Les formes atypiques de la maladie des griffes du chat. Revue de la littérature

The bacteria involved in cat-scratch disease is identified now: Bartonella Henselae. The vector responsible in the transmission of the disease is the flea and the contamination is done by a scratch or a bite of an asymptomatic cat or by the sting of an infected flea.It is important to think about it, in front of atypical manifestations in adult: neurologic, ocular, cardiovascular, hepatosplenic, cutaneous, bony or even a prolonged fever to limit the useless paramedical investigations and to reduce the use of coasty treatments.To the clinical criteria for diagnose cat scratch disease and to the histopathology of the lymphadenitis, we have to give a value for serology by indirect immunofluorescent test or by enzymatic immuno-assay to detect IgG and IgM and the polymerase chain reaction performed on biopsy of lymphadenitis or cardiac valves.Cure is obtained in 90% of cat disease cases, but antibiotherapy is mandatory in cardiac infections.     

Description du statut vaccinal de la population adulte française

Objective: The aim of the study was to describe the vaccinal status of adult French patients consulting general practitioners and to identify the reasons justifying the absence and/or the delay of a booster injection from both patient and physician’s point of view.Methodology: A cross sectional epidemiological study was made on the first 3 patients consulting for vaccination against diphtheria, tetanus, and poliomyelitis.Results: Six thousand and two hundred sixty nine patients, 44 ± 15 years of age, were included in the study by 2,122 general practitioners, a representative sample 90,5%, 94,4%, and 92,6% of their patients had been vaccinated against diphtheria, tetanus, and poliomyelitis but only 58,4%, 66,1%, and 63,4% had received the required booster injection. This means that 40% of the adult French population is not properly protected. This situation appears essentially linked to negligence rather than to reluctance: only 3,6% of the patients were really reluctant. The low coverage rate was greater among underprivileged classes and the elderly.Conclusion: These results show the limits of prevention campaigns and underline the necessity of a better involvement of occupational medicine and general practitioners.     

Chronicité de la consommation de médicaments psychotropes dans la main-d’œuvre canadienne : quelle est la contribution de la profession et des conditions de l’organisation du travail ?

BackgroundThis study aims to better understand the contributions of occupation and work organization conditions to the development of chronic psychotropic drugs use among workers in Canada.MethodsThe study is based on a secondary analysis of the longitudinal data of the National Population Health Survey (NPHS) of Statistics Canada which includes five cycles from 1994–1995 to 2002–2003. A panel of 6585 people from 15 to 55 years old and employed at cycle 1 and nested in 1413 neighbourhoods was selected. Multilevel models of regression were estimated on three levels: repeated measures (level 1 = 24,785 observations) were nested in the individuals (level 2 = 6585 individuals) and the individuals nested in the local communities (level 3 = 1413 neighborhoods).ResultsThe prevalence of multiple episodes (two episodes and more between cycle 1 and cycle 5) of psychotropic drugs use was 6.7% (95%CI=6.0–7.4%). Only occupation and the number of working hours showed a significant contribution. Family and individual variables like marital status and personality traits (locus of control and sense of coherence) had a significant contribution, in addition to time, gender, age, physical health, number of cigarettes and stressful childhood events.ConclusionWork contributes weakly to the risk of chronic psychotropic drugs use, whereas individual characteristics make a much more important contribution to the phenomenon.     

Cinco paradojas de la promoción de la salud

The World Health Organization states that health promotion is a key strategy to improve health, and it is conceived as a global process of enabling people to increase control over, and to improve, their health. Health promotion does not focus solely on empowering individuals dealing with their knowledge, attitudes and skills, but it also takes political, social, economic and environmental aspects influencing health and wellbeing into account. The complexity of applying these concepts is reflected in the five paradoxes in health promotion; these arise in between the rhetoric in health promotion and implementation. The detected paradoxes which are described herein involve the patient versus the person, the individual versus the group, disease professionals versus health professionals, disease indicators versus health indicators, and health as an expense versus health as an investment. Making these contradictions explicit can help determine why it is so complex to put the concepts related to health promotion into practice. It can also help to put forward aspects that need further work if health promotion is to put into practice.     

Investigation et gestion d’un foyer de saturnisme infantile dans un quartier de la commune du Port, Île de la Réunion

BackgroundA national survey conducted in 2008–2009 by the French Institute for Public Health Surveillance for detection of lead impact in childhood identified a high blood lead level in a young boy living in the town of “Le Port”, Reunion Island. Previously, cases of lead-poisoning on the island had been exceptional; only a dozen cases were reported in the 1980s in adults, related to the use of lead-containing instruments for food preparations.MethodsThe family of the index case was invited to participate in screening tests and an environmental investigation was conducted using a standardized questionnaire. Screening was then broadened to the neighborhood of the index case and samples of soil outside the home and in the immediate vicinity were taken. The environmental survey was then extended with soil samples taken from the entire geographical area. Information was then provided to local inhabitants (87 families and 287 people) in order to encourage lead blood testing for all children under six years and all pregnant women living in the area.ResultsThe index case lived in the neighborhood of “The Oasis”, a shantytown of Le Port. The results of soil analysis revealed heterogeneous pollution of superficial soils by lead throughout the area of the shantytown, the highest level recorded (5200 mg/kg) reached more than 300 times the background level of the natural soils of the island. The screening identified 76 cases of childhood lead-poisoning (blood lead level greater or equal to 100 μg/L) among 148 samples (51%). All cases of blood poisoning involved children under the age of 15 years. The median age of children with a positive test was 5.6 years; the median blood lead level was 196 μg/L [102–392 μg/L].ConclusionThe main hypothesis to explain the contamination of the soil in the area of the shantytown is the presence of waste deposits (car batteries) and diffuse activities of metal recovery. The authorities managed to remove all the families from the environmental exposure to lead by rapidly ensuring rehousing outside the contaminated area.