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N Mamelle

Publications and source records attributed to N Mamelle.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Who delivers where? Who is born where? Analysis of the 1997-1998 AUDIPOG Sentinel Network].

OBJECTIVE: The purpose of this study was to describe the care level, legal status and size of the maternity units where deliveries take place in France according to risk level for mother and infant. We analyzed the 1997-1998 data to better implement the network's perinatal policy. MATERIAL: and methods. Our standardized sample included 4200 single births in 1997 and 3650 in 1998 collected by the French Sentinel Network after applying a sample rectification technique to offset the methodological problems created by the volunteer nature of the sample population. Distribution of care level, legal status and size of the maternity unit where deliveries took place were recorded according to the risk level of the patients. RESULTS: In 1997-1998, 22% of pregnant women delivered in level III maternity units and 33% in level II units. Twenty percent of the deliveries took place in level II maternity units with less than 1500 deliveries per year. During this period, women with diabetes or hypertension delivered more often in level III units (31% and 27% respectively) than women in the general population. This was not true for women with a previous perinatal death (23%). Inversely, births of infants before 33 weeks gestation or weighing less than 1500 g occurred more often in level III maternity units (55% and 59% respectively) than in the general population. Twenty-seven percent of the infants requiring neonatal transportation were born in level I maternity units. For 'low risk' mothers, delivery occurred more often in level I maternity units (more than 50%) or in small maternity units with less than 1000 deliveries per year (45%) than for the general population (45% and 36% respectively). CONCLUSION: These data obtained from the Sentinel Network provide precise information on where deliveries occur in France. These data will be useful for implementing the network's perinatal policy. They will also provide a means of following referral practices in the future.

Birth Rate↗
PubMed1999

Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.

BACKGROUND: The Lyon Diet Heart Study is a randomized secondary prevention trial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction. An intermediate analysis showed a striking protective effect after 27 months of follow-up. This report presents results of an extended follow-up (with a mean of 46 months per patient) and deals with the relationships of dietary patterns and traditional risk factors with recurrence. METHODS AND RESULTS: Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or the preceding plus major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events requiring hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced (14 events versus 44 in the prudent Western-type diet group, P=0.0001), as were CO 2 (27 events versus 90, P=0.0001) and CO 3 (95 events versus 180, P=0. 0002). Adjusted risk ratios ranged from 0.28 to 0.53. Among the traditional risk factors, total cholesterol (1 mmol/L being associated with an increased risk of 18% to 28%), systolic blood pressure (1 mm Hg being associated with an increased risk of 1% to 2%), leukocyte count (adjusted risk ratios ranging from 1.64 to 2.86 with count >9x10(9)/L), female sex (adjusted risk ratios, 0.27 to 0. 46), and aspirin use (adjusted risk ratios, 0.59 to 0.82) were each significantly and independently associated with recurrence. CONCLUSIONS: The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approaches are warranted.

Aged↗
PubMed1999

[Growth curves from birth to 6 years of age: growth in weight, height and cranial circumference according to sex].

UNLABELLED: The growth supervision of children using growth curves is a widespread and useful tool in general pediatric practice. In France the latest reference curves are rather ancient, therefore it seemed to us interesting to re-examine some growth parameters and to compare them to the current reference data. PATIENTS AND METHODS: The studied sample was composed of 7,000 children from the Rhône-Alpes region in France who were seen for a school health check-up. Anthropometric measurements (35,000) related to weight, height and cranial circumference of these children aged from 0 to 6 were selected from their health booklets. Centile curves for these three variables were drawn from these measurements using the LMS method, which is specifically suited to these types of data. RESULTS: If height and cranial circumference can be considered as normally distributed, weight is markedly skewed to the right, reflecting a high prevalence of children with heavy weight. Comparison with current references data shows more or less similar results for weight, height and cranial circumference: the medians and the 2.5 centile are constantly higher in our sample than those of the reference data (the discrepancy increasing with age). The differences are more important regarding the part of the distribution which concerns the highest values: overall, the 90th centile of our distribution corresponds rather closely to the 97.5th one of the current reference data. Thus, at 6 years of age, the 97.5th centile of the reference weight distribution for girls is 23,400 kg, while it is estimated at 27,770 kg in our sample. One should take in account the different characteristics of the two studies to interpret these differences. CONCLUSION: The aim and use of such growth curves is discussed, together with recent computer applications in this field.

Age Factors↗
PubMed1998

Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate.

BACKGROUND: The Mediterranean dietary pattern is thought to reduce the risk of cancer in addition to being cardioprotective. However, no trial has been conducted so far to prove this belief. METHODS: We compared overall survival and newly diagnosed cancer rate among 605 patients with coronary heart disease randomized in the Lyon Diet Heart Study and following either a cardioprotective Mediterranean-type diet or a control diet close to the step 1 American Heart Association prudent diet. RESULTS: During a follow-up of 4 years, there were a total of 38 deaths (24 in controls vs 14 in the experimental group), including 25 cardiac deaths (19 vs 6) and 7 cancer deaths (4 vs 3), and 24 cancers (17 vs 7). Exclusion of early cancer diagnoses (within the first 24 months after entry into the trial) left a total of 14 cancers (12 vs 2). After adjustment for age, sex, smoking, leukocyte count, cholesterol level, and aspirin use, the reduction of risk in experimental subjects compared with control subjects was 56% (P=.03) for total deaths, 61% (P=.05) for cancers, and 56% (P=.01) for the combination of deaths and cancers. The intakes of fruits, vegetables, and cereals were significantly higher in experimental subjects, providing larger amounts of fiber and vitamin C (P<.05). The intakes of cholesterol and saturated and polyunsaturated fats were lower and those of oleic acid and omega-3 fatty acids were higher (P<.001) in experimental subjects. Plasma levels of vitamins C and E (P<.05) and omega-3 fatty acids (P<.001), measured 2 months after randomization, were higher and those of omega-6 fatty acids were lower (P<.001) in experimental subjects. CONCLUSIONS: This randomized trial suggests that patients following a cardioprotective Mediterranean diet have a prolonged survival and may also be protected against cancer. Further studies are warranted to confirm the data and to explore the role of the different lipids and fatty acids in this protection.

Diet↗
PubMed1998

[The importance of lipoprotein(a) as a predictive factor of coronary atherosclerosis].

OBJECTIVE: The predictive value of lipoprotein(a), Lp(a), for coronary artery disease, is strongly suspected, though unproven. The normal serum level is 0.3 g/l. We searched for correlations between serum Lp(a) levels and coronary artery disease in a population of patients hospitalized in a general cardiology unit. METHOD: Serum Lp(a) was assayed in all patients consecutively hospitalized during 1994 in the Valence hospital cardiology unit. Two groups were distinguished: patients with coronary artery disease (n = 444) and those presumed free of coronary artery disease (n = 555). Coronography were performed when required. Serum Lp(a) levels were compared for the following variables: age, sex, smoking habits, blood pressure, total cholesterol, HDL and LDL-cholesterol, triglycerides and apolipoproteins A1 and A2. Univariate, then multivariate analysis were performed first patients of all ages, then for those aged more and less than 60 years. RESULTS: Univariate analysis demonstrated that Lp(a) > 0.3 g/l was associated with coronary heart disease (OR = 1.33; p = 0.03), although this correlation was no longer significant after adjustment for other known risk factors (OR = 1.28; p = 0.07), except in the subgroup of patients over 60 years of age (OR = 1.37; p = 0.04). CONCLUSION: There was a non-significant trend favoring an association between serum Lp(a) level > 0.3 g/l and the development of coronary artery disease.

Adult↗
PubMed1998

[The Association for Computerized Medical Records Users in Perinatology, Obstetrics and Gynecology sentinel network for maternity hospitals. II. Changes in practices and results. 1994-1997].

OBJECTIVE: The observation of medical practices and the analysis of outcome as a function of practices are essential today for monitoring and improvement of the healthcare system. The AUDIPOG Sentinel Network provides a tool for the self-assessment of practices that enables each unit to assess its position relative to a group of maternity wards. MATERIAL AND METHODS: Pooling of individual data about births that occurred during the month of January each year in about a hundred volunteer wards allows assessing perinatal health indicators and following their evolution over time. A sample rectification technique, adapted from the quota method, allows offsetting the methodological problems created by volunteering and assessing perinatal indicators at the national level. RESULTS AND CONCLUSION: The analysis of data collected from 1994 to 1997 indicates a number of trends, even in the short run, and justifies that a real practice monitoring and assessment tool be set up in order to improve perinatal health.

Adult↗
PubMed1998

[Relations between blood pressure at 3-4 years of age and body mass at birth: a population-based study].

BACKGROUND: To study the association between blood pressure of 3-4 year-old children and birth corpulence estimated from birth ponderal index (body weight/length3), a school based, cross sectional survey was conducted in the Rhône department. METHODS: 1296 randomly selected children were examined at the time of a school medical visit. Physicians abstracted information on pregnancy and measurements at birth from the Child Health Handbook and from parents interview. Systolic and diastolic blood pressure measurements were carried out by using an automated oscillometric device. RESULTS: Multiple linear regression analyses revealed an inverse association between systolic blood pressure and birth ponderal index (converted into Z-score adapted to gestational age), this was obtained after adjustment for current length and for current body mass index (body weight/length2--converted into Z-score), for child emotion and for linked study factors. Such a model provided an assessment of regression coefficient: -0.67 mmHg/birth ponderal index Z-score unit (95% confidence interval: -1.24 to -0.11). So, estimation of systolic blood pressure difference between two 3-4 year-old children, one at -2 SD birth ponderal index and another at +2 SD, was obtained: 2.6 mmHg. No evidence of an association between diastolic blood pressure and birth ponderal index was observed. CONCLUSION: In this large population with a limited range of age, our results show that, at age 3-4 years, systolic blood pressure is higher with lower birth ponderal index, suggesting that thinness at birth might be a risk factor of hypertension in adulthood.

Age Factors↗
PubMed1998

[Prevention of prematurity by psychotherapeutic management].

The establishment of the mother-baby relationship is often disturbed in case of preterm birth. Clinical observations and epidemiological studies have highlighted the existence of a relationship between psychological factors and preterm birth. Therefore, a psychological support may have a beneficial effect in order to prevent preterm delivery. The aim of this study was to assess the effectiveness of psychological support in pregnant women with symptoms of preterm labor, which is considered as a somatic expression of psychological difficulty related to pregnancy. The study, which involved two cohorts of women, hospitalized or not, identified during two successive periods in the same maternity ward, included 309 women in the experimental group and 323 in the control group. The women in the control group were followed up according to the usual therapeutic procedures, whereas additional psychological support was offered to the experimental group. 92% of the women who met the psychologist accepted the psychological support. The analysis, conducted "in intent to treat", showed a significant decrease in the preterm birth rate in the experimental group (12%) compared with the control group (26%). This study confirms the feasibility of this kind of intervention and the effectiveness of psychological support on the risk of preterm delivery. The interviews help the women regain confidence in their own capacity to fulfil their pregnancy.

Female↗
PubMed1997

Prevention of preterm birth in patients with symptoms of preterm labor--the benefits of psychologic support.

OBJECTIVE: The aim of this study was to assess the effectiveness of psychologic support against preterm delivery in pregnant women with symptoms of preterm labor. STUDY DESIGN: The study, which involved two cohorts of women identified during two successive periods in the same maternity ward, included 309 women in the experimental group and 323 in the control group. The women in the control group were followed up according to the usual therapeutic procedures, whereas additional psychologic support was offered to the experimental group. The analysis, conducted "in intent to treat," was based on the estimation of the relative risk by a multivariate logistic regression adjusting for confounding factors. RESULTS: A significant decrease in the preterm birth rate was observed in the experimental group (12.3%) compared with the control group (25.7%), with an adjusted relative risk of 0.37 (95% confidence interval 0.30 to 0.47). CONCLUSION: This study confirms the feasibility of this kind of intervention and the effectiveness of psychologic support on the risk of preterm delivery.

Cohort Studies↗
PubMed1997

[Is it possible to improve sleep in children? A research on health education in nursery schools].

An educational project in nursery schools was carried out with the aim to improve children's sleep. Its effectiveness was tested in terms of awareness of families and length of sleep of children. The method was a prevention trial based on the random division of classes of 3-year old into two groups (intervention group and control group) comprising children enrolled in nursery schools in the Rhône region (France) in 1992. The project, lasting 2 years, relied on physicians from the community (Maternal, Child Health Service and School Health Service), their role being to mobilise the teaching teams, distribute specific teaching tools and raise awareness of families to respect the sleep patterns of children, during routine medical examinations. The study was carried out in 140 nursery schools with 1,500 children in each group. The evaluation was based on the application of a logistical regression model taking potentially confounding factors into account, and an analysis in sub-groups in order to demonstrate the effectiveness of intervention on particularly exposed groups. The results show: 1) the feasibility of such an intervention among nursery school children on a large scale, 2) the effectiveness of the action, with a reduction of the risk of "poor knowledge" among parents (OR = 0.76), particularly in urban areas, and a reduction in the risk "short nights" in the sub-group of children who had " little sleep at 3 years" in low social class families (OR = 0.50).

Child, Preschool↗
PubMed1997

Control of bias in dietary trial to prevent coronary recurrences: The Lyon Diet Heart Study.

BACKGROUND AND OBJECTIVES: A major limitation of dietary trials is that double blind design is not feasible. These trials are therefore prone to biases. The Lyon diet heart study is a single-blind secondary prevention trial to test the hypothesis that a Mediterranean-type of diet may prevent recurrences after a first myocardial infarction. A surprising 73% reduction of the risk of new major cardiac events was observed in the experimental group. For this reason, it is important to describe the methods used in the trial. We now report our techniques to randomize the patients, to change their diet and to control for possible bias, in particular any investigator or attending physician bias. DESIGN: In this dietary trial, a specific design was used to recruit and randomize the patients without informing them and their physicians that they were participating in a comparative trial. The attending physician bias was evaluated by studying drug usage and the investigator bias by constructing a questionnaire from which specific scores were used to evaluate (1) how the patients appreciated their participation in the study and (2) whether this participation resulted in significant changes in their way of living. SUBJECTS: 605 survivors of a first myocardial infarction were randomized into either a control or a Mediterranean group. RESULTS: The two randomized groups were similar for all the variables of prognosis. Drug usage was not significantly different between groups, suggesting that there was no major attending physician bias. Analyses of the appreciation scores and of the change score did not detect any significant investigator bias. CONCLUSIONS: Although the study cannot be completely shielded from minor biases, the data presented here provide evidence that the dietary modifications per se were protective, not other (including psychosocial) changes resulting from the participation to the trial.

Adrenergic beta-Antagonists↗
PubMed1997

Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France.

PURPOSE: To define the role of a 10-Gy boost to the primary tumor in the conservative treatment of early infiltrating breast carcinoma treated by limited surgery and radiotherapy. PATIENTS AND METHODS: Between 1986 and 1992, 1,024 women with early breast carcinoma (< or = 3 cm in diameter) were treated by local excision, axillary dissection, and conventional 50-Gy irradiation given in 20 fractions over 5 weeks and then randomly assigned to receive either no further treatment or a boost of 10 Gy by electrons to the tumor bed. The median follow-up time was 3.3 years as of September 1994. The occurrence of telangiectasia was reported, and the patients were asked to evaluate the cosmetic result. RESULTS: At 5 years, 10 patients of 521 who had received the boost (Kaplan-Meier estimate of local relapse rate, 3.6%) and 20 of 503 who had received no further treatment (Kaplan-Meier estimate of local relapse rate, 4.5%) had developed a local recurrence (P = .044). After adjustment for the main prognostic variables, the relative risk was still significantly lower for the boost group (0.3; range, 0.12 to 0.95). The boost group had a higher rate of grade 1 and 2 telangiectasia (12.4% v 5.9%), but no difference was seen between the two treatment arms in the self-assessment score for the cosmetic result. CONCLUSION: Delivery of a boost of 10 Gy to the tumor bed after 50 Gy to the whole breast following limited surgery significantly reduces the risk of early local recurrence, with no serious deterioration in the cosmetic result. Additional follow-up evaluation will be required to assess the long-term results.

Adult↗
PubMed1997

Mass screening programs for breast cancer in France--average values of assessment criteria.

Breast cancer is the most common cancer in women worldwide. Many studies have been performed worldwide to assess the effectiveness of screening in terms of reduced mortality due to breast cancer. Since the end of 1989, 10 breast cancer mass screening programs using mammography have been carried out in France under the sponsorship of the National Fund for Health Prevention, Education, and Information (FNPEIS) from the National Health Insurance of Salaried Workers (CNAMTS). These 10 campaigns, which are on a district scale, are organized according to variable methods and are assessed using a common procedure. Four groups of criteria are measured in this procedure, which investigates the impact, quality, effectiveness, and costs of screening programs. The average and extreme values of each criterion as calculated from the campaigns are presented in this paper. In order to enlighten the judgment on the French results, a comparison with the international standards in force and with the results of foreign screening programs is proposed.

Aged↗
PubMed1997

Use of mammography as a breast cancer screening tool in six districts in France.

Mass screening programs to detect breast cancer are currently under way in many countries. In France, several districts have been running mammographic screening programs since 1989. A survey was conducted in five of these districts and in a sixth district where no screening program was implemented. Using a self-addressed questionnaire mailed to a sample of 1500 women aged over 20 years, the survey was aimed at assessing women's use of mammography as well as their knowledge and perception of mammographic breast cancer screening. According to district, the compliance of the women replying to the questionnaire ranged from 72 to 82%. The proportion of women who had at least one mammography during their life ranged from 41 to 54%, according to district. The percentage of women aged 50 to 69 who had one mammography within 3 years before the survey ranged from 57 to 78% in the experimental districts and was only 48% in the control district. In all districts, women did not know exactly at what age it is recommended to start screening and with what periodicity, but, when invited to do so, they were satisfied with the program and intended to participate again.

Adult↗
PubMed1997

[Mass screening programs for breast cancer in France. Comparative evaluation].

OBJECTIVE: The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers. MATERIAL AND METHODS: The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program). RESULTS: The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force. CONCLUSION: The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.

Breast Neoplasms↗
PubMed1996

Effect of a mediterranean type of diet on the rate of cardiovascular complications in patients with coronary artery disease. Insights into the cardioprotective effect of certain nutriments.

OBJECTIVES: We sought to describe the various cardiovascular complications that occurred in the Lyon Diet Heart Study (a secondary prevention trial testing the protective effects of a Mediterranean type of diet), to analyze their relations with the associated drug treatments and to gain insights into the possible mechanisms underlying the beneficial effects of certain nutriments. BACKGROUND: Dietary habits are implicated in coronary heart disease, and the traditional Mediterranean diet is thought to be cardioprotective. However, the exact mechanisms of this protection are unknown. METHODS: A total of 605 patients (303 control subjects and 302 study patients) were studied over a mean period of 27 months. Major primary end points (cardiovascular death and nonfatal acute myocardial infarction), secondary end points (including unstable angina, stroke, heart failure and embolisms) and minor end points (stable angina, need for myocardial revascularization, postangioplasty restenosis and thrombophlebitis) were analyzed separately and in combination. RESULTS: When major primary and secondary end points were combined, there were 59 events in control subjects and 14 events in the study patients, showing a risk reduction of 76% (p < 0.0001). When these end points were combined with the minor end points, there were 104 events in control subjects and 68 events in the study patients, giving a risk reduction of 37% (p < 0.005). By observational analysis, only aspirin among the medications appeared to be significantly protective (risk ratio after adjustment for prognosis factors 0.45; 95% confidence interval 0.25 to 0.80). CONCLUSIONS: These data show a protective effect of the Mediterranean diet. However, the risk reduction varied depending on the type of end point considered. Our hypothesis is that different pathogenetic mechanisms were responsible for the development of the various complications. It is likely that certain nutriments characteristic of the Mediterranean diet (omega-3 fatty acids, oleic acid antioxidant vitamins) have specific cardioprotective effects.

Aspirin↗