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Resume Introduction Les determinants individuels du decrochage ont fait l’objet d’importants developpements dans la litterature recente. Notre objectif est de faire le point sur les connaissances scientifiques disponibles en ce domaine. Methode L’article present est une revue de litterature realisee a partir de PsycInfo et basee sur un total de 50 articles publies entre 2010 et 2017. Resultats Les performances scolaires et les conduites a risque precoces restent les meilleurs determinants du decrochage. Anxiete, depression et troubles externalises peuvent jouer un role direct ou indirect dans la prediction du decrochage. Le manque de soutien psycho-affectif favorise fortement l’intention de decrocher. Discussion Les biais methodologiques nuancent l’importance du genre, des resultats scolaires, et du redoublement. Le developpement des connaissances sur les relations entre differents determinants, les profils d’eleves a risque et les temporalites a risque doivent permettre de mieux comprendre les trajectoires de decrochage et les processus a l’œuvre au sein de differents contextes scolaires.

Health promotion stakeholders are encouraged to base their intervention strategies on evidence. However, the evidence produced by public health research is outcome-based and provides little information on “how to act?” It is necessary to complete this evidence with experiential data constituting an evidence of a different nature, answering questions about organizations, skills and tools mobilized to achieve the results, and valuing skilled actors’ knowledge and good practice. For two years, a group of 15 French organizations has been working on capitalization and sharing experiential knowledge. This work is part of the setting up of a national evidence platform. After a benchmarking phase, the group developed and tested a capitalization method which focuses on the collection and analysis of qualitative data and aims to explain the contexts and processes at work in the actions: knowledge and skills, strategies, perceived challenges and facilitating factors, key moments. The group also worked on the structure, content and use of a shareable document. The test has shown the pedagogical interest of the method for the actors who were invited to develop a reflective thinking about their action, as well as the relevance of this method to build experiential knowledge. The ongoing group’s work concerns the dissemination of collected data. A practical guide for stakeholders is being finalised. The group is defining the selection process of the initiatives to be valued, in particular with regard to results that make sense for all stakeholders. The main difficulty of the approach - its low level of recognition and entrenchment in public health - will be discussed during the presentation, as well as the necessity to ensure the legitimacy of this approach in a context where the notion of evidence is centered on quantitative data produced with an objective defined “a priori” and in a controlled context. Key messages This work opens the way for an original reflection in public health to build a shareable experiential knowledge, and to valorize and strengthen field actors’ practical expertise. This work has pedagogical, political, scientific and informational impacts. It contributes to knowledge transfer and provides self-training, a practical vision of policies, and questions for research.

Background Bone Mineral density (BMD) assessment is a useful tool to evaluate bone fragility and is largely recommended in patients at risk of osteoporosis. We have previously reported in 250 women aged 50 year-old or more that only $≈ $10% of them had a BMD after a forearm fracture (1). Objectives Herein, we evaluated BMD assessment and prescription of anti-osteoporotic drugs after a forearm fracture in women after 50 year-old in a large population database. Methods We identified all forearm fractures in women aged 50 years old or more in the “Centre-Val de Loire, France” area between 01/01/2011 and 31/12/2012, using the National Health Insurance database which cover both private and public sectors of the whole population. We analyzed the reimbursement and determinants of BMD assessment such as age, consumption of drugs inducing osteoporosis, anti-osteoporotics drugs and long term illnesses. Results We identified 4120 women with a forearm fracture during the study period. Among them, 546 (13.25%) had a BMD assessment performed at a median time of 4 months after the fracture. Women who had had a BMD were significantly yonger than those who had not (67.44 years versus 74.63 years: OR=0.941 CI95% (0.932–0.949)). Anti-aromatase treatment was positively associated with BMD assessment (OR=3.233 (CI95%: 1.976–5.290)) while corticosteroid were not (OR=0.866 (CI95%: 0.601–1.247)). Among the women who had a BMD assessment, 168/546 (30.77%) had an anti-osteoporotic drug initiated after the forearm fracture, versus 231/3574 (6.46%) in those who had no BMD performed (p Conclusions In this large population, less than 15 percent of women over 50 year-old have a BMD assessment after a forearm fracture. BMD assessment was associated with anti-osteoporotic drugs initiation. References Erny F, Auvinet A, Chu Miow Lin D, et al (2015) Management of osteoporosis in women after forearm fracture: data from a French health insurance database. Joint Bone Spine: 82:52–55. Acknowledgements We thank Caroline Rault, department of Pharmaco-epidemiology, Rennes and Florence Erny, department of Rheumatology, Tours for their support and contribution in this project. This work would not have been possible without the help of Mehdi Gabbas “Caisse National d9assurance Maladie” (CNAM-TS), Valerie Edel, “Institut des donnees de Sante” (IDS), and the “Institut National de la Sante de de la Recherche Medicale” (Inserm). This study has been funded by the “groupe de recherche et d9investigation sur l9osteoporose” (GRIO) and by the “Association Francais de lutte anti-Rhumatismale” (AFLAR). This work is the result of the “Prevention of osteoporosis after distal forearm fracture – Prevention de l9Osteoporose apres fracture du Poignet (POP)” study group. Disclosure of Interest None declared

Resume L’objectif de cette etude est d’explorer un lien entre un vecu d’abus sexuel et une situation d’inaptitude a l’education physique et sportive ( eps ), appelee communement « dispense de sport ». Population Nous avons interviewe 361 adolescents de classe de seconde de deux lycees d’enseignement general ou des eleves de niveau equivalent (premiere annee de bep ) d’un lycee d’enseignement professionnel de Tours (France) : soit 43 % de garcons, n = 151 et 57 % de filles, n = 204 ; âge moyen 16,58 ans, ET 0,87 an et etendue 4,67 ans. Materiel Des questions exploraient un vecu anterieur d’abus sexuel (attouchements [1] ou sexualite forcee [2]) et le fait d’avoir deja beneficie au cours de sa scolarite d’un certificat d’inaptitude a l’ eps : (a) a l’annee, (b) de plus de trois mois, (c) pour des durees breves, mais repetees et representant au total plus de trois mois et (d) le fait d’etre parfois absent du cours sans raison valable. Ces questions etaient completees par des echelles sur la sante psychique (General Health Questionnaire, Goldberg 1972), l’estime de Soi (Rosenberg’s Self-Esteem Scale, Rosenberg 1965) et le niveau d’ideation suicidaire (Suicidal Ideation Questionnaire, Reynolds 1987). Procedure En avril 2004 en classe (anonymat garanti et participation basee sur le volontariat). Resultats La prevalence des abus sexuels parmi ceux qui ont beneficie d’une inaptitude a l’ eps est importante. Le vecu d’attouchements (1) parmi (a) les inaptitudes annuelles concerne 10,8 % des filles (n = 3) ; (b) 32,1 % (n = 9) pour les inaptitudes de plus de trois mois et (c) 50 % (n = 28) pour celles cumulees. Le seul garcon concerne n’a beneficie d’aucun certificat d’inaptitude. Le vecu d’une sexualite forcee (2) concerne respectivement (a) 16,7 % des filles (n = 2), (b) 41,7 % (n = 5) et (c) 50 % (n = 6). Tandis qu’un des deux garcons concerne a beneficie de toutes les formes de certificat d’inaptitude. Ces resultats sont confirmes par une analyse de variance. Pour les adolescentes, nous ne retrouvons un effet significatif que sur les inaptitudes de courte duree et cumulees (superieures a trois mois d’arret) pour le vecu de violences sexuelles, ou de rapport sexuel force. Pour les garcons, il existe une influence de la sexualite contrainte sur les inaptitudes annuelles. Une recherche de correlations complete cette approche. On retrouve un lien entre inaptitudes cumulees (superieures trois mois) et un vecu d’attouchements, et de relations sexuelles contraintes. Il existe egalement une relation significative entre les inaptitudes superieures a trois mois et les relations sexuelles forcees, et des liens entre l’absenteisme au cours d’ eps et les deux situations d’abus. Ces resultats ont ete completes par l’etude des relations entre ce vecu d’abus sexuel et les variables psychologiques : les filles concernees presentent une plus grande morbidite psychique, une moins bonne estime d’elles-memes et davantage d’ideations suicidaires. Discussion Cette etude montre l’existence d’un lien entre inaptitude a l’ eps et vecu d’abus sexuel. L’expression de la souffrance psychique au travers d’une demande de certificat pour inaptitude a l’ eps est moins reperable que des conduites a risque « bruyantes ». Par consequent, toute demande d’inaptitude a l’ eps de longue duree (annuelle ou de plus de trois mois) doit attirer l’attention des professionnels. Celles de courte duree et qui se repetent doivent faire l’objet d’une vigilance accrue, puisqu’elles ne sont pas controlees par le medecin scolaire. Ces situations d’inaptitudes ne peuvent etre systematiquement rapprochees d’un vecu d’abus sexuel, mais elles sont une bonne occasion d’evaluer la sante psychique de l’adolescent, la qualite de son soutien social et du fonctionnement familial. Cette recherche apporte des premiers constats qu’il s’agira de completer par des travaux ulterieurs.

Resume Le dosage de l'excretion urinaire d'albumine (EUA) peut se faire sur un echantillon urinaire sur les premieres urines du matin, sur les urines de 24 heures ou sur prelevement urinaire minute. Les valeurs definissant la microalbuminurie sont : urines de 24 heures : 30–300 mg/24 h ; echantillon urinaire : 20–200 mg/ml ou 30–300 mg/g creatinine urinaire ou 2,5–25 mg/mol (chez l'homme), ou 3,5–35 mg/mol (chez la femme) creatinine urinaire ; echantillon urinaire minute : 20–200 μg/min. La place du dosage semi-quantitatif (bandelettes) n'est pas clairement definie. La microalbuminurie est consideree comme un reflet d'une atteinte generalisee de l'endothelium, mais ce n'est pas demontre. Chez le sujet diabetique La microalbuminurie est un marqueur independant de risque cardiovasculaire (CV), renal et de mortalite totale chez les diabetiques de type 1 et 2. L'augmentation de l'EUA au cours du temps est un marqueur de risque CV et renal chez le diabetique de type 1 ; sa regression est associee a une regression de ces risques. Chez le sujet non diabetique La microalbuminurie est un marqueur independant de risque CV, de risque de diabete, d'alteration de la fonction renale et de mortalite totale. Elle est un marqueur de risque de developper une hypertension arterielle chez le sujet normotendu et un marqueur de risque d'evolution defavorable, ou de deces au cours de cancers et de lymphomes. L'elevation ou la persistance d'une EUA elevee au cours du temps est associee a un pronostic pejoratif chez certains hypertendus. La mesure d'EUA peut etre recommandee chez certains hypertendus ayant un ou deux facteurs de risque CV associes dont le risque CV semble mal evalue ou ayant une hypertension arterielle (HTA) refractaire : la microalbuminurie indique ici un risque CV eleve et incite a assurer un controle tensionnel strict. Il y a peu d'etudes chez les sujets non hypertendus et non diabetiques ; elles suggerent globalement que la microalbuminurie est un facteur de comorbidite et de mauvais pronostic comme chez les sujets hypertendus ou diabetiques. En prevention secondaire, la microalbuminurie est un marqueur de risque independant, mais n'a pas de retombees therapeutiques specifiques. Il n'est pas recommande de rechercher systematiquement une microalbuminurie chez le sujet non hypertendu, non diabetique, sans antecedent de maladie renale. Il est recommande d'effectuer une surveillance de la fonction renale annuelle (excretion urinaire d'albumine creatininemie et estimation du debit de filtration glomerulaire) chez les sujets microalbuminuriques. Therapeutique Chez tout patient ayant une microalbuminurie : reduction ponderale et de l'apport sode excessif ( chez le diabetique , prescription d'un inhibiteur de l'enzyme de conversion (diabete de type 1) ou d'un antagoniste des recepteurs de l'angiotensine 2 (diabete de type 2) a dose suffisante en premiere intention. Les diuretiques thiazidiques ont un effet synergique avec les bloqueurs du systeme renine angiotensine sur la reduction de l'EUA ; chez le non diabetique , les cinq grandes classes d'antihypertenseurs (IEC, ARA2, diuretiques, antagonistes calciques, betabloquants) sont utilisables en premiere intention.

Introduction Les biomedicaments sont des innovations therapeutiques de plus en plus prescrites en raison des perspectives therapeutiques qu’elles offrent. Comme leurs prix sont tres eleves, plus de 80 % de la depense en molecules onereuses de la liste en sus (hors GHS) provient de la prescription de biomedicaments. Partant du constat que la depense en molecules onereuses augmente chaque annee dans les etablissements ex-DGF, nous nous interrogeons sur la contribution des biomedicaments a cette progression. Methodes Notre base de donnees, issue du PMSI, est constituee de l’ensemble des molecules onereuses consommees par les habitants de la region Centre – Val de Loire entre 2008 et 2013. Les biomedicaments ont ete distingues des molecules chimiques grâce au concours d’H. Watier, PU-PH en immunologie biologique a Tours. Pour expliquer l’evolution des depenses en molecules onereuses, nous avons procede a une decomposition de l’effet-prix et de l’effet-volume (lui-meme decompose en un effet quantite et un effet structure) grâce au calcul des indices de Laspeyres et de Paasche. Resultats Nous observons que : – la depense en molecules onereuses chimiques a baisse : l’effet prix negatif (baisse des prix) est superieur a l’effet volume positif (moins d’unites ont ete consommees mais la composition du panier de consommation s’est deformee au profit des molecules les plus cheres) ; – la depense en biomedicaments a augmente : l’effet prix negatif (baisse des prix) est inferieur a l’effet volume positif (moins d’unites ont ete consommees mais la composition du panier de consommation s’est deformee au profit des biomedicaments les plus chers). La decomposition des effets sur le sous-echantillon des biomedicaments immunosuppresseurs (dont la part est grandissante) conduit aux memes resultats. Discussion/conclusion Bien que leurs prix soient eleves, la croissance de la depense en biomedicaments au sein de la liste en sus ne s’explique pas donc par une hausse de leurs prix mais par une orientation croissante de la prescription vers les biomedicaments les plus chers.

Introduction La base de donnees des hospitalisations, le PMSI, est utilisable strategiquement par la direction (notamment pour les nouveaux groupements hospitaliers de territoire) et par les cliniciens (outil clinico-epidemiologique). L’etat des lieux de l’activite d’hospitalisation en Indre-et-Loire, a partir du PMSI, est presente. Methode L’unite principale d’evaluation etait le sejour hospitalier dans un des etablissements d’Indre-et-Loire, entre 2012 et 2014 (hors seances) via les donnees du PMSI agregees de l’ATIH. Les donnees ont ete analysees suivant les regroupements de la classification (du domaine d’activite au GHM) par annee. L’interpretation en a ete faite grâce a l’expertise des Departements d’information medicale (pratiques de codage locales) et des cliniciens (connaissance du terrain). Resultats Au total, 187 000 sejours ont ete extraits des 25 domaines d’activite chaque annee. Treize ont ete analyses en 2014, declines en groupes de planification, groupes d’activite et GHM, detailles pour le Centre hospitalier regional universitaire (CHRU) et les trois principales cliniques (89 % de l’activite, dont 49 % du CHRU). Les domaines d’activite pour lesquels le CHRU est leader dans le departement ont ete examines (exemple : hematologie, 63 % de l’activite du departement), et ceux pour lesquels la concurrence, notamment public/prive, est plus forte. L’expertise des cliniciens a explique des bascules d’activite du CHRU vers des etablissements prives (exemple : departs de praticiens dans la prise en charge des cancers du sein). Des profils differents d’activite ont egalement ete mis en evidence selon le statut de l’etablissement, par exemple : interventions sur la hanche (secteur public : activite d’urgence, pediatrie et activite plus lourde ; secteur prive : activite programmee et nombre moindre de GHM). Discussion/Conclusion L’analyse des parts d’activite des etablissements hospitaliers d’un departement via le PMSI permet d’adapter le projet medical d’etablissement. Elle est toutefois limitee par le decoupage a visee financiere des GHM et necessite le recours a l’expertise de terrain pour distinguer une modification reelle d’activite d’un effet codage.

We investigated on the correlation of the habitat fragmentation with bird communities of two Neapolitan parks: Camaldoli and Troisi. The first one is a prevalently wooded park, the second one is characterized by an heterogeneous vegetation and a small lake. We elaborated some landscape indices correlating them with the structure indices of community. The landscape indices show some different values between the two parks, while the structure indices of community are quite similar.

Introduction Les traumatismes crâniens, plus precisement les traumatismes cerebraux (TC), meme legers, peuvent etre source de deces ou de handicap. Methodes Les donnees du PMSI ont ete analysees pour les courts sejours hospitaliers de 2013 en France metropolitaine. Deux grandes categories de codes diagnostics CIM-10 ont ete definies pour selectionner les sejours d’interet. Les codes S06 de lesions traumatiques intracrâniennes, correspondent a un diagnostic certain de TC. D’autres codes ont ete retenus car consideres, de facon consensuelle, comme le plus souvent associes a un TC : fracture de la voute ou de la base du crâne (S021-S020), fractures ouvertes des os malaire ou maxillaires (S0241), fractures multiples ou d’autres os du crâne et de la face (S027-S028), ecrasement du crâne (S071), lesions traumatiques du nerf et des voies optiques (S040). L’algorithme de selection a consiste a extraire les sejours comportant un diagnostic principal parmi les codes S06, puis, parmi l’ensemble des sejours restants, les sejours comportant un diagnostic associe en S06. Cette procedure a ete repetee ensuite avec les codes consensuels sur les sejours non retenus par les precedentes etapes. L’ensemble des sejours pour TC ainsi extraits a ete analyse. Resultats En 2013, 135 535 patients souffrant d’un TC ont ete hospitalises, ils ont effectue 146 051 sejours. Le diagnostic de commotion etait le plus frequent (62 %). Pres d’un tiers (32 %) des patients avaient moins de 25 ans et 37 % plus de 70 ans, 57 % etaient des hommes. Le nombre de deces a l’hopital etait de 5539. Conclusion Ces premiers resultats permettent d’estimer la frequence des traumatismes crâniens ayant necessite une hospitalisation. La methode de selection doit etre validee. L’enregistrement des causes de TC dans le PMSI serait un outil supplementaire pour orienter les actions de prevention.

The aim of this study was to determine the prevalence of adolescents engaged in cyber-bullying and then to identify whether students involved in cyber- and school bullying present the same characteristics of internalizing problems (insomnia, perceived social disintegration, psychological distress) and externalizing problems (general aggressiveness, antisocial behavior).Semi-structured interviews were conducted with 738 adolescents from a high-school and a middle-school (mean age=14.8 ± 2.7). The Electronic Bullying Questionnaire and the Olweus Bully/Victim Questionnaire were used to identify profiles of cyber-bullying (cyber-victim, cyber-bully, cyber-bully/victim and cyber-neutral) and school bullying (victim, bully, bully/victim and neutral). Internalizing problems were investigated using the Athens Insomnia Scale, a Perceived Social Disintegration Scale and a Psychological Distress Scale. Externalizing problems were assessed using a General Aggressiveness Scale and an Antisocial Behavior Scale.Almost one student in four was involved in cyber-bullying (16.4% as cyber-victim, 4.9% as cyber-bully and 5.6% as cyber-bully/victim); 14% of our sample was engaged in school bullying as a victim, 7.2% as a bully and 2.8% as a bully/victim. The majority of adolescents involved in cyber-bullying were not involved in school bullying. With regard to the problems associated with school bullying, internalizing problems were more prevalent in victims and bully/victims, whereas externalizing problems were more common in bullies and bully/victims. A similar pattern was found in cyber-bullying where internalizing problems were characteristic of cyber-victims and cyber-bully/victims. Insomnia was elevated in the cyber-bully group which is specific to cyberbullying. General aggressiveness and antisocial behavior were more prevalent in cyber-bullies and cyber-bully/victims. Looking at the differences between types of bullying, victims of "school only" and "school and cyber" bullying had higher scores for insomnia and perceived social disintegration than victims of "cyber only" bullying or students "non-involved". Higher general aggressiveness scores were observed for "school only" bullies and "school and cyber" bullies than for bullies in "cyber only" bullying or students "non-involved". Regarding antisocial behavior, "school only" bullies, "cyber only" bullies, "school and cyber" bullies had higher scores than students "non-involved".This study highlights the importance of investigating both school and cyber-bullying as many psychosocial problems are linked to these two specific and highly prevalent forms of bullying.

Streptococcus pneumoniae is a significant cause of morbidity-mortality: leading agent of community-acquired pneumonia and the first cause of death due to infectious diseases in France. Vaccines are available for children and adults, avoiding serious complications. We studied hospitalizations for pneumococcal pneumonia in Centre region in 2004-2008, using the 2004-2008 national hospital discharges database and assessed vaccine coverage of a sample population.Hospital discharges with diagnosis of pneumococcal pneumonia were selected, using the corresponding code (J13) in the French Diagnosis-Related Group coding system. We analysed hospitalization and patient data using linkage of the inpatient stays with their anonymous identification number. We analysed hospitalization and patient data: number and length of stay/patient, co-morbid factors and pneumococcal immunisation status.One thousand five hundred and forty-one hospitalisations were found for pneumococcal pneumonia in Centre Region, in 2004-2008. The time pattern showed an annual increase in hospital stays: winter hospitalisations were most frequent. The median age was 58 years, range: 2 months-106 years. The sex ratio M/F of the 1417 distinct inpatients was 1.43. The hospital impact was substantial, with prolonged length of stay (mean=9.9 days), frequent stays in intensive care unit (20%) and high death rate (6%). The vaccine coverage of the population with pneumococcal pneumonia was only 23%.Using the national hospital discharges database, this study presents a snapshot of pneumococcal pneumonia in one French region and demonstrates the local major clinical impact, as found in France. It shows that the hospital discharge database is a potential tool for epidemiology despite its possible bias. This type of study could be useful for organizing a regional vaccination campaing due to the better knowledge of the disease.

Delirium tremens (DT) is the most severe complication from alcohol withdrawal. Risk factors for DT (before the withdrawal begins) and early predictive factors for the development of the withdrawal syndrome towards DT (once withdrawal has started) are not clearly established. We reviewed the literature from PubMed/Medline database to identify risk factors for DT. Twenty-one studies were been selected. Three only were prospective. The most commonly identified risk factors included personal history of DT, seizures, presence of acute somatic comorbidity especially infectious, presence of early withdrawal symptoms, and genetic predisposition. Most of these risk factors are still debated and prospective studies might appear useful considering the DT prevalence and the absence of consensual both diagnostic and therapeutic protocols.

To describe the clinical forms and epidemiology of Lyme borreliosis, in French adult patients hospitalized in Indre-et-Loire (Centre region).Patients were recruited from standardized discharge summaries collected in the hospital database. All adult patients, hospitalized in public hospitals of the Indre-et-Loire administrative district, over a period of 8 years (1999-2006), who satisfied the European diagnostic criteria of Lyme borreliosis, were included.Encoding of Lyme borreliosis had a poor positive predictive value (65%). Forty-seven adult patients presented with the 50 following clinical forms: erythema migrans (n=5), neuroborreliosis (n=32), knee single-joint arthritis (n=4), acrodermatitis chronica atrophicans (n=3), carditis (n=2), ocular borreliosis (n=2), miscellaneous (n=2). Three patients had a combination of two different clinical forms. Meningoradiculitis was the most frequent neurologic manifestation. When a cranial nerve was involved, it was constantly the facial nerve, and mainly bilaterally. Few patients in our study had erythema migrans: these patients are usually treated in a general medicine setting. Although the incidence in the Centre region was lower than in some other regions of France and Europe, the clinical spectrum of the disseminated forms was similar.This cohort illustrates the diversity of clinical manifestations of Lyme borreliosis in hospitalized patients, particularly at disseminated and late stages as well as the complexity of its diagnosis and its epidemiological surveillance.

International audience; The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

Measurement of urinary albumin excretion (UAE) may be done on a morning urinary sample or on a 24 hour-urine sample. Values defining microalbuminuria are: - 24-hour urine sample: 30-300 mg/24 hours - Morning urine sample: 20-200 mg/mL or 30-300 mg/g creatinine or 2.5-25 mg/mmol creatinine (men) or 3.5-35 mg/mol (women). - Timed urine sample: 20-200 mug/min. The optimal use of semi-quantitative urine test-strip is not clearly defined. It is generally believed that microalbuminuria reflects a generalized impairment of the endothelium; however, no definite proof has been shown in humans. In diabetic subjects, microalbuminuria is a marker of increased risk of cardiovascular (CV) and renal morbidity and mortality in type 1 and type 2 diabetic subjects. The increase in UAE during follow-up is also a marker of CV and renal risk in type 1 and type 2 diabetic subjects; its decrease during follow-up is associated with lower risks. In non-diabetic subjects, microalbuminuria is a marker of increased risk for diabetes mellitus, deterioration of the renal function, CV morbidity and all-cause mortality. It is a marker of increased risk for the development of hypertension in normotensive subjects, and is associated with unfavorable outcome in patients with cancer and lymphoma. Persistence or elevation of UAE overtime is associated with deleterious outcome in some hypertensive subjects. Measurement of UAE may be recommended in hypertensive subjects with 1 or 2 CV risk factors in whom CV risk remains difficult to assess, and in those with refractory hypertension: microalbuminuria indicates a high CV risk and must lead to strict control of arterial pressure. Studies focused on microalbuminuria in non-diabetic, non-hypertensive subjects are limited; most of them suggest that microalbuminuria predicts CV complications and deleterious outcome as it is in diabetic or hypertensive subjects. Subjects with a history of CV or cerebrovascular disease have an even greater CV risk if microalbuminuria is present than if it is not; however, in all cases, therapeutic intervention must be aggressive regardless of whether microalbuminuria is present or not. It is not recommended to measure UAE in non-diabetic non-hypertensive subjects in the absence of history of renal disease. Monitoring of renal function (UAE, serum creatinine and estimation of GFR) is annually recommended in all subjects with microalbuminuria.in patients with microalbuminuria, weight reduction, sodium restriction (6 g/day), smoking cessation, strict glucose control in diabetic subjects, strict arterial pressure control are necessary; in diabetic subjects: use of maximal doses of ACEI or ARB are recommended; ACEI/ARB and thiazides have synergistic actions on arterial pressure and reduction of UAE; in non-diabetic subjects, any of the five classes of anti-hypertensive medications (ACEI, ARB, thiazides, calcium channel blockers or beta-blockers) can be used.

SUMMARYVertebral osteomyelitis (VO) is a rare event. To estimate the incidence of VO in France for 2002–2003, national hospital-discharge data were used. Hospital stays were categorized as definite, probable or possible VO. Unique patient identification numbers allowed the investigators to link patients with multiple hospital stays and to analyse data for individual patients. A sample of medical records was reviewed to assess the specificity of the VO case definition. In 2002–2003, 1977 and 2036 hospital stays corresponding to 1422 and 1425 patients (median age 59 years, male:female ratio 1·5) were classified as definite (64%), probable (24%) and possible (12%) VO. The overall incidence of VO was 2·4/100 000. Incidence increased with age: 0·3/100 000 (70 years). The main infectious agents reported wereStaphylococcusspp. (38%) andMycobacterium tuberculosis(31%). The most frequent comorbidities were septicaemia (27%) and endocarditis (9%). Three percent of patients died. A review of 90 medical records confirmed the diagnosis of VO in 94% of cases. Using a hospital database and a specific case definition, nationwide surveillance of VO is possible.

Urinary albumin excretion (UAE) may be assayed on a morning urinary sample or a 24 h-urine sample. Values defining microalbuminuria are: 1) 24-h urine sample: 30-300 mg/24 h; 2) morning urine sample: 20-200 mg/ml or 30-300 mg/g creatinine or 2.5-25 mg/mmol creatinine (men) or 3.5-35 mg/mmol (women); 3) timed urine sample: 20-200 mug/min. The optimal use of semi-quantitative urine test-strip is not clearly defined. It is generally believed that microalbuminuria reflects a generalized impairment of the endothelium; however, no definite proof has been obtained in humans.Microalbuminuria is a marker of increased risk of cardiovascular (CV) and renal morbidity and mortality in type 1 and type 2 diabetic subjects. The increase in UAE during follow-up is associated with greater CV and renal risks in type 1 and type 2 diabetic subjects; its decrease during follow-up is associated with lower risks. IN NON-DIABETIC SUBJECTS: Microalbuminuria is a marker of increased risk for diabetes mellitus, deterioration of renal function, CV morbidity and all-cause mortality. It is a marker of increased risk for the development of hypertension in normotensive subjects, and is associated with unfavorable outcome in patients with cancer and lymphoma. Persistence of elevated UAE during follow-up is associated with poor outcome in some hypertensive subjects. Measurement of UAE may be recommended in hypertensive medium-risk subjects with 1 or 2 CV risk factors in whom CV risk remains difficult to assess, and in those with refractory hypertension: microalbuminuria indicates a high CV risk and must lead to strict control of arterial pressure. Studies focused on microalbuminuria in non-diabetic non-hypertensive subjects are limited; most of them suggest that microalbuminuria predicts CV complications and deleterious outcome. Subjects with a history of CV or cerebrovascular disease have an even greater CV risk if microalbuminuria is present than if it is not; however, in all cases, therapeutic intervention must be aggressive regardless of whether microalbuminuria is present or not. It is not recommended to measure UAE in non-diabetic non-hypertensive subjects in the absence of history of renal disease. Monitoring of renal function (UAE, serum creatinine and estimation of GFR) is recommended annually in all subjects with microalbuminuria.In patients with microalbuminuria, weight reduction, sodium restriction (6 g per day), smoking cessation, strict glucose control in diabetic subjects, strict arterial pressure control are necessary; in diabetic subjects: use of maximal doses of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are recommended; ACEI/ARB and thiazides have synergistic actions on arterial pressure and reduction of UAE; in non-diabetic subjects, any of the five classes of anti-hypertensive medications (ACEI, ARB, thiazides, calcium channel blockers or beta-blockers) can be used.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 1 - p. 1-2

Since 1989, when the law dealing with the financing of CME was passed, CME in university hospital centers has become more strategic. Evidence for this was provided by the responses to a questionnaire sent every two years since 1989 to the 31 hospitals involved in the study. Five indicators were taken into account. With a response rate of 76% to 97% the results were representative. The financial allocation increased between 1988 and 1990 and remained stable in the subsequent years. In 1994, a commission for CME existed in almost all the hospitals. Most of the time, there was a partnership between the administration and physicians. In 1994, only half of the hospitals had a training plan, Physicians’ needs were taken into account by almost all the hospitals. Physicians’ administrative needs were also taken into account by 87% of the hospitals in 1994, which appeared not to have been the case before. Although efforts were made to evaluate the training sessions, no evaluation of the effects was carried out. We must point out two reasons which made the interpretation difficult: questionnaires differed from one year to another and not all hospitals had usable information about CME. In conclusion, resources have increased, and strategic objectives have appeared or been confirmed

Objectifs Presenter les resultats medico-economiques de l’etude nationale STIC « echographie de contraste temps reel dans la prise en charge diagnostique des lesions nodulaires hepatiques » au nom des centres participants. Materiels et methodes Huit cent soixante quinze patients presentant un nodule hepatique visible mais non caracterise en echographie conventionnelle ont beneficie d’une exploration par echographie de contraste et d’un examen de reference TDM ou IRM dans 15 centres francais. Il a ete realise une relecture en double aveugle des acquisitions echographiques et simple relecture du TDM ou IRM. Ont ete consideres le diagnostic final et les couts de mise en œuvre des differentes methodes. Resultats Les resultats qui seront presentes concerneront la fiabilite diagnostique des differentes methodes, la reproductibilite de la relecture, les effets secondaires observes, les couts de mise en œuvre a savoir agents de contraste, materiel et amortissement, personnel mis en œuvre. Il sera alors precise quelle methode semble la plus viable economiquement en fonction de la fiabilite diagnostique. Conclusion L’etude pharmaco-economique realisee a mis en lumiere la volonte des centres de participer a cette etude et a renforce l’ attractivite de l’echographie de contraste en pathologie nodulaire hepatique.

Constructability is the optimum use of construction knowledge and experience in planning, engineering, procurement and field operations to achieve overall objectives. Seven concepts for improving constructability during the engineering/procurement phase of a project are presented and analyzed. A limited number of specific applications of each concept are also presented. The concepts promote construction‐driven schedules, simplified design configurations, standardization of elements, and module/preassembly designs which facilitate fabrication, transport, and installation. Concepts also address the accessibility of manpower, materials, and equipment; design modifications to facilitate construction in adverse weather; and specification improvements.

Resume Par une etude multicentrique retrospective aupres des centres hospitaliers regionaux et universitaires, nous avons recense, sur une periode de 18 mois, 21 deces consecutifs a un acces palustre a P. falciparum . Tous les sujets decedes etaient de nationalite europeenne. Parmi eux, 7 n'avaient suivi aucune chimioprophylaxie lors de leur sejour en zone d'endemie palustre. Dans 17 cas la contamination a eu lieu en zone de chimioresistance. Un delai allant de 2 a 13 jours entre l'apparition des signes cliniques et la mise en route d'un traitement approprie fut observe dans 14 cas. La fievre elevee, l'ictere, la thrombopenie, l'hypercreatininemie sont les signes les plus frequemment retrouves lors de l'admission en milieu hospitalier.

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