Determinants of user satisfaction with a Clinical Information System.
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Clinical Information Systems (CIS) implementation has faced user resistance. Consequently, we aimed to assess the acceptability of an integrated CIS. We designed an electronic survey instrument from two theoretical models (Delone and McLean, and Technology Acceptance Model). Dimensions hypothesized to be determinant of user satisfaction were: user characteristics, CIS use, quality, usefulness, and service quality. The questionnaire was administered to physicians, nurses and medical secretaries of the Georges Pompidou university Hospital (HEGP) in Paris. Answers were obtained from 324 users (93 physicians, 174 nurses, and 57 secretaries). Cronbach's alpha coefficients showed a correct reliability within each dimension. Secretaries and nurses were more satisfied with the CIS than physicians. Except for CIS use, after adjustment for confounders, female gender, perceived CIS quality, usefulness, and service quality were strongly correlated with user satisfaction. This study reinforces the necessity of several models and dimensions to evaluate the acceptability of a complex CIS, with a specific approach for different user profiles. (+info)
Glycol ethers and semen quality: a cross-sectional study among male workers in the Paris Municipality.
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OBJECTIVES: Apparent increases in human male reproductive disorders, including low sperm production, may have occurred because of increased chemical exposure. Various glycol ether-based solvents have pronounced adverse effects on sperm production and male fertility in laboratory animals. The authors investigated the effects of past and current exposure to glycol ether-containing products on semen quality and reproductive hormones among men employed by the Paris Municipality. METHODS: Between 2000 and 2001 the authors recruited 109 men who gave semen, blood and urine samples and underwent an andrological examination. Information on lifestyle, occupation, exposure and medical history was obtained by interview. According to their job and chemical products used during the period 1990-2000, men were classified as either occupationally exposed or non-exposed. Current exposure levels to glycol ethers at the time of the study were evaluated by biological monitoring of six urinary metabolites. RESULTS: Previous exposure to glycol ethers was associated with an increased risk for sperm concentration, for rapid progressive motility and for morphologically normal sperm below the World Health Organization semen reference values. No effect of previous glycol ether exposure on hormones levels was observed. By contrast, current glycol ether exposure levels were low and not correlated with either seminal quality or hormone levels. CONCLUSIONS: This study suggests that most glycol ethers currently used do not impact on human semen characteristics. Those that were more prevalent from the 1960s until recently may have long lasting negative effects on human semen quality. (+info)
Level of dependency: a simple marker associated with mortality during the 2003 heatwave among French dependent elderly people living in the community or in institutions.
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BACKGROUND: In France, the August 2003 heat wave was responsible for considerable excess mortality among the elderly. We wonder whether the dependency level could be a marker of the risk for mortality during this heat wave. METHODS: Retrospective cohort study of deaths that occurred between 1 and 20 August 2003, conducted in five departments in the Paris area (Ile-de-France) among the beneficiaries of the Allocation personnalisee d'autonomie (APA), a stipend specifically allocated to dependent subjects > or =60 years of age. Their dependency level was determined by the GIR group (defined by the French law) used to fix the APA amount. Subjects' GIR group classification and demographic variables were obtained from departmental administrative files. RESULTS: Among the 31,603 APA beneficiaries alive on 31 July 2003, 16,779 were community dwellers and 14,824 lived in institutions. Between 1 and 20 August 2003, 858 subjects died: 300 community dwellers and 558 institutionalised (mortality rates of 2.7, 1.8 and 3.8 per cent, respectively). Independent risk factors for mortality were: age, sex and GIR group in community dwellers; age, GIR group and living in a region highly exposed to heatwave mortality for institutionalised elderly; independent factors for mortality were age, sex, GIR group, type of residence (institution/community), living in a region highly exposed to heatwave mortality and income for the overall population. CONCLUSION: The dependency level was associated with mortality during the 2003 heatwave in France, especially for elderly community dwellers. Dependency might help identify high-risk subjects and guide targeted prevention measures against heatwave-associated mortality. (+info)
Contribution of the metabolic syndrome to sudden death risk in asymptomatic men: the Paris Prospective Study I.
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AIMS: To compare the risk of sudden death and non-sudden death from myocardial infarction associated with the metabolic syndrome (MetS) in asymptomatic men. METHODS AND RESULTS: The mortality status of 6,678 middle-aged men from the Paris Prospective Study I, who were free of diabetes and coronary heart disease (CHD) at the baseline examination, has been investigated over 21 years of follow-up. The sagittal abdominal diameter was substituted for waist circumference, and HDL cholesterol was unavailable. The presence of three abnormalities and the presence of abdominal adiposity plus at least two abnormalities defined the MetS, using the NCEP-ATP III and IDF criteria, respectively. Frequency estimate of the MetS was 14.4 and 16.7%, using the NCEP-ATP III and IDF criteria, respectively. The MetS increased the risk of sudden death and non-sudden death by 68% [95% confidence interval (CI) 1.05-2.70] and 38% (95% CI 0.95-2.01), respectively, after adjustment for other CHD risk factors (P for the comparison of the hazard ratios = 0.25). Hazards ratio using the IDF criteria were 2.02 (95% CI 1.30-3.14) and 1.69 (95% CI 1.20-2.38), respectively, (P = 0.26). CONCLUSION: In healthy middle-aged men, the MetS increased the risk of sudden death and, to a lesser extent, the risk of non-sudden death over 21 years independent of CHD risk factors. (+info)
New insight into solvent-related end-stage renal disease: occupations, products and types of solvents at risk.
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OBJECTIVES: It has been shown that all-solvent exposure is associated with the progression of primary glomerulonephritis to end-stage renal disease (ESRD), but little is known about the type of solvents that are high risk. The aim of this study was to investigate the role of solvents by occupation, product and type. METHODS: Using a retrospective cohort design, the authors studied 269 patients with non-end-stage and biopsy-proven primary glomerulonephritis diagnosed between 1994 and 2001 in Paris and its suburbs. Two industrial hygienists evaluated patients' exposures from lifetime occupational histories collected by interview from 2002-4, and using a list of the 30 most common solvents. The studied outcome was ESRD, defined as glomerular filtration rate <15 ml/mn/1.73 m(2) or dialysis. It was recorded during a mean follow-up of five years. Cox models were used to estimate adjusted hazard ratios (HR) of ESRD related to exposures. RESULTS: Eighteen per cent of the patients had ever been exposed to solvents. Those with the highest risk of progression to ESRD were exposed machinery fitters and machine assemblers (HR 4.7, 95% CI 1.2 to 17.4) and plumbers/welders (HR 4.2, 95% CI 1.3 to 13.6), as compared to never exposed patients, as well as those who ever handled printing inks and petroleum products (HR 12.6 (95% CI 1.7 to 94.9) and 3.2 (95% CI 1.4 to 7.2), respectively). Among solvents, the highest risks were found for: toluene/xylene (HR 5.1, 95% CI 1.8 to 14.8), gasoline, fuel and gas-oil (HR 8.6, 95% CI 2.7 to 27.4), and ketones (HR 13.3, 95% CI 1.4 to 123.5). CONCLUSION: This study highlights the potential nephrotoxicity of several solvents. Intervention to promote screening for proteinuria in exposed workers may prevent the progression of glomerulonephritis to ESRD. (+info)
A quality control programme for acute myocardial infarction management in out-of-hospital critical care medicine.
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This study, conducted over two time periods, aimed to evaluate the effectiveness of the diffusion of data, implementation of correctives measures and updated protocols in reducing time to reperfusion in acute myocardial infarction (AMI) management in the out-of-hospital setting. Mean (SD) time to hospital admission and to arterial puncture improved (58 (13) vs 67 (18) min, p = 0.03; and 82 (16) vs 95 (29) min, p = 0.02). The study, performed according to quality control programme methodology, showed that the chronology of AMI management could be improved by appropriate interventions and monitoring of intervention times. (+info)
What makes people decide who to turn to when faced with a mental health problem? Results from a French survey.
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BACKGROUND: The unequal use of mental health care is a great issue, even in countries with universal health coverage. Better knowledge of the factors that have an impact on the pathway to mental health care may be a great help for designing education campaigns and for best organizing health care delivery. The objective of this study is to explore the determinants of help-seeking intentions for mental health problems and which factors influence treatment opinions and the reliance on and compliance with health professionals' advice. METHODS: 441 adults aged 18 to 70 were randomly selected from the general population of two suburban districts near Paris and agreed to participate in the study (response rate = 60.4%). The 412 respondents with no mental health problems based on the CIDI-SF and the CAGE, who had not consulted for a mental health problem in the previous year, were asked in detail about their intentions to seek help in case of a psychological disorder and about their opinion of mental health treatments. The links between the respondents' characteristics and intentions and opinions were explored. RESULTS: More than half of the sample (57.8%) would see their general practitioner (GP) first and 46.6% would continue with their GP for follow-up. Mental health professionals were mentioned far less than GPs. People who would choose their GP first were older and less educated, whereas those who would favor mental health specialists had lower social support. For psychotherapy, respondents were split equally between seeing a GP, a psychiatrist or a psychologist. People were reluctant to take psychotropic drugs, but looked favorably on psychotherapy. CONCLUSION: GPs are often the point of entry into the mental health care system and need to be supported. Public information campaigns about mental health care options and treatments are needed to educate the public, eliminate the stigma of mental illness and eliminate prejudices. (+info)
Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities.
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BACKGROUND: Access to timely and effective medical services can reduce rates of premature mortality attributed to certain conditions. We investigate rates of total and avoidable mortality (AM) and the percentage of avoidable deaths in France, England and Wales and the United States, three wealthy nations with different health systems, and in the urban cores of their world cities, Paris, Inner London and Manhattan. We examine the association between AM and an income-related variable among neighbourhoods of the three cities. METHODS: We obtained mortality data from vital statistics sources for each geographic area. For two time-periods, 1988-90 and 1998-2000, we assess the correlation between area of residence and age- and gender-adjusted total and AM rates. In our comparison of world cities, regression models are employed to analyse the association of a neighbourhood income-related variable with AM. RESULTS: France has the lowest mortality rates. The US exhibits higher total, but similar AM rates compared to England and Wales. Rates of AM are lowest in Paris and highest in London. Avoidable mortality rates are higher in poor neighbourhoods of all three cities; only in Manhattan is there a correlation between the percentage of deaths that are avoidable and an income related variable. CONCLUSIONS: Beyond the well-known association of income and mortality, persistent disparities in AM exist, particularly in Manhattan and Inner London. These disparities are disturbing and should receive greater attention from policy makers. (+info)