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Background: Evidence of a dose-response relationship between prenatal exposure to methylmercury (MeHg) and neurodevelopmental consequences in terms of IQ reduction, makes it possible to evaluate the economic consequences of MeHg exposures. Objective: To perform an economic evaluation of annual national benefits of reduction of the prenatal MeHg exposure in France. Methods: We used data on hair-Hg concentrations in French women of childbearing age (18-45 years) from a national sample of 126 women and from two studies conducted in coastal regions (n = 161and n = 503). A linear dose response function with a slope of 0.465 IQ point reduction per µg/g increase in hair-Hg concentration was used, along with a log transformation of the exposure scale, where a doubling of exposure was associated with a loss of 1.5 IQ points. The costs calculations utilized an updated estimate of £2008 17,363 per IQ point decrement, with three hypothetical exposure cut-off points (hair-Hg of 0.58, 1.0, and 2.5 µg/g). Results: Because of higher exposure levels of women in coastal communities, the annual economic impacts based on these data were greater than those using the national data, i.e. £ 1.62 billion (national), and £ 3.02 billion and £ 2.51 billion (regional), respectively, with the linear model, and £ 5.46 billion (national), and € 9.13 billion and £ 8.17 billion (regional), with the log model, for exposures above 0.58 µg/g. Conclusions: These results emphasize that efforts to reduce MeHg exposures would have high social benefits by preventing the serious and lifelong consequences of neurodevelopmental deficits in children. [ABSTRACT FROM AUTHOR]

Fusarium oxysporum is typically a soilborne fungus but can also be found in aquatic environments. In hospitals, water distribution systems may be reservoirs for the fungi responsible for nosocomial infections. F. oxysporum was previously detected in the water distribution systems of five French hospitals. Sixty-eight isolates from water representative of all hospital units that were previously sampled and characterized by translation elongation factor 1α sequence typing were subjected to microsatellite analysis and full-length ribosomal intergenic spacer (IGS) sequence typing. All but three isolates shared common microsatellite loci and a common two-locus sequence type (ST). This ST has an international geographical distribution in both the water networks of hospitals and among clinical isolates. The ST dominant in water was not detected among 300 isolates of F. oxysporum that originated from surrounding soils. Further characterization of 15 isolates by vegetative compatibility testing allowed us to conclude that a clonal lineage of F. oxysporum circulates in the tap water of the different hospitals. [ABSTRACT FROM AUTHOR]

Abstract: Dijon Hospital is a French tertiary care institution undergoing major renovation, and different microbiological controls revealed the presence of Fusarium spp. in the water distribution system. Because some Fusarium spp. can cause life-threatening opportunistic infections in immunocompromised patients, an 8-month survey was conducted in two hospital sites in order to evaluate the prevalence of the fungi in the water system. In 2 units of one hospital site, 100% of the samples of tap-water were positive, with high concentrations of Fusarium spp. (up to 105 cfu/L). In the second hospital site, 94% of samples were positive, but generally with lower concentrations. The analysis of translation elongation factor 1α (TEF) sequences of 146 isolates revealed the presence of two different Fusarium species: F. oxysporum was detected in all units explored of both hospital sites, and F. dimerum only in one unit of one hospital site. For both species, we suggest that the fungi discovered could be particularly adapted to an aquatic environment. [Copyright &y& Elsevier]

Members of the Fusarium group were recently detected in water distribution systems of several hospitals in the world. An epidemiological investigation was conducted over 2 years in hospital buildings in Dijon and Nancy (France) and in non-hospital buildings in Dijon. The fungi were detected only within the water distribution systems of the hospital buildings and also, but at very low concentrations, in the urban water network of Nancy. All fungi were identified as Fusarium oxysporum species complex (FOSC) and Fusarium dimerum species complex (FDSC) by sequencing part of the translation elongation factor 1-alpha (TEF-1α) gene. Very low diversity was found in each complex, suggesting the existence of a clonal population for each. Density and heterogeneous distributions according to buildings and variability over time were explained by episodic detachments of parts of the colony from biofilms in the pipes. Isolates of these waterborne populations as well as soilborne isolates were tested for their ability to grow in liquid medium in the presence of increasing concentrations of sodium hypochlorite, copper sulfate, anti-corrosion pipe coating, at various temperatures (4°-42 °C) and on agar medium with amphotericin B and voriconazole. The waterborne isolates tolerated higher sodium hypochlorite and copper sulfate concentrations and temperatures than did soilborne isolates but did not show any specific resistance to fungicides. In addition, unlike waterborne isolates, soilborne isolates did not survive in water even supplemented with glucose, while the former developed in the soil as well as soilborne isolates. We concluded the existence of homogeneous populations of FOSC and FDSC common to all contaminated hospital sites. These populations are present at very low densities in natural waters, making them difficult to detect, but they are adapted to the specific conditions offered by the complex water systems of public hospitals in Dijon and Nancy and probably other localities in the world., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Lead exposure remains a public health concern due to its serious adverse effects, such as cognitive and behavioral impairment: children younger than six years of age being the most vulnerable population. In Europe, the lead-related economic impacts have not been examined in detail. We estimate the annual costs in France due to childhood exposure and, through a cost benefit analysis (CBA), aim to assess the expected social and economic benefits of exposure abatement., Methods: Monetary benefits were assessed in terms of avoided national costs. We used results from a 2008 survey on blood-lead (B-Pb) concentrations in French children aged one to six years old. Given the absence of a threshold concentration being established, we performed a sensitivity analysis assuming different hypothetical threshold values for toxicity above 15 μg/L, 24 μg/L and 100 μg/L. Adverse health outcomes of lead exposure were translated into social burden and economic costs based on literature data from literature. Direct health benefits, social benefits and intangible avoided costs were included. Costs of pollutant exposure control were partially estimated in regard to homes lead-based paint decontamination, investments aiming at reducing industrial lead emissions and removal of all lead drinking water pipes., Results: The following overall annual benefits for the three hypothetical thresholds values in 2008 are: €22.72 billion, €10.72 billion and €0.44 billion, respectively. Costs from abatement ranged from €0.9 billion to 2.95 billion/year. Finally, from a partial CBA of lead control in soils and dust the estimates of total net benefits were € 3.78 billion, € 1.88 billion and €0.25 billion respectively for the three hypothesized B-Pb effect values., Conclusions: Prevention of childhood lead exposure has a high social benefit, due to reduction of B-Pb concentrations to levels below 15 μg/L or 24 μg/L, respectively. Reducing only exposures above 100 μg/L B-Pb has little economic impact due to the small number of children who now exhibit such high exposure levels. Prudent public policies would help avoiding future medical interventions, limit the need for special education and increase future productivity, and hence lifetime income for children exposed to lead.

Background: Nosocomial infection (NI) is a cause of patient morbidity and mortality. Conducting an audit of deaths due to NI is a potentially useful approach to improving professional standards. In France, these deaths are required to be reported, but the reporting is left to clinicians, who often do not comply. The aim of the present study was to assess whether linking the microbiological database with the hospital mortality database might be a suitable surveillance approach for identifying patients who died with an NI., Methods: A total of 1,726 deaths were recorded in the mortality database of a French university hospital between September 1, 2006, and September 16, 2007. During this same period, 6,290 potential NIs (PNIs) were identified by bacteriological examination. These PNIs were generated using a computer algorithm specific to the bacteriology database. PNI information request forms were sent to the senior doctor of the unit where the samples had been obtained to determine whether the PNI was an NI, colonization, or a non-nosocomial infection. A total of 364 cases were common to both databases; from these, a sample of 135 cases was selected for further analysis. To establish the strength of evidence for NI as the cause of death, the 135 cases were analyzed using the patient record by an investigator from the hospital hygiene team., Results: During the study period, no deaths associated with NI were reported spontaneously. Of the 135 cases analyzed, NI was considered the main cause of death in 6 (4.4%) and a contributory factor in 51 (37.8%). Thus, NI was estimated to be the main cause of death in 0.9% of all patients who died in the hospital during the study period and a contributory cause in another 8.0% of these patients., Conclusion: Linking databases from bacteriology with those containing hospital mortality records is a simple, reproducible tool for identifying the number of deaths attributable to NI. This may provide a powerful approach to help reduce the burden of disease due to NI through the auditing of such identified deaths., (Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Hand hygiene of healthcare personnel is one of the most important interventions for reducing transmission of nosocomial pathogens. Previous studies have demonstrated that the use of alcohol-based hand gel increases hand hygiene compliance, but that effective use of this product cannot be taken for granted., Objective: Evaluate factors associated with poor hand hygiene effectiveness of hospital workers using an alcohol-based hand gel and the effect of an education program., Design: A direct observational prospective study of hand hygiene effectiveness prior to training and immediately after training., Setting and Subjects: 3067 hospital workers of different professional categories in several hospital units in the University Hospital of Nancy (France)., Results: Time after program start (OR 0.97, 95%CI 0.96-0.97) and being female (OR 0.37, 0.24-0.58) were highly associated with increased effectiveness of hand hygiene prior to training. Wearing rings other than a wedding ring (OR 1.8, 1.2-2.7), a bracelet (OR 2.0, 1.1-3.6), a watch (OR 1.9, 1.3-2.9) and having long nails were associated with ineffective hand rub use. Professional background was also a strong predictor with nurses and especially senior nurses demonstrating much better effectiveness than all other professional groups. Wearing wedding rings or long sleeves, and having varnished nails, visibly dirty hands prior to washing and cutaneous lesions were not associated with effective gel use., Conclusion: These results demonstrate that an educational program can significantly improve the proper practices for using hand rub and hand washing compliance. This study has also demonstrated that wearing rings, bracelets, watches and long nails impair hand gel application but that wedding rings, long sleeves and varnished nails do not. The finding of that hand hygiene effectiveness increased with time even prior to training indicates that knowledge gained by staff trained early diffused into those who had not yet been trained., (Copyright (c) 2010. Published by Elsevier Ltd.)

Background: This study was designed to investigate the impact on mortality of colonization by glycopeptide-resistant Enterococci (GRE) during hospitalization., Methods: Between 2004 and 2006, a hospital in Nancy, France, was subject to a GRE van A outbreak. Some 113 patients who had acquired GRE after hospital admission were matched with 113 controls. Basic demographic data, such as sex, age, principal pathology, history of surgery, and presence of associated pathology, were obtained for each case and control. Information on whether or not the case subject was still alive was obtained by searching the hospital mortality database and the civil death register and by phoning the patient's home. Statistical analysis used the Cox proportional hazards model for calculating survival function with SPSS software version 9.1 (SPSS Inc., Chicago, IL)., Results: The mean age was 71.2 in the GRE+ group and 70.8 in the control group (P = .80). There was a significant difference between the groups for severity status health (P = .035). The mortality rate was 30.1% in the case group and 19.5% in the control group. Single predictor variable analysis showed a hazard ratio of death in the case group of 4.61 (95% confidence interval [CI]: 2.58-8.28], P = 2 x 10(-7)). The final Cox regression model with multiple predictor variables showed that only GRE presence (OR, 1.63 [95% CI: 1.04-2.57], P = .035) and severity of comorbidity (P = .013) were independently significant predictors of mortality., Conclusion: This study shows that the GRE acquisition has a poor prognosis and that this is independent of the other prognostic factors such as age and severity of underlying disease. Survival in GRE+ patients was significantly shorter.

Urologists frequently advise a high fluid intake to their patients with calcium stones, but apart from this simple advice, they often have few convincing arguments. This article describes the various types of drinking water available in France (mineral water, spring water, tap water), the legislation concerning drinking water, and the ions that must be taken into account for long-term forced diuresis. After studying their composition and adapting the dietary advice (particularly concerning dairy foods) to this ionic composition, various types of water can be advised to patients, including tap water, most types of spring water, but not all mineral waters.