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Purpose: Data on encephalitis in elderly patients are scarce. We aimed to describe the characteristics, aetiologies, management, and outcome of encephalitis in patients older than 65 years. Methods: We performed an ancillary study of ENCEIF, a prospective cohort that enrolled all cases of encephalitis managed in 46 clinical sites in France during years 2016–2019. Cases were categorized in three age groups: (1) 18–64; (2) 65–79; (3) ≥ 80 years. Results: Of the 494 adults with encephalitis enrolled, 258 (52%) were ≥ 65 years, including 74 (15%) ≥ 80 years. Patients ≥ 65 years were more likely to present with coma, impaired consciousness, confusion, aphasia, and rash, but less likely to present with fever, and headache (P < 0.05 for each). Median cerebrospinal fluid (CSF) white cells count was 61/mm3[13–220] in 65–79 years, 62 [17–180] in ≥ 80 years, vs. 114 [34–302] in < 65 years (P = 0.01). The proportion of cases due to Listeria monocytogenes and VZV increased after 65 years (P < 0.001), while the proportion of tick-borne encephalitis and Mycobacterium tuberculosis decreased with age (P < 0.05 for each). In-hospital mortality was 6/234 (3%) in < 65 years, 18/183 (10%) in 65–79 years, and 13/73 (18%) in ≥ 80 years (P < 0.001). Age ≥ 80 years, coma on admission, CSF protein ≥ 0.8 g/L and viral encephalitis were independently predictive of 6 month mortality. Conclusion: Elderly patients represent > 50% of adults with encephalitis in France, with higher proportion of L. monocytogenes and VZV encephalitis, increased risk of death, and sequels. The empirical treatment currently recommended, aciclovir and amoxicillin, is appropriate for this age group. [ABSTRACT FROM AUTHOR]

The psychosocial safety climate (PSC) reflects workers’ perceptions of senior management’s concern for mental health. Because the COVID-19 pandemic has exacerbated organizational issues, PSC could be a target for interventions attempting to preserve both the psychological health of employees and the economic health of companies. This study examines the direct and indirect relationships between PSC and work performance through two indicators of psychological health, psychological distress and post-traumatic growth, during a health crisis, i.e., prior to the second confinement in France. To this end, 2,004 participants from the French workforce completed a survey in October 2020. The results of mediation analyses indicate that PSC has a direct and positive influence on post-traumatic growth (PTG) and performance, as well as a direct negative influence on psychological distress. PSC also has an indirect positive influence on performance via psychological distress. Organizations that wish to jointly address mental health and performance at work would benefit from optimizing PSC. [ABSTRACT FROM AUTHOR]

Background: The pathogenic and oncogenic roles of papillomavirus (HPV) infections have been documented and shown to occur in women as well as in men. While other countries have already extended their vaccination guidelines to include boys, in 2019 the French National Authority for Health validated implementation of HPV vaccination in the 2020 vaccination schedule. There is, however, a climate of distrust in regard to vaccination in France, and there have been few studies to date regarding the acceptability of HPV vaccination in boys in France. The aim of this study was, therefore, to evaluate the acceptability of extending the recommendations for HPV vaccination in men, among middle and high school students and their parents. Methods: Our study (HPVac) was a prospective, multicenter, departmental, and descriptive survey applied to a sample of male middle and high school students attending schools in the Loire-Atlantique department and their parents. It took place from January 2017 to January 2018. Results: We analyzed the information obtained from 127 parent questionnaires and 145 children questionnaires. In terms of acceptability, 36.6% (n = 53) of the children and 37.8% (n = 48) of the parents were in favour of being vaccinated or of having their children vaccinated against HPV (51.7% (n = 75) and 50.4% (n = 64), respectively, were undecided). The perception of a risk stemming from HPV infection was positively associated with acceptability of the HPV vaccine. Being against vaccines in general, being discouraged by their parents, parents thinking that their child is not at risk, and the belief that the vaccine is not mandatory were arguments cited and significantly associated with a willingness to be vaccinated. Conclusion: This study revealed a lack of information among boys and their parents about HPV and its vaccination. It also clearly showed that taking time to discuss the consequences of an infection and the merits of being vaccinated can help parents overcome their reluctance. The children then generally go along with their parent's choice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: A recent measles epidemic in France incited us to report and describe measles cases requiring hospitalization, to raise the awareness of health professionals on under-diagnosis and frequent complications of this viral disease. Design: We carried out a retrospective and epidemiologic study of measles cases recorded in the Nantes Teaching Hospital between August 2008 and September 2009. All these cases where confirmed by biological diagnosis and recorded by the Teaching Hospital virological laboratory. Results: Thirteen cases of measles (11 adults and two children) were recorded during the study period. Adults were young (mean age 21.4 years); the oldest was 35 years old. We noted two severe cases with viral pneumonia and hypoxemia and one case with bacterial pneumonia. Two female patients were pregnant; one delivered prematurely, in the acute phase of measles, with no complication for the newborn. Two cases occurred in the nursing staff by documented nosocomial transmission. Sixty-nine percent of the patients were not vaccinated whereas the vaccinal status was not documented for 31%. Conclusions: These cases underline the potential severity of this infection and the difficulty to diagnose measles at the early phase because of lack of awareness of medical staff. It will be necessary to reinforce prevention messages and promote measles vaccination in children as well as in young people and health workers. [Copyright &y& Elsevier]

Microplastic (MP) input into agroecosystems is of particular concern as their sources are diverse (mulching films, biosolid application, wastewater irrigation, flooding, atmospheric input, road runoff). Compost application, which is needed to sustain soil ecosystem services in the context of a circular economy, may be a source of microplastics. The aim of this study was to evaluate how different composts derived from urban wastes impact the nature and quantity of coarse (2–5 mm) microplastics (CMP) in soils, using a long-term field experiment in France. Composts resulting from different levels of urban waste sorting were investigated. Our approach included the isolation of microplastics from composts and amended soils followed by their characterization using pyrolysis GC/MS spectrometry. We found that coarse microplastic concentrations varied from 26.9 to 417 kg per hectare depending on the compost type, after 22 years of bi-annual application. These values may be higher than for conventional agricultural practices, as application rate was twice as high as for normal practices. Composts made from municipal solid waste were by far the organic amendments leading to the highest quantity of plastic particles in soils, emphasizing the urgent need for limiting plastic use in packaging and for improving household biowaste sorting. Our results strongly suggest that standards regulating organic matter amendment application should take microplastics into account in order to prevent contamination of (agricultural) soils. Moreover, although no impacts on the soil bio-physico-chemical parameters has been noted so far. However, given the huge microplastic inputs, there is an urgent need to better evaluate their effect on soil functioning. [Display omitted] • Coarse microplastics (CMP) pollution in amended soils depend on compost type. • Non-selective waste sorting led to high CMP amount in compost amended soil. • Polyethylene and polystyrene were the most abundant CMP in composts and soils. • Repeated application of compost can lead toCMP accumulation in soils. [ABSTRACT FROM AUTHOR]

The flâneur has remained little more than a hazy, nostalgic figure since first described in detail by Baudelaire in 19th-century Paris. Here, the work of Walter Benjamin, who did more than any other to advance the notion of flânerie post-Baudelaire, is considered alongside that of his friend and critic Theodor Adorno, in an attempt to conceive of a modern-day version of the type. The many critical exchanges between Adorno and Benjamin are envisioned as a moving dialectic: a constant interplay between anticipation and suspicion. What results is a concept of flânerie that mingles a tentatively optimistic Benjamin with a perpetually sceptical Adorno, in order to conjure up an image of the individual strolling and wandering about the margins of contemporary urbanity, balanced on the cusp of hope and hopelessness. [ABSTRACT FROM AUTHOR]

Résumé: Propos: La résurgence de la syphilis est constatée depuis le début des années 2000. Nous décrivons rétrospectivement les cas de syphilis hospitalisés au CHU de Nantes entre 2000 et 2010. Méthodes: Les dossiers étaient retenus sur la base des données sérologiques du service de bactériologie et les données du PMSI. Le diagnostic reposait sur la positivité du TPHA et du VDRL. Résultats: Le nombre de sérologies positives a été multiplié par 8 sur la période examinée. Sur les 36 patients hospitalisés, 97 % étaient des hommes, de 17 à 75 ans. Dix-huit étaient infectés par le VIH. Parmi eux, 94 % étaient homosexuels et 67 % avaient un antécédent d’infections sexuellement transmissibles. Le délai moyen entre les symptômes et le diagnostic était significativement plus grand chez les patients non infectés par le VIH. Trente-trois pour cent des patients présentaient une syphilis secondaire cutanéo-muqueuse souvent accompagnée de signes généraux, 50 % une neurosyphilis sous la forme d’une uvéite le plus souvent, et un patient présentait une syphilis tertiaire sous la forme de gommes osseuses. Les patients présentant une syphilis secondaire isolée étaient traités par une à trois injections de benzathine pénicilline G. Les patients présentant une syphilis tardive ou une neurosyphilis étaient traités par pénicilline G ou ceftriaxone. Trente-neuf pour cent des patients atteints de neurosyphilis gardaient des séquelles neurosensorielles. Conclusion: Ce travail souligne l’augmentation d’incidence de la syphilis en France et les potentielles sévérités et complexités diagnostiques de cette infection, imposant la réalisation plus large de la sérologie de la syphilis devant un tableau clinique compatible. [ABSTRACT FROM AUTHOR]

Francisella tularensis, the agent of tularemia, is a Gram-negative coccobacillus primarily pathogen for animals and occasionally for humans. The clinical manifestations of tularemia include pneumonia, ulceroglandular, oropharyngeal, or typhoidal disease. Rare manifestations are also described, but to our knowledge, we describe here the first case of F. tularensis aortitis in a human. Diagnosis was confirmed by the presence of F. tularensis in blood culture, by the presence of F. tularensis DNA in the aortic biopsy and by specific IgG and IgM responses against the bacteria. The outcome was favorable after surgery and specific antimicrobial therapy. [ABSTRACT FROM AUTHOR]

We identified 2 cases of European bat lyssavirus subtype 1 transmission to domestic carnivores (cats) in France. Bat-to-cat transmission is suspected. Low amounts of virus antigen in cat brain made diagnosis difficult. [ABSTRACT FROM AUTHOR]

The article discusses on the Rhône-Alpes health platform. This endeavor aims to develop a health information platform linking most health facilities in the Rhône-Alpes region in France. For this platform, developers chose a use-centered design that takes into consideration doctors' requirements. The platform's creators also regards a direct connection to the legacy systems be given. It allows fast and more appropriate medical decisions compared to those that do not have this kind of information system. Medical documents are presented in a uniform format with the use of this iconic interface.

Entre aventures, syllogismes et confessions. Belgique, Roumanie, Suisse, Marc Quaghebeur & Laurent Rossin, (dir.), (2004) Bruxelles: Peter Lang, 377 pp., ISBN 90-5201-209-4 (pbk), €32.50, £23, US $38.95 Reframing Difference: Beur and Banlieue Filmmaking in France, Carrie Tarr, (2005) Manchester: Manchester University Press, 230 pp., ISBN 0–7190–6877–0, £14.99 Discours et constructions identitaires, Denise Deshaies and Diane Vincent (eds), (2004) Québec: Les Presses de l'Université Laval, 228 pp., ISBN 2–7637–8189–6 (pbk), CAN$25 Travel in Twentieth-Century French and Francophone Cultures: The Persistence of Diversity, Charles Forsdick, (2005) Oxford: Oxford University Press, 255 pp., ISBN 0–1992–5829–5 (hbk), $95.00 France and ‘Indochina’: Cultural Representations, Kathryn Robson and Jennifer Yee (eds), (2005) Lanham, MD: Lexington Books, 237 pp., ISBN 0–7391–0840–9 (pbk), £17.99 Les Juifs de la République en Algérie et au Maroc: Mémoires d'autres temps, Roger Bensadoun, (2003) Paris: Publisud, 185 pp., ISBN 2–86600–950–9 (pbk), €22.60 The Collected Works of Langston Hughes, Volume 16: The Translations: Federico García Lorca, Nicolás Guillén, and Jacques Roumain, Langston Hughes (edited by Dellita Martin-Ogunsola), (2003) Columbia: University of Missouri Press, xvii + 267 pp., ISBN 0–8262–1435–5 (hbk), $34.95 [ABSTRACT FROM AUTHOR]

The article offers information regarding a retrospective analysis of 55 cases of measles resurgence. It mentions that the incidence of higher percentages of measles patients and their hospitalizations are higher in France since 2008. It also mentions that the incidence of notified measles cases was 0.96 per 100,000 population in 2008 (604 cases), and rose to 2.5 per 100,000 in 2009 (1.544 cases) and approximately 2000 cases were reported from January to May 2010.

Purpose: The aim of this study was to assess the impact of implementing health information systems (HIS) on the activity per surgeon and use of operating rooms in acute care hospitals across France. Context: HIS are increasingly being adopted in healthcare settings. However, they require significant upfront and ongoing investments [1]. In France, the Ministry of Health (DGOS) launched the national "Hopital numérique 2012-2017" program, a strategic plan for the modernization of HIS, with the goal of making hospitals more efficient [2]. Methods: Four national databases were used in this retrospective study: oSIS (observatoire des systèmes d'information de santé-2012), IPAQSS (indicateurs pour l'amélioration de la qualité et la sécurité des soins-2011), Hospi-Diag (French hospital performance indicators - 2012), and the national accreditation database. National data and methodological support were provided by the DGOS and French National Authority for Health (HAS). We used two multivariate linear models to estimate the activity per surgeon (model 1) and operating room usage (model 2), which were dependent variables [3-5]. For both models, the independent variables were the proportion of electronic health records (EHRs) used (full, partial, or no EHRs); number of computers per capita connected to the HIS; shared planning tools or electronic programming tools; type of hospital (teaching, private non-profit, for-profit, or other public hospital); accuracy of the care, with versus without home care hospitalization; number of surgical beds; level of severity of the medical issue; number of stays related to oncology; and geographic region of the hospital. For consistency, only hospitals with the highest rates of surgical inpatients were used for the analyses. Results and discussion: In model 1 (n = 149 hospitals, pseudo R2 = 0.32), we found that the higher the number of full EHRs used, the higher the activity per surgeon (p < 0.001). The activity per surgeon also increased with the number of computers per capita connected to the HIS (p = 0.003), in for-profit hospitals (p = 0.011), and for care that does not involve home care hospitalization (p = 0.001). The activity per surgeon decreased when the patient's medical issue rose above severity level 3 and 4 (p < 0.003). In model 2 (n = 149 hospitals, pseudo R2 = 0.44), the use of operating rooms increased when shared planning tools or electronic programming tools were adopted (p = 0.004) and in for-profit hospitals (p < 0.001). The analysis also revealed that the higher the number of surgical beds, the higher the operating room usage (p < 0.001). The operating room usage decreased when the patient's medical issue rose above severity level 3 and 4 (p < 0.029). Neither full nor partial EHRs were associated with a higher use of operating rooms. In both models, at least one variable related to the HIS (EHR, number of computers or shared planning tools) had a significant positive impact on the activity per surgeon and use of operating rooms within French hospitals. Our findings are useful for guiding broad development of HIS in healthcare settings [6]. [ABSTRACT FROM AUTHOR]

To identify factors associated with unfavourable in-hospital outcome (death or disability) in adults with community-acquired bacterial meningitis (CABM). In a prospective multicentre cohort study (COMBAT; February 2013 to July 2015), all consecutive cases of CABM in the 69 participating centres in France were enrolled and followed up for 12 months. Factors associated with unfavourable outcome were identified by logistic regression and long-term disability was analysed. Among the 533 individuals enrolled, (Streptococcus pneumoniae 53.8% (280/520 isolates identified), Neisseria meningitidis 21.3% (111/520), others 24.9% (129/520)), case fatality rate was 16.9% (90/533) and unfavourable outcome occurred in 45.0% (225/500). Factors independently associated with unfavourable outcome were: age >70 years (adjusted odds ratio (aOR) 4.64; 95% CI 1.93–11.15), male gender (aOR 2.11; 95% CI 1.25–3.57), chronic renal failure (aOR 6.65; 95% CI 1.57–28.12), purpura fulminans (aOR 4.37; 95% CI 1.38–13.81), localized neurological signs (aOR 3.72; 95% CI 2.29–6.05), disseminated intravascular coagulation (aOR 3.19; 95% CI 1.16–8.79), cerebrospinal fluid (CSF) white-cell count <1500 cells/μL (aOR 2.40; 95% CI 1.42–4.03), CSF glucose concentration (0.1–2.5 g/L: aOR 1.92; 95% CI 1.01–3.67; <0.1 g/L: aOR 2.24; 95% CI 1.01–4.97), elevated CSF protein concentration (aOR 1.09; 95% CI 1.03–1.17), time interval between hospitalization and lumbar puncture >1 day (aOR 2.94; 95% CI 1.32–6.54), and S. pneumoniae meningitis (aOR 4.99; 95% CI 1.98–12.56), or meningitis other than N. meningitidis (aOR 4.54; 95% CI 1.68–12.27). At 12 months, 26.7% (74/277) had hearing loss, 32.8% (87/265) depressive symptoms, 31.0% (86/277) persistent headache, and 53.4% had a physical health-related quality of life (142/266) <25th centile of the distribution of the score in the general French population (p < 0.0001). The burden of CABM (death, disability, depression, impaired quality of life and hearing loss) is high. Identification of cases from the first symptoms may improve prognosis. Gov identification number: NCT01730690. [ABSTRACT FROM AUTHOR]

Abstract: We report the first case in Europe of co-infection with disseminated cryptococcosis and histoplasmosis. The diagnosis of invasive histoplasmosis was confirmed by microscopic examination of the anatomic right colon specimen (hemicolectomy). Histoplasma antigen detection is not yet available in France but it could have a key role in the early diagnosis of disseminated histoplasmosis co-existing with a cryptococcal infection, especially in HIV-infected African people. [Copyright &y& Elsevier]

• As the risk of pertussis in infants needs to be reduced and as WHO guidelines recommend vaccination of mothers against pertussis, our study evaluated current knowledge and beliefs on pertussis and vaccination against pertussis as well as acceptance of the maternal pertussis vaccination strategy in two large cohorts of postpartum women and health professionals. • We observed a lack of knowledge about pertussis in both surveys, but acceptance of maternal pertussis vaccination was high (77% among women and 93% among health professionals). • Our findings provide a ray of optimism in the current context of vaccine hesitancy and controversies. Protection of French young infants against pertussis only relies on their relatives' vaccination. The alternative is vaccination of pregnant women against pertussis (cocooning strategy), but this strategy is not yet recommended in France. We assessed the acceptance of this strategy among French postpartum women and health professionals. We performed a multicenter survey in 2016 among postpartum women and health professionals (family physicians, obstetricians-gynecologists, midwives, and medical students) to determine the acceptance of anti-pertussis vaccination. We evaluated knowledge, perception, and attitude towards vaccination to identify factors associated with acceptance. Questionnaires were completed by 52% (1208/2337) of women and 40% (694/1754) of health professionals. Seventy-seven per cent of women (95% CI: 74–79) and 93% of health professionals (95% CI: 91–95) were favorable to anti-pertussis vaccination of pregnant women. Thirty-three per cent (227/687) of health professionals believed that pertussis induced life-long immunity and 20% (136/687) of them were not aware of the cocooning strategy. In multivariate analysis, factors associated with acceptance among women were younger age, higher knowledge, having received advice during pregnancy, being vaccinated against influenza, and having never refused any vaccine; among health professionals, factors associated with acceptance were belief that inactivated vaccines are obstetrically safe, regular practice of influenza vaccination in pregnant women, pertussis cocooning strategy, and never prescribing preventive homeopathy for influenza. Vaccination of pregnant women against pertussis should be well-accepted by informed mothers and health professionals. If this strategy were to be implemented in France, efforts should be made towards adequate information. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including the promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances.Objective: The aim of this study was to evaluate the impact of EHR use on the quality of care management in acute care hospitals throughout France.Methods: This retrospective study was based on data derived from three national databases for the year 2011: IPAQSS (indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. Several multivariate models were used to examine the association between the use of EHRs and specific EHR features with four quality indicators: the quality of patient record, the delay in sending information at hospital discharge, the pain status evaluation, and the nutritional status evaluation, while also adjusting for hospital characteristics.Results: The models revealed a significant positive impact of EHR use on the four quality indicators. Additionally, they showed a differential impact according to the functionality of the element of the health record that was computerized. All four quality indicators were also impacted by the type of hospital, the geographical region, and the severity of the pathology.Conclusion: These results suggest that, to improve the quality of care management in hospitals, EHR adoption represents an important lever. They complete previous work dealing with EHR and the organizational performance of hospital surgical units. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. The aim of this study was to evaluate the impact of EHR use on the organizational performances of acute care hospital surgical units throughout France.Methods: This retrospective study was based on data derived from three national databases for year the 2012: IPAQSS (Indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. National data and methodological support were provided by the French Ministry of Health (DGOS) and the French National Authority for Health (HAS). Multivariate linear models were used to assess four organizational performance indicators: the occupancy rate of surgical inpatient beds, operating room utilization, the activity per surgeon, and the activity per both nurse anesthetist and anesthesiologist which were dependent variables. Several independent variables were taken into account, including the degree of EHR use.Results: The models revealed a significant positive impact of EHR use on operating room utilization and bed occupancy rates for surgical inpatient units. No significant association was found between the activity per surgeon or the activity per nurse anesthetist and anesthesiologist with EHR use. All four organizational performance indicators were impacted by the type of hospital, the geographical region, and the severity of the pathologies.Conclusion: We were able to verify the purported potential benefits of EHR use on the organizational performances of surgical units in French hospitals. [ABSTRACT FROM AUTHOR]

Background Many cases of measles in adults were notified during the epidemic in France in 2008. Studying these cases can lead to a better understanding of their potential complications, little data having been reported on renal dysfunction during measles. Methods A retrospective study of biologically confirmed measles cases in patients hospitalized for more than 24 hours was carried out in the Nantes Teaching Hospital, between January and December 2011. The renal function was assessed using the modification of diet in renal disease (MDRD) equation. Results Thirty-eight patients were included, 17 (45%) presented with a clearance below 90 mL/min. One patient presented with acute renal failure, with a clearance at 37 mL/min, and proteinuria at 2.8 g/L. His renal function was restored on day 2. Conclusion Acute renal failure can occur during measles in adults. Serum creatinine should be systematically assessed during the initial medical evaluation. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Since 2009, accelerated partial breast irradiation (APBI) in North America has been allowed to be used for selected group of patients outside a clinical trial according to the ASTRO consensus statement. In France, accelerated partial breast irradiation is still considered investigational, several clinical trials have been conducted using either intraoperative (Montpellier) or Mammosite® (Lille) or brachytherapy modality (PAC GERICO/FNCLCC). Here, we report the original dosimetric results of this technique. Patients and methods: Since October 2007, Institut Gustave-Roussy has initiated a phase II trial using 3D-conformal accelerated partial breast irradiation (40Gy in 10 fractions BID in 1week). Twenty-five patients with pT1N0 breast cancer were enrolled and were treated by two minitangent photons beams (6MV) and an “en face” electron beam (6–22MeV). Results: The mean clinical target volume and planning target volume were respectively 15.1cm3 (range: 5.2–28.7cm3) and 117cm3 (range: 52–185cm3). The planning target volume coverage was adequate with at least a mean of 99% of the volume encompassed by the isodose 40Gy. The mean dose to the planning target volume was 41.8Gy (range: 41–42.4Gy). Dose inhomogeneity did not exceed 5%. Mean doses to the ipsilateral lung and heart were 1.6Gy (range: 1.0–2.3Gy) and 1.2Gy (range: 1.0–1.6Gy), respectively. Conclusion: The 3D conformal accelerated partial breast irradiation using two minitangent and “en face” electron beams using a total dose of 40Gy in 10 fractions BID over 5days achieves appropriate planning target volume coverage and offers significant normal-tissue sparing (heart, lung). Longer follow-up is needed to evaluate the tissue tolerance to this radiation dose. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of this study was to evaluate the vaccinal status among Croix-Rousse Hospital workers, attitude towards this vaccination, and the information delivered in order to promote this vaccination. Methods: Questionnaires were delivered by electronic mailing. Results: Six hundred (and) twenty-nine questionnaires were analyzed (26.7% of hospital workers); 30.7% of responders were vaccinated against influenza, 89.2% of responders were aware of influenza and vaccine. Vaccine coverage was lower in younger workers, non health-care workers, non physician health-care workers, and surgeons who responded. Motivation and reserve varied according to the status, position, and age, with some discrepancies. Conclusion: These results suggest implementing a better targeted vaccination campaign, according to the various categories of personnel. [Copyright &y& Elsevier]

Depuis 2016, le contexte migratoire en France a confronté les centres de luttes antituberculeuses (CLAT) à la découverte fréquente de séquelles de tuberculose pulmonaire (TP) chez les migrants primo-arrivants (MPA) en France depuis moins de 2 ans. Forts de cette constatation et de l'absence de recommandations actualisées concernant les séquelles de TP, une analyse de la prise en charge de ces séquelles de TP chez les MPA dans un CLAT a été réalisée entre 2016 et 2019 avec étude rétrospective de tous les dossiers en vue d'une harmonisation de pratiques. Analyse rétrospective des pratiques concernant les patients migrants primo-arrivants pris en charge au sein d'un CLAT pour des séquelles de TP de 2016 à 2019 : description du contexte diagnostic (symptômes, imagerie, prélèvements respiratoires), des caractéristiques des patients et de la prise en charge proposée à partir des dossiers médicaux et des données extraites du logiciel institutionnel. Entre 2016 et 2019, 94 cas de séquelles de TP ont été diagnostiqués chez des MPA, majoritairement dans le cadre d'un dépistage systématique (n = 88) ou moins souvent dans le cadre de symptômes évocateurs de tuberculose-maladie (n = 6). Le recours au scanner thoracique était quasiment systématique (n = 92). Quarante-neuf patients (52 %) ont bénéficié de prélèvements respiratoires (dont 24 fibroscopies) : toutes les cultures étaient stériles. Les patients étaient majoritairement des hommes (n = 74, 79 %), l'âge médian était de 32 ans, 11 patients étaient mineurs. Plus de 20 % des MPA présentaient une antériorité de tuberculose-maladie (TM) traitée dans les 10 années précédant l'arrivée en France (n = 19, 21 %) dont 6 TM (31 %) considérées comme mal ou non traitées. La prise en charge de ces patients a consisté en un suivi clinicoradiologique dans 53 % des cas (n = 50), un traitement de séquelles par rifampicine et isoniazide pendant 4 mois dans 35 % des cas (n = 33) ou un traitement antituberculeux standard dans 6,5 % des cas (n = 6) majoritairement du fait d'une immunodépression. Cinq patients (5,6 %) n'ont pas été suivis sur décision médicale. Parmi ces 94 patients, nous avons eu connaissance d'une récidive tuberculeuse, les autres patients n'ayant pas fait l'objet d'une déclaration à l'Agence régionale de santé de notre département. Devant le nombre élevé de diagnostics de séquelles de TP chez les migrants primo-arrivants et le besoin d'harmonisation des pratiques, il a été construit un algorithme de prise en charge des séquelles sur la base de ce travail d'analyse rétrospective des dossiers, des données de la littérature et de l'avis des référents/experts locaux. Les paramètres choisis pour la construction de l'algorithme sont l'âge du patient, la date d'arrivée en France, l'antécédent daté de tuberculose et la notion de traitement antérieur adapté ou non. Depuis 2019, cet algorithme est utilisé systématiquement et les patients sont suivis prospectivement, l'étape suivante étant la validation externe de l'algorithme sur un échantillon indépendant via le réseau des CLAT. [ABSTRACT FROM AUTHOR]

La prévention vaccinale est un sujet de santé publique prioritaire en France et les professionnels de santé, notamment les médecins généralistes, ont un rôle important d'information auprès de leurs patients. La formation de ces professionnels est une des missions du Centre de vaccinations polyvalentes (CVP). L'objectif de cette étude était de connaître les besoins des professionnels de santé en matière de vaccination et d'évaluer, au travers leur perception de la vaccination et leurs difficultés, s'ils identifiaient bien le CVP comme centre ressource, plus de 10 ans après sa création. Une enquête transversale et descriptive a été réalisée en janvier 2019 par l'envoi postal d'un questionnaire à destination de l'ensemble des 1334 médecins généralistes, exerçant une activité libérale, répertoriés auprès de la Caisse primaire d'assurance maladie du département. Une enveloppe T était fournie pour le retour de leur réponse. Il n'y a pas eu de relance. Les analyses ont été effectuées avec les logiciels Microsoft Excel et Epi-Info 7. Les pourcentages se basent sur le nombre de répondant pour chaque question. Le taux de réponses était de 34,6 % (n = 461). Les médecins avaient en moyenne 46,5 ans, 57,4 % (n = 263) étaient de sexe féminin et 73,8 % (n = 338) exerçaient la médecine générale de manière exclusive. L'opinion favorable à la vaccination, sur le plan individuel et collectif, était partagée par respectivement 98,3 % (n = 451) et 99,8 % (n = 458) des praticiens mais 52,9 % (n = 243) estimaient qu'elle était une source d'inquiétude pour la population. D'ailleurs, 99,4 % (n = 455) avaient déjà été confrontés à des réticences de la part de leurs patients : les vaccins contre le papillomavirus et l'hépatite B étaient les plus cités, respectivement 66,2 % (n = 294) et 75,5 % (n = 335). La peur des effets secondaires était la principale raison, identifiée par 60,1 % (n = 175) des 291 médecins ayant précisé les réticences de leurs patients. Parmi les 26,5 % (n = 120) de praticiens ayant eux-mêmes des réticences à prescrire certains vaccins, 47,9 % (n = 57) citaient le vaccin contre le papillomavirus. Concernant l'obligation vaccinale des nourrissons au 1/01/18, 75,4 % (n = 343) d'entre eux jugeaient cette loi nécessaire pour la santé publique. Des informations sur le thème de la vaccination étaient souhaitées par 64,3 % (n = 286) d'entre eux. Enfin, 72 % (n = 317) connaissaient le CVP, versus 22,4 % (n = 103/459 répondants) en 2008, selon une enquête réalisée avec la même méthodologie (p < 0,001). Les médecins généralistes sont favorables à la vaccination mais ont besoin d'outils et d'informations pour argumenter auprès de leurs patients réticents et ainsi augmenter la couverture vaccinale. Le CVP doit continuer à être un acteur de la promotion vaccinale et l'interlocuteur privilégié des médecins généralistes. Il doit mettre l'accent sur la communication auprès des professionnels de santé sur les outils existants et mis à leur disposition afin de les aider dans leur pratique. [ABSTRACT FROM AUTHOR]

A ten years survey of 848 patients having sustained traumatic spinal cord injury between 1969 and 1979 was conducted in the Rhône-Alpes Region, France. All patients had been referred to the spinal cord injury unit, Hôpital Henry Gabrielle. 48 deaths were recorded: 36 patients admitted early to the Unit, and 12 patients injured before 1969 but followed-up in the Unit. The deceased patients were older and more frequently male and tetraplegic than the rest of the group. In 75 per cent of the deceased patients, the survival time was less than 1/5 of the theoretical life expectancy. In 59 per cent, it was less than 1/10. Twenty tetraplegics died of respiratory complications. Three patients committed suicide, the rest died of urinary complications. The results appear to determine a secondary period with high mortality rate, after the initial high mortality of these patients. About one year post-injury, the life expectancy in our series appears to tend towards the values observed in the French population.