Un parcours de soins spécifique pour la dénutrition

Malnutrition has been considered as a hospital illness for nearly forty years. Despite this fact, we know this malnutrition finds its roots earlier within the community. Therefore, considering the evolutionary history of this pathology even an early hospital screening proves to be overdue. Nutritional condition often deteriorates during hospitalization and, with most favorable treatment conditions, increasingly short lengths of stay rarely allow for a complete correction. Coordination with home care network becomes essential to maintain nutritional treatment that was initiated in hospital. Since 2012, French health authorities proposes different care pathways involving patients as well as doctors, paramedical and medico-social practitioners in malnutrition prevention, early detection and home medical care. It is now essential to consider that malnutrition, like any chronic disease, asks for a specific care pathway, whatever the age of the patient.     

Recommandations pour la prévention et la prise en charge des tuberculoses chez les patients traités par infliximab

An unusually large number of cases of tuberculosis, often with miliary or dissemination, has been reported in patients taking infliximab for rheumatoid arthritis or Crohn’s disease. Recommendations have been issued in France regarding the definition of high-risk patients, the screening methods to be used in these patients, and possible prophylactic treatments. The present update is also intended to help physicians manage tuberculosis occurring before or during infliximab therapy.     

Les soins primaires : une définition du champ pour développer la recherche

Background

Research in the field of primary care has dramatically increased in France in recent years, especially since 2013 with the introduction of primary care as a thematic priority for research proposals launched by the Ministry of Health (Direction générale de l’offre de soins).

Pratique des combinaisons d'antipaludiques pour le traitement et la prévention du paludisme

Combinations of various drugs are used for the prevention or treatment of malaria (most frequently Plasmodium falciparum), to improve the efficacy of monotherapy. These regimens are prescribed for treatment and prevention and to reduce the risk of resistance. About 30 combinations have been evaluated. Some are abandoned, others are restricted to specific situations, or still under investigation, some are used. The most common treatment combinations are: quinine and tetracycline (in case of low quinine effectiveness); sulfadoxine and pyrimethamine (Fansidar^®) in areas of chloroquinoresistance where this combination is still efficient; proguanil and atovaquone (Malarone^®), artemether and lumefantrine or coartemether (Coartem^®, Riamet^®) for multiresistant malaria strains (in July 2001, co-artemether did not receive official approval in France); mefloquine-artesunate in Southeast Asia to improve the immediate efficiency of artesunate. The most recent combinations are expensive, restraining their large use in endemic countries. Primaquine is used as an additional treatment for the prevention of relapse for P. vivax. Since sulfadoxine-pyrimethamine is no longer used for chemoprophylaxis, the only combination prescribed, in areas of moderate resistance to chloroquine, is chloroquine-proguanil. Atovaquone-proguanil would be efficient in all cases of resistance but, for the sake of ecology, it will hopefully be used only for malaria treatment. When coming back from an endemic zone, primaquine is sometimes prescribed to eradicate the hepatic stage of P. vivax.     

Dénutrition de la personne âgée : de la sarcopénie à la cachexie

Because of metabolic changes due to ageing, malnutrition is accompanied by a preferential loss of fat free mass in the elderly and it exaggerates the physiological loss of body cell mass, muscle mass and muscle function observed in the aged. Exercise training has positive anabolic effects even in the frail elderly and may improve the effect of renutrition in malnourished elderly patients.     

L''information sur les risques pour la santé en prison: Evaluation d''un dépliant

Résumé Un document éducatif, illustré et en couleur, a été élaboré pour les détenus des prisons suisses. Ce dépliant «Hygiène et santé en détention» concerne les maladies transmissibles en général, et le SIDA en particulier; il devrait remplacer de simples feuilles A4 dactylographiées et peu leus. L'évaluation du dépliant a eu lieu dans une prison suisse sur la base de questions posées aux détenus lors d'une entrevue. Les réponses des détenus ayant reçu le l'ancienne feuille ont été comparées à celles des détenus ayant reçu dépliant. L'évaluation concernant la présentation des informations est positive. Le dépliant est plus attractif que la feuille A4 grâce à une présentation illustrée et en couleur. Le dépliant plaît plus que la feuille A4 (chi-carré=6.52, p=0.01). Les détenus se souviennent mieux d'avoir reçu le dépliant que de la feuille A4 (chi-carré=10.02, p=0.001). Ils sont plus nombreux à lire le dépliant que l'ancienne feuille (chi-carré=4.22, p=0.04). L'évaluation concernant les principaux messages préventifs n'est que partiellement positive. Ceux qui lisent les messages ne les retiennent ni mieux, ni moins bien avec le dépliant.Summary An illustrated full colour brochure has been elaborated for Swiss prisoners. This brochure, named Hygiene and Health in detention, concerns transmissible diseases in general and AIDS in particular. It is meant to replace typed A4 sheets which were not generally read. The evaluation of the brochure took place in a Swiss prison on the basis of 22 questions put to inmates during interviews. Answers of inmates having received the old sheet were compared with answers of inmates who received the new brochure. The evaluation concerning the informations' presentation is positive. The brochure is more attractive than the A4 sheet thanks to its illustrated and coloured presentation (chi-square=6.52, p=0.01). Prisoners remember having received the brochure more than the old sheet (chi-square=10.02, p=0.001). More prisoners have read the folder than the A4 sheet (chi-square=4.22, p=0.04). The evaluation concerning the principal preventive messages is only partially positive. Inmates do not appear to have assimilated the medical information any better than from the old A4 sheet.

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Zusammenfassung Ein informativer Faltprospekt, illustriert und farbig, wurde für die Insassen schweizerischer Gefängnisse hergestellt. Der Faltprospekt Hygiène et santé en détention betrifft allgemein übertragbare Krankheiten und AIDS im besonderen. Er soll die wenig gelesenen, maschinengeschriebenen A4-Blätter, die üblicherweise beim Eintritt ins Gefängnis abgegeben werden, ersetzen. Die Evaluation des Faltprospektes wurde auf der Basis von Gesprächen in einem schweizerischen Gefängnis durchgeführt. Die Antworten der Häftlinge, welche die A4-Blätter erhalten hatten, wurden mit den Antworten derjenigen verglichen, welche den neuen Faltprospekt erhalten haben. Die Evaluation bezüglich der Darstellung der Informationen ist positiv. Der Faltprospekt ist, dank der farbigen Abbildungen, attraktiver als die A4-Blätter. Er gefällt besser als die A4-Blätter (chi-square=6.52, p=0.01). Die Häftlinge erinnern sich besser daran, den Faltprospekt erhalten zu haben als bei den A4-Blättern (chi-square=10.02, p=0.001). Sie geben häufiger an, den Faltprospekt gelesen zu haben als die Empfänger der A4-Blätter (chi-square=4.22, p=0.04). Die Evaluation der hauptsächlichen Präventions-Informationen ist nur teilweise positiv ausgefallen. Wenn die Informationen gelesen wurden erinnerten sich die Häftlinge weder besser noch schlechter als bei den A4-Blättern.