Search PubMed⌕ Search

Biomedical subjects

A Fontaine

Publications and source records attributed to A Fontaine.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Analysis of pediatric home care services of the Assistance Publique--Hôpitaux de Paris].

BACKGROUND: The Home Health Care services for children in Paris was recently established and it is interesting to analyse the first results of their activities. POPULATION AND METHODS: A random sample (n = 157) of the 418 children admitted to home health care in the Assistance publique-Hôpitaux de Paris (HAD-P) in 1991 has been studied; only one episode of care was analyzed for each child. The data analysed included sociodemographic characteristics of the children, their clinical diagnosis and the care received. RESULTS: More than half of the children presented chronic diseases. Follow-up of newborn children was the main reason for admitting children with acute conditions. Housing and socioeconomic conditions were poor for a significant number of children. A seasonal pattern was found, with higher activity in the beginning and in the end of the year. CONCLUSIONS: More efforts are needed to develop complementarity between hospital-based and home health care services, beginning with improved communication of detailed information regarding home health care objectives and conditions.

Acute Disease↗
PubMed1996

Induction of a local anti-IpaC antibody response in mice by use of a Shigella flexneri 2a vaccine candidate: implications for use of IpaC as a protein carrier.

The capacity of Shigella flexneri to act as a delivery system for stimulation of local immunity was investigated by use of an S. Flexneri 2a vaccine candidate (SC602). This vaccine strain was constructed by deletion of virulence genes responsible for dissemination (icsA) and survival (iuc:iut) of bacteria within the colonic mucosa. Among the most immunogenic S. flexneri 2a proteins inducing a local immunoglobulin A antibody response, the IpaC invasion was selected as a potential protein carrier. Overexpression of IpaC from a plasmid in trans within SC602 (SC602/pIpaC) was shown to be required for the induction of optimal anti-IpaC antibody response in the murine pulmonary infection model. A weak anti-IpaC antibody response was obtained after intranasal inoculations with SC602/pIpaC live bacteria. This response was enhanced by combining systemic priming with SC602/pIpaC killed bacteria and local boosting with SC602/pIpaC live bacteria. These results suggest that naive B cells primed systemically could account for local antibody production. This immunization protocol will allow further evaluation of the immunogenicity of IpaC hybrid proteins expresses in SC602.

Animals↗
PubMed1995

Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in France.

BACKGROUND: Two representative samples of primary care physicians (N = 600) and medical oncologists (N = 300) in France were surveyed about their attitudes toward and knowledge about cancer pain management. METHODS: The survey was conducted by telephone with a questionnaire based on a model developed by the University of Wisconsin-Madison Pain Research Group. It was designed to assess physicians' estimates of the prevalence of pain among patients with cancer, their practice in prescribing analgesics, their training in cancer pain management, and the quality of care received by cancer patients in their own practice and in France. RESULTS: Barriers to adequate cancer pain management are prevalent and consistently more common among primary care physicians than among medical oncologists. Although 85% of primary care physicians and 93% of medical oncologists express satisfaction with their own ability to manage cancer pain, 76% of primary care physicians and 50% of medical oncologists report being reluctant to prescribe morphine for cancer pain. Both groups cite fear of side effects as their main reason to hesitate to prescribe morphine. Concerns about the risk of tolerance (odds ratio [OR], 1.15-2.52), perceptions that other effective drugs are available (OR, 1.11-2.41), perceptions that morphine has a poor image in public opinion (OR, 0.96-2.07), and the constraints of prescription forms (OR, 1.12-2.26) contribute significantly to physicians' infrequent prescription of morphine, as are being female (OR, 1.01-2.03) and being an older oncologist (OR, 1.09-2.51). CONCLUSIONS: This study (1) confirms the existence among French physicians of attitudinal barriers and knowledge deficits previously reported in other countries that can impede cancer pain management, (2) identifies new barriers to the proper prescription of morphine for cancer pain control, and (3) reveals discrepancies in physicians' attitudes and knowledge about pain control which suggest a need for the systematic evaluation of cancer patients' care.

Adult↗
PubMed1995

Clinical correlates of [18F]fluorodopa uptake in five grafted parkinsonian patients.

To assess the efficacy of fetal mesencephalic grafts in Parkinson's disease, it is important to know if the grafted cells survive and are functional. Positron emission tomography (PET) and [18F]fluorodopa ([18F]dopa) have been used to demonstrate the survival of the grafted cells, but the relationship of [18F]dopa uptake changes in the grafted striatum to motor function remains unclear. We investigated this question with 16 serial PET scans in 5 severe parkinsonian patients unilaterally grafted in whom we found a significant and progressive increase of the [18F]dopa uptake in the grafted putamen. The number of patients was too small to assess the sensitivity of [18F]dopa PET scans in individual patients. Yet, by analyzing the 16 serial PET scans we found a correlation between the [18F]dopa uptake (Ki) in the grafted putamen and the percentage of daily time spent "on," suggesting that Ki changes have a functional meaning. In addition, the Ki values were correlated with the contralateral finger dexterity to the same extent in both the grafted and nongrafted putamen. These results indicate that [18F]dopa uptake reflects the motor function of the opposite side of the body, similarly in the grafted and ungrafted putamen, at least in terms of these tasks. Finally, extrapolating from these correlations offers the suggestion that clinical optimal results of the graft could be achieved if the graft brings the Ki values in the putamen to about two standard deviations of mean control values.

Brain↗
PubMed1995

A model based on dimensional analysis for noninvasive quantification of valvular regurgitation under confined and impinging conditions: in vitro pulsatile flow validation.

A technique is proposed for the noninvasive quantification of regurgitant flows under confined and impinging conditions. Its use requires only the knowledge of the jet orifice velocity, receiving chamber diameter, orifice-to-end wall distance and any downstream jet centerline velocity at a known distance from the orifice. The technique is based on dimensional analysis and provides a prediction of peak regurgitant flow rates. To validate the technique, known physiologic pulsatile flows were pumped through 2- and 4-mm circular orifices at 70 to 150 beats/min, into two different receiving chambers of 51 and 88 mm in diameter. At each heart rate, the peak orifice velocity was varied from 2 to 5 m/s, and the orifice-to-end wall distance was varied from 30 to 93 mm. Centerline velocities were recorded by pulsed Doppler ultrasound and averaged over multiple beats. A dimensional analysis of the parameters of the study provided an equation relating normalized centerline velocity to orifice-to-end wall distance, chamber diameter and downstream location. Statistical modeling of the experimental data was performed to compute the constants involved in this equation. The estimated (i.e., predicted by the technique) peak regurgitant flow rates were found to fall within 10% of the actual values, when centerline velocities were measured over a range of centerline distances from six orifice diameters to 85% of the chamber length. Therefore, the proposed technique provides, for the first time, a quantitative method for calculating valvular regurgitant flow rates under confined and impinging conditions.

Blood Flow Velocity↗
PubMed1995

[Screening for lead poisoning in children by measuring lead levels in housing: a study of the Paris region].

Screening programs for lead poisoning in France rely usually on the preliminary identification of risk factors among children seen in Maternal and Child Health (MCH) clinics. To assess the potential relevance of screening strategies based on the quantification of exposure to lead in housing, we estimated first the prevalence of exposure to lead in a representative sample of older buildings, then the prevalence of lead poisoning among children living in those buildings where high levels of lead had been found. Exposure to lead was measured in dust and paint samples collected in hallways and other collective areas of the buildings. Venous blood samples were collected from the children aged 10 months to 6 years residing in buildings where lead exceeded 1.5 g/kg in paint samples or 1000 micrograms/m2 in dust samples. Paint and dust samples were collected in 137 buildings: 74% presented high dust and/or paint lead contents. Blood samples were collected from 145 out of a total of 189 children residing in these buildings: blood lead levels (PbB) were higher than or equal to 10 micrograms/dl for 65% of these children; 29% were higher than or equal to 15 micrograms/dl, 16% higher than or equal to 20 micrograms/dl. Out of 42 children with PbB > or = 15 micrograms/dl, 21 had not been previously identified through the screening program conducted in local MCH clinics. Clinic-based and environment-based screening appeared to be complementary. It seems thus justified to develop screening strategies based on the assessment of exposure to lead in the environment.

Child↗
PubMed1995

[Evaluation of decontamination interventions in 59 homes of children with lead poisoning].

Old peeling paint with high content of lead has been identified as the main source of lead poisoning for children screened in Paris since 1985. In 1989, Médecins Sans Frontières and Migration Santé tested abatement methods in 59 homes of severely lead-poisoned children. The effectiveness of abatement is evaluated with respect to the evolution in dust lead contents and of the children's blood lead levels. Lead content wsas measured in dust samples collected from the floor of the homes before abatement, then every three months after abatement; results are available for 24 homes. Blood lead levels were assessed in the course of the children's medical follow-up; results are available before and after abatement for 78 children living in 41 of the abated homes. The effect of abatement on the children's blood lead level was assessed through multivariate analysis. The median decrease in dust lead contents was 365 micrograms/m2 one to two months after abatement and 300 micrograms/m2 three to six months after abatement. However, dust lead contents of more than 1,000 micrograms/m2 were found in more than half of the communal areas of the buildings six to twenty-eight months after abatement. For 2 of the families, abatement was associated with an increase in the children's blood lead-levels. For all of the other children, abatement was associated with a significant decrease in blood lead levels, controlling for the child's age and initial lead poisoning level, and for the overall downward trend in blood lead levels over time since the initial screening.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1995

[Tonsillectomy in a day care hospital. A socioeconomic study at the Robert Debré Hospital in Paris].

Tonsillectomy as an outpatient procedure in children is a common practice in the United States and many other countries. In French public hospitals, it remains quite rare. A 6-month prospective study was conducted in order to check the procedure's feasibility in a large Paris university children's hospital, to describe the involved population and to search for the possible benefits which could be made by a public hospital from an increase in day surgery practice for tonsillectomy. In terms of quality of postoperative outcome, this study confirms the absence of major complications related to this procedure if the proper criteria are met for day surgery. In fact, medical and social findings from the involved patients tend to limit here a large extension of this procedure. For example, in the inpatients group, more than 43% of children had a tonsillar hypertrophy with significant airway obstruction and 47% did not have lodging conditions which would allow day surgery with the required safety. Only 20% of patients could be transferred to ambulatory surgery which leads to 2-3 additional cases each week here. Finally, the cost analysis shows no benefit in human resources at this hospital because the requested differential activity threshold would not be reached.

Ambulatory Surgical Procedures↗