Service de Sante Publique et dInformation Medicale

Hôpital-Camfrout, France

Service de Sante Publique et dInformation Medicale

Hôpital-Camfrout, France
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Lesieur E.,Service de gynecologie obstetrique | Blanc J.,Service de gynecologie obstetrique | Loundou A.,Aix - Marseille University | Dubuc M.,Service de sante publique et dinformation medicale | Bretelle F.,Aix - Marseille University
Gynecologie Obstetrique Fertilite et Senologie | Year: 2017

Objective To evaluate professional practices relative to episiotomies in the Provence Alpes Côte d'Azur (PACA) region by analysing their incidence in maternity hospitals, by type and by sector of activity. Following this, to analyse maternal and obstetric characteristics associated with episiotomies and the occurrence of perineal tears in Marseille's university hospitals (CHU). Methods Data were extracted from the database for the period from 1st January 2012 to 31 December 2014. The sample included 41 maternity hospitals: 13 private and 28 public. Twenty of the maternity hospitals were level 1, 15 were level 2, and 2 were level 3 (Nice and AP–HM). Results In the PACA region, 176,573 patients gave birth by vaginal delivery. The incidence of episiotomy over the 3 years was 21.6% (0.50% – 76.13%) with a statistically significant reduction in the incidence between 2012 and 2014 (P < 0.001). There was a significant difference by sector (P < 0.001) and level (P < 0.001) of maternity hospitals. In the Marseille CHU, 21.6% of women had an episiotomy (66.4% in primiparas – 33.6% in multiparous) and 43% had perineal tears (62.3% in primiparas – 37.7% in multiparous). After multivariate analysis, gender, weight of the newborn, presentation, gestational age, and mode of delivery were shown to be factors significantly associated with occurrence of episiotomy and occurrence of perineal tear (P < 0.001). Conclusion A significant decrease in the incidence of episiotomy was observed in the PACA region from 2012 to 2014, associated with a wide variation in rates depending on the maternity hospitals, their types and their sectors. © 2017 Elsevier Masson SAS

Anglaret X.,University of Bordeaux Segalen | Minga A.,University of Bordeaux Segalen | Gabillard D.,University of Bordeaux Segalen | Messou E.,University of Bordeaux Segalen | And 11 more authors.
Clinical Infectious Diseases | Year: 2012

Background. In Western Europe, North America, and Australia, large cohort collaborations have been able to estimate the short-term CD4 cell count-specific risk of AIDS or death in untreated human immunodeficiency virus (HIV)-infected adults with high CD4 cell counts. In sub-Saharan Africa, these CD4 cell count-specific estimates are scarce. Methods. From 1996 through 2006, we followed up 2 research cohorts of HIV-infected adults in Côte d'Ivoire. This included follow-up off antiretroviral therapy (ART) across the entire spectrum of CD4 cell counts before the ART era, and only in patients with CD4 cell counts >200cells/μL once ART became available. Data were censored at ART initiation. We modeled the CD4 cell count decrease using an adjusted linear mixed model. CD4 cell count-specific rates of events were obtained by dividing the number of first events occurring in a given CD4 cell count stratum by the time spent in that stratum. Results. Eight hundred sixty patients were followed off ART over 2789 person-years (PY). In the ≥650, 500-649, 350-499, 200-349, 100-199, 50-99, and 0-49cells/μL CD4 cell count strata, the rates of AIDS or death were 0.9, 1.7, 3.7, 10.4, 30.9, 60.8, and 99.9 events per 100 PY, respectively. In patients with CD4 cell counts ≥200 CD4cells/μL, the most frequent AIDS-defining disease was tuberculosis (decreasing from 4.0 to 0.6 events per 100 PY for 200-349 and ≥650 cells/μL, respectively), and the most frequent HIV non-AIDS severe diseases were visceral bacterial diseases (decreasing from 9.1 to 3.6 events per 100 PY).Conclusions.Rates of AIDS or death, tuberculosis, and invasive bacterial diseases are substantial in patients with CD4 cell counts ≥200 cells/μL. Tuberculosis and bacterial diseases should be the most important outcomes in future trials of early ART in sub-Saharan Africa. © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Mitton N.,Registre des Cancers de lIsre | Colonna M.,Registre des Cancers de lIsre | Trombert B.,Service de Sante Publique et dInformation Medicale | Olive F.,Grenoble University Hospital Center | And 13 more authors.
Journal of Cancer Epidemiology | Year: 2011

Objective. Use of cancer cases from registries and PMSI claims database to estimate Département-specific incidence of four major cancers. Methods. Case extraction used principal diagnosis then surgery codes. PMSI cases/registry cases ratios for 2004 were modelled then Département-specific incidence for 2007 estimated using these ratios and 2007 PMSI cases. Results. For 2007, only colon-rectum and breast cancer estimations were satisfactorily validated for infranational incidence not ovary and kidney cancers. For breast, the estimated national incidence was 50,578 cases and the incidence rate 98.6 cases per 100,000 person per year. For colon-rectum, incidence was 21,172 in men versus 18,327 in women and the incidence rate 38 per 100,000 versus 24.8. For ovary, the estimated incidence was 4,637 and the rate 8.6 per 100,000. For kidney, incidence was 6,775 in men versus 3,273 in women and the rate 13.3 per 100.000 versus 5.2. Conclusion. Incidence estimation using PMSI patient identifiers proved encouraging though still dependent on the assumption of uniform cancer treatments and coding. Copyright © 2011 Nicolas Mitton et al.

Leydet-Quilici H.,Service de Rhumatologie | Le Corroller T.,Service de Radiologie | Bouvier C.,Service dAnatomo pathologie | Giorgi R.,Service de Sante Publique et dInformation Medicale | And 6 more authors.
Osteoarthritis and Cartilage | Year: 2010

Objectives: To correlate magnetic resonance imaging (MRI) aspects of the femoral head with histological findings in advanced hip osteoarthritis (OA), with special emphasis on bone marrow edema (BME). Methods: MRI was performed in patients with advanced hip OA scheduled for hip arthroplasty. Coronal T1-, fat-suppressed T2-, T1 with gadolinium intravenous injection sequences were obtained on a 1.5. T MR-scanner within 1 month before surgery.Coronal MR images corresponding to the ligamentum teres plane were analyzed by two independent readers blinded to histological data. Normal bone marrow, subchondral cyst, subchondral fracture, edema-like, necrosis-like, and necrosis MR patterns were reported on a synthesis scheme. After surgery, the femoral heads specimens were cut through the ligamentum teres plane and histologically analyzed for correlations. Results: Twenty-three femoral heads were analyzed (female 56.5%, mean age 64.5 years). Edema-like MR pattern was correlated with histological (H) edema (Kappa (K): 0.77). Necrosis-like MR pattern was correlated with H fibrosis (K: 0.49) and with H necrosis (K: 0.24). Cyst MR pattern was correlated with H bone cysts (K: 0.58). Necrosis MR pattern corresponded to a mixture of histological lesions. Sensitivity and specificity of MRI varied from 26% to 80% and from 86% to 95% respectively. Conclusion: In advanced hip OA, the so-called "BME" MR lesion corresponds to a combination of edema, fibrosis, and necrosis at histopathology. When the classical "BME" is more specifically separated into edema-like and necrosis-like MR patterns, MR Imaging and histological findings show substantial agreement, with edema-like MR pattern mainly corresponding to histological edema. © 2010 Osteoarthritis Research Society International.

Carsin A.,Marseille University Hospital Center | Gorincour G.,Marseille University Hospital Center | Bresson V.,Marseille University Hospital Center | Oudyi M.,Marseille University Hospital Center | And 8 more authors.
Archives de Pediatrie | Year: 2012

Objective: To describe the chest radiographs of infants hospitalized for acute bronchiolitis and to assess whether patient management changed after radiography. Study design: All infants hospitalized in our pediatric unit with a first episode of acute bronchiolitis from October 2010 to March 2012 were included in the study. Infants with chronic disease or transferred from a pediatric intensive care unit were excluded. The following data were collected: sex, age, neonatal history, atopy, tobacco exposure, admission criteria, treatment, laboratory parameters, ultrasonography and its outcome, results of chest radiography on admittance, the reason for a second chest radiograph, change in management as a result of the radiograph. Results: The study comprised 232 infants (median age 2.2 months, boys 56%, positive respiratory syncytial virus 73.4%). Among them, 227 children had a routine chest radiograph revealing distension and/or bronchial wall thickening (n=141, 62.4%), focal opacity (19.9%), or atelectasis (17.7%). This radiograph led to the prescription of antibiotics in six patients (2.6%) and allowed the diagnosis of vascular abnormality to be made in one case (0.4%). Thirty-five patients (15.4%) had a second chest radiograph during their hospitalization owing to oxygen reason specified (n=1). Pneumonia (n=7) and/or atelectasis (n=15) were then found in 62.9%. Patient management (antibiotics, postural maneuvers) was modified in six patients (17.1%). Conclusions: Routine chest radiographs contribute only partially to the treatment of infants hospitalized for acute bronchiolitis. However, radiography is useful when the hospitalized child does not improve at the expected rate or if the disease is severe. The indication of chest radiography in infants hospitalized for acute bronchiolitis should be discussed on a case by a case basis. © 2012 Elsevier Masson SAS.

Mardassi A.,Service dOrl et de Chirurgie Cervicofaciale | Deveze A.,Service dOrl et de Chirurgie Cervicofaciale | Sanjuan M.,Service dOrl et de Chirurgie Cervicofaciale | Mancini J.,Service de Sante Publique et dInformation Medicale | And 6 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2011

Objective: To assess the efficiency of ossiculoplasty procedures with the Kurz titanium ossicular prosthesis and evaluate prognostic factors for the functional results. Methods: Retrospective chart reviews were performed for ossiculoplasty involving Kurz titanium prostheses between 2006 and 2009 in the ENT Head and Neck Department of the hôpital Nord, Marseille, France. Results: The population studied was 70 patients, with 37 procedures using the partial (PORP) and 33 the total ossicular replacement prosthesis (TORP). Mean follow-up was 9 months. Pre- and postoperative audiological parameters on four frequency averages (0.5, 1, 2, and 3 kHz) were compared according to AAO-HNS guidelines. A postoperative air-bone gap (ABG) ≤ 20 dB was obtained in 71.43% of the patients (86.49% for PORP, and 54.55% for TORP). The mean change in ABG was 12.45 dB in cholesteatomatous otitis versus 13.41 dB in non- cholesteatomatous otitis. Conclusion: Increasing the length of the ossicular prosthesis, especially TORP, may improve postoperative functional results. © 2010 Elsevier Masson SAS.

Farinetti A.,Aix - Marseille University | Ben Gharbia D.,Aix - Marseille University | Mancini J.,Service de Sante Publique et dInformation Medicale | Mancini J.,Aix - Marseille University | And 3 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2014

Objectives The purpose of this study was to assess the postoperative complications related to cochlear implants and to discuss the differences observed between adult and paediatric populations. Cochlear implant complications were defined as any pathological events observed during the postoperative period, whether or not they were directly related to the surgical technique. We therefore recorded all complications, in the broad sense of the term, ranging from acute otitis media to cochlear explantation. Study design Retrospective analysis of cochlear implant patients. Material and methods All surgical procedures (unilateral or bilateral cochlear implantation, revision surgery) performed in our institution between March 1993 and January 2013 were reviewed. This population comprised 168 adults (median age at the time of implantation: 51.9 years), and 235 children (median age at the time of implantation: 4.5 years). All postoperative complications were classified as either major (requiring surgical revision or hospital management) or minor (requiring conservative management). Results The global complication rate was 19.9% (80/403 cases), comprising 5% of major complications (20 cases) and 14.9% of minor complications (60 cases). This complication rate was significantly higher in the adult population (P = 0.004). Conclusion Cochlear implantation is a safe hearing rehabilitation surgical technique associated with a low complication rate. However, surgeons must be familiar with these complications in order to ensure optimal prevention. Minor complications were mainly infectious in children (acute otitis media) and cochleovestibular in adults (tinnitus and vertigo). Major complications were mostly reimplantation following revision surgery or device failure. Only the minor complication rate was significantly higher in the adult population. © 2014 Elsevier Masson SAS.

Bonello L.,Hopital University Nord | Bonello L.,French Institute of Health and Medical Research | Pansieri M.,Service de Cardiologie | Mancini J.,Service de Sante Publique et dInformation Medicale | And 17 more authors.
Journal of the American College of Cardiology | Year: 2011

Objectives: The aim of this study was to investigate the relationship between platelet reactivity (PR) after a loading dose (LD) of prasugrel and thrombotic events. Background: Post-treatment PR has been shown to be strongly associated with the occurrence of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in the clopidogrel era. Prasugrel is a new P2Y12adenosine diphosphate receptor with a higher potency on PR. Methods: A prospective multicenter study included patients who underwent successful PCI for acute coronary syndromes and received prasugrel therapy. Vasodilator-stimulated phosphoprotein (VASP) index was measured after the prasugrel LD. High on-treatment PR was defined as a VASP index ≥50%. MACE included cardiovascular death, myocardial infarction, and definite stent thrombosis at 1 month. Results: Three hundred one patients were enrolled. The mean VASP index after 60 mg of prasugrel was 34.3 ± 23.1%. High on-treatment PR was observed in 76 patients (25.2%). Patients experiencing thrombotic events after PCI had significantly higher VASP indexes compared with those free of events (64.4 ± 14.4% vs. 33.4 ± 22.7%; range: 51% to 64% and 5% to 47.6%, respectively; p = 0.001). Kaplan-Meier analysis comparing good responders and patients with high on-treatment PR demonstrated a significantly higher rate of MACE in patients with suboptimal PR inhibition (log-rank p < 0.001). Receiver-operating characteristic curve analysis found a cutoff value of 53.5% of the VASP index to predict thrombotic events at 1 month (r = 0.86, p < 0.001). Patients with minor or major Thrombolysis In Myocardial Infarction unrelated to coronary artery bypass grafting bleeding and those without had similar VASP indexes (30 ± 17.8% vs. 34.3 ± 23%, p = 0.70). Conclusions: Despite the use of prasugrel, a significant number of patients undergoing PCI in the setting of acute coronary syndromes do not achieve optimal PR inhibition. Such patients have a higher risk for MACE after PCI. © 2011 American College of Cardiology Foundation.

Jaussaud N.,Service de Chirurgie Cardiaque | Gariboldi V.,Service de Chirurgie Cardiaque | Grisoli D.,Service de Chirurgie Cardiaque | Berbis J.,Service de Sante Publique et dInformation Medicale | And 3 more authors.
Journal of Heart Valve Disease | Year: 2012

Background and aim of the study: Today, when a mitral valve replacement is required, more patients and surgeons choose a bioprosthesis. Yet, the rationale of this choice is unclear in patients in whom age represents a predicting factor for reoperation. The study aim was to define the risk factors for reoperation after mitral bioprosthesis failure. Methods: A total of 282 consecutive patients (202 women, 80 men; mean age at surgery 61 years; range: 28-88 years) who underwent reoperation for mitral bioprosthesis failure between 1990 and 2006 was reviewed. Surgery was undertaken because of bioprosthesis degeneration (91%), prosthetic valve infective endocarditis (6%), paravalvular leak (2%), or other causes (1%). Emergency procedures were performed in 7% of cases. Associated procedures included tricuspid valve surgery in 16% of patients (tricuspid valve repair in 11%, tricuspid valve replacement in 5%) and coronary artery bypass graft in 5%. Almost one-fifth of patients (18%) had undergone more than one previous mitral valve replacement. Results: The overall operative mortality was 7.4% (n = 21). Factors identified (by multivariate analysis) as predictors of operative death included: presence of diabetes mellitus (odds ratio (OR) = 8.69, 95% CI 2.55-29.61; p = 0.001), chronic obstructive pulmonary disease (OR = 9.01, 95% CI 1.72-47.18; p = 0.009), NYHA class III/IV (OR = 5.46, 95% CI 1.41-21.16; p = 0.01), and pulmonary artery pressure >60 mmHg (OR = 3.13, 95% CI 1.10-8.94; p = 0.03). Associated procedures were not significant risk factors for mortality. New prostheses were mechanical in 68% of cases, and bioprostheses in 32%. Conclusion: One reoperation for mitral bioprosthesis dysfunction is acceptable if the patient can be expected to survive to reoperation while free from comorbidities and the severe effects of mitral disease. The application of strict selective criteria to recipients at the first valve replacement, combined with a close follow up, may allow this goal to be achieved. © Copyright by ICR Publishers 2012.

Razafimahefa-Raoelina T.,Aix - Marseille University | Farinetti A.,Aix - Marseille University | Nicollas R.,Aix - Marseille University | Triglia J.-M.,Aix - Marseille University | And 3 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2016

The aim of this study was to assess quality of life in children fitted with cochlear implants,using combined self-and parental assessment.Materials and methods: Thirty-two children, aged 6 to 17 years, with prelingual hearing loss and receivingcochlear implants at a mean age of 22 months, were included along with their families. The KIDSCREEN-27 questionnaire was implemented, in face-to-face interview, in its parents and children-adolescentsversions, with 27 items covering physical well-being ("physical activities and health"), psychological well-being ("general mood and feelings about yourself"), autonomy and parents ("family and free time"), peers and social support ("friends") and school environment ("school and learning"). Parent and child responseswere compared with a general population database, and pairwise.Results: Global scores were compared against the general population on Cohen d effect-size. For childself-assessment, the results were: physical well-being, 72.81 (d = 0); psychological well-being, 78.13(d =-0.4); autonomy and parents, 63.84 (d =-0.2); peers and social support, 61.72 (d =-0.4); and schoolenvironment 73.83 (d = 0). For parent assessment, the respective results were 62.66 (d =-0.8), 74.89(d =-0.3), 57.37 (d =-1.2), 51.56 (d =-0.8), and 68.95 (d =-0.4). Half of the children could not answerthe questionnaire, mainly due to associated disability. Schooling and language performance were poorerin non-respondent than respondent children. Quality of life was comparable between implanted and non-implanted children: Cohen d, 0 to 0.4. Early cochlear implantation in children with pre-lingual heartingloss provides quality of life comparable to that of the general population. © 2015 Published by Elsevier Masson SAS.

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