Défaut de couverture vaccinale pneumococcique chez l’adulte à risque

Objective

This study had for aim to assess pneumococcal vaccination rates in hospitalized patients.

Design

A prospective study was carried out in two medical wards of the Nice University Hospital, France. Patients were included from December 31, 2007 to February 12, 2008.

Results

Hundred and thirty-seven patients, aged 62 ± 20 years, were included. Pneumococcal vaccination was indicated for 62 patients (45 %). Among these 62 patients, 53 (85 %) had not been vaccinated in the previous 5 years, for the following reasons: no medical advice on vaccination (36 cases), no medical consultation in the past years (nine cases), patient opposed to vaccination (two cases), physician opposed to vaccination (one case), miscellaneous (five cases). Among the 53 patients, seven were vaccinated during their hospital stay and 13 were advised to be vaccinated by their general practitioner.

Conclusions

This study highlights a low rate of pneumococcal vaccination in hospitalized patients, mainly due to insufficient counseling from physicians, both in community or in hospital practice.     

Statut vaccinal des médecins généralistes dans le département de la Loire,France

Objectives

We surveyed the vaccination status of family physicians (FP) in the Loire district (France) in 2010.

Subjects and methods

A self-administered questionnaire was proposed to a panel of 460 FP; 288 (64%) answered.

Results

The vaccination coverage for Diphtheria-Tetanus-Polio in the previous 10 years, BCG, pertussis, seasonal influenza, A/H1N1 2009 influenza, and hepatitis B was 81, 74, 59, 73, 65, and 87% respectively. Sixty-four percent of FP reported they were vaccinated against measles and 49% against chicken pox; 76% were aware of vaccination recommendations for healthcare professionals but 41% wanted more information on the subject. The younger physicians were better vaccinated for Diphtheria-Tetanus-Polio, measles, hepatitis B, and influenza according to a multivariate analysis.

Conclusions

The vaccinations of FP (knowledge, practice) must be improved, especially by yearly updates, continuous medical education, and medical follow-up of healthcare professionals.     

Tétanos néonatal et de la femme en âge de procréer à la clinique des maladies infectieuses de Dakar

Objectives

This study had for aim to describe and compare the epidemiological, clinical and outcome features of tetanus in neonates (NT) and women of child bearing age (WCBAT) in Dakar.

Patients and method

This retrospective study was made on NT (3 to 28 days of age) and WCBAT (15 to 49 years of age) patient files, admitted in the Fann University Hospital Infectious Diseases Clinic from 2000 to 2007.

Results

One hundred and thirty-eight WCBAT (11.9%) and 103 NT (8.9%), for a total of 1156 cases of tetanus were admitted. A decrease of the annual rate of these populations was noted over this 8 year period.The majority (59.4%) of WCBAT was between 15 and 25 years of age and the mean age of NT was 9.3 days. Most of the patients in both groups came from suburban areas (78%). The tetanus immunization status was not updated for 92% of WCBAT. The most frequent portals of entry were cutaneous wounds for WCBAT (77.4%) and umbilical stumps for NT (85.4%). On admission, 64% of NT presented with severe tetanus (stage III on the Mollaret scale) compared to 11.6% for WCBAT. The death rate was significantly higher in NT (48.5%) than in WCBAT (26.8%); p = 0.0005.

Conclusion

To eliminate neonatal tetanus, the prognosis of which is worse in Dakar, an intensification of the large vaccination program is needed with supplementary vaccination campaigns including women of child bearing age in areas of risk.     

Alimentation, activité physique et surpoids chez des enfants de l’est Algérien

The prevalence of overweight and obesity were measured in a sample of 251 children aged 8 to 12 year in an urban area of the Eastern part of Algeria. IOTF references are used in order to define overweight and obesity.The overall prevalence of overweight and obesity is 21.5 %. 15.9 %. Overweight alone is found in 15.9% and obesity in 5,6 % of the children. Obese children consume less often a breakfast and less milk than that normal weight children and eat more often high fat, high carbohydrates foods. Mean caloric intakes are similar. Meals and snacking take often place while watching television. Energy percent derived from proteins but not their absolute amount and fat intakes are higher in overweight children. Most of the overweight children (78 %) do not practice any sport activity. Fat intake adjusted on energy intake is positively correlated with sport duration.This preliminary study suggest that childhood obesity is now a public health threat in Algeria.     

Mesure de l’efficacité et de l’observance du traitement antirétroviral chez des patients infectés par le VIH au Cameroun

Objective

The aim of the study was to identify the most useful clinical criteria to measure effectiveness and adherence to antiretroviral treatment in a rural area of Cameroon.

Patients and method

All patients under antiretroviral therapy followed for at least 3 months at the Tokombéré UPEC hospital were eligible. Therapeutic failure was defined according to clinical criteria including weight, Karnofsky's index, or occurrence of WHO stage IV conditions. The criteria for drug adherence were based on patient statement (drugs taken over the last 4 days) and pharmacy-controlled drug delivery. Patient sociodemographic characteristics were collected via a questionnaire.

Results

Fifty-six patients were included, most of whom were at AIDS stage on treatment initiation. The mean duration of antiretroviral therapy was 1 year. 21, 10, and 19% of patients were in therapeutic failure according to “weight”, “Karnofsky's index”, and “WHO stage IV”, respectively. Non-adherence was reported in 5% of patients according to the declarative method and 20% according to pharmacy controlled drug delivery. Weight modification during treatment was significantly correlated with the evolution of Karnofsky's index (p = 0.03). A significant correlation between therapeutic failure and non-observance was only found when using the weight criterion and the declarative method (p = 0.004).

Conclusion

The effectiveness and adherence to antiretroviral therapy can be evaluated by simple clinical criteria. Using these criteria can be recommended in rural areas until access to biological follow-up becomes available in developing countries.     

Développement d’actions de prévention du VIH,des hépatites et des infections sexuellement transmissibles chez les immigrants consultant dans les missions France de Médecins du monde

The mission France of Doctors of the World has for objective to facilitate the access to care and to rights in the common law system for vulnerable populations and to bring testimonies out. The objective of the project is to ensure daily actions of prevention: to bring people to screen for HIV and hepatitis as well as obtaining full access to treatment for populations consulting in the Reception centers for Care and Orientation (RCCO). The screening is proposed systematically to all new patients (90% of them are immigrants) after a medical consultation or a special prevention consultation. The prevalence of HIV, hepatitis B and C was respectively 15, 10,5, and 7 times higher than the national average among patients screened in 2007, The centers of Doctors of the World are privileged places to inform, prevent, offer screening, and bring healthcare to this population particularly exposed to risks.     

Comparaison coût/bénéfice de la campagne vaccinale et de la réduction de l’absentéisme,après vaccination contre la grippe du personnel du CHU de Clermont-Ferrand

Objective

The aim of this study was to compare the cost of vaccination for the Clermont-Ferrand University hospital (CHU) personnel and the cost of sick leave among vaccinated and non-vaccinated employees in 2003, 2004, and 2005.

Design

The study included 7256 CHU staff (medical and non-medical personnel). The cost of sick leave was calculated on the basis of short-term disease (four to nine days) over the three months of the epidemic season in 2004, 2005, and 2006.

Results

In 2005, the overall cost of vaccination was 4.02 € per vaccinated employee. Over the three years, the total sick leave reached 804 days for employees vaccinated against 5670 for non-vaccinated employees. In 2003, 2004, and 2005, the vaccinal coverage was 13, 20.5, and 30.1%, the mean duration of sick leave was 0.16, 0.17, and 0.18 day among vaccinated staff, and 0.26, 0.39, and 0.34 day among non-vaccinated staff corresponding to a benefit per vaccinated employee of 5, 26, and 20 €, respectively for each year. The total benefit for the institution was 86,458 € (4630 + 38,168 + 43,660). If the vaccinated rate of 75% recommended by the Haute Autorité de santé (HAS) had been reached, the additional benefit would have been 250,193 € (33,157 + 152,256 + 65,180).

Conclusions

The number of sick leave days and the related cost were approximately twice less important for vaccinated employees, economically justifying this vaccination including a period of weak epidemic, as checked over three consecutive years.     

Mesures objectives de l’environnement bâti et statut pondéral des enfants et adolescents : revue de la littérature

In the framework of the study of the Environmental links to physical activity, nutrition and health (ELIANE), we performed a systematic review of the associations between objective spatial measurements of the built environment and weight status in youth. Of the 25 identified papers, 18 reported at least one significant relationship, although only almost one-third of the associations tested were significant. Inverse relationships of weight with different walkability indices were the most consistent (7/9 papers). Weight was also positively related to spatial accessibility to convenience stores (3/6 papers), and inversely to the accessibility to recreational physical activity facilities (4/9 papers). Relationships with parks, other food retail outlets and restaurants were inconsistent. Reasons for such discrepant results are discussed. Better-built environment measures are needed. The challenge lies also in better understanding the complex pathways through which the built environment, the socioeconomic context, and the perception of their environment by the subjects impact childhood behaviors and weight status.     

Lieu de contrôle chez les obèses : traduction et première étude de validation de l’échelle du lieu de contrôle du poids de saltzer

The objectives of this study are to enable the use of the concept of locus of control in the treatment of obese subjects and to verify if the presence of an alimentary disorder influences the belief in the weight’s control. The translation and validation in French is also part of the objective. We translated into French Saltzer’s specific scale of Weight Locus of Control (WLOC: weight locus of control) and then examined it’s validity. Then we compared it on general scales of the place of control (IPC of Levenson and SOC-3 of Paulhus). The subjects were both classified according to the presence of eating disorders (ED). A sample of 46 obese women (IMC>30) was tested, 20 of them without ED, and 26 with, associated to the presence ED, according to the criteria of the DSM-IV.The internal validity of WLOC is rather satisfactory. It correlates negatively with internality (IPC), personal control and interpersonal control (SOC-3). ED at the obese subjects are related on the externality of weight control and the externality of personal control. Obese subjects without ED believe more in weight control by themselves and personal control that the obese subjects with ED (Eating Disorders). Finally the scale of weight locus of control (WLOC) remains the most adapted in the treatment and the study of the obese subject.     

Maladie cœliaque de l’adulte : actualités du régime sans gluten

Adult celiac disease (ACD) is an autoimmune enteropathy induced by the ingestion of gluten in genetically predisposed individuals. Its classical lesion is total or subtotal villous atrophy in at least the proximal small bowel, responding to the dietary exclusion of prolamins, the alcohol-soluble fractions of four cereals reputed to be toxic: gliadins of wheat gluten, secalins of rye, hordenins of barley, and - probably to a lesser extent - avenins of oats.Gluten-free diet (GFD) is based on the exclusion of any food containing one or another of these four toxic cereals, and their possible replacement by others such as rice and maize. That oats is well-tolerated by adult celiacs is presently strongly suggested, but its long-term (more than 5 years) harmlessness remains to be proved. GFD is a constraining diet for patients and - in terms of follow-up - for dieticians and physicians. Indeed, wheat gluten is present in a huge number of food-stuffs, products and culinary preparations (basic food as bread ans pastes, as well as cooked dishes, sweets, starchy food, icecreams, chocolate, some beers and appetizers. ACD patients have to know how to read product stickers to detect gluten even in trace amounts. Strict adherence to a GFD is difficult, particularly due to the subsequent decreased conviviality and high cost of replacement products. Prognosis of ACD under a strict and supervized GFD is excellent: the clinical response preceeds the biological and pathological ones. In adult celiacs clinically non-responding after a 3 month-diet period, poor adherence must be at first looked for. Primary or secondary true resistance to a GFD (refractory sprue: non-response to a 6-12 month strict and regularly supervized GFD) occurs in 5 to 8% of cases. Pseudo-refractory sprue is due to diet transgressions, more often unacknowledged than unvoluntary, but can result in true refractory sprue and its complications including lymphoma and death related or not to lymphoma. In adult celiacs, an at least 5 year-long strict GFD significantly decreases the risk of malignancy, especially T-cell lymphoma, and death. In the next future, the discovery of the toxic peptidic sequence of gliadin remains an interesting issue of potential importance for manufacturing strictly atoxic food-stuffs. Otherwise, the recent experimental observation that a bacterial prolyl endopeptidase causes degradation and loss of the antigenicity of a 33-aminoacid immunodominant peptide of α2-gliadin might ultimately find therapeutic relevance.     

Éducation et prévention de l’obésité de l’enfant. bilan des études en population

The prevalences of overweight and obesity are increasing in France as well as in many countries around the world. Results of randomised controlled primary prevention studies in schools are summarized. They show the feasibility of improving school meals and energy expenditure during PE classes. However, the effect on overweight and obesity prevention are often modest. It is clear that the out-of-school life can totally compensate the effect of an intervention at school. Studies that have been able to modify the children's sedentary and active behaviours out of school have shown the most promising results. The National Nutrition and Health Plan in France comprises a set of actions targeting the whole population, from young children to the elderly, for several years. In that context, we may hope that the different actions undertaken in France including those at school will end with more favourable results.     

Ascite riche en protides survenant deux mois après un accouchement par césarienne : diagnostic par association du dosage de l’adénosine-désaminase et de l’imagerie

We report the case of a 38-year-old woman, born and raised in Congo, in France for 7 years, who developed ascitis 2 months after delivery by C-section. Thrombopenia at 95,000 elements per millimeter cube was diagnosed during her pregnancy and her obstetrician initiated a treatment with corticosteroids. Analysis of the ascitic fluid showed a high concentration of proteins (55.7 g/l), with 2000 elements, 80% of which were lymphocytes, and very high levels of adenosine deaminase. Thoracoabdominal tomodensitometry revealed ascitis, a multinodular spleen, and hyperemia of the peritoneum; but the liver and the lungs were normal and no adenoma was identified. Laparoscopy was not performed and the suspected diagnosis of peritoneal tuberculosis was confirmed by only one culture of ascitic fluid.     

De quelques maux de la prévention contemporaine. Le cas de l’obésité et du surpoids

Overweight and obesity are considered major public health issues, and many preventive campaigns are designed to prevent unhealthy eating habits among the French. But these campaigns may be ineffective, and even sometimes counterproductive. Firstly, because prevention is a moral enterprise that can lead to stigmatizing targeted people. Secondly, because the ‘merchandization’ of prevention fuels a ‘dietary cacophony’. Thirdly, the medicalisation of overweight/obesity involves some shortcomings: it can prevent us from understanding eating habits, and many general physicians are insufficiently trained to take care of overweight or obese patients.