Characteristics and health of homeless families: the ENFAMS survey in the Paris region, France 2013.

BACKGROUND: The objectives were to estimate the size of homeless family population in Paris region, to describe their living conditions and health and to analyse the impact of homelessness on children's growth and development, which was never investigated in France. METHODS: A cross-sectional survey was conducted on a random sample of homeless sheltered families in 2013. Families were interviewed in 17 languages and a nurse took anthropometric measures, blood samples and collected health data from child health reports. RESULTS: The population size was estimated at 10 280 families. Half were single-parent female families and 94% were born outside France. Most families had experienced housing instability and 94% were living below the poverty line (828 euros/month). Malnutrition was a major problem: the prevalence of food insecurity was high (77% of parents and 69% of children), as well as anaemia (50% of mothers and 38% of children), overweight (38% of mothers and 22% of children) and obesity (32% of mothers and 4% of children). High rates of depressive disorders were found in 30% of homeless mothers and 20% of children had signs of possible mental health disorders. DISCUSSION: These first results highlight the important number of families among the homeless population in Paris region. Families differed from other homeless people regarding social characteristics such as birthplace, single-parent status and residential instability that are likely to influence schooling, social ties, health and access to care. These results demonstrate the need for urgent actions targeting homeless families, in terms of reducing housing instability and providing adequate care, especially for children.

Indicators of progressive corneal exposure to dry eye conditions.

PURPOSE: To establish the main indicator of progressive corneal exposure to dry eye conditions in an animal model. METHODS: Cell surface covered by microvilli (SCM), intercellular junctions (IJs), cell area, cell shape, and cell shade were measured in 988 epithelial corneal cells from rabbit eyes that were kept open for different drying times (DT) between 0 and 3 h. Two multivariate logistic regressions were used to model the relationship between these morphometric cell characteristics and DT. To corroborate the results, terminal differentiation was assessed by cluster analysis. RESULTS: Scanning electron microscopy images of the epithelial cells showed typical desiccation changes that increased in frequency and intensity as DT were prolonged. Binomial logistic regression, to distinguish cells exposed to desiccation from the control cells, displayed SCM, IJ, and cell shade as significant indicators (p < 0.01) of desiccation exposure. Multinomial logistic regression analysis showed SCM, IJ, cell shade, and cell area as significant indicators (p < 0.01) differentiating the four levels of desiccation exposure, and SCM was the variable that showed elevated odds ratio in all the analysis. In addition, the cells were grouped in three groups (G1, G2, and G3) by cluster analysis. G2 cells increased in percentage as DT grew (p < 0.05, χ2 test) in detriment of G1 cells, while the percentage of G3 cells remained stable. These changes were consistent with a terminal differentiation process from G1 cells to G2 cells, which was the group with the lowest values of SCM (p < 0.001, Mann-Whitney test). CONCLUSIONS: The variable SCM could be the best determining indicator of progressive corneal exposure to dry eye conditions. The development of clinical methods to analyze microvilli density could allow a more accurate assessment of the level of degradation of the corneal epithelium under evaporative conditions.

Efficacy and safety of switching from enfuvirtide to raltegravir in patients with virological suppression.

OBJECTIVE: To assess the Efficacy and safety of switching from HAART containing enfuvirtide to raltegravir as a simplification strategy in patients with viral suppression and intolerance to enfuvirtide. METHODS: Thirty-six patients with sustained plasma HIV RNA levels <50 copies/mL for at least 3 months with injection site reactions and/or injection fatigue while receiving an enfuvirtide-containing optimized background regimen switched from enfuvirtide to raltegravir (400 mg bid). RESULTS: Patientshad received enfuvirtide for a median of 96 weeks and had sustained HIV RNA <50 copies/ mL for a median of 95 weeks. One patient discontinued raltegravir due to the appearance of cutaneous rash (grade 2) unresponsive to antihistamines after 19 days of starting raltegravir. The remaining 35 patients were followed for 24 weeks and 18 of them for 48 weeks. All patients maintained virological suppression <50 copies/mL at Weeks 24 and 48. No patient had blips in their viral load after switching to raltegravir. There were no grade 3 or 4 adverse events related to raltegravir. CONCLUSIONS: A switch from enfuvirtide to raltegravir in virologically suppressed patients who are highly treatment-experienced maintained both virologic and immunologic efficacy up to 48 weeks.