Strengthened Ebola surveillance in France during a major outbreak in West Africa: March 2014-January 2016.

Introduction An unprecedented outbreak of Ebola virus diseases (EVD) occurred in West Africa from March 2014 to January 2016. The French Institute for Public Health implemented strengthened surveillance to early identify any imported case and avoid secondary cases. METHODS: Febrile travellers returning from an affected country had to report to the national emergency healthcare hotline. Patients reporting at-risk exposures and fever during the 21st following day from the last at-risk exposure were defined as possible cases, hospitalised in isolation and tested by real-time polymerase chain reaction. Asymptomatic travellers reporting at-risk exposures were considered as contact and included in a follow-up protocol until the 21st day after the last at-risk exposure. RESULTS: From March 2014 to January 2016, 1087 patients were notified: 1053 were immediately excluded because they did not match the notification criteria or did not have at-risk exposures; 34 possible cases were tested and excluded following a reliable negative result. Two confirmed cases diagnosed in West Africa were evacuated to France under stringent isolation conditions. Patients returning from Guinea (n = 531; 49%) and Mali (n = 113; 10%) accounted for the highest number of notifications. CONCLUSION: No imported case of EVD was detected in France. We are confident that our surveillance system was able to classify patients properly during the outbreak period.

Care-related pain in hospitalized patients: severity and patient perception of management.

BACKGROUND: Hospitalized patients commonly undergo painful procedures, but little is known about care-related pain (CRP) in the overall population of inpatients. We conducted a cross-sectional 1-day survey to assess the prevalence and characteristics of CRP and its management in all units of a university hospital in Paris and determined the factors linked to severe CRP. METHODS: All patients who were able to communicate and were hospitalized for at least 24 h but not in a day-care or neonatal unit were included. RESULTS: From 938 patients who completed the questionnaire, 554 patients reported pain within the previous 24 h, for a 59% prevalence of pain, and 540 (58%) had experienced CRP in the previous 15 days (51% males; mean [SD] age 54 [18] years). Of 907 procedures, 330 (37%) resulted in severe pain. The most-often reported painful procedures were vascular punctures and patient mobilization. Severe CRP was associated with long hospitalization; non-vascular invasive punctures, catheterization, mobilization or radiological examination; or pain during the previous 24 h due to surgery or treatment. Only half of the patients declared that they had received information regarding the painful procedure. Treatment for pain was proposed and delivered in less than one quarter of cases. CONCLUSIONS: Our results of a survey of pain management in hospitalized patients relate to a wide variety of medical conditions and procedures. Health-care workers should be more systematic in managing CRP, and attention should be paid to patients at greatest risk of severe CRP.

Determinants of patient satisfaction regarding pain care.

BACKGROUND: The management of pain in hospitalized patients remains a major public hospital priority. It has been the object of three French national programs since 1999. The purpose of this study was to reassess pain prevalence, pain intensity and patient perception of its management ten years after the first national program and to determine the factors related to the patient satisfaction with efforts to decrease pain intensity. METHODS: A 1-day cross-sectional survey in a university hospital. RESULTS: Pain prevalence was 59%. Pain intensity varied according to the medical department with lower intensity in surgery and obstetrics than medicine departments. Eighty-one percent of patients were satisfied with their pain management. Patient satisfaction was higher when doctors and nurses were heavily involved in the process of pain relief (OR=6.6; 95% CI 3.8, 11.4), and when their pain had decreased (OR=2.9; 1.7, 5.0). The magnitude of decrease in pain were higher when the medical team was involved (OR=1.9; 95% IC 1.1, 3.3) and pain intensity was measured (OR=1.6; 1.0, 2.4). Perceptions of doctor and nurse involvement in the patient's care was higher when pain intensity was measured (OR=6.0; 3.4, 10.5), an immediate treatment offered (OR=3.5; 2.0, 6.2), encouragement to ask for an analgesic was provided (OR=2.0; 1.1, 3.5) and for patients with acute pain (OR=2.2; 1.0, 4.7). CONCLUSIONS: This study identifies the factors related to patient satisfaction with pain management and the magnitude of the decrease in pain which should allow further efforts to improve the management of pain and reduce its intensity in hospital inpatients.

[Adherence to national guidelines for lipid management in a department of endocrinology]. / Prise en charge des patients dyslipidémiques : analyse des écarts entre le référentiel et la pratique dans un centre hospitalier.

OBJECTIVES: National guidelines for lipid management have been updated in March 2005 by the French Health Products Safety Agency (Afssaps). The objective of this study was to assess clinical practices based on these recommendations in a department of endocrinology specialized in the management of dyslipidemic patients. MATERIALS AND METHODS: A sample of patients was independently selected among those referred to our outpatient clinic for assessment of hyperlipidemia. We analyzed retrospectively whether the management of dyslipidemia in these patients was consistent with national guidelines. RESULTS: We included 62 patients. At admission, 61% of patients had a lipid-lowering treatment that was consistent with the guidelines and a LDL-cholesterol value below the target level. At discharge, the lipid-lowering treatment was modified in 27% of patients. The changes were consistent with Afssaps guidelines in 79% of patients. Cases of non-compliance with the guidelines were explained by a lower threshold of LDL-cholesterol target in patients with carotid plaques and no changes because LDL-cholesterol was just above the LDL-cholesterol target. CONCLUSION: Lipid management was consistent with Afssaps guidelines in a majority of patients. However, this study emphasized unresolved problems in lipid management, such as the question of integrating arterial status in the therapeutic decision.

[Dental status, access to care and precariousness]. / Etat dentaire, recours aux soins et précarité.

BACKGROUND: The oral status of people living in precarious conditions is problematic. Although the public universal health insurance should allow better access to care, access to dental care remains a critical issue. The analysis of the patient population of a hospital dental consultation (Groupe Pitié-Salpêtrière, Paris) seemed relevant to evaluate the needs of care and the means to provide it. The principal objectives are: to estimate dental health and needs of this population, to describe their sociodemographic characteristics and to compare them with patients living in common social conditions. METHODS: A cross sectional study was conducted from February to June 2003. A medical questionnaire and a dental file record were used. All outpatients coming to the dental consultation, in need of conservative or prosthetic treatment, were included. We analysed the risk factors associated with poor dental health. RESULTS: Three hundred and thirty three questionnaires were analysed: two third were men, 45% were foreigners. More than half of them benefited from a special social health insurance for disadvantaged people or didn't have any health insurance. The comparative analysis of this precarious group vs regular insured people showed significant differences for sociodemographic and oral characteristics. Namely, in the precarious group, a poor dental status was generally observed: more cavities (3.6 versus 2), more absent teeth not replaced (6.8 versus 3.5) and less treated teeth (1.9 versus 3.9)--p < 0.0001. Multivariate analysis showed that main risk factors of poor dental status were to be aged and to be a foreigner. CONCLUSION: This study stresses the importance of the dental care needs in a context of poor insurance refunding for the costs of dental treatments and the lack of structures able to provide dental care for patients living in difficult social condition. These findings question the organization of the dental care system in France.

[Quality-assessment of the transfusion record in a Paris hospital in 2003]. / Evaluation du dossier transfusionnel dans un centre hospitalier parisien en 2003.

AIM OF THE STUDY: To realize a clinical audit of the quality of the transfusion record in the Pitie-Salpetriere hospital (Paris, France). MATERIALS AND METHODS: Using a 1/10th poll method, a representative sample of patients who underwent a blood transfusion in the first quarter of 2002 in the hospital was constituted. Data were collected in the clinical units using a standardized questionnaire. RESULTS: Sample size was 247 patients for whom 219 patient files and 207 transfusion record (94.5%, CI(95%) [91.5-97.5]) were found. Transfusion record did not follow the patient in 29 cases (59%). Among the transfusion record, 82.1% contained a copy of the prescription for blood components, 89.8% a transfusion card, 93.2% a traceability note, 100% an ABO group card, 98.6% an antibody screen, 57.1% a pretransfusion viral testing results and 7,8% a copy of the posttransfusion biology testing. Traceability of pre and posttransfusion patient information was respectively 6,8% and 21,1%. Presence of pretransfusion testing results, patient information and posttransfusion prescription was significantly higher in the surgical and intensive care units' patient files than in the medical units (resp. P = 0.018; 0.02 and 0.017). CONCLUSION: Difficulties in the transmission of transfusion records when patients change clinical unit or are rehospitalized and a lack of knowledge concerning the elements which are mandatory to be kept in the transfusion record could explain the results of this study. This assessment is fully in line with the process of transfusion security improvement. In order to promote the quality of the transfusion record, new recommendations and tools were elaborated following this study.

[Virologic evolution in HIV-infected subjects with an undetectable viral load in the first trimester of 1997]. / Evolution virologique des personnes infectées par le VIH à charge virale indétectable au 1er trimestre 1997.

OBJECTIVES: Assess the evolution of viral load in HIV-infected patients whose viral load was < 500 copies/ml during the first three months of 1997. PATIENTS AND METHODS: The viral load during the first three months of 1998 was recorded for comparison. Data were collected from the DM12 database implanted in the CISIH and concerned 2113 patients. RESULTS: Virological failure was observed in one-third of the patients in the study cohort whose viral load was undetectable in 1997 (< 500 copies/ml) as their load was > 500 copies/ml one year later in 1998. The percentage of patients in a situation of virological failure in 1998 who were taking tritherapy in 1997 (38%) was lower than that in those who were not (47%). The clinical and immunological characteristics were however similar. The difference in the therapeutic regimen would probably explain the difference. CONCLUSION: These findings demonstrate that virological failure is an important problem. Other analyses should be conducted in other cohorts to determine the influence of non compliance or resistance to antiretroviral treatments. Future therapeutic strategies should take into account the results of such studies.

[Initial antiretroviral prescriptions in patients with HIV. Second semester 1994-second semester 1996]. / Les primoprescriptions d'antirétroviraux chez les patients atteints par le VIH. Second semestre 1994-second semestre 1996.

OBJECTIVES: The nature of antiretroviral therapy has radically changed these last years. A study has been conducted on data obtained from the DMI2 information system to evaluate changes on treatments, immunity and transmission profile of the patient naive to antiretroviral therapy when initiating a therapy. METHODS: DMI2 is a national, multicentered database which contains medical, epidemiological and economic information on hospital care for HIV patients. This study, on 18,510 patients followed up in one of the fifty hospitals belonging to the Centers for Information and Care of Human immune Deficiency, was conducted from the second half of 1994 to the second half of 1996. RESULTS: The therapeutic changes seen on the whole seropositive population are also observed on these patients: the proportion of regimen with only one nucleoside analogue have decreased from 90.2% in 1994 to 7.5% in 1996. The proportion of treatment with two nucleoside analogues increased from 7.9% to 67.6%. The proportion of two nucleoside analogues with one protease inhibitor regimen increased from 1.9% in 1994 to 24.6% at the end of 1996. A study focused on the second semester of 1996 shows that the proportion of homo-bisexual patients initiating an antiretroviral treatment with a three antiretroviral agents combination (29.7%) is greater than the one in the IVDU group (20.4%) or in the heterosexual group (20.8%). CONCLUSION: These results show that a higher number of patient naive to the antiretroviral therapy initiate therapy earlier, with a two or three agents combination preferentially and at a better stage of immunity.

[Evaluation of decontamination interventions in 59 homes of children with lead poisoning]. / Evaluation des travaux de décontamination de 59 logements d'enfants atteints de saturnisme.

Old peeling paint with high content of lead has been identified as the main source of lead poisoning for children screened in Paris since 1985. In 1989, Médecins Sans Frontières and Migration Santé tested abatement methods in 59 homes of severely lead-poisoned children. The effectiveness of abatement is evaluated with respect to the evolution in dust lead contents and of the children's blood lead levels. Lead content wsas measured in dust samples collected from the floor of the homes before abatement, then every three months after abatement; results are available for 24 homes. Blood lead levels were assessed in the course of the children's medical follow-up; results are available before and after abatement for 78 children living in 41 of the abated homes. The effect of abatement on the children's blood lead level was assessed through multivariate analysis. The median decrease in dust lead contents was 365 micrograms/m2 one to two months after abatement and 300 micrograms/m2 three to six months after abatement. However, dust lead contents of more than 1,000 micrograms/m2 were found in more than half of the communal areas of the buildings six to twenty-eight months after abatement. For 2 of the families, abatement was associated with an increase in the children's blood lead-levels. For all of the other children, abatement was associated with a significant decrease in blood lead levels, controlling for the child's age and initial lead poisoning level, and for the overall downward trend in blood lead levels over time since the initial screening.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prescription of antiretroviral and prophylactic drugs in HIV diseases: reality of medical practices]. / Les prescriptions des antirétroviraux et des médicaments prophylactiques dans la pathologie VIH: la réalité des pratiques médicales.

Antiretroviral and prophylactic therapy given to HIV-infected patients attending hospital (DMI 2 data base) was analyzed according to TCD4+ cell count; 19,020 patients were included in the study. Under 200 TCD4+/mm3, more than 80% of the patients received antiviral therapy, most often AZT (45.3%) or ddI (27.2%). Combined treatment was quite low, less than 8%. Although above 500 TCD4+/mm3, 11.6% of patients received AZT, this study showed that antiretroviral therapy followed French recommendations. This was not the case for prophylaxis: a large proportion of patients under 200 TCD4+/mm3 did not received pentamidine aerosol, or cotrimoxazole, or dapsone.

[The health of foreign populations in France]. / La santé des populations d'origine étrangère en France.

In France, 8% of the population are foreign. They come from the lowest socio-economic level. In distinguishing the new arrivals from those who have lived in France for several years, the migrant related health patterns are applied. Health problems of foreigners in France can be examined in a number of different ways: --Foreign workers are found in unskilled work and in jobs where they are constantly subjected to hazards of the workplace, occupational health risks and accidents. --The quality of maternal and child health care among foreign women is lower than among the French. --Foreign children are hospitalized more often and for longer than French children. The types of illness are not specific. The truancy rate is more significant than the national mean. --Restrictions on the opportunities for enjoying certain social rights, administrative and financial obstacles encountered as well as difficulties in communication all make it harder to meet the needs of this section of the population.

[Humoral immunity, 5 years after anti-tetanus vaccination, in a group of malaria-infected and malnourished African children]. / Etude de l'immunité humorale, cinq ans après vaccination antitétanique, d'un groupe d'enfants africains paludéens et malnutris.

In 1978 a campaign of vaccination against tetanus was conducted in a savannah biotope of Burkina Faso (Garango). The effects of 1 or 2 tetanus toxoid injections and of concomitant malnutrition and malaria infection were assessed by measurements of specific antibody and cell-mediated responses. None of these 2 variables did interfere with the development of anti-tetanus immunity. In 1983, 5 years later, similar results were obtained, giving evidence that in spite of malnutrition and malaria, factors known for their immunosuppressive action, a good degree of specific protection was acquired. This local survey revealed also that multiple schemes of vaccination, 1 to 5 injections of vaccine over 5 years, had been performed by unidentified operators. The issues raised by such incongrous, costly and possibly detrimental practices are discussed within the frame of national vaccination policies.

Haemoglobin disorders among Southeast-Asian refugees in France.

Haemoglobin disorders were studied among Southeast-Asian refugees (Vietnamese, Cambodians and Laotians). Phenotypic haemoglobin investigations and genotypical studies concerning the alpha loci were carried out. Most of the observed cases of microcytosis were related to a thalassaemic defect. High prevalence of Hb E and alpha-thalassaemia were found.

[Measles vaccination in the Sudan-Sahel region of Africa. Absence of the immunodepressive effect of malaria]. / Vaccination antirougeoleuse en afrique soudano-sahelienne. Absence d'effet immunodépresseur du paludisme.

A survey aiming at assessing the effectiveness of anti-measles vaccination was carried out in a rural Upper-Volta population. The haemagglutination inhibition technique was used for detection of anti-measles antibodies; a reciprocal antibody titer of 20 or more was considered as a positive one and the subject considered as immunized. In the age group of 1-3 years old studied here, malaria does not seem to be a factor that modulates the ability of vaccinated subjects of producing anti-measles antibodies. Thus the immunodepressive properties of the Plasmodium is not observed in this immunizing system which effectiveness has been further improved by the development of thermostable vaccines.

[Efficacy of measles vaccination in young malnourished African children]. / Contribution à l'étude de l'efficacité de la vaccination antirougeoleuse chez le jeune enfant Africain malnutri.

A survey aiming at assessing the anti-measles vaccination efficiency among malnourished children, 1-3 years old, has been conducted in rural Upper-Volta. The haemagglutination inhibition technique has been used and antibodies titers higher or equal to 20 were considered as markers of protective immunity. Malnutrition does not seem to be a factor that decreases the anti-measles antibodies production, because there is no significative difference between seroconversion percentages of well and malnourished children. It is proposed that a new serological technique would be useful in the assessment of actual post-vaccinal immunity, mainly in children with ages ranging from 6 to 12 months old.

[Effect of the use of drinking water on the pathogenic fecal flora in a Sahel rural region]. / Retentissement sur la flore fécale pathogène de l'utilisation d'une eau potable en milieu rural sahélien.

Within the scope of a village hydraulic programme, in a Sahel rural area, an investigation was conducted in a school to determine the effect of the use of drinking water on fecal flora. One year following the installation of a hydraulic pump, it was observed that pathogenic salmonellae, shigellae and amoebic cysts had virtually disappeared. In contrast, the perennial character of viral contamination was demonstrated. Water guaranteed potable, therefore, appears to be an essential factor in the prevention of infections due to fecal pathogenic microorganisms. It is essential, however, that the areas surrounding the pumps be subjected to strict supervision to avoid pollution of the underground water sheet.