Santé et instabilité professionnelle : résultats issus des centres d’examens de santé de l’assurance-maladie

BackgroundJob insecurity has increased over the last 30 years. Socioeconomic changes have led to various insecure employment categories, including fixed term employment, part time employment and government sponsored jobs. This study was aimed at investigating relationships between employment status and health.MethodsThe study population was composed of 767 184 people, aged 26 to 59 years, examined between 2003 and 2005 in the Health Examination Centers of the French General Health Insurance. Employment status was defined using insecure employment (combining permanent/fixed-term contracts and part-time/full time), government sponsored jobs and duration of unemployment (from < 6 months to ≥ 3 years). Health indicators were poor perceived health, smoking, lack of gynecological follow-up, obesity, untreated caries and high blood pressure. Data were analysed by logistic regression (odds ratios [OR]) adjusted on age, occupational social class and education level, the reference category being permanent full time contracts (OR = 1).ResultsSignificant level-dependent relations with health were observed between non permanent versus permanent employments, part time versus full time. Most OR of unemployed people were higher than those of having employment and increased with duration of unemployment. For example, for poor perceived health in men, OR ranged between 1.00 and 1.68 (95%CI 1.57–1.78) according to job insecurity categories, and between 1.75 (95%CI 1.67–1.83) and 2.80 (95%CI 2.72–2.89) according to duration of unemployment. For obesity in women, OR increased from 1.00 to 1.48 (95%CI 1.37–1.60) in active women and from 1.35 (95%CI 1.27–1.44) to 1.77 (95%CI 1.70–1.84) in unemployed.ConclusionsThis study showed quantitative relationships between job insecurity, unemployment and health. In particular, workers having government-sponsored jobs and long-time unemployed people were at high risk of health problems.     

Existe-t-il des différences d’immunogénicité et de tolérance des vaccins en fonction du mode d’injection ?

Objective

A literature review was made to answer the following question: are there differences in immunogenicity and safety of vaccines according to the administration route (intramuscular or subcutaneous) and the length of needles used for injection?

Design

The search strategy included electronic searching (Medline database via PubMed) and cross-references. Articles were selected by reading abstracts, guided by the clinical question. A total of 18 articles were selected and analyzed; 13 answered the question.

Results

Nine articles compared the immunogenicity and/or the safety of a given vaccine administered via both intramuscular and subcutaneous routes. All the results showed that immunogenicity and systemic safety of the intramuscular route was at least as good as that of the subcutaneous route. Local tolerance was usually better via intramuscular route (lower risk of developing erythema or edema). Four articles compared the immunogenicity and the safety of vaccines administered with short (16 mm) and long (25 mm) needles in children. Long needles induced fewer local reactions, probably because they can reach more vascularized muscle, especially in overweight and obese patients.

Conclusions

Immunogenicity and safety results are in favor of intramuscular vaccination. The appropriate needle length must to be adapted according to the morphological aspects (subcutaneous tissue and muscle thickness).     

Activité in vitro en 1999/2000 de la levofloxacine vis-à-vis de streptococcus pneumoniae et des streptocoques isolés à l’hôpital et en pratique de ville en France

Objective: To assess the activity of levofloxacin against pneumococci and streptococci.Method: One thousand two hundred and fifty five strains of pneumococci (1015) and streptococci (240) was obtained from October 1999 to March 2000 in 46 participant centers: 35 hospital laboratories and 11 community laboratories. Susceptibilities were determined by the standard disc-diffusion test and MICs of beta-lactams (penicillin, amoxicillin, cefotaxime, cefpirome, cefpodoxime and cefuroxime) by Etest. MICs of levofloxacin were measured, for a sample of susceptible strains and for all strains that were resistant by disc-diffusion.Results: 41.3% and 31.1% of S. pneumoniae strains were susceptible, 34% and 57.4% intermediates, 24.7% and 11.5% were resistant to penicillin by Etest in hospital and in community laboratories, respectively. Percentages of susceptibilities to levofloxacin were of 98.2% (hospitals) and 100% (community), and of 41.2% (hospital) and 21.6% (community) to erythromycin. The highest percentage of non susceptible strains observed in the community was probably related to the fact that strains isolated in community mostly originated from children: 64.2% versus 26.5%.Susceptibility of Streptococcus pyogenes to penicillin remains constant, 100% of strains being susceptible. Macrolides still exhibit good activity against this species with 93.3% of susceptible strains to erythromycin. Percentage of susceptible strains of S. pyogenes was 97.8. Viridans group streptococci are less susceptible to antibiotics with 73.5% and 47% of strains being susceptible to penicillin and macrolides, respectively. 95.4% of strains were susceptible to levofloxacin.Conclusion: The results of this study show the good in vitro activity of levofloxacin against S. pneumoniae in hospital and in community.     

Connaissances,attitudes et pratiques des prestataires de soins de santé de face aux cas suspects d’Ebola en Guinée

Background

Developing a more resilient health system to Ebola Virus Disease (EVD) is a necessity in Guinea. This implies having information on the knowledge and practices that health staffs had during the preceding the EVD outbreak. The objective of this study was to compare the knowledge, attitudes and practices of routine healthcare providers on suspected EVD cases in the affected and non-affected districts in Guinea.

La vaccination anticoquelucheuse de l’adulte et des professionnels de santé est-elle connue et appliquée ?

The prevalence of pertussis in newborns led French health authorities to recommend using a booster dose at 13 years of age, and adding a booster dose for parents, siblings, and health care workers. OBJECTIVE: The aim of the study was to check if the new recommendations were applied by health care workers and if mothers still in the maternity ward were informed and agreed with these recommendations. METHOD: A questionnaire assessing knowledge, acceptance of the recommendations was sent to different health care workers and given to mothers in two maternity wards. RESULTS: Three hundred and seventy-five questionnaires filled out by health care workers were analyzed (298 general practitioners, 30 pediatricians, 24 obstetricians, 21 midwives) and 100 questionnaires by mothers. Only 1% of mothers and 55% of health care workers knew about the new recommendations, but only 8.3% of obstetricians and 4.8% of midwives. 92.6% of health care workers considered they were justified, but not applicable in 21.3%, 75% declared informing mothers systematically, and 14.5% documenting their pertussis vaccine status. The vaccination status was greater than 80% for diphtérie-tétanos-polio (dTP) in health care workers, 29.5% of these workers and 49% of mothers considered being vaccinated in a near future. CONCLUSION: Information, educational campaigns and specific actions are needed to apply the new recommendations which will warrant the success of targeted vaccination, in order to reduce pertussis in infants of more than six months of age.     

Qualité du codage des diagnostics et motifs de prise en charge (principal et associés) dans le recueil d’informations médicalisé en psychiatrie (RIM-P) en 2015 et 2016, France

BackgroundBased on the observation of the misuse of ICD-10 to code the diagnoses in the RIM-P (lack of completeness, conformity and diversity), the Technical Agency for information on Hospital Care (ATIH), which provides tools for collecting medical information, conducted two actions in 2016. First, a chapter devoted to the instructions of coding has been written in the methodological guide of production of the RIM-P, second, a variable “type psy” was added to the ICD-10 nomenclature's file framing ICD-10 coding in the RIM-P. The purpose of this study is to describe the quality of diagnosis coding using ICD-10 in the RIM-P in 2015 and 2016.MethodsThe quality of diagnosis coding using ICD-10 in the summaries of activity of the RIM-P national databases was described in 2015 and 2016. The study focused on the completeness, the conformity and the diversity of coding.ResultsBetween 2015 and 2016, the percentage of summaries without primary diagnosis (“DP”) decreased slightly for full-time (5.2% vs. 3.8%), part-time (6.3% vs. 4.9%) inpatient stays and outpatient care (9.9% vs. 8.9%). ICD-10 codes used to code DP or associated diagnosis (“DA”), while prohibited, mainly belong to Chapter V Mental and behavioral disorders. Per year, only one-third of the summaries and one-half of patients had two or more ICD-10 codes reported for inpatient stays (one-fifth of the summaries and one-fourth of the patients for outpatient care). In addition, per year and per facility, the average number of distinct ICD-10 codes used to fill “DP” or “DA” was approximately half as important in part-time hospitalization, as in full-time hospitalization or for outpatient care. Moreover, 90% of the health facilities used < 550 distinct ICD-10 codes in full-time inpatient stays, < 270 in part-time inpatient stays and < 950 for outpatient care to code the “DP” or the “DA”. The diversity of ICD-10 codes used was low and similar between 2015 and 2016, especially to describe the socio-economic environment, resistance to treatment or non-compliance.ConclusionThis study emphasizes the need for a collective effort to improve the diversity of the diagnoses’ coding in the RIM-P.     

L''impact du tabagisme sur la mortalité des Suisses et sur leur durée de vie en 1988/1993

Résumé L'élaboration de nouvelles tables de mortalité par l'Office fédéral de la statistique a permis d'estimer l'impact de différentes pathologie ou facteurs de risque sur la durée moyenne de vie de la population résidante permanente en Suisse. Ainsi, les décès attribuables au tabagisme ont pour effet de diminuer l'espérance de vie à la naissance des personnes résidant en Suisse de 2,9 ans pour les hommes et de 0,7 ans pour les femmes pour la période 1988/1993. Le calcul des taux de mortalité attribuables à ce facteur de risque montre que le risque de décès a diminué depuis la fin des années 1960 pour tous les groupes d'âge quinquennaux entre 35 et 74 ans. Le tabagisme serait responsable d'environ 16% des décès observés dans la population suisse, et de 20% des décès dits prématurés (entre 25 et 64 ans). La présente analyse montre par ailleurs que des évolutions différentes de la mortalité liées au tabagisme caractérisent les hommes et les femmes.

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Summary The elaboration of new mortality tables by the Swiss statistical office has allowed to estimate the impact of different pathology or risk factors on the average life duration of the resident population in Switzerland. Thus, attributable death of the smoking habits have for effect to decrease the life expectancy of swiss citizens of 2.9 years for men and 0.7 years for women, for the period 1988/1993. The calculation of mortality rates attributable to this factor of risk shows nevertheless that the risk of death has decreased since the end of years 1960 for all quinquennial age groups between 35 and 74 years. The smoking habits would be responsible of approximately 16% of deaths observed in the swiss population and 20% of premature deaths (between 25 and 64 years). The present analysis shows furthermore that different evolutions of the mortality associated with the smoking habits characterize men and women.

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Zusammenfassung Das Bundesamt für Statistik hat neue Sterbetafeln entwickelt, dank denen der Einfluss verschiedener Krankheitsbilder oder Risikofaktoren auf die mittlere Lebensdauer der Wohnbevölkerung in der Schweiz ermittelt werden kann. Danach reduzierte sich die Lebenserwartung der in der Schweiz wohnhaften Personen infolge auf Tabakkonsum zurückzuführende Todesfälle für die Periode 1988/1993 bei den Männern um 2,9 und bei den Frauen um 0,7 Jahre. Aus der Berechnung von Sterbeziffern in Bezug auf diesen Risikofaktor geht jedoch hervor, dass die Sterbewahrscheinlichkeit seit dem Ende der 60er Jahre für sämtliche Altersgruppen zwischen 35 und 74 Jahren (1 Altersgruppe=5 Jahre) abgenommen hat. Gemäss diesen Zahlen sind rund 16% der in der Schweizer Bevölkerung registrierten Todesfälle und 20% der sogenannten frühzeitigen Todesfälle (zwischen 25 und 64 Jahren) auf Tabakkonsum zurückzuführen. Die vorliegende Studie zeigt weiter, dass die Entwicklung bei Männern und Frauen nicht identisch verläuft, was die Todesfälle infolge von Krankheiten anbetrifft, die auf Tabakkonsum zurückgehen.

     

Sensibilité aux antibiotiques des souches de staphylocoques et d’entérocoques isolées en pédiatrie

Objectives – This 4 month study was made in six French pediatric centers, to assess the antimicrobial resistance of Gram-positive cocci. Methods – Staphylococcus aureus, enterococci, and coagulase negative staphylococci (CNS) were collected from June to October 1998. Only CNS isolated from blood samples were studied. Results – Methicillin resistance reached 7.8% for S. aureus isolates and 63% for CNS. About 41% of S. aureus strains were resistant to gentamicin, and all strains were susceptible to glycopeptides. CNS were more resistant to all antibiotics than S. aureus, except for pefloxacin. A decreased susceptibility to teicoplanin was observed in 3.3% of strains and only one strain was resistant. Among the 925 enterococci, seven strains (0.86%) had a VanA phenotype and only one had a VanB phenotype. Conclusions – These results prove the higher resistance of CNS. However, the resistance to glycopeptides of Gram positive cocci  remains low pediatrics in France.