[Dental status, access to care and precariousness]. / Etat dentaire, recours aux soins et précarité.

BACKGROUND: The oral status of people living in precarious conditions is problematic. Although the public universal health insurance should allow better access to care, access to dental care remains a critical issue. The analysis of the patient population of a hospital dental consultation (Groupe Pitié-Salpêtrière, Paris) seemed relevant to evaluate the needs of care and the means to provide it. The principal objectives are: to estimate dental health and needs of this population, to describe their sociodemographic characteristics and to compare them with patients living in common social conditions. METHODS: A cross sectional study was conducted from February to June 2003. A medical questionnaire and a dental file record were used. All outpatients coming to the dental consultation, in need of conservative or prosthetic treatment, were included. We analysed the risk factors associated with poor dental health. RESULTS: Three hundred and thirty three questionnaires were analysed: two third were men, 45% were foreigners. More than half of them benefited from a special social health insurance for disadvantaged people or didn't have any health insurance. The comparative analysis of this precarious group vs regular insured people showed significant differences for sociodemographic and oral characteristics. Namely, in the precarious group, a poor dental status was generally observed: more cavities (3.6 versus 2), more absent teeth not replaced (6.8 versus 3.5) and less treated teeth (1.9 versus 3.9)--p < 0.0001. Multivariate analysis showed that main risk factors of poor dental status were to be aged and to be a foreigner. CONCLUSION: This study stresses the importance of the dental care needs in a context of poor insurance refunding for the costs of dental treatments and the lack of structures able to provide dental care for patients living in difficult social condition. These findings question the organization of the dental care system in France.

[Quality-assessment of the transfusion record in a Paris hospital in 2003]. / Evaluation du dossier transfusionnel dans un centre hospitalier parisien en 2003.

AIM OF THE STUDY: To realize a clinical audit of the quality of the transfusion record in the Pitie-Salpetriere hospital (Paris, France). MATERIALS AND METHODS: Using a 1/10th poll method, a representative sample of patients who underwent a blood transfusion in the first quarter of 2002 in the hospital was constituted. Data were collected in the clinical units using a standardized questionnaire. RESULTS: Sample size was 247 patients for whom 219 patient files and 207 transfusion record (94.5%, CI(95%) [91.5-97.5]) were found. Transfusion record did not follow the patient in 29 cases (59%). Among the transfusion record, 82.1% contained a copy of the prescription for blood components, 89.8% a transfusion card, 93.2% a traceability note, 100% an ABO group card, 98.6% an antibody screen, 57.1% a pretransfusion viral testing results and 7,8% a copy of the posttransfusion biology testing. Traceability of pre and posttransfusion patient information was respectively 6,8% and 21,1%. Presence of pretransfusion testing results, patient information and posttransfusion prescription was significantly higher in the surgical and intensive care units' patient files than in the medical units (resp. P = 0.018; 0.02 and 0.017). CONCLUSION: Difficulties in the transmission of transfusion records when patients change clinical unit or are rehospitalized and a lack of knowledge concerning the elements which are mandatory to be kept in the transfusion record could explain the results of this study. This assessment is fully in line with the process of transfusion security improvement. In order to promote the quality of the transfusion record, new recommendations and tools were elaborated following this study.