[Air pollution and heart rhythm disturbance: A retrospective study]. / Pollution atmosphérique et troubles du rythme cardiaque : une étude rétrospective.

INTRODUCTION: According to many studies, exposure to air pollution increases cardiovascular morbidity and mortality. It has also been shown that the frequency of heart rhythm disorders in Region wallonne is very high. OBJECTIVES: The objective of this study is to test the hypothesis of a link between rhythm disorders measured by cardiac holters and data from devices measuring the concentration of air pollutants present in ambient air. METHODOLOGY: The health data were obtained via the Erasme hospital's cardiology center. This is a retrospective data collection over the last 2 to 5 years. The environmental data are: PM2.5, PM10, NO2, O3 and temperature. The statistical models were based on "cross-case" analyses. RESULTS: An association between PM10 and the number of ESAs was observed. An increase of 10µg/m3 of PM10 increases the number of ESAs by 20% (P=0.040). The number of ESAs increases with age (63% more ESAs when age increases by 10 years). A history of intervention also decreases the number of ESAs (-35%), the same phenomenon is observed for pacemaker wearers (-66%). The strongest association observed between NO2 and ESA with an OR of 1.37 (P=0.027) in the final model. No significant association was observed between the effects of air pollution and VPCs. CONCLUSION: Our analyses resume the effects of the different pollutants on rhythm disorders, the effects adjusted for treatment and co-morbidities. They open the door to other more refined studies based on individual measurements.

[Analysis of comorbidities in hospitalized patients for ischemic stroke and their effects on lethality]. / Analyse des comorbidités chez les patients hospitalisés pour un accident vasculaire cérébral ischémique et leurs influences sur la létalité.

OBJECTIVES: The aim of the study consists of analyzing the comorbidities of acute ischemic stroke and those influencing its hospital lethality. METHODS: We considered patients from Wallonia aged 25 years or more and admitted to a Belgian hospital for an acute ischemic stroke in 2013 and 2014. The analyzed medico-administrative data are taken from the Minimum Hospital Summary. A factorial correspondence analysis (FCA) was used to demonstrate the comorbidities profiles. A logistic regression was used to analyse the comorbidities influencing hospital lethality by ischemic stroke. RESULTS: The stroke risk factors vary according to the age. Cardiac problems are more common in older people aged 85 years or more. High blood pressure, hypercholesterolemia and diabetes are more present between 65- and 84-year-olds. Overweight is more present between 55 and 74-year-olds. People who are addicted to alcohol or tobacco are often 65 years or younger. The logistic regression showed that age and heart problems are the risk factors that increase lethality. However there is a lethality diminution in the presence of high blood pressure, hypercholesterolemia, overweight and addiction to alcohol or tobacco. CONCLUSION: This study demonstrates that medico-administrative databases and factorial statistical methods are perfectly adapted to confirm the ischemic stroke risk factors. This type of study will allow to target with more precision the secondary and tertiary prevention actions of stroke.

[Influence of obstetric factors on characteristics of umbilical cord blood transplants]. / Influence de facteurs obstétricaux sur les caractéristiques des greffons de sang de cordon ombilical.

OBJECTIVES: There is a correlation between the success of the cord blood transplant and the numbers of HSC found in the unit of cord blood donation. The purpose of this analysis is to identify obstetric factors that may influence the quality of a cord blood unit taken during delivery. METHODS: A retrospective study was carried out at the Liège cord blood bank on a sample of 7.463 cord blood units collected between 2000 and 2016. Eight obstetric factors were analyzed in relation to two dependent variables; the total nucleated cells (TNC) and the volume of one unit of cord blood. The Welch test, the percentiles 25 and 75 and the non-parametric Mann-Whitney Wilcoxon test were used. RESULTS: Several obstetric parameters were found to influence (P<0.05) the quality of the cord blood unit are: cord clamping (>15 seconds), the use of oxytocin during labor, a more advanced gestational age (38-41 weeks), a higher birth weight (>3300 gr), and a higher weight of the placenta (>500 gr). A female newborn and the use of epidural, influence (P<0.05) the number of TNC but not the volume of the cord blood unit. CONCLUSION: We can conclude that the birth weight, the weight of the placenta, the gestational age and cord clamping are parameters that could be used by maternity hospitals to identify births that enable more voluminous grafts which are richer in total nucleated cells.

Facteurs prédictifs de naissance d'un nouveau-né séronégatif issu d'une mère séropositive au VIH à Douala

Introduction. La transmission mère-enfant du VIH constitue le principal mode de contamination chez les enfants âgés de moins de 5 ans. L'introduction de la thérapie antirétrovirale chez les femmes enceintes séropositives, les accouchements par césarienne et l'allaitement artificiel ont réussi à réduire considérablement la transmission verticale du virus de l'immunodéficience humaine. En l'absence de ces mesures préventives, le taux de transmission verticale varie entre 10 à 40%. L'objectif de cette étude est de présenter les facteurs qui prédisposent à la transmission du VIH de la mère à l'enfant à Douala. Matériel et méthodes. Il s'agit d'une étude rétrospective, analytique et transversale menée à l'hôpital du district de Nylon, sur une période de sept mois allant de 01 décembre 2015 au 08 juin 2016. Les données ont été recueillies sur la base d'un questionnaire et les facteurs de transmission du VIH de la mère à l'enfant ont été évalués par régression logistique multi variée. Le test de Hosmer et Lemeshow a été utilisé pour vérifier l'ajustement du modèle. Les différences dans les proportions ont été testées en utilisant le test du chi carré. Les tests de Kruskal-Wallis ont été utilisés pour évaluer les différences globales, puis deux à deux le Mann-Whitney U-tests a été utilisé pour évaluer les différences entre les groupes. Résultats. Au total 157 dossiers de nourrissons ont été enrôlés dans cette étude, parmi eux, 20 étaient infectés par le VIH (P=12%). L'âge moyen au moment du diagnostic était de 4,3±3,6 mois (extrêmes : 1,5 et 16 mois). Les enfants nés avec un poids de moins de 2500 grammes présentaient un risque de TME de 5,6 fois supérieur par rapport à ceux nés avec un poids ≥2500 grammes (OR=5,6 ; IC95% :1,9-16,7). Les enfants qui n'avaient pas reçu de la Névirapine à la naissance (10/15) ont été plus infectés que ceux qui en avaient reçu (10/142) et présentaient un risque de 26,4 fois d'être infectés (OR=26,4 ; IC95% : 7,6-92,3 ; p<0,001). Conclusion. Les délais de mise sous traitement, le stade OMS IV de la maladie, l'alimentation mixte, les CD4 <100/mm3 se présentent comme étant les facteurs prédictifs de TME. Il est donc nécessaire de réduire la charge virale maternelle afin de pouvoir renforcer son système immunitaire et par ailleurs celui de l'enfant en favorisant l'allaitement maternel exclusif

Population lymphocytaire des nourrissons exposés mais non infectés par le VIH à Douala

Introduction. L'objectif de cette étude était de mettre rechercher la présence d'un déficit en cellules T chez le nourrisson exposé non infectés (ENI), l'hypothèse étant que le déficit serait plus marqué lorsque la charge virale maternelle est élevée. Matériels et méthodes. Il s'agit d'une étude transversale analytique menée du 1er décembre 2015 au 08 juin 2016. En phase rétrospective, les données ont été collectées à base d'un questionnaire préétabli. En phase prospective les prélèvements sanguins ont été effectués et les profils immunologiques ont été établis. Les facteurs de transmission du VIH de la mère à l'enfant ont été évalués par régression logistique multi variée. Le test de Hosmer et Lemeshow ont été utilisés pour vérifier l'ajustement du modèle. Résultats. 153 patients répartis en trois groupes dont 60 enfants exposés non infectés, 60 enfants non exposés (NE) et 33 enfants exposés infectés (EI) ont été enrôlés. Les profils immunologiques des enfants NE et ENI ont montré une différence statistiquement significative (P=0,007) pour les taux de CD4. Les profils immunologiques des enfants de la tranche d'âge de 12 à 59 mois d'une part EI et ENI ont montré des différences significatives pour les CD45 (P=0,003), les CD4 (P=0,01), les CD8 (P=0,02). Conclusion. Chez les nourrissons non infectés nés de mères séropositives, plusieurs anomalies immunologiques peuvent être détectées. Ces anomalies pourraient être une conséquence de l'exposition au VIH in utero et en début de vie, et/ou à l'exposition aux médicaments antirétroviraux, ou à la transmission précoce des infections virales persistantes telles que CMV

Risk factors for mortality in patients with tuberculosis and HIV in Douala (Cameroon).

Despite prevention efforts, and free treatment, TB-HIV co-infection still occurs in Cameroon. The objective of this work is to present the risk factors for mortality in patients co-infected with TB and HIV in Douala from 2009 to 2014. This transversal, analytic, and retrospective study took place from November 2014 to May 2015 in the Laquintinie Hospital in Douala. A review of our records identified patients aged at least 15 years, with this co-infection who received TB treatment, with or without antiretroviral agents. The bivariate analysis compared qualitative variables with Pearson's Chi2 test. In the multivariate analysis, we determined the risk factors for mortality by backward stepwise logistic regression. Model fit was tested with the Hosmer-Lemeshow test. The study identified 394 patients, 213 (54.1%) of whom were women (sex ratio 0.84). The mean age was 39 ± 10 years. All patients received drugs to treat tuberculosis drugs; 351 (89%) also received antiretroviral drugs, 78.2% of them including efavirenz; and 320 (81.2%) received cotrimoxazole prophylaxis. During the study period, 67.3% were cured of tuberculosis and 15.7% died. The multivariate regression results show that hepatitis B (P <0.0009), absence of cotrimoxazole prophylaxis (P <0.005), poor treatment adherence (P <0.0001), and a CD4 count <50 (P <0.0001) were risk factors for mortality. The cure rate for patients co-infected with TB and HIV in Cameroon remains low, and their mortality high. Comorbidities and the presence of opportunistic diseases are risk factors for death. Appropriate measures to prevent this co-infection and the systematic use of cotrimoxazole should reduce this mortality rate.

Impact du niveau socio-économique sur l'utilisation du programme de prévention de la transmission du VIH de la mère à l'enfant à Douala - Cameroun

Introduction : L'infection à VIH chez les femmes enceintes demeure un problème majeur de santé publique. L'une des solutions envisagées par l'OMS a été la mise à échelle du programme PTME. Malgré la gratuité des services de ce programme, la fréquentation reste très insatisfaisante. Dans la recherche de solutions à ce manque d'adhésion, l'objectif de cette étude est de rechercher l'influence du niveau socio-économique des populations vis-à-vis de l'utilisation de la PTME à Douala. Matériel et méthodes : Il s'agit d'une étude analytique basée sur un design transversal menée pendant cinq mois à Douala. Ont été incluses les femmes au troisième trimestre de la grossesse, ayant été reçues en consultations prénatales ou en salle d'accouchement, également les femmes allaitantes. Les données sociodémographiques, économiques et culturelles ont été recueillies. Les différentes comparaisons ont été faites à l'aide du test Khi2 de Pearson ou le test de Fisher. Les moyennes ont été comparées en utilisant les tests de Wilcoxon et Mann-Whitney. Résultats : Au total, 300 femmes ont été incluses, l'âge moyen était de de 30 ± 6 ans. Les plus représentatives étaient celles âgées entre 31 et 35 ans. Plus de la moitié de ces femmes était du niveau secondaire 195 (65%). Concernant le statut matrimonial, les femmes célibataires étaient les plus représentées, 177 (59%). Les sujets n'ayant pas de revenu mensuel, 148 (49,3%) étaient les plus nombreux. L'absence de moyen de transport a été l'une des causes de la non-adhésion. Le niveau d'étude s'est révélé être un facteur déterminant pour l'utilisation des services de la PTME. Conclusion : Plusieurs obstacles se dessinent sur la voie de l'utilisation des services de PTME. Le niveau socioéconomique et notamment le niveau éducationnel et financier semblent être des déterminants importants à l'adhésion aux soins. Les pouvoirs publics devraient multiplier des efforts de décentralisation de la prise en charge et d'éducation des populations

Air pollution and ST-elevation myocardial infarction: A case-crossover study of the Belgian STEMI registry 2009-2013.

BACKGROUND: Previous studies have shown that air pollution particulate matter (PM) is associated with an increased risk for myocardial infarction. The effects of air pollution on the risk of ST-elevation myocardial infarction (STEMI), in particular the role of gaseous air pollutants such as NO2 and O3 and the susceptibility of specific populations, are still under debate. METHODS: All patients entered in the Belgian prospective STEMI registry between 2009 and 2013 were included. Based on a validated spatial interpolation model from the Belgian Environment Agency, a national index was used to address the background level of air pollution exposure of Belgian population. A time-stratified and temperature-matched case-crossover analysis of the risk of STEMI was performed. RESULTS: A total of 11,428 STEMI patients were included in the study. Each 10µg/m3 increase in PM10, PM2.5 and NO2 was associated with an increased odds ratio (ORs) of STEMI of 1.026 (CI 95%: 1.005-1.048), 1.028 (CI 95%: 1.003-1.054) and 1.051 (CI 95%: 1.018-1.084), respectively. No effect of O3 was found. STEMI was associated with PM10 exposure in patients ≥75y.o. (OR: 1.046, CI 95%: 1.002-1.092) and with NO2 in patients ≤54y.o. (OR: 1.071, CI 95%: 1.010-1.136). No effect of air pollution on cardiac arrest or in-hospital STEMI mortality was found. CONCLUSION: PM2.5 and NO2 exposures incrementally increase the risk of STEMI. The risk related to PM appears to be greater in the elderly, while younger patients appear to be more susceptible to NO2 exposure.

Prise en charge des anémies chez les patients cancéreux dans un hôpital de référence de Douala, Cameroun

Introduction : L'anémie représente un facteur limitant dans la prise en charge des patients cancéreux. L'objectif général de ce travail était d'évaluer la prise en charge de l'anémie chez les patients cancéreux reçus à l'hôpital général de Douala, par rapport aux recommandations internationales. Patients et méthodes : Il s'agit d'une étude prospective menée du 1er septembre 2013 au 30 avril 2014. La sévérité de l'anémie après traitement spécifique a été évaluée à l'aide du classement OMS des grades de toxicité hématologique chimio-induite. La qualité de vie des patients a été évaluée grâce au score OMS du Performance status. La prise charge de l'anémie a été comparée aux standard options et recommandations françaises 2007. Résultats : Au total 301 patients ont été colligés. L'âge médian était de 42,5 ± 15,1. La prévalence de l'anémie à l'entrée était de 71,4% et passait à 80,7% après traitement. Tous les cancers ont été pourvoyeurs d'anémie sans différence statistiquement significative. Le taux d'abstention thérapeutique était de 16,9% avant l'initiation du traitement spécifique et de 13,6% après. Les anémies légères ≥ 10g/dl ont été traitées par fer oral. Les anémies modérées à sévères ont été traitées par transfusion sanguine. Les agents stimulants de l'érythropoïétine ont été utilisés dans 2,3% des cas. Le taux de respect des recommandations était de 17,5%. Conclusion : Cette prise en charge conformément aux recommandations internationales reste insuffisante. Elle se heurte à plusieurs obstacles dont le principal est financier, ainsi qu'à la rareté des médicaments. Un plaidoyer pour une subvention de médicaments sur cette problématique est à développer

Use of oral rehydration therapy in the treatment of childhood diarrhoea in Douala, Cameroon.

INTRODUCTION: The use of oral rehydration solutions in our context remains limited. This study was conducted to analyze the rate of this use in Douala, Cameroon and thereby determine the factors associated with it. METHOD: A cross-sectional survey was administered to parents of children aged five years and younger during a six-month study period. The studied variables focused on the socio-demographic data of the population, data on diarrhoea and its severity, data on oral rehydration salts (ORS), and data related to other interventions for diarrhoea. The chi-square test was used to qualify associations between variables, with the significance level being set at 5%. RESULTS: Overall, 672 people agreed to participate in the study. Among them, 418 (62.2%) correctly defined diarrhoea. When their children develop diarrhoea, the majority of the parents (348, 51.8%) reported seeking hospital assistance before any intervention, while 225 parents (33.5%) preferred the use of ORS first. Four hundred seventy-five parents (70.7%) had heard of ORS and among them 313 (65.9%) had actually given ORS to their children as treatment during these children's most recent episodes of diarrhoea. Of the parents who had given their children ORS, 217 (69.3%) knew how to prepare it, and 122 (39.0%) knew how to administer it. One hundred thirty-five parents (20.1%) had administered metronidazole to treat their children's diarrhoea. The age of the children, the parents' level of education, and the number of children in the household significantly influenced the use or non-use of ORS (respectively, p < 0.001, p = 0.003 and p < 0.0001). Rehydration was correctly identified by 234 parents (34.8%) as the purpose of administering ORS. CONCLUSION: The knowledge and the use of ORS in diarrhoea by the study sample was insufficient. The role of ORS was poorly known. Awareness campaigns can be carried out in order to improve the use of this effective intervention for diarrhoea.

[Clinical and immunological profile of HIV-infected patients at the initiation of antiretroviral therapy in Douala]. / Profil clinique et immunologique des patients infectés par le VIH à l'initiation du traitement antirétroviral à Douala.

The aim of this study was to describe the clinical and immunological profile of patients infected with HIV after initiation of antiretroviral therapy. Sociodemographic characteristics, clinical and immunological patients were recorded. Chi square test and Mann-Whitney were used to compare variables. The multivariate regression model identified risk factors. So that, 936 (56.2%) patients were in stages III and IV of the WHO and 65.2% at an advanced stage of the disease. Factors associated with initiation at an advanced stage, were male sex (p = 0.007) and time to diagnosis (p = 0.005). In 2/3 cases, treatment is started at an advanced stage of disease. It is therefore important to intensify awareness campaigns for early detection and encourage patients to ensure regular medical follow-up screening.

[Association of air-pollution with acute myocardial infarction: A case-crossover study]. / Association entre pollution atmosphérique et infarctus du myocarde sur base de la méthode cas-croisé.

BACKGROUND: A large number of studies have demonstrated an association between ambient air pollutant exposures and acute myocardial infarctions (AMI). Case-crossover methods are frequently used for analyzing the acute health effects of air pollution. Nevertheless, only a few studies controlled for potential confounders like other air pollutants and temperature. METHODS: The defined geographic entity for the collection of acute myocardial infarctions was composed of 15 municipalities in Charleroi. Charleroi is a relatively highly polluted region in Wallonia, the South of Belgium. The analyses presented hereafter concern patients in the 25-74 years age range over time from 1999 to 2009. Ambient concentrations of PM10, O3, NO2, CO and temperature were available from stationary monitors during this time period. A time-stratified case-crossover approach was applied. Season stratified analysis and analysis matching for environmental confounders were also performed. RESULTS: A total of 3303 AMIs were analyzed during the study period. For the entire year, O3 was significantly associated with AMI, OR=1.028 (CI95%: 1.003-1.054). The highest associations (for a 10 µg.m(-3) rise in pollutant levels) between air pollution and myocardial infarction were observed for PM10 and O3 during the warm period, OR=1.086 (CI95%: 1.020-1.151) and 1.064 (CI95%: 1.024-1.105), respectively. Matching cases and controls for temperature produced weaker association between O3 and AMI (OR=1.003, CI95%: 0.974-1.032). In contrast, this matching had no effect on the association between PM10 and AMI. The adjustment for NO2 concentration decreased the association between PM10 and AMI. CONCLUSIONS: The results of this study reinforce the evidence of the short-term effects of air pollution on acute myocardial infarction, especially during the warm season. This also suggests that the case-crossover method is a suitable tool in studying the association between acute events and air pollution. Controlling for potential environmental confounding effects is also feasible with this method.

Breastfeeding duration: a survival analysis-data from a regional immunization survey.

OBJECTIVE: To report the duration of and factors associated with exclusive and any breastfeeding among the French-speaking community of Belgium (Wallonia). MATERIAL AND METHODS: A two-stage cluster sample was drawn from the population of children aged 18-24 months living in the area in 2012. Anamnestic data on breastfeeding and sociodemographic information were collected from 525 mothers. Cox's proportional hazards model was used to identify factors associated with discontinuing breastfeeding. RESULTS AND DISCUSSION: Only 35.1% of the women were satisfied with their duration of any breastfeeding. At 3 months, 54.1% of the infants were breastfed, of which 40.6% exclusively, with these percentages falling to 29.1% and 12.6% at 6 months. Exclusive and any breastfeeding durations were independently positively associated (P < 0.05) with foreign-born mothers, awareness of WHO recommendations, and maternity leave >3 months. Exclusive BF duration was associated with higher parental income and the prenatal decision to breastfeed. The duration of any breastfeeding was associated with the mothers' age of ≥30 years and whether they were exclusively breastfeeding at discharge from the maternity unit. CONCLUSIONS: Programs promoting and supporting BF should concentrate on training prenatal health-care professionals. Prenatal professional advice may promote adherence to WHO BF guidelines. The benefits of exclusive BF should be emphasized. Pregnant women should be discouraged from introducing supplementary feeding in the maternity ward.

[Qualitative analysis of palliative care and support in medical practices in DRC]. / Approche qualitative sur les soins palliatifs et d'accompagnement dans les pratiques médicales en République démocratique du Congo.

This work aims at documenting the representations that health professionals in Kinshasa have of palliative care and end-of-life support. This qualitative study was conducted among 30 doctors and 90 nurses with at least one year of experience in six hospitals in Kinshasa that receive patients at the end of life. The results show that health professionals believe that this care is time-consuming and that the inability to say some things to patients and families generates misunderstandings and concerns likely to prevent the application of palliative care. For them, it is often a futile therapeutic obstinacy, added hygienic care, and neglect of the patient. The obstacles to implementing this care might be linked to the lack of training about this approach and a health system based essentially on curative approaches. The representation of health professionals about palliative care and support are many and varied. They are, however, more structured among physicians than nurses.

[Analysis of health policies to prevent non communicable diseases in the Wallonie-Brussels Federation]. / Analyse des politiques de prévention des maladies non transmissibles dans la Fédération Wallonie-Bruxelles.

Because of their high prevalence and constant increase, and their impact in terms of human and financial costs, non-communicable diseases (NCD) represent an important public health issue. Recognizing this alarming situation, the international Community took decisive commitments to reduce the spread of this epidemic of the 21st century. These commitments have been translated in the national prevention and care policies. In the Wallonie-Brussels Federation (WBF), a set of health policies to prevent non communicable diseases was initiated. The objectives of the study were to describe, explore promotion and primary and secondary prevention against NCDs policies in WBF, to highlight the main challenges and issues, and to provide some recommendations to concerned actors. To achieve the objectives of this study, a literature review and a qualitative approach were used. Semi-structured interviews of key stakeholders were conducted in WBF. It involved 14 actors selected for their involvement in the formulation and implementation of these policies. It appears that the Belgian institutional complexity, the lack of willingness of policymakers in prevention and health promotion, the lack of a comprehensive structured policy of prevention and health promotion and an absence of any coordination structure are the main obstacles facing the formulation and implementation of these policies.

[Particle pollution effects on the risk of cardiovascular diseases]. / Effets de la pollution particulaire sur le risque de maladies cardiovasculaires.

The effects of air pollution on health are quite well-documented and the influence of particulate pollution on morbidity and mortality from myocardial infarction and stroke is increasingly evident. The objective of this literature review is to identify and synthesize articles on the impact of air pollution by PM10 and PM2.5 of myocardial infarction and stroke. A total of 14 studies were reported on the effects of PM10 and five on the effects of PM2.5. Nine out of 14 studies for PM10 and two studies of five for PM2.5 have found a significant association with myocardial infarction and/or stroke. Particle composition according to location, study period and population must be considered in interpreting the results on the health effects of air pollution. The integration of these elements is important for decision making in tune with social and economic conditions specific to each environment.

[Acute myocardial infarction in Charleroi: evolution of risk factors and therapeutic practices]. / Infarctus aigu du myocarde à Charleroi : évolution des facteurs de risque et des pratiques thérapeutiques.

OBJECTIVES: The aim of the study consists in analyzing the evolution of acute coronary risk factors as well as the 28 days case fatality and the therapeutic practices over 12 years of follow-up in Charleroi. The factors influencing the mortality of these patients are also investigated. METHODS: The Charleroi register of ischaemic cardiopathies is the oldest register of infarctions in the French-speaking community of Belgium. Analyses presented hereafter relate only patients in the 25-69-year age range over time from 1998 to 2009. Some analysis was extended to 25-74-year range. Treatment and risk factors evolutions over time were analysed using Chi(2) tests. Logistic regression was used to identify factors influencing 28 days mortality. RESULTS: The analysis shows a significant decline in 28 days mortality. A marked increase in the prevalence of hypertension and hypercholesterolemia is highlighted as well as an increase of utilization of percutaneous transluminal coronary angioplasty (PTCA) between 1998 and 2009. The use of ß-blockers and antiplatelet drugs remained fairly stable between 1998 and 2009 with approximately 75% and 90% of the patients treated, respectively. The factors associated with fatality were specifically age of patients, antecedents of diabetes and antecedents of myocardial infarction, hypercholesterolaemia as well as oral antiplatelet drugs, ß-blockers therapies and PTCA. CONCLUSIONS: The evolution of the therapeutic data on AMI in this register confirms that PTCA becomes the main coronary reperfusion. Angiotensin-converting enzyme inhibitors were without effect on mortality.

[Qualitative analysis of factors supporting the motivation for gastric bypass]. / Analyse qualitative des facteurs favorisant le recours au bypass gastrique.

Half of Belgium's adult population is overweight and approximately 14% are obese. Apart from organic diseases associated with obesity, the psychological repercussion is very important and requires a specific caring. Conservative treatments containing diet, physical-activity and drugs often show limits in particular when the patient presents food behavioural disorders. The bariatric surgery is presented like an ultimate therapy. It is a specific treatment which involves risks and high cost for the patient. This study is based on a qualitative study including patients coming to a gastric bypass in order to appreciate the surgical indications and to describe the individual motivations which lead the patients to request this intervention. The study consists of semi-structured interviews with hospitalized patients. The majority of the patients do not correspond to the criteria defined by the law. The psychological repercussion of obesity compared to the family sight and the society seems to constitute a crucial factor in the recourse to the gastric bypass. The motivations to undergo this intervention are: importance attached to the physique, need for being with the mode, for answering at the request of a spouse or for decreasing health risks. The social support of the family and friends, during and after the intervention is a key component of the success and the acceptability of the intervention. This study proposes to re-examine the criteria of access to the bariatric surgery and to ensure a psychological accompaniment before and after the intervention. That is important for patients who are badly informed about conditions and consequences of the intervention.

[Qualitative analysis of the offer for prevention and caring of sickle cell anaemia in Brussels]. / Analyse qualitative de l'offre pour la prevention et la prise en charge de la drépanocytose à Bruxelles.

Sickle cell disease (SCD) is the first genetic disease in the world and remains largely ignored by the population but also by health professionals. SCD is characterized by a variable clinical expression, however most of the patients are at risk to develop acute and severe complications conducting to a fatal issue. This study develops a qualitative approach to analyze the adequacy between the services offered for those patients in Brussels and the sociocultural characteristics of the target population and more specifically of the migrant population originating of sub-saharan Africa which is the most concerned. To have a global vision of the preventive and care services provided for SCD in Brussels, semistructured interviews were conducted with health professionals and patients associations. The results were analyzed to determine if they match the expectations of health professionals and audiences across the voluntary sector. The results show the absence of a real recognition at the national level of sickle cell anaemia, a deficit in psychosocial care of patients and their families. SCD is often considered by the African community as a disease of the curse which has to be hidden. To the physical pain and multiple organ complications one must add a psychological distress that patients drive back into silence. The management of this disease therefore requires a dedicated approach. With the exception of newborn screening performed in all maternity hospitals in Brussels and Liège, there is no specific measure for the management of SCD in Belgium.