Nutrition et infertilité masculine : revue de la littérature

Infertility affects about 15% of couples. Many foctors relating to lifestyle and environment (drugs, alcohol, tobacco, pollution, exposure to heat, diet and sport…) are likely to influence fertility. As an adapted nutrition could prevent 30% of cancers, diet could be essential, but largely neglected, in the prevention of infertility. Some studies tried to explore the impact of diet on testis function and on semen quality, unfortunately rarely informative. Similarly, supplementation with vitamins or micronutrients, prescribed in order to improve sperm parameters, have rarely been validated by double-blind, randomized, placebo controlled studies. The aim of this review is to assess the role of nutrition in spermatogenesis and sperm maturation.     

Contribution de la biologie moléculaire et de l’antigénémie galactomannane aspergillaire au diagnostic de l’histoplasmose

We report a case of a pulmonary histoplasmosis in an HIV-positive patient usually living in Cambodia, with a positive Aspergillus galactomannan antigenemia resulting from a cross-reaction, that decreased after antifungal therapy. We discuss the potential interest of the detection of fungal DNA by PCR and Aspergillus galactomannan antigenemia for the diagnosis of histoplasmosis, especially in countries where Histoplasma capsulatum antigen testing is not available.     

Pratiques de la transfusion massive en Tunisie et proposition de protocole

Introduction: Massive transfusion (MT) is a life-saving therapy in situations of major hemorrhage awaiting radical haemostatic treatment. Poor management and control of this therapy may, however, compromise the patient’s vital prognosis. The main aim of our study was to take stock of massive transfusion practices in Tunisia. The secondary aim was to propose a massive transfusion protocol. Methods: An analytical observational study based on a questionnaire was conducted. We targeted physicians brought in their clinical practice to use MT. Results: A total of 124 clinicians responded to the questionnaire. The majority (62%) were anesthesiologists or emergency physicians. More than half of the participants were residents (51%). The use of MT based on a clinical or biological score was only found for a minority (13%). The initial order was for the majority of participants (N=69) made up of red blood cell concentrates (RBC) and fresh frozen plasma (FFP). The FFP: RBC ratio was1:2 for 51% of the participants. A higher ratio was adopted by the rest. Respectively 23.5% and 9.6% of participants transfused platelets and fibrinogen concentrates without waiting for the result of biology. The use of tranexamic acid was systematically advocated by 60.5% of clinicians. The majority (86.3%) adopted a restrictive transfusion strategy (target hemoglobin between 7 and 9 g/dl). The latter was more adopted by the youngest physicians (92.1% of residents versus 55.6% of professors; p=0.008). Conclusions: The professional practices of MT in Tunisia are heterogeneous. Given the lack of a clear institutionalized procedure which frames this therapy, a MT protocol has thus been proposed.     

Emergence et devenir du systeme de prise en charge de la tuberculose en France entre 1900 et 1940

In industrialised countries the treatment of tuberculosis was one of the first public health services to appear at the beginning of the 20th century. This initiative represented a departure from the usual measures set up by public health specialists for improving living and environmental conditions, as new knowledge about the process of infection meant that action could be taken on the population directly. The processes which served to stratify and differentiate living standards characteristic of this period of industrialisation are reflected in the epidemiology of tuberculosis: the hierarchy of mortality rates runs parallel to that of the social groups.Many authors now question the role of the health service in the regression of infectious diseases, which they attribute more to changes in lifestyle. This text attempts to analyse the context and the objectives which surrounded the establishment of the service to combat tuberculosis in France, with reference to the various theories which seek to explain the emergence of social services in health or in education. Hence three theses are examined with reference to the actual history of the tuberculosis service. In this service an instrument of the ruling class, owners of the means of production, who thereby assure the reproduction of the workforce at a time when industrialisation demands an increase in the workforce, and when additional reserves of manual labour are being exhausted?Was the use of techniques arising out of new knowledge accompanied by an extension of the power of doctors into areas which had hitherto been outside their field of intervention? Did medical activity lead to new norms being introduced into everyday life in the name of scientific values?An interpretation in terms of social control is put forward to explain both the public health movement, compulsory education and urbanisation. Is this helpful in understanding how the organisation of the struggle against tuberculosis came about?This research is based on the systematic analysis of documents and journals on tuberculosis published in France during the period under study. Support is found for elements of all the theses examined without any one being able to account for all aspects of the establishment of this service. The service represents the meeting point of a number of different forces: economic forces; political forces, as witnessed in the debate between the social and technical approach before the first World War; and professional forces, given the transformation of medical practice with the introduction of public health services and national insurance.     

Consommation d’huiles et matières grasses en France : relations avec le niveau d’étude et la région de résidence dans la cohorte SU.VI.MAX

The relationships between intake of added oils and fats with region of residence and educational level were also assessed. Our objective was to describe the relative contribution of ten created food groups to total fat intake in middle-aged subjects.Subjects were participants of the SU.VI.MAX study who completed at least six 24-h dietary records after inclusion into the study (n=6572).Added oils and fats were the main source of total fat intake. Animal fat (AF) and margarine intakes showed a significant inverse association with educational level, whereas oils with mono-unsaturated fatty acids (MUFA) were positively associated with education level. AF intake was significantly higher in the Western and Northern parts of France (54.2 and 50.4%) and lower in the Mediterranean Coast (39.0%). A significant inverse gradient was found with oils with poly-unsaturated fatty acids (PUFA) or MUFA in the Southwest and the Mediterranean Coast compared to the Northern part of France.We showed a north to south gradient for animal fat intake and the opposite for oils with MUFA and PUFA in France This gradient parallels the known disparities for cardiovascular mortality in this country. This should contribute to adapt dietary guidelines for dietary change in a public-health perspective.     

Évaluation et prise en charge des troubles de la déglutition

Swallowing is a complex phenomenon, allowing per os feeding but with a protection of respiratory tract. Swallowing disorders are frequent, involve liquids, solids or theses two textures, and are mainly caused by neurological or otorhinolaryngological diseases. They may have severe consequences, like an alteration of quality of life for patients or their relatives, an increased risk of aspiration, of malnutrition or dehydration, and finally a possible decrease of survival. Assessment includes careful questioning and physical examination. The reference complementary investigation is videofluoroscopic evaluation. Nutritional assessment is mandatory. Taking care of swallowing disorders in a multidisciplinary manner is recommended, with interventions of physician, speech therapist, dietician, sometimes dentist or surgeon, and needs a strong contribution of the paramedical staff and the patient relatives. Enteral nutrition is recommended when repeated or severe respiratory complications occur, when the nutritional status is altered in spite of feeding enrichment, modulations of textures or use of oral nutritional supplements, or when the meals are too long.     

L’hygiène hospitalière et les étudiants en médecine

Objective

Training in hospital hygiene is essential to prevent nosocomial infections and to promote health care quality. A survey was made on Caen medical students for hand hygiene habits, personal medical equipment, and white coat cleaning as well as on their opinion concerning hospital hygiene training quality.

Design

An anonymous questionnaire was submitted to medical students in third, fourth, and fifth year of medical studies.

Results

Hygiene was “always” or “often” a priority (94%) when students were working in clinical areas. Nevertheless, nearly half of them (46%) were not aware of the difference between simple hand washing and antiseptic hand washing. The white coat was too large for 50% of students. The white coat was cleaned on average every 3.5 weeks. Only 40% students cleaned their stethoscope regularly and 23% their reflex hammer. At last, 66.5% of students were dissatisfied by hospital hygiene training judged insufficient and unfit for their practice.

Conclusion

the medical students’ general knowledge of hospital hygiene must be improved. Further initial training should improve practices.     

Barreras para la normalización de la telemedicina en un sistema de salud basado en la concertación de servicios

Objective

Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers’ contracts.

Methods

We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations.

Results

The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability.

Conclusions

In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers’ contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer.     

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.     

Modalités de l’offre alimentaire (hors restauration scolaire) dans les collèges et lycées d’aquitaine: Évolution entre 2004 et 2005 en application de la loi de santé publique du 9 août 2004

Within the framework of the French National Programme on Nutrition and Health, a survey was conducted in middle and high schools of the French Aquitaine region with the aim of describing the food supply within middle and high schools in 2004-2005, before and after the application of regulation of snack machins in September 2005 of the recent French law of public health.The results show that:

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20 % of schools offered free snacks, specially bread (67 %) and fruit (39,3 %).

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63 % of the answering schools had food or drink sales, concerning pastries (74,6 %), chocolate bars (30 %) and soft drinks (25,4 %).

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In 2004-2005, 44 % of the high schools had snack machins. In Septembre 2005, each school (99 %) had removed on snack machines.

These results highlight the importance of the actions implemented in the programme of “Nutrition, prevention and health of children and teenagers in Aquitaine”, especially actions focussing on food supply within schools.     

Prévention et prise en charge de la dénutrition dans les EHPAD

In order to identify best practices for undernutrition prevention and management in the 597 institutions for the dependent elderly in Pays de la Loire, two questionnaires were sent in early 2009. Three-quarters had a nutritional axis in their care project, 25% worked with a Diet and Nutrition Liaison Committee (CLAN), and 67% with dieticians; 70% had less than 25% of their staff recently trained to food-nutrition for the elderly. Two thirds were conducting detection of malnutrition at admission and during follow-up. There was enough time for meals in 60% cases, and 48% had all their residents who underwent a long overnight fast. Among beneficial environmental factors identified, the nutritional axis in the care project seemed to be a major determinant of food-nutrition practices. In conclusion, these results show the real structures involvement in this field in the region, but some practices must be further improved. Nutritional policies seem to be a major way to achieve.     

Prévalence et conséquences de la dénutrition dans l'insuffisance respiratoire chronique

From large series of patients with COPD, the prevalence of malnutrition can be estimated at 25% taking a cut-off value for Body Mass Index (BMI) less than 20 kg/m², and 35% for a body weight less than 90% of the ideal body weight. Data are very scarce for the other causes of respiratory failure. Malnutrition is a feature of emphysema. There is a well established correlation between height related body weight and FEV1, and TCO: it is not possible to assert that malnutrition is lither a cause or a consequence of the altered respiratory function. Nutritional status is a predictor for the capacity of exercise, independently of the alteration of respiratory function. There is probably a link between malnutrition and the performance of respiratory muscles. The prognostic influence of malnutrition in chronic respiratory failure is well established, with the best survival rates for overweight patients.     

Medida de la importancia de las dimensiones de la satisfacción en la provisión de servicios de salud

Objective

Identifying users’ perceptions of the quality of care is essential to improve health services delivery. The main objective of this article was to describe the application of a methodology to identify factors that facilitate the identification of areas for improvement.

Method

A questionnaire was applied in three health areas in Catalonia (Spain) (primary care [n = 332], outpatient specialty care [n = 410] and hospital emergency care [n = 413]) to measure user satisfaction and assess the importance given to the aspects analyzed.

Results

The main areas for improvement in primary care identified by an importance-performance analysis involved the time devoted to patients as well as health professionals’ willingness to listen to their views. In hospital emergency care, the main area of improvement was related to the hospital's physical conditions.

Conclusions

The tools designed and implemented by the Catalan Health Service (Spain) have proved to be valid for the detection of priority areas to improve service delivery and promote regional equity.