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Abstract: Objective: The aim of the study was to identify the most useful clinical criteria to measure effectiveness and adherence to antiretroviral treatment in a rural area of Cameroon. Patients and method: All patients under antiretroviral therapy followed for at least 3 months at the Tokombéré UPEC hospital were eligible. Therapeutic failure was defined according to clinical criteria including weight, Karnofsky''s index, or occurrence of WHO stage IV conditions. The criteria for drug adherence were based on patient statement (drugs taken over the last 4 days) and pharmacy-controlled drug delivery. Patient sociodemographic characteristics were collected via a questionnaire. Results: Fifty-six patients were included, most of whom were at AIDS stage on treatment initiation. The mean duration of antiretroviral therapy was 1year. 21, 10, and 19% of patients were in therapeutic failure according to “weight”, “Karnofsky''s index”, and “WHO stage IV”, respectively. Non-adherence was reported in 5% of patients according to the declarative method and 20% according to pharmacy controlled drug delivery. Weight modification during treatment was significantly correlated with the evolution of Karnofsky''s index (p =0.03). A significant correlation between therapeutic failure and non-observance was only found when using the weight criterion and the declarative method (p =0.004). Conclusion: The effectiveness and adherence to antiretroviral therapy can be evaluated by simple clinical criteria. Using these criteria can be recommended in rural areas until access to biological follow-up becomes available in developing countries. [Copyright &y& Elsevier]

Abstract: Objectives: The study''s objective was to evaluate with a standardized questionnaire the knowledge of healthcare workers (HCWs) regarding occupational vaccinations and their vaccination coverage. Population and Methods: This cross-sectional survey was conducted in the department of infectious diseases of a 1796 bed-teaching hospital in Dijon, France. Results: Fifty-seven (93%) out of 61 HCPs completed the questionnaire. Vaccination against HVB was the most frequently mentioned vaccination (79%), followed by BCG (66%), and combine vaccine against diphteria, tetanus, and polio (DTP) (66 %). Influenza was the most often quoted among recommended vaccinations (70%), followed by measles (61%), pertussis (39%), and varicella (14%). The number of correct answers was significantly correlated with age of participants, being a physician, and having had courses on vaccination. Almost all HCPs were up to date for mandatory vaccinations. In 2009 to 2010, vaccination rates against seasonal flu and H1N1 flu reached 88%. Only 52% of HCPs knew about their pertussis immunization and only a third of those born before 1980 had been tested for measles. Conclusions: HCPs knowledge of mandatory vaccinations is adequate but more limited for recommended vaccinations. Information on influenza vaccination has significantly improved its perception among HCPs resulting in a better adhesion to vaccination. [Copyright &y& Elsevier]

Following the implementation of strict, coordinated animal health measures in the 1950s, France was officially declared free of bovine tuberculosis (bovine TB, bTB) in 2001 [1]. • the social representation of tuberculosis is still widespread and infection with M. bovis is commonly inappropriately confused by patients and their entourage with M. tuberculosis infection. Via a letter hand-delivered to each worker, the OP informs the worker's general practitioner of the actions taken, and if necessary of screening test results. [Extracted from the article]

Abstract: Introduction: Informal consultations for advice in the infectious diseases department (IDD) induce a significant workload for physicians. Our aim was to retrospectively quantify and describe this activity in our institution. Method: The data was obtained from files documented and faxed by physicians from October 2009 to May 2012. One thousand nine hundred and seventy-two files were included. The file was faxed to the IDD specialist, analyzed, then a telephone conversation allowed making precisions, and the documented form was faxed back. Results: The requests for advice concerned 39% of female and 61% of male patients with a mean age of 64±21 years. Twenty-nine percent of requests came from surgical departments and 71% from medical departments (P <0.01). The departments most frequently concerned were cardiology (10%), gastro-enterology (10%) and cardiovascular surgery (9.7%). The most frequent infections were urogenital (19%), osteoarticular (14%), and cardiovascular (11%). Forty-nine percent were considered as nosocomial and 25.3% were bacteremic. The requests concerned diagnostic aid in 16.2% of cases and therapeutic issues in 95.6%. The IDD specialist made therapeutic recommendation in 96.5% of cases and gave diagnostic advice in 43.7%. Treatment modification was suggested in 38.5% of cases. Twenty-two percent of consultations required a second one. Conclusion: This study documented the importance of antibiotic changes among medical and surgical units, the increasing need of these units to be helped, and also the complexity of the medical cases, all requiring the advice of an ID specialist. Our fax-phone-fax procedure seems to prevent the bias associated with informal consultations by phone, which is the most commonly used in other institutions. [Copyright &y& Elsevier]

Abstract: Aim: The authors wanted to identify the factors associated with prescription or non-prescription of antibiotics by general practitioners (GPs), for three frequent infectious diseases: tonsillitis, acute bronchitis (AB) and exacerbations of chronic bronchitis (ECB). Patients and methods: A cross-sectional study included 574 patients followed by 58 randomly selected GPs in Eastern France. Data on physicians, patients (clinical, social and environmental) and antibiotic treatment (type, motivations) was collected during the consultation via a standardized questionnaire. Results: Official recommendations for tonsillitis, AB and ECB were known by GPs in 100, 96 and 91% of the cases, respectively. An antibiotic was administered in 61% of tonsillitis cases, 64% of AB and 84% of ECB. The correlation between prescribing or not antibiotics and official recommendations was variable (tonsillitis: 81.3%, ECB 89.6%, AB: 36.5%). Clinical criteria were the main factors influencing antibiotic prescription. A rapid antigen detection test for streptococcus A was performed in 65% of tonsillitis cases (positive in 55%) increased conformity with recommendations to 93.7%. A second consultation, poor tolerance and patient demand were also significantly associated with a higher rate of antibiotic prescription. Conclusions: Recommendations were known, but semiologic definitions and nosologic limits varied from one physician to another. Recommendations must be based on routine medical practice surveys to include factors influencing prescription, even if non significant. Paraclinical tests help in therapeutic decision making and in the non-prescription of antibiotics but such tests need to be more commonly used. [Copyright &y& Elsevier]

Introduction Le suivi thérapeutique pharmacologique (STP) est un des outils du suivi des personnes vivant avec le VIH (PVVIH). L’objectif de cette étude est d’évaluer en pratique courante l’utilisation du STP, ainsi que les situations dans lesquelles il apporte un bénéfice thérapeutique. Matériels et méthodes Toutes les PVVIH ayant bénéficié d’au moins un STP entre le 1 er janvier 2009 et le 31 décembre 2012 ont été rétrospectivement incluses. Chaque fois qu’un STP a été réalisé, nous avons analysé sa conformité aux recommandations françaises, les concentrations plasmatiques des molécules antirétrovirales, les modifications thérapeutiques consécutives, et l’évolution virologique 6 mois après le premier STP. Résultats Sur 571 PVVIH incluses, 248 (43,4 %) ont bénéficié d’au moins un STP de leur traitement antirétroviral. Le STP était conforme aux recommandations chez 120 patients (48 %). Les STP réalisés conformément aux recommandations mettaient plus fréquemment en évidence des concentrations en dehors de l’intervalle thérapeutique (107 [28,4 %] vs. 74 [19,6 %] p = 0,03), en particulier lorsque motivés par un échec virologique (156 [41,5 %] vs. 110 [29,2 %] p = 0,09). Au total, 56 patients (22,6 %) ont bénéficié d’une modification de leur traitement antirétroviral, consécutive au STP. Les inhibiteurs de protéase, les inhibiteurs non nucléotidiques de la transcriptase inverse et le raltégravir étaient consécutivement plus souvent modifiés lorsque la concentration plasmatique était en dehors de l’intervalle thérapeutique ( p = 0,008, p = 0,05 et p = 0,02, respectivement). Au final, seuls 44 STP (11,7 %) ont mis en évidence une concentration en dehors de l’intervalle thérapeutique motivant une modification du traitement avec un contrôle virologique VIH confirmé 6 mois après. Conclusion Si le bénéfice global du STP en pratique courante peut apparaître modéré lorsqu’il est pratiqué largement, il est d’un intérêt lorsqu’il est réalisé dans le cadre défini par les recommandations. Il n’est pas, à l’échelon individuel, un outil de décision en soi, mais un outil utile lorsqu’intégré à une approche globale incluant le contexte clinique et virologique. [ABSTRACT FROM AUTHOR]