Impact of a pilot team on patients' pain reduction and satisfaction in an emergency department: A before-and-after observational study.

BACKGROUND: Pain management and patient satisfaction were targeted in the emergency department of a Paris university hospital. In 1999, 77.0% of patients complained of pain on arrival and more than half of patients did not experience pain relief at discharge. The purpose of the study was to evaluate the outcomes of the implementation of a team piloting pain management on pain reduction and pain care satisfaction. METHOD: Two cross-sectional surveys (04/10/1999 to 19/10/1999 and 03/04/2007 to 18/04/2007) were conducted before and after a team piloting pain management was deployed in the emergency department. Consecutive patients age 18 years and older who visited the department suffering from pain were given structured questionnaires that validated scales scoring pain upon arrival and at discharge. Patients' files were analyzed using structured forms. The parameters associated with pain reduction and patient satisfaction were sought. RESULTS: In 2007, 65.0% of patients had their pain relieved vs. 35.1% in 1999 (P<0.001); 60.2% were satisfied with the pain care received vs. 39.8%. Pain management (e.g. waiting time ≤ 20 min: 47.6% vs. 20.8%; interventions on pain before the physician's examination: 63.0% vs. 13.8%; and pain reassessment after intervention: 13.8% vs. 4.5%) improved. Both pain reduction and patient satisfaction were significantly associated with intervention before the physician's examination. Pain reduction was independently and positively associated with time of survey, triage level (depending on the severity of their condition), pain intensity on arrival, and negatively associated with discharge without hospitalization. Satisfaction was independently and positively associated with waiting time before examination (0-20 min) and the absence of procedural pain. CONCLUSION: The implementation of a team piloting pain management seemed to have had positive effects on pain management in the emergency department. However, respectively, 56.2% and 39.8% of patients remained without pain relief and dissatisfied with pain management at the end of their visit.

Burden of breast cancer with brain metastasis: a French national hospital database analysis.

OBJECTIVE: Incidence of breast cancer with brain metastases (BCBM) is increasing, especially among patients over-expressing HER2. Epidemiology on this sub-type of cancer is scarce, since cancer registries carry no information on the HER2 status. A retrospective database analysis was conducted to estimate the burden of BCBM, especially among HER2-positive patients in a secondary objective. METHODS: Patients with a new diagnosis of BCBM carried out between January and December 2008 were identified from the national hospital database using the International Disease Classification. Patients receiving a targeted anti-HER2 therapy were identified from the national pharmacy database. Hospital and pharmacy claims were linked to estimate the burden of HER2-positive patients. Data on hospitalizations were extracted to describe treatment patterns and healthcare costs during a 1-year follow-up. Predictors of treatment cost were analyzed through multi-linear regression analysis. RESULTS: Two thousand and ninety-nine BCBM patients were identified (mean age (SD) = 57.8 (13.6)), of whom 12.2% received a targeted anti-HER2 therapy; 79% of patients had brain metastases associated with extracranial metastases, and the attrition rate reached 82%. Patients received mostly palliative care (47.4%), general medical care (40.6%), and chemotherapy (35.0%). The total annual hospital cost of treatment was 8,426,392€, representing a mean cost of 22,591€ (±14,726) per patient, mainly influenced by extracranial metastases, surgical acts, and HER2-overexpression (p < 0.0001). CONCLUSIONS: The database linkage of hospital and pharmacy claims is a relevant approach to identify sub-type of cancer. Chemotherapy was widely used as a systemic treatment for breast cancer rather than for local treatment of brain metastases whose morbi-mortality remains high. The variability of treatment costs suggests clinical heterogeneity and, thus, extensive individualization of protocols.

Prognostic factors of disease-free survival after thyroidectomy in 170 young patients with a RET germline mutation: a multicenter study of the Groupe Francais d'Etude des Tumeurs Endocrines.

BACKGROUND: In hereditary medullary thyroid carcinoma (HMTC), prophylactic surgery is the only curative option, which should be properly defined both in time and extent. OBJECTIVES: To identify and characterize prognostic factors associated with disease-free survival (DFS) in children from HMTC families. DESIGN: We conducted a retrospective analysis of a multi-center cohort of 170 patients below age 21 at surgery. Demographic, clinical, genetic, biological data [basal and pentagastrine-stimulated calcitonin (CT and CT/Pg, respectively)], and tumor node metastasis (TNM) status were collected. DFS was assessed based on basal CT levels. Kaplan-Meier curves, Cox regression, and logistic regression models were used to determine factors associated with DFS and TNM staging. RESULTS: No patients with a preoperative basal CT <31 ng/ml had persistent or recurrent disease. Medullary thyroid carcinoma defined by a diameter ≥10 mm [hazard ratio (HR): 6.0; 95% confidence interval (95% CI): 1.8-19.8] and N1 status (HR: 20.8; 95% CI: 3.9-109.8) were independently associated with DFS. Class D genotype [odds ratio (OR): 48.5, 95% CI: 10.6-225.1], preoperative basal CT >30 ng/liter (OR: 43.4, 95% CI: 5.2-359.8), and age >10 (OR: 5.5, 95% CI: 1.4-21.8) were associated with medullary thyroid carcinoma ≥10 mm. No patient with a preoperative basal CT <31 ng/ml had a N1 status. Class D genotype (OR: 48.6, 95% CI: 8.6-274.1), and age >10 (OR: 4.6, 95% CI: 1.1-19.0) were associated with N1 status. CONCLUSION: In HMTC patients, DFS is best predicted by TNM staging and preoperative basal CT level below 30 pg/ml. Basal CT, class D genotype, and age constitute key determinants to decide preoperatively timely surgery.

Knowledge, attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations.

OBJECTIVES: Immunization of healthcare workers (HCWs) is a major issue for infection control in healthcare facilities. The aim of this study was to evaluate knowledge regarding occupational vaccinations, HBV, varicella and influenza vaccination rates and attitudes towards influenza vaccine among HCWs. DESIGN AND SETTING: A cross-sectional survey was conducted in two wards (Medicine and Paediatrics) of a 1182-bed teaching hospital in Paris, France. METHODS: A standardized, anonymous, self-administered questionnaire was used. RESULTS: Of 580 HCWs, 395 (68%) completed the questionnaire. Knowledge about the occupational vaccinations of HCWs was low. HBV (69%), tuberculosis (54%) and influenza (52%) were the most cited vaccinations. Paediatric staff was more aware of influenza and pertussis immunizations (p<.05). HBV vaccination rate was 93%, among whom 65% were aware of their immune status. Influenza vaccination rate for 2006-2007 was 30% overall, ranging from 50% among physicians to 20% among paramedical staff (p<.05). Physicians based their refusal on doubts about vaccine efficacy, although paramedics feared side effects. Influenza vaccination was associated with knowledge of vaccine recommendations [OR=1.75, 95% CI: 1.13-2.57] and contact with patients [OR=3.05, 95% CI: 1.50-5.91]. CONCLUSIONS: Knowledge of recommended occupational vaccinations is insufficient in HCWs, except for HBV and influenza. Although the HBV vaccine coverage of HCWs is satisfactory, a large proportion of them is unaware of immune status. Influenza vaccine coverage remains low, especially among paramedical staff because of fear of side effects. As vaccine coverage is associated with knowledge, educational campaigns should be strengthened to increase the adhesion of HCWs to vaccinations.

Hepatitis B vaccination in women healthcare workers: a seroepidemiological survey.

OBJECTIVE: To assess the concentration and kinetics of antibody response after hepatitis B vaccination among women healthcare workers. DESIGN: Longitudinal retrospective seroepidemiological survey among women vaccinated against hepatitis B working in a university hospital and followed-up in an occupational health department. A structured form was used to collect socio-demographic characteristics, clinical data, age at vaccination, vaccination schedule, measurement of antibodies to hepatitis B surface antigen (anti-HBs antibody). Subjects were considered seronegative against hepatitis B when anti-HBs antibody concentration was less than 10 mIU/ml. SETTING: A 1260-bed general hospital in Paris, France. PARTICIPANTS: All women healthcare workers visiting the occupational health department between January 1997 1st and December 2000 31st and who had a measurement of anti-HBs antibody. RESULTS: Irrespective of the age at the primary vaccination, 810 (92%) women were seropositive (anti-HBs antibody > or = 10 mIU/ml). Only 22 women (4.5%) vaccinated before 26 years of age were seronegative, against 46 (13.2%) vaccinated after 25 years of age (p < 0.001). Seven years after vaccination, 78% of women were still seropositive. An inadequate vaccination schedule (adjusted hazard ratio (HR), 3.0; 95% confidence interval [CI], 1.6-5.5) and an age greater than 25 years at primary vaccination (HR, 2.6; 95% CI, 1.5-4.4) were associated with being seronegative against hepatitis B. CONCLUSIONS: Despite vaccination, some women healthcare workers were seronegative against hepatitis B virus. Vaccinating early in the career of a health-care worker using an adequate schedule seems key-elements to guarantee an anti-HBs measurement > or =10 mIU/ml.

Short peripheral venous catheters: effect of evidence-based guidelines on insertion, maintenance and outcomes in a university hospital.

This study was designed to evaluate the impact of hospital-wide guidelines for short peripheral venous catheters (SPVC) insertion on the frequency of local catheter-related complications. In a 1051-bed Parisian university hospital, two observational, point prevalence surveys were undertaken in 1996 and in 1998, separated by implementation of written guidelines for SPVC insertion. The outcomes of SPVC insertion were defined as the presence or absence of local catheter-related complications (erythema, purulence around the insertion point, tenderness or induration along the cannulated vein). The proportion of polyurethane catheter materials used (56% vs. 81%, P<0.001), correct and sterile fixation (80% vs. 92%, P<0.05), non-movable catheters (92% vs. 98%, P=0.03) and insertion record (58% vs. 76%, P<0.01) increased between 1996 and 1998. The frequency of local catheter-related complications decreased (15% vs. 4%, P<0.01). Age >73 years [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.28-28.05] was positively associated with local catheter-related complications, whereas duration of insertion (until 72 h) (OR 0.29, 95% CI 0.09-0.89) and the implementation of guidelines (OR 0.26, 95% CI 0.09-0.67) were negatively associated with local catheter-related complications. The implementation of guidelines was independently negatively associated with local catheter-related complications (OR 0.31, 95% CI 0.09-0.97). The results suggest that hospital guidelines for SPVC insertion can improve catheter care and significantly reduce local catheter-related complications.

[Helicobacter pylori infection in children of developing countries]. / Infection a Helicobacter pylori chez l'enfant dans les pays en développement.

A characteristic feature of Helicobacterpylori infection in developing countries is early acquisition of the bacteria during childhood. Recent study has documented the frequency of transient infection in young children in particular during the first year following eradication therapy. Children living in developing countries present several risk factors for acquisition including crowding, young age, and recurrent gastroenteritis. The risk of infection increases significantly in function of the number of infected persons in a child's family. Using molecular biology techniques based on gene sequencing, we have shown that strains in different members of the same family were identical not only between parents and children but also between siblings. The relationship between chronic diarrhoea, retarded growth, iron-deficient anaemia, and Helicobacter pylori infection in children especially from developing countries remains controversial. Gram staining of biopsy smears to detect Helicobacter pylori is an efficient diagnostic method and can be a good alternative when culture is unfeasible. Respiratory testing and detection of antigens in stools are effective and appear to be well suited to diagnosis of Helicobacter pylori infection. In developing countries Helicobacter pylori is a common infectious agent warranting further study to gain insight into clinical presentation, epidemiological features, and treatment requirements including sensitivity to antibiotics

Risk factors for adult renal cell carcinoma.

This study confirmed several independent risk and protective factors for RCC identified in the authors' previous study. Protective factors such as oral contraceptive use and moderate alcohol consumption were identified only in women. Tobacco consumption and severe obesity were the main independent risk factors. There were other modifiable risk markers, however, such as occupational exposure, thiazidic drug intake, and urinary tract infections. The associations between risk factors and RCC were weak, even for tobacco, for which the association was weaker than that for lung cancer. The identified risks involve a large proportion of the population, however, and the risk attributable to these types of exposure is high. The authors' recommendations for the prevention of RCC are therefore similar to those for the prevention of cardiovascular disease and cancer, and should be disseminated to the general population. The high-risk groups identified are too large for a specific early-screening program for RCC, but such screening might be appropriate if restricted to selected age groups.

Reducing the number of T3 orders in the Paris hospital network: towards better appropriatness of thyroid function test prescription.

In vitro thyroid function tests are among the most frequently prescribed laboratory procedures. Serum triiodothyronine (T3) tests are seldom necessary as a first-level measurement. Our objectives were to measure the proportion of T3 measurements relative to all in vitro thyroid function tests in a large hospital network and to investigate the contributions of various interventions to change prescribers'behavior. We performed two cross-sectional surveys in 1995 and 1998 in the 50 Paris University hospitals. Questionnaires were mailed to the heads of the 30 laboratories performing thyroid function tests. One-month orders of free and total thyroxine, free and total T3 and thyrotropin were recorded; changes in T3 measurement orders between the two periods were estimated and association with interventions were expressed as odds ratios and 95% confidence intervals. Twenty-five heads of laboratory responded to both surveys. In 1995, T3 measurements constituted 21% of in vitro thyroid function test ordering, which seems to us exceedingly high. The decrease in T3 measurement ordering observed in 1998 (15% of thyroid function test ordering) was independently associated with multiple behavioral changes: educational interventions, structured test form use and year of prescription.

Homelessness and high-dosage buprenorphine misuse.

AIM: To determine whether intravenous drug users (IDUs) are more likely to misuse high dosage buprenorphine (HDB) if they are homeless. DESIGN: We carried out a cross-sectional study using data collected from HDB users between 1998 and 1999. Data were collected by use of a structured questionnaire with questions about demographic characteristics, and use of HDB and other substances. IDUs were considered to be homeless if they did not live on their own or with their parents or friends. SETTING: IDUs were recruited from three centers for the treatment of drug users, three health care networks, one prison, one sleep-in, and two centers that provide psychosocial support for IDUs. PARTICIPANTS: Of the 788 eligible patients, 779 answered the questionnaire (response rate: 98.9%). RESULTS: Homeless IDUs were more likely to have injected HDB than those who were not homeless (67% vs. 47%; p<0.001), and their injection behaviors were more likely to be unsafe. The first HDB injection was more likely to result in medical complications in the homeless group than in the nonhomeless group (58% vs. 38%; p=0.001). Homeless IDUs were less likely to receive medical followed-up and were less well informed about the correct way of using HDB than nonhomeless IDUs. CONCLUSION: Homeless IDUs are more likely to misuse HDB. Thus, HDB maintenance therapy may not be the most appropriate maintenance therapy for this group.

[Buprenorphine abuse: high dose intravenous administration of buprenorphine]. / Substitution et mésusage: l'injection intraveineuse de buprénorphine haut dosage.

BACKGROUND: In France, actually, around 70 000 drug addicts are treated with buprenorphine available as sublingual tablets. Clinical studies have demonstrated the clinical efficacity of buprenorphine for opiate addiction. But, it has been reported that some of them injected buprenorphine. Some inquiries have suggested measured with 10% to 40% injectors. To use buprenorphine tablets for injections have had heavy sanitary consequences (4). OBJECTIVES: To know the use buprenorphine context in our population and to analyse the circumstances and outcomes of buprenorphine injection for drug addicts. METHOD: In 1998-1999, we conducted a cross-sectional survey using a structured questionnaire. Information wax collected during a 30-minute face-to-face interview through an 69-item structured questionnaire administered by trained investigators. The questionnaire was composed of questions about social demographic data, the drugs taken before the first use of buprenorphine, the circumstances of the first buprenorphine experiment, the reasons for the first buprenorphine injection into drug addicts, the other substances used in the same time, the risks behaviors, the sensations seeking, the medical consequences. The questionnaire was first tested in a pilot study through ten patients. Drug addicts were followed-up in 8 drug abuse treatment centres among which 2 networks of general practitioners in Paris region, in Strasbourg region and in Nice region. The investigators were general practitioners, psychologists, psychiatrists, educators, nurses. All drugs addict which reported use buprenorphine were seen in treatment centre and were 18 years old or older, were eligible. Drugs addict with severe mental disorders, unable to answer the questions were excluded. Respondents received an assurance of confidentiality and informed consent was obtained. Standard descriptive statistics were used to analyse subjects characteristics: frequency, standard deviation. The study was funded by the Observatoire Français des Drogues et des Toxicomanies (OFDT). RESULTS: Of the 779 consecutive drug addicts interviewed, 770 completed the questionnaire. The study has shown that the majority of subjects were male (77.2%), mean age was 31.3 (SD: 5.98). Most of them were unmarried (67.5%). They had no real employment (56.5%). The mean age at the first use opiate was 19.5 (SD: 4.5). The mean age at the first heroin injection was 20.7 (SD: 4.6). At the time of interview, most of drugs addict used more than two types of drugs (42.6%). Many associations with buprenorphine are described particularly associations to alcohol (41.2%), benzodiazepines (40%), cocaine (12.4%), heroin (7.8%), crack (7.2%); most of these subjects getting buprenorphine without any medical prescription. Most drug addicts had asked themselves for using buprenorphine (61.0%). Near fifty per cent (49.5%) injected buprenorphine. Among them, 39.6% injected this substance the first time they used it. Curiosity (72.8%), need for injection (69.0%), sensation seeking (49.0%) were reasons given by drug addicts for buprenorphine injection. Others reasons were given: an inadequate dosage of sublingual buprenorphine, to find buprenorphine in black market. Buprenorphine injection took place in the secure environment (57.5%). Drug addicts were not alone when they injected (53.6%). The introducer was an buprenorphine user (57%). The first buprenorphine injection sensation was not pleasant (61%), although injection of buprenorphine is usually performed by 80% of them. However, 93% had been informed that buprenorphine injection was contra-indicated. CONCLUSION: Since six years, many French patients have received a treatment for opiate addiction. High dosage buprenorphine is actually the principal treatment for substitution medication in France. Some misappropriations and wrong uses have been seen, the most frequent and sever being using tablets for injections. The prevalence of buprenorphine injection is high among drug addicts. The results of the study show that the first buprenorphine Injection takes places place a few time after the first buprenorphine use. The codependance to other substances is one of risk markers for intravenous use of buprenorphine tablets and the dangers of polyintoxication were known. Curiosity, need for injection favour buprenorphine injection. But, the sensation seeking brings on the drug addict too. The rather loose frame of prescription, a lack of training among general practitioners, the fragility of the specialises network, the complexities in the care of drug users which not resumed by a substitution must take into consideration. The drug addict's career, the subject's environment and the circumstances of the buprenorphine injection have not been previously described. However their knowledge are of prime necessity to prevent this abnormal use and to find the best treatment for drug addicts.

A terminal care support team in a Paris university hospital: care providers' views.

OBJECTIVES: Following three years of a terminal care support team (TCST) activity: (a) to describe current management of terminally ill patients from the care providers' viewpoint, (b) to compare the views of head nurses and physicians about this management, and (c) to identify ways of further improving palliative care. METHODS: A questionnaire was sent to all head nurses and physicians of the hospital. RESULTS: Care-providers consider that the TCST provides therapeutic counselling, training, and psychological help to patients, staff, and families. Few care providers were reluctant to request advice in the management of their patients. Most were satisfied with the partnership with the TCST and deemed it effective. Further improvements suggested for terminally ill patient care included greater assistance from the TCST, especially for nurses, and expanding TCST activities to outpatient management and home care programs. CONCLUSION: Health care providers consider the implementation of the TCST to have been successful.

[Liver transplantation for alcoholic liver disease]. / Transplantation hépatique pour maladie alcoolique du foie.

Alcoholic cirrhosis is a major public health issue in France. The prevalence of alcoholic cirrhosis and the number of potential candidates for liver transplantation is unknown but certainly underestimated. Despite physicians' ethical reserves concerning this self-inflicted disease and the public's misgivings, liver transplantation for alcoholic cirrhosis can provide survival rates comparable with those observed for other chronic liver diseases. in this indication, liver transplantation if often associated with a low risk of acute rejection and a high rate cancer of the upper respiratory and digestive tracts. The risk of recurrent alcoholism after liver transplantation is also a major problem. Its prevalence varies from 10 to 50%, depending on the assessment criteria, and the rate recurrent risk for the liver graft (alcohol intake>40 g/d) is to the order of 10%. These figures illustrate the importance of careful management and support for these patients. At least 6 months weaning from alcohol is a commonly accepted selection criterion for transplantation candidates. Criteria for liver transplantation generally include patients aged under 65 years, weaned for more than 6 months, with Child C cirrhosis or less, uncontrollable digestive tract hemorrhage, spontaneous severe infection, hepatorenal syndrome, hepatopulmonary syndrome, or multifocal hepatocellular carcinoma if the largest nodule measures less than 3 cm. Acute alcoholic hepatitis is a severe disease, fatal in 50% of the cases, and resistant tot corticosteroid therapy. Liver transplantation in this subpopulation of often young patient who have not achieved weaning merits further evaluation.

Multidrug-resistant bacteria infection control: study of compliance with isolation precautions in a Paris university hospital.

Isolation practices in a university hospital were analyzed for 137 patients with multidrug-resistant bacteria. Isolation was ordered in writing by physicians for 40% and instituted by nurses for 60%; 74% were isolated. Compliance depended on physician ordering in writing (odds ratio, 36.3; 95% confidence interval, 4.8-274.9). Nurses complied best with hand washing.

Venous thromboembolism in medical inpatients: prophylaxis with low-weight heparin in a university hospital and prevalence of thromboembolic events.

The aim of this study was to determine the prevalence of venous thromboembolism (VT) in current prophylactic practice with low-molecular-weight heparin (LMWH) among medical inpatients and to analyze associated risk factors for VT. A cross-sectional survey on five given days was conducted in the medical departments of a university hospital. The prevalence of prophylaxis and confirmed VT was measured. Risk markers for receiving high doses of LMWH and for VT under prophylaxis were assessed by logistic regression models. Of 1,194 inpatients, 1.4% suffered VT. The mean proportion of patients with LMWH prophylaxis was 24% (range: 4-64%). The prevalence of VT was higher among inpatients receiving prophylaxis than among those patients not receiving prophylaxis (3.5% vs. 0.7%, p = 0.002). Under prophylaxis, independent risk markers for thrombosis were history of vein thrombosis (odds ratio [OR]: 4.03; confidence interval [95%CI]: 1.04-15.62) and age (OR: 1.08; 95%CI: 1.01-1.15). Two factors were independently associated with the prescription of high doses of LMWH: obesity was positively associated (OR: 7.50; 95%CI: 2.97-18.92; p < 0.0001) and respiratory insufficiency was negatively associated. In medical departments, current prophylaxis practice leads to many patients being given LMWH. LMWH doses and other preventive measures should be adapted in high-risk inpatients.

Prises de risques lors de la premiere injection intraveineuse de drogue.

Aims. - The objectives of the study were to describe the circumstances surrounding the intiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. Design.- In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. Participants.- Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. Findings. - The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72% and 74% of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83% and 85% of cases. Conclusion. - Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices.

HCV status knowledge and risk behaviours amongst intravenous drug users.

The aim of this study was to identify relationships between injecting and sexual risk behaviours and hepatitis C virus (HCV) status knowledge in intravenous drug users (IDUs). It was a cross-sectional survey (March 1994-June 1995) in 10 drug abuse treatment or psychosocial centres in Paris, France. We used a structured questionnaire about sexual, injecting, HIV and HCV antibody testing practices and results during the previous 6 months. Six hundred and twelve sexually active IDUs aged 18 or older who were current injecting drug users were interviewed. Of 592 respondent IDUs, 37% did not report consistent HCV testing and 34% reported being HCV-positive. HCV-positive IDUs were older than HCV-negatives and HCV-unknowns. HCV-unknowns and HCV-positives had a lower educational level than HCV-negatives. After adjusting for demographic characteristics and HIV status, the factors associated with being HCV-unknown were not using condoms (OR: 2.9; 95% CI: 1.9-4.6) as well as clean equipment (OR: 1.8; 95% CI: 1.2-3.0). Not using new equipment was negatively associated with being HCV-unknown (OR: 0.4; 95% CI: 0.2-0.6) and with being HCV-positive (OR: 0.5; 95% CI: 0.3-0.8). Our study suggests that particular sexual and injecting risk-behaviours are associated with not knowing HCV status. As HCV-unknown IDUs are likely to be at the risk of transmitting HCV or acquiring other infections. HCV testing should be encouraged and associated with sexual counselling. Special attention should be paid to disinfecting practices for HCV-positives and use of new injecting equipment should be recommended for HCV-negatives.

Differences between burns in rural and in urban areas: implications for prevention.

This study aimed to identify typical features of burns in rural areas and to improve their prevention by comparing the characteristics of burnt patients and their burns in rural and urban areas. A cross-sectional survey was conducted in 19 of the 23 French burns units over one year, using a structured questionnaire. We analysed the resulting database. Of the 1422 patients, excluding 188 burnt in unclassified areas, 420 (34%) were burnt in rural areas. Burns were more frequent in rural than in urban areas. Occupational burns were more frequent in rural than in urban areas. The characteristics of patients and burns did not differ between the areas. Patients burnt during everyday activities were older and more frequently had predisposing factors in rural than in urban areas. Burns occurred outdoors more often in rural than in urban areas and were frequently due to flames or explosions or to the use of barbecues or open fires. The hands and perineum were burnt more frequently in rural than in urban areas. Rural burns were more severe than urban burns: they were deeper, involved a larger body surface area and caused more deaths. Preventive measures in rural areas should take into account occupation and everyday activities. They should be specifically adapted to the profiles of burnt patients.