Virginie Migeot

Parental use of the Internet to seek health information and primary care utilisation for their child: a cross-sectional study

BackgroundUsing the Internet to seek health information is becoming more common. Its consequences on health care utilisation are hardly known in the general population, in particular among children whose parents seek health information on the Internet. Our objective was to investigate the relationship between parental use of the Internet to seek health information and primary care utilisation for their child.MethodsThis cross-sectional survey has been carried out in a population of parents of pre-school children in France. The main outcome measure was the self-reported number of primary care consultations for the child, according to parental use of the Internet to seek health information, adjusted for the characteristics of the parents and their child respectively, and parental use of other health information sources.ResultsA total of 1 068 out of 2 197 questionnaires were returned (response rate of 49%). No association was found between parental use of the Internet to seek health information and the number of consultations within the last 12 months for their child. Variables related to the number of primary care consultations were characteristics of the child (age, medical conditions, homeopathic treatment), parental characteristics (occupation, income, stress level) and consultation of other health information sources (advice from pharmacist, relatives).ConclusionWe did not find any relationship between parental use of the Internet to seek health information and primary care utilisation for children. The Internet seems to be used as a supplement to health services rather than as a replacement.

Satisfaction with care among patients with non-metastatic breast cancer: development and first steps of validation of the REPERES-60 questionnaire

AbstractBackgroundThe care itinerary for cancer involves difficulties that occur in several different areas, whether in the diagnostic procedures, in surgery, or in adjuvant treatment. The aim of this work was to obtain a valid instrument measuring satisfaction among patients with breast cancer and exploring their care itinerary overall.MethodsDevelopment phase: Patient focus groups were implemented in two French regions in order to identify areas of satisfaction in relation to the different phases of care provision in breast cancer. On the basis of the literature and the themes and wordings derived from the focus groups, the patients identified several areas of satisfaction, which they found to be partially covered in an American satisfaction measure that has been validated in the French general population (the Consumer Satisfaction Survey in its French version, CSS-VF, 39 items). The patient focus groups suggested adaptation of certain dimensions of this instrument to the potential care providers (37 items) and produced 45 new items in six areas. Validation phase: Using a large sample of patients (cohort of 820 women with invasive non-metastatic breast cancer) approached one month after treatment, this phase selected items that were comprehensible (non-response rate < 10%), non-redundant (r < 0.80) and reproducible (test-retest conducted on a sub-sample of 166 patients). The dimensions were identified by factor analysis on the selected items. Divergent and discriminant validity were assessed (relationships with quality of life questionnaire, comparisons between extreme groups).ResultsResults were in favour of not inserting additional broken-down items into the CSS-VF and retaining 21 new items. The factor analysis found the initial structure of the CSS-VF (39 items in 9 dimensions) and the 21 new items divide up into four dimensions (listening abilities and information provided by doctors, organisation and follow-up of medical care provision, psychological support, material environment). No redundancy was observed between new items and CSS-VF items. Internal consistency was high. Divergent and discriminant validity were satisfactory.ConclusionAdding four new dimensions to the CSS-VF yielded a valid 60-item instrument for assessment of care provided in breast cancer. These promising results now require further investigations of its responsiveness and its robustness in other linguistic, cultural and healthcare settings.

Reliable quantification of bisphenol A and its chlorinated derivatives in human breast milk using UPLC-MS/MS method

Bisphenol A is a widespread industrial chemical which over the past decade has demonstrated its toxicity as an endocrine disruptor. Chlorine present in drinking water may react with bisphenol A to form chlorinated derivatives, which have demonstrated a heightened level of estrogenic activity. In this work, we have comprehensively validated a method using on-line SPE-UPLC-MS/MS and isotope dilution quantification to measure bisphenol A and its chlorinated derivatives in human breast milk according to accepted guidelines. Deutered bisphenol A was used as internal standard. The matrix calibration curve ranged from 0.40 to 6.40 ng/mL for each of the target compounds and provided good linearity (r²>0.99).This method was precise (the intra and inter-day coefficient of variation was <20% at two different concentrations (0.40 and 3.20 ng/mL) and accurate (recovery ranged from 81% to 119%). The limits of detection obtained for BPA and its chlorinated derivatives ranged from 0.01 to 0.09 ng/mL. The limit of quantification for all the compounds validated at 0.40 ng/mL when using 500 μL of milk was found to be suitable for the concentration existing in real samples. The analytical method developed in this study is in accordance with the requirements applicable to biomonitoring of BPA and its chlorinated derivatives in human breast milk.

Reliability of bedside ABO testing before transfusion

BACKGROUND : Previous studies of bedside transfusion compatibility tests have shown high rates of erroneous transfusion decision, due to defective techniques and poor user performance. An experimental study was conducted to evaluate the error rate obtained with a new ready‐to‐use device (Vu‐Test, Medigis), in comparison with the most popular bedside card used in France (Safety‐Test ABO, Diagast Laboratories).

Drinking-water exposure to a mixture of nitrate and low-dose atrazine metabolites and small-for-gestational age (SGA) babies: A historic cohort study

BACKGROUND Groundwater, surface water and drinking water are contaminated by nitrates and atrazine, an herbicide. They are present as a mixture in drinking water and with their endocrine-disrupting activity, they may alter fetal growth. OBJECTIVES To study an association between drinking-water atrazine metabolites/nitrate mixture exposure and small-for-gestational-age(SGA). METHODS A historic cohort study based on birth records and drinking-water nitrate and pesticide measurements in Deux-Sèvres (France) between 2005 and 2009 was carried out. Exposure to drinking-water atrazine metabolites/nitrate mixture was divided into 6 classes according to the presence or absence of atrazine metabolites and to terciles of nitrate concentrations in each trimester of pregnancy. Regression analysis of SGA by mixture exposure at second trimester was subsequently conducted. RESULTS We included 11,446 woman-neonate couples of whom 37.0% were exposed to pesticides, while 99.9% of the women were exposed to nitrates. Average nitrate concentration was from 0 to 63.30 mg/L. In the second trimester of pregnancy, the risk of SGA was different with mixture exposure when drinking-water atrazine metabolites, mainly 2 hydroxyatrazine and desethylatrazine, were present and nitrate dose exposure increased: compared to single first tercile of nitrate concentration exposure, single second tercile exposure OR was 1.74 CI 95% [1.10; 2.75] and atrazine metabolites presence in the third tercile of nitrate concentration exposure OR was 0.87 CI 95% [0.45;1.67]. CONCLUSIONS It is possible that the association found at the second trimester of exposure with regard to birth weight may likewise be observed before birth, with regard to the estimated fetal weight, and that it might change in the event that the atrazine metabolites dose were higher or the nitrate dose lower. It would appear necessary to further explore the variability of effects.

Determinants of variability in waiting times for radiotherapy in the treatment of breast cancer

PURPOSE To examine psycho-social and geographic determinants of delay in starting radiotherapy in early invasive breast cancer patients. MATERIAL AND METHODS Waiting time was defined as the time elapsed until the beginning of radiotherapy, starting from the date of surgery (in absence of chemotherapy) or from the end of chemotherapy. RESULTS Eight hundred and ninety six women aged 24-89 took part in the study. Mean waiting times were 52 days (sd=19) between surgery and radiotherapy and 31 days (sd=14) between chemotherapy and radiotherapy. Differences between radiotherapy centres (p<0.0001) accounted for 30% and 12%, respectively, of total variance in waiting times. Using a multivariate mixed analysis that took into account intra-centre correlation, the time between surgery and radiotherapy was shorter for young patients (p=0.020), those who had sought information about their illness (p=0.024) and those who had undergone surgery and radiotherapy in the same centre (p=0.021). On the other hand, no patient characteristic was associated with the time between chemotherapy and radiotherapy. CONCLUSION Centre is the major factor that explained longer waiting times in radiotherapy, emphasising the structural hypothesis. It is important to pursue initiatives to improve the organization within radiotherapy centres and then to verify that these initiatives have succeeded in shortening waiting times.

Determination of bisphenol A in water and the medical devices used in hemodialysis treatment

Bisphenol A (BPA) is an endocrine disruptor found in food containers and plastic beverages and also in medical devices such as dialyzers. The aim of this study is while taking into account the BPA originating in medical devices and the water used in dialysate production, to provide the first published investigation of overall potential exposure to BPA during hemodialysis treatment in patients suffering from end-stage renal disease. BPA concentration in water (at each step of purification treatment) and in dialysate and BPA leaching from dialyzers were determined using solid-phase extraction coupled to ultra-high-performance-liquid chromatography tandem mass spectrometry. We have corroborated the hypothesis that a significant amount of BPA may migrate from dialyzers and also demonstrated that BPA is provided by the water used in dialysate production (8.0±5.2ngL(-1) on average) and by dialysis machine and dialysate cartridges, leading to dialysate contamination of 22.7±15.6ngL(-1) on average. Taking into account all the sources of BPA contamination that may come into play during a hemodialysis session, the highest exposure could reach an estimated 140ng/kg b.w./day for hemodialyzed patients, directly available for systemic exposure. Finally, BPA contamination should be taken into account as concerns both the medical devices commonly used in hemodialysis and purified water production systems.

Intérêt de la détection et de la prise en compte d’une surdispersion dans un modèle de Poisson : illustration à partir d’un exemple

BACKGROUND Researchers often use the Poisson regression model to analyze count data. Overdispersion can occur when a Poisson regression model is used, resulting in an underestimation of variance of the regression model parameters. Our objective was to take overdispersion into account and assess its impact with an illustration based on the data of a study investigating the relationship between use of the Internet to seek health information and number of primary care consultations. METHODS Three methods, overdispersed Poisson, a robust estimator, and negative binomial regression, were performed to take overdispersion into account in explaining variation in the number (Y) of primary care consultations. We tested overdispersion in the Poisson regression model using the ratio of the sum of Pearson residuals over the number of degrees of freedom (chi(2)/df). We then fitted the three models and compared parameter estimation to the estimations given by Poisson regression model. RESULTS Variance of the number of primary care consultations (Var[Y]=21.03) was greater than the mean (E[Y]=5.93) and the chi(2)/df ratio was 3.26, which confirmed overdispersion. Standard errors of the parameters varied greatly between the Poisson regression model and the three other regression models. Interpretation of estimates from two variables (using the Internet to seek health information and single parent family) would have changed according to the model retained, with significant levels of 0.06 and 0.002 (Poisson), 0.29 and 0.09 (overdispersed Poisson), 0.29 and 0.13 (use of a robust estimator) and 0.45 and 0.13 (negative binomial) respectively. CONCLUSION Different methods exist to solve the problem of underestimating variance in the Poisson regression model when overdispersion is present. The negative binomial regression model seems to be particularly accurate because of its theorical distribution ; in addition this regression is easy to perform with ordinary statistical software packages.

Saliva promotes survival and even proliferation of Candida species in tap water

Candida yeasts colonize the human oral cavity as commensals or opportunistic pathogens. They may be isolated from water circulating in dental unit waterlines mixed with traces of saliva mainly because of the dysfunction of antiretraction valves. This study deals with the growth ability of Candida albicans, Candida glabrata and Candida parapsilosis in tap water with saliva (0-20% v/v). Results show that C. glabrata is the most susceptible species in tap water. Furthermore, saliva promotes both survival and proliferation of the three studied Candida species in tap water.

Improving perinatal Group B streptococcus screening with process indicators

RATIONALE Group B streptococcus (GBS) neonatal infection can be prevented by screening pregnant women for GBS colonization from the 34th to the 38th week of gestation, as has been recommended in France since 2001. We assessed guideline adherence among midwives and obstetricians. METHODS From 2006 to 2008, new and mandatory GBS data were added to the obstetric database. We merged the latter with a bacteriological database and a paediatric database and defined process indicators for pregnant women who delivered from the 37th week of gestation in the hospital of Poitiers and for neonates hospitalized for a GBS infection from 2006 to 2008. RESULTS We abstracted 5997 pregnant women (1942 in 2006, 1975 in 2007 and 2080 in 2008) and 84 neonates (17 in 2006, 32 in 2007 and 35 in 2008). GBS pregnancy colonization prevalence was 15%, 13% and 18% respectively. Availability of GBS screening status was stable (96%, P = 0.15). The rate of GBS screening during pregnancy increased significantly (86% to 90%, P = 0.002). Percentage of correct-term screening increased significantly (89% to 96%, P < 0.001). Percentage of women who received intra-partum antibiotic prophylaxis decreased significantly (84% to 70%, P = 0.001). Percentage of women who received correct intra-partum antibiotic prophylaxis was stable (75%, P = 0.65). Percentage of neonates whose mother had been correctly screened but negative was 77%, 67% and 68% respectively (P = 0.61). CONCLUSION Our mandatory database entailed guideline adherence over a short lapse of time and resulted in a significant increase of the screening rate at the correct term. However, circumstances where neonates are infected still remain. Screening test performance needs to be re-evaluated.