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International audience; Objective: To explore the factors associated with the uptake of mammography screening in Reunionese women aged 50-65 years.Methods: This study included all women aged 50 to 65 years participating in a population-based cross-sectional study "FOSFORE". Participants were recruited between March and June 2017 using two sampling frames. The first frame consisted of households with a landline telephone, with or without a mobile line, by first randomly generating a telephone number and then randomly selecting an individual from among all eligible women in the household. The second sampling frame was constituted of women with an exclusive mobile line, who were selected directly if they met the eligibility criteria. Data were weighted for age and socio-professional status to ensure representativeness at the Reunion Island level. Weighted logistic regression was used to calculate odds ratios while adjusting for confounders.Results: 417 women were included in the study; 63.8% were up to date with guidelines on mammography screening and 36.2% were not up to date. Four factors were significantly associated with mammography screening, with an adjusted odds ratio of 2.92 (95% CI 1.51-5.61) for not having an Active Solidarity Income, 1.98 (95% CI 1.22-3.23) for having a regular gynecological follow-up by a physician, 6.53 (95% CI 3.23-13.21) for performing a Pap smear test in the past two years, and 2.07 (95% CI 1.21-3.52) for having an adequate literacy level (HLQ3).Conclusion: The findings of this study suggest that higher socio-economic status is an indicator of participation in mammography screening in La Réunion, and future educational and intervention programs should target women in deprived areas.

International audience; Introduction: The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists.Methods: We devised a tool that included nine questions covering anxiety, depression, suicide risk and psychotic symptomatology. Its use required no specific background and 2 h training. Specificity and sensitivity of the QST were assessed in a population of 418 PWID recruited via respondent driven sampling, using the Mini International Neuropsychiatric Interview questionnaire plus clinical evaluation as a reference standard. Acceptability was assessed using a self-administered anonymous questionnaire submitted to all CBO members who used the QST.Results: CBO members considered the QST easy to use, relevant and helpful to deal with mental health issues. Area under the curve for detection of any symptom using the QST was 0.770. The maximum sensitivity and specificity were reached with a cut-off of 2 [sensitivity was 71.1% (95% confidence interval 62.4, 78.8), specificity was 75.9% (70.5, 80.7)].Discussion and conclusions: The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.

International audience; Approaching the mechanisms related to false positives HIV rapid diagnostic tests (RDT) in patients with sleeping sickness may help to improve the accuracy of screening for HIV infection in areas endemic for Human African trypanosomiasis (HAT).We report on a patient from Congo who was managed like an AIDS-associated meningoencephalitis, based on a false positive HIV RDT at admission, and eventually received a diagnosis of sleeping sickness. A further retrospective cohort study performed in patients with HAT shows that most of positive HIV RDT obtained prior to treatment for sleeping sickness are false positives. We found that half of them were cleared at the end of treatment course, suggesting an early clearance of some antibodies involved in cross-reactivity.A substantial clearance of HIV RDT false positives occurs during therapy for HAT. In areas where Elisa HIV tests are not readily available, repeating the HIV RDT at the end of therapy may help to identify roughly half of false positives.

International audience; We used a mathematical model to evaluate the impact of mass testing in the control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Under optimistic assumptions, one round of mass testing may reduce daily infections by up to 20–30%. Consequently, very frequent testing would be required to control a quickly growing epidemic if other control measures were to be relaxed. Mass testing is most relevant when epidemic growth remains limited through a combination of interventions.

This work resulted from the MOD-COV Project (Modelling of the hOspital Dissemination of SARS-CoV-2), a collaboration between the Institut Pasteur, the Conservatoire Nationale des Arts et Métiers, and the AVIESAN/REACTing working group “Modelling SARS-CoV-2 dissemination in healthcare settings”, whose members we thank (Niccolo Buetti, Christian Brun-Buisson, Sylvie Burban, Simon Cauchemez, Guillaume Chelius, Anthony Cousien, Pascal Crepey, Vittoria Colizza, Christel Daniel, Aurélien Dinh, Pierre Frange, Eric Fleury, Antoine Fraboulet, Marie-Paule Gustin, Lidia Kardas-Sloma, Elsa Kermorvant, Jean Christophe Lucet, Chiara Poletto, Rodolphe Thiebaut, Sylvie van der Werf, Philippe Vanhems, Linda Wittkop, Jean-Ralph Zahar).We also thank the i-Bird Study Group (Anne Sophie Alvarez, Audrey Baraffe, Mariano Beiró, Inga Bertucci, Pierre-Yves Boëlle, Camille Cyncynatus, Florence Dannet, Marie Laure Delaby, Pierre Denys, Matthieu Domenech de Cellès, Eric Fleury, Antoine Fraboulet, Jean-Louis Gaillard, Boris Labrador, Jennifer Lasley, Christine Lawrence, Judith Legrand, Odile Le Minor, Caroline Ligier, Lucie Martinet, Karine Mignon, Catherine Sacleux, Jérôme Salomon, Thomas Obadia, Marie Perard, Laure Petit, Laeticia Remy, Anne Thiebaut, Damien Thomas, Philippe Tronchet, Isabelle Villain), as well as Jacob Barrett for helpful discussion.; International audience; Background: Long-term care facilities (LTCFs) are vulnerable to outbreaks of coronavirus disease 2019 (COVID-19). Timely epidemiological surveillance is essential for outbreak response, but is complicated by a high proportion of silent (non-symptomatic) infections and limited testing resources.Methods: We used a stochastic, individual-based model to simulate transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) along detailed inter-individual contact networks describing patient-staff interactions in a real LTCF setting. We simulated distribution of nasopharyngeal swabs and reverse transcriptase polymerase chain reaction (RT-PCR) tests using clinical and demographic indications and evaluated the efficacy and resource-efficiency of a range of surveillance strategies, including group testing (sample pooling) and testing cascades, which couple (i) testing for multiple indications (symptoms, admission) with (ii) random daily testing.Results: In the baseline scenario, randomly introducing a silent SARS-CoV-2 infection into a 170-bed LTCF led to large outbreaks, with a cumulative 86 (95% uncertainty interval 6-224) infections after 3 weeks of unmitigated transmission. Efficacy of symptom-based screening was limited by lags to symptom onset and silent asymptomatic and pre-symptomatic transmission. Across scenarios, testing upon admission detected just 34-66% of patients infected upon LTCF entry, and also missed potential introductions from staff. Random daily testing was more effective when targeting patients than staff, but was overall an inefficient use of limited resources. At high testing capacity (> 10 tests/100 beds/day), cascades were most effective, with a 19-36% probability of detecting outbreaks prior to any nosocomial transmission, and 26-46% prior to first onset of COVID-19 symptoms. Conversely, at low capacity (< 2 tests/100 beds/day), group testing strategies detected outbreaks earliest. Pooling randomly selected patients in a daily group test was most likely to detect outbreaks prior to first symptom onset (16-27%), while pooling patients and staff expressing any COVID-like symptoms was the most efficient means to improve surveillance given resource limitations, compared to the reference requiring only 6-9 additional tests and 11-28 additional swabs to detect outbreaks 1-6 days earlier, prior to an additional 11-22 infections.Conclusions: COVID-19 surveillance is challenged by delayed or absent clinical symptoms and imperfect diagnostic sensitivity of standard RT-PCR tests. In our analysis, group testing was the most effective and efficient COVID-19 surveillance strategy for resource-limited LTCFs. Testing cascades were even more effective given ample testing resources. Increasing testing capacity and updating surveillance protocols accordingly could facilitate earlier detection of emerging outbreaks, informing a need for urgent intervention in settings with ongoing nosocomial transmission.

Background Rapid elimination of Plasmodium falciparum malaria in Cambodia is a goal with both national and international significance. Transmission of malaria in Cambodia is limited to forest environments, and the main population at risk consists of forest-goers who rely on forest products for income or sustenance. The ideal interventions to eliminate malaria from this population are unknown. Methods In two forested regions of Cambodia, forest-goers were trained to become forest malaria workers (FMWs). In one region, FMWs performed mass screening and treatment, focal screening and treatment, and passive case detection inside the forest. In the other region, FMWs played an observational role for the first year, to inform the choice of intervention for the second year. In both forests, FMWs collected blood samples and questionnaire data from all forest-goers they encountered. Mosquito collections were performed in each forest. Results Malaria prevalence by PCR was high in the forest, with 2.3–5.0% positive for P. falciparum and 14.6–25.0% positive for Plasmodium vivax among forest-goers in each study site. In vectors, malaria prevalence ranged from 2.1% to 9.6%, but no P. falciparum was observed. Results showed poor performance of mass screening and treatment, with sensitivity of rapid diagnostic tests equal to 9.1% (95% CI 1.1%, 29.2%) for P. falciparum and 4.4% (95% CI 1.6%, 9.2%) for P. vivax. Malaria infections were observed in all demographics and throughout the studied forests, with no clear risk factors emerging. Conclusions Malaria prevalence remains high among Cambodian forest-goers, but performance of rapid diagnostic tests is poor. More adapted strategies to this population, such as intermittent preventive treatment of forest goers, should be considered.

Introduction: Castiglione D’Adda is one of the municipalities more precociously and severely affected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) epidemic in Lombardy. With our study we aimed to understand the diffusion of the infection by mass serological screening. Methods: We searched for SARS-CoV-2 IgGs in the population on a voluntary basis using lateral flow immunochromatographic tests (RICT) on capillary blood (rapid tests). We then performed chemioluminescent serological assays (CLIA) and naso-pharyngeal swabs (NPS) in a randomized representative sample and in each subject with a positive rapid test. Factors associated with RICT IgG positivity were assessed by uni- and multivariable logistic regression models. Results: Out of the 4143 participants, 918 (22·2%) showed an RICT IgG positivity. In multivariable analysis, IgG positivity increases with age, with a significant non-linear effect (p=0·0404). We found 22 positive NPSs out of the 1330 performed. Conclusions: Albeit relevant, the IgG prevalence is lower than expected and suggests that a large part of the population remains susceptible to the infection. The observed differences in prevalence might reflect a different infection susceptibility by age group. A limited persistence of active infections (positive NPSs) could be found after several weeks after the epidemic peak in the area. Funding Statement: CISOM (Corpo Italiano di Soccorso dell'Ordine di Malta), FC Internazionale Milano, SFD s.p.a , Emporio Armani Olimpia Milano through donations to the Dipartimento di Scienze Biomediche e Cliniche (DIBIC) of the University of Milan and to Banca Mediolanum through donation to ASST FatebenefratelliSacco, Milano. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The study was approved by University of Milan’s Ethical Committee.

ObjectiveTo assess trends in the average costs and effectiveness of the French ultrasound screening programme for birth defects.DesignA population-based study.SettingNational Public Health Insurance claim database.ParticipantsAll pregnant women in the ‘Echantillon Généraliste des Bénéficiaires’, a permanent representative sample of 1/97 of the individuals covered by the French Health Insurance System.Main outcomes measuresTrends in the costs and in the average cost-effectiveness ratio (ACER) of the screening programme (in € per case detected antenatally), per year, between 2006 and 2014. incremental cost-effectiveness ratio (ICER) from 1 year to another were also estimated. We assessed costs related to the ultrasound screening programme of birth defects excluding the specific screening of Down’s syndrome. The outcome for effectiveness was the prenatal detection rate of birth defects, assessed in a previous study. Linear and logistic regressions were used to analyse time trends.ResultsDuring the study period, there was a slight decrease in prenatal detection rates (from 58.2% in 2006 to 55.2% in 2014; p=0.015). The cost of ultrasound screening increased from €168 in 2006 to €258 per pregnancy in 2014 (p=0.001). We found a 61% increase in the ACER for ultrasound screening during the study period. ACERs increased from €9050 per case detected in 2006 to €14 580 per case detected in 2014 (p=0.001). ICERs had an erratic pattern, with a strong tendency to show that any increment in the cost of screening was highly cost ineffective.ConclusionEven if the increase in costs may be partly justified, we observed a diminishing returns for costs associated with the prenatal ultrasound screening of birth defects, in France, between 2006 and 2014.

Introduction - The new French recommendations propose the introduction of the HPV test as part of organized screening. This has the advantage of being able to be carried out using a vaginal self-sampling, efficient to increase the participation of non-participating women. The main objective of the study was to collect the views and feelings of women regarding HPV vaginal self-sampling.Methodology - Eleven women who had not had a smear for at least three and a half years, and aged between 30 and 65, have been interviewed by semi-structured individual interview using an interview guide. The women were able to appropriate the test as well as the leaflet, created for the study.Results - For some women, the HPV vaginal self-sampling seemed easy to use, small, ergonomic, practical, more intimate. The test appeared to be a medical device and allowed control of the gesture. Other women were confused about the manipulation, the risk of contamination or falsifying the results. Some women were afraid of being faced with a positive result. Women of lower socio-economic status seemed more perplexed, less confident, but the test seemed feasible. The women wanted an organized course of care combined with clear, precise and varied information. Several screening strategies have been proposed, such as sending a self-sampling kit by mail or involving doctors.Conclusion - The HPV vaginal self-sampling seemed to be a promising alternative for non-participating women. Information actions, the establishment of an organized care path combining strategies and upgrading the place of the general practitioner could be avenues to evaluate for a good integration of the HPV vaginal self-sampling.; Introduction : les nouvelles recommandations françaises proposent l’introduction du test HPV dans le cadre d’un dépistage organisé. Celui-ci a pour avantage de pouvoir être réalisé à partir d’un auto-prélèvement vaginal (APV), efficace pour augmenter la participation des femmes non participantes. L’objectif principal de l’étude était de recueillir le point de vue des femmes vis-à-vis de l’APV HPV.Méthodologie : onze femmes non à jour du frottis depuis au moins 3 ans et demi, âgées entre 30 et 65 ans, ont été interrogées par entretien individuel semi-dirigé à l’aide d’un guide d’entretien. Les femmes ont pu s’approprier le test ainsi que la notice, créée pour l’étude.Résultats : pour certaines femmes, l’APV semblait facile à utiliser, petit, ergonomique, pratique, plus intime. Il paraissait être un dispositif médical et permettait une maitrise du geste. D’autres femmes étaient perplexes quant à la manipulation, le risque de contamination ou de fausser les résultats. Certaines femmes avaient peur de se retrouver devant un résultat positif. Les femmes de niveau socio-économique plus faible semblaient plus perplexes, moins confiantes mais l’APV paraissait faisable. Les femmes souhaitaient un parcours de soin organisé associé à une information claire, précise et variée. Plusieurs stratégies de dépistage ont été proposées comme l’envoi d’un kit APV par la poste ou l’implication des médecins.Conclusion : l’APV semblait être une alternative prometteuse pour les femmes non participantes. Des actions d’informations, l’instauration d’un parcours de soin organisé combinant les stratégies et la revalorisation de la place du médecin généraliste pourraient être des pistes à évaluer pour une bonne intégration de l’APV.

International audience; OBJECTIVE. Fast breast MRI protocols have the same sensitivity as conventional protocols, but their specificity is variable and can be inadequate. An ultrafast sequence provides early enhancement of lesion characteristics that optimize the characterization of the fast protocol, increasing positive predictive values without increasing time. CONCLUSION. These new abbreviated protocols could constitute a viable screening tool both for women at high risk of breast cancer and for those at intermediate risk with high breast density.

International audience; The purpose of this paper is to identify which Provider-Initiated HIV Testing and Counseling (PITC) organizational models are the most efficient to maximize testing coverage. We conducted a systematic literature review to identify published articles that evaluated routine PITC programs implemented in adult health facilities in Sub-Saharan Africa. We considered only articles measuring PITC offer, PITC acceptability and PITC coverage. Adjusted meta-regression models were performed to measure the association between PITC offer, acceptability and coverage with PITC organizational model. A total of 30 articles were included in the meta-analysis. Overall, 85.4% [95%CI: 77.2-93.5] of patients were offered a test, and 87.1% [82.4-91.7] accepted the test resulting in a PITC coverage of 74.3% [66-82.6]. Four types of PITC organizational models were identified: PITC initiated and performed during the consultation (model A), PITC initiated before consultation (model B), PITC referred on-site (model C) and PITC referred off-site (model D). Compared to model A, model B had a similar coverage (aOR: 1.02 [0.82-1.26]). However, coverage was lower for model C (aOR: 0.81 [0.68-0.97]) and model D (aOR: 0.58 [0.44-0.77]). Initiating the testing process before or during medical consultation is recommended for maximizing testing coverage among patients.

Context: the coexistence of individual screening (IS) and organized screening (OS) for breast cancer is a French particularity. Interregional disparities show the difficulty for primary care physicians to position themselves between IS and OS. Objective: this study aimed to compare the risk of breast cancer on mammograms between patients who performed mammograms as part of an individual screening and those who did it as part of organized screening. Methods: a cross-sectional multicenter study included women aged 50 to 74, with no personal history of breast cancer, performing mammograms in 3 radiology centers in Paris. The nature of the screening (OS or IS), mammographic outcome (high risk: ACR 4, 5 or low risk: ACR 1, 2, 3), breast cancer risk factors and clinical breast examination (CBE) abnormalities were collected. Patients in the IS and OS group were matched on age, breast density, history of benign lesions and family history of breast cancer with a propensity score. The association between the nature of screening and the risk of malignancy was evaluated by conditional logistic regression. Results: the mean age was 59.7 (+/-6.7) years old for the 2190 included patients. Those who performed IS mammography represented 77% of the population and had significantly more CBE abnormalities (23% vs 11%), a history of benign lesion (15% vs 11%) and a family history (42% vs 29%). After pairing 503 OS patients with 941 IS patients, the high risk of malignancy on mammography and the nature of the screening were not associated (OR = 0,72 [0.35-1.47], p=0.50). Conclusion: the risk of malignancy was the same whether the mammography was performed as part of the OS or IS. The use of an intermediate endpoint to assess cancer risk is one of the main limitations, but it seems relevant because it is the result of mammography that is decisive in further exploration.; Contexte : la coexistence d’un dépistage individuel (DI) et d’un dépistage organisé (DO) dans le cadre du cancer du sein est une particularité française. Les disparités interrégionales montrent la difficulté pour les médecins de soins premiers à se positionner entre DI et DO. Objectif : cette étude avait pour objectif d’étudier si le risque de malignité sur mammographie était différent entre les patientes effectuant une mammographie dans le cadre d’un dépistage individuel (DI) et celles en ayant bénéficié dans le cadre du dépistage organisé (DO). Méthodes : une étude transversale multicentrique a inclus les femmes de 50 à 74 ans sans antécédent de cancer du sein effectuant une mammographie dans plusieurs centres de radiologie en région Parisienne. La nature du dépistage (DO ou DI), le résultat de la mammographie (haut risque : ACR 4, 5 ou faible risque : ACR 1, 2, 3), les facteurs de risque de cancer du sein et les anomalies à l’examen clinique des seins (ECS) étaient recueillis. Les patientes du groupe DI et DO, étaient appariées sur l’âge, la densité mammaire, les antécédents de lésions bénignes et les antécédents familiaux de cancer du sein grâce à un score de propension. L’association entre la nature du dépistage et le risque de malignité était recherchée par une régression logistique conditionnelle. Résultats : les 2190 patientes incluses étaient âgées en moyenne de 59,7 (+/-6,7) ans. Celles ayant réalisé une mammographie dans le cadre du DI représentaient 77% de la population et avaient significativement plus d’anomalies à l’ECS (23% vs 11%), d’antécédents de lésion bénigne (15% vs 11%) et d’antécédents familiaux (42% vs 29%). Après appariement de 503 patientes du DO avec 941 patientes du DI, le haut risque de malignité à la mammographie et la nature du dépistage n’étaient pas associés (OR = 0,72 [0.35-1.47], p=0.50). Conclusion : le risque de malignité était identique, que la mammographie soit réalisée dans le cadre du DO ou du DI. L’utilisation d’un critère de jugement intermédiaire pour évaluer le risque de cancer est une des principales limites, mais il semble pertinent car c’est le résultat de la mammographie qui est déterminant dans la poursuite des explorations.

The health of migrants is a complex issue in public health. In French Guyana, as elsewhere, globalization, through migrants in particular, has transformed the care of diseases previously geographically distant. In this context, the borders now concern the entire territory and not just the peripheries. These borders contribute to the aggravation of the migrants health determinants through the complex and sometimes risky paths that they generate. Transboundary areas are also areas of high vulnerability. However, these cross-border spaces and routes can also constitute health resources, in the original interfaces that they can produce in terms of cooperation promoting shared screening and monitoring programs.FRONTIÈRES : PROBLÈMES OU RESSOURCES EN SANTÉ POUR LES MIGRANTS ? EXEMPLE DE LA GUYANE. La santé des migrants représente un enjeu complexe en santé publique. En Guyane comme ailleurs, la globalisation, au travers des migrants notamment, a transformé les prises en charge sanitaires de pathologies qui étaient jusqu’alors géographiquement bien éloignées. Dans ce contexte, les frontières intéressent dorénavant l’ensemble du territoire et non plus seulement les périphéries. Ces frontières participent à l’aggravation des déterminants en santé des migrants du fait des parcours complexes et parfois risqués qu’elles engendrent. Les espaces transfrontaliers représentent également des zones de grande vulnérabilité. Cependant, ces espaces et parcours transfrontaliers peuvent aussi constituer des ressources en santé dans les interfaces originales qu’elles peuvent produire en termes de coopération promouvant des programmes partagés de dépistage et de suivi.

Author(s): Vermeulen, Marion; Sykes, Wendy; Coleman, Charl; Custer, Brian; Jacobs, Genevieve; Jaza, Jabulisile; Kaidarova, Zhanna; Hlela, Carol; Gessain, Antoine; Cassar, Olivier; Poole, Colwyn; Ingram, Charlotte; Murphy, Edward L; Reddy, Ravi | Abstract: Background and objectivesDonated blood is not currently screened for human T-cell lymphotropic virus (HTLV) in South Africa. Several small studies have detected HTLV-1 in South Africa, but prevalence by geographic region or population group is unavailable.Materials and methodsWe performed a large seroprevalence study of South African blood donors during 3 months in 2013. All geographic regions except the Western Cape were included, and Black and Coloured (local term for mixed race) donors were oversampled. Identity-unlinked plasma samples were screened with the Abbott Prism HTLV-1/2 assay, and repeatedly reactive samples were tested by the Inno-LIA HTLV-1/2 Score confirmatory assay. Odds ratios were calculated with multivariable logistic regression.ResultsOf 46 752 donors tested, 133 (0·28%) were initially reactive, 111 (0·24%) repeatedly reactive and 57 (0·12%) confirmed positive for HTLV-1; none were HTLV-2 positive. Prevalence was 0·062% weighted to annual blood donations but highly concentrated in the Black population group (OR = 20·24 CI: 2·77-147·88); higher in females than males (OR = 1·81 CI: 1·06-3·08); and in donors aged g50 years compared to ages 16-19 (OR = 6·4 CI: 2·95-13·86). After controlling for age, sex and population group, there was no difference in prevalence between new and repeat blood donors or among geographic regions within South Africa.ConclusionsWe conclude that HTLV-1 infection is widespread among the Black population of South Africa and its epidemiology is similar to other endemic areas. Because South Africa is increasing its recruitment of Black blood donors, the implications for blood screening require further consideration.

The health of migrants is a complex issue in public health. In French Guyana, as elsewhere, globalization, through migrants in particular, has transformed the care of diseases previously geographically distant. In this context, the borders now concern the entire territory and not just the peripheries. These borders contribute to the aggravation of the migrants health determinants through the complex and sometimes risky paths that they generate. Transboundary areas are also areas of high vulnerability. However, these cross-border spaces and routes can also constitute health resources, in the original interfaces that they can produce in terms of cooperation promoting shared screening and monitoring programs., La santé des migrants représente un enjeu complexe en santé publique. En Guyane comme ailleurs, la globalisation, au travers des migrants notamment, a transformé les prises en charge sanitaires de pathologies qui étaient jusqu’alors géographiquement bien éloignées. Dans ce contexte, les frontières intéressent dorénavant l’ensemble du territoire et non plus seulement les périphéries. Ces frontières participent à l’aggravation des déterminants en santé des migrants du fait des parcours complexes et parfois risqués qu’elles engendrent. Les espaces transfrontaliers représentent également des zones de grande vulnérabilité. Cependant, ces espaces et parcours transfrontaliers peuvent aussi constituer des ressources en santé dans les interfaces originales qu’elles peuvent produire en termes de coopération promouvant des programmes partagés de dépistage et de suivi.

The reliability and validity of a screening test for a deficit in elementary visuo-spatial perception (EVSP) were evaluated.This prospective study collected performance from 210 typically developing individuals and evaluated the internal consistency of the EVSP screening test. Test-retest reliability was examined with 25 individuals. Validity also involved retrospective clinical data collected from 223 non-typically developing children coming to the hospital for outpatient consultation. Since EVSP matures through childhood, we standardized the EVSP screening test scores by age category and performed Pearson correlations with standardized clinical tests scores.Test-retest reliability (intraclass correlation coefficient=0.76) and internal consistency (Cronbach's alpha=0.76) were satisfactory. Construct validity included correlation with the subtests of the Wechsler Intelligence Scale IV (WISC-IV) involving visuo-spatial analysis (Matrix Reasoning and Block Design, P0.01; Symbol Search and Coding, P0.05) and was reinforced by the expected non-correlation between the Verbal Comprehension Index and EVSP scoring class. The EVSP scoring class was correlated with Manual dexterity of the M-ABC (P0.05) and the Working Memory Index (P0.05) of the WISC-IV including the subtest Arithmetic (P0.01).This screening test is reliable and valid to evaluate EVSP before more complex cognitive or motor assessment.

International audience; Background & aims: Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy.Methods: We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (

Background The prevalence of and mortality from HIV-associated tuberculosis (HIV/TB) in hospital inpatients in Africa remains unacceptably high. Currently, there is a lack of tools to identify those at high risk of early mortality who may benefit from adjunctive interventions. We therefore aimed to develop and validate a simple clinical risk score to predict mortality in high-burden, low-resource settings. Methods and findings A cohort of HIV-positive adults with laboratory-confirmed TB from the STAMP TB screening trial (Malawi and South Africa) was used to derive a clinical risk score using multivariable predictive modelling, considering factors at hospital admission (including urine lipoarabinomannan [LAM] detection) thought to be associated with 2-month mortality. Performance was evaluated internally and then externally validated using independent cohorts from 2 other studies (LAM-RCT and a Médecins Sans Frontières [MSF] cohort) from South Africa, Zambia, Zimbabwe, Tanzania, and Kenya. The derivation cohort included 315 patients enrolled from October 2015 and September 2017. Their median age was 36 years (IQR 30–43), 45.4% were female, median CD4 cell count at admission was 76 cells/μl (IQR 23–206), and 80.2% (210/262) of those who knew they were HIV-positive at hospital admission were taking antiretroviral therapy (ART). Two-month mortality was 30% (94/315), and mortality was associated with the following factors included in the score: age 55 years or older, male sex, being ART experienced, having severe anaemia (haemoglobin < 80 g/l), being unable to walk unaided, and having a positive urinary Determine TB LAM Ag test (Alere). The score identified patients with a 46.4% (95% CI 37.8%–55.2%) mortality risk in the high-risk group compared to 12.5% (95% CI 5.7%–25.4%) in the low-risk group (p < 0.001). The odds ratio (OR) for mortality was 6.1 (95% CI 2.4–15.2) in high-risk patients compared to low-risk patients (p < 0.001). Discrimination (c-statistic 0.70, 95% CI 0.63–0.76) and calibration (Hosmer-Lemeshow statistic, p = 0.78) were good in the derivation cohort, and similar in the external validation cohort (complete cases n = 372, c-statistic 0.68 [95% CI 0.61–0.74]). The validation cohort included 644 patients between January 2013 and August 2015. Median age was 36 years, 48.9% were female, and median CD4 count at admission was 61 (IQR 21–145). OR for mortality was 5.3 (95% CI 2.2–9.5) for high compared to low-risk patients (complete cases n = 372, p < 0.001). The score also predicted patients at higher risk of death both pre- and post-discharge. A simplified score (any 3 or more of the predictors) performed equally well. The main limitations of the scores were their imperfect accuracy, the need for access to urine LAM testing, modest study size, and not measuring all potential predictors of mortality (e.g., tuberculosis drug resistance). Conclusions This risk score is capable of identifying patients who could benefit from enhanced clinical care, follow-up, and/or adjunctive interventions, although further prospective validation studies are necessary. Given the scale of HIV/TB morbidity and mortality in African hospitals, better prognostic tools along with interventions could contribute towards global targets to reduce tuberculosis mortality., Author summary Why was this study done? HIV-associated tuberculosis (TB) is very common in hospitals in sub-Saharan Africa, and is a major cause of morbidity and mortality. There is a lack of tools to identify which patients are more likely to die early; therefore, these patients cannot be targeted for more intensive clinical care or other treatments in addition to TB antibiotics and antiretroviral drugs. A new urine TB diagnostic test (detecting a substance called lipoarabinomannan [LAM]) can identify patients at higher risk of dying and, along with other simply measured clinical signs or symptoms, may be useful for predicting which patients are most likely to do poorly. What did the researchers do and find? We used data from HIV-positive adults admitted to hospital in Malawi and South Africa and diagnosed with TB to develop a simple clinical risk score to identify patients with a 50% chance of dying within 2 months. The score included 6 factors that can be measured at admission to hospital, including the results of the urine TB test, presence of anaemia, and some demographic factors. We then tested the performance of the risk score using data from studies of different patients from sub-Saharan Africa, and it performed similarly. The score was able to identify patients at higher risk of dying during admission to hospital, and after discharge from hospital. What do these findings mean? This score could be used to identify patients admitted to hospital and diagnosed with HIV-associated TB who may benefit most from more intensive clinical care, additional treatments, and/or closer follow-up after discharge. It could also be used as a research tool to study new drugs or strategies aimed at reducing mortality from with HIV-associated TB. This is the first such tool to our knowledge in this patient population, and future studies could optimise such predictive tools, in particular if appropriate new interventions and/or diagnostics become available.

BACKGROUND Dermatologists are recommended to ask psoriasis patients about musculoskeletal complaints to allow early detection and treatment of psoriatic arthritis (PsA). Screening tools have been developed to help identify patients warranting further rheumatologic assessment, but evidence suggests room for improvement in their diagnostic value and ease of use for outpatient practice. OBJECTIVE To develop and internally validate a brief tool for dermatologists to screen patients to refer to a rheumatologist for PsA diagnosis. METHODS After the literature review, 23 items were selected, covering pain at various locations and inflammatory signs of PsA. The validation study was conducted in medically diagnosed psoriasis patients consecutively recruited between 2012 and 2014 (Saint Joseph Hospital, Paris, France). Patients were enrolled by a dermatologist who helped to complete the questionnaire. Diagnosis of PsA was established by a rheumatologist based on CASPAR criteria. Multivariate logistic regression models were performed to build the scale, assessing discrimination through sensitivity, specificity and area under the ROC curve (AUC). Final model was internally validated using bootstrapping techniques. RESULTS One hundred and sixty-eight patients were recruited, of whom nine were excluded for known PsA and 21 did not attend the rheumatologist consultation. Of 137 included patients (median age 43 years, 59.6% men), 21 (15.3%) had a PsA diagnosis. Final regression model retained four independent items, including evocative signs of dactylitis, inflammatory heel pain, bilateral buttock pain and peripheral joint pain with swelling in patients aged

International audience; The total PSA testing has been frequently criticized for its effectiveness in the early detection of prostate cancer. These widely resumed in and out of the medical community have led to a decrease in prescriptions. Recommendations against the use of PSA for screening have been issued in France and in most countries. In the US, the significant decline in total PSA use since 2004 has led to an increase in advanced cancer diagnosis, which has led the authorities to back down. The US preventive services task force (USPSTF) now recommends that men between the ages of 55 and 69 make an individual decision about prostate cancer screening with their clinician. The purpose of this work is to summarize the good practices for the use of the total and free PSA with the views of these last data.

International audience; PURPOSE:While familial forms of complex disorders/differences of sex development have been widely reported, data regarding isolated hypospadias are sparse and a family history is thought to be less frequent. We aimed to determine the frequency of hypospadias in families of boys with hypospadias, to establish whether these familial forms exhibit a particular phenotype and to evaluate the prevalence of genetic defects of the main candidate genes.MATERIALS AND METHODS:A total of 395 boys with hypospadias were prospectively screened for a family history with a standardized questionnaire, extensive clinical description, family tree and sequencing of AR, SF1, SRD5A2 and MAMLD1.RESULTS:Family history of hypospadias was more frequent than expected (88 patients, 22.3%). In 17 instances (19.3%) familial hypospadias cases were multiple. Familial hypospadias was related to the paternal side in 59.1% of cases, consisting of the father himself (30.7%) as well as paternal uncles and cousins. Premature birth, assisted reproductive techniques, other congenital abnormalities and growth retardation were not more frequent in familial hypospadias than in sporadic cases. The severity of phenotype was similar in both groups. The results of genetic analysis combined with previous data on androgen receptor sequencing revealed that familial cases more frequently tend to demonstrate genetic defects than sporadic cases (5.68% vs 1.63%, p = 0.048).CONCLUSIONS:Familial forms of hypospadias are far more frequent than previously reported. Even minor and isolated forms justify a full clinical investigation of the family history. Detecting these hereditary forms may help to determine the underlying genetic defects, and may improve followup and counseling of these patients.

Objective To determine the prevalence of cytological abnormalities and high risk Human PapillomaVirus (hrHPV) in cervical smears from French women aged over 65 years who attended the referent Gynecology Clinic of the Besancon University Hospital. Methods Between 2002 and 2012, 796 French women aged 66–99 years were cotested for cytology and hrHPV by Hybrid Capture 2 (hc2). hc2-positive cases were subjected to real time PCR for specific HPV 16/18/45 genotyping. Women with normal Pap smears and positive for hrHPV were followed-up every 12 months. Results Cytological abnormalities were detected in more than 30% of women and cervical cancers (CC) in 2.9% of women. Benign lesions were more frequent in women aged 66–75 years while (pre)-malignant lesions were preferentially found in women over 76. The prevalence of hrHPV was 22.7%. HPV 16 was the most frequent (23.8%), followed by HPV 45 (7.7%) and HPV 18 (3.9%). The rate of hrHPV increased with the lesion severity and HPV 16 was identified in 50% of CC. Among the followed-up women, those who developed CIN3 were HPV16 positive at study entry. Conclusion The study provides important estimates of the prevalence of cervical abnormalities and hrHPV positivity in a French hospital based-population over 65. Findings suggest to consider this high risk population in regards to cervical cancer.

International audience; The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale-up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar-es-Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar-es-Salaam were obtained from records. In 2015, consecutive HCV-seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV-seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34-41), and 65 (44%) were co-infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar-es-Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania.

International audience; Here we propose a strategy allowing implementing efficient and practicable large-scale seroepidemiological studies for Zika Virus (ZIKV). It combines screening by a commercial NS1 protein-based Zika IgG ELISA, and confirmation by a cytopathic effect-based virus neutralization test (CPE-based VNT). In post-epidemic samples from Martinique Island blood donors (a population with a dengue seroprevalence above 90%), this strategy allowed reaching specificity and sensitivity values over 98%. The CPE-based VNT consists of recording CPE directly under the optical microscope, which is easy to identify with ZIKV strain H/PF/2013 at day 5 pi. Overall, considered that CPE-based VNT is cost effective and widely automatable, the NS1 protein-based Zika IgG ELISA+CPE-based VNT combination strategy represents a convenient tool to expedite ZIKV seroprevalence studies.

Introduction: the study of a population's health state is linked to the development of health policy choices. These measures make it possible to reach the socio-demographic characteristics, life habits and prevalence of pathologies impacting the individual. The environments in which the French military operates necessitate the medical selection of candidates when enlisting in the armies. They receive a complete medical examination and screening. While this medical expertise is oriented towards military fitness, it identifies a significant amount of data, allowing the study of the health status of the population that wishes to join the Armed Forces. Methods: a descriptive epidemiological study carried out within the 1st Antenna of Initial Military Expertise including all applicants for the engagement throughout June 2017, based on the data of the Medical-Biographical Questionnaires and the examination of the military selection physician. Results: 637 candidates were included. 86% of them were males, with an average age of 21.33 years, from Île de France, with a level of education equivalent to the end of secondary school, 34% of them were smokers and practiced on average 4.34 hours of sports per week. 87.4% of the candidates were fit for the enlisting, 40% of the reasons for incapacity were cardiac or orthopedic. Conclusion: the population wishing to join the Armed Forces has particular sociobiological characteristics compared to the general population of the same age. This systematic examination in adulthood led to 79 specialized investigations for the benefit of individuals.; Introduction : l’étude de l’état de santé d’une population est liée à la construction des volontés politiques sanitaires, ces mesures permettant d’approcher les caractéristiques socio-démographiques, des habitudes de vie et de prévalence des pathologies impactant l’individu. Les environnements dans lesquels évoluent les militaires français imposent la sélection médicale des candidats à l’engagement dans les Armées. Ceux-ci bénéficient d’un examen médical complet et de la réalisation de dépistages. Si cette expertise médicale est orientée vers l’aptitude à un emploi militaire, elle recense un grand nombre de données permettant l’étude de l’état de santé de la population souhaitant s’engager dans les Armées. Méthodes : étude épidémiologique descriptive réalisée au sein de la 1ère Antenne d’Expertises Militaires Initiales incluant tous les candidats à l’engagement durant tout le mois de Juin 2017, à partir des données des Questionnaires Médico-Biographiques et de l’examen du médecin militaire de sélection. Résultats : 637 candidats ont été inclus. 86% d’entre eux étaient de sexe masculin, d’âge moyen de 21,33 ans, étaient issus d’Île de France, avec un niveau scolaire équivalent à la fin du secondaire, 34% étaient fumeurs et pratiquaient en moyenne 4,34 heures de sport par semaine. 87,4% des candidats étaient aptes, 40% des motifs d’inaptitude étaient cardiologiques ou orthopédiques. Conclusion : la population souhaitant s’engager dans les Armées possède des caractéristiques sociobiologiques particulières par rapport à la population générale du même âge. Cet examen systématique à l’âge adulte a permis de faire réaliser 79 explorations spécialisées au bénéfice des individus.

Five to ten % of the elderly have protein-energy malnutrition. The early detection by the general practitioner could avoid a diagnosis at the stage of complications. Purpose : does the training of general practitioners to use the Mini Nutritional Assessment – Short Form (MNA-SF), in addition of training to screen, increase the amount of screening? Methods : it is an experimental, comparative, randomized, single blinded study. 80 general practitioners were randomly chosen in Haute-Savoie. They were excluded in the event of a refusal, absence or specific practice. All the physicians were randomised in two groups and were trained to screen the malnutrition of aged people. The test group was also trained to use the MNA-SF. They were asked to fill in a questionnaire 4 weeks later. Results : 50 general practitioners took part in the study, 25 in each group, from november 2016 to february 2017. The groups were similar. Eight % already knew the MNA-SF before training. Four weeks later, the test group did 126 screenings against 78 by the witness group (p=0.12). 24% of witness practitioners made 4 screenings or more, against 56% of the test practitioners (p=0.04). There were 27 positive screenings in the witness group, 60 in the test group (p=0.01). The opinion about the MNA-SF was great. Conclusion : training the general practitioners to use the MNA-SF could improve the amount and sensibility of protein-energy malnutrition’s screening in the elderly. The MNA-SF is insufficiently known in general practice.; Cinq à dix % des personnes âgées souffrent de dénutrition. Le dépistage précoce par le médecin traitant permettrait d’éviter le diagnostic au stade de complications. Objectif : la formation des médecins généralistes à la réalisation du Mini Nutritional Assessment – Short Form (MNA-SF), en plus d’une sensibilisation au dépistage, permet-il d’augmenter le nombre de dépistages réalisés ? Méthode : étude expérimentale comparative, randomisée, en simple aveugle. 80 médecins était tirés au sort parmi les médecins généralistes de Haute-Savoie. Ils étaient exclus en cas de refus ou d’absence ou de pratique spécifique. Les médecins participants étaient répartis en deux groupes par randomisation par bloc. Ils recevaient une formation au dépistage de la dénutrition des sujets âgés. Le groupe test bénéficiait en plus d’une formation au MNA-SF. Ils recevaient un questionnaire après 4 semaines d’activité. Résultats : 50 médecins généralistes ont participé à l’étude, 25 dans chaque groupe de novembre 2016 à février 2017. Les groupes étaient comparables. 8% connaissait le MNA-SF avant l’intervention. Après 4 semaines, le groupe test a réalisé 126 dépistages contre 78 dans le groupe témoin (p=0.12). 24% du groupe témoin ont réalisé au moins quatre dépistages contre 56% dans le groupe test (p=0.04). Le groupe témoin a totalisé 27 dépistages positifs contre 60 dans le groupe test (p=0.01). L’évaluation du MNA-SF était positive. Conclusion : la formation au MNA-SF des médecins généralistes semble améliorer la quantité et la sensibilité du dépistage de la dénutrition des personnes âgées. Le MNA-SF est encore insuffisamment répandu.

Introduction: About 30,000 people live with HIV in France without knowing it. After a mass screening policy, the recommendations of experts and the CNGE advocates targeted screening of high-risk populations. This study aims to assess the screening practices of GPs in order to verify their adhesion to the recommendations.Materials and Methods: Between January 3rd and April 2nd 2016, questionnaires were distributed by mail to a sample of GPs practicing in Île-de-France after telephonic agreement thereto. Meanwhile, other questionnaires were distributed to GPs during a general medical congress. All data were entered into Excel and statistical analysis was performed via Python.Result: Were included in the study 196 general practitioners, 42% of the GPs prescribed less than 20 HIV tests per year. Serological tests were mainly prescribed pursuant to the initiative of GPs (53%). Only part of the risk situations identified by the recommendations resulted in testing: STI (100%), IDU (98%), MSM (88%), multiple partners (87%), insecurity (82%), pregnancy (80%), origin (68%), change of emotional life (65%), contraception (54%), herpes zoster (47%), herpes (37%), pneumonia (16%) and seborrheic dermatitis (11%). Only 12% of physicians (n=24) performed screening in more than 7 risk situations. Only the female sex was associated with "good” screener.Conclusion: France has chosen targeted HIV testing policy, but GPs still identify too little risk situations. We must improve the implementation of the recommendations.; Introduction : Environ 30.000 personnes vivent avec le VIH en France sans le savoir. Après une politique de dépistage de masse, les recommandations d’experts et le CNGE préconisent un dépistage ciblé sur les populations à risque. Cette étude a pour objectif d’évaluer les pratiques de dépistage des médecins généralistes afin de vérifier leur adhésion à ces recommandations.Matériels et Méthodes : Entre le 3 janvier et le 2 avril 2016, des questionnaires ont été distribués par mail à un échantillon de médecins généralistes installés en Île-de-France après accord téléphonique. Parallèlement, d’autres questionnaires ont été distribués lors d’un congrès de médecine générale. L’ensemble des données a été saisie dans Excel puis une analyse statistique a été effectuée via Python.Résultats : Ont été inclus 196 médecins généralistes, dont 42% prescrivaient moins de 20 sérologies VIH par an. Les sérologies étaient majoritairement prescrites à leur initiative (53%). Les situations à risques identifiées par les recommandations n’étaient que partiellement identifiées : IST (100%), UDI (98%), HSH (88%), partenaires multiples (87%), précarité (82%), grossesse (80%), origine (68%), changement de vie affective (65%), contraception (54%), zona (47%), herpès (37%), pneumopathie (16%) et dermite séborrhéique (11%). Seulement 12% des médecins (n=24) s’évaluaient dépister dans plus de 7 situations. Seul le sexe féminin était associé aux « bons dépisteurs ».Conclusion : La France a opté pour une politique de dépistage VIH ciblé, mais les médecins généralistes identifient encore trop peu les situations à risque. Il est important de mieux diffuser les recommandations.

Objective: to evaluate the diagnosis policy with labor induction in case of suspicion of fetal macrosomia (SFM: EFW=95ep) in current practice. We compared obstetric and neonatal issues between 2 groups: 1) women which delivery was induced due to SFM and 2) women who gave birth to a macrosomic child without labor induction and in absence of SFM. Method: our study is retrospective observational over the course of 5 years in 2 type 3 maternity. Our main evaluation criteria was occurrence of shoulders dystocia (SD). Then, we studied neonatal and maternal induced morbidity. Results: only 21.9% of macrosomic newborns were screened prenatal. In group 1, we observed a decrease in birth weight (p

International audience; The PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) trial highlights the effectiveness of implementing a screening strategy in high schools to prevent overweight/obesity among adolescents. The strategy comprises three steps: i) body measurements to detect overweight/obese adolescents, ii) a medical interview with each adolescent identified to discuss the findings, and iii) an adapted care management consisting of seven group educational sessions. A process evaluation was conducted in the PRALIMAP trial to assess the effective implementation of the screening strategy activities, and the participation of adolescents and school professionals in them, from a qualitative and a quantitative point of view. The present paper describes the process and the implementation of the screening strategy as performed in the PRALIMAP trial, and discusses the feasibility of such an intervention in high school settings. The ability of nurses to explain the screening results improved with the addition of specialist support. The ability of adolescents to take part in the screening strategy improved when the adapted care management was conducted inside schools and could be increased even further if the waiting time between the three steps could be minimised.

International audience; In France, HIV prevention within Maghrebi or French of Maghrebi origin has been seldom studied. The purpose of this study is to compare the recourse to HIV test according to nationality and origin. Data were from the 2010 SIRS cohort, which included 3,006 households representative of the Paris metropolitan area. Results of the study show comparatively low HIV testing rate among Maghrebi and French of Maghrebi origin compared to French with French parents.

Cardiovascular diseases are currently the first cause of mortality in the world. These diseases, often due to atherosclerosis, are mostly « avoidable » and the associated risk factors are well identified : high blood pressure, high cholesterol, diabetes, family history, smoking, overweight … Most of these risk factors can be avoided throught cardiovascular prevention, and the workplace seems to be the appropriate place to implement prevention actions. In order to evaluate the importance of cardiovascular information and risk factor screening in the workplace, and to study the current knowledge of employees in terms of cardiovascular risk factors and cardiovascular diseases, we have made a litterature review and distributed a questionnary. Results shown that the employees were poorly informed by their general practitioner and by the occupationnal medical service. According to them, the workplace, where they spend most of their time, is the best place to implement prevention actions. Finally, based on litterature recommandations and employees feedbacks, we have proposed several actions to implement : dietetic programs, physical activity promotion, counselling campaigns to quit smoking and to prevent pshycological pressure. The occupational physician has an essential role to play in the implementation of these measures and can have a real impact on cardiovascular prevention.; Les maladies cardiovasculaires représentent actuellement la première cause de mortalité dans le monde. Ce sont, pour la plupart, des maladies « évitables », souvent dues à l’athérosclérose, dont les facteurs de risque sont bien identifiés à ce jour : hypertension artérielle, dyslipidémie, diabète, antécédents familiaux, tabagisme, surpoids… La problématique réside dans la prévention du risque cardiovasculaire, et le lieu de travail apparait comme un lieu propice à la mise en place de telles actions de prévention. Afin d’étudier l’importance de l’évaluation des facteurs de risque et de la sensibilisation au risque cardiovasculaire en entreprise, et d’évaluer le niveau de connaissance des salariés en matière de facteurs de risque et de maladies cardiovasculaires, nous avons réalisé une étude bibliographique puis un questionnaire ciblé. Il en est ressorti un manque criant d’information et de sensibilisation des salariés interrogés, que ce soit par leur médecin traitant ou par la médecine du travail. Selon eux, le lieu de travail, où ils passent une grande partie de leur temps, est le terrain à privilégier pour des actions de prévention cardiovasculaire. Enfin, en cohérence avec la littérature et avec l’opinion des salariés interrogés, nous avons souhaité proposer certaines actions à mettre en place : programmes de nutrition et de promotion de l’activité physique, programmes de lutte anti-tabac et prévention des risques psychosociaux notamment. La médecine du travail a un rôle essentiel à jouer dans l’implémentation de ce type de mesures, et peut de ce fait avoir un réel impact dans la prévention des maladies cardiovasculaires.

Approaches that allow global analysis of cell transcriptomes are greatly accelerating the dissection of lymphocyte signaling. Using serial analysis of gene expression, a recent study has provided evidence that most plasma membrane proteins of T cells have now been identified. Is this also true for the proteins governing intracellular signaling circuitries? This article comments on the recent study and describes other high-throughput screenings aimed at identifying and functionally characterizing signaling proteins.

Background: sickle cell disease (SCD) is the first genetic disease in France. Screening sickle cell carriers is possible with heamoglobin study and must be done before a possible pregnancy. Couples at risk can anticipate and decide if they want to acces to genetic counselling and antenatal diagnosis for a pregnancy. This study comes back to one year of experience of sickle cell carriers screening by general practitioners. The objective is to study the participation and to analyse the results. Methods: this prospective multicenter study includes 166 patients native of a region at risk for SCD, in childbearing age. Results : 66,9% of the patients did the heamoglobin study. The child number is the only decisive factor in the realization of the screening test (p=0,0099), unlike age, sex, native country, familial situation, social protection, current pregnancy, the reason for consulting. Among the 111 patients who have made the test, 75,7% are AA, 16,2% are AS and 8,1% are silent carriers of an other heamoglobin disorder. Heterozygous patients are more likely to wish screening for their near relations. Conclusion: screening of sickle cell carriers is well accepted by the patients and is a good way to make the disease be known for the population at risk. A specific formation for the practitioners is an essential prerequisite.; Contexte : la drépanocytose est la première maladie génétique en France. Il est possible de dépister les porteurs sains du trait drépanocytaire avec une étude de l’hémoglobine. Connaitre son statut vis à vis de la drépanocytose permet d’anticiper un éventuel recours au conseil génétique et au diagnostic prénatal pour un couple à risque en cas de grossesse. Cette étude revient sur une année d’expérience de dépistage du trait drépanocytaire en médecine générale. L’objectif est d’étudier la participation au dépistage et d’en analyser les résultats. Méthode : il s’agit d’une étude prospective multicentrique ayant inclus 166 patients en âge de procréer originaires d’un pays à risque pour la drépanocytose. Les patients ont été classés en 2 groupes selon qu’ils aient fait le dépistage ou non et ont été comparés pour mettre en évidence des facteurs de réalisation du dépistage. Résultats : le taux de participation est de 66,9%. Seul le nombre d’enfant apparait comme un facteur déterminant dans la réalisation du dépistage (p=0,0099). L’âge, le sexe, le pays de naissance, la situation familiale, la couverture sociale, une grossesse en cours, le motif de consultation initial n’interviennent pas dans la réalisation du dépistage. Parmi les 111 patients dépistés, 75,7% sont AA, 16,2% sont AS et 8,1% sont porteurs sains d’une autre anomalie de l’hémoglobine. Les patients hétérozygotes sont plus enclins à souhaiter faire dépister un proche (p=0,0026). Conclusion : le dépistage du trait drépanocytaire est bien accepté par les patients et essentiel pour faire connaître la maladie auprès des populations cibles, mais une formation spécifique pour les médecins semble nécessaire.

Military Centre for Epidemiology and Public Health, Camp Militaire de Sainte Marthe, Marseille, France (FdL); French Armed Forces Health Service in French Guiana, Quartier La Madeleine, BP 6019, 97306 Cayenne Cedex, French Guiana (FdL, NB, CC, SB); Institut Pasteur of French Guiana, Laboratory of Virology, National Reference Centre for Arboviruses (SM, DR), and Unit of Medical Entomology (SB), Cayenne, French Guiana; French Armed Forces Biomedical Research Institute, National Reference Centre for Arboviruses (MM, EY, IL-G), and Unit of Parasitology and Medical Entomology (SB), Hopital d’Instruction des Armees Laveran, Marseille, France; Research Unit in Emerging Infectious and Tropical Diseases, UM 63, CNRS 7278, IRD 198, and INSERM 1095, Faculte de Medecine La Timone, Aix-Marseille Universite, Marseille, France (SB)

Background : New recommendations (2010) have changed the post-occupational medical follow-up for asbestos exposed workers. Main objective : To estimate the prevalence of lung asbestos related diseases in a medically followed- up population. Methods : A bicentric descriptive retrospective study, in two CCPP of Ile-de-France, over followed-up patients between 2011 and 2013. Results : 624 patients got followed-up. They were mostly men (93,9%), active (85,7%), with an average of age of 54,7 years +/-7,9. They were mostly classified in the intermediary cumulated exposure level (78,2%). 433 initial computed tomography (CT) scans were analyzed. The asbestos related diseases prevalence among followed-up patients is 8% (n=51) (mostly pleural plaques, n=46). Nodules were found on 46,4% of realized CT scans. Only one lung cancer was diagnosed (0,8% of followed-up patients), with a mean for the nodules follow-up of 12,7 months+/-7,3 and the average of 1,72 extra CT scan per patient. Conclusion : These results need caution due to the limited size of the sample and the recruitment way. However, this work provides elements about the concrete realization and the limits of the actual follow-up.; Contexte : De récentes recommandations (2010) ont modifié le suivi post-professionnel des travailleurs exposés à l’amiante. Objectif principal : Evaluer la prévalence des pathologies pulmonaires attribuables à l’amiante dans une population ayant bénéficié du dépistage. Méthodes : Etude descriptive rétrospective bi-centrique, portant sur deux Centres de Consultations de Pathologies Professionnelles d’Ile-de-France, sur des patients dépistés entre 2011 et 2013. Résultats : 624 patients ont bénéficié du dépistage. Il s’agit en majorité d’hommes (93,9%), d’actifs (85,7%), avec une moyenne d’âge de 54,7 ans +/-7,9. Ils ont été classés en majorité en niveau d’exposition cumulé intermédiaire (78,2%). 433 examens de tomodensitométrie (TDM) initiaux ont été analysés. La prévalence des pathologies attribuables à l’amiante chez les patients dépistés est de 8% (n=51) (en majorité des plaques pleurales, n=46). Des nodules ont été retrouvés sur 46,4% des examens TDM réalisés. Un seul cancer broncho-pulmonaire a été diagnostiqué (0,8% des patients suivis), avec une moyenne de suivi des nodules de 12,7 mois +/-7,3 et 1,72 TDM supplémentaire en moyenne par patient. Conclusion : La taille limitée de l’échantillon et le mode de recrutement nécessitent d’interpréter les résultats avec précaution. Néanmoins ce travail apporte des éléments sur la réalisation concrète et les limites du dépistage actuel.

the aim of this study is to compare the profitability of three screening strategies for different sampling sites chosen for ESBL and MRSA. This is a retrospective, descriptive, single-center study conducted in surgical intensive care. All hospitalized patients were included. The samples were collected on admission of the patient and then weekly. Period 1 (n=598), from 01/01/2009 to 31/08/2009, with a screening at nostrils, armpits, scarpas and pharynx; period 2 (n=447), from 31/05/2011 to 31/12/2011, with a screening at nostrils and scarpas; and period 3 (n=563), from 01/01/12 to 31/08/12, with a screening at nostrils, armpits and rectum. With a total of 8951 samples. ESBL carriage rate was 1.5 %, 2.24% and 4.4% during periods 1, 2 and 3, respectively. ESBL carriage rate increased statistically during the time (p0,05). L’incidence de prélèvements rectaux positifs était significativement plus importante durant la période 3 comparé à l’incidence des prélèvements positifs de scarpas à la période 1 et 2 (p

Deprivation has been linked to more complicated and uncontrolled diabetes. The validated Évaluation de la précarité et des inégalités de santé dans les centres d'examens de santé (EPICES; Evaluation of the Deprivation and Inequalities of Health in Healthcare Centres) score could help to identify such deprived patients. The present study evaluated the relationships between deprivation and prevalence of complications, uncontrolled diabetes and quality of life.This prospective study was conducted in the diabetology department of a tertiary university hospital from November 2006 to July 2007. Patients with diabetes were divided into two groups, according to their deprivation status [non-deprived: EPICES score30.17; deprived: EPICES score≥30.17 (56.5%)]. Diabetes control, complications and quality of life [Short Form Health Survey (SF-36)] were compared in the two groups.Of a total of 102 patients, 97 completed all of the questionnaires: 18 had type 1 diabetes and 79 had type 2 diabetes, in a geographical area moderately affected by deprivation. No statistical relationship could be demonstrated between deprivation and HbA(1c). Deprived patients with diabetes presented with higher levels of fasting blood glucose, lower levels of LDL cholesterol and a significantly higher risk of obesity (P=0.0020). As for complications, microalbuminuria was linked to deprivation (P=0.03), but no associations with other complications were found. Quality of life was poorer for all physical, mental and social dimensions in deprived patients.In this diabetic population, deprivation and glycaemic control were not associated. However, more deprived subjects with diabetes were at higher risk of renal disease. A deprived state was related to an altered quality of life as assessed by the SF-36 score.

International audience; The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women.

Background— Ethnicity is an important determinant of cardiovascular adaptation in athletes. Studies in black male athletes reveal a higher prevalence of electric repolarization and left ventricular hypertrophy than observed in white males; these frequently overlap with those observed in cardiomyopathy and have important implications in the preparticipation cardiac screening era. There are no reports on cardiac adaptation in highly trained black females, who comprise an increasing population of elite competitors. Methods and Results— Between 2004 and 2009, 240 nationally ranked black female athletes (mean age 21±4.6 years old) underwent 12-lead ECG and 2-dimensional echocardiography. The results were compared with 200 white female athletes of similar age and size participating in similar sports. Black athletes demonstrated greater left ventricular wall thickness (9.2±1.2 versus 8.6±1.2 mm, P P =0.008) than white athletes. Eight black athletes (3%) exhibited a left ventricular wall thickness >11 mm (12 to 13 mm) compared with none of the white athletes. All athletes revealed normal indices of systolic and diastolic function. Black athletes exhibited a higher prevalence of T-wave inversions (14% versus 2%, P P 1 through V 3 ). Conclusions— Systematic physical exercise in black female athletes is associated with greater left ventricular hypertrophy and higher prevalence of repolarization changes than in white female athletes of similar age and size participating in identical sporting disciplines. However, a maximal left ventricular wall thickness >13 mm or deep T-wave inversions in the inferior and lateral leads are rare and warrant further investigation.

International audience; Sixty-five people had a resection of their baseline screen-diagnosed lung cancers in the Early Lung Cancer Action Program. Forty-nine of the carcinomas were solitary, and 42 of these were adenocarcinomas. More than 1 carcinoma was found in 16 patients after pathologic examination of the lobectomy specimen; 15 of the 16 second carcinomas were adenocarcinomas, mixed subtype. Eighteen cases were submitted by local pathologists as Bronchioloalveolar carcinomas but were found to be invasive adenocarcinomas according to the World Health Organization classification by the Pathology Review Panel. Of the 65 resected cases, 57 were N0, 7 were N1, and 1 was N2. Upon careful review of the lobectomy specimens, 49 cases had solitary malignancies, 30 were Stage IA, 13 Stage IB, 3 Stage IIA, 2 Stage IIB, and 1 Stage IIIA on the basis of the American Joint Committee on Cancer/International Union for Cancer Control criteria. In the 16 cases found to have multiple malignancies, 6 had histologically different carcinomas and the remaining 10 had histologically identical malignancies. Eighty-three percent (76/92) of the carcinomas invaded the stroma with destruction of normal lung, and 21% (19/92) also showed either pleural or angiolymphatic invasion, even though 88% (57/65) of the carcinomas were free of lymph node metastases. This report describes the pathologic findings of the resected cases. Histopathologic distinctions among atypical adenomatous hyperplasia, bronchioloalveolar carcinomas, and invasive adenocarcinoma are described in detail.

International audience; BACKGROUND/AIMS: In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting for distance to medical care, and evaluating the impact of the place of residence on patients' clinical characteristics. METHODS: Between 1994 and 2001, 1938 newly detected cases were recorded in a French population of 1,005,817 inhabitants. Age and sex-adjusted detection rates for 10(5) inhabitants were estimated for urban and rural areas and for classes of distance to the nearest practitioner. RESULTS: Detection rates were lower in rural than in urban areas [14.1, (95CI: 12.5-15.7) versus 24.7, (95CI: 23.5-26.0)] and decreased as the distance to the general practitioner increased [27.0, (95CI: 25.5-28.4) versus 13.7, (95CI: 12.1-15.3) for a cutoff value of 1.5 km]. In multivariate analyses, detection rates were only influenced by the distance to general practitioner. Hepatocellular carcinoma at diagnosis was more frequent among rural than among urban patients (adjusted OR = 2.28, 95CI: 0.97-5.39, P = 0.059). CONCLUSIONS: A poorer geographic access to care explained the lower detection of hepatitis C in rural areas. Hepatocellular carcinoma was more frequent in rural patients. It may result from later detection and/or involvement of environmental factors on hepatocarcinogenesis.

BackgroundUser-friendly, accurate, point-of-care rapid tests to detect glucose-6-phosphate dehydrogenase deficiency (G6PDd) are urgently needed at peripheral level to safely recommend primaquine for malaria elimination.MethodsThe CareStart G6PD RDT (AccessBio, New Jersey, USA), a novel rapid diagnostic test and the most commonly used test, the fluorescent spot test (FST) were assessed against the quantitatively measured G6PD enzyme activity for detecting G6PDd. Subjects were healthy males and non-pregnant females aged 18 years or older residing in six villages in Pailin Province, western Cambodia.FindingsOf the 938 subjects recruited, 74 (7.9%) were severe and moderately severe G6PD deficient (enzyme activity ConclusionsThe CareStart G6PD RDT reliably detected moderate and severe G6PD deficient individuals (enzyme activity

Introduction: brief motivational interventions and interventions delivered by computer are effective in alcohology. Their interests not yet known in pregnant women as abstinence are recommended. Methods: Prospective Randomized the efficiency of brief intervention delivered by interactive terminal and of brief motivation self‐assessed their alcohol consumption; the AUDIT was used to assess the maternal risk and AUDIT-­G to assess the fetal risk. Women included were divided into three groups: (1) Information by a standard booklet recommending abstinence, (2) information by the terminal with a customized booklet (3) brief motivational intervention. The main outcome criterion was the abstinence rate in each group one month after intervention, secondary criteria were reducing in consumption at one month and at birth. Results Among 1994 participants, 21.2% reported alcohol consumption in fetal risk. Of the 154 included, 54 became abstinent one month after surgery with no significant difference between groups. After a month, decreasing consumption was greater in the brief motivational intervention group compared to the other two groups and also in the intervention group using a terminal compared to the control group, in frequency of use (p=0.001) and extent of consumption (p=0.045). Conclusion: Pregnant women tend to decrease their alcohol consumption following its identification and intervention in whatever form. Following several quantitative criteria, the decrease in consumption was greater in the brief motivational intervention group.; Introduction : Les interventions brèves motivationnelles ou délivrées par ordinateur sont efficaces en alcoologie. Leur intérêt n’est pas établi pour les femmes enceintes chez qui l’abstinence est recommandée. Méthodes : Étude Prospective randomisée contrôlée testant l’efficacité d’une intervention délivrée par une borne interactive et d’une intervention brève motivationnelle orale. Au moyen d’une borne interactive, les femmes enceintes de six maternités d’Île­‐de-­France ont auto-évalué leur consommation d’alcool ; l’AUDIT évaluait le risque maternel et l’AUDIT-­G le risque fœtal. Les incluses ont été réparties en trois groupes : Délivrance (1) d’un livret informatif recommandant l’abstinence, (2) d’un livret de conseils personnalisés et (3) d’une intervention brève orale. Le critère de jugement principal était le taux d’abstinence un mois après l’intervention, les critères secondaires la réduction de la consommation à un mois et à la naissance. Résultats : Parmi les 1994 participantes, 21,2% ont déclaré une consommation à risque fœtal. Sur les 154 incluses, 54 sont devenues abstinentes un mois après l’intervention sans différence significative intergroupe. À un mois, la diminution de consommation était plus marquée dans le groupe intervention brève orale par rapport aux deux autres groupes et dans le groupe intervention par la borne par rapport au groupe contrôle en fréquence de consommation (p=0,001) et en quantité absorbée (p=0,045). Conclusion : Les femmes enceintes diminuent leur consommation suite au repérage et à l’intervention quelle qu’en soit la forme. Sur plusieurs critères quantitatifs, la diminution a été plus importante dans le groupe intervention brève orale.

Objectives: To determine the number of additional tests prescription during periodic medical examination and following this medical checkup. To determine the interests of these prescription, their results and estimate the cost of a such practice. Method: Descriptive, prospective and retrospective study, carried out from January 2013 to July 2014, using a questionnaire. The study population was military from Kremlin-Bicetre fort. Results: - Patients drinking alcohol, without sport activity and with factors of cardiovascular risk or medical history have more additional medical tests than the other. - 1 out of 2 militaries has an additional examination prescription after the VMP. Half of these patients attended this examination and 20% of them shown an abnormality. Conclusion: Supplementary examinations performed during VMP have an interest in determining the ability of the military to maintain the operational capability of the forces. Indeed, additional tests help to maintain the military long-term health when they are carried out in the context of preventive medicine and they are prescribed appropriately.; Objectifs : Connaître le nombre de prescription d’examens paramédicaux lors des VMP et le nombre de prescription d’examens complémentaires à l’issue des VMP. Connaître les intérêts de leur prescription, leurs résultats et d’évaluer le coût d’un telle pratique. Méthode : Étude descriptive prospective et rétrospective, réalisée de janvier 2013 à juillet 2014, auprès des militaires du Fort du Kremlin-Bicêtre, à l’aide d’un questionnaire. Résultats : - Les patients qui consomment de l’alcool, qui sont non sportifs, qui ont des facteurs de risques cardio-vasculaires ou des antécédents ont plus d’examens complémentaires que les autres. - 1 militaire sur 2 a une prescription d’examen complémentaire à l’issue de la VMP. 1 patient sur 2 réalise cet examen et pour 20% d’entre eux une anomalie est retrouvée. Conclusion : Les examens paramédicaux réalisés lors des VMP ont un intérêt dans la détermination des aptitudes des militaires permettant le maintien de la capacité opérationnelle des forces. Les examens complémentaires, réalisés dans le contexte d’une médecine préventive, permettent de préserver à long terme la santé des militaires, lorsqu’ils sont prescrits à bon escient.

Neuroblastoma (NB) is the most common extracranial solid tumor of childhood and the third most common pediatric cancer. Although numerous factors including patient age, disease stage and genetic abnormalities have been shown to be predictive of outcome, the mechanisms responsible for the highly variable clinical behavior of this tumor remain largely unknown. In order to gain new insights into the biology of this tumor, we performed microarray analysis and compared the gene expression patterns of NB detected by mass screening, characterized by highly probable spontaneous regression, versus stage 4 NB with poor prognosis. The bioinformatics analysis revealed a set of 19 discriminatory genes that may play a significant role in the natural progression of the disease. Validation of these results and further mechanistic studies would shed new light on the biology of tumor progression, and provide new tools to predict clinical outcome in children with NB.

International audience; The aim was to determine the relevance of human papillomavirus (HPV) testing in identifying high-grade cervical intraepithelial neoplasia or worse (CIN2/3+) in a hospital population (n=3574) characterised by a high rate of cytological abnormalities and high-risk HPV infections. According to the results of the initial Papanicolaou and HPV test, women were directly referred for colposcopy/biopsy or recalled for a control visit. Sensitivity and specificity were corrected for verification bias. HPV-testing sensitivity was 94.3%, higher than that of cytological testing at any cut-off point (65.1%-86.8%), while specificity was greater for cytology than for HPV testing (99.3% or 91.8% versus 83.4%). The combination of both tests allowed 100% sensitivity and negative predictive value. We conclude that HPV testing is a relevant tool for the detection of cervical disease. The best way of combining cytology and HPV detection in screening programmes should be evaluated in large-scale studies.

International audience; We draw attention to a number of important considerations in the arguments about screening and outcome of intervention in children with autism and other developmental disorders. Autism screening in itself never provides a final clinical diagnosis, but may well identify developmental deviations indicative of autism-or of other developmental disorders-that should lead to referral for further clinical assessment. Decisions regarding population or clinic screening cannot be allowed to be based on the fact that prospective longitudinal RCT designs over decades could never be performed in complex developmental disorders. We propose an alternative approach. Early screening for autism and other developmental disorders is likely to be of high societal importance and should be promoted and rigorously evaluated.

Background: Evaluation of Paris general practicioners’ screening strategies for HIV infection in 2013. We wanted to evaluate the modifications since the publication of the 2009 new French guidelines : routine HIV testing for all patients from 15 to 70 years old, independently of the risk factors. Methods: From January to April 2013, after phone agreement, Paris general practicioners answered to a closed-ended questionnaire by mail or email. The statistical analysis has been done with Excel software and Chi square Test. Results: We have collected 407 answers. Except for sexually transmitted infections general pratictioners did not always recognize the situations needing a HIV screenning test. The attitude varied between Paris’ districts. Doctors working in the 1st district and in Paris’northeast were facing HIV infections more often than theirs colleagues, were more prone to propose screening and got positive results more often. Attitudes towards HIV testing also differed according to the practioners’age and sex and their type of practice. Only 45% of the general practitioners were aware of the new French guidelines about routine HIV testing. Collaboration with a medical university was associated with the knowledge of the new French guidelines. Conclusion: Screening strategies among Paris’ general practicioners depend on their demographic features, the area and the type of practice. They have not changed since the publication of the 2009 French guidelines. The reevaluation of the dissemination methods of those guidelines seems to be necessary.; Objectif : Évaluation des pratiques de dépistage de l’infection par le VIH des médecins généralistes installés à Paris en 2013 et recherche des modifications depuis la parution en 2009 de la recommandation par l’HAS du dépistage systématique de l’infection de tous les patients de 15 à 70 ans indépendamment des facteurs de risque en plus du dépistage ciblé. Méthode : De janvier à avril 2013, après accord téléphonique, les médecins généralistes parisiens ont répondu à un questionnaire à réponses fermées par mail ou courrier. L’analyse statistique a été réalisée avec le logiciel Excel et le Test du Chi 2. Résultats : 407 réponses ont été obtenues. À part les infections sexuellement transmissibles, les médecins n’identifiaient pas toujours les situations à risque. Les pratiques différaient selon les arrondissements. Les médecins du 1er arrondissement et ceux du nord-est de Paris étaient plus confrontés à l’infection par le VIH que leurs confrères. Les stratégies de dépistage variaient en fonction des caractéristiques démographiques des médecins (âge et sexe) et de leur type d’exercice (secteur d’affiliation à la sécurité sociale). Seuls 45% des médecins sont au courant de la recommandation sur le dépistage systématique de l’infection par le VIH. La collaboration avec une faculté de médecine était un facteur associé à la connaissance de la recommandation. Conclusion : Les médecins généralistes parisiens n’ont pas modifié leur pratique de dépistage depuis la publication de la nouvelle stratégie de dépistage. Une réévaluation des méthodes de diffusion des recommandations semble nécessaire.

Although around half the French population has had an HIV test, many people are still not diagnosed until the disease is advanced. Cyrille Delpierre and colleagues believe the answer is to expand routine testing

Background: In the recent French guidelines, the general practitioner becomes one of themain actors in the routine HIV screening. Review of the international studies shows thatgeneral practitioners perform rarely a sexual history.Methods: From January 2011 to April 2012, 340 self-administered questionnaires werecompleted by patients consulting general practitioners, in Paris area. This study was focusedon the patients’ opinion, concerning routine HIV screening and sexual history-taking.Results: 72% of the patients have already been testing and mainly on their own demand.Nearly 80% of patients would accept routine HIV screening. Two thirds of patients havenever mentioned sexuality with their physician and most of them do not wish to do it. Men,patients aged between 26 and 40 years and the patients, who do not know their physician verywell, answer more often that they won’t mind to talk about sexuality with their generalpractitioner.Conclusion: The majority of the patients agree with routine HIV screening but they are notaware yet to talk about sexuality with their own general practitioner. Sexuality is still a taboo,either for the patient or the physician.; Contexte : Dans les nouvelles recommandations, le médecin généraliste devient un desacteurs principaux du dépistage systématique du VIH. Dans la littérature, les médecinseffectuent peu d’anamnèse sexuelle.Méthodes : 340 auto-questionnaires ont été remplis par des patients consultant des médecinsgénéralistes d’Ile de France entre janvier 2011 et avril 2012. L’étude s’est intéressée à l’avisdes patients sur le dépistage systématique du VIH et l’abord de la sexualité avec leur médecin.Résultats : 72% des patients ont déjà fait le dépistage et principalement à leur demande. Prèsde 80% des patients accepteraient le dépistage systématique. Deux tiers des patients n’ontjamais parlé de sexualité avec leur médecin et la plupart ne souhaitent pas le faire. Leshommes, les 26-40 ans et les patients connaissant moins leur médecin, répondent plus souventqu’ils souhaitent en parler.Conclusion : La majorité des patients sont favorables au dépistage systématique mais ils nesouhaitent pas pour autant, aborder la sexualité avec leur médecin généraliste. La sexualitéreste un sujet tabou tant au niveau des patients que des médecins.