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PubMed1995

Mortality amongst Paris fire-fighters.

This paper is the first mortality cohort study undertaken in France to examine the association between fire-fighting and cause of death. The cohort investigated in this study consisted of 830 male members of the Brigade des sapeurs-pompiers de Paris (BSPP). These professional had served for a minimum of 5 years on 1 January 1977. They were monitored for a 14 year period, finishing 1 January 1991. When compared to the average French male, the Paris fire-fighters were found to have a far lower overall mortality (SMR = 0.52 [0.35-0.75]). None of the cause specific SMRs were significantly different from unity. However a greater number of deaths than expected was observed for genito-urinary cancer (SMR = 3.29), digestive cancer (SMR = 1.14), respiratory cancer (SMR = 1.12) and 'cerebrovascular disease' (SMR = 1.16). The low overall SMR observed was consistent with the healthy worker effect. As for cause specific SMRs, they will be confirmed or invalidated by a further analysis as the follow-up of this cohort is being carried on.

Adult↗
PubMed1997

MIRIAM: the PACS project in Paris: overview and implementation.

In this article the authors describe the Management Informatique de la Radiologie et de l'Imagerie Médicale (MIRIAM) major picture archiving and communication system (PACS) project in Paris, France. The Assistance Publique of Paris, France is a healthcare provider and took the initiative to start the largest PACS program in Europe to date. The MIRIAM project will start in 1997 and will be used in different, consecutive phases. A consortium of several companies is in charge of the implementation. Thirty-three hospitals with 54 imaging departments will be integrated in one system.

Computer Communication Networks↗
PubMed2002

Psychiatric disorders in Sardinian immigrants to Paris: a comparison with Parisians and Sardinians resident in Sardinia.

BACKGROUND: The aim of the present study was to compare the prevalence of ICD-10 psychiatric disorders in a community sample of subjects of Sardinian origin resident in Paris (here "immigrants"), of the general Parisian population ("Parisians") and of Sardinians resident in Sardinia ("Sardinians"). METHODS: The sample of immigrants was obtained by contacting a fifth of all households with a Sardinian surname in Paris telephone directories. The other samples have already been partially described in previous studies. All subjects were interviewed using the CIDIS, a shortened version of the structured WHO interview CIDI. RESULTS: High or very high response rates were achieved in all studies. The final sample sizes were: 153 immigrants, 2,260 Parisians and 1,040 Sardinians. Immigrants showed high rates of depressive disorders, as did Parisians, and high rates of anxiety disorders, as did Sardinians. The immigrants' offspring (second-generation immigrants) seemed to be particularly at risk for depression, drug-abuse and bulimia. Elderly Sardinians who had returned to Sardinia after a long period of emigration showed an increased risk of dysthymia. The presence of a confidential relationship had a protective effect. CONCLUSIONS: The results are consistent with previous findings which suggest a greater risk of anxiety disorders in Southern Europe and of depression in Northern European countries. Immigrants in this study seem to present a particularly unfavourable pattern of mental disorders compared to both origin and host populations. The role of social support, use of mental health services and social conditions of second-generation immigrants should be analysed in greater depth.

Adult↗
PubMed1997

The T705I mutation of the low density lipoprotein receptor gene (FH Paris-9) does not cause familial hypercholesterolemia.

Familial hypercholesterolemia (FH) is a genetic disease caused by mutations in the low-density lipoprotein receptor gene. Among the more than 200 mutations so far identified, the T705I substitution in exon 15, designated FH-Paris 9, has been previously described as an FH-causing mutation. During the course of denaturing gradient gel electrophoretic screening of exon 15 we have identified the T705I single-base substitution not only in an FH family but also in a control, normocholesterolemic population. Therefore, we conclude that FH-Paris 9 is a missense mutation not associated with FH.

Adult↗
PubMed1996

[Claims related to anesthesia at the University Hospitals of Paris].

OBJECTIVE: To evaluate the number and the reason of anaesthesia-related malpractice claims in university hospitals of Paris. STUDY DESIGN: Retrospective study. METHODS: From December 1977 to December 1994, 1,185 claims, originating from all departments, dental trauma excluded, were reviewed and classified by one medical expert. They were analyzed with regard to type of activity responsible for the damage. RESULTS: Out of the 789 claims resulting from surgical activity, 41 were directly anaesthesia-related. The most frequent problems were the neurological complications of spinal or epidural anaesthesia (n = 10), and the consequences of difficult intubation or aspiration of stomach contents (n = 5). A series of 19 damages due to posture was difficult to classify as surgery- or anaesthesia-related. In the 41 anaesthesia-related claims, an indemnification was alloted to seven (5.2%). This rate was similar to that for surgical activity-related claims. However, the amount of the anaesthesia-related malpractice compensations was equivalent to 26% of those alloted to the surgery-related claims and to two-thirds of the indemnifications equal to or above 2,000,000 FF. CONCLUSIONS: There are few anaesthesia-related claims in the Paris university hospitals. Only few claims result in a compensation. By contrast, when a indemnification is alloted, its amount is very high. Locoregional anaesthesia seems to be at a higher risk for malpractice claims.

Anesthesia↗
PubMed2004

Paris heat wave and oligohydramnios.

OBJECTIVE: The objective of this study was to determine the frequency of oligohydramnios in term pregnancies during the Paris heat wave of 2003 (August 4-14). STUDY DESIGN: A comparison of this frequency to a historical control group examined during the same period in 2002. RESULTS: The frequency of oligohydramnios in normal term pregnancies was 17.5% during the heat wave that affected Paris in August 2003. CONCLUSION: This frequency was substantially higher than the rate of oligohydramnios in normal term pregnancies in August 2002 (4.4%).

Cohort Studies↗
PubMed2004

[Survey on the use of mannitol in prehospital care in Paris area].

OBJECTIVE: To evaluate the use of mannitol in prehospital care in Paris area. STUDY DESIGN: Survey using telephone interviews. METHODS: Emergency physicians on duty in the 37 emergency departments in charge of prehospital care in Paris area were called by one investigator. They were asked to answer a questionnaire about their own use of mannitol in the prehospital setting. RESULTS: Ninety-six questionnaires were recorded. Physicians were anaesthesiologists (9%) or emergency physicians (87%). In three departments, mannitol was not available in the ambulances. Thirty-five per cent (n = 34) reported no use of mannitol and 17% (n = 16) just once. Fourteen physicians (15%) did not want to use it. The reasons for not using mannitol were lack of knowledge about efficacy for five, need for previous brain imaging for seven or neurosurgeon's agreement before using mannitol for three. For those who had already used mannitol or were ready to use it, the main indication was increased intracranial pressure with clinical signs of brain herniation after severe brain injury for 92% of physicians. Thirty-one % reported not knowing the dose of mannitol, 33% having a memorandum immediately available and among those who answered the question, 63% gave a value compatible with guidelines. CONCLUSION: A significant percentage of physicians tacking part in the French prehospital care system, do not follow published guidelines on the use of mannitol. Actions improving implementation of those guidelines should be supported.

Ambulances↗
PubMed2005

Decrease of atmospheric deposition of heavy metals in an urban area from 1994 to 2002 (Paris, France).

Total atmospheric deposition, i.e. both wet and dry ones, was sampled during three different sampling periods between 1994 and 2002. The aim of this study is to determine the temporal variation of the atmospheric deposition fluxes of four heavy metals (Cd, Cu, Pb and Zn) in an urban area (Paris region, France). The global pattern shows a decrease of the fluxes for most of elements during this period. Indeed, the atmospheric deposition fluxes measured in 2001-2002 were lower than those measured during the 1994-1997 period by factors reaching 16, 2.5, 4 and 7.5 at Créteil and 7, 1, 6 and 4.5 at Chatou for Cd, Cu, Pb and Zn, respectively. At the Paris site, the decreasing factors were 2.5 and 3 for Cd and Pb, respectively while Cu and Zn fluxes were nearly similar during the whole studied period.

Air Pollutants↗
PubMed2006

Skin lightening and its complications among African people living in Paris.

BACKGROUND: Complications caused by skin lightening practices have not been systematically studied in Europe. OBJECTIVE: Our aim was to assess the complications of skin lightening among people of African descent living in Paris. METHODS: This was a descriptive study. All patients presenting with complications from skin lightening procedures underwent a complete clinical examination and were questioned about their practice. RESULTS: Forty-six patients from various African countries (39 women, 7 men) presented with skin changes suggestive of side effects from skin lightening practices. The complications seemed mainly related to the use of clobetasol and hydroquinone. LIMITATIONS: The selection bias does not allow assessment of uncomplicated skin lightening. CONCLUSION: Complications arising from skin lightening practices represent a significant health problem for people of African descent living in Paris.

Adrenal Insufficiency↗
PubMed2004

Preliminary report on AED deployment on the entire Air France commercial fleet: a joint venture with Paris XII University Training Programme.

The positive effect of early defibrillation on survival from cardiac arrest has been demonstrated. We describe the use of AEDs over 1 year following the training of flight attendants. Air France and the University of Paris XII together designed a 1 year training programme for 14000 flight attendants. The university emergency departments (SAMU) provided 250 instructors. AEDs training and certification was conducted for crew members between November 2001 and November 2002. By January 2003, all aircraft were fully equipped with AEDs. All cases of cardiac arrest that occurred during the study were reviewed comprehensively. Comments from the crew were collected. Twelve cardiac arrests were reported between November 2002 and November 2003 out of 4194 cases of emergency care delivered to passengers. Shock treatment was advised initially in 5/12 cases. The survival rate after in-flight cardiac arrest was 3/12. The survival rate at discharge from hospital following in flight shock was 2/5. No complications arose from the use of AEDs. Training by professionals gave the flight attendants confidence and allowed for the survival of two young passengers. Our study highlights the ability of flight attendants to give better onboard care for the future. The next step is to consolidate the network between in-flight care and the medical dispatch centre in Paris.

Adult↗
PubMed2005

Short-term variability of dissolved trace element concentrations in the Marne and Seine rivers near Paris.

The concentrations of dissolved trace elements (Li, B, Mn, Cu, As, Rb, Sr, Mo, Cd, Ba, Pb) in the Marne and Seine rivers in the Paris urban area were monitored over a 2-year period. The resulting data indicated moderate contamination of waters by the most toxic elements (Cu, As, Cd and Pb). The River Marne upstream and the River Seine downstream of the city of Paris displayed similar concentrations. However higher fluxes of trace elements were observed in the Seine than in the Marne due to their different discharges. Li, B, Rb, Sr and Ba concentrations were correlated with river discharge and concentrations were higher during high river flow. This was interpreted as a dilution by discharge from a major natural or anthropogenic source. Mn, Cu, Mo, Cd and Pb concentrations were not correlated with discharge. Dissolved Mn, Cu and Cd increased rapidly in summer, whereas the concentration of Mo decreased. These variations were attributed to redox processes. During summer when the dissolved oxygen concentrations decrease, Mn, Cu, Cd and Pb are released into solution whereas Mo is immobilised. Like metals, variations in arsenic contents were not linked with discharge. Its similarity with phosphate distribution suggests similar controls involving phytoplankton uptake and release from sediments through organic matter mineralization.

Environmental Monitoring↗
PubMed2006

Geostatistical assessment of Pb in soil around Paris, France.

This paper presents a survey on soil Pb contamination around Paris (France) using the French soil monitoring network. The first aim of this study is to estimate the total amount of anthropogenic Pb inputs in soils and to distinguish Pb due to diffuse pollution from geochemical background Pb. Secondly, this study tries to find the main controlling factors of the spatial distribution of anthropogenic Pb. We used the technique of relative topsoil enhancement to evaluate the anthropogenic stock of Pb and we performed lognormal kriging to map Pb regional distribution. The results show a strong gradient of anthropogenic stock of Pb around the urban Paris area. We estimate a total amount of anthropogenic stock of Pb close to 143,000 metric tons, which corresponds to an average accumulation of 5.9 t km(-2). Our study suggests that a grid-based survey can help to quantify diffuse Pb contamination by using robust techniques of calculation and that it might also be used to validate predictions of deposition models.

Environmental Monitoring↗
PubMed2001

Evidence of pre-industrial air pollution from the Heads of the Kings of Juda statues from Notre Dame Cathedral in Paris.

Pollution originating from wood combustion characterised the urban atmospheres of the past and led to the formation of thin grey crusts on the surface of the stone of monuments. The grey crusts discovered on the Heads of the Kings of Juda statues, which adorned the facade of Notre Dame in Paris from the 13th century until 1792, constitute a material record of the effects of this ancient air pollution. The height at which the statues stood suggests that the effect was not the result of a point phenomenon, but was caused by a generalised pollution of the Paris atmosphere at the time.

Air Pollution↗
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↗
PubMed1999

[Coincidental outbreaks of rotavirus and respiratory syncytial virus in Paris: a survey from 1993 to 1998].

PATIENTS AND METHODS: In a pediatric hospital of Paris, from 1993 to 1998, respiratory secretions were positive for respiratory syncytial virus (RSV) in 26.3% of 4,738 children (0-5 years) examined or hospitalized for lower respiratory tract infections. Rotavirus detection was positive in stools of 23.7% of the 8,537 children of the same age with acute diarrhea. RESULTS: The RSV epidemic peak occurred annually in Paris in December and the rotavirus outbreak peaks were observed in December/January. The winter seasonal peaks remained constant for both pathogens and the temporal appearance of these peaks was constant from 1993 to 1998. Fifty to sixty-one percent of rotavirus and 77 to 92% of RSV infections were observed in November, December or January. These simultaneous outbreaks provoked important problems in hospital organization and prevention of nosocomial infections. CONCLUSION: The coincidence of RSV and rotavirus peaks is not found in all countries. The epidemic patterns have to be checked in other parts of France and Europe because this could be important when active immunization programs will be available for these two pathogens.

Child, Preschool↗
PubMed1999

The Galezowski tradition in Paris.

Xavier Galezowski (1832-1907) was born in Poland, received his first MD degree in St. Petersburg, Russia, and a second MD degree in Paris. He established an important ophthalmologic clinic in Paris, which trained many prominent ophthalmologists and treated numerous patients. He published many articles and textbooks.

Diagnostic Techniques, Ophthalmological↗
PubMed2002

Dietary intakes and vitamin status of a sample of homeless people in Paris.

OBJECTIVE: To determine nutritional intake and vitamin status in a sample of homeless people who had been on the streets of Paris for more than 2 y. DESIGN: The nutritional status was evaluated by a 24 h recall questionnaire and by assay of circulating levels of vitamins A, B1, B6, B12, C and E. SETTING: The study was conducted in four accommodation centres of the SAMU Social of Paris (CHUSI units) from July 1999 to May 2000. SUBJECTS: A total of 329 homeless people were interviewed. Only 87 subjects, aged 26-76 y, were recruited based on seven selection criteria (over 18 y old, being homeless for more than 2 y, interviewed before taking a meal in the CHUSI units, good understanding of French, in a calm state, not coming from hospital or another CHUSI units, without any acute condition that might affect usual dietary habits), and completed the dietary questionnaire. Out of these 87, 71 agreed to blood sampling. RESULTS: In all 84% of the subjects declared that they drank alcoholic beverages regularly (175+/-167 g/day of alcohol), and 75.5% of the subjects also declared that they smoked. The mean total energy intake was 2111+/-1482 kcal/day for the men (8823.98+/-6194.76 kJ/day) and 1523+/-531 kcal/day for the women (6366.14+/-2219.58 kJ/day). Alcohol accounted for 44+/-30% and 19+/-17% of the total energy intakes (TEI) for the men and women, respectively. Proteins, lipids and carbohydrates accounted for 21+/-9, 23+/-14 and 57+/-16%, respectively, of the energy intake without alcohol for men, and 15+/-5, 22+/-11 and 62+/-14% EIWA for women. For all micronutrients, except for iron in the men, more than 50% of the population studied had intakes below the French recommendations for the adult population. All the women had calcium, vitamin E and vitamin B1 intakes below the recommendations for French women (900, 12 and 1.3 mg/day, respectively) in the general population. For the men, 98.7, 96.1 and 93.5% of the subjects had vitamin E, B1 and C intakes below the recommendations for French males in the general population (12, 1.5 and 80 mg/day, respectively). It is of note that subjects who ate in the CHUSI units more than once a day per week had significantly (P=0.018) higher intakes of vitamin C (27+/-38 mg/day) than did the subjects who ate in the CHUSI units less than once a day (8+/-12 mg/day). Measurement of serum vitamin levels demonstrated a deficiency in 95% of the subjects, mainly for vitamin C. The mean concentration in serum was 16+/-8 micromol/l, although 72% of the subjects had levels of 6 micromol/l. In contrast, 50.7, 42.2 and 35.2% of the subjects had high levels of vitamin B6, B12 and B1, respectively (100 nmol/l, 420 pmol/l and 40 micromol/l). CONCLUSION: Alcohol takes a high place in the diet of these homeless people. Although the total energy intake was too low, macronutrient intakes seem to be satisfactory in quality (well-balanced). However, calcium and vitamin C intakes were too low, and these deficiencies favour the development of disease (scurvy, asthenia, ecchymosis), in addition to alcohol-linked disease. Furthermore, the overexposure to vitamin B6, among the other B vitamins, is a matter of concern since it has been shown to be toxic in high doses.

Adult↗
PubMed2006

Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade.

INTRODUCTION: This article reports the results of a retrospective study of 8 years of experience of the Paris Fire Brigade with the prehospital use of hydroxocobalamin. METHODS: The head physician at the Paris Fire Brigade extracted and summarized data from standardized forms completed at the fire scene and, when available, hospital reports to assess survival status and clinical parameters associated with the use of hydroxocobalamin for each patient who received it for smoke inhalation-associated cyanide poisoning from 1995 to 2003. RESULTS: Of the 101 patients administered hydroxocobalamin, 30 survived, 42 died (17 at the fire scene and 25 at the intensive-care unit), and survival status was not known in the remaining 29 patients. Among the 72 patients for whom survival status was known, survival rate was 41.7% after the administration of hydroxocobalamin. Of the 38 patients found in cardiac arrest, 21 had a return of spontaneous circulation during prehospital care. Of the 12 patients who were initially hemodynamically unstable (systolic blood pressure 0 to < or =90 mmHg), 9 recovered systolic blood pressure an average of 30.6 minutes after the start of hydroxocobalamin infusion. Among nonsedated patients in the sample as a whole (n = 52), mean (SD) Glasgow coma scale score improved from 7.9 (5.4) initially to 8.5 (5.7) after administration of hydroxocobalamin. Among nonsedated patients who were initially neurologically impaired (n = 18), Glasgow coma scale score improved in 9 patients, did not change in 8 patients, and worsened in 1 patient. Two adverse events--red or pink coloration of urine or skin (n = 5) and cutaneous rash (n = 1)--were assessed as being possibly related to hydroxocobalamin. CONCLUSION: Hydroxocobalamin has a risk:benefit ratio rendering it suitable for prehospital use in the management of acute cyanide poisoning caused by smoke inhalation.

Adult↗