[Impact of stopping reimbursement of olmesartan for hypertensive patients in primary care]. / Impact du déremboursement de l'olmésartan chez les patients hypertendus en soins premiers.

AIMS OF STUDY: Since January 2017, olmesartan-based treatment are no longer reimbursed by French national health insurance. Indeed, enteropathy cases, potentially lethal, were described in relation to this medication. Objectives were to study the impact of stopping the reimbursement of olmesartan for hypertensive patients. PATIENTS AND METHOD: A descriptive retrospective study was performed with data from two primary care facilities in French occidental Normandy. To evaluate the blood pressure control, different blood pressure measurements were considered during the year before (period 1) and the year after (period 2) potential stopping olmesartan. A medico-economic analysis was also realized. RESULTS: From June 2015 to July 2017, 107 hypertensive patients treated by olmesartan were included. Among them, 47 patients (44%) had an antihypertensive monotherapy. olmesartan had been mainly switched by another sartan (75%, 80/107) including valsartan (59%, 47/80). Mean blood pressures during period 1 and period 2 were not statistically different. Moreover, 83% of patients were initially controlled with olmesartan and 81% after switching medication (P=0,86). The use of olmesartan generated an additional cost of 58% compared to the other drugs that replaced it during period 2. CONCLUSIONS: Stopping olmesartan reimbursement didn't seem to have a significant impact on blood pressure control of hypertensive patients while its cost is significant. In addition to potential serious side effects, olmesartan has not shown any improvement in cardiovascular morbi-mortality.

[Human papillomaviruses vaccination: Parental awareness and acceptance of the vaccine for children in Lower Normandy schools and informative campaign during the 2015-2016 school year]. / Vaccination contre les papillomavirus humains : intentions vaccinales et connaissances de parents d'élèves bas-normands avant intervention au cours de l'année scolaire 2015­2016.

BACKGROUND: The vaccine against human papillomavirus (HPV) can be administered starting at the age of 9 years. Parents thus play a major role in the choice of vaccination. The objective of this study was to investigate parental awareness about anti-HPV vaccination in Lower Normandy and to measure their vaccinal intentions before an informative campaign. METHODS: The study population included parents of children aged 10-11 years enrolled in school (2015-2016) in Lower Normandy, France. The initial study was observational and descriptive. With the agreement of the academic directors, 16 middle schools were selected. A questionnaire was delivered to the school children and collected in September 2015 by the school nurses. RESULTS: Within the selected middle schools, 1427 questionnaires were delivered. School nurses collected 1168 questionnaires (81.9%) among which 1155 could be analyzed because they contained answers (80.9%). Out of 575 girls aged 10-11 years, 523 (91.0%) were not vaccinated against HPV. Among parents of non-vaccinated schoolgirls who answered, 48.4% did not know if they intended to have their children vaccinated (251 of 519 questionnaires). There was a significant association between the socio-professional status of the parents who answered and their intention to vaccinate their daughters against HPV (P=0.03). Parents were significantly more likely to immunize their children when they previously knew about the vaccine (P<0.001) and when they had good knowledge about the vaccine (P<0.05). Parents who previously had their daughters vaccinated were also significantly more likely to have their sons vaccinated against HPV (P<0.001). CONCLUSION: The significant association between knowledge about the vaccine and intentions to have their children vaccinated allows us to predict the effectiveness of information campaigns on vaccination rates.

[Audit "Toys and incubators in neonatology"]. / Audit << Les jouets et les couveuses en néonatologie >>

Owing to an increase in nosocomial septicaemias in the Neonatalogy department, we've judged it necessary to consider the role of items not linked to the nursing procedures, and nevertheless present in the incubators, as well as the hygiene techniques applied to them. In November 2007, we've made a longitudinal prospective study consisting in an observation audit during 3 successive days, observing every single incubator with a newborn baby. In each incubator, we've checked whether there were or not items that weren't required by the nursing activities, along with their characteristics and the hygiene procedures applied to them. We've inquired as well whether the parents and the nursing staff knew and applied the required hygiene procedures. In 13 among the 17 incubators under survey, at least one item not strictly required by the nursing procedures could be found. The number of toys in each incubator varied from seven to one. Among the 33 toys surveyed, 24 (73%) of them showed a score of maximum fluffiness (4 out of 4), and only 10 wore labels giving cleansing advice from the manufacturers. Without any record about the cleaning/disinfecting of the toys brought in hospital, we have observed that the parents were given varied advice about how to clean the toys at home before putting them in the incubators (only four parents had washed the toys in their washing machines at more than 30 degrees C). From the six samples under scrutiny, all the culture results were tested positive. In particular two of the soft toys sampled were found infected by a Pseudomonas oryzihabitans. These particular toys belonged to a baby who had been diagnosed with a septicaemia characterized by hemocultures positive to a P. oryzihabitans of a different strain. Our audit has been an efficient reminder that any item put in an incubator is a potential vector and reservoir of pathogen organisms. After a general feedback towards the department staff, the medical staff then prescribed to permanently ban all the items not strictly required by the nursing activities from all the incubators of the department.