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Biomedical subjects

P Chauvin

Publications and source records attributed to P Chauvin.

At least 37 records · Page 2Linked to original sources
PubMed1997

A new out-patient care facility for HIV-infected destitute populations in Paris, France.

In France, the entire population theoretically has access to health coverage, but in fact a section of the poorest population does not. Institutions have therefore been set up to provide medical care for the destitute. The objectives of this study were to describe the social characteristics of the HIV-positive destitute population attending an out-patient clinic providing free health care for the destitute in a Paris University Hospital, to compare their clinical-epidemiological characteristics with those of non-destitute HIV-positive patients, and to evaluate the quality of their care. We performed a historical prospective study wherein a cohort of 115 HIV-positive destitute patients (defined as having no health coverage at their first consultation) was compared with a control cohort of 183 HIV-positive non-destitute patients attending the same clinic. Ninety-five per cent of the destitute patients had no stable employment, 32% had no source of income, 75% had no permanent residence and 27% were i.v. drug abusers. Fifty-nine per cent were foreigners, most of whom had legal residence papers and had been in France for more than 3 years. When comparing the control and the destitute groups, the latter had a three times greater risk of developing tuberculosis (RH = 3.2, CI 95% = [1.1-9.4]). Medical compliance, access to antiretroviral treatment and hospitalization were identical in both groups. No difference was observed in terms of occurrence of a new AIDS-related disease during follow-up when full-blown AIDS before entry, CD4 count at entry and transmission group were taken into account in multivariate analysis. From the moment that destitute patients attended this adapted medico-social facility, their access to care was the same as, if not better than, that of the other patients. The development of out-patient medico-social facilities for HIV-positive destitute patients must be a public health priority even for those countries theoretically providing generalized health coverage.

AIDS-Related Opportunistic Infections↗
PubMed1997

Monitoring the compliance of sentinel general practitioners in public health surveillance: which GPs persevere?

OBJECTIVES: This study was undertaken to develop a novel approach to measure compliance of general practitioners (GPs) in sentinel public health surveillance. More specifically, its purpose was to determine the characteristics in the SGP's profile which can be objectively associated with perseverance. METHODS: Since 1984, the French sentinel network has collected weekly data on eight communicable diseases, involving volunteer SGPs. In this study, 'compliance' was defined as the length of time during which a SGP complies with a given theoretical surveillance protocol. This left-censored variable was computed from individual SGP's connection time series. Kaplan-Meier method was used to estimate the compliances survival distribution for all the SGPs (1824 SGPs who have been part of the network, at one point, or another, since 1984). Using Cox regression model, a prospective survey on the 376 most recent recruits allowed us to select the characteristics associated with a longer compliance. Sensitivity analyses were carried out using the bootstrap method. RESULTS: According to the maximum number of silences allowed by the given theoretical protocol, median compliances varied between 11.7 (95% CI: 11.1-12.3) and 38.8 (95% CI: 35.7-40.7) months. In multivariate analyses we observed long compliances for SGPs whose main motivation for being involved in the network was an interest in epidemiology and SGPs with < or = 5 or > or = 20 years seniority. On the other hand, interest in local epidemiological surveys and previous experience with other surveillance networks were associated with short compliances. We found no statistical association between compliance and computing experience, having a medical secretary, a particular feeling of being a 'public health actor', or the desire to belong to a GPs' network. CONCLUSION: We have shown our longitudinal method to be an efficient tool for monitoring non-compliant SGPs with respect to given surveillance protocols. Furthermore, this approach allows us to select out of the SGPs' profile the characteristics which are associated with a longer compliance. This regression model could be further refined by extending the SGPs' profile. The additional variables to be taken into account in this profile could be identified through a complementary sociological approach. Our work addresses the question of understanding what determines the motivation of GPs to participate in public health surveillance. This question is essential if we hope to turn general practice information systems into genuine public health surveillance tools.

Adult↗
PubMed1997

Predictive risk factors of residual cholesteatoma in children: a study of 256 cases.

OBJECTIVE: This study aimed to determine which children are at risk of having residual cholesteatoma develop after initial surgery for either cholesteatoma or severe retraction pocket. This study aimed to identify the characteristics of each patient and assessing whether predictive factors exist to propose a well-guided therapeutic approach. DESIGN: This was a retrospective study. Mean follow-up period (after the last eradication intervention) was 42 months. PATIENTS: Two hundred thirty-one children (256 ears) with either cholesteatoma (n = 157) or severe retraction pockets (n = 99), both treated surgically, composed the patient group. METHODS STATISTICAL ANALYSIS: univariate analysis of event-free survivals (using log-rank test and Kaplan-Meier estimate) and multivariate analysis (using Cox regression model) of clinical history, surgical observations, residuals occurrence (using Kaplan-Meier's statistical method) were used. RESULTS: Posterior mesotympanum involvement, ossicular chain interruption after disease excision (and moreover combination of both), relative lack of experience of the surgeon, and presumed incomplete removal were identified as independent risk factors highly correlated with residuals' development (relative risks ranging from 2.02-4.84). Disease extension, type of process (cholesteatoma vs. retraction pocket), eventual surgical history, and surgical method initially used (closed or open) showed no such correlation. CONCLUSION: The identification of any of these factors should instigate a mandatory second-look procedure regardless of other initial surgical findings and of technique used. The authors propose to advance this procedure from 12 to 9 months when all these factors are found in one child.

Adolescent↗
PubMed1996

Correlation between polysialic-neural cell adhesion molecule levels in CSF and medulloblastoma outcomes.

PURPOSE: To quantify CSF levels of polysialic-neural cell adhesion molecule (PSA-NCAM) in patients with medulloblastoma (MB) metastasis, to assess the correlation with other diagnostic techniques (imaging and cytology) and clinical features, and to determine whether it is a suitable marker to monitor response to treatment and subsequent follow-up data. PATIENTS AND METHODS: PSA-NCAM levels were measured using a double-site enzyme-linked immunoadsorbant assay (ELISA) in 145 samples from 14 controls and 29 patients with MB. Clinical status of patients, imaging, and cytologic data were available at the time of each lumbar puncture. Medians and ranges for the 131 pooled PSA-NCAM concentrations were calculated for the MB versus the control groups, and for MB patients for normal versus abnormal groups at cytology or imaging, and for four clinical subgroups, respectively. For patients with MB, three PSA-NCAM measurements that corresponded to punctures performed during three time periods following surgery were selected. The kappa measure of agreement was calculated between normal and abnormal groups at cytology or imaging, and between groups of patients in remission and refractory, respectively. For the same phases, sensitivity and specificity of PSA-NCAM and cytology tests and their 95% confidence intervals (95% CIs) were computed. RESULTS: PSA-NCAM was never detected in control CSF. PSA-NCAM concentration medians were higher in CSF with metastatic cells or that corresponded to abnormal imaging than in the corresponding normal groups (P < .05). The PSA-NCAM concentration median was significantly higher (P < .05) in CSF from patients refractory to treatment or who relapsed than from patients in remission. Agreements between PSA-NCAM and clinical status and between PSA-NCAM and cytology were excellent during and after treatment. The sensitivity of PSA-NCAM test was always better than that of cytology, whereas its specificity was lower for phases that corresponded to more than 1 month following surgery. However, specificity was 100% for patients refractory to treatment or with relapse. CONCLUSION: PSA-NCAM measurement appears to be a new biologic marker of possible use in the management of patients with MB.

Biomarkers, Tumor↗
PubMed1996

[Management of bronchial infectious episodes in general medicine].

BACKGROUND: Acute bronchitis and chronic obstructive pulmonary disease exacerbations are frequent reasons for consultation with a general practitioner (GP). Since no consensus exists about the use of antibiotics in such indications and little is known about the use of pulmonary function tests in general practice, our objective was to describe GP's attitudes and prescription habits when faced with patients suffering from acute bronchitis (AB) or chronic bronchitis (CB) exacerbation. METHODS: The GPs participating in public health surveillance through the "réseau Sentinelles" (French Communicable Diseases Network) in March 1993 answered a postal questionnaire. This questionnaire collected their clinical attitude and prescriptions for 7 clinical cases of varying severity. RESULTS: 430 (94.7%) of the GPs answered the questionnaire. Of these more than 95% prescribed antibiotics in all the clinical cases, including for common acute bronchitis. Wide spectrum penicillins and macrolides were prescribed significantly less often as the past history increased in severity, whereas tetracyclins and oral cephalosporins were prescribed significantly more often in severe cases. Fluoroquinolones were nearly exclusively reserved for the treatment of advanced CB. Smoking cessation was systematically advised by the GPs. Faced with AB and a smoking history, 44.2% of the GPs prescribed a chest x-ray. In the case of repeat episodes of winter bronchitis, more than 70% of them evoked the diagnosis of CB. 98.% of the GPs had easy access to pulmonary function tests (PFTs) which 69.2% of the GPs prescribed as soon as CB was suspected. CONCLUSION: In the absence of a therapeutical consensus regarding bronchitis, antibiotics were prescribed virtually systematically. PFTs were not yet a routine gesture in general practice even though they were widely available and prescribed.

Acute Disease↗
PubMed1995

Early results of conventional versus two-portal endoscopic carpal tunnel release. A prospective study.

The authors compare in a prospective, randomized study the early outcome of carpal tunnel release using either a conventional palmar open release (n = 40) or a two-portal endoscopic release (n = 56). Both groups were similar. No statistically significant differences were found regarding pain, disappearing of paraesthesiae or time to return to work. However, better recovery of grip strength was observed in the endoscopic group at 1 and 3 months. No surgical complications were observed in either group.

Adult↗
PubMed1995

Attitude of French general practitioners to the public health surveillance of communicable diseases.

BACKGROUND: The attitude of general practitioners (GPs) to public health surveillance is not well documented, even though they furnish essential information, in particular for sentinel surveillance among the general population. METHODS: The attitude of 560 French GPs to the surveillance of 17 communicable diseases was researched. Half the GPs had previous experience in public health surveillance and the other half did not. Their motivation for belonging to a public health surveillance network and some of their demographic characteristics were also investigated. Their attitude was compared with an objective evaluation of public health surveillance priorities, based on 10 criteria. RESULTS: Primarily, GPs are interested in the surveillance of uncommon and serious diseases (HIV infection, tuberculosis, meningitis), and/or preventable ones (viral hepatitis, flu' syndrome, measles, sexually transmitted diseases), which coincides with the choices made by public health decision makers. The age of the GPs, their type of practice (urban/rural), and their participation (or not) in a surveillance network modify their priorities: in general the GPs' perception of the risks to which their patients may be exposed influences their choice of which diseases should be subject to surveillance in general medicine.

Adult↗
PubMed1995

[Epidemiology and prevention of measles in the United States: 30 years of vaccination].

Measles vaccine has been available and widely used in the United States for 30 years. During the first 20 years, the incidence of measles dramatically decreased and the Department of Health hoped that the disease would be eradicated from the United States by 1982. Yet, as early as 1970, some American epidemiologists started to doubt whether it would be possible to attain this goal with a single dose schedule. From 1989, many outbreaks have occurred in some inner-cities. This resurgence shows that the existence of small non-immune population groups is sufficient for a persistent and epidemic transmission of the disease. New control measures were proposed, and evaluated, to increase the vaccination coverage of these populations and to prolong the immunity of adolescents vaccinated in their early childhood. With 30 years experience, the description of the modifications of the epidemiological characteristics of measles following mass vaccination is useful for countries which became involved in such programmes more recently.

Adolescent↗
PubMed1995

[Predictive factors of residual cholesteatoma in children].

The decision on the appropriate surgical technique for treating cholesteatoma in children raises a number of controversial questions, most because of personal convictions rather than because of established data. We attempted to determine which patients are at risk of residual cholesteatoma in order to propose the most rational therapeutic strategy. A retrospective study of 250 children with cholesteatoma or severe retraction underwent surgery between 1986 and 1992. During this period 69 cases of residual cholesteatoma were recorded during a second intervention. After a mean follow-up of 33 months after the final operation, the Kaplan-Meier plot shows a rate of 31% and 34% at 3 and 5 years respectively. The univariate and multivariate (Cox regression) analysis was performed to search for a correlation between residual cholesteatoma development and past history including type of process involved, peroperative findings and surgical technique. Three factors were closely and independently related (p < 0.003) to residual cholesteatoma: invasion of the posterior middle ear, presence of ossicular erosion after excision and presumption of incomplete ablation. Inversely, age, surgical history, extension and nature of the process involved as well as surgical technique had no effect on development of residual cholesteatoma. Only one comparable study has been published where only ossicular erosion was found to be significant on multivariate analysis. The presence of one or more of the three of the factors mentioned above should lead to a second intervention, perhaps after a short delay, whatever the initial technique (open or closed).

Child↗
PubMed1994

Constitution and monitoring of an epidemiological surveillance network with sentinel general practitioners.

The Réseau National Télé-informatique de surveillance et d'information sur les Maladies Transmissibles (RNTMT) (French communicable diseases computerised surveillance network) comprises a network of sentinel general practitioners (SGP). These benevolent volunteers are responsible for the weekly epidemiological surveillance. Since its creation, 1,700 SGPs have participated in the RNTMT, representing a total of more than 120,000 connections to the RNTMT telematic service center. The principal motivation of these benevolent SGPs was to 'actively participate in public health', although only a minority of them (17.6%) had any training in this field. Such a system, based on the benevolent and voluntary activity of SGPs, requires a good understanding of SGPs' attitudes towards epidemiological surveillance in general and the tool used, in order to quantitatively and qualitatively follow their participation and to provide regular and useful feedback to the surveillance actors.

Attitude of Health Personnel↗
PubMed1989

[Immediate hypersensitivity to latex: a new problem. Future perspectives].

From a series of 30 cases of immediate allergy to the latex of Hevea Brasiliensis, the authors recall the principal clinical aspects of these allergies, specially contact urticaria (during the use of surgical or cleaning gloves) and systemic anaphylactic accidents, essentially the anaphylactic shock during surgical procedures. They mention the diagnostic procedures; skin tests and measurement of specific IgE (RAST). They show the interest of biological research, yielding to the identification of the allergens of the latex in order to obtain non allergenic latex. Such a result would be of interest to limit the number of the accidents in a period where the use of rubber protective material is much larger/gloves and condoms).

Dermatitis, Contact↗
PubMed1986

Conditioned taste aversion and conditioned drinking: two independent and opposing effects of 5-hydroxytryptophan?

Four experiments were carried out to examine the effects of 5-HTP in a conditioned taste aversion (CTA) paradigm. Using two-choice tests to measure the CTA, administration of 5-HTP following consumption of a novel flavour caused aversions to saline and saccharin solutions. In single-choice tests 5-HTP reduced consumption of saccharin, sugar cubes and beef-flavoured stock cubes, but only reduced saline consumption if animals had been pretreated with the 5-HTP decarboxylase inhibitor benserazide or the 5-HT receptor antagonist xylamidine, both of which act peripherally. Benserazide did not attenuate the CTA in any experiment. The results are interpreted in terms of two competing behavioural effects of 5-HTP: a centrally-mediated CTA and a peripherally-mediated conditioned drinking response.

5-Hydroxytryptophan↗