Factors associated with referral to physiotherapists for adult patients consulting for musculoskeletal disorders in primary care; an ancillary study to ECOGEN

BACKGROUND

Musculoskeletal disorders (MSD) are multifactorial requiring multidisciplinary treatment including physiotherapy. General practitioners (GP) have a central role in managing MSDs and mostly solicit physiotherapists accounting for 76.1% of physiotherapy referrals in France. Patient, physician, and contextual factors, including healthcare accessibility, can influence physiotherapy referral rates.

OBJECTIVE

To identify patient, physician, and contextual factors associated with physiotherapy referral in adult patients with MSDs in general practice.

METHODS

This study is based on the 2011/2012 French cross-sectional ECOGEN study. Analyses included working-age patients consulting their GP for any MSD. Physiotherapy referral was assessed initially, then adjusted multilevel logistic model analysis of patient, physician, geographical area-related factors associated with these referrals was performed.

RESULTS

Among the 2305 patients included, 456 (19.8%) were referred to a physiotherapist. Following multilevel multivariate analyses, physiotherapist referral was more frequent for female patients (OR 1.28; 95% CI [1.03, 1.59]) with spinal (OR 1.47; 95% CI [1.18, 1.83]) and upper limb disorders (OR 1.66; 95% CI [1.20, 2.29]), and less frequent for patients ≥ 50 years (OR 0.69; 95% CI [0.52, 0.91]), living in deprived geographical areas (OR 0.60; 95% CI [0.40, 0.90]). GPs referred to a physiotherapist less frequently if they were ≥ 50 years (OR 0.50; 95% CI [0.39, 0.63]), had a high number of annual consultations, or were practicing in semi-urban area in a multidisciplinary team.

CONCLUSION

This multilevel analysis identifies factors associated with physiotherapy referral for patients with MSDs, including living in deprived geographical areas. This constitutes an original contribution towards addressing healthcare disparities.

X-Ray induced desorption and photochemistry in CO ice

We report an investigation of X-ray induced desorption of neutrals, cations and anions from CO ice. The desorption of neutral CO, by far the most abundant, is quantified and discussed within the context of its application to astrochemistry. The desorption of many different cations, including large cations up to the mass limit of the spectrometer, is observed. In contrast, the only desorbing anions detected are O- and C-. The desorption mechanisms of all these species are discussed with the aid of their photodesorption spectrum. The evolution of the X-ray absorption spectrum shows significant chemical modifications of the ice upon irradiation, which along with the desorption of large cations gives a new insight into X-ray induced photochemistry in CO ice.

Mechanism of Indirect Photon-Induced Desorption at the Water Ice Surface

Electronic excitations near the surface of water ice lead to the desorption of adsorbed molecules, through a so far debated mechanism. A systematic study of photon-induced indirect desorption, revealed by the spectral dependence of the desorption (7-13 eV), is conducted for Ar, Kr, N_{2}, and CO adsorbed on H_{2}O or D_{2}O amorphous ices. The mass and isotopic dependence and the increase of intrinsic desorption efficiency with photon energy all point to a mechanism of desorption induced by collisions between adsorbates and energetic H/D atoms, produced by photodissociation of water. This constitutes a direct and unambiguous experimental demonstration of the mechanism of indirect desorption of weakly adsorbed species on water ice, and sheds new light on the possibility of this mechanism in other systems. It also has implications for the description of photon-induced desorption in astrochemical models.

Desorption of neutrals, cations, and anions from core-excited amorphous solid water

Core-excitation of water ice releases many different molecules and ions in the gas phase. Studying these desorbed species and the underlying desorption mechanisms can provide useful information on the effects of x-ray irradiation in ice. We report a detailed study of the x-ray induced desorption of a number of neutral, cationic, and anionic species from amorphous solid water. We discuss the desorption mechanisms and the relative contributions of Auger and secondary electrons (x-ray induced electron stimulated desorption) and initial excitation (direct desorption) as well as the role of photochemistry. Anions are shown to desorb not just through processes linked with secondary electrons but also through direct dissociation of the core-excited molecule. The desorption spectra of oxygen ions (O⁺, OH⁺, H₂O⁺, O^-, and OH^-) give a new perspective on their previously reported very low desorption yields for most types of irradiations of water, showing that they mostly originate from the dissociation of photoproducts such as H₂O₂.

XUV photodesorption of carbon cluster ions and ionic photofragments from a mixed methane-water ice

The photochemical processing of a CH₄ : D₂O 1 : 3.3 ice mixture adsorbed on an HOPG surface in the XUV regime was investigated using pulses obtained from the Free-electron LASer in Hamburg (FLASH) facility. Ice films were exposed to femtosecond pulses with a photon energy of hν = 40.8 eV, consistent with the HeII resonance line. Cationic species desorbing directly from the ice films were detected using time-of-flight (ToF) mass spectrometry. Simple ions formed through the fragmentation of the parent molecules and subsequent recombination reactions were detected and are consistent with efficient D⁺ and H⁺ ejection from the parent species, similar to the case for low energy electron irradiation. The FEL fluence dependencies of these ions are linear or exhibit a non-linear order of up to 3. In addition, a series of C_n⁺ cluster ions (with n up to 12) were also identified. These ions display a highly non-linear desorption yield with respect to the FEL fluence, having an order of 6-10, suggesting a complex multi-step process involving the primary products of CH₄ fragmentation. Two-pulse correlation measurements were performed to gain further insight into the underlying reaction dynamics of the photo-chemical reactions. The yield of the D₂O derived products displayed a different temporal behaviour with respect to the C_n⁺ ions, indicating the presence of very different reaction pathways to the two families of ionic products.

Thermal balloon ablation versus transcervical endometrial resection: evaluation of postoperative pelvic pain in women treated for dysfunctional uterine bleeding

PURPOSE OF THE STUDY

To evaluate postoperative pain after mini-invasive surgical treatment for dysfunctional uterine bleeding (DUB) with transcervical endometrial resection or thermal ablation balloon.

MATERIALS AND METHODS

A longitudinal observational study, analyzing 47 women affected by DUB who underwent endometrial ablation was conducted. The authors collected evaluation of pelvic pain at one and four hours after intervention and the individual necessity of analgesics. After 30 days, all patients underwent a gynecological visit to evaluate postoperative outcome.

RESULTS

Pelvic pain was higher one and four hours after procedure in thermal balloon ablation group, and patients in the same group required more analgesic rescue dose. There were no complications such as uterine perforation, heavy blood loss or thermal injuries with both the procedures.

CONCLUSION

Thermal balloon ablation appears a more painful procedure than endometrial resection, both in the immediate postsurgical time and 30 days after surgery. Ad hoc anaesthesiologic and analgesic protocol should be adopted to ensure quick recovery and good acceptance of the procedure.

Pregnancy outcome after laparoscopic myomectomy

PURPOSE OF INVESTIGATION

Main purpose of this study was to analyze the reproductive and obstetrical outcome as delivery mode and incidence of major complications (uterine bleeding and uterine rupture) after laparoscopic myomectomy.

MATERIALS AND METHODS

The authors conducted an observational study in patients who underwent laparoscopic myomectomy. Inclusion criteria were: surgery performed for single and or multiple myomas sized between five and 15 cm and pregnancy desire. Exclusion criteria were: surgery for pedunculated myomas and male or tubal infertility. Collected data on pregnancy desire, success in obtaining pregnancy surgical interval time before pregnancy, performing assisted reproductive medicine, gestational weeks, mode of delivery, indicating a possible cesarean section, and complications. On collected data the authors calculated pregnancy and abortion rates.

RESULTS

Among patients aged between 19 and 42 years who answered a telephonic questionnaire, the authors selected 185 patients with pregnancy willing. A total number of 426 myomas were removed; 115 (62.2%) patients reported 151 pregnancies, nine in a total of 17 patients achieved it with reproductive assistance, 38 pregnancy ended in abortion, and two had an ectopic implantation. The authors finally reported 111 successful pregnancy, with seven preterm deliveries (6.3%). Mode of delivery had been cesarean section in 69 cases (63.4%) and vaginal delivery in 42 cases (36.6%), with a respective mean interval time between surgery and delivery of 24.6 +/- 20.0 months and 19.2 +/- 13.3 months.

CONCLUSION

Laparoscopic myomectomy proved to be an effective procedure feasible for women who wish to become pregnant with a subsequent good reproductive outcomes, both in terms of pregnancy and abortion rates that were comparable with the literature. If laparoscopic suturing of the fovea myometralis is adequate, there are no contraindications for vaginal delivery, regardless of the patient's age, the number, size, and location of the myomas removed.

Laparoscopic hysterectomy: really so risky to a vaginal cuff dehiscence?

PURPOSE OF INVESTIGATION

The authors report their experience with vaginal vault suturing procedure in patients that underwent total laparoscopic hysterectomy (TLH) for benign diseases. Vaginal vault colpotomy and closure were only laparoscopically carried out.

MATERIALS AND METHODS

Longitudinal retrospective study was conducted in 550 patients, affected by gynaecological benign pathologies, that underwent TLH were enrolled. Information about age, body mass index, parity, corticosteroid therapy, previous pelvic surgery, smoking, diabetes, menopausal status, and procedure characteristics (operating time, blood loss, uterus weight, postoperative recovery time, and adverse outcomes) were collected. Postoperative complications and adverse outcomes were recorded.

RESULTS

Only one case (0.2%,) of vaginal cuff dehiscence (VCD) occurred four weeks after surgery, which was quickly laparoscopically repaired with interrupted intracorporeal knots. The trigger event was sexual intercourse in a patient affected by systemic lupus erythematosus (SLE). No cases of VCD presented in patients with other considered comorbidities.

CONCLUSION

A careful technique could further decrease the incidence of postoperative vaginal cuff dehiscence, regardless of laparoscopic or vaginal suture approach.

[Schools meals in French secondary state schools: compliance to national recommendations and schools catering patterns]

BACKGROUND

Recent reports on the lack of nutritional quality of meals served in schools have led public authorities to draft, in 1999, recommendations for restoring a balanced food supply. Following the survey carried out by the French food safety Agency in 2005-2006, which highlighted gaps in the implementation of these recommendations, a law passed in July 2010 plans to make these recommendations mandatory, as their 2007 revised version. Thus, the objective of this study was to assess initial school compliance with regard to this last revised version of the recommendations and to identify school patterns through their catering management and implication in a dietary project.

METHODS

Seven hundred and seven secondary state schools were questioned (570 were administrated by the Ministry of Education and 137 by the Ministry of Agriculture) on their catering practices. Twenty consecutive menus from each school were also analyzed with a specific coding system to establish its nutritional composition for comparison with the 2007 recommendations.

RESULTS

On average, schools complied with half of the recommendations. Good compliance was observed with the 2007 recommendations concerning fried products, starchy foods, fruits, and dairy products whereas very few schools were in compliance with recommendations concerning fish, cheeses and sweetened desserts containing less than 15 % fat and more than 20 g of sugar per portion. Furthermore, compliance with recommendations was significantly better for lunch meals, and even better for agricultural establishments. A 5-component meal was also associated with greater compliance with the recommendations. In addition, four school patterns were identified based on catering management practices. The first two categories of establishments had knowledge of the recommendations but exhibited different levels of application. The last two types of establishments had no knowledge of the recommendations and differed in their catering management practices.

CONCLUSION

Compliance with recommendations was contrasted, with high adequacy for some guidelines and low for others. Nevertheless, application of the current guidelines and real implication of the school in a dietary project did improve the dietary offer in such schools.

The role of an absolutely conserved tryptophan residue in octamer formation and stability in mitochondrial creatine kinases

In most organisms, mitochondrial creatine kinase (MtCK) is present as dimers and octamers with the latter predominating under physiological conditions. An absolutely conserved tryptophan residue (Trp-264 in chicken sarcomeric MtCK) appears to play a key role in octamer stability. Recently, it has been shown that the sponge Tethya aurantia, a member of the most ancient group of living multi-cellular animals, expresses an obligate, dimeric MtCK that lacks this absolutely conserved tryptophan residue, instead possessing a tyrosine in this position. In the present study we confirm that the absolutely conserved tryptophan residue is lacking in other sponge MtCKs where it is instead substituted by histidine or asparagine. Site directed mutations of the Trp-264 in expression constructs of chicken sarcomeric MtCK and the octameric MtCK from the marine worm Chaetopterus destabilized the octameric quaternary structure producing only dimers. A Tyr-->Trp mutation in an expression construct of the Tethya MtCK construct failed to produce octamerization; Tyr-->His and Tyr-->Asn mutations also yielded dimers. These results, in conjunction with analysis of homology models of Chaetopterus and Tethya MtCKs, strongly support the view that while the absolutely conserved tryptophan residue is important in octamer stability, octamer formation involves a complex suite of interactions between a variety of residues.

Relationship between glycopeptide use and decreased susceptibility to teicoplanin in isolates of coagulase-negative staphylococci

To investigate the relationship between glycopeptide use and decreased susceptibility to teicoplanin in coagulase-negative staphylococci (CNS) isolates, data on teicoplanin susceptibility and glycopeptide use from existing microbiology laboratory and pharmacy databases were collected for the period between July 2000 and March 2001. Pooled data for the entire study period were first used to analyse associations. Univariate analysis showed that the incidence of CNS with decreased susceptibility to teicoplanin was significantly correlated with the use of glycopetides, particularly with vancomycin use. This association was confirmed by multivariate analysis. This study suggests that variations in antimicrobial resistance are related to variations in antimicrobial use in the model of CNS with decreased susceptibility to teicoplanin, thus confirming the usefulness of restricting antimicrobial prescribing as a means of controlling resistance.

Modelling the usefulness of a dedicated cohort facility to prevent the dissemination of MRSA

The aim of this retrospective study was to determine whether or not a surgical dedicated cohort facility, mainly dedicated to the care of orthopaedic patients, can control the risk of infection caused by methicillin-resistant Staphylococcus aureus (MRSA). We tested this hypothesis on the orthopaedic surgery ward of a university-affiliated public hospital with 1228 beds by determining whether there was a significant correlation between the colonization pressure exerted by MRSA and the number of cases of acquired MRSA. This was then used as a tool to predict the number of patients contaminated with MRSA in hospitals with and without dedicated cohort facilities. We found that the relative risk of MRSA acquisition increased with the colonization pressure exerted by MRSA imported cases. This statistical model enabled us to predict that the risk of MRSA acquisition would increase by 160% per year in the absence of a dedicated cohort facility. We conclude that these units are useful to control the spread of MRSA in hospitals.

The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants

BACKGROUND

Invasive aspergillosis (IA) is associated with significant morbidity and mortality in solid organ transplant recipients but data on the incidence rates stratified by type of solid organ are limited.

OBJECTIVE

To describe the attack rates and incidence of IA in solid organ transplant recipients, and the impact of universal Aspergillus prophylaxis (aerosolized amphotericin B or oral itraconazole) in lung transplant recipients.

PATIENTS

The 2,046 patients who received solid organ transplants at the Cleveland Clinic Foundation from January 1990 through 1999 were studied.

METHODS

Cases were ascertained through computerized records of microbiology, cytology, and pathology reports. Definite IA was defined as a positive culture and pathology showing septate hyphae. Probable IA was clinical disease and either a positive culture or histopathology. Disseminated IA was defined as involvement of two or more noncontiguous anatomic sites.

RESULTS

We identified 33 cases of IA (28% disseminated) in 2,046 patients (attack rate = 1.6%) for an incidence of 4.8 cases per 1,000 patient-years (33 cases/6,813 pt-years). Both the attack and the incidence rates were significantly higher for lung transplant recipients vs. other transplant recipients: lung 12.8% (24 cases/188 patients) or 40.5 cases/1,000-pt year vs. heart 0.4% (3/686) or 1.4 per 1,000-pt year vs. liver 0.7% (3/439) or 2.1 per 1,000-pt year vs. renal 0.4% (3/733) or 1.2 per 1,000-pt year (P < 0.01). The incidence of IA was highest during the first year after transplantation for all categories, but cases occurred after the first year of transplantation only in lung transplant recipients. The attack rate of IA in lung transplant recipients was significantly lower after institution of routine Aspergillus prophylaxis (4.9% vs. 18.2%, P < 0.05).

CONCLUSIONS

The highest incidence and attack rate of invasive aspergillosis among solid organ transplant recipients occurs in lung transplant recipients and supports the routine use of Aspergillus prophylaxis for at least one year after transplantation in this group.

Use of risk projection models for the comparison of mortality from radiation-induced breast cancer in various populations

The aim of our study is to compare lifetime risk estimates for radiation-induced breast cancer between various populations. Some epidemiological studies, mainly on Japanese A-bomb survivors, but also on North American populations irradiated for medical reasons, provide risk coefficients for excess mortality from breast cancer after exposure to ionizing radiation. For this comparative study, these risk coefficients have been transferred into the Japanese, American, and French populations, using demographic data, risk projection models, and assuming an individual acute exposure. The lifetime risk estimates are similar in the three populations when the additive projection model is used because of the similarity of the life tables of the three countries. However, using the multiplicative model, large differences appear due to the discrepancies in the baseline breast cancer rates between the Japanese and Occidental populations. It is for this reason that transfer of risk coefficients fitted on the Japanese population data must be considered with caution when applied to an Occidental population. Lifetime risk estimates for a given population, the French population for example, are largely dependent on the risk coefficients considered from various epidemiological studies. Nevertheless, for each source of data, they are higher with the multiplicative model than with the additive one. Moreover, it should be noted that data from medical irradiation lead to higher risk estimates when using the additive model, whereas studies of the A-bomb survivors lead to higher risk estimates with the multiplicative model. This comparative study points out the variations of the lifetime risk calculations according to the baseline breast cancer mortality rates of the three populations and with the use of different mathematical projection models.

[Radiation-induced tumors of the nervous system in man]

The risk of developing a tumor of the nervous system in humans is analysed in several studies of populations, exposed to ionising radiation for medical reasons, or exposed to military or occupational radiation. The main data come from series of patients who underwent radiotherapy during childhood: a high incidence of tumors of the nervous system is found after irradiation of one to a few grays as treatment of a benign disease (especially tinea capitis), as well as after irradiation at higher doses of a few tens of grays for the treatment of cancer (in particular cerebral irradiation in acute lymphoblastic leukaemia). The type of radiation-induced tumors is variable, but meningioma is more frequent after low doses and glioma and sarcoma after higher doses used in the treatment of neoplastic diseases. A dose-effect relationship appeared between the risk of tumor of the nervous system and the radiation dose. The risk was higher when radiation was delivered at a younger age. Much less data are available after radiotherapy in the adulthood, but an increased risk of cerebral tumor appears in the series of ankylosing spondylitis patients. As for the exposures to radiodiagnosis exams, the main problem is the risk of cerebral tumor in children whose mother has undergone abdominal or pelvic X-rays during pregnancy. No risk of neurologic tumor was found in the A-bomb survivors irradiated at Hiroshima and Nagasaki. Occupational exposure to ionising radiation has been incriminated in the first radiologists exposed to high doses. In nuclear industry workers, the results of epidemiological studies are contradictory and at the present time it is not possible to link their radiologic exposure with a risk of tumor of the nervous system. In populations living near nuclear plants, mortality due to tumors of the nervous system was not increased.

[Non-Hodgkin's malignant lymphoma with primary localization in the breast. Apropos of 2 cases: review of the literature]

The malignant non-hodgkinian lymphoma (M.N.H.L.) with pripary mammary localization is relatively rare, but deserves to be accounted for in the evaluation of breast cancers. The diagnosis of the primary localization in the breast responds to definite criteria, well established by Wiseman and Liao. On the other hand, the initial mammary localization is more frequent, revealing a hemato-sarcoma clinically silent until then, but with nodal spread (most of the time lumbo-aortic). The problem is to know whether it is possible, in front of a breast nodule, to evoke lymphoma in view of some clinical and paraclinical characteristics. An accurate pathological diagnosis (International Formula for clinical use of the National Cancer Institute-1982) and a minutious work-up for spread determination (AnnArbor Classification) represent the two essential aspects of the prognosis. It is advised to resort to surgical excision-biopsy in order to obtain an exact histology with analysis of immunological markers, rather than an extemporaneous examination which often leads to the wrong diagnosis of cancer and a mutilating and unnecessary surgery. Progresses in chemotherapy have greatly contributed to improve survival of these hematosarcomas with extranodal localization, which remain however a neoplastic disease with a disseminating tendency.

[Will Naegleria fowleri become a public health problem?]

Primary amebic meningoencephalitis due Naegleria Fowleri is a rare disease. Less than 100 cases have been published and non have been described in France. Historical, clinical, taxonomical and epidemiological aspects of this infection are reviewed. The recent publication of a case which resolved under treatment and the discovery of Naegleria Fowleri in French warm waters incite to carry on pathogenetic and immunological research and field investigations for this parasite in order to understand its ecology.

[Influence of atmospheric pollution by sulfur products and dusts on public health. I. - Method problems (author's transl)]

Since the great atmospheric pollution accidents from sulfur oxides and suspended particulate matters, the concentrations of these pollutants have notably reduced. The experimental concentrations which are necessary to obtain results are even more important than these "historical" concentrations. Among the aggregate of epidemiologic surveys regarding these problems, some find a relationship between strong concentrations of pollution and morbidity and mortality. Such results are explained by references to experimental and metrologic knowledge. As far as epidemiological problems are concerned infectious and meteorological factors have to be eliminated to determine which is the place of atmospheric pollution. But such a place in all respects being so small, has to be defined in a more precise way. One cannot be certain whether the improvement of epidemiological and metrological methods may give more conclusive results, taking into account the foreseeable reduction of the pollution in the years to come.

Interactions of short chain aliphatic hydrocarbons with human blood and haemoglobin A solutions

The solubilities of methane, propane, butane and propylene were measured in human whole blood, human plasma and defatted haemoglobin solutions at 37 degrees C. For these four hydrocarbons the solubility coefficient (alpha = ml of gas STPD dissolved in one mal of the solvent under a pressure of one atmosphere) is higher in plasma than in an isoosmolar aqueous solution and higher in whole blood than in plasma. This is due to the presence of proteins and particularly of haemoglobin as shown by the dependence of alpha upon the concentration of haemoglobin in the medium. O2 capacity of human blood is not altered in the presence of these hydrocarbons and its affinity for O2 is slightly decreased.