RESUMEN
The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991. The population study included 355 patients who were admitted to an ICU during pregnancy, delivery or within 42 days after delivery, for an obstetrical cause. The main outcome measure was the severity of maternal condition at ICU admission estimated from the level of consciousness and from the Simplified Acute Physiology Score (SAPS). The most severe maternal condition was associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and with treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3). Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation during pregnancy affects the prognosis of severe maternal condition. The factors involved appear to include the management of unpredictable disorders, the conditions of maternal transfers before ICU admission, and antenatal care of foreigners.
Asunto(s)
Enfermedad Crítica , Unidades de Cuidados Intensivos , Complicaciones del Embarazo , Adulto , Femenino , Francia , Edad Gestacional , Hemorragia/mortalidad , Hospitales , Humanos , Hipertensión/mortalidad , Embarazo , Complicaciones del Embarazo/mortalidad , Embarazo Múltiple , Trastornos Puerperales/mortalidad , Factores de Riesgo , Tromboembolia/mortalidadRESUMEN
The single-breath nitrogen washout (SBN2) test was used, along with spirometry, in the baseline examination of a longitudinal study in a cohort of active coal miners from North-eastern France. The procedure was computerized, allowing the technician to coach and encourage the subject, and excluding computation errors. While all miners performed satisfactory spirometry, a significant number were unable to meet the National Heart and Lung Institute recommendation concerning a 10% agreement of vital capacities. When the limits were set at +/-12%, 57 miners (24.2%) were still classified as failing to perform. When compared to those who succeeded, those failing proved to be significantly older, had more cumulated dust exposure, a higher prevalence of chronic cough and sputum, and a trend for more micronodulation on the chest radiographs. The ventilatory function did not differ between the two groups. These results confirm previous data on spirometric test failure concerning older age and respiratory symptoms, extending them to the SBN2 test. The present study further indicates that dust exposure and roentgenologic pneumoconiosis nodulation are associated with failure to perform the SBN2 test.
Asunto(s)
Minas de Carbón , Enfermedades Pulmonares Obstructivas/diagnóstico , Pulmón/fisiopatología , Nitrógeno , Enfermedades Profesionales/diagnóstico , Adulto , Factores de Edad , Análisis de Varianza , Diagnóstico por Computador , Polvo , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Exposición Profesional , Pruebas de Función RespiratoriaRESUMEN
OBJECTIVE: To ascertain the frequency of serious diseases in pregnant women. STUDY DESIGN: A population based survey was performed in France. The cases were all the women admitted for treatment in intensive care unit (ICU). The severity of the cases was measured with the simplified acute physiology score (SAPS) the lethality and the rate of still birth. RESULTS: 435 obstetric patients were included. The estimated frequency of severe diseases was 310 S.D.36 per 100,000 live births. The most frequent diagnose that motived admission in ICU was hypertensive diseases. The lethality rates differed greatly between specific disorders. The lethality rate was lower when scheduled maternity was located in a teaching hospital. CONCLUSION: Regarding these results it appears that the majority of obstetric patients with severe diseases are referred to suitable care, but a small proportion of women who had to change their type of care registered a significant higher lethality.
Asunto(s)
Unidades de Cuidados Intensivos , Complicaciones del Embarazo/mortalidad , Complicaciones del Embarazo/terapia , Femenino , Francia , Humanos , Hipertensión/mortalidad , Hipertensión/terapia , Tiempo de Internación , Embarazo , Complicaciones del Embarazo/epidemiologíaRESUMEN
Respiratory symptoms and lung function of 80 coal workers suspected of pneumoconiosis (pulmonary X-rays classified 0/1 or 1/0 according to International Labour Organisation classification) who worked for at least 10 years at face work (Ts) were studied in comparison with two control groups matched by age (+/- 2 years), height (+/- 5 cm), weight (+/- 10 kg) and smoking habits: the Tn group constituted by 80 coal workers who worked for at least 10 years at face work with normal pulmonary X-rays, and the HTn group constituted by 80 underground miners who worked mainly out of face work with normal pulmonary X-rays. The frequencies of cough, expectoration, chronic bronchitis or dyspnoea were significantly higher in Ts group than in the two others. The one-second forced expiratory volume to vital capacity ratio (FEV1/VC) was lower, closing volume to vital capacity (CV/VC) or to total lung capacity ratios (CV/TLC) were higher in Ts group than in the control groups. Unexpectedly, vital capacity (VC), one-second forced expiratory volume (FEV1), total lung capacity (TLC), compliance, diffusing capacity (DLCO) referred to alveolar volume (VA) were higher. In Ts group, the small rounded opacities were noted in the top part of the lung (56.9%), the irregular ones were distributed on the entire lung (65.5%). There were no relation between the category of small opacities and respiratory symptoms or lung function.
Asunto(s)
Minas de Carbón , Neumoconiosis/diagnóstico , Radiografía Torácica , Pruebas de Función Respiratoria , Adulto , Volumen de Cierre , Diagnóstico Diferencial , Volumen Espiratorio Forzado , Humanos , Masculino , Neumoconiosis/diagnóstico por imagen , Factores de Tiempo , Capacidad Pulmonar Total , Capacidad VitalRESUMEN
Within-subject (difference between paired tests, or coefficient of variation [c. var.] of three consecutive measurements) and between-subjects (standard deviation of the mean group) variability were assessed for the variables derived from the single-breath nitrogen (SBN2) test in a group of healthy, asymptomatic subjects (n = 289) aged 20-64 years, from a rural area in North-East France. Duplicate measurements in 99 subjects showed excellent agreement between the two attempts (correlation coefficients between 0.94 and 0.98) for static lung volumes and the alveolar N2 slope (PIII); closing volumes (CV) were more variable (r = 0.77 for absolute value, 0.79 for % VC) while closing capacities (CC) were in intermediate position (r = 0.86 for absolute value, and 0.88 for % TLC). The variability of three consecutive measures in 190 subjects showed the coefficients of variation to be low for static volumes and closing capacity (2.4-7.4%) and higher for PIII (15.1%) and CV or CV/VC (18.2 and 17.8%). The analysis of variance did not detect significant differences between the three sets of measurements, with the exception of a progressive increase of vital capacity (VC), and decrease in residual volume (RV) from test 1 to test 3, the total lung capacity being the same. Variability was uninfluenced by age or sex, except a higher c. var. for female VC as compared to males (2.8 vs. 2.2%, P = 0.02) and a higher variability of TLC (2.9 vs. 2.3%, P = 0.03) and VC (2.8 vs. 1.9%, P = 0.003) in people older than 40 years as opposed to those younger than 40 years.
Asunto(s)
Nitrógeno , Pruebas de Función Respiratoria/normas , Adolescente , Adulto , Anciano , Pruebas Respiratorias , Computadores , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Alveolos Pulmonares/fisiología , Valores de Referencia , Población RuralRESUMEN
The prevalence of habitual snoring and its associations with respiratory symptoms, personal and familial risk factors, ear, nose, and throat (ENT) abnormalities, and its influence on ventilatory function were studied in a sample of 190 children aged 5 to 6 years from nine kindergartens in Nancy (northeastern France). Nineteen (10%; 95% CI 5.7-14.3%) of the children were habitual snorers; the prevalence was the same in boys and girls. In univariate analysis habitual snoring was significantly associated with a personal history of exercise-induced bronchospasm [relative risk (RR) 4.50]; a history of adenotonsillectomy (RR, 2.56); a personal history of allergy (RR, 2.83); a sibling history of atopy (RR, 2.39); and doctor-assessed tonsillar hypertrophy (RR, 2.51). These factors were entered into a logistic regression model that retained as independent determinants exercise-induced asthma, personal history of allergy, sibling history of allergy, and tonsillar hypertrophy. The height-adjusted peak expiratory flow rate was slightly, non-significantly lower in habitual snorers as compared to non-snorers (2.01 +/- 0.32 vs 2.10 +/- 0.38 L/s/m2). Due to the limited numbers in the sample, the increased risk for paternal (RR, 1.8) and maternal (RR, 1.6) smoking at home remained nonsignificant.
Asunto(s)
Ronquido/epidemiología , Niño , Preescolar , Enfermedad Crónica , Femenino , Francia/epidemiología , Humanos , Masculino , Ápice del Flujo Espiratorio , Prevalencia , Factores de Riesgo , Ronquido/etiología , Ronquido/fisiopatologíaRESUMEN
Protein binding of sodium salicylate in synovial fluid and in serum from 23 inpatients with rheumatic diseases were studied, ex vivo, by equilibrium dialysis. Scatchard model with two classes of sites was used as a mathematical tool. At therapeutic concentrations, protein binding of sodium salicylate was significantly higher in serum than in synovial fluid. The ratio of areas under the curves for bound concentrations for synovial fluid to that for serum was 0.867. This difference was attributed to the hypoalbuminemia observed in the synovial fluid; for a given molar ratio of drug to albumin, or in other words, for the same amount of available drug per mole of albumin. The number of sites occupied was the same in the two biological media.