French Administrative Region Research Articles

Groundwaters in the Auvergne-Rhône-Alpes Region, France: Grouping Homogeneous Groundwater Bodies for Optimized Monitoring and Protection

The number and diversity of groundwater bodies (GWBs) in large French administrative regions pose challenges to their monitoring and protection by regional health agencies. To overcome this obstacle, we propose, for the Auvergne-Rhône-Alpes region (about 70,000 km2), a grouping of GWBs into homogeneous groups based on the sources of variability within a large dataset of groundwater physico-chemical and bacteriological characteristics (8078 observations and 13 parameters). This grouping involved a dimensional reduction in the data hyperspace by principal component analysis (PCA) and a clustering based on the mean values of each GWB on the factorial axes. The information lost when clustering from the sample point scale to the GWB scale and then to that of the GWB group was quantified by analysis of variance and showed that grouping GWBs is accompanied by a small loss of information. A discriminant analysis confirmed the high spatial and temporal variability within the dataset, as well as the effectiveness of the proposed method for establishing homogeneous sets. Some roadmaps for more targeted monitoring of water resources were briefly proposed.

The physical and psychological health of children entrusted to the care of the child protection and welfare service in Vendée

BackgroundThe international literature has long established the importance of health issues presented by children entrusted to Child Protection and Welfare Service (Aide Sociale à l'Enfance –ASE, in France). This study examined the health of children entrusted to the ASE in Vendée (a French administrative region) in order to better understand and address their health needs. MethodsA retrospective study of all children (623 out of 920) aged 0–18 years placed in foster care or an institution during 2019 was carried out. The data collection was based on the information in the medical form completed by the doctor during the annual health check. ResultsMore than one quarter of the children had a written or spoken language disorder, 32% of children did not have a normal body mass index for their age, 10% of children suffered from enuresis, 4% from encopresis, and sleep disorders were observed in 29% of the study population. Furthermore, 51% of the children expressed psychological distress by internalizing or externalizing it, and 6% of children over 6 years of age had already run away or put themselves in danger. ConclusionThe results of our study are congruent with the international literature and confirm that children and adolescents in out-of-home care (foster care, residential care) have significantly higher healthcare needs than their peers. The findings also suggest several areas for improving the healthcare of children and adolescents entrusted to the care of the child protection and welfare services.

Small bowel capsule endoscopy and deep enteroscopy procedure load in France: a nationwide population-based study over 7 years

Abstract Background and study aims Capsule endoscopy (CE) is a diagnostic tool mainly used to explore the small bowel (SB), whereas device-assisted enteroscopy (DAE) is preferred for therapeutics. We aimed to describe the procedure load of SB endoscopy in France from 2015 to 2021. Patients and methods Using the French national health data system and the French national hospital discharge database, we identified all SBCEs and DAEs reported between January 2015 and December 2021. Information on DAEs was crosschecked with data on purchase or maintenance from manufacturers. Centers and procedures were described by type, year, type of practice, and according to the 13 French administrative regions in the mainland and in those overseas. Results A total of 151,096 SBCEs and 6,802 for DAEs were considered over the study period. SBCE service was offered in all regions, in both public and private settings, and the case load increased from 18,956 to 24,183 (+27.6%). The number of DAEs decreased nationwide, from 1,030 to 932 (–9.5%). Eighty-seven percent of all DAEs were performed in public university hospitals. Retrograde route varied between 18.8% and 22.8% of all DAEs yearly. The number of centers offering DAE varied from 0 to 5, over regions and years. DAE caseloads increased in five regions but ended, decreased or the procedure was not yet used in the nine remaining regions. Conclusions SB endoscopy in France is marked by a 22-fold unbalanced procedure load in CE (nationwide coverage) and in DAE (absent in some regions). This gap has widened over the years from 2015 to 2021.

Phylodynamics of SARS-CoV-2 in France, Europe, and the world in 2020

Although France was one of the most affected European countries by the COVID-19 pandemic in 2020, the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) movement within France, but also involving France in Europe and in the world, remain only partially characterized in this timeframe. Here, we analyzed GISAID deposited sequences from January 1 to December 31, 2020 (n = 638,706 sequences at the time of writing). To tackle the challenging number of sequences without the bias of analyzing a single subsample of sequences, we produced 100 subsamples of sequences and related phylogenetic trees from the whole dataset for different geographic scales (worldwide, European countries, and French administrative regions) and time periods (from January 1 to July 25, 2020, and from July 26 to December 31, 2020). We applied a maximum likelihood discrete trait phylogeographic method to date exchange events (i.e., a transition from one location to another one), to estimate the geographic spread of SARS-CoV-2 transmissions and lineages into, from and within France, Europe, and the world. The results unraveled two different patterns of exchange events between the first and second half of 2020. Throughout the year, Europe was systematically associated with most of the intercontinental exchanges. SARS-CoV-2 was mainly introduced into France from North America and Europe (mostly by Italy, Spain, the United Kingdom, Belgium, and Germany) during the first European epidemic wave. During the second wave, exchange events were limited to neighboring countries without strong intercontinental movement, but Russia widely exported the virus into Europe during the summer of 2020. France mostly exported B.1 and B.1.160 lineages, respectively, during the first and second European epidemic waves. At the level of French administrative regions, the Paris area was the main exporter during the first wave. But, for the second epidemic wave, it equally contributed to virus spread with Lyon area, the second most populated urban area after Paris in France. The main circulating lineages were similarly distributed among the French regions. To conclude, by enabling the inclusion of tens of thousands of viral sequences, this original phylodynamic method enabled us to robustly describe SARS-CoV-2 geographic spread through France, Europe, and worldwide in 2020.

Qualitative assessment of the national initiative to implement antimicrobial stewardship centres in French administrative regions

BackgroundIn May 2020, the French Ministry of Health funded the creation of regional antimicrobial stewardship (AMS) coordination centres (CRAtb) in preparation for the new national framework for the prevention of antimicrobial resistance. This study aimed to assess through qualitative methods the implementation process, the activities carried out, and the interactions with other regional stakeholders of the newly created CRAtb.MethodsWe conducted a mixed-method study based on a cross-sectional survey and semi-structured interviews by French regions among implemented CRAtb. Of the eight eligible French regions with an existing CRAtb, seven participated to the online survey. Regional partners involved in AMS from the eight regions were interviewed between September 2021 and April 2022. The survey questionnaire addressed, through closed questions, the organization of the CRAtb, articulation with other regional actors involved in AMS and infection prevention and control (IPC), and AMS activities. The semi-structured interviews approached the implementation and the role of CRAtb, and the collaboration of other AMS and IPC stakeholders. Interview transcripts were analysed using thematic content analysis methodology.ResultsAMS activities carried out by CRAtb were mainly focusing on hospitals (n = 3), primary care (n = 2) and nursing homes (n = 1). Education mostly relied on training days and AMS help lines, communication on websites and newsletters. CRAtb members reported still being more engaged in providing advice to professionals for individual antibiotic treatments rather than collective-level AMS activities. Interactions were frequent between CRAtb, IPC regional centres and health authorities, but rarely involved other stakeholders. Interviews were performed with 28 professionals involved in AMS from eight regions. Pre-existing networks and working relationships in AMS and more broadly facilitated the implementation of CRAtb. Streamlining and decompartmentalizing IPC and AMS regional activities were considered a way to optimise the prevention of antimicrobial resistance across sectors. The engagement with liberal health professionals was identified as a significant obstacle for CRAtb.ConclusionsTwo years after the launch of a new national framework, the implementation of CRAtb appeared complex in most regions. An integrative model joining IPC and AMS efforts, relying on existing networks, with engagement from liberal health profession organisations may be the next pivotal step.

Phylodynamic analysis of the highly pathogenic avian influenza H5N8 epidemic in France, 2016-2017.

In 2016-2017, France experienced a devastating epidemic of highly pathogenic avian influenza (HPAI) H5N8, with more than 400 outbreaks reported in poultry farms. We analyzed the spatiotemporal dynamics of the epidemic using a structured-coalescent-based phylodynamic approach that combined viral genomic data (n=196; one viral genome per farm) and epidemiological data. In the process, we estimated viral migration rates between départements (French administrative regions) and the temporal dynamics of the effective viral population size (Ne) in each département. Viral migration rates quantify viral spread between départements and Ne is a population genetic measure of the epidemic size and, in turn, is indicative of the within-département transmission intensity. We extended the phylodynamic analysis with a generalized linear model to assess the impact of multiple factors-including large-scale preventive culling and live-duck movement bans-on viral migration rates and Ne. We showed that the large-scale culling of ducks that was initiated on 4 January 2017 significantly reduced the viral spread between départements. No relationship was found between the viral spread and duck movements between départements. The within-département transmission intensity was found to be weakly associated with the intensity of duck movements within départements. Together, these results indicated that the virus spread in short distances, either between adjacent départements or within départements. Results also suggested that the restrictions on duck transport within départements might not have stopped the viral spread completely. Overall, we demonstrated the usefulness of phylodynamics in characterizing the dynamics of a HPAI epidemic and assessing control measures. This method can be adapted to investigate other epidemics of fast-evolving livestock pathogens.

Quantification of the effects of climatic conditions on French hospital admissions and deaths induced by SARS-CoV-2

An estimation of the impact of climatic conditions—measured with an index that combines temperature and humidity, the IPTCC—on the hospitalizations and deaths attributed to SARS-CoV-2 is proposed. The present paper uses weekly data from 54 French administrative regions between March 23, 2020 and January 10, 2021. Firstly, a Granger causal analysis is developed and reveals that past values of the IPTCC contain information that allow for a better prediction of hospitalizations or deaths than that obtained without the IPTCC. Finally, a vector autoregressive model is estimated to evaluate the dynamic response of hospitalizations and deaths after an increase in the IPTCC. It is estimated that a 10-point increase in the IPTCC causes hospitalizations to rise by 2.9% (90% CI 0.7–5.0) one week after the increase, and by 4.1% (90% CI 2.1–6.4) and 4.4% (90% CI 2.5–6.3) in the two following weeks. Over ten weeks, the cumulative effect is estimated to reach 20.1%. Two weeks after the increase in the IPTCC, deaths are estimated to rise by 3.7% (90% CI 1.6–5.8). The cumulative effect from the second to the tenth weeks reaches 15.8%. The results are robust to the inclusion of air pollution indicators.

Evaluating validation strategies on the performance of soil property prediction from regional to continental spectral data

Visible-near infrared (vis–NIR) spectroscopy has been widely used to characterize soil information from field to global scales. Before applying a calibrated spectral predictive model to acquire soil information, either independent validation or k-fold cross validation is used to evaluate model performance. However, there is no consensus on which validation strategy is more suitable and robust when evaluating model performance for the studies in different scales. The objective of this study is to evaluate and compare the model performance of two validation strategies coupling different calibration sizes (a ratio of calibration to validation of 2:1, 4:1 and 9:1) and calibration sampling strategies (random sampling (RS), rank, Kennard-Stone (KS), rank-Kennard-Stone (RKS) and conditioned Latin hypercube sampling (cLHS)) across scales. A total of 17,272 vis–NIR spectra of mineral soils from LUCAS data (continental scale) and their soil organic carbon (SOC) and clay contents were used in this study, and the dataset was further split into national (2761 samples in France) and five regional datasets (110 to 248 samples from five French administrative regions). To eliminate the effect of changing validation set on the model performance, a consistent test set (20% of total samples at each scale) was split to evaluate all the combinations involved in two validation strategies. The Lin’s concordance correlation coefficient (CCC) of the cubist model were stable for both SOC and clay for different calibration sizes, calibration sampling and validation strategies for a large calibration size (>1400) at the national and continental scales. A larger calibration size can potentially improve model performance for a small dataset (<300) at the regional scale, and a wider calibration range would result in better model performance. No silver bullet was found among the different calibration sampling strategies at the regional scale. For five French regions (small data set), we found a high variation (95th percentile minus the 5th percentile) in the CCC among the models built from 50 repeated RS (0.10–0.44 for SOC, 0.16–0.52 for clay) and cLHS (0.08–0.40 for SOC, 0.12–0.36 for clay). This finding indicates that a one-time RS or cLHS for selecting the calibration set has high uncertainty in model evaluation for a small dataset and therefore should be used with caution. Therefore, we suggest the following: (1) for a large data set (thousands), either one-time random sampling for independent validation or k-fold cross validation would be appropriate; (2) for a small data set (dozens to hundreds), k-fold cross validation and/or repeated random sampling for independent validation would be more robust for spectral predictive model evaluation.

Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays.

The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT). We conducted a prospective national-level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019. The primary end point was the variation of patients receiving MT during the epidemic period. Secondary end points included care delays between onset, imaging, and groin puncture. To analyze the primary end point, we used a Poisson regression model. We then analyzed the correlation between the number of MTs and the number of COVID-19 cases hospitalizations, using the Pearson correlation coefficient (compared with the null value). A total of 1513 patients were included at 32 centers, in all French administrative regions. There was a 21% significant decrease (0.79; [95%CI, 0.76-0.82]; P<0.001) in MT case volumes during the epidemic period, and a significant increase in delays between imaging and groin puncture, overall (mean 144.9±SD 86.8 minutes versus 126.2±70.9; P<0.001 in 2019) and in transferred patients (mean 182.6±SD 82.0 minutes versus 153.25±67; P<0.001). After the instatement of strict epidemic mitigation measures, there was a significant negative correlation between the number of hospitalizations for COVID and the number of MT cases (R2 -0.51; P=0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both P<0.05). Our study showed a significant decrease in patients treated with MTs during the first stages of the COVID epidemic in France and alarming indicators of lengthened care delays. These findings prompt immediate consideration of local and regional stroke networks preparedness in the varying contexts of COVID-19 pandemic evolution.

Temperature Decreases Spread Parameters of the New Covid-19 Case Dynamics.

(1) Background: The virulence of coronavirus diseases due to viruses like SARS-CoV or MERS-CoV decreases in humid and hot weather. The putative temperature dependence of infectivity by the new coronavirus SARS-CoV-2 or covid-19 has a high predictive medical interest. (2) Methods: External temperature and new covid-19 cases in 21 countries and in the French administrative regions were collected from public data. Associations between epidemiological parameters of the new case dynamics and temperature were examined using an ARIMA model. (3) Results: We show that, in the first stages of the epidemic, the velocity of contagion decreases with country- or region-wise temperature. (4) Conclusions: Results indicate that high temperatures diminish initial contagion rates, but seasonal temperature effects at later stages of the epidemy remain questionable. Confinement policies and other eviction rules should account for climatological heterogeneities, in order to adapt the public health decisions to possible geographic or seasonal gradients.

Predicting suitable habitats of four range margin amphibians under climate and land-use changes in southwestern France

Whereas the effects of climate change on the potential range shifts of amphibians have been modeled at various scales, exploring the future impacts of land-use changes has rarely been considered. We modeled the potential distribution of Bombina variegata, Hyla arborea, Hyla meridionalis, and Triturus cristatus using ecological niche modeling, in the French administrative region Nouvelle-Aquitaine. The species are all at range margin in the study area which makes them interesting model species to study range shifts because of their potential local adaptations to their marginal habitat. We used Dyna-CLUE modeling framework to produce land-use change scenarios and combined them with RCP 2.6 and RCP 8.5 climate change scenarios to predict their impact on local amphibian distributions. B. variegata, H. arborea, and T. cristatus were predicted to shift eastward and northward. H. meridionalis was predicted to increase its probability of presence in the study area. The effect of climate determined the general pattern of distribution and was modulated depending on the scenarios of land-use change.

Evidence of slow-release morphine sulfate abuse and diversion: epidemiological approaches in a French administrative area.

Slow-release oral morphine sulfate (SM) is one of the most abused prescription opioids in France. However, the regional feature of the abuse of morphine is poorly documented. To investigate the abuse of SM in a French administrative region, a multisource approach was applied. The first approach was based on SM exposition at national and regional level using the OPPIDUM survey. In a second approach, we analyzed a drug reimbursement database to assess the magnitude of SM abuse in Languedoc-Roussillon (LR) region. A clustering method was applied to classify patients and to describe the profile of deviant patients. The third approach was based on a self-administered anonymous questionnaire, proposed to patients seen in addiction care centers in the LR region and consuming oral SM. The OPPIDUM study showed that in most regions, where the prevalence of heroin use is higher than the national average of 9.1%, SM consumers were fewer. With the clustering method, three subgroups were identified. One of them gathered 35 users (3.2%) with a deviant behavior characterized by significantly more dispensations, dispensing pharmacies, and prescribers. These subjects were mainly men, younger, and more consumers of benzodiazepines and opioid maintenance therapy than the others. The third study allowed specifying that SM was mainly injected (93.7%), bought in the street (80%), and used because of unavailability and the poor quality of heroin (33.9%). The three proposed approaches are complementary and help to clarify the abuse of oral SM, while assessing the motivations of this abuse.

Impact of meteorological drivers on regional inter-annual crop yield variability in France

The impact of intra-seasonal climate variability on inter-annual variation in winter wheat and grain maize yields over 92 French administrative regions is assessed. Observed monthly time series of temperature, precipitation and solar radiation during the growing season are analysed together with reported annual crop yields with a statistical approach based on partial least square regression. Results highlight remarkable spatial differences in the contribution of the main meteorological drivers to crop yield variability and in the timing of the maximum impact. Overall, temperature and global solar radiation are identified as the most important variables influencing grain maize yields over the southern, eastern and northern parts of France, while rainfall variability dominates yields over the central and north-western parts of the country. Positive rainfall anomalies during the summer months lead to an increase in maize yields, while positive temperature and radiation anomalies have the opposite effect. Extensive irrigation suppresses the rainfall signal in dry years. Winter wheat yields are predominantly influenced by temperature variations in eastern France and by rainfall variations over the northern, north-western and south-eastern France. In general, variation in global radiation plays a more important role in the southern than in the northern part of the country. Our study contributes to a better understanding of the impact of intra-seasonal climate variability on crop yields. Potential applications of the inferred models are discussed, especially in terms of seasonal crop yield forecasting and validation of dynamic crop model simulations.

Hospitalizations for COPD Exacerbations: Trends and Determinants of Death

Objectives: to understand epidemiological trends in severe COPD exacerbations through analyzes of hospitalizations and deaths during three consecutive years in a French administrative region area. Methods: Medico-administrative records of hospitalizations for COPD exacerbations were sorted from 2010 to 2012 using selected International Classification of Diseases (ICD10) codes. Four groups of hospitalization for COPD severe exacerbations were elicited leading to hospitalizations (general ward without respiratory failure, general ward with acute respiratory distress, ICU without mechanical ventilation, ICU with mechanical ventilation). Results: Data extraction identified 5007, 4986 and 5359 admissions related to 4136, 4155 and 4460 patients in 2010, 2011 and 2012, respectively. Marked seasonal variations were observed. Duration of stay (median (IQR), 7 (7) vs 9 (8) vs 10 (9) vs 14 (16) days, P < .001), death rates (3.6% vs 14.2% vs 14.4% vs 21.2%, P < .01), number of co-morbid conditions (median (IQR), 2 (2) vs 2 (2) vs 4 (5) vs 4 (4.5), P < .01), type of institution (64.9% in public institution vs 79.9% vs 87.8% vs 76.6%, P < .01) were significantly associated with the hospitalization group and more than 8% of admissions led to death (3% to 24%). Age, type of institution and past hospitalizations were independent risk factors for deaths. Readmissions were infrequent but mainly related to the worsening of the co-morbid conditions. Conclusion: COPD severe exacerbations are frequent and lead to an important numbers of deaths related to the severity of acute respiratory failure and the number of co-morbid conditions.

Antifungal agents use in a French administrative region

BackgroundThe increased use of new costly antifungal agents has led to a considerable increase in pharmaceutical expenditure. In December 2011, the Lorraine Regional Health Agency commissioned the Antibiolor network to evaluate costly antifungal agent stewardship using as reference regional, French, and international recommendations. MethodsWe performed a regional retrospective multicenter study. The criteria for evaluation were the appropriateness of the indication for treatment, the choice of the agent or of a combination, compliance with dose and treatment duration, and the absence of any alternative. ResultsOne hundred and fourteen prescriptions were analyzed, in 7 intensive care units, 4 hematology units, and 1 infectious diseases unit. The indication for costly antifungal treatment was appropriate in 110 cases (96.5%), the choice of the antifungal agent in 102 cases (93%), the dose in 98 cases (89%), treatment duration in 102 cases (93%), and an alternative antifungal treatment was possible in 10 cases (9%). Eighty-two prescriptions (74.5%) complied with the marketing authorization, 19 (17%) were related to a protocol for temporary use, and 9 (8%) were considered as inappropriate. ConclusionOur results show a high rate of appropriate prescriptions. The easily accessible and regularly updated local recommendations probably resulted in the standardization and optimization of costly antifungal agent prescriptions.

Survival from sports-related sudden cardiac arrest: In sports facilities versus outside of sports facilities

We sought to evaluate frequency, characteristics, and outcomes of sudden cardiac arrest (SCA) during sports activities according to the location of occurrence (in sports facilities vs those occurring outside of sports facilities). This is an observational 5-year prospective national French survey of subjects 10 to 75 years old presenting with SCA during sports (2005-2010), in 60 French administrative regions (covering a population of 35 million people). Of the 820 SCA during sports, 426 SCAs (52%) occurred in sports facilities. Overall, a substantially higher survival rate at hospital discharge was observed among SCA in sports facilities (22.8%, 95% CI 18.8-26.8) compared to those occurring outside (8.0%, 95% CI 5.3-10.7) (P < .0001). Patients with SCA in sports facilities were younger (42.1 vs 51.3 years, P < .0001) and less frequently had known cardiovascular diseases (P < .0001). The events were more often witnessed (99.8% vs 84.9%, 0.0001), and bystander cardiopulmonary resuscitation was more frequently initiated (35.4% vs 25.9%, P = .003). Delays of intervention were significantly shorter when SCA occurred in sports facilities (9.3 vs 13.6, P=0.03), and the proportion of initially shockable rhythm was higher (58.8% vs 33.1%, P < .0001). Better survival in sports facilities was mainly explained by concomitant circumstances of occurrence (adjusted odds ratio 1.48, 95% CI 0.88-2.49, P = .134). Sports-related SCA is not a homogeneous entity. The 3-fold higher survival rate reported among sports-related SCA is mainly due to cases that occur in sports facilities, whereas SCA during sports occurring outside of sports facilities has the usual very low rate of survival.

A new reliable index to measure individual deprivation: the EPICES score.

Deprivation is associated with inequalities in health care and higher morbidity and mortality. To assess the reliability of a new individual deprivation score, the EPICES score and to analyse the association between the Townsend index, the Carstairs index and the EPICES score and causes of death in one French administrative region. Eligible patients were 16 years old or more who had come for consultation in Health Examination Centres of the French administrative region of Nord-Pas-de-Calais. An ecological study was performed between 2002 and 2007 in the 392 districts of this administrative region. The EPICES score was compared with the Townsend and the Carstairs indices. These three measurements of deprivation were compared with social characteristics, indicators of morbidity, health-care use and mortality and specific causes of death. The Pearson correlation coefficients were calculated to assess the reliability of the EPICES score. The association between deprivation and mortality was assessed by comparison of the standardized mortality ratio (SMR) between the most and least deprived districts. The EPICES score was strongly correlated with the Townsend and Carstairs indices and with the health indicators measured. SMR increased with deprivation and the higher the deprivation the higher the SMR for all-cause mortality, premature and avoidable deaths and for most specific causes of death. The individual deprivation EPICES score is reliable. Deprivation was related to excess death rate, which clearly indicates that deprivation is a determinant factor that should be considered systematically by health policy makers and health-care providers.

Parures annulaires massives à décor incisé du Bronze moyen au Nord-Ouest de la France (Bretagne, Pays de la Loire, Basse-Normandie). Pour une remise en question du type de Bignan

Au cours du Bronze moyen, la production metallique est caracterisee, entre autres, par la diffusion de parures annulaires originales, massives et portant un riche decor incise, qui constituent la forme de parure majoritaire au sein des depots de cette periode en France de l’Ouest. J. Briard (1965) fut le premier a individualiser ces objets, auxquels il donna le nom de bracelets du type de Bignan, d’apres un depot morbihannais en contenant dix-huit exemplaires. Presents tres frequemment dans les depots du Massif armoricain, ces objets sont depuis indistinctement designes ainsi lors de leur decouverte. Il semble desormais necessaire de revenir sur cette denomination, qui regroupe des productions parfois tres differentes, et qui ne permet pas la prise en compte des particularismes morphologiques et decoratifs regionaux. La presente etude concerne les parures annulaires decouvertes en Bretagne, Pays de la Loire et Basse-Normandie, une aire geographique formant une zone relativement homogene pour ce type de productions. Les regions Haute-Normandie, Poitou-Charentes, Aquitaine, Ile-de-France et le Sud de l’Angleterre ont livre des objets relativement proches, mais dont la morphologie et le decor se distinguent cependant par des caracteristiques regionales propres. Ils seront donc egalement etudies ici afin de replacer le Nord-Ouest francais au sein d’un phenomene qui apparait generalise a l’ensemble de l’Europe atlantique. Il convient aujourd’hui de determiner les ressemblances et differences existant entre les zones de concentration de ces objets, ainsi que de tenter d’en deceler les mecanismes de production, d’utilisation, d’echange et de depot. L’etude precise de la repartition geographique, des contextes de decouverte, des caracteres morphologiques et decoratifs de ces elements de parure permet de proposer une classification renouvelee ainsi que la definition de plusieurs groupes de production. Les differentes zones geographiques etudiees ici presentent des combinaisons preferentielles de criteres morphologiques et decoratifs, liees a des choix techniques, symboliques ou esthetiques, necessitant une reprise des donnees concernant la typologie et la terminologie des bracelets du type de Bignan.

Escherichia coli antibiotic resistance in emergency departments. Do local resistance rates matter?

Ciprofloxacin and cotrimoxazole are recommended to treat uncomplicated pyelonephritis and uncomplicated cystitis, respectively, provided that local resistance rates of uropathogens do not exceed specified thresholds (10 and 20%, respectively). However, Escherichia coli resistance rates in Emergency Departments (ED) remain poorly described. Our objectives were to assess E. coli ciprofloxacin and cotrimoxazole resistance rates in EDs of a French administrative region, and to determine if resistance rates differ between EDs. This was a retrospective study of E. coli urine isolates sampled in ten EDs between 2007 and 2012. The following risk factors for resistance were tested using logistic regression: ED, sex, age, sampling year, sampling month. A total of 17,527 isolates were included. Ciprofloxacin local resistance rates (range, 5.3% [95% CI, 4.0-7.1%] to 11.7% [95% CI, 5.2-23.2%]) were ≤10% in nine EDs in 2012. Five EDs were risk factors for ciprofloxacin resistance, as were male sex, age and sampling in April or October. Cotrimoxazole local resistance rates (range, 13.3% [95% CI, 6.3-25.1%] to 20.4% [95% CI, 18.9-22.0%]) were ≤20% in seven EDs in 2012. Five EDs were risk factors for cotrimoxazole resistance, as were age, sampling between October and December, and sampling in 2011 and 2012. We found a significant variability of E. coli ciprofloxacin and cotrimoxazole resistance rates among EDs of a small region. These differences impact on the feasibility of empirical treatment of urinary tract infections with ciprofloxacin or cotrimoxazole in a given ED. Continuous local survey of antibacterial resistance in ED urinary isolates is warranted to guide antibacterial therapy of urinary tract infections.

A methodology for the development of innovation clusters: application in the healthcare sector

For more than ten years, the French State and administrative regions have pursued economic development policies that stimulate all forms of innovation and encourage strategic market alliances of the economic stakeholders of a region. These ‘cluster’ policies aim to create ecosystems that are conducive to innovation and promote the emergence of collaborative organisations. Among these innovation clusters, we are concerned with those in the healthcare field pertaining to ageing and autonomy. Business models and action plans for these collaborative organisations are neither easy to define nor easy to stabilise and reinforce, because of the diversity of stakeholders with multiple expectations involved. This paper presents an application of the FAcT-Mirror method in the Sol’iage (http://www.soliage.com/english-version/) innovation cluster during its development stage. We demonstrate that the FAcT-Mirror method is particularly efficient and effective during the process of transformation from the emerging stage (stage of intention) to the development stage (stage of action) for a healthcare cluster to collectively produce common tools (definitions, strategy, working groups, and action plans).