Deprivation, occupational hazards and perinatal outcomes in pregnant workers.

BACKGROUND: Recent global economic difficulties have widened social inequalities, but their impact on pregnant workers is not known. AIMS: To investigate the association between deprivation, exposure to occupational hazards and adverse perinatal outcomes in pregnant workers. METHODS: A cross-sectional study performed in 2014 in French occupational health services. Eligible workers were women who had worked during their pregnancy and had a medical visit by occupational health physicians (OHPs) after delivery and at the time of returning to work. Deprivation was measured using the EPICES scale (Evaluation of Precariousness and Inequalities in Health Examination Centres). Information on birth outcomes was self-reported. Occupational risks for pregnancy were assessed by OHPs. Jobs were coded by the occupational health team using standardized French nomenclature. The groups (deprivation/no deprivation) were compared using univariate (chi-squared test) and multivariate Poisson regression analyses. RESULTS: Of 1402 pregnant workers, 293 (21%) were classed as deprived. This group more frequently encountered occupational hazards, particularly for physical exposures (P < 0.001), and had a higher risk of cumulated occupational hazards of three or more for pregnancy [adjusted relative risk (RRa) = 4.2; 95% confidence interval (CI) 2.2-7.9]. Our findings suggest that deprivation and exposure to three or more occupational hazards during pregnancy cumulatively increased the risk of pre-term birth (RRa = 3.9; 95% CI 1.2-12.4). CONCLUSIONS: Our data suggest that deprived pregnant workers are an occupationally vulnerable group.

[Evaluation of patient compliance among hypertensive patients treated by specialists]. / Evaluation de l'observance par l'interrogatoire au cours du suivi des hypertendus dans des consultations spécialisées.

OBJECTIVES: To evaluate compliance with antihypertensive therapy by a self-report in patients referred to hypertension specialists. METHODS: We studied 484 treated hypertensive subjects referred to several hypertension clinics and who were treated since at least one year. Patients were asked to fill in the Compliance Evaluation Test (CET), a questionnaire with 6 questions previously validated to assess factors that could affect medication compliance. We defined patients as "good compliant" when "No" was answered to the 6 items, as "minor noncompliant" when 1 or 2 "Yes" were answered, and as "noncompliant" when 3 or more "Yes" were answered. A good agreement was demonstrated between CET score and compliance evaluated by the number of pills missed during the previous month according to patient interview. RESULTS: We observed 8% of "noncompliant", 53% of "minor noncompliant" and 39% of "good compliant". [table: see text] Logistic regression analysis including age, sex, education level, blood pressure level and the number of antihypertensive tablets confirm the statistical differences observed. CONCLUSIONS: In clinical practice, a method of assessing medication compliance is to ask the patient for a self-report interview. We demonstrated that the compliance evaluation test is able to detect factors usually associated with poor compliance (young age, elevated blood pressure, number of tablets per day). The use of the compliance evaluation test may help physicians to face the problem of nonadherence among their hypertensive patients.

Use of a prostacyclin analogue in cholesterol crystal embolism.

The prognosis of cholesterol embolism is often poor, and no treatment is presently available. We report the use of a stable prostacyclin analogue in treating cholesterol embolism in a diabetic patient with arteriopathy. As a sole therapy, it improved cutaneous manifestations and pain, in parallel with an increased transcutaneous oxymetry. We think that prostacyclin analogues are novel candidates for the treatment of cholesterol embolism.

Nonfasting plasma glucose is a better marker of diabetic control than fasting plasma glucose in type 2 diabetes.

OBJECTIVE: To evaluate the relative value of plasma glucose (PG) at different time points in assessing glucose control of type 2 diabetic patients. RESEARCH DESIGN AND METHODS: Glycemic profiles, i.e., PG at prebreakfast (8:00 A.M.), prelunch (11:00 A.M.), postlunch (2:00 P.M.), and extended postlunch (5:00 P.M.) times over the same day, were obtained in 66 type 2 diabetic patients on an ambulatory basis. The different time points of PG were compared with a measurement of HbA1c made in a reference laboratory. RESULTS: Extended postlunch PG was lower than prebreakfast PG (104 +/- 21 vs. 133 +/- 35 mg/dl, P < 0.02) in patients demonstrating good diabetic control (HbA1c < or = 7.0%), was not different from prebreakfast PG (149 +/- 47 vs. 166 +/- 26 mg/dl, NS) in patients demonstrating fair diabetic control (7.0% < HbA1c < or = 8.5%), and was higher than prebreakfast PG (221 +/- 62 vs. 199 +/- 49 mg/dl, P < or = 0.01) in those demonstrating poor diabetic control (HbA1c < or = 8.5%). Prebreakfast, prelunch, postlunch, and extended postlunch PG values were all significantly correlated with HbA1c. Multiple linear regression analysis demonstrated that postlunch PG and extended postlunch PG correlated significantly and independently with HbA1c, but that prebreakfast PG and prelunch PG did not. Moreover, postlunch PG and extended postlunch PG demonstrated better sensitivity, specificity, and positive predictive value in predicting poor glycemic control than did prebreakfast PG or prelunch PG. CONCLUSIONS: In type 2 diabetes, postlunch PG and extended postlunch PG are better predictors of glycemic control than fasting plasma glucose (FPG). We therefore suggest that they be more widely used to supplement, or substitute for, FPG in evaluating the metabolic control of type 2 diabetic patients.

[Left ventricular performance and morphologic myocardial changes in untreated hypertensive patients]. / Performance ventriculaire gauche et modifications morphologiques myocardiques chez l'hypertendu jamais traité.

Left ventricular contractile performance and geometric adaptation to hypertension were investigated in 255 patients with untreated essential hypertension and 160 normotensive subjects by M-mode echocardiography. Because all "ejection-phase" measurements are affected by changes in afterload, ventricular performance was estimated at the operating level of systolic wall stress by the afterload-corrected fractional shortening. Mitral regurgitation was excluded in all patients by Doppler echocardiography. Patients were categorized according to values of end-diastolic relative wall thickness and left ventricular mass index. Among hypertensive patients, ventricular mass and relative wall thickness were normal in 44%, whereas 20% had increase relative wall thickness with normal ventricular mass "concentric remodeling", 22% had concentric hypertrophy (increase both ventricular mass and relative wall thickness) and 14% had increased ventricular mass with normal relative wall thickness (eccentric hypertrophy). Arterial pressure and body mass index were higher in patients with concentric hypertrophy. Left ventricular contractile performance paralleled ventricular geometry, with a decrease of the afterload-corrected fractional shortening in the group with concentric remodeling and hypertrophy, whereas systolic function was normal in the eccentric group despite higher level of systolic wall stress. This study suggests a strong dependence of left ventricular mass with chamber size and myocardial contractility. Thus arterial pressure was not the sole determinant of left ventricular hypertrophy in essential hypertension. The respective role of this factors remains to be determined.