Predictive value of oral colonization by Candida yeasts for the onset of a nosocomial infection in elderly hospitalized patients.

The incidence of nosocomial yeast infections has increased markedly in recent decades, especially among the elderly. The present study was therefore initiated not only to determine the predictive value of oral colonization by yeasts for the onset of a nosocomial Candida infection in elderly hospitalized patients (> 65 years), but also to clarify the factors that promote infection and to establish a relationship between the intensity of oral carriage and the onset of yeast infection. During this prospective cohort study, 256 patients (156 women and 100 men with a mean age of 83 +/- 8 years) were surveyed for yeast colonization or infection. Samples were collected every 4 days from day 0 to day 16 from four sites in the mouth, and intrinsic and extrinsic factors that might promote infection were recorded for each patient. Pulsed field gel electrophoresis was performed on Candida albicans isolates from all infected patients. Poor nutritional status was observed in 81 % of the patients and hyposalivation in 41 %. The colonization level was 67 % on day 0 (59 % C. albicans) and a heavy carriage of yeasts (> 50 c.f.u.) was observed for 51 % of the patients. The incidence of nosocomial colonization reached 6.9 % on day 4 (6.1 % on day 8 and 2.7 % on day 12), and that of nosocomial infection was 3.7 % on day 4 (6.8 % on day 8, 11.3 % on day 12 and 19.2 % on day 16). Of the 35 patients infected, 57 % were suffering from oral candidiasis. The principal risk factors for colonization were a dental prosthesis, poor oral hygiene and the use of antibiotics. The risk factors for infection, in addition to those already mentioned for colonization, were endocrine disease, poor nutritional status, prolonged hospitalization and high colony counts. Genotyping revealed person-to-person transmission in two patients. Thus, this study demonstrates a significant association between oral colonization and the onset of yeast infections in elderly hospitalized patients. Therefore, oral samples should be collected at admission and antifungal treatment should be administered in cases of colonization, especially in patients presenting a heavy carriage of yeasts. Genotyping of the strains confirmed the possibility of person-to-person transmission.

[Maternal obesity: effects on labor and delivery: Excluding other diseases that might modify obstetrical management]. / Conséquences de l'obésité maternelle sur le déroulement du travail et l'accouchement: A l'exclusion des autres pathologies pouvant modifier la prise en charge obstétricale.

AIMS: The aim of this survey was to analyze the effects on labor, delivery, afterbirth, and neonatal status of maternal obesity, independently of other diseases that might modify obstetrical management. POPULATION AND METHODS: Cross-sectional survey of cases during one year in the obstetrics department of a university hospital center. The inclusion criterion was obesity, defined as BMI > 30. The exclusion criteria were hypertension, pregnancy-related hypoxemia, diabetes (pre-existing or pregnancy-related), maternal cardio-pulmonary disease, uterine scar, multiple pregnancy, and non-cephalic presentation. Two groups, one obese and the other not, were matched for age and parity. RESULTS: The rate of post-term deliveries was higher among obese women (p = 0.04), induction of labor more frequent (p = 0.05), and the duration of its first phase longer (p = 0.003); the cesarean rate was seven times higher (14.6% versus 2.1%) and the mean weight of the newborns significantly higher (p = 0.01). Multivariate analysis found the following factors to be significantly associated with maternal obesity: longer duration of the first phase of labor, less frequent spontaneous vaginal delivery, higher cesarean rate, and higher rate of lack of progress in dilatation. CONCLUSION: This study shows that maternal obesity is a risk factor for complications during pregnancy, independently of its standard complications--pregnancy-related diabetes and hypertension. It compromises the smooth progression of labor and delivery. Pregnancy in obese women must be considered to be "at risk", regardless of any complications of obesity. It is thus important to help obese women become more aware of the importance of a balanced diet for themselves and their children. The presence of an obese adult in the household quadruples the risk of obesity in children.

[Evaluation of a university hospital unit specialising in treating adults at risk of suicide]. / Evaluation de l'unité spécialisée d'accueil des suicidants adultes au CHU d'Angers.

In France, suicide prevention has been a public health priority since 1992. Half of all suicide attempts are repeated attempts made by people who have already tried to commit suicide, and the risk of death increases by 1% after the first attempt. Today, hospitalisation has become an unavoidable consequence for those who have attempted suicide, and recommendations for best practice were recently issued in France (1998). The objective of this study was two-fold: 1) to assess the quality of management and care provided for patients hospitalised in a university hospital in Angers after having attempted suicide, an evaluation that was based in part on the criteria of the National Agency on Health Accreditation and Evaluation (ANAES); and 2) the demonstrate the value and high utility of such a unit specialising in caring for patients recovering from attempted suicide. The unit has now been in existence for over 5 years, and has treated 42% of such patients who require hospitalisation. One investigator was responsible for asking 251 patients (on the day of their release) who had been hospitalised anytime during the given 6 month period (November 2002 - May 2003) to complete a questionnaire containing approximately 100 items. In order to be eligible for the study, patients had to be older than 16 years and hospitalised for at least 48 hours. 155 questionnaires were completed (62%), and there were 96 patients were notable to participate on the day of their release. Nine of the 14 criteria recommended by the ANAES were met in over 65% of the cases, and three in less than 40%. Following the analysis of the data through logic regression, it remained clear that unit specialising in the care of people who have attempted suicide was better able and equipped to meet the standards of the ANAES' recommendations than a standard hospital medical unit. Visits with a psychiatrist or psychiatric nurse occurred more frequently in the specialised unit (p < 0.04), interviews with the patients' family members were more frequent (p < 0.01), the confidentiality of the discussions from the interviews was more often respected and maintained (p < 0001), and the information provided by the caregivers and staff was more effective in the specialised unit (p < 0.03). One of the main benefits and results of these aforementioned differences is that the patients in the suicide unit more often perceived a distinct improvement in their depression (p < 0.007). All of these arguments indicate that hospitalisation in a special unit provides real benefits to patients, and the results of this study advocate strongly in favour of increasing the capacity of the unit, which is currently limited to only 6 beds.

[Female general practitioners in Maine-et-Loire: "1990-2000"]. / Les femmes médecins généralistes dans le Maine-et-Loire: "1990-2000".

In 1990, there were approximately 60 female general practitioners in the Maine-et-Loire region, 58 of which participated in the survey that year. By the year 2000, the number had risen to 137. A new study was conducted involving 70 women who had opened practices over that decade. Analyses of the responses to the questionnaire and a comparison with the results of the previous survey demonstrate distinct changes and a real evolution in the working conditions of this new generation of female general practitioners and in their relationships with their colleagues and families. More involved in their work and professional lives, they are now more accepted by other physicians and enjoy real family support. They are fulfilled and appear to succeed fully in all of their roles--those of physician, mother and wife. More active participation in social and political life would enable these professionals to achieve greater self-fulfillment and satisfaction; it is perhaps still too early to comprehend the true specificity, if any, of the private general practice of medicine by women. A new survey is planned to be conducted in ten years.