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1.
A. Cabié F. Bissuel S. Abel P. Huc L. Paturel S. Pierre-François 《Médecine et maladies infectieuses》2009
Objective
Late screening for HIV is frequent in people living in the French West Indies. Rapid tests (RT) create new opportunities to improve screening for HIV. We evaluated the feasibility and acceptability of RT among users of free and anonymous screening consultations in Fort-de-France and Saint-Martin.Methods
After confirming its reliability on more than 20,000 samples, a RT (Determine HIV-1 + 2®) was offered on site to all testers in addition to the classic tests.Results
From October 2007 to May 2008, 373 RT were performed, four were confirmed positive. Results of RT were returned to 99.4% of testers versus 89.4% of persons who underwent additional classic tests. The rate for unclaimed classic tests results was higher for the latter than for persons who had only RT: 22.2% versus 10.6%.Conclusions
Results show that RT improves the proportion of people who are informed of their results. Nevertheless, efforts must be made to persuade patients to come back for results of the standard tests to be informed of a potential sexually transmitted infection or an acute HIV infection. 相似文献2.
M. Mohseni-Zadeh D. Rey M.-L. Batard G. Beck Wirth M.-L. Partisani J.-M. Lang Y. Hansmann D. Christmann M. Martinot 《Médecine et maladies infectieuses》2010
Introduction
HIV patients have a high rate of infectious complications. Vaccination, though less efficient in case of severe immunosuppression, can prevent some of these infections. Since 2006, new vaccine recommendations have been elaborated in France. We studied the vaccine status of HIV+ patients for influenza, Streptococcus pneumoniae, tetanus, and hepatitis A and B among an alsatian HIV+ population.Patients and methods
From August 20, 2007 to September 15, 2007, HIV patients of the Alsace HIV center (COREVIH) were included in a prospective study, screening demographic, medical, immunovirologic, and vaccination data.Results
Three hundred and thirty-one patients were included, 49% of whom were asymptomatic, 29% symptomatic without AIDS, 18% at AIDS stage, and no documentation for 4%. Seventy-one patients (21.4%) were vaccinated against influenza, 11 (3.3%) against Streptococcus pneumoniae, 34 against HAV (only 16.3% of patients with a negative test before), 120 against HBV (60% of patients with no serological markers before), and 186 (56.2%) against tetanus. The most frequent reasons for non-vaccination were non-proposal by physicians, lack of expected effectiveness, and fear of an immunovirological adverse effect.Conclusion
Vaccination coverage for recommended vaccines of HIV infected people remains at a low level and appears sometimes inferior to the rates reached among the general French population. It is necessary to inform prescribers and HIV positive patients about the interest of vaccination. 相似文献3.
4.
C. Fontaine A. Hema E. Kamboule J.-B. Guiard-Schmid F.-X. Lescure L. Slama G. Pialoux A. Sawadogo 《Médecine et maladies infectieuses》2010
Objective
The goal of the study was to assess the activity of a multidisciplinary structure for HIV infected patients, two years after the opening of the day hospital.Design
A retrospective observational study of the Bobo Dioulasso day-hospital was made using the ESOPE® (Epiconcept, France) software.Results
In 2002, 147 patients were followed in the Bobo Dioulasso university hospital, 27 (or 18.5 %) of whom were treated with antiretrovirals. Between 2005, opening of the day-hospital, and 2007, the total number of patients increased by 20 %. The number of patients on antiretrovirals rose from 47 to 70 % in the same time. The rate of patients with waved antiretroviral costs rose from 6 to 53 %. Three hundred and eighty-six patients died between 2002 and 2007. 1450 patients were lost to follow-up between 20002 and 2007.Conclusions
Two years after its opening, the Bobo Dioulasso day-hospital manages one of the largest HIV cohort in sub-Saharan Africa and has become a reference structure in Burkina Faso. The analysis of this cohort was an opportunity to identify issues concerning HIV patient treatment in 2009. 相似文献5.
Martín-Cabo R Losa-García JE Iglesias-Franco H Iglesias-González R Fajardo-Alcántara A Jiménez-Moreno A 《Gaceta sanitaria / S.E.S.P.A.S》2012,26(2):116-122
Objectives
To promote human immunodeficiency virus (HIV) testing in the primary care setting and to describe patients’ attitudes toward this practice.Methods
A non-randomized intervention was conducted on five physicians of an urban primary care center attending patients aged 18-65 years old, who were scheduled to undergo blood tests for other reasons. The patients were systematically offered HIV blood testing if they reported having had sex without a condom with a person of unknown HIV status. Not being tested required active refusal. The intervention period was from October to December 2008 and the control period was from October to December 2007. The main variable was the difference in the number of HIV tests requested. The proportion of patients accepting the test was also analyzed.Results
Demographic factors were similar in patients in the two periods. The number of HIV tests increased from 3.7% (22/599) to 27.2% (212/780), p <0.001. A total of 209 patients were offered the HIV test. Their mean age was 45.6 years (SD 11.7), 141 were women (68%) and 11 were born outside Spain (5%). One hundred and ninety-five patients (93%) admitted the possibility of having been or being at risk. Of these patients, only three (1.5%), refused the HIV test.Conclusions
Routine HIV testing in the primary care setting is feasible and few patients refuse to be tested. 相似文献6.
Isabel Portillo Isabel Idígoras Enrique Ojembarrena Eunate Arana-Arri Miren Begoña Zubero José Ignacio Pijoán Antonio López Urrutia María Luz Marqués 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To describe the procedures of the colorectal cancer screening program in the Basque Country (Spain), and the main results of the first rounds in 2009-2011.Method
We carried out a retrospective study of invitations to attend screening between 2009 and 2011. Participation rates and the number of positive results of the fecal occult blood test (FOBT) were analyzed by sex and age group.Results
There were 235.371 valid invitations (sent to the correct addresses), with an average participation rate of 64.3% (95%CI: 64.1-64.5%). Significant differences were found (p < 0,001) between women (67.1%; 95%CI: 66.9-67.4) and men (61.4%; 95%CI: 61.1-61.7). The rate of positive FOBT results was higher (p < 0,001) among men (9.1%; 95%CI: 8.9-9.2) than among women (4.8%; 95%CI: 4.7-4.9).Conclusions
Participation rates were adequate compared with those in the reviewed literature. These rates were probably affected by the invitation strategy and by cultural and social factors. 相似文献7.
8.
A. Jlizi A. Azzouzi I. Bouzayen A. Slim S. Ben Rejeb M. Garbouj A. Ben Ammar El. Gaaied 《Médecine et maladies infectieuses》2009
Settings
In Tunisia, therapeutic failure profile is detected in 42.22% of treated patients. These patients are still confronted to ethical and socioeconomic problems but also to therapeutic and technical ones. Indeed, the limited number of available antiretroviral (ARV) molecules and the unavailability of resistance genotypic test in routine use is the reason why the same therapeutic combination of ARV molecules is maintained after therapeutic failure in some cases.Objective and method
The authors studied the evolution, on two consecutive samples, of resistance mutations in patients with prolonged exposure to the same therapeutic combination after therapeutic failure and the resulting effect on management of these patients.Results
We found a greater number of patients presenting with mutant viral stains after a prolonged exposure to the same ARV molecules. Results also showed that the detected mutation frequency increased and even more on the second sample, compared to the first one. Thus, the early diagnostic of resistance mutations using genotypic resistance test would be of great interest by allowing the physician to take necessary measures to reduce resistance rate and find an optimal treatment for the patient.Conclusion
The introduction of new ARV molecules in our country was also an important step by improving the therapeutic management of HIV infected patients. 相似文献9.
C. Marrakchi I. Maâloul D. Lahiani B. Hammami T. Boudawara M. Zribi M. Ben Jemaâ 《Médecine et maladies infectieuses》2010
Objective
The aim of the study was to evaluate the contribution of microbiology, cytology, and anatomopathology in 50 cases of peripheral tuberculous lymphadenitis.Methodology
Our patients underwent bacteriological tests and cytology and/or histopathology for lymphadenitis.Results
Ziehl-Neelsen stains and cultures were positive in only 29.7% and 10.8% of cases respectively. The diagnosis was confirmed by cytology in 31.3% of cases (10/32) and by histology in 58.6% of cases (27/46). Granulomas were observed in 46.8% (15/32) of needle aspirates and 76% (35/46) of surgical biopsies.Conclusion
Our study reveals a weak contribution of conventional microbiological techniques. Cytology remains the procedure of choice in endemic countries. Excisional biopsy may be performed in case of doubt. 相似文献10.
R. Gauthier J.-M. Livrozet F. Prevoteau du Clary O. Taulera S. Bouée J.-P. Aubert A.M. Py J.M. Peter C. Majerholc S. Héber Suffrin C. Compagnon A. Wajsbrot 《Médecine et maladies infectieuses》2012
Background
In France, around 50,000 people were unaware of their HIV positivity at the end of 2008. The latest guidelines recommend routine screening of all adults. Family physicians have been identified as key persons for this new policy. Rapid HIV tests (RHT) have been proposed as an alternative to conventional blood tests.Objectives
The authors assessed the feasibility and acceptability of RHT test based screening in French community practice.Method
We made a prospective interventional study of the BioMerieux VIKIA® HIV 1/2 RHT among French family physicians. Data on the RHT was posted in the physician's waiting room.Results
Sixty-two French physicians, mostly family practitioners, included 383 patients with a mean age of 36.2 years, from June to October 2010. Twenty-two percent (83) of these patients had never been tested for HIV. The RHT was proposed and 382 tests were accepted and performed (acceptability rate of 99.7%). Sixty-five percent of the tests were made on the patient's request. The tested population represented 1.5% of consulting patients during the study period (feasibility rate). Patients were quite satisfied but physicians less so. Test steps and capillary blood sampling were the main source of difficulty mentioned. At the end of the study, 59% of physicians were ready to continue using RHT in their daily practice.Conclusion
Routine RHT screening in community practice is feasible and well accepted by patients. It was the first screening test for 22% of our patients. Its feasibility was limited by capillary blood sampling technique and time constraints during consultation. 相似文献11.
Ana Belén García-Garrido José Andrés Vázquez-Rodríguez Elena Grande-González María Ángeles Ramos-Barrón 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To analyze cervical cancer screening performed in Cantabria by evaluating the coverage and costs of screening and by calculating the available direct costs of the disease and the indirect costs of cervical cancer mortality.Methods
Screening for cervical cancer is performed in women aged between 21 and 65. According to the census for 2011 in Cantabria, there were 189.111 women in this age group. We performed a cross sectional, quantitative and qualitative study of the Pap smears performed and analyzed the direct and indirect costs of cervical cancer.Results
Between 2006 and 2011, 51% of women studied had one Pap smear, and 26% had two. In 2011, 31.554 Pap smears were performed in opportunistic screening in Cantabria, and the direct cost was 2,904.760 €. The annual direct cost of cervical cancer (average 2008-2010) was 567.567 €. The annual indirect costs (average 2001-2008) of cervical cancer was 386.122.02 €, in the reference scenario considered.Conclusions
Only 26% of women in Cantabria attended screening within the intervals recommended in the current opportunistic protocol. The cost data provided in this study may be useful for future economic evaluations. 相似文献12.
M. Luisa Guitard Sein-Echaluce Joan Torres Puig-gros Divina Farreny Justribó Josep M. Gutiérrez Vilaplana Miguela Martínez Orduna Eva M. Artigues Barberá 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To determine the prevalence of adherence to physical activity recommendations in the hypertensive population of Lerida (Spain) attended in primary care and to identify related factors.Methods
A cross sectional study was carried out in hypertensive adults. The dependent variable was adherence to physical activity recommendations measured with the Minnesota Questionnaire. The independent variables were sociodemographic factors, the information received, and attitudes to physical activity.Results
A total of 786 hypertensive patients participated in this study; 53.9% were women and the mean age was 66.0 ± 10.2 years. Adherence to recommendations was found in 64.3% (95% CI: 60.9-67.6); this percentage was 65.2% in men (95% CI: 60.2-70.0) and 63.4% in women (95% CI: 58.8-67.9). Greater adherence was associated with age in men and with residence in a rural area in women. In both genders, greater adherence was associated with unpaid work and with having a favorable attitude to physical activity. No association was observed with the number of recommendations received in the last 6 months.Conclusions
More than half the hypertensive population adhered to physical activity recommendations. To improve physical activity levels, recommendations can be tailored to the attitudes of individual patients. 相似文献13.
14.
Ana Redondo Mercedes SáezPatricia Oliva Maria SolerAntoni Arias 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To describe variability in the cesarean ratio and indications for this procedure in women with and without a previous cesarean section.Methods
We conducted a cross-sectional study of 111 hospitals (year 2010) categorized in six levels. Ten groups of indications for cesarean section were developed. Measures of central tendency and diversity were used to determine variability and the Kruskal-Wallis test was used for comparisons among hospital levels.Results
The percentage of cesarean sections was 25.4%. In women without a previous cesarean section, the percentage was higher in private and public hospitals with a lower technological level (34.7% and 30.4% in private and 22.4% in lower level public hospitals). Among public hospital levels, no differences in the percentage of cesarean sections indicated were observed.Conclusions
Research on non-clinical factors could clarify the differences in the ratio of cesarean sections in private hospitals compared with public hospitals and among distinct levels of public hospitals. 相似文献15.
V. Pinaud F. Ballereau S. Corvec C. Ferron P. Bordure J. Caillon A. Reynaud N. Asseray G. Potel D. Lepelletier 《Médecine et maladies infectieuses》2009
Objective
The purpose of this study was to describe the characteristics of patients hospitalized for a peritonsillar abscess over a 1-year period and to evaluate the proportion of patients exposed to anti-inflammatory and antibiotic drugs before hospitalization.Design
Adult patients hospitalized in the ENT department at the Nantes University Hospital were included in the study during 2006. Data related to prior use of anti-inflammatory and antibiotic drugs, microbiology and treatment was analyzed.Results
Thirty-four patients were included in the study, 20 (59%) and 21 (62%) patients had been previously exposed to anti-inflammatory and antibiotic drugs, respectively. Half of the patients had received antibiotics despite the negativity of the rapid screening test. All diagnoses were made on pus examination after aspiration. Tonsillectomy was performed only in two cases. A total of 21 bacterial isolates (13 anaerobic and 9 aerobic) were identified. Single bacterial isolates were recovered in 8 infections. The most frequent bacteria were Streptococcus, Fusobacterium, and Prevotella.Conclusions
Many patients were exposed to both anti-inflammatory and antibiotic drugs, which did not prevent the peritonsillar abscess. 相似文献16.
Maria Ramos Maria Taltavull Pilar Piñeiro Raquel Nieto Maria Llagostera 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To describe the cultural, social and gender features that determine attitudes to colorectal cancer screening in a target group of patients aged 50 to 69 years old in the primary health care setting.Methods
We performed a qualitative ethnographic study from a gender perspective. Participants consisted of men and women aged 50 to 69 years old in the Balearic Islands and Barcelona. Group discussion and a field diary were used.Results
The key element was diagnosis at an early stage. Until recently, cancer was considered an incurable disease but is currently perceived as a serious health problem that can be cured if diagnosed promptly. The participants requested more information on cancer and felt they were at risk, mainly because of their age. Men tended to pay attention to symptoms while women tended to ignore them. Attitudes to colorectal cancer screening were generally positive, even to colonoscopy. Some barriers to screening were identified in women, such as a fear of having cancer.Conclusions
The opportunity for early diagnosis is the key element in promoting participation in a colorectal cancer screening program. Perceptions-and hence willingness to participate in screening-differ between men and women. Factors to be taken into account in the design of population-based colorectal cancer programs are health concerns in men and fear of a cancer diagnosis in women. 相似文献17.
N.M. Manga S.A. Diop C.T. Ndour N.-M. Dia A. Mendy M. Coudec B. Taverne B.M. Diop P.S. Sow 《Médecine et maladies infectieuses》2009
Background and methodology
The delay in the diagnosis of HIV infection is a major obstacle to optimal care for this disease. To deal with this problem, we conducted this study among newly diagnosed HIV patients hospitalized in the Fann University Hospital Infectious Diseases Clinic in Dakar. The epidemiological, clinical, biological and outcome aspects are described and patient history reviewed. A qualitative socio-anthropological study was made to understand and describe the logic of the decision processes in the patient's search for treatment.Results
One hundred patients were included, with a mean age of 39.5 ± 11.1 years and a sex-ratio: 1.08. The transmission was mainly heterosexual (90%), and chronic diarrhea (64%) and/or chronic cough (66%) were the principal symptoms leading to diagnosis. The mean delay before diagnosis was 5 ± 4.27 months. The major opportunistic diseases were tuberculosis (44 cases) and infectious diarrhea (23 cases). Most patients were diagnosed at the AIDS stage (97%) and the death rate was 30% among hospitalized patients after admission. Sixty-eight percent of patients had consulted at least three times, generally a “traditional practitioner”, at first and 43% had been hospitalized at least once. The qualitative investigation revealed that the “representation” or the “feeling of severity” of the disease were the principal justifications for consulting the “traditional practitioner” or the physician, respectively.Conclusion
Better information for health workers and global population is necessary for an earlier diagnosis of HIV infection in Dakar. 相似文献18.
Pere Godoy Joan Torres José Otal Anna Gort Pilar Bach Miquel Falguera 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
To describe the census and contact investigation in a case of laryngeal tuberculosis.Methods
Based on a patient with laryngeal tuberculosis and through interviews and ocular inspection, we established three circles of contacts. The tuberculin test was performed (positive ≥5 mm). Persons testing positive were invited to undergo a chest x-ray. The association of the infection was calculated with the odds ratio. The exposure-response relationship was determined with the linear trend χ2 test.Results
The overall prevalence of infection was 39.9% (67/168). The prevalence among coworkers was 60.0% (24/40), that among frequenters of the town bar was 43.3% (13/30) and the conversions rate was 12.9%. There was a relationship with the degree of exposure (p <0.0001).Conclusions
Laryngeal tuberculosis involved high transmission to coworkers and frequenters of the town bar. In-depth studies through concentric circles and good communication with exposed individuals should be carried out. 相似文献19.
Vanesa Rodríguez-Salés Esther Roura Raquel Ibáñez Mercè Peris F. Xavier Bosch Ermengol Coma E Silvia de Sanjosé 《Gaceta sanitaria / S.E.S.P.A.S》2014
Objective
To estimate cervical cytology coverage for the period 2008-2011 by age groups and health regions from data recorded in the medical records of women attending centers within the Catalan national health system.Methods
The data used to estimate coverage were obtained from the primary care information system. This information was anonymous and included age, center, date, and the results of cytological smears for a total of 2,292,564 women aged 15 years or more.Results
A total of 758,690 smears were performed in 595,868 women. Among women aged 25-65 years, the estimated coverage was 32.4% of the assigned population and was 40.8% in the population attended. Geographical variation was observed, with higher coverage among health regions closer to Barcelona. Abnormal Pap smears increased slightly from 2008 to 2011 (from 3% to 3.5%, respectively, p <0.001). In women with a negative first smear, the mean interval until the second smear was 2.4 years, but only 50% of women with a negative first smear in 2008 attended a second round during the study period.Conclusions
Cervical screening coverage in the National Health Service of Catalonia includes one in three women. Second round participation was poor. Existing computer systems in primary care centers can ensure monitoring of population-based screening programs for cervical cancer. These systems could be used to plan an organized screening program to ensure wider coverage and better follow-up. 相似文献20.
Adriana Marqueta Isabel Nerín Adriana Jiménez-Muro Pilar Gargallo Asunción Beamonte 《Gaceta sanitaria / S.E.S.P.A.S》2013