Screening women in young adulthood for disabling dysmenorrhoea: a nationwide cross-sectional study from the CONSTANCES cohort.

RESEARCH QUESTION: How do different warning indicators help to identify disabling dysmenorrhoea among women in young adulthood? DESIGN: A nationwide cross-sectional study of women aged 18-25 years from the CONSTANCES cohort was constructed. Disability was assessed with the Global Activity Limitation Indicator question 'For the past 6 months, have you been limited in routine activities?Yes, severely limited/Yes, limited/ No, not limited'. Dysmenorrhoea pain intensity and other chronic pelvic pain symptoms (dyspareunia and non-menstrual pain) were evaluated according to questions from a specific questionnaire. Probability of disability was estimated using a logistic prediction model according to dysmenorrhoea intensity, other indicators of pelvic pain symptoms and other obvious covariates. The results of the predictive model of disabling dysmenorrhoea were presented on a nomogram. RESULTS: Among 6377 women, the rate of disability was estimated at 7.5%. Increased intensity of dysmenorrhoea (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13), increased frequency of dyspareunia (from OR 1.69, 95% CI 1.33-2.14 up to OR 3.41, 95% CI 2.16-5.38) non-menstrual chronic pelvic pain (OR 1.75, 95% CI 1.40-2.19), body mass index over 25 kg/m2 (OR 1.45, 95% CI 1.17-1.80) and non-use of the hormonal contraceptive pill (OR 1.29, 95% CI 1.05-1.59) were significantly associated with disability. According to the nomogram, a predicted probability of 15% or more could be chosen as a threshold. This represents almost 4.6% of young women in this sample being classified at risk of disabling dysmenorrhoea. CONCLUSIONS: Dysmenorrhoea pain intensity and associated pelvic pain symptoms are warning indicators that can be measured to help screen young women who may suffer from disabling dysmenorrhoea.

[Hysterectomy: Practices evolution between 2009 and 2019 in France]. / Hystérectomie : évolution des pratiques entre 2009 et 2019 en France.

OBJECTIVE: Hysterectomy is the most common procedure in women. We wanted to make an assessment of the hysterectomy in France in 2019. We also assessed the variations over time in the indications and the surgical approch for hysterectomy, this with regard to the various events that may have been at the origin of the modification practices. METHODS: We used the Medical Information Systems Program in Medicine, Surgery, Obstetrics and Dentistry to extract all acts relating to a hysterectomy regardless of its route of approach from 2009 to 2019. RESULTS: Hysterectomy is a frequent procedure which was performed in nearly 60,000 women in France in 2019. The most frequently used surgical approach is now laparoscopy, performed in 30% of hysterectomies, followed by laparotomic (29%), then vaginal approaches (26%) and coelio-vaginal (15%). Laparoscopic procedures are performed more often in public than private hospitals. Adnexectomy is associated with 41% of hysterectomies. A decrease in the number of hysterectomies was observed between 2008 and 2019, from approximately 72,000 in 2008 to approximately 60,000 in 2019. This decrease occurs during a period in which new therapies have emerged as well as new recommendations. CONCLUSION: The evolution of the number of hysterectomies is correlated with the development of therapeutic alternatives for pathologies for which a hysterectomy has traditionally been performed.

[Neonatal deafness: screening coverage assessment throughout national PMSI database in the region of Paris] / Surdité néonatale : mesure exploratoire par le PMSI de la couverture du dépistage en Île-de-France.

OBJECTIVE: To estimate the screening coverage of neonatal bilateral permanent deafness (NBPD) among neonates in the region of Paris (Île-de-France), between 2012 and 2017, using data from the Program for Medicalization of Information System (PMSI). METHOD: The study population covers hospital stays of newborns (0 to 28 days of life) in the region of Paris between 2012 and 2017. The data were extracted from PMSI database using DIAMANT system. The annual screening coverage rate is estimated by the ratio between the number of newborn stays with the code Z13.51 and one of the two specific medical procedures for NBPD screening and the number of live births recorded in health facilities. RESULTS: In 2017, 133 152 newborn stays with a Z13.51 code were counted in the Ile-de-France region, out of 178 011 live births; less than 75% of newborns. Hospital stays including a medical procedure CDQP009 or CDQP017 represent a proportion of 16.3% in 2017. The annual estimated rate of screening coverage of NBPD using the PMSI (89,8%, taking into account the different coding practices) is lower than the one calculated from data of the FPDPHE (95,5%) and national/regional target rate set by the National screening Program. CONCLUSION: Our methodology and the observed results revealed that an annual NBPD screening coverage rate could be estimated, if the National plan and coding practices requirements follow the guidelines. Harmonization of coding practices and data quality assurance are essential to be able to build an indicator of NBPD screening coverage based on routinely collected data (PMSI, SNDS), which can contribute to the monitoring of the implementation of the screening program for the neonates.

Detection of complicated ectopic pregnancies in the hospital discharge database: A validation study.

OBJECTIVE: Complicated ectopic pregnancies with severe bleeding (CEPSB) are life-threatening situations and should be considered maternal near-miss cases. Previous studies have found an association between severe maternal morbidity secondary to CEPSB and substandard care. Almost all women with CEPSB are hospitalized, generating administrative and medical records. The objective of this study was to propose a method to measure the validity of the hospital discharge database (HDD) to detect CEPSB among hospital stays in two gynecological units. METHODS: We included all hospital stays of women who were 18-45 years old and hospitalized for acute pelvic pain or/and metrorrhagia in the two hospitals. The HDD was compared to medical data (gold standard). Two algorithms constructed from the International Classification of Disease (ICD-10) and Common Classification of Medical Procedures (CCAM), were applied to the HDD: a "predefined algorithm" according to coding guidelines and a "pragmatic algorithm" based on coding practices. Sensitivity, specificity and positive likelihood-ratios were calculated. False negatives and positives were analyzed to describe coding practices. RESULTS: Among 370 hospital stays included, 52 were classified as CEPSB cases. The "predefined algorithm" gave a sensitivity of 23.1% (95% CI: 11.6-34.5) and a specificity of 99.1% (95% CI: 98.0-100.0) to identify CEPSB. The "pragmatic algorithm" gave a sensitivity of 63.5% (95% CI: 50.4-76.5) and a specificity of 94.7% (95% CI: 92.2-97.5) to identify CEPSB. Coding errors (77.6%) were due to misuse of diagnosis codes and because complications were not coded. CONCLUSION: HDD is not reliable enough to detect CEPSB due to incorrect coding practices. However, it could be an ideal tool to monitor quality of care if a culture in data quality assessment is developed to improve quality of medical information.

From knowledge to planning considerations: a matrix to assess health needs for the perinatal network in eastern Paris.

BACKGROUND: Regionalization of perinatal care is required throughout networks to reduce perinatal morbidity and mortality and to organize access to health services for high-risk new borns, such as in the eastern Paris in 2007. Our study sought to design a matrix to build a perinatal knowledge base for assessing health needs and facilitating public health planning process for the perinatal network in eastern Paris. METHODS: Our matrix listed as its columns 'perinatal stages' from conception through the age of 6 years, whereas the rows covered components related to public health planning (i.e. target population, perinatal risk factors and health services). For each situation, the matrix lists require information and potential data sources to measure health status and health services. RESULTS: Our matrix structures the cyclical process for building knowledge for action. The eastern Paris has a population of 670,000. Its nine maternity units are distributed into three levels of care, a level-3 unit opened up in June 2007. A total of 16,400 deliveries occur every year in the nine units; 2500 women living in the eastern area deliver outside the area. CONCLUSION: Our matrix is useful for building a comprehensive perinatal knowledge base depending upon perinatal stages and health-care dimensions. It should imply stakeholders in collecting, synthesizing and analysing massive amounts of data. It can be adapted to any health network or local health policy.