August 2003: Reflections on a French Summer Disaster Thirion, Xavier; Debensason, David; Delarozière, Jean Christophe ...
Journal of contingencies and crisis management,
12/2005, Volume:
13, Issue:
4
Journal Article
Peer reviewed
The heat wave of August 2003 caused a hecatomb in France. Its extent and consequences (INVS 2003) require analysis in order to understand why such a situation occurred and how to avoid that the same ...medical disaster will be caused in the future by identical climatic conditions. This natural disaster had no known precedent in France. The heatwave lasted for three weeks in August 2003 and led to 14800 deaths. However, the human toll of this catastrophe cannot be explained solely by the violence of the attack. Any analysis of this dramatic crisis, as for any public health threat, should take into account the agent involved, the population concerned, the specific relation between the agent and the target, and, based upon this, the crisis management needed. The analysis presented in this article, following the described line, shows that the crisis management was far from optimal. Learning from this situation should allow us to do better, next time such a climatic catastrophe occurs. A key factor is promoting adequate citizen response.
Neocodion, a codeine antitussive preparation (codeine camphosulfonate + Grindelia + sulfogaiacol) is known to be misused by opiate addicts. This study aimed to examine the evolution in Neocodion use ...between 1992 and 2002. Since 1992, three surveys (1992, 1997 and 2002) investigating Neocodion misuse were performed via several community networks of pharmacists. During the same time, data on Neocodion use were extracted from the French drug-dependence monitoring programme (OPPIDUM Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse). A marked and continuous decrease in Neocodion consumption was observed. The number of requests for Neocodion per pharmacy and per week largely decreased from 9.9 to 2.1 between 1992 and 2002. OPPIDUM data also showed a reduction in the rate of Neocodion consumption (from 8% in 1992 to 0.4% in 2002). Patients were older (30.4 years in 1992 and 33.7 years in 2002) and their socioeconomic conditions were better. Eighty-six percent of the subjects studied were poly-drug consumers. In fact, Neocodion was less sought after for opiate maintenance than for its psychoactive effects. Despite the reduction in the consumption of Neocodion, the changes observed in the consumption patterns for this medication suggest that vigilance is still required.
Background Previous studies suggest that vigorous myocardial contractions stimulate ventricular mechanoreceptors and lead to vasovagal syncope. We studied an endocardial index of myocardial ...contractility during the head-up tilt test in vasovagal patients and control patients, and we evaluated the effect of negative inotropic drugs on myocardial contractility and tilt test outcome. Methods and Results We investigated 19 patients with recurrent vasovagal syncope and positive tilt test (group 1) and 11 patients with no syncope and negative tilt test (group 2). Myocardial contractility was continuously measured during a tilt test (60°) through a microaccelerometer incorporated in the tip of a right ventricular electrode to sense left ventricular contractility. Patients in groups 1 and 2 were evaluated during an unmedicated tilt test, and patients in group 1 were reevaluated during a tilt test with infusion of esmolol (n = 10) or disopyramide (n = 9). During the unmedicated test, patients in group 1 exhibited a significant increase in myocardial contractility immediately on postural change (P <.05), unlike patients in group 2. Patients in group 1 also had a further increase in myocardial contractility before the end of tilt (P <.01). With drug administration, the changes in supine myocardial contractility were nonsignificant and were not related with the outcome of the tilt test (P <.05). Conclusions An increase in myocardial contractility is detected by the sensor during the tilt test. The changes induced by the drugs on supine myocardial contractility are minor and not related with the outcome of the head-up tilt test. (Am Heart J 2000;139:1022-30.)
Hypoxia-related pulmonary vasoconstriction enhanced by norepinephrine could be deleterious in patients with the acute respiratory distress syndrome (ARDS) and sepsis. A prospective study compared the ...effects of nitric oxide on cardiorespiratory parameters, including the evaluation of right ventricular function in patients with ARDS and sepsis who were receiving or not receiving norepinephrine.
During a 15-month period, 27 patients with ARDS and sepsis were prospectively investigated (group 1: 15 patients not receiving norepinephrine; group 2: 12 patients receiving norepinephrine). Right ventricular ejection fraction was measured by thermodilution. After baseline measurements, nitric oxide was administered at increasing inspiratory concentrations.
The ratio of oxygen tension in arterial blood to the fractional concentration of oxygen in inspired gas increased in the two groups. After logarithmic transformation of the data, an analysis of variance was performed that did not show any difference between the two groups. A dose-dependent decrease in mean pulmonary arterial pressure was observed in the two groups. This decrease and the increase in right ventricular ejection fraction induced by inhaled nitric oxide were more marked when patients received norepinephrine (P < 0.0001).
Norepinephrine did not influence the beneficial effects of inhaled nitric oxide administered to patients with ARDS and sepsis on oxygenation.
L’épidémie du VIH a bouleversé le rapport de la médecine à l’individu et inversement. D’une part, la forte stigmatisation associée à la contamination par le virus a rendu le vécu de la maladie plus ...complexe que pour toute autre pathologie. D’autre part, la chronicisation de l’infection impliquant une prise en charge complexe à base d’une multithérapie au long cours a contraint les soignants à s’interroger plus en profondeur sur la relation intime du patient à son traitement, et tout particulièrement sur l’observance thérapeutique. L’idée de ce travail de thèse est de poursuivre une argumentation en faveur d’une nouvelle approche moins paternaliste de l’observance aux antirétroviraux, incluant un partage des savoirs entre le médecin et le patient, et de l’appliquer à des populations de patients dont les comorbidités compliquent la prise en charge telles que la dépendance aux opiacés et l’infection par le virus de l’hépatite C. A travers une série d’articles, nous avons montré que la prise en compte de la perception du patient vis-à-vis des soins permettait de mieux comprendre la non-observance aux traitements. Chez les personnes traitées pour leur dépendance, la non-observance peut être définie comme l’injection du traitement de substitution ou la consommation d’opiacés illicites. La diminution ou l’arrêt de ces pratiques est un processus long, souvent ponctué de rechutes et elles peuvent être le reflet d’une prise en charge inadaptée. Les résultats de ce travail ont permis de mettre en évidence l’effet positif d’un accès à des soins adaptés, à travers une prise en charge de la pathologie mais aussi la réduction des risques liés à la non-observance. Il s’agit là de promouvoir une relation plus délibérative entre le médecin et le patient.
The epidemic of Human Immunodeficiency Virus (HIV) has profoundly changed the relationship between medicine and humans and vice versa. On the one hand, the intense stigmatization associated with HIV infection has made the disease more complex than for any other pathology. On the other hand, the chronicization of infection has forced care providers to investigate in greater detail the intimate relationship between patient and treatment, and more particularly, the therapeutic adherence. My research work aimed to investigate this latter argument in greater detail, favoring a less paternalistic approach toward therapeutic adherence in HIV-infected patients and applying this approach to multi-treated populations with comorbidities such as drug dependence and hepatitis C. Through several articles, we tried to put in evidence that a model of care that includes patient’s perception about care may lead to better understand non-adherence to treatment (ongoing drug use, drug injection or treatment diversion). In fact, injection cessation or reduction of opioid consumption in dependent individuals is a non-linear process which could take a long time, and which is often punctuated with relapse. Our findings showed the positive impact of access to adequate care to treat not only the disease but also the harm related to non adherence to treatment. The idea is to promote a more deliberative relationship between physician and patient, including a harm reduction approach.
Objectives. We evaluated the effects of transrectal ultrasound-guided biopsy of the prostate on serum total and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting ...variations in PSA levels.
Methods. Serum total and free PSA levels and the free/total PSA ratio were determined in 48 men (mean age 66 ± 7 years) before and 1 hour, 8 days, and 30 days after prostate biopsy. At least six cores were taken using a biopsy gun with an 18-gauge needle. The coefficient of variation of PSA was calculated as the postbiopsy/prebiopsy PSA ratio. Changes in PSA levels and the coefficient of variation were studied.
Results. Fifteen (31%) of 48 men had adenocarcinoma on biopsy. Total and free PSA values were significantly increased 1 hour and 8 days after biopsy, and both returned to baseline 30 days after biopsy. The free/total PSA ratio was significantly increased (55%) 1 hour after biopsy and significantly decreased (12%) 8 days after biopsy. Thirty days after biopsy, the median of the free/total PSA ratio (18%) was not significantly different from the prebiopsy ratio (16%). The median of the coefficient of variation of the free/total PSA ratio was 3, 0.7, and 1 at 1 hour, 8 days, and 30 days after biopsy, respectively. Age, prostate volume, number of cores, and digital rectal examination and histologic findings were not significantly associated with variation in percent free PSA. Variation in percent free PSA at day 8 was associated with prebiopsy total PSA value and the free/total PSA ratio.
Conclusions. Prostate biopsy dramatically alters the percent free PSA. The free/total PSA ratio was decreased 8 days after biopsy and returned to prebiopsy levels in 75% of patients at 1 month after biopsy. Measurement of free PSA levels and the free/total PSA ratio should not be done within 4 weeks of prostate biopsy.
Recent observations suggest the existence of trihexyphenidyl abuse linked to its hallucinogenic and euphoric effects. In order to determine the importance of this practice and the characteristics of ...those involved, a study based on data from the Provence-Alpes-Côte-d'Azur and the Corsica health reimbursement system was carried out. Individuals from these regions affiliated to the French health reimbursement system who had a prescription for trihexyphenidyl (Artane, Parkinane) reimbursed between January 1, 2001, and February 15, 2001, were selected. The delivery of prescriptions was monitored over a 9-month period. In total, 3028 subjects were selected. A subgroup comprising 2.1% of subjects with deviant behaviour was identified by factorial analysis and compared with the subgroup without deviant behaviour. The subjects with deviant behaviour were young and mostly male. The dosage of trihexyphenidyl was higher in these subjects (28 mg/day versus 7 mg/day) and a greater proportion used benzodiazepine and high-dose buprenorphine compared with those without deviant behaviour. The number of prescriptions delivered was higher (23.0 versus 7.7) as well the number of different physicians (4.9 versus 1.5) and pharmacies (5.0 versus 1.3) for those subjects with deviant behaviour. This study confirms the abuse and dependence potential associated with trihexyphenidyl use and the need to increase the supervision of this drug.
This prospective study was conducted to determine the percentage of patients with long-term pacemaker dependency after successful radiofrequency ablation of the atrioventricular junction. Abrupt ...inhibition of the pacemaker was performed 13.5 ± 8.1 months after ablation in 59 patients. A ≥5-second asystole was considered to indicate pacemaker dependency. Pacemaker dependency was present in 18 patients. Absence of escape rhythm immediately after ablation was strongly associated with a higher incidence of long-term pacemaker dependency. The following variables were not associated with pacemaker dependency: age, presence of cardiac disease, presence of preablation bundle branch block, number of radiofrequency applications, a bilateral approach for ablation, and continuation of antiarrhythmic therapy after ablation. We concluded that (1) long-term pacemaker dependency is present in 30.5% of the patients after successful atrioventricular junction radiofrequency ablation and (2) absence of escape rhythm immediately after ablation predicts long-term pacemaker dependency. (Am Heart J 1997;133:580-4.)
The aim of this study was to compare DDD and dual sensor VVIR (activity and QT) pacing modes in complete AV block (CAVB). Eighteen patients (14 men and 4 women, aged 70 +/- 6.5 years) implanted with ...a dual chamber, dual sensor pacemaker for CAVB with normal sinus node chronotropic function were studied. A quality-of-life and cardiovascular symptom questionnaire, and a treadmill exercise test were completed after a period of VVIR and a period of DDD pacing, each lasting 1 month. Overall quality-of-life and cardiovascular symptoms did not significantly differ, though three patients felt discomfort during VVIR mode. There was no significant statistical difference in cardiopulmonary parameters. DDD and VVIR modes yielded the following respective data: maximum heart rate = 105.7 +/- 21.8 beats/minute versus 107.6 +/- 21.6 beats/minute (NS); maximum workload = 60 +/- 33.4 W versus 59.3 +/- 37.8 W (NS); treadmill duration = 10.1 +/- 3.8 minute versus 10.1 +/- 3.6 minute (NS); oxygen consumption at anaerobic threshold = 14.6 +/- 4.1 mL/kg per minute versus 14.9 +/- 4.6 mL/kg per minute (NS); maximum minute ventilation = 49.6 +/- 9L/min versus 46 +/- 12 L/min (NS); and respiratory quotient = 1.08 +/- 0.15 versus 1.08 +/- 0.13 (NS). We conclude that, during a 1-month follow-up period, no difference was found between DDD and dual sensor VVIR (QT and activity) pacing modes in CAVB patients with regard to quality-of-life and cardiopulmonary performance, though a trend toward an increased sense of well being was noted with the DDD mode.
