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J Goujard

Publications and source records attributed to J Goujard.

At least 55 records · Page 3Linked to original sources
PubMed1984

[Economic analysis of the dissemination of a medical innovation: prenatal diagnosis by early amniocentesis as an example. Part 1. Epidemiologic, medical and socioeconomic bases. The dissemination of a diagnostic innovation].

The article offers a detailed analysis of the characteristics of the supply and demand of prenatal diagnosis by amniocentesis in order to identify the major problems that must be faced in formulating a policy designed to diffuse the use of this technique. The data collected for the whole of France made it possible to evaluate exhaustively the increase in the number of prenatal diagnoses during the years 1972-1981; to determine the number and geographic distribution of the diagnostic centers; to identify the medical criteria justifying the examinations. A comprehensive survey covering all examinations performed in the Ile de France (Paris region) in 1979--which constituted 46.5% of all the prenatal diagnoses performed in France that year--made it possible to determine the predominant socioeconomic characteristics of the women who took this examination, revealing, particularly, the significant inequalities of access, with an underrepresentation of the least privileged socioprofessional categories. The confirmation of the influence of socioeconomic status on access to this medical innovation is further reinforced by the fact that usage rates vary widely according to place of residence; furthermore, it adds to the financial barriers implicit in any policy of having reimbursement of the examinations dependent upon Social Security conventions. A public health policy regulating the diffusion of this innovation must take into account the discriminatory aspects of the first phase of diffusion, as analyzed here.

Adult↗
PubMed1984

[Evolution of the mortality rate of newborn infants transferred to a Parisian intensive care service from 1969 to 1978].

This study reports on the trend in neonatal death rates in a Paris intensive care unit between 1969 and 1978. Three time-periods were compared: 1969-1971, 1972-1974, and 1975-1978. These limits were chosen to take into account the introduction of continuous airway positive pressure in the unit in 1972, and the gradual implementation, from 1972 onwards, of a new perinatal care policy in France. The mortality rate was significantly lower in the second period than in the first, after adjustment on birthweight and type of disease. This trend varied according to type of disease: the death decreased significantly in case of membrane disease or foetal distress, but not in case of admission for amniotic inhalation or congenital anomalies. The gradual improvement in newborn's condition on arrival in the unit played a part in the improvement in survival, as well as the use of the continuous airway positive pressure.

Critical Care↗
PubMed1983

[Administration of diethylstilbestrol during pregnancy, a public health problem].

The analysis of the health risks associated with the administration of diethylstilbestrol (DES) during pregnancy (for the prevention or treatment of threatened abortions) has been largely published. Concerning mothers, a relationship between DES exposure during pregnancy and risk of cancer is unproved. However, existing studies are sufficient cause for serious concern over drug's carcinogenic potential, and further follow-up studies are required. Concerning daughters, a clear association between in utero exposure to DES and clear cell adenocarcinoma of the vagina or cervix is established (incidence between 0.14 and 1.4 per 1000 through age 24). The risk for squamous cell cancer of the vagina and cervix does not seem to be increased. Cervico-vaginal adenosis is frequent (20% to 60% of exposed subjects). This is not a pre-cancerous lesion, its spontaneous evolution is towards regression. No treatment is prescribed. Morphological changes of the genital tract have been described, their consequences on fertility and pregnancy are not clear. Concerning sons, an excess of genital abnormalities (especially of the epididymis and undescended testis) has been reported, but information on the fertility implications of these findings is not available. There is no evidence of an increased risk of testicular cancer. The analysis of all these informations should allow to bring up a policy to take into account these risks in the population.

Adult↗
PubMed1983

[Placental smears in a maternity ward. Importance of early diagnosis of neonatal bacterial infections caused by materno-fetal contamination].

Direct cytobacteriological investigation of the amniochorionic plate of the placenta has been used systematically in the Maternity Hospital as a test to detect amniotic infection. This test was practised on fresh placentae in the laboratory of Histology, preceding the examination of the placenta. The test gave, within 30 minutes of delivery, information about the presence of bacteria of fungi on the amniotic surface, their abundance and their morphology. The results of the placental smears were compared to the results of bacteriological cultures obtained from the placenta, the infant and occasionally the mother. The diagnosis of neonatal infection was established from clinical, biological and bacteriological criteria which were defined in advance. Two series are presented: the first concerns 2,514 cases selected in the delivery room over a period of 4 years for high risks infection, i.e. 1 in 6 of the 15,377 deliveries registered during this period. The rate of positive smears was 9%: 63% Gram positive, 17% Gram negative, and 20% mixed. The most common bacteriologically proven neonatal infections were streptococcus B (40%) and Escherichia coli (33%). The second is a prospective survey of 400 unselected consecutive cases observed during a period of 7 weeks: 1% of the smears were positive - and the test would have been justified in 1 in 5 cases. From these two surveys, it appears that placental smear is a good test to detect maternofetal contamination. The positive predictive value of the test is 80%. The negative predictive value is 98% and approaches 100% if cases where the mother received antibiotics before delivery are excluded.

Bacterial Infections↗
PubMed1983

[Registration of congenital malformations in Paris. Evaluation and perspectives of a study carried out under the auspices of the European Economic Community].

Since 1976 a registration of congenital malformations has been gradually set in Paris. At present it covers 95% of the births registered in this department which amount to 38,925 births in 1982. Since 1981, it has been extended to include malformations diagnosed during the first month of life in neonatal units in Paris, for residents in Paris, and also a register of therapeutic abortions for congenital abnormalities. It is part of the 17 registers which have been started on the initiative of the European Economic Community. The results of the frequency of different types of congenital malformation are given for the years 1978 to 1982. The value of this register as epidemiological information and the studies that have been carried out with a view to determining aetiology are discussed.

Congenital Abnormalities↗
PubMed1982

[Transfer of neonates in northern france. Factors of mortality (author's transl)].

An extensive study was undertaken in northern France from January 1st to May 31st 1978, concerning the transfer of neonates from maternity hospitals to specialized units. Analysis of 250 children whose birth weight was below 2,000 gm showed that several risk factors could be taken into account to reduce neonatal mortality in this area. Prematurity (22% children weighing less than 1,500 gm in those discharged alive, 54% in the dead), neonatal distress (36% versus 61% of resuscitation) hypothermia (7% versus 23% with temperature below 34 degrees 6 at the time of admission), the need for an other transfer (1% vs. 12%) seem to be features highly related with poor prognosis. This stresses the importance of the prevention of prematurity, of proper management of the babies in the maternity hospital, of the conditions of transport and of the choice of the neonatal unit.

France↗
PubMed1982

[Forms of care, health evaluation at 10 months, and maternal behavior].

The purpose of this survey was the comparison of 4 forms of day care: day care center, baby minder, care at home by the mother herself or care at home by someone else. A sample of 1,010 children, born to French mothers in a public hospital in Paris, was examined at a check-up clinic organized by National Social Security for 10 months old children. Home care by the mother herself was more frequent for mothers with primary level education or for families with 2 children or more; care at home by someone else was often chosen by families with high social level. The health and psychosocial and motor development of the children were not very different according to the type of day care. There was a higher frequency of acute respiratory tract infections and a lower weight gain for children in day care centers. Mothers whose children went to a day care center were more anxious about medical symptoms and more often called for a doctor.

Body Weight↗
PubMed1981

[Epidemiology of hypothyroidism due to congenital malformation of the gland: athyreosis or ectopic thyroid (author's transl)].

The neonatal characteristics of 322 cases of hypothyroidism due to congenital malformation of the gland --athyreosis or ectopic thyroid--were compared with a national sample of births (N = 11,373), and a sample of births in public hospitals in Paris (N = 12, 895), in order to see if genetic factors were involved in the etiology of the disease. The hypothesis of multifactorial inheritance has been especially studied. Factors which appeared compatible with a multifactorial etiology were: marked excess of females (74%); higher frequency of twins (3.4%), of maternal familial thyropathy (9.2% among the mothers), of familial cases of thyroid malformations (11 cases); higher frequency of associated malformations of multifactorial origin (5.4%). But this type of malformation was not more frequent among siblings and relatives of the studied cases; it is thus not possible to accept the hypothesis of multifactorial inheritance without reservation.

Adult↗
PubMed1979

[Severity factors of poisoning in children admitted to intensive care units].

From 1964 to 1976, 854 children were admitted with poisoning to three intensive care units in Paris. The severity of the condition has been assessed in terms of the patients received: 1. observation only (67%). 2. routine intensive care (27%). 3. very seriously ill (6%). At the time of discharge, 92% of children were normal, 3% had minor sequelae, 3% had major sequelae; 2% died. The outcome was closely related to the severity of the illness. The main factors affecting the severity were: 1. The nature of the ingested substance. Poisoning with Amanita phalloides was the most serious with a high mortality. Poisoning with domestic agricultural and industrial products were more often responsible for major sequelae, particularly affecting the oesophagus, than drugs. 2. The type of poisoning. This was related to the age of the child. Iatrogenic poisoning of infants and self poisoning by adolescents were more serious than accidental poisoning in toddlers. 3. The toxicity of the ingested dose. 4. The interval between ingestion and effective treatment. Although all the factors are interrelated, each factor has its own prognostic value.

Adolescent↗
PubMed1979

[Hormonal tests of pregnancy and congenital malformations (author's transl)].

I.N.S.E.R.M. has carried out two prospective inquiries centred on the evaluation of the teratogenic action of drugs on human beings. The first survey was between 1963 and 1969 and the second between 1975 and 1977 and they were carried out in maternity hospitals. The first test, which was carried out on 12,764 women, had shown no overall association between the use of hormonal tests for the diagnosis of pregnancy (oestrogens-progestogens) and congenital malformation in the infant. The second study, which was carried out on 3,451 women who were questioned in the same way, shows that there is an excessive number of newborn babies with malformations when the mothers took certain products (oestrogens-progestogens when the progestogen was a derivative of testosterone). The problem of a methodological bias is discussed and the results are interpreted in the light of epidemiological studies that have recently been carried out abroad.

Abnormalities, Drug-Induced↗