Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study.

OBJECTIVE: France encounters difficulties attracting physicians to work in hospitals. Organisation at work and at home may be at the heart of the problem for female as well as for male physicians. PARTICIPANTS: A comprehensive questionnaire was filled out online by a representative sample of 1924 French hospital physicians. METHODS: We conducted gender bivariate and multivariate analysis of the risk factors for burnout and intent to leave the profession(ITL). RESULTS: ITL was declared by 17.4% of physicians. According to 41.3% of female physicians (FP), their profession was an obstacle to having children (versus 19.3% for male physicians (MP)). Major factors linked with burnout were Effort/Reward imbalance (FP adjOR = 5.09, MP adjOR = 5.93), Work-family conflicts (FP adjOR = 2.97, MP adjOR = 3.04), and Low quality of teamwork (FP adjOR = 1.82, MP adjOR = 2.68). Major factors linked with ITL were Low quality of teamwork (FP adjOR = 4.49, MP adjOR = 3.03), Patient-related burnout (FP adjOR = 2.10, MP adjOR = 2.35) and General burnout (FP adjOR = 1.85, MP adjOR = 1.45). CONCLUSIONS: Excessive job demands are linked with burnout and with work-family conflicts, conducting to difficulties in organising one's life in order to have and raise children. Potential solutions include facilitating teamwork in order to reduce departure, which increase workload on those who stay increasing their work family conflict.

Emergency physicians accumulate more stress factors than other physicians-results from the French SESMAT study.

INTRODUCTION: France is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical system's first line of defence. METHODS: The authors prepared a comprehensive questionnaire using established scales measuring various aspects of working conditions, satisfaction and health of salaried physicians and pharmacists. It was made available online, and the two major associations of emergency physicians promoted its use. 3196 physicians filled out the questionnaire. Among them were 538 emergency physicians. To avoid bias, 1924 physicians were randomly selected from the total database to match the demographic characteristics of France's physician population: 42.5% women, 57.5% men, 8.2% < 35 years old, 33.8% 35-44 years old, 34.5% 45-54 years old and 23.6% ≥ 55 years old. The distribution of physicians in the 23 administrative regions and by speciality was also precisely taken into account. This representative sample was used to compare subgroups of physicians by speciality. RESULTS: The outcomes indicate that the intent to leave the profession (ITL) was quite prevalent across French physicians and even more so among emergency physicians (17.4% and 21.4% respectively), and burnout was highly prevalent (42.4% and 51.5%, respectively). Among the representative sample and among emergency physicians, work-family conflict (OR=4.47 and OR=6.14, respectively) and quality of teamwork (OR=2.21 and OR=5.44, respectively) were associated with burnout in a multivariate analysis, and these risk factors were more prevalent among emergency physicians than other types. A serious lack of quality of teamwork appears to be associated with a higher risk of ITL (OR=3.92 among the physicians in the representative sample and OR=4.35 among emergency physicians), and burnout doubled the risk of ITL in multivariate analysis. CONCLUSIONS: In order to prevent the premature departure of French doctors, it is important to improve work-family balance, working processes through collaboration, multidisciplinary teamwork and to develop team training approaches and ward design to facilitate teamwork.

[Sodium fluoride controlled release system for intra buccal use]. / Système intra buccal delibèration contrôlée de fluorurede sodium.

Hydroxyapatite which has the same elemental chemical composition as natural bone and teeth is one of the promising raw material for the design of drug controlled release system in intrabuccal use. It is stable and biocompatible and widely used in orthopedics and odontology. So, in order to improve the administration of drugs for intrabuccal use, we have developped a fluoride controlled release delivering system. We have formulated tablets of 160 to 200 mg to be fixed on the vestibular face of a molar or a premolar and permitting to reach high enough local concentrations for desirable therapeutic effect. The tablets have a granular matrix composed of hydroxyapatite and fillers, ethylcellulose and/or Eudragit. For all tablets, the pharmacotechnical values support the pharmacopoeia norms. On fragments of tissue maintained in culture, the sodium fluoride is released at constant rate. The release profiles observed are predictable. No disintegration of tablets have been observed during release studies and after. Histological analyses performed after release studies showed the biocompatibility qualities of the tablets.

Fluoride controlled release tablets for intrabuccal use.

We have developed a fluoride controlled release delivering system for intrabuccal use, permitting to reach high enough local concentrations for desirable therapeutic effect with minimal side effects. We have formulated tablets of 160-200mg intended to be fixed on a tooth. The tablets have a granular matrix composed of pure hydroxyapatite, Eudragit((R)) and/or ethylcellulose. NaF is added either by a mechanical mixing or an impregnation method. Profiles of continuous in vitro drug release in saline phosphate buffered solution were recorded by means of a fluoride selective electrode. Linear profiles are observed when ethylcellulose is used. The most reproducible results are obtained when the impregnation method is used. Eudragit((R)) increases the dissolution efficiencies while ethylcellulose decreases it.

Tissues and bone adhesives--historical aspects.

Glues and adhesives attach to a surface principally involving molecular attraction, whereas cements mostly work through mechanical interlocking. The adhesive and its degradation products must be biocompatible: chemical, clinical, legal, physical aspects are considered; the toxicity of even minor components must be extremely reduced. The idea of bone bonding using biological materials has been proposed by Gluck, in Berlin, more than a century ago. Cements and adhesives have been used for the fixation of fractures, the repair of defects and the fixation of prostheses. The cements are initially liquid or plastic and conform with the irregularities in the substratum, producing better bonding on rough surfaces. Developed during the early 1950s, cyanocrylate adhesives attracted the medical community by their bonding strength and ability to bond in wet environments but reports of displacement of the fracture ends were followed by reports of high infection rates, nonunion, and severe local reactions. Polymethylmethacrylate does not form a chemical bond with bone but a mechanical bond, a weak bone-polymer joint. Charnley used self-curing acrylic cement to bond a femoral head prosthesis into a femur. When adhesives are used to bond tissues, the polymer acts as a barrier between the growing edges and delay healing; the adhesive tends to be rapidly isolated from the bone by a fibrotic, non-adhesive capsule. No proof exists concerning the osteogenic potential of fibrin sealing (FS); its beneficial effect on bone formation has been questioned even if there is some evidence that FS should influence the early phases of bone repair and may help to solve the problem of reattachment of small osteocartilagenous fragments following joint trauma.

Casted titanium for dental applications: an XPS and SEM study.

Casted titanium for dental crowns has been investigated by means of X-ray Photoelectron Spectroscopy (XPS), X-Ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). The samples were prepared according to the Ohara process. XRD analysis revealed that the investment consisted essentially of SiO2, Mg2P2O7, SiO2 x H2O and Mg2SiO4. SEM experiments combined with EDX analysis revealed the following atomic concentrations Si (62.6%), Mg (19.7%), P (17.1%), and Ca (0.6%). After casting, the titanium samples exhibit a rough and irregular surface, and XRD analysis indicated that titanium contains essentially the alpha phase and traces of the beta phase. After demoulding titanium samples, the investment side which was in contact with titanium was black colored, proving the reaction between titanium and the investment. XPS analysis performed on this side of the investment indicated that the Si 2p peak presents a shoulder on the low binding energy side and thus suggest that SiO2 has been transformed into metallic Si.

Elaboration and evaluation of an intraoral controlled release delivering system.

In order to improve the administration of drugs for all pathology of the oral cavity, we have developed an intraoral controlled release delivering system, permitting to reach high enough local concentrations for desirable therapeutic effect with minimal side effects. We have formulated tablets of 200 mg intended to be fixed on a tooth. These tablets resist food and drink attacks. The tablets we elaborated have a granular matrix composed of hydroxyapatite, ethyl cellulose and Eudragit. Zinc sulfate is used as the first model of an active drug, it has a therapeutic effect on buccal mucous. Profiles of continuous in-vitro drug release in distilled water at 37 degrees C show that zinc sulfate release by the matrix structure for the different tablet formulations is regulated by the proportions of the different components.

[What is thought of the various surface treatments of biomaterials used in dental and maxillofacial implantology?]. / Que faut-il penser des différents traitements de surface sur les biomatériaux utilisés en implantologie dentaire et maxillo-faciale?

The surface treatments for biomaterials have the following goals: to increase the biocompatibility and the tissue acceptation, to prevent infection to reduce the abrupt interfaces; to favour the biological integration and the long term in service behaviour. Advantages and inconveniences of these methods are analysed for the main biomaterials categories: metals, synthetic polymers, ceramics, materials of biological origin. In addition to appropriate physico-chemical and mechanical properties, the existence of biologically functional interfaces with the living cells is more and more wished. In the next 20 years, it appears likely that the design of prostheses or implants in actual clinical use will have to be totally or partly reconsidered.

[Development and evaluation of an active substance controlled-release device for use in the oral cavity]. / Elaboration et évaluation d'un dispositif à libération contrôlée de substance active au niveau de la cavité buccale.

In order to improve drug administration for diseases of the oral cavity, we have developed an intraoral controlled release delivery system enabling local concentrations high enough for desirable therapeutic effect with minimal side effects. We have formulated 200 mg tablets to be fixed on a tooth. These tablets resist attacks by food and beverages. The tablets have a granular matrix composed of hydroxyapatite, ethyl cellulose and Eudragit. Zinc sulfate, which has a therapeutic effect on the buccal mucosa was used as the first model of an active drug. Profiles of continuous in vitro drug release in distilled water at 37 degrees C show that zinc sulfate release by the matrix structure for the different tablet formulations is regulated by the proportions of the different components.

Surface characterization of C/Ti-6Al-4V coating treated with ion beam.

Surface of titanium alloy (Ti-6AI-4V) has been modified by ion beam mixing of thin C film. X-ray photoelectron spectroscopy analysis showed that after mixing, the surface film consists essentially of a Ti compound containing (Ti, O and C), TiO2, Ti and C contamination. The composition of the surface modified film determined by Rutherford backscattering spectrometry is approximately Ti0.5O0.3C0.2 and its thickness is about 200 nm. After three months immersion in a simulated body fluid, the growth of calcium phosphate species containing both HPO4- and H2PO4- (probably CaHPO4 and Ca(HPO4)2) have been observed. Titanium is found to be essentially composed of the Ti compound after immersion suggesting that both metallic Ti and TiO2 have dissolved.

[Biomaterials and public health: avoid the drift]. / Biomatériaux et santé publique: éviter la dérive.

The difficulties found in the maturation of the Science of Biomaterials are analysed at the different levels: research, education, industry, reglementary and legislative environment, needs of hospitals and private practices. Proposals are made for a better response to the needs of an area which should have a growth at least as important as that of drugs.

[Rutherford back-scattering spectrometry and photoelectron spectroscopy of the calcium/titanium interface]. / Etude par spectrométrie de rétrodiffusion de Rutherford (RBS) et par spectroscopie de photoélectrons (XPS) des interfaces calcium/titane.

Evaporation of calcium on commercially pure titanium was performed. Heatings under vacuum or oxygen flow improved calcium diffusion in the titanium substrate. X-Ray Photoelectron Spectroscopy did not revealed any superficial segregation of titanium but revealed the formation of CaCO3. The film formed on titanium was characterized using X-ray photoelectron spectroscopy with argon-ion sputtering. The results indicated that: the surface layer consisted of CaCO3; the interface contained CaCP3, CaO et TiO2; only CaO was present in the bulk titanium.

Late complication of a Greenfield filter associating caudal migration and perforation of the abdominal aorta by a ruptured strut.

We report the case of a 67-year-old woman who was admitted for surgical removal of a Greenfield filter that had been inserted 7 years before because of recurrent deep vein thrombosis associated with pulmonary embolism. This complication appeared on a plain abdominal radiogram that showed a 7 cm distal migration of the filter, a 30-degree angulation, and rupture of a strut at the level of the hub. Computed tomography, aortography, and ascending cavography demonstrated that the inferior vena cava was perforated by the struts and that the ruptured strut had penetrated the infrarenal aorta. As demonstrated by scanning electron microscopy, the fracture was due to a structural defect of the strut at its insertion point within the hub, with no sign of corrosion. Energy-dispersive radiography analysis failed to demonstrate impurity in the metal composition.

[Biomaterials and infection in dental and maxillofacial surgery]. / Biomatériaux et infectiologie en chirurgie dentaire et maxillo-faciale.

Based on metals, polymers, ceramics, carbons or natural products, biomaterials represent an essential contribution to the repair or reconstruction of the hard or soft tissues of the dental and maxillofacial area. In order to avoid unsuccessful results these materials should realize a satisfactory tissue integration without bacterial colonization able to compromise the tissue-biomaterial finalized cooperation. The evolution of the science and technology of biomaterials should allow to get tissue toxicity-free materials which also inhibit microorganisms adherence, the infectability becoming a criteria as important as the biocompatibility itself.

[How and when to prescribe systemic antibiotics?]. / Comment et quand prescrire les antibiotiques par voie generale?

The use and prescription of antibiotics is getting everyday more and more complex for the general practitioner. Nowadays, due to the increasing number of antibiotics, it is necessary to know the patient's medical history, as well as be knowledgeable in bacteriology, pharmacology and toxicology, immunology and infectiology. It is important to determine the administration mode, the dosage and length of the antibiotic treatment, to get maximum effectiveness, while being aware of the possible drug interactions.