Evaluation of a mobile team dedicated to behavioural disorders as recommended by the Alzheimer Cooperative Valuation in Europe joint action: observational cohort study.

BACKGROUND AND PURPOSE: Preventing behavioural crises appears to be crucial to promote quality of life of the patient-caregiver dyad, to reduce inappropriate hospitalizations and to delay institutionalization. The Alzheimer Cooperative Valuation in Europe promotes mobile care to prevent patients from severe behavioural and psychological symptoms in dementia. This study assessed the potential efficacy of a mobile team for Alzheimer's disease on hospitalization sparing and behavioural disorder reduction. METHODS: A cohort study was set up from 1 January 2012 to 31 December 2013 by the Clinical and Research Memory Centre of Lyon (France). It included patients with behavioural and psychological symptoms living at home or in a nursing home. An interview explored the alternative patient pathways used by general practitioners (GPs) if the mobile team had not existed (hospitalization sparing). The Neuropsychiatry Inventory score was assessed at inclusion and 30 days later. The sample included 424 consecutive patients with Alzheimer's disease or related disorders and behavioural disorders at any cognitive and functional stage of the disease, taken in charge by the mobile team. RESULTS: Amongst the 424 patients (84.0 ± 7.2 years), 220 (51.9%) hospitalizations were considered by their GPs and 181 (82.3%) were avoided. The Neuropsychiatric Inventory score declined after mobile team intervention (45.8-29.9, P < 0.001). Sleep and appetite disorders, endangered situation and caregiver burnout were associated with higher risk of hospitalization at 30 days. CONCLUSIONS: The mobile team for Alzheimer's disease allows a high proportion of hospitalizations related to behavioural disorders to be avoided and may help to reduce behavioural disorders.

Serological and molecular characterization of Chlamydophila psittaci strains using serovar-specific monoclonal antibodies and ompA sequence analysis.

In the present study, 21 avian Chlamydophila psittaci field isolates from 4 different European countries (Belgium, Germany, Italy and The Netherlands) were characterized using serovar-specific monoclonal antibodies as well as ompA sequence analysis, enabling the comparison between the two characterization methods for future epidemiological studies. The 21 European isolates included 6 isolates from the order Psittaciformes, 6 isolates from the Anseriformes, 5 isolates from the order Columbiformes and 4 Galliformes respectively. Only 19 on 21 isolates could be serotyped while all isolates were successfully genotyped. In addition, genotyping revealed the presence of mixed infections in 5 on 21 isolates while serotyping could only detect one of these 5 mixed infections. Interestingly, genotyping indicated the existence of a new genotype designated E/B. The E/B genotype is closely related to the genotypes A, B and E but the ompA gene of E/B strains shows a guanosine on position 1006 and 1021 in combination with a cytidine on position 1022 to be unique. Genotype E/B isolates reacted with both the serovar E- and B-specific monoclonal antibody leading to the conclusion of a mixed infection while only one specific ompA sequence was present in the sample. For epidemiological studies genotyping by use of ompA sequence analysis is to be preferred as it is more sensitive than serotyping and can distinguish genotype B, E and E/B strains.