Publications by authors named "Marianne Sarazin"

12 Publications

  • Page 1 of 1

Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database.

Colorectal Dis 2021 Feb 11. Epub 2021 Feb 11.

Ecole des Mines de Saint-Etienne, Saint-Etienne, France.

Aim: The aim of this work was to determine the rate of incisional hernia (IH) repair and risk factors for IH repair after laparotomy.

Method: This population-based study used data extracted from the French Programme de Médicalisation des Systèmes d'Informations (PMSI) database. All patients who had undergone a laparotomy in 2010, their hospital visits from 2010 to 2015 and patients who underwent a first IH repair in 2013 were included. Previously identified risk factors included age, gender, high blood pressure (HBP), obesity, diabetes and chronic obstructive pulmonary disease (COPD).

Results: Among the 431 619 patients who underwent a laparotomy in 2010, 5% underwent IH repair between 2010 and 2015. A high-risk list of the most frequent surgical procedures (>100) with a significant risk of IH repair (>10% at 5 years) was established and included 71 863 patients (17%; 65 procedures). The overall IH repair rate from this list was 17%. Gastrointestinal (GI) surgery represented 89% of procedures, with the majority of patients (72%) undergoing lower GI tract surgery. The IH repair rate was 56% at 1 year and 79% at 2 years. Risk factors for IH repair included obesity (31% vs 15% without obesity, p  < 0.001), COPD (20% vs 16% without COPD), HBP (19% vs 15% without HBP) and diabetes (19% vs 16% without diabetes). Obesity was the main risk factor for recurrence after IH repair (19% vs 13%, p < 0.001).

Conclusion: From the PMSI database, the real rate of IH repair after laparotomy was 5%, increasing to 17% after digestive surgery. Obesity was the main risk factor, with an IH repair rate of 31% after digestive surgery. Because of the important medico-economic consequences, prevention of IH after laparotomy in high-risk patients should be considered.
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February 2021

Use of the French healthcare insurance database to estimate the prevalence of exposure to potential drug-drug interactions.

Eur J Clin Pharmacol 2020 Dec 7;76(12):1675-1682. Epub 2020 Jul 7.

Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France.

Purpose: Drug-drug interactions (DDIs) require monitoring in an aging population with increasing polypharmacy exposure. We aimed to estimate the prevalence of exposure to potential DDIs using the French healthcare insurance system database, for six DDIs with various clinical relevance: angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs (ARBs-ACEIs + NSAIDs), antiplatelet agents and NSAIDs (AAP + NSAIDs), serotonergic drugs and tramadol (SD + T), statins and macrolides (S + M), oral anticoagulant and NSAIDs (OAC + NSAIDs), and colchicine and macrolides (C + M).

Methods: We used exhaustive healthcare data from a 1/97th random sample of the population covered by the French health insurance system (EGB) between 2006 and 2016. Exposure to a DDI was defined as overlapping exposure to two interacting drugs. The prevalence of exposure was estimated by year.

Results: Prevalence of exposure in 2016 was estimated at 3.7% for ARBs-ACEIs + NSAIDs, 1.5% for AAP + NSAIDs, 0.76% for SD + T, 0.36% for S + M, 0.24% for AOC + NSAIDs, and 0.02% for C + M. In 26% to 58% of episodes of exposure, the two interacting drugs were prescribed by the same physician and dispensed by the same pharmacy the same day. Between 2006 and 2016, the yearly prevalence was increasing for SD + T and for DDIs involving NSAIDs, and it was decreasing for those involving macrolides.

Conclusion: Exposures to potential DDIs in France are not uncommon with a high proportion resulting from a co-prescription by the same physician. Monitoring the prevalence of exposure to DDIs is needed to implement prevention measures. Administrative data enable this surveillance in large and representative cohorts.
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December 2020

[Therapeutic education in elderly over 75 years old living at home A pilot study of 48 patients].

Geriatr Psychol Neuropsychiatr Vieil 2020 03;18(1):43-52

Département de gérontologie clinique, CHU de Saint-Étienne, France.

Therapeutic patient education (TPE) allows elderly as well as young adults to evaluate patient's self-care and adaptation skills to their own clinical condition. Falling is a symptom present in various chronic diseases, which leads to loss of autonomy, fear of recidivism and frequent admissions into institutions. Study objective was to evaluate at 3 and 6 months the impact of TPE on fall recurrence, perceived quality of life and fear of falling, in elderly over 75 living at home.

Methods: We performed a prospective study comparing two groups: a group participating in day hospital (group "TPE") and a control group (group "Hospitalized") of elderly patient not receiving TPE recruited in short geriatric stays following a fall at home.

Results: 28 patients in the "TPE" group and 20 patients in the "Hospitalized" group were included. The "TPE" group reported significantly better perceived quality of life at 3 months and 6 months. At 6 months, fear of falling was twice as high in the "Hospitalized" group than in the "TPE" group.

Conclusions: The group of subjects who was able to benefit from therapeutic education at home had an improved quality of life at 3 and 6 months and a decrease in the fear of falling at 6 months.
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March 2020

Comparison of two hospitalization modes in geriatrics either directly via a hotline or after an emergency unit admission.

Geriatr Psychol Neuropsychiatr Vieil 2018 Sep;16(3):255-262

Département de gérontologie clinique, Service de gérontologie clinique, Hôpital la charité, CHU Saint-Etienne, France.

Hospitalizations via the emergency services of the elderly represent on average 41% of the stays. The family physician is aware of the deleterious effects of using emergency rooms and know that intensive use contributes to the disorganization of these services. The provision of a telephone line, enabling doctors to have direct access to a geriatrician doctor, is a new service allowing, if necessary, direct hospitalization in geriatrics but its interest is still poorly evaluated.

Methods: From June 1st, 2015, to June 1st, 2016, we compared the route of care for inpatients directly in short stays of geriatrics thanks to the hotline (group hotline) versus the route of those passed by emergencies (group EU, emergency unit).

Results: 520 patients were included in the study. The duration of stay was shorter during hospitalization via the hotline, 11.6 [95% CI, 10.8-12.3] days in a direct hospitalization versus 14.1 [95% CI, 13.5-14.7] days of a passage through emergencies (p <0.05). Patients who were admitted to the emergency room were more likely to be hospitalized again. Among the 170 patients re-hospitalized, an average duration before re-hospitalization of 29.5 [CI 95%, 23.6-35.4] days was observed in patients hospitalised via the hotline, while those entered by emergencies were hospitalized in 24.1 [95% CI, 20.4-27.8] days (p <0.05).

Conclusion: This analysis suggests that the intra-hospital course of geriatric patients directly addressed in short stays of geriatrics by direct admission was shorter and more efficient than the course of an intermediate stage in the emergencies. It seems important to discuss the generalization of the hotline device for the functioning of the geriatric pathway.
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September 2018

[Impact of a in situ laboratory on physician expectancy].

Ann Biol Clin (Paris) 2018 01;76(1):45-51

Laboratoire de biologie médicale, Hôpital de Roanne, Roanne, France.

Biological examinations are essential for clinicians' medical care. The aim of this study is to assess clinicians' expectations in healthcare facilities and their perception of medical biology in different types of organization. We performed a prospective transversal study by electronic questionnaire conducted among 242 practitioners in four healthcare facilities. The aspects explored were as follows: quality, reliability, rendering time of examination results and biology platform support. Analyses were conducted after rectification of the sample by weight. Sixty one clinicians responded (25.2% [19.7-30.7]). The rendering time of examination is the main criterion mentioned with a requirement of less than one hour in case of emergency (81.5% [71.8-91.2] of the answers) to less than 72 hours for specialized examinations (81.5% [71.8-91.2] of the answers). Better collaboration with biologists is expected by clinicians (54.7% [50.9-58.5]). Satisfaction with the biology platform support and rendering time of emergency cases results was significantly (p <0.005) lower in facilities without an on-site laboratory. In conclusion, although medical biology performance is generally satisfactory within medical facilities, it remains nonetheless affected when the laboratory is not on site. The rendering time of examination, depending on the biology platform support functions and the proximity of the laboratory, remains the main criterion. Clinician-biologist collaboration, which increases of the medico-economic efficiency of patient's healthcare, appears as an essential criterion in a structural conception of medical biology.
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January 2018

Impact of a Computer System and the Encoding Staff Organization on the Encoding Stays and on Health Institution Financial Production in France.

Stud Health Technol Inform 2016 ;228:14-7

IRIS Nice - SESSTIM Inserm - Marseille - France.

In France, medicalization of information systems program (PMSI) is an essential tool for the management planning and funding of health. The performance of encoding data inherent to hospital stays has become a major challenge for health institutions. Some studies have highlighted the impact of organizations set up on encoding quality and financial production. The aim of this study is to evaluate a computerized information system and new staff organization impact for treatment of the encoded information.
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April 2017

Predicting Fluctuating Rates of Hospitalizations in Relation to Influenza Epidemics and Meteorological Factors.

PLoS One 2016 16;11(6):e0157492. Epub 2016 Jun 16.

Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1136, Paris, France.

Introduction: In France, rates of hospital admissions increase at the peaks of influenza epidemics. Predicting influenza-associated hospitalizations could help to anticipate increased hospital activity. The purpose of this study is to identify predictors of influenza epidemics through the analysis of meteorological data, and medical data provided by general practitioners.

Methods: Historical data were collected from Meteo France, the Sentinelles network and hospitals' information systems for a period of 8 years (2007-2015). First, connections between meteorological and medical data were estimated with the Pearson correlation coefficient, Principal component analysis and classification methods (Ward and k-means). Epidemic states of tested weeks were then predicted for each week during a one-year period using linear discriminant analysis. Finally, transition probabilities between epidemic states were calculated with the Markov Chain method.

Results: High correlations were found between influenza-associated hospitalizations and the variables: Sentinelles and emergency department admissions, and anti-correlations were found between hospitalizations and each of meteorological factors applying a time lag of: -13, -12 and -32 days respectively for temperature, absolute humidity and solar radiation. Epidemic weeks were predicted accurately with the linear discriminant analysis method; however there were many misclassifications about intermediate and non-epidemic weeks. Transition probability to an epidemic state was 100% when meteorological variables were below: 2°C, 4 g/m3 and 32 W/m2, respectively for temperature, absolute humidity and solar radiation. This probability was 0% when meteorological variables were above: 6°C, 5.8g/m3 and 74W/m2.

Conclusion: These results confirm a good correlation between influenza-associated hospitalizations, meteorological factors and general practitioner's activity, the latter being the strongest predictor of hospital activity.
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July 2017

Opinion about seasonal influenza vaccination among the general population 3 years after the A(H1N1)pdm2009 influenza pandemic.

Vaccine 2015 Nov 29;33(48):6849-54. Epub 2015 Aug 29.

Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, F-75012 Paris, France; INSERM, UMR_S 1136, F-75012 Paris, France. Electronic address:

Objective: To assess the opinions of the French general population about seasonal influenza vaccination three years after the A(H1N1)pdm 09 pandemic and identify factors associated with a neutral or negative opinion about this vaccination.

Study Design: The study was conducted using data collected from 5374 participants during the 2012/2013 season of the study. The opinion about seasonal influenza vaccination was studied on three levels ("positive", "negative" or "neutral"). The link between the participant's characteristics and their opinion regarding the seasonal influenza vaccination were studied using a multinomial logistic regression with categorical variables. The "positive" opinion was used as the reference for identifying individuals being at risk of having a "neutral" or a "negative" opinion.

Results: Among the participants, 39% reported having a positive opinion about seasonal influenza vaccine, 39% a neutral opinion, and 22% a negative opinion. Factors associated with a neutral or negative opinion were young age, low educational level, lack of contact with sick or elderly individuals, lack of treatment for a chronic disease and taking a homeopathic preventive treatment.

Conclusions: These results show that an important part of the French population does not have a positive opinion about influenza vaccination in France. Furthermore, it allows outlining the profiles of particularly reluctant individuals who could be targeted by informative campaigns.
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November 2015

A survey of French general practitioners on the epidemiology of wounds in family practice.

Int J Gen Med 2015 16;8:215-20. Epub 2015 Jun 16.

INSERM, UMR_S 1136, F-75012, Paris, France ; Sorbonne Universités, UPMC University Paris 06, UMR_S 1136, F-75012, Paris, France ; UVSQ, Université de Versailles Saint Quentin, F-78000 Versailles, France ; Assistance Publique Hôpitaux de Paris, service de Médecine Interne, Hôpital Ambroise Paré, F-92100 Boulogne Billancourt, France.

Background: To measure the frequency and nature of wounds in patients treated in general practice and to describe the patients' tetanus vaccination status and the sources providing information about this status.

Methods: A descriptive, prospective, week-long, national electronic survey was conducted among general practitioners within the Sentinelles network.

Results: The participation rate was 12.6% (95% confidence interval [CI], 10.6%-14.6%; 130 general practitioners): 197 patients with wounds were reported, and 175 of them were described. Wound frequency was 1.4 (95% CI, 1.2-1.6) per 100 consultations. These wounds had an acute character in 76 (95% CI, 69.7-82.3) of cases, were mostly of traumatic origin (54.8% of cases; 95% CI, 47.5%-62.1%), were more than 24 hours old (67.1%; 95% CI, 59.1%-75.1%), and were clean, without bone and/or muscle decay (94%; 95% CI, 90.5%-97.5%). Vaccination status was known for 71 (95% CI, 64-78) patients. According to the 2013 immunization schedule, 21% (95% CI, 13.9%-28.1%) of the patients had not updated their vaccinations, mostly among the patients older than 75 years.

Conclusion: This survey describes in detail the wounds treated in general practice in France and the associated patients' immunization status. It also shows how difficult it is for general practitioners to assess the risk of contracting tetanus and the disease's development. It highlights as well the fact that the ideal solution to assess tetanus risk is an up-to-date immunization schedule.
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June 2015

A survey of French general practitioners and a qualitative study on their use and assessment of predictive clinical scores.

Int J Gen Med 2013 25;6:419-26. Epub 2013 Jun 25.

Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France ; Centre Hospitalier, Firminy, France.

Background: Predictive clinical scores, diagnostic as well as prognostic, are considered to be useful tools for making decisions under conditions of uncertainty. They are not intended to replace clinical judgment or medical experience, but to help physicians in the interpretation of clinical information. The general practitioner (GP), the gateway to care in the French health system, should be the main beneficiary of their utilization. However, there is no information on the prevalence of their use in general practice in France.

Methods: A national, transversal epidemiological survey was conducted by electronic mail among GPs belonging to the French Sentinelles network. GPs were asked about their use of scores, the context of their utilization and the expected benefit. A qualitative study (focus groups) was also carried out with three groups of GPs within the context of continuous medical education.

Results: The study consisted of 358 GPs. They were questioned on their use of seven predictive clinical scores (six diagnostic and one prognostic). Clinical scores were used by 75% of GPs, with no statistical difference with regard to their age or sex. The most often used were: the Mini Mental Status Examination (MMSE) (95%), Fagerström test (90%), Hamilton scale (65%), McIsaac scores (61%), DETA/CAGE (45%), Simple Calculated Osteoporosis Risk Estimation (SCORE) for osteoporosis (33%), and the only prognostic score CHADS2 (28%). Clinical scores were especially used when elderly people were involved (77%) and when the diagnosis was uncertain (63%). The qualitative study gave additional information on the barriers and obstacles to the use of predictive clinical scores.

Conclusion: This study, the first one in France, gives information on the perception of clinical scores and on the rationale for their use by GPs. Suggestions to improve the situation (availability and rate of utilization of clinical scores) are provided.
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July 2013

Age distribution of influenza like illness cases during post-pandemic A(H3N2): comparison with the twelve previous seasons, in France.

PLoS One 2013 5;8(6):e65919. Epub 2013 Jun 5.

INSERM, U 707, F-75012, Paris, France.

In France, the 2011-2012 influenza epidemic was characterized by the circulation of antigenically drifted influenza A(H3N2) viruses and by an increased disease severity and mortality among the elderly, with respect to the A(H1N1)pdm09 pandemic and post-pandemic outbreaks. Whether the epidemiology of influenza in France differed between the 2011-2012 epidemic and the previous outbreaks is unclear. Here, we analyse the age distribution of influenza like illness (ILI) cases attended in general practice during the 2011-2012 epidemic, and compare it with that of the twelve previous epidemic seasons. Influenza like illness data were obtained through a nationwide surveillance system based on sentinel general practitioners. Vaccine effectiveness was also estimated. The estimated number of ILI cases attended in general practice during the 2011-2012 was lower than that of the past twelve epidemics. The age distribution was characteristic of previous A(H3N2)-dominated outbreaks: school-age children were relatively spared compared to epidemics (co-)dominated by A(H1N1) and/or B viruses (including the 2009 pandemic and post-pandemic outbreaks), while the proportion of adults over 30 year-old was higher. The estimated vaccine effectiveness (54%, 95% CI (48, 60)) was in the lower range for A(H3N2) epidemics. In conclusion, the age distribution of ILI cases attended in general practice seems to be not different between the A(H3N2) pre-pandemic and post-pandemic epidemics. Future researches including a more important number of ILI epidemics and confirmed virological data of influenza and other respiratory pathogens are necessary to confirm these results.
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January 2014

The Chikungunya epidemic on La Réunion Island in 2005-2006: a cost-of-illness study.

PLoS Negl Trop Dis 2011 Jun 14;5(6):e1197. Epub 2011 Jun 14.

Université Pierre et Marie Curie-Paris, France.

Background: This study was conducted to assess the impact of chikungunya on health costs during the epidemic that occurred on La Réunion in 2005-2006.

Methodology/principal Findings: From data collected from health agencies, the additional costs incurred by chikungunya in terms of consultations, drug consumption and absence from work were determined by a comparison with the expected costs outside the epidemic period. The cost of hospitalization was estimated from data provided by the national hospitalization database for short-term care by considering all hospital stays in which the ICD-10 code A92.0 appeared. A cost-of-illness study was conducted from the perspective of the third-party payer. Direct medical costs per outpatient and inpatient case were evaluated. The costs were estimated in Euros at 2006 values. Additional reimbursements for consultations with general practitioners and drugs were estimated as € 12.4 million (range: € 7.7 million-€ 17.1 million) and € 5 million (€ 1.9 million-€ 8.1 million), respectively, while the cost of hospitalization for chikungunya was estimated to be € 8.5 million (€ 5.8 million-€ 8.7 million). Productivity costs were estimated as € 17.4 million (€ 6 million-€ 28.9 million). The medical cost of the chikungunya epidemic was estimated as € 43.9 million, 60% due to direct medical costs and 40% to indirect costs (€ 26.5 million and € 17.4 million, respectively). The direct medical cost was assessed as € 90 for each outpatient and € 2,000 for each inpatient.

Conclusions/significance: The medical management of chikungunya during the epidemic on La Réunion Island was associated with an important economic burden. The estimated cost of the reported disease can be used to evaluate the cost/efficacy and cost/benefit ratios for prevention and control programmes of emerging arboviruses.
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June 2011