Biomedical subjects

Michèle Dramaix

Publications and source records attributed to Michèle Dramaix.

14 recordsLinked to original sources

PubMed2006

Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals.

This study examined the impact of cost outliers in term of hospital resources consumption, the financial impact of the outliers under the Belgium casemix-based system, and the validity of two "proxies" for costs: length of stay and charges. The cost of all hospital stays at three Belgian general hospitals were calculated for the year 2001. High resource use outliers were selected according to the following rule: 75th percentile +1.5 xinter-quartile range. The frequency of cost outliers varied from 7% to 8% across hospitals. Explanatory factors were: major or extreme severity of illness, longer length of stay, and intensive care unit stay. Cost outliers account for 22-30% of hospital costs. One-third of length-of-stay outliers are not cost outliers, and nearly one-quarter of charges outliers are not cost outliers. The current funding system in Belgium does not penalize hospitals having a high percentage of outliers. The billing generated by these patients largely compensates for costs generated. Length of stay and charges are not a good approximation to select cost outliers.

Adult↗

PubMed2006

Analysis of cost outliers within APR-DRGs in a Belgian general hospital: two complementary approaches.

CONTEXT AND OBJECTIVES: The objective of this study was to find factors that could explain high and low resource use outliers, by associating an explanatory analysis with a statistical analysis. METHOD: High resource use outliers were selected according to the following rule: 75th percentile + 1.5* inter-quartile range. Low resource use outliers were selected according to: 25th percentile - 1.5* inter-quartile range. The statistical approach was based on a multivariate analysis using logistic regression. A decision tree approach using predictors from this analysis (intensive care unit (ICU) stay, high severity of illness and social factors associated with longer length of stay) was also tested as a more intuitive tool for use by hospitals in focussing review efforts on "not explained" cost outliers. RESULTS: High resource use outliers accounted for 6.31% of the hospital stays versus 1.07% for low resource use outliers. The probability of a patient being a high resource use outlier was higher with an increase in the length of stay (odds ratios (OR) = 1.08), when the patient was treated in an intensive care unit (OR = 3.02), with a major or extreme severity of illness (OR=1.46), and with the presence of social factors (OR = 1.44). The probability of being a low outlier is lower for older patients (OR = 0.98). The probability of being a low outlier is also lower without readmission within the year (OR = 0.55). The more intuitive decision tree method identified 92.26% of the cases identified through residuals of the regression model. One quarter of the high cost outliers were flagged for additional review ("not justified" on the basis of the model), with nearly three-quarters "justified" by clinical and social factors. CONCLUSION: The analysis of cost outliers can meet different aims (financing of justifiable outliers, improvement of the care process for the outliers not justifiable on medical or social grounds). The two methods are complementary, by proposing a statistical and a didactic approach to achieve the goal of high quality care using fewer resources.

Adolescent↗

PubMed2006

[Simplified prognostic model of overall intrahospital mortality of children in central Africa].

OBJECTIVES: To find a simple mortality prediction model based on nutritional and infection indicators for the assessment of the care of children admitted to hospital in central Africa. METHOD: Cohort study of 414 children admitted at Goma Hospital between 1.4.2003 and 31.3.2004. We conducted univariate analysis and logistic regression, computed adjusted odds ratios and constructed a prognostic score from the coefficients of logistic regression. The performance of logistic model and score were evaluated by the calculation of areas under the ROC curves. RESULTS: The intrahospital mortality rate reached 15.9%. In univariate analysis, age, WAZ, arm circumference, neurological status (Blantyre coma score), stiff neck, subcostal indrawning, and infection were significantly associated with mortality. Logistic regression model analysis and adjusted odds ratios (AOR) confirmed higher risks of death for young (AOR 3.4 (1.4-8.8) and underweight children (WAZ -2->-3 and WAZ < or = -3, AOR 3.2 (1.4-7.6) and AOR 4.4 (1.7-11.2)), for children with arm circumference under 115 mm (AOR 3.4 (1.5-7.3)), impaired consciousness (AOR 9.6 (3.1-29.9)) and bloodstream infections (AOR 6.6 (2.1-21.1)). The area under the ROC curve of the prognostic model is 0.83 (0.78-0.88), that of the prognostic score, 0.80 (0.75-0.86). CONCLUSION: This study provides a simple mortality prediction model for hospitalised children in central Africa, based on age, weight for age or arm circumference, neurological status (Blantyre coma score), and infection. This model and scoring system can be used to evaluate programs set up to reduce intrahospital mortality in this region.

Age Factors↗

PubMed2006

Risk factors for Buruli ulcer, Benin.

We identified risk factors for Buruli ulcer (BU) in Benin in an unmatched case-control study at the Centre Sanitaire et Nutritionnel Gbemoten in southern Benin. A total of 2,399 persons admitted from 1997 through 2003 and 1,444 unmatched patients with other conditions in 2002 were recruited. Adjusted odds ratios were determined for age, sex, place of residence, Mycobacterium bovis BCG vaccination at birth, type of water for domestic use, and occupation. Children <15 years of age and adults >49 years of age had a higher risk for BU. Use of unprotected water from swamps was associated with increased risk for BU; this association was strongest in adults >49 years of age. Sex was not a risk factor for BU. Our data showed that BU was mainly associated with age, place of residence, and water sources in all age groups. Risk for BU was higher in BCG-vaccinated patients > or =5 years of age.

Adolescent↗

PubMed2006

BCG vaccine effectiveness against Buruli ulcer: a case-control study in Benin.

BCG remains the only possible prophylactic intervention against Buruli ulcer (BU). Estimating its public health impact on BU control is an important issue. We conducted a case-control study to investigate the vaccine effectiveness of routine BCG vaccine against BU in southern Benin. From August 2002 to August 2003, BCG vaccination status was obtained for 279 clinically diagnosed BU cases and 988 age- and sex-matched neighborhood controls. BCG coverage, which was estimated by the presence of a scar or a vaccination record, was 64.5% in cases and 67.2% in controls. There was no evidence of a protective effect of routine BCG vaccination against BU in southern Benin (vaccine effectiveness adjusted for socioeconomic status = 12%, 95% confidence interval = -24% to 37%).

Adolescent↗

PubMed2005

Stroke presentation and outcome in developing countries: a prospective study in the Gambia.

BACKGROUND AND PURPOSE: Despite increasing burden of stroke in Africa, prospective descriptive data are rare. Our objective was to describe, in The Gambia, the clinical outcome of stroke patients admitted to the Royal Victoria Teaching Hospital in the capital Banjul, to assess mortality and morbidity, and propose preventive and therapeutic measures. METHODS: Prospective data were collected on consecutive patients older than 15 years old admitted between February 2000 and February 2001 with the diagnosis of nonsubarachnoid stroke. Risk factors, clinical characteristics, and social consequences were assessed using a modified National Institutes of Health Stroke Scale (mNIHSS), the Barthel Activity in Daily Living scale, the Siriraj score for subtypes, and the Bamford criteria for location/extension. Patients were followed-up at home up to 1 year after discharge. RESULTS: Ninety-one percent (148/162) of eligible patients were enrolled and followed-up. Hypertension and smoking were the most prevalent risk factors. Severity was high at admission, especially in women, and was strongly correlated to the outcome. mNIHSS and consciousness level on admission were strong predictors of the mortality risk. Swallowing difficulties at admission, fever, lung infection, and no aspirin treatment were, independently, risk factors for a lethal outcome susceptible to being addressed by treatment. Mortality was 41% in-hospital and 62% after 1 year. In survivors, autonomy levels improved over time. Drug compliance was poor. At home, family members provided care. Long-term socioeconomic and cultural activities were affected in most patients. CONCLUSIONS: Case-fatality was high compared with Western cohorts. Preventive measures can be developed. Rational treatment, in the absence of head imaging for initial assessment, requires adapted protocols. Providers should be trained, both at hospital and community levels.

Activities of Daily Living↗

PubMed2005

Improving asthma control in patients suboptimally controlled on inhaled steroids and long-acting beta2-agonists: addition of montelukast in an open-label pilot study.

BACKGROUND: Airway inflammation and symptoms often persist in asthma patients despite treatment with inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA). It is hypothesized that the leukotriene receptor antagonist montelukast, treating a pathway of inflammation distinct from that of ICS, might confer additional benefit. OBJECTIVE: To evaluate the efficacy of montelukast in improving asthma control in patients symptomatic on a fixed-association (FA) medium dose of ICS and LABA. METHODS: A 2-month, open-label, real-life observational study was undertaken by 131 Belgian pulmonologists. Patients (> or = 15 years old) suffering from persistent asthma (pre-bronchodilator FEV1 > or = 60% of predicted value) and insufficiently controlled on a FA therapy of fluticasone/salmeterol or budesonide/formoterol were given montelukast 10 mg daily as add-on therapy. Asthma control was assessed by the standardized Juniper asthma control questionnaire (ACQ) at baseline and after a 2-month treatment with montelukast. Global evaluation of therapy was made both by the patients and physicians. RESULTS: A total of 313 patients were eligible for analysis. Forty-nine per cent received inhaled fluticasone/salmeterol and the rest budesonide/formoterol. Mean ACQ score decreased significantly on montelukast (13.9 +/- 5.1 at baseline versus 7.4 +/- 4.7 on montelukast, p < 0.001), with a significant improvement in all individual symptom scores (p < 0.001) and in pre-bronchodilator FEV1 score (from 2.2 +/- 1.5 to 1.6 +/- 1.4; p < 0.001). Parallel to these results, 78.6% of the patients reported a global improvement of their asthma. The same proportion of improvement was observed in the global evaluation made by the physicians (kappa = 0.66). CONCLUSION: This pilot study suggests that addition of montelukast in patients symptomatic on a FA of ICS and LABA may result in significant improvements in asthma control. A randomised, placebo-controlled clinical trial seems warranted.

Acetates↗

PubMed2005

Bacterial contamination of indoor air, surfaces, and settled dust, and related dust endotoxin concentrations in healthy office buildings.

Endotoxin, a characteristic external fraction of the outer membrane from Gram-negative bacteria, continuously shed into the environment, is considered as an important risk factor for human health. Our purpose was to study the bacterial species contaminating healthy working environments. Airborne, working surfaces and carpet dust samples were collected from 25 offices. Bacterial species were identified with biochemical ApiSystem strips. Endotoxin concentrations in settled dust were measured with the kinetic chromogenic Limulus assay. The airborne bacterial level varied from 44-2,511, with a median of 277 cfu/m(3). Bacterial contamination on surfaces ranged from 1-1000, with 33 cfu/25 cm(2) as median value. On carpets, bacterial concentration ranged from 0.73-185 x 10(5) cfu/g, with 7.28 x 10(5) cfu/g as median value. Endotoxin concentration varied from 4.6-116.2 EU/mg, with a median of 20.3 EU/mg. Altogether, 501 bacterial strains were isolated. The species variability was greater in Gram-negative bacteria than in Gram-positive cocci with 41 versus 34 various species. In conclusion, people working in healthy offices can be exposed to large concentrations of airborne and dust bacteria and related endotoxin concentrations, giving a risk of work-related diseases.

Air Microbiology↗

PubMed2004

[Profile of members and non members of mutual health insurance system in Rwanda: the case of the health district of Kabutare].

The establishment of mutual health insurance systems is one of the priorities of the Rwandan government. Pilot studies have been conducted in three districts of the country. Nonetheless, after 4 years of implementation (1999-2003), the population coverage by these insurance systems remains relatively low. A cross-sectional study of 1042 households in the Kabutare health district allowed for a comparison of socio-economic and demographic variables, and the medical, surgical, gynaecological, and obstetrical history of health insurance scheme members and non-members. The results of the study demonstrate that the distribution of members and non-members is similar in terms of sex, marital status, professional status and medical history. However, larger households (more than five members) and those having a relatively higher income (more than USD 230 per annum) are more likely to be insured than other households. Members of the mutual health insurance use more the health services than non-members, spend less on health care and increasingly maintain membership. The study emphasizes the relevance to further promote mutual health insurance, but also points to the need for mechanisms to ensure financial access for the poor rural population.

Cross-Sectional Studies↗

PubMed2004

Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, Southern Benin, 1997-2001.

Data from 1,700 patients living in southern Benin were collected at the Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado, Benin, from 1997 through 2001. In the Zou region in 1999, Buruli ulcer (BU) had a higher detection rate (21.5/100,000) than leprosy (13.4/100,000) and tuberculosis (20.0/100,000). More than 13% of the patients had osteomyelitis. Delay in seeking treatment declined from 4 months in 1989 to 1 month in 2001, and median hospitalization time decreased from 9 months in 1989 to 1 month in 2001. This reduction is attributed, in part, to implementing an international cooperation program, creating a national BU program, and making advances in patient care.

Benin↗

PubMed2004

Maternal Trypanosoma cruzi infection, pregnancy outcome, morbidity, and mortality of congenitally infected and non-infected newborns in Bolivia.

This work compares the results of two epidemiologic and clinical surveys on the consequences of maternal chronic Trypanosoma cruzi infection. They were conducted in 1992-1994 and 1999-2001 in the same maternity clinic in Bolivia, a country highly endemic for infection with this parasite. In both surveys, the materno-fetal transmission of parasites occurred in 5-6% of the infected mothers. Maternal chronic T. cruzi infection had no effect on pregnancy outcome and health of newborns when there was no materno-fetal transmission of parasites. Comparisons between the older and the more recent surveys highlighted significant reductions in frequencies of symptomatic cases (from 54% to 45%), Apgar scores < 7, and low birth weights and prematurity (from 32-50% to 6-16%) among congenitally infected babies. Neonatal mortality related to congenital Chagas disease also decreased from 13% to 2% in the interval between both studies. These results suggest that the decrease in poverty that has occurred in Bolivia between both surveys might have contributed to reduce the morbidity and mortality, but not the transmission rate of T. cruzi congenital infection, which remains a serious public health problem in this country.

Adult↗

PubMed2003

Cord C-peptide and insulin-like growth factor-I, birth weight, and placenta weight among North African and Belgian neonates.

OBJECTIVE: Despite their low socioeconomic status, infants of North African immigrants have been reported to have high birth weights in Belgium. The aim of the study was to further explore potential mechanisms explaining this high birth weight. STUDY DESIGN: Venous umbilical cord blood samples and perinatal characteristics of live-born infants from mothers of North African and Belgian nationality were collected in 1997 through 1998 at the University Hospital La Citadelle, Liège, Belgium. RESULTS: The median connecting peptide (C-peptide) concentration was significantly higher among North African than Belgian neonates (0.125 vs 0.110 pmol/mL, P=.04). However, the median insulin-like growth factor-I concentrations among North African and Belgian newborn infants were, respectively, 74.0 and 69.6 ng/mL (P=.45). Nationality remained significantly associated with C-peptide after adjusting for age and parity. C-peptide, insulin-like growth factor-I correlated positively with birth weight and remained significant factors for birth weight after adjusting for confounders in multiple regression. CONCLUSION: These results suggest a link between higher C-peptide levels and birth weights among North African neonates in Belgium.

Adult↗

PubMedDate not supplied

[Analysis of data routinely collected in the maternity ward of Rutshuru in the Democratic Republic of the Congo between 1980 and 1998. I. Maternal mortality and obstetrical interventions].

UNLABELLED: This report is the first of 2 papers that analyse data routinely collected in the maternity ward of Rutshuru (democratic Republic of Congo). The present work describes the evolution of caesarean section, maternal deaths and the associated risk factors. MATERIAL AND METHODOLOGY: Between 1980 and 1998, data on 13,042 deliveries were collected. Characteristics, mortality, morbidity of mothers and new-borns and obstetrical interventions were recorded. The statistical analyses applied included khi2, t-test, simple linear and multiple logistic regression. RESULTS: Fifteen percent had a caesarean section and 1.9% of women died. When referred to the expected births during the period, these numbers led to a ratio of 150 maternal deaths for 100,000 expected births and a ratio of caesarean section of 1.2%. At admission, 35% of the women presented at least one of the four risk factors used for reference. The proportion of women with at least one of the 4 risk factors went up from 26.1% to 39.5%. The proportion of caesarean sections went up from 1.9% to 34.1%. The proportion of maternal deaths remained constant except in 1988, 1994, 1995 and 1997. Three of the four reference factors, the Baudeloque diameter, parity and height were associated with caesarean section. Age only was associated with maternal death. Education and marital status were both associated with caesarean section and maternal death. CONCLUSION: This analysis shows high levels of maternal mortality and caesarean section. The authors recommend to analyse on a larger scale the value of the reference factors used in antenatal services and to standardise indications for the different obstetrical interventions.

Adolescent↗

PubMedDate not supplied

[Analysis of data routinely collected in the maternity ward of Rutshuru in the Democratic Republic of the Congo between 1980 and 1998. II. New-born deaths and low birth weights].

UNLABELLED: This second paper aims at deriving useful information allowing to improve the strategy applied for maternal health care. MATERIAL AND METHODOLOGY: Between 1980 and 1998, data on 13,042 deliveries were collected. Characteristics, mortality, morbidity of mothers and new-born and obstetrical interventions were recorded. The present work describes the evolution of low birth weight (LBW), new-born deaths, and associated risk factors. The statistical analyses applied included khi2, t-test, and multiple logistic regression. RESULTS: Eighteen percent of new-born weights below 2.5 kg and 7.9% died. The proportion of low birth weights remains globally constant. Low proportions of new-born deaths were observed in 1981, 1982, 1988 and 1998. At admission, 35% of the women presented at least one of the four risks defined by the factors used for reference; this proportion went up from 26.1 to 39.2%. The four reference factors were associated with low birth weight. Baudelocque diameter and age were not associated with new-born death. Education and BMI were associated with an increased risk of new-born death. Marital status was not associated with any of the two outcomes. CONCLUSION: This analysis shows small variation of LBWs and perinatal deaths. It confirms the association between these two outcomes and most of the risk factors studied. The efficacy of the strategies implemented for improving perinatal health is questioned. The authors recommend that they be reassessed.

Adolescent↗