Retrospective survey of Chikungunya disease in Réunion Island hospital staff.

Réunion Island (Indian Ocean) has been suffering from its first known Chikungunya virus (CHIKV) epidemic since February 2005. To achieve a better understanding of the disease, a questionnaire was drawn up for hospital staff members and their household. CHIKV infected about one-third of the studied population, the proportion increasing with age and being higher in women. Presence of a garden was associated with CHIKV infection. The geographical distribution of cases was concordant with insect vector Aedes albopictus distribution. The main clinical signs were arthralgia and fever. The disease evolved towards full recovery in 34.4% of cases, a relapse in 55.6%, or a chronic form in 10%. Paracetamol was used as a painkiller in 95% of cases, sometimes associated with non-steroidal anti-inflammatory drugs, corticoids, or traditional herbal medicine. The survey provided valuable information on the factors that favour transmission, the clinical signs, the importance of relapses and the therapies used.

[Agauria salicifolia intoxication]. / Intoxication par bois de gale (Agauria salicifolia).

INTRODUCTION: Several plants of the Ericaceae family produce grayanotoxins, which can poison humans. The best-known of these intoxications involves the eating of "mad honey" contaminated by rhododendron nectar grayanotoxins. The authors report a case of poisoning due to ingestion of Agauria salicifolia, an Ericaceae species endemic in the Mascarene Islands. CASE: A 28-year-old woman mistakenly ingested a herbal tea made with leaves of this plant. Symptoms were characteristic of grayanotoxin intoxication, with vomiting, arterial hypotension and bradycardia. The patient was managed in an intensive care unit and recovered within a few hours after symptomatic treatment of the low blood pressure and the severe digestive disorders. CONCLUSION: This case underlines that ingestion of some plants can be toxic.

[Benchmarks for evaluating health care networks]. / Repères pour l'évaluation des réseaux de soin.

The implementation of health care networks is accompanied by a certain number of changes in professional practices. At the heart of the economic, organisational, and political stakes, new questions are posed, especially in terms of evaluation. It is true that no matter what the level of evaluation, it is essential today to rely on the support of existing information systems to develop methodologies and to better describe the produced effects, in economic terms and health outcomes, but also from a more qualitative point of view, in terms of public satisfaction and benefits to clients. Laying down some reference points for evaluating health care networks can only contribute to developing new strategies for showing their effectiveness and efficiency and learning from this experimentation.

Utilization of health care in an African urban area: results from a household survey in Ouagadougou, Burkina-Faso.

This study analysed the level of utilization of different kinds of health care providers, and its correlates, by people reporting an illness via a household health survey in a representative sample of 547 households (3667 persons) in the city of Ouagadougou, Burkina-Faso in 1989. More than one-fourth of the sample reported suffering from a health care problem in the 2-week period preceding the interview. Self care was the most frequently reported type of care received (55.6%). Bivariate analysis and logistic regression revealed that the principal determinants of the utilization of modern care givers were age, socio-economic level, illness characteristics (type, length, severity), and cost of care and transportation. In particular, we found that: (1) Even though the family remained the main provider of care in case of minor (mild and short) illnesses, it did not prevent modern health facilities from playing their curative role in case of serious illnesses. (2) Residential zone (central versus peripheral zone) was not significantly associated with health care choice, which was contrary to expectation. (3) On the other hand, socio-economic status strongly affected health-seeking behavior. (4) The travel pattern of the ill persons favored health carde facilities in the central zone. Taken together, the results of this study question the role of community health workers in the urban program of community health care which was in the process of being implemented at the time of the study. They suggest that the family, instead of the community health workers, should be seen as the provider of curative care for minor illnesses. Community health workers may have a more effective role in health education than in curative tasks.

[Analysis of pediatric home care services of the Assistance Publique--Hôpitaux de Paris]. / Analyse de l'activité de l'hospitalisation à domicile pédiatrique de l'Assistance Publique--Hôpitaux de Paris.

BACKGROUND: The Home Health Care services for children in Paris was recently established and it is interesting to analyse the first results of their activities. POPULATION AND METHODS: A random sample (n = 157) of the 418 children admitted to home health care in the Assistance publique-Hôpitaux de Paris (HAD-P) in 1991 has been studied; only one episode of care was analyzed for each child. The data analysed included sociodemographic characteristics of the children, their clinical diagnosis and the care received. RESULTS: More than half of the children presented chronic diseases. Follow-up of newborn children was the main reason for admitting children with acute conditions. Housing and socioeconomic conditions were poor for a significant number of children. A seasonal pattern was found, with higher activity in the beginning and in the end of the year. CONCLUSIONS: More efforts are needed to develop complementarity between hospital-based and home health care services, beginning with improved communication of detailed information regarding home health care objectives and conditions.