[Alcohol consumption patterns and behaviour among people using the health care system in Lower-Normandy]. / Les conduites de consommation d'alcool chez les personnes ayant recours au système de soins en Basse-Normandie.

A national study on the prevalence of excessive alcohol consumption behaviour was undertaken throughout France. The results presented in this paper are those from Lower-Normandy. Two surveys were carried out: one among patients of general practitioners, and another among those in hospitals. The following data were specifically examined: the CAGE test score, the use of alcohol, the level of dependence, the conclusion of the care provider and the patient's profile. The results show that the frequency of excessive alcohol consumption in Lower-Normandy remains slightly higher than the national average. However, a significant reduction, which has been confirmed by the decrease in mortality rates, has been obtained within the last two decades. But nevertheless, the fight must continue and with on-going determination, and this aspect must rely more heavily upon general practitioners.

[Regional evaluation of long-term care facilities for the elderly]. / Evaluation régionale de structures d'hébergement pour les personnes âgées.

The increase in the total number of very elderly people demands the precision and specification of the needs of long-term care structures in the coming years. A survey conducted in Lower-Normandy is presented and described. Questionnaires were sent to directors of residence homes and nursing homes in order to investigate their operations and their problems. The increase in the number of spaces to foresee seems moderate if the progressive trend remains unchanged (+1% per year until the year 2010), but within the same timeframe, the demographic decline in the number of potential family helpers and home health workers to take care of the elderly in their homes, coupled with the establishment of a new state allowance for dependent people, could alter the situation. Furthermore, more than 50% of nursing homes and residence homes for the elderly are in need of significant improvements: a reduction in the number of shared rooms (52.5% of nursing homes) and the development of equipment to meet the needs of the handicapped and disabled. The means in personnel and staff qualifications are particularly heterogeneous and difficulties in coping with dependency are reported most everywhere. The application of the 1999 decree stipulating the approval of these structures based upon thorough evaluations of available services is urgently needed.

Role of anxiety and depression in the onset of spontaneous preterm labor.

The aim of this cohort study conducted in France in 1997-1998 was to investigate the effects of antenatal anxiety and depression on spontaneous preterm labor. A consecutive series of 634 pregnant women with singleton pregnancies was included. Anxiety and depression were assessed using self-administered questionnaires: Spielberger's State-Trait Anxiety Inventory and the Edinburgh depression scale. Depression scores were dichotomized with a cutoff value suggestive of major depression. The 75th percentile was used for anxiety scores. A logistic regression analysis, controlling for sociodemographic and biomedical factors and including interaction terms, revealed that depression was positively associated with the outcome among underweight women, defined as women with a prepregnancy body mass index below 19 (adjusted odds ratio (OR) = 6.9, 95% confidence interval (CI): 1.8, 26.2). A similar result was observed for trait anxiety in women with a history of preterm labor (adjusted OR = 4.8, 95% CI: 1.1, 20.4). The association was close to significance for state anxiety in women with vaginal bleeding (adjusted OR = 3.6, 95% CI: 0.9, 14.7). These findings show that anxiety and depression, when combined with specific biomedical factors, are associated with spontaneous preterm labor. A synergic action of psychological and biomedical factors on the secretion of placental corticotropin-releasing factor is hypothesized.

[Computer-assisted instruction applied to preventive medicine in adolescents: bibliographic analysis and perspectives]. / L'enseignement assisté par ordinateur appliqué à la prévention chez les adolescents: analyse bibliographique et perspectives.

Computer-assisted instruction (CAI) for adolescent health promotion is still underused in France. We analysed the literature on existing systems in terms of current issues, techniques used, efficacy and difficulties experienced. All the authors noted that youth show a great interest in computer-assisted instruction and that they have made progress in their knowledge of health related risks. In some cases, an improvement in behaviours has been seen. CAI has many advantages due to the use of computers and in particular, the interactivity involved. Designers of CAI software for prevention issues must work as a team. Directed by a group of experts, the development of an interactive dialogue must involve youth input, take the adult point of view into consideration, and utilise the expertise of education and communication specialists. The use of computers and the Internet in schools provides great opportunities for developing multimedia health programmes.

[Requirements for the successful implementation of unity of care: study of a computer-assisted dispensation of pharmaceuticals]. / Les conditions du succès de l'informatisation de l'unité de soins: à propos d'un logiciel de dispensation pharmaceutique.

PURPOSE: Even though computerized workstations bring undisputed benefits in nursing units, introducing them is still hard when most of the staff members have to share the workstation. We took advantage of the implementation of the drug prescription software SAUPHIX in a nephrology department to better define the encountered difficulties. The workstation described in this paper is shared by physicians who enter their prescriptions (proprietary names, doses, routes of administration), nurses who use dosage schedules for drug administration, and the chemist who has authority to control prescription orders. METHODS: Six months after the implementation of the workstation, physicians and nurses had to fill out an anonymous questionnaire aimed at assessing each function of the software. RESULTS: Prescriptions proved to be more accurate and legible, while management of drugs was more precise. However, interns complained that entering data was time consuming. Furthermore, they raised objections to control of prescription orders. Nurses criticized dosage schedules, the primary reason being that they had to change their practice. The convenience of notebooks was questioned by both physicians and nurses who would have preferred a greater number of desktop computers at their disposition. CONCLUSION: The implementation of a computerized workstation requires information, diplomacy and negotiations to obtain real implication of the staff. Tasks and schedules must be specified for everybody. The system has to be carefully customized, according to the requirement of the unit. Computers must be properly chosen and allocated in sufficient number. Finally, appropriate preparation, staff training and follow-up of the computerized system are essential.

[Isolation rooms in the psychiatric environment]. / Les chambres d'isolement en milieu psychiatrique.

To date, there has been no survey concerning psychiatric isolation rooms in France. We conducted a mail survey in 1993 involving all adult psychiatric care catchment areas covering the French departments. The survey revealed an estimated number of 1560 isolation rooms. Isolation rooms were considered as absolutely necessary in all the departments but also as an unsatisfactory solution by one-third of them. Isolation rooms were usually small and poorly adapted to efficient patient surveillance. Furthermore, equipment was often inadequate, particularly for noise and fire protection. A serious accident (fire, suicide, escape) was reported by large number of departments. The rooms were used for agitated psychotic (84%) and psychopathic (16) people. Although requested by the physician, but also in some cases by the patient, conditions of use and design of isolation rooms may be dangerous both for the patient and the nursing staff. Financial investment devoted to isolation rooms varies greatly and there is no specific control over the number of installation. Construction must comply with precise specifications defined in co-ordination with the experts involved.

[Computer records of anesthesiology information. Evaluation of the operative risk]. / Archivage sur ordinateur des informations anesthésiologiques. Evaluation du risque opératoire.

This work proposed: 1) to record all the anaesthetic information in the SYSRES system, 2) to carry out a global numerical evaluation of the surgical risks in the form of a coefficient (CORI) defining a probability of complications thanks to a table established from several hundred case-files. This method has several purposes: the carrying-out of very quick summaries of case-files, and of statistical studies, several of which could be used as a basis in scientific work and, most of all, allow an increase in the safety of the patients.