR=7.6, p=0.008), and volume of brain tissue covered by the 12 Gy isodose (V12 Gy) of at least 11 cm(3) (RR=7.8, p=0.05).A radiosurgery prescription algorithm taking into account the prescribed dose to the periphery (or = 18 Gy) and reduction of V12 Gy was elaborated from these data.

To report the occurrence of complications following placement of peripherally inserted central catheters (PICC). Materials and methods. A total of 127 PICC lines were placed in 115 patients for TPN (n=54), long-term antibiotics (n=29), chemotherapy (n=14) or miscellaneous intravenous therapy (n=18).All PICC lines were successfully inserted. PICC lines were used for a mean duration of 16 days (1-166 days). The following complications were recorded: occlusion (7%), rupture (1.6%), accidental withdrawal (2.4%), infection (3.1%) and venous thrombosis (2.4%).PICC lines are a simple, safe and effective alternative to conventional central venous catheters. The occurrence of complications, typically "mechanical", must be reduced and prevented by strict management of this type of central line by the treating team.