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Il a été postulé qu’en plus d’influencer les comportements parentaux, les caractéristiques personnelles des parents joueraient un rôle important dans leur degré de coopération avec leur partenaire (Abidin, 1992 ; Belsky, 1984). Toutefois, peu d’études se sont penchées sur les liens unissant les traits de personnalité des parents et l’alliance parentale (Jacobson et al., 1995; Stright et Bales, 2003). Le premier objectif de l’étude était donc d’évaluer les liens intra-parents, c’est-à-dire si les traits de personnalité d’un parent d’enfant d’âge préscolaire permettent de prédire sa propre perception de l’alliance parentale et ce, après avoir contrôlé pour l’effet de son niveau de scolarité, de son revenu ainsi que de sa perception de sa situation financière. Le second objectif était d’examiner les liens inter-parents, donc de vérifier si les traits de personnalité d’un partenaire contribuent à prédire la perception de l’alliance parentale de l’autre parent. Finalement, le troisième objectif consistait à vérifier s’il existait des différences sexuelles dans les relations prédictives entre les traits de personnalité et l’alliance parentale. L’échantillon est composé de 170 dyades de parents ayant un enfant âgé entre 42 et 48 mois et résidant dans la grande région métropolitaine de Montréal. Les parents ont été évalués par le biais de questionnaires auto-révélés. Les résultats montrent que l’amabilité des mères et la stabilité émotionnelle des pères sont positivement associées à leur perception de l’alliance parentale. De plus, une forte amabilité chez les conjoints prédit positivement l’alliance parentale, autant pour les mères que les pères. Par ailleurs, le trait d’amabilité maternelle prédit significativement mieux la perception de l’alliance parentale des pères que l’amabilité paternelle. Toutefois, aucune différence sexuelle significative n’a été constatée quant à la magnitude de la contribution des traits de personnalité des parents sur la perception de l’alliance parentale des mères. Cette étude met en lumière l’importance de certaines caractéristiques personnelles influençant la perception de la coopération entre les parents sur la sphère parentale., It has been theorized that personality has implications in both parenting behaviours and the extent to which parents are willing to collaborate in order to respond to a child’s changing needs (Abidin, 1992 ; Belsky, 1984 ). However, few studies examined the relationship between parent’s personality traits and their parenting alliance (Jacobson et al., 1995; Stright et Bales, 2003). This study focused on three objectives. The first aim was to examine the influence of parent’s personality traits on his own perception of the parenting alliance. The second objective was to verify if the partner’s personality traits predicted the perception of the parenting alliance of the other parent. Lastly, the study aimed to identify potential sexual differences in the predictive relations between personality traits and parenting alliance. Data was collected using a sample of 170 mothers and fathers of children aged 24 to 48 months, living in the Montreal area, who completed self-report questionnaires. The results of this study show that high agreeableness in mothers and high emotional stability in fathers were linked to better perception of the parenting alliance. Furthermore, spouse’s high agreeableness predicted higher parenting alliance scores, for both parents. Compared to father’s agreeableness, mother’s agreeableness is significantly a better predictor of father’s perception of the parenting alliance. Also, when mother’s and father’s scores were compared, none of the partner’s personality traits emerged as a more significant predictor of the parenting alliance as perceived by mothers. This study provides evidence that some parent’s characteristics are important in understanding how they perceive the cooperation with their spouse in regard to parenting.

Purpose To describe the occurrence of potential statin misuse, its characteristics and associated factors in older people. Methods A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) using French health insurance databases. Study population comprised community-dwelling patients and nursing homes residents aged 80 and over, who received at least one statin prescription between January 1, 2017 to April 30, 2017 (N = 38 268). Potential statin misuse was identified considering off-label uses, high-intensity doses, drug contraindications and statin-drug interactions. Results At least one potential statin misuse was detected for 19 468 patients (50.9%). Off-label prescription was the most frequent misuse observed (53.6%), followed by high-intensity statin dose (30.5%). Polypharmacy (five to nine drugs) and excessive polypharmacy (10 or more drugs) were the main risk factors associated with potential statin misuse (adjusted OR = 2.6 and 4.7 respectively). Nursing home, multi-morbidity and the presence of multiple prescriptions from different doctors for the same patient were other risk factors significantly associated. Two sensitivity analyzes (reconsiderations of off-label and high statin dose definitions) revealed the same statistical trend. Conclusion Potential statin misuse is frequent in people aged 80 and over. These findings should serve as a warning to health care professionals and hopefully will contribute to ensure an appropriate and safe use of statin in aged population.

Background The vast majority of patients with systemic lupus erythematosus (SLE) complain about fatigue. They also report fatigue as one of their most debilitating symptoms. Yet, in clinical practice, fatigue is only rarely assessed and remains poorly understood. The purpose of this study is to validate the Fatigue Assessment Scale (FAS) and assess the impact of disease activity on fatigue in SLE. Methods A cross-sectional single-center study of patients was included in the Swiss SLE Cohort Study. The FAS and the Short Form 36 (SF-36) were administered to SLE patients and controls with primary Sjogren’s syndrome (pSS) and healthy volunteers (HV) attending our clinic. Disease activity in SLE was captured at the same time as patient-reported outcomes using the SLE Disease Activity Index score with the Safety of Estrogens in SLE National Assessment modification (SELENA-SLEDAI) and the physician’s global assessment. We explored the internal consistency, reproducibility, construct validity, and convergence of the FAS, in comparison to the vitality subscale (VT) of the SF-36. We examined the association of FAS with demographics, disease type, SLE disease activity, and clinical features. Results Of the 73 SLE subjects, 89% were women and 77% were Caucasians. The median age was 43 years, and 23 (32%) patients had active SLE. Demographics in pSS and HV were similar. Within the SLE group, FAS displayed good internal consistency (Cronbach’s alpha = 0.93), unidimensionality, and test-retest reliability (ICC = 0.90). FAS and VT correlated well. The total FAS was highest in active SLE and pSS and higher in non-active SLE compared to HV. Conclusion The FAS is a promising tool to measure fatigue in SLE. Patients with SLE display a significantly higher level of fatigue than HV, which is even more pronounced in active disease and comparable to fatigue levels measured in pSS.

Breast cancer is detected through screening or through signs and symptoms. In Canada, mammograms for breast cancer screening are offered in organized programs or independently (opportunistic screening). Province of Ontario breast Diagnostic Assessment Units (DAUs) are facility-based programs that provide coordinated breast cancer diagnostic services, as opposed to usual care, in which the primary care provider arranges the tests and consultations. This study describes breast cancer detection method, diagnostic interval and DAU use across Ontario.The study cohort consisted of 6898 women with invasive breast cancer diagnosed in 2011. We used the Ontario Cancer Registry linked to administrative health care databases. We determined the detection method using the Ontario Breast Screening Program (OBSP) data and physician claims. The diagnostic interval was the time between the initial screen, specialist referral or first diagnostic test and the cancer diagnosis. The diagnostic route (whether through DAU or usual care) was determined based on the OBSP records and biopsy or surgery location. We mapped the diagnostic interval and DAU coverage geographically by women's residence.In 2011, 36% of Ontario breast cancer patients were screen-detected, with a 48% rate among those aged 50 to 69. The provincial median diagnostic interval was 32 days, with county medians ranging from 15 to 65 days. Provincially, 48.4% were diagnosed at a DAU, and this ranged from zero to 100% across counties.The screening detection rate in age-eligible breast cancer patients was lower than published population-wide screening rates. Geographic mapping of the diagnostic interval and DAU use reveals regional variations in cancer diagnostic care that need to be addressed.Le cancer du sein est détecté soit par un examen de dépistage, soit à l’aide de signes et symptômes. Au Canada, les mammographies pour le dépistage du cancer du sein sont offertes dans le cadre de programmes organisés ainsi qu'en contexte indépendant (dépistage opportuniste). Les unités d’évaluation diagnostique (UED) de la province de l’Ontario sont des programmes en établissement qui fournissent des services diagnostiques coordonnés pour le cancer du sein, à la différence des soins habituels où le fournisseur de soins de première ligne organise les examens et les consultations. Cette étude décrit les méthodes de détection, l’intervalle diagnostique et l’utilisation des UED pour le cancer du sein en Ontario.L’étude a porté sur une cohorte de 6 898 femmes ayant reçu un diagnostic de cancer du sein envahissant en 2011. Nous avons utilisé le Registre d’inscription des cas de cancer de l’Ontario jumelé à des bases de données administratives sur les soins de santé. Nous avons déterminé la méthode de détection à l’aide des données du Programme ontarien de dépistage du cancer du sein (PODCS) et des demandes de règlement des médecins. L’intervalle diagnostique a été défini comme le temps écoulé entre le dépistage initial, l’aiguillage vers un spécialiste ou la première épreuve diagnostique et le diagnostic de cancer lui-même. Le parcours diagnostique (qu'il passe par les UED ou les soins habituels) a été déterminé en fonction des dossiers du PODCS et du lieu de biopsie ou d’intervention chirurgicale. Nous avons cartographié l’intervalle diagnostique et de la couverture des UED en fonction du lieu de résidence des femmes.En 2011, 36 % des cas de cancer du sein en Ontario ont été détectés par dépistage, dont 48 % chez des femmes de 50 à 69 ans. L’intervalle diagnostique provincial médian était de 32 jours, les médianes par comté variant entre 15 et 65 jours. À l’échelle provinciale, 48,4 % des cas ont été diagnostiqués dans une UED, ce pourcentage variant entre 0 et 100 % selon les comtés.Le taux de détection au dépistage correspondant aux patientes admissibles du fait de leur âge s'est révélé inférieur au taux de dépistage officiel du cancer du sein pour l’ensemble de la population. La répartition géographique de l’intervalle diagnostique et du recours aux UED révèle des variations régionales dans les soins diagnostiques en oncologie qu'il est nécessaire de corriger.

Resume Objectifs Les objectifs etaient de decrire les caracteristiques des patients vus en urgence par les ophtalmologistes d’un service de CHU et d’identifier celles qui etaient associees a une veritable urgence. Materiel et methodes Une etude transversale incluant tous les patients examines en urgence par un ophtalmologiste du CHRU de Nancy sur deux mois a ete conduite. Les caracteristiques demographiques, medicales, et l’estimation du caractere veritable par l’ophtalmologiste ont ete analysees. Resultats Sur 1308 patients, l’âge median [Q1–Q3] etait de 49 [32–64] ans et 56 % etaient des hommes. Les principaux motifs de consultation etaient l’œil rouge (32,6 %), la douleur (30,0 %), les traumatismes (26,1 %), et une alteration visuelle (23,3 %). Pres de 40 % des consultations n’etaient pas de veritables urgences. Les elements d’orientation associes a une veritable urgence etaient le motif de consultation (alteration visuelle, œil rouge, douleur oculaire), le sexe masculin, l’âge inferieur a 60 ans et un delai de consultation survenant moins de 3 jours apres l’apparition des symptomes. Conclusion Dans les consultations non programmees, la proportion de consultations non veritablement urgentes etait importante, et des facteurs permettant d’orienter les patients ont ete identifies. La redaction de protocoles ophtalmologiques destines aux urgentistes et aux infirmieres d’accueil des structures d’urgences pourrait etre un outil interessant pour determiner quand adresser le patient a l’ophtalmologiste.

Dans les régions tropicales, les maladies fébriles représentent la principale cause de consultation, le paludisme est la plus importante. De nombreux efforts ont été déployés, notamment en Afrique, dans la lutte contre le paludisme avec des progrès importants au cours des dernières années. Or très peu d’attention a été donnée à la prise en charge des autres maladies fébriles. Cependant, des éléments probants montrent que la mortalité est plus élevée dans le groupe de patients fébriles sans paludisme que parmi les patients atteints de paludisme dans les régions endémiques. C’est un problème de santé publique qui a été davantage mis en évidence avec la généralisation de l’utilisation des tests de diagnostic rapide (TDR) de paludisme. Cette étude transversale et de caractère exploratoire, visait à réaliser une analyse de la pratique des professionnels de la santé à l’égard des maladies fébriles aigües non paludiques en régions urbaines et rurales du Burkina Faso. Inspiré de l’approche de Schön, qui soutient l’évaluation de la pratique professionnelle dans le cours de l’action, nous avons tenté de décoder cette pratique par l’entremise de vignettes cliniques. L’hypothèse générale de cette recherche est que la pratique professionnelle à l’égard des maladies fébriles aigües non paludiques au Burkina Faso ne correspond pas aux lignes directrices émises par le ministère de la Santé Burkinabè et de l’Organisation mondiale de la Santé (OMS). Une enquête de pratiques, caractérisée par l’utilisation des vignettes cliniques et basée sur des normes et guides officiels du ministère de la Santé burkinabè et de l’OMS, a été réalisée auprès de 286 professionnels de la santé burkinabès. L’utilisation d’un modèle mixte hiérarchique linéaire sur les données de l’enquête a dévoilé une connaissance limitée de la gestion des maladies fébriles aigües non paludiques. Ceci était plus évident en ce qui concerne l’admission et le diagnostic. Le personnel provenant des régions rurales a mieux répondu aux situations mettant en question le diagnostic, le traitement et l’utilisation des antibiotiques. Dans l’ensemble, les participants les plus instruits ont obtenu de meilleurs scores. Près de 50% des participants ont manifesté qu’ils avaient besoin d’une formation dans au moins un des points mis en question dans les vignettes cliniques. Au vu des résultats, il est nécessaire de renforcer la capacité de gestion des maladies fébriles aigües non paludiques du personnel de santé burkinabè. Ceci à travers de la formation continue, mais aussi en incluant ce thème dans la formation de base des professionnels de santé primaire., In tropical regions, febrile diseases are the main cause of consultation with malaria playing a major role. Many efforts have been made, particularly in Africa, in the fight against malaria with significant progress in recent years. Unfortunately, little attention has been given to the management of febrile diseases other than malaria. There is, in fact, evidence that mortality is higher in the group of febrile patients without malaria than among those with malaria in endemic regions. This is a public health issue that has been further highlighted by the widespread use of rapid diagnostic tests (RDTs) for malaria. The main objective of this research is to carry out an analysis of the professional practices of healthcare providers in the management of non-malaria acute febrile illness in urban and rural sites in Burkina Faso. Inspired by Schön’s approach, which supports the evaluation of professional practice in the course of action, we have attempted to decipher this practice through clinical vignettes. The general hypothesis of this research is that the professional practice regarding non-malarial acute febrile illness in Burkina Faso is not in accordance to the guidelines issued by the Burkinabe Ministry of Health and the World Health Organization (WHO). A survey of practices, characterized on clinical situations and based on officials’ standards and guides of the Ministry of Health Burkinabè and the WHO, was conducted among 286 Burkinabè healthcare providers. The use of a linear mixed hierarchical model on the survey data showed limited knowledge about management of non-malaria acute febrile diseases. This gap was more evident at the admission and diagnosis level. The healthcare providers answers from rural areas answered to diagnosis, treatment and the use of antibiotics were more in accordance with official’s standards and guides. Overall, more educated participants had higher scores. Nearly 50% of participants felt that they needed training in at least one of the clinical situations in clinical vignettes. There is a need to strengthen capacity of non-malaria acute febrile illness management of Burkinabè healthcare providers. It can be acheived through continuing education, but also by including this important issue in the basic training courses of primary healthcare providers.

International audience; * Introduction * Depression is a public health problem and constitutes the most frequently psychic manifestation observed among students. Its prevalence is much higher (30%) than in the other populations. Depression among students can have negative impacts on their social, relational situation and significantly impact their quality of life. Depression is misdiagnosed, misdetected and thus mistreated. In clinical practice at the University, the clinician finds difficulty in correctly diagnosing depression comorbidity including depression with a physical illness and/or somatic problems. It underestimates or overestimates depression (false negative diagnosis or false positive diagnosis). The difficulties of diagnosing depression and overlap with the physical symptoms of the disease are the challenges for the clinician to differentiate if certain symptoms are related to depression or physical illness. Thus, the difficulty in detecting and/or diagnosing depression can lead to false diagnoses of depression. So to avoid the false diagnosis of depression in the university context or in the disease, we must take into account the cognitions of depression. The BDI-FS, self-assessment scale to detect depression, considers these cognitions and therefore avoids the false diagnosis of depression in the presence of problems (such as a physical illness or somatic problems) and properly detects the depression. * Objective * This article presents the French validation of the Beck Depression Inventory-Fast Screen (BDI-FS Inventory) on a sample of students. * Method * A cross-sectional study was conducted on 473 students of the University of Caen Normandy. * Results * The Beck Depression Inventory-Fast Screen-France (BDI-FS-Fr) gets a good sensitivity, specificity and good positive and negative predictive value, a coefficient of Yule very strong and area under the curve satisfactory. He has a very good internal validity of structure: an exploratory factor analysis identified a factor that explains 40.21% of the total variance of the BDI-FS-Fr, and he has a satisfactory internal consistency (0.74). The BDI-FS-Fr has a very good external validity of structure (construct validity: convergent and divergent validity; P < 0.001) and discriminate validity (P < 0.001), and concurrent validity (P < 0.001). The split-half reliability (odd-even) was 0.73 (P < 0.001). The test-retest reliability was 0.82 (P < 0.001). Regarding clinical practice in the University, clinicians can use a simple questionnaire include 7 items (Beck Depression Inventory-Fast Screen-French: BDI-FS-Fr) to assess depression avoiding false diagnosis of depression in the University. The BDI-FS-Fr only evaluates the non-somatic symptoms (cognitive) rather than physical symptoms (somatic), which may overlap with problems due to the university or physical illness and depression may overlap. The BDI-FS-Fr only includes items the BDI-II that are related to the direct psychological experience of depression. Thus, the key strength of the BDI-FS-Fr is that it prevents symptoms of physical illness (e.g., weight loss, difficulty concentrating) from confounding the psychodiagnostic picture. The BDI-FS-Fr also allows us to evaluate the two diagnoses DSM-IV-TR (the main symptoms of depression: sadness and anhedonia). It also allows us to observe and assess the risk of suicide in people (ex. students and patients) by observing the items 2 (pessimism) and 7 (thoughts or desires of suicide) that are considered suicidal risk indicators. The BDI-FS is a diagnostic tool that minimizes the risk of giving falsely high estimates of depression in subjects focusing on the cognitive symptoms of depression. For pre-cited reasons, the clinicians can use the BDI-FS-Fr among students to diagnose their depression and assess their risk for suicide without false negative or false positive diagnosis.* Conclusion *The French version of the BDI-FS has very favourable psychometric properties. It is valid for self-assess depression, its intensity and its evolution, and it is a good complement to BDI for students. The BDI-FS-Fr thus has very good psychometric properties and is a useful tool for researchers and practitioners.; Objectif : Cet article présente la validation française de l’Inventaire de BDI-FS (Beck Depression Inventory-Fast Screen) sur un échantillon d'étudiants. Méthode : Une étude transversale a été menée sur 473 étudiants de l'Université de Caen Normandie. Résultats : Le BDI-FS-Fr (Beck Depression Inventory-Fast Screen-France) obtient une bonne sensibilité, spécificité et une bonne valeur prédictive positive et négative, un coefficient de Yule très fort et une aire sous la courbe satisfaisante. Il a une très bonne validité de structure interne : une analyse factorielle exploratoire a dégagé un facteur expliquant 40,21% de la variance totale du BDI-FS-Fr, et il présente une consistance interne satisfaisante (0,74). Le BDI-FS-Fr a une très bonne validité de structure externe (validité de construit : validité convergente et divergente ; p

International audience; Background : People who use drugs (PWUDs) are at a high risk for hepatitis C virus (HCV) and human immunodeficiency virus (HIV), but they have different characteristics depending on the local context. In France, seroprevalence, sociodemographic, and behavior information have only been studied at a national level rather than at a local level. The Aim : of this study was to describe and examine profile and drug use practice differences in seven French cities and departments and to assess whether these differences can explain HCV and HIV seroprevalence variations between French geographical areas. Methods Data were collected from the cross-sectional ANRS-Coquelicot survey conducted for the second time in 2011 among drug users having injected or snorted drugs at least once in their life. Professional interviewers administrated a face-to-face questionnaire in six different areas in France: Paris, Marseille, Bordeaux, Lille, Strasbourg and the Seine-Saint-Denis department (Paris suburbs). Participants were asked to self-collect a fingerpick blood sample in order to search for the presence of anti-HIV and anti-HCV antibodies and to estimate seroprevalence in PWUDs. Results Overall, HCV and HIV seroprevalence was 44% [95% CI: 39.6–47.9] and 10% [95% CI: 7.5–12.6] respectively. The highest HCV seroprevalence was 56% in Marseille and the lowest was 24% in Bordeaux and for HIV the highest was 18% in Seine-Saint-Denis and the lowest was 0% in Lille. The population's age differed between areas and could mostly explain HCV seroprevalence variation but not exclusively. Profiles and practices, different in each area, can also explain this variation. In multivariate analysis, HCV seroprevalence was lower in Bordeaux (prevalence ratio [PR] = 0.64), Strasbourg (PR = 0.76), and Seine-Saint-Denis (PR = 0.8) than in Paris. Nearly one-third of injectors declared having had difficulties to obtain syringes in the 6 previous months, but disparities existed between areas. Conclusion HCV risk exposure in PWUDs remains high in France and varies between different areas. Innovative harm reduction strategies including educative programs about safe injecting and supervised consumption rooms need to be developed.; osition du problèmeLes usagers de drogues constituent une population particulièrement touchée par le virus de l’hépatite C (VHC) et par le virus de l’immunodéficience humaine (VIH) mais cette population a des caractéristiques différentes d’une ville à l’autre. L’objectif de cet article est de présenter les différences locales dans les profils et les pratiques de consommation qui pourraient expliquer les différences de séroprévalences selon les zones géographiques. Environ un tiers des injecteurs déclarent avoir eu des difficultés pour se procurer des seringues dans les 6 derniers mois. Des disparités existent selon les zones géographiques.MéthodeLes données sont issues de l’enquête transversale ANRS-Coquelicot, menée pour la deuxième édition en 2011 auprès d’usagers de drogues ayant sniffé ou injecté au moins une fois dans la vie. Les informations ont été collectées grâce à un questionnaire réalisé en face à face dans six zones géographiques françaises (cinq agglomérations et un département) : Paris, Marseille, Bordeaux, Lille, Strasbourg, et en Seine-Saint-Denis. Un autoprélèvement de sang a été réalisé par les usagers permettant la recherche des anticorps anti-VIH et anti-VHC en laboratoire et l’estimation des séroprévalences.RésultatsLes séroprévalences du VIH et du VHC sont respectivement de 10 % [IC 95 % : 7,5–12,6] et de 44 % [IC 95 % : 39,6–47,9] sur l’ensemble de la population des usagers de drogues. Elles varient entre 24 % [IC 95 % : 13,5–39,7] à Bordeaux et 56 % [IC 95 % : 47,8–63,5] à Marseille où elle est particulièrement élevée pour le VHC, et de 0 % à Lille et 18 % [IC 95 % : 8,9–31,8] en Seine-Saint-Denis pour le VIH. Ces différences sont liées à une structure par âge différente d’une ville à l’autre mais s’expliquent aussi par des profils et des pratiques de consommation propres à chaque zone géographique. Après ajustement sur ces variables, la séroprévalence du VHC est plus faible à Bordeaux (RP = 0,64), à Strasbourg (RP = 0,76) et en Seine-Saint-Denis (RP = 0,8) par rapport à Paris.ConclusionL’exposition au risque VHC reste élevée dans la population des usagers de drogues en France et varie selon les zones géographiques. Il est donc indispensable d’accentuer les efforts en matière de réduction des risques et de proposer des dispositifs innovants tels que l’accompagnement aux risques liés à l’injection et les salles de consommation à moindre risque.

International audience; BACKGROUND:The Epidemiology Network and Nephrology Information provides since 2001 the epidemiological monitoring of end stage renal disease (ESRD) in France. Two cross-sectional studies to estimate the level of quality of life in ESRD patients were performed in 2005 and 2007 and repeated in 2011. The main objective is to analyze the evolution of the quality of life of ESRD between these two surveys.METHODS:The studies were conducted on a representative sample of subjects aged 18 and over, prevalent dialysis or holders of a functioning kidney transplant last year, followed in center dialysis and/or transplantation in one of the eight French regions selected. The quality of life was measured by a generic questionnaire, and two specifics questionnaires.RESULTS:The evolution of the quality of life deteriorated slightly between 2005-2007 and 2011. There is however few dimensions affected. The variation in scores is not meaningful in general, with maximum decreases less than 4 points according to the statistical methods used. This diminution is not clinically significant.DISCUSSION:The quality of life in dialysis patients or transplant did not evolve between 2005-2007 and 2011. Currently, it is difficult to assess the benefits of the national plan for improving the quality of life of people with chronic diseases because the last data are too close to the end of the plan.; IntroductionLe réseau épidémiologie et information en néphrologie (REIN) assure depuis 2001 le suivi épidémiologique et la prise en charge de l’insuffisance rénale chronique terminale (IRCT) en France. La connaissance d’indicateurs de qualité de vie (QDV) relative à la santé est capitale afin de mieux comprendre les domaines touchés par la maladie et ainsi proposer des actions appropriées visant à mieux vivre avec sa pathologie. Dans ce contexte, deux études transversales visant à estimer le niveau de QDV liée à la santé des patients en IRCT ont été mises en place en 2005 (enquête dialyse) et 2007 (enquête greffe) sur un échantillon de patients français, puis reconduites en 2011. L’objectif de cet article est de comparer ces deux enquêtes et d’analyser l’évolution de la qualité de vie des patients atteints d’IRCT entre ces deux enquêtes.MéthodesLes études ont été réalisées sur un échantillon représentatif de sujets âgés de 18 ans et plus, prévalents dialysés (quelles que soient les modalités de dialyse) ou porteurs d’un greffon rénal fonctionnel depuis un an, suivis dans un centre de dialyse et/ou de transplantation dans l’une des huit régions françaises sélectionnées. Le recueil des données a été réalisé par auto-questionnaire adressé par voie postale au domicile des patients. La qualité de vie (QDV) a été mesurée par un questionnaire générique, le MOS SF-36 et deux questionnaires spécifiques : le Kidney Disease Quality of Life (KDQOL) version courte pour les dialysés et le ReTransQol V2 (RTQ V2) pour les patients greffés. L’évolution des scores a été réalisée par des analyses multivariées, le calcul d’un score de propension et de pondération afin de prendre en compte les différences de profil des patients entre les périodes d’enquêtes.RésultatsLa QDV s’est légèrement dégradée entre 2005–2007 et 2011, et ce, quel que soit le questionnaire utilisé (générique ou spécifique). Il n’y a cependant que peu de dimensions affectées, avec 2 ou 3 domaines par outils de mesure. Pour le SF-36, ce sont les dimensions « santé générale », « douleurs physiques » ainsi que « vie et relation avec les autres » qui diminuent de manière significative (−3,2, −3,7 et −3,8 points). Pour les questionnaires spécifiques, la dimension « traitement » du RTQ V2 est la plus affectée (−2,5 points), ainsi que la dimension « symptôme/problèmes » du KDQOL (−2,4 points). La variation des scores de QDV est peu signifiante dans l’ensemble, allant de −1,6 point à −3,8 points pour la plus forte baisse, selon les méthodes statistiques utilisées. Cette diminution reste toujours inférieure au seuil des 5 points considérés comme cliniquement signifiant.DiscussionLa qualité de vie chez les patients dialysés ou greffés s’est légèrement dégradée entre 2005–2007 et 2011. Le recueil des dernières données de notre étude ayant été réalisé dès la fin du plan pour l’amélioration de la qualité de vie des personnes atteintes de maladies chroniques 2005–2011, le bénéfice du plan paraît donc difficile à évaluer dans sa globalité.

Few studies have considered the factors independently associated with chronic fatigue syndrome (CFS) and/or fibromyalgia (FM) or considered the impact of these conditions on health status using population-based data.We used data from the nationally representative 2010 Canadian Community Health Survey (n = 59 101) to describe self-reported health professional-diagnosed CFS and/or FM, and their associations with 6 health status indicators.In 2010, diagnosed CFS and FM are reported by 1.4% (95% confidence interval [CI]: 1.3%-1.6%) and 1.5% (1.4%-1.7%), respectively, of the Canadian household population aged 12 years and over, with comorbid CFS and FM affecting 0.3% (0.3%-0.4%) of that population. Prevalent CFS and/or FM were more common among women, adults aged 40 years and over, those with lowest income, and those with certain risk factors for chronic disease (i.e. obesity, physical inactivity and smoking). After controlling for differences between the groups, people with CFS and/or FM reported poorer health status than those with neither condition on 5 indicators of health status, but not on the measure of fair/poor mental health. Having both CFS and FM and having multiple comorbid conditions was associated with poorer health status.Co-occurrence of CFS and FM and having other chronic conditions were strongly related to poorer health status and accounted for much of the differences in health status. Understanding factors contributing to improved quality of life in people with CFS and/or FM, particularly in those with both conditions and other comorbidities, may be an important area for future research.Le syndrome de fatigue chronique et la fibromyalgie au Canada : prévalence et associations avec six indicateurs de l’état de santé.Peu d’études ont traité, à l’aide de données populationnelles, des facteurs associés de façon indépendante au syndrome de fatigue chronique (SFC) et à la fibromyalgie (FM) ou des répercussions de ces affections sur l’état de santé.Nous avons utilisé les données de l’Enquête sur la santé dans les collectivités canadiennes de 2010 (n = 59 101), représentative de la population à l’échelle nationale, pour décrire les cas autodéclarés de SFC et de FM diagnostiqués par un professionnel de la santé et pour déterminer les associations de ces affections avec six indicateurs de l’état de santé.En 2010, 1,4 % (intervalle de confiance [IC] à 95 % : 1,3 % à 1,6 %) des Canadiens de 12 ans ou plus vivant à domicile ont déclaré avoir reçu un diagnostic de SFC, 1,5 % (IC à 95 %: 1,4 % à 1,7 %) de FM, et 0,3 % (IC à 95 %: 0,3 % à 0,4 %) a déclaré être atteinte à la fois de SFC et de FM. Les cas de SFC comme ceux de FM étaient plus fréquents chez les femmes, les adultes de 40 ans ou plus, les personnes à faible revenu et les personnes présentant certains facteurs de risque de maladie chronique (obésité, sédentarité et tabagisme). Après ajustement en fonction des différences existant entre les groupes, les personnes ayant déclaré être atteintes du SFC ou de FM ou des deux avaient un moins bon état de santé que les personnes atteintes d’aucune de ces affections pour cinq indicateurs de l’état de santé, mais aucune différence n'a été trouvée entre ces groupes par rapport à l’indicateur de santé mentale. Le fait d’être atteint à la fois du SFC et de FM et de présenter de multiples affections comorbides était associé à un moins bon état de santé.La présence concomitante du SFC, de la FM et d’autres affections chroniques était étroitement associée au fait d’avoir un moins bon état de santé, et les différences relatives à l’état de santé étaient dues en bonne partie à la présence concomitante de ces affections. La compréhension des facteurs qui contribuent à l’amélioration de la qualité de vie des personnes atteintes du SFC ou de FM, et en particulier des personnes qui présentent ces deux affections ainsi que diverses affections comorbides, serait un champ important à explorer dans le cadre de travaux de recherche ultérieurs.

Contexte: Le diabète de type 2 est un problème de santé publique important. La pratique régulière de l’activité physique contribue à la prévention de cette maladie chronique. Toutefois, peu de recherches portent sur l’association entre l’activité physique de transport, notamment la marche utilitaire, et le diabète. Objectif : L’objectif de cette étude est d’examiner l’association entre la présence d’un diagnostic de diabète de type 2 et les pratiques de marche utilitaire dans un échantillon transversal. Méthode : Cette étude est une analyse secondaire de données provenant d’un projet de recherche sur l’implantation d’un système de vélos libre-service. 7012 adultes ont été recrutés par téléphone au printemps 2009, à l’automne 2009 et à l’automne 2010. La marche utilitaire a été mesurée en utilisant des questions adaptées du International Physical Activity Questionnaire (IPAQ). L’association entre la marche utilitaire et le diabète auto-rapporté a été examinée au moyen d’analyses de régression logistique multivariées. L’influence des variables socio- démographiques, du niveau d’activité physique autre et de l’indice de masse corporelle a été contrôlée. Des analyses de sensibilité ont aussi été faites, utilisant un seuil différent pour le temps de marche utilitaire. Résultats : Dans le modèle final, la marche utilitaire est associée à une prévalence du diabète plus faible (RC=0,721; IC 95% : 0,547-0,950). Conclusion: La pratique de la marche utilitaire est associée à une prévalence plus faible de diabète auto-rapporté. La promotion de ce type d’activité physique aurait sa place dans la prévention du diabète dans une perspective de santé publique., Background: Type 2 diabetes is an important public health problem. Regular involvement in physical activity contributes to the prevention of this chronic disease. However, limited research has examined associations between transportation physical activity, especially utilitarian walking, and diabetes. Purpose: To examine the association between utilitarian walking and the prevalence of diabetes in a cross-sectional sample. Methods: Secondary analysis of data from a research project on the reach and potential impact of the implementation of a public bicycle share program was conducted. A sample of 7012 adults were recruited to telephone surveys in spring 2009, fall 2009, and fall 2010 via random-digit dialing with oversampling in locations where the public bike share was available. Utilitarian walking was estimated using questions adapted from the International Physical Activity Questionnaire (IPAQ). Multivariable logistic regression models examined the association between utilitarian walking and diabetes. The influence of socio- demographic covariates, involvement in other physical activities, and body mass index were controlled and sensitivity analyses were performed. Sensitivity analyses were performed using a different cut-off for utilitarian walking time. Results: In final models, utilitarian walking was associated with a lower likelihood of self-reporting diabetes (OR=0.721; 95% CI: 0.547, 0.950). Conclusion: Adoption of utilitarian walking is associated with a lower likelihood of reporting diabetes. Replication of these results in longitudinal studies could have implications for strategies to encourage people to incorporate more walking into their daily routine.

À l’instar de plusieurs systèmes de santé, les centres hospitaliers québécois ont amorcé l’informatisation du dossier patient sous forme papier pour la transition vers un dossier clinique informatisé (DCI). Ce changement complexe s’est parfois traduit par des répercussions sur les pratiques de soins, la sécurité et la qualité des soins offerts. L’adoption de la part des utilisateurs de technologies de l’information (TI) est considérée comme un facteur critique de succès pour la réalisation de bénéfices suite au passage à un DCI. Cette étude transversale multicentrique avait pour objectifs d’examiner des facteurs explicatifs de l’adoption, de l’utilisation réelle d’un DCI, de la satisfaction des infirmières et de comparer les résultats au regard du sexe, de l’âge, de l’expérience des infirmières et des stades de déploiement du DCI. Un modèle théorique s’appuyant sur la Théorie unifiée de l’adoption et de l’utilisation de la technologie a été développé et testé auprès d’un échantillon comptant 616 infirmières utilisant un DCI hospitalier dans quatre milieux de soins différents. Plus particulièrement, l’étude a testé 20 hypothèses de recherche s’intéressant aux relations entre huit construits tels la compatibilité du DCI, le sentiment d’auto-efficacité des infirmières, les attentes liées à la performance, celles qui sont liées aux efforts à déployer pour adopter le DCI, l'influence sociale dans l’environnement de travail, les conditions facilitatrices mises de l’avant pour soutenir le changement et ce, relativement à l’utilisation réelle du DCI et la satisfaction des infirmières. Au terme des analyses de modélisation par équations structurelles, 13 hypothèses de recherche ont été confirmées. Les résultats tendent à démontrer qu’un DCI répondant aux attentes des infirmières quant à l’amélioration de leur performance et des efforts à déployer, la présence de conditions facilitatrices dans l’environnement de travail et un DCI compatible avec leur style de travail, leurs pratiques courantes et leurs valeurs sont les facteurs les plus déterminants pour influencer positivement l’utilisation du DCI et leur satisfaction. Les facteurs modélisés ont permis d’expliquer 50,2 % de la variance des attentes liées à la performance, 52,9 % des attentes liées aux efforts, 33,6 % de l’utilisation réelle du DCI et 54,9 % de la satisfaction des infirmières. La forte concordance du modèle testé avec les données de l’échantillon a notamment mis en lumière l’influence des attentes liées à la performance sur l’utilisation réelle du DCI (r = 0,55 p = 0,006) et sur la satisfaction des infirmières (r = 0,27 p = 0,010), des conditions facilitatrices sur les attentes liées aux efforts (r = 0,45 p = 0,009), de la compatibilité du DCI sur les attentes liées à la performance (r = 0,39 p = 0,002) et sur celles qui sont liées aux efforts (r = 0,28 p = 0,009). Les nombreuses hypothèses retenues ont permis de dégager l’importance des effets de médiation captés par le construit des attentes liées à la performance et celui des attentes liées aux efforts requis pour utiliser le DCI. Les comparaisons fondées sur l’âge, l’expérience et le sexe des répondants n’ont décelé aucune différence statistiquement significative quant à l’adoption, l’utilisation réelle du DCI et la satisfaction des infirmières. Par contre, celles qui sont fondées sur les quatre stades de déploiement du DCI ont révélé des différences significatives quant aux relations modélisées. Les résultats indiquent que plus le stade de déploiement du DCI progresse, plus on observe une intensification de certaines relations clés du modèle et une plus forte explication de la variance de la satisfaction des infirmières qui utilisent le DCI. De plus, certains résultats de l’étude divergent des données empiriques produites dans une perspective prédictive de l’adoption des TI. La présente étude tend à démontrer l’applicabilité des modèles et des théories de l’adoption des TI auprès d’infirmières œuvrant en centre hospitalier. Les résultats indiquent qu’un DCI répondant aux attentes liées à la performance des infirmières est le facteur le plus déterminant pour influencer positivement l’utilisation réelle du DCI et leur satisfaction. Pour la gestion du changement, l’étude a relevé des facteurs explicatifs de l’adoption et de l’utilisation d’un DCI. La modélisation a aussi mis en lumière les interrelations qui évoluent en fonction de stades de déploiement différents d’un DCI. Ces résultats pourront orienter les décideurs et les agents de changement quant aux mesures à déployer pour optimiser les bénéfices d’une infostructure entièrement électronique dans les systèmes de santé., Like many other healthcare systems, healthcare institutions in Quebec are in the process of transitioning from paper-based patient records to Electronic Patient Records (EPRs). For some time now, this considerable and complex transition has had a high failure rate and unexpected consequences on care practices and the quality and safety of the care provided to patients. The acceptance of information technology by users is considered to be a critical success factor in realizing the benefits of EPR implementation. The goal of this multicenter cross-sectional study was to examine the explanatory factors of the adoption and actual use of an EPR by nurses and their satisfaction. It also aimed at comparing the outcomes by gender, age and experience and by EPR adoption stage. To do so, a theoretical model based on the unified theory of acceptance and use of technology (UTAUT) was developed and tested on a sample of 616 nurses who use an EPR in four different acute care facilities. Specifically, the study tested 20 research hypotheses on the relationships among eight different constructs, namely EPR compatibility, self-efficacy, performance expectancy, effort expectancy, social influence, facilitating conditions explaining the actual use of an EPR by nurses and their satisfaction. Fifteen research hypotheses were supported following structural equation modeling analysis. The results revealed that performance expectancy, effort expectancy, facilitating conditions and compatibility of the EPR (with preferred work style, existing work practices and values of nurses) were strong determinants of the actual use of an EPR by nurses and their satisfaction. The variables explained 50.2% of the variance of performance expectancy, 52.9% of effort expectancy, 33.6% of actual use of an EPR by nurses and 54.9% of their satisfaction. The strong fit of the model tested with the sample data showed the influence of performance expectancy on the actual use of the EPR by nurses (r = .55 p = .006) and on their satisfaction (r = .27 p = .010), the influence of the facilitating conditions on effort expectancy (r = .45 p = .009), EPR compatibility on performance expectancy (r = .39 p = .002) and on effort expectancy (r = .28 p = .009). The numerous hypotheses supported highlight the importance of the mediation effects captured by the performance expectancy and effort expectancy constructs. Comparisons based on age, experience and gender of the respondents did not reveal any statistically significant differences in terms of the acceptance and actual use of an EPR by nurses and their satisfaction. However, those based on the four EPR adoption stages revealed significant differences in terms of the relationships modelled. The results suggest that certain key relationships become more intense as the EPR adoption stages progress, thereby providing a better explanation of the variance in the satisfaction of nurses. Some results of the study also differ from the empirical data produced in a predictive perspective of information technology adoption. The study shows the applicability of the technology acceptance models and theories for nurses working in hospital centres. The results suggest that an EPR that meets performance expectancies is the most determining factor in positively influencing the actual use of the EPR and the satisfaction of nurses. To manage change, the study identified some explanatory factors of the acceptance and use of an EPR, and the model testing revealed how the relationships evolve based on the various EPR adoption stages. The results could help guide decision makers and change agents in determining the measures to implement in order to maximize the benefits of a fully electronic infostructure in healthcare systems.

International audience; Background Contradictory findings have recently been published on the association between atopic dermatitis (AD) severity and vitamin D deficiency. The aim of this study was to examine the correlation between 25-hydroxyvitamin D (25(OH)D) concentration and \AD\ severity. Patients and methods A cross-sectional study was conducted from June 2011 to March 2013 in dermatology departments in adults and children with a diagnosis of AD. The severity of \AD\ was assessed using the \SCORAD\ and PO-SCORAD indexes and serum 25(OH)D concentrations were determined for all patients. Results Sixty patients were included: 30 with severe \AD\ and 30 with mild-to-moderate AD. The 25(OH)D concentration was lower in patients with severe \AD\ than in patients with mild-to-moderate \AD\ (15.9 ± 8.3 ng/mL vs. 21.5 ± 8.2 ng/mL; P = 0.01). There was a negative correlation between 25(OH)D concentration and respectively, \SCORAD\ (r = −0.47; P

International audience

International audience; Objective –To estimate the quality of life (QOL) of patients with end-stage renal disease (dialysis or transplant).Methods –Cross-sectional survey by self-administered questionnaire conducted in 2011 in patients over 18 years old followed in one of the 21 regions participating in the network REIN (Renal Epidemiology and Information Network) in 2009. Patients were selected randomly after stratification on their age and region. QOL was measured using the MOS SF-36 generic questionnaire and specific questionnaires, the KDQOL for dialysis patients and the RETRANSQOL for transplanted patients.Results –1,251 dialysis patients and 1,658 transplanted patients participated in the survey. QOL scores were higher (from 10 to 30.6 points) in transplant patients than in dialysis patients, and in all dimensions of the MOS SF36, with regional differences. In transplanted patients, these scores tended to be closer to those of the general population. Dialysis patients registered on the waiting list for transplantation had a better QOL than dialysis patients not enrolled for all dimensions, with differences ranging from 3.9 (general vitality dimension) to 7.5 (physical functioning). Similarly, preemptive transplanted patients reported better QOL than non-preemptive patients, with differences ranging from 4.2 points (mental health) to 8.5 (limitations due to physical condition).Conclusion –The results of these studies on QOL give clinicians arguments in favor of transplantation. Clinicians can inform their patients that when transplantation is feasible and when associated pathologies are comparable, life after transplantation is of better quality, mainly because of an increase in their physical abilities, a reduction of physical limitations and an improvement of their social relations.; Objectif –Estimer le niveau de qualité de vie (QDV) des patients atteints d’insuffisance rénale chronique terminale (dialysés ou greffés).Méthodes –Enquête transversale par auto-questionnaire menée en 2011 auprès de patients de plus de 18 ans suivis dans l’une des 21 régions participant au Réseau épidémiologie et information en néphrologie (REIN) en 2009. Les patients ont été tirés au sort après stratification sur l’âge et la région. La QDV a été mesurée avec le questionnaire générique MOS SF36, et des questionnaires spécifiques, le KDQoL pour les patients dialysés et le ReTransQoL pour les greffés.Résultats –1 251 patients dialysés et 1 658 patients transplantés ont participé à l’enquête. Les scores de QDV étaient plus élevés (de 10 à 30,6 points) chez les greffés que chez les dialysés, et ce sur toutes les dimensions du MOS SF36, avec des différences régionales. Chez les greffés, ces scores tendaient à se rapprocher de ceux de la population générale. Les dialysés inscrits sur liste d’attente de greffe présentaient une meilleure QDV que les dialysés non inscrits sur toutes les dimensions, avec des différences variant de 3,9 (dimension vitalité générale) à 7,5 (fonctionnement physique). De même, les greffés préemptifs déclaraient une meilleure QDV que les non préemptifs, avec des différences variant de 4,2 points (santé mentale) à 8,5 (limitations dues à l’état physique).Conclusion –Les résultats de ces études de QDV donnent des arguments en faveur de la greffe aux cliniciens. Ces derniers pourraient indiquer à leurs patients que, lorsque la transplantation est réalisable et à pathologies associées comparables, la vie après la greffe est de meilleure qualité, notamment du fait d’une augmentation de leurs capacités physiques, de moindres limitations physiques et d’une amélioration de leurs relations sociales.

Self-rated health is a frequently used measure, notably in the field of gerontology. Different authors have studied factors that can influence self-rated health among older persons and, according to studies, the factors taken into account and their influence vary. This article aims at synthesising the biomedical literature, published since 1993, on factors that influence self-rated health of non-institutionalised older persons aged 65 years and over, with a focus on cross-sectional quantitative studies. Of the 1801 articles that were identified by our search strategy in the Medline database, 22 were retained. The proportion of older persons assessing their health positively ranged, depending on the studies, from 48.4% to 78.0%. Fifteen studies out of 22 investigated what was rather associated with an unfavourable self-rated health. Two studies took into account only one kind of independent variables. In more than half of the studies, 1 to several variables belonging to at least 3 kinds of independent variables were associated with self-rated health in multivariable analysis. The associations between these different kinds of independent variables considered (sociodemographic characteristics - morbidity - functional status - mental health - social support - other variables) and self-rated health are here presented and synthesized. This work shows that the factors that influence self-rated health among older people, factors measured differently according to authors, are varied and belong to different domains. These domains include morbidity, functional status, as well as sociodemographic characteristics, mental health, certain aspects of social support and other kinds of factors.

Stroke is a common, severe, and disabling condition that is recognized as a major public health problem. Our goal was to study the clinical features and prognosis of motor deficits in stroke patients hospitalized in the neurology department of the Yalgado-Oeudraogo University Hospital in Burkina Faso. This cross-sectional study took place from March 1 through September 30, 2012. The study included all patients with motor disabilities following a CT-confirmed stroke that had occurred within the previous month. Patients were reviewed at one month (M1) and three months (M3) to assess their current treatment and their autonomy, by the Barthel Index. During the study period, 59 patients were hospitalized for stroke, 56 with motor disabilities for a 95% prevalence of stroke with motor deficit. Their mean age was 57.8 ± 17.7 years (range: 20 to 84 years), and the sex-ratio of 1.6 (male/female). Overall, 61% of the strokes were ischemic and 39% hemorrhagic, with an equal distribution of right and left hemiplegia (46.4% each) and 7% of the patients showing bilateral involvement. The mortality rate before M1 was 29% and before M3, 40%. On admission, 4% of patients had a Barthel Index greater than 60, at M1 35%, and at M3, 60%. Only 51% of patients received physical therapy. Characteristics significantly associated with functional recovery were age younger than 65 years (p = 0.0026), sphincter disorders at M1 (p = 0.002), hemorrhagic stroke (compared to ischemic) (p = 0.0038), functional rehabilitation (p = 0.0012), and right (versus left) hemisphere damage (p = 0.010).

This cross-sectional study aimed to assess the daily dietary intake of type 2 diabetes patients attending Mohamed VI hospital in Marrakech during Ramadan 2010. Sociodemographic and clinical data were collected by interview, and qualitative and quantitative food intake, based on French nutritional tables, was assessed by a dietician. Of the 71 patients recruited, 55% were fasting. The average age of participants was 56.3 (SD 11,2) years. There were no statistically significant clinical differences between the fasting and nonfasting groups except for overweight/obesity and insulin dependence, which were more prevalent in the nonfasting group. The mean total daily caloric intake was significantly lower in the fasting than nonfasting group [1447.5 (SD 756.3) versus 1919.0 (SD 823.4) Kcal/d], as was the carbohydrate, lipid and protein intake. Carbohydrate intake was 57% and 56% of total calories. Overall during Ramadan the diet of the fasting group was calorie deficient and inadequate while for non-fasters it was excessive, which put them at risk of complications. Nutritional education may be needed for diabetic patients for Ramadan.

Objective To investigate the possible impact of long-term occupational exposure to hydrocarbons on respiratory health. Methods Respiratory health was assessed by questionnaires, spirometry, and exhaled nitric oxide in 250 male workers from a company handling and distributing refined petroleum products (exposed) and 250 electricians (controls). Exposure to hydrocarbons was assessed by personal air monitoring. Results Aerial exposure to hydrocarbons was low. Respiratory and nasal symptoms were significantly more frequent among exposed subjects than among controls. Although forced vital capacity and forced expiratory volume in 1 second did not differ, ratio of forced expiratory volume in 1 second to forced vital capacity and maximal expiratory flows were significantly lower in exposed than in control subjects, adjusting for smoking. Exhaled nitric oxide was significantly higher among exposed subjects (30.1 ppb) than among controls (21.6 ppb), adjusting for age and smoking. Conclusions Even low exposure to petroleum-derived hydrocarbons is associated with more respiratory and nasal symptoms, lower pulmonary function, and airway inflammation.

Polyneuropathies of pregnancy and the postpartum period are considered rare but also understudied in Sub-Saharan Africa. They are usually related to a thiamine deficiency in under- or malnourished women. Our aim was to study the clinical and etiological factors of this disease in the Yalgado Ouedraogo University Hospital of Ouagadougou in Burkina Faso. Our prospective cross-sectional study lasted for 20 months, from August 2008 to April 2010. During the period, 27 women received this diagnosis. Their mean age was 27.5 years (range: 20 to 38). All but two (92%) had no or a very small or a modest income. Their monotonous diet was based on local cereals and available irregularly. Almost all (24/27, 89%) had developed one or more diseases during pregnancy, primarily excessive vomiting (70%) and severe anorexia (89%). Sensory symptoms were present in 70% of cases, and sensorimotor symptoms in 30%. The cause was always a deficiency-related polyneuropathy. All patients were treated with vitamin B complex and all symptoms disappeared by the third month of treatment. We conclude that polyneuropathies during pregnancy and during the postpartum delivery occur in women eating an unbalanced diet and living in a deprived social and economic situation and that it is manifested by serious vomiting and anorexia.

This population-based cross-sectional study sought to assess the epidemiology of keloids and the reasons for refusal of surgical treatment for them in 24 municipalities of Kinshasa (Democratic Republic of the Congo). The study took 3 months (from March 1 through May 31, 2011) and enrolled 71 patients (43 females and 28 males). The keloids were situated on the ear (21%), chin and neck (20%), thorax (13%), cheek (12%), belly (11%), arm and forearm (6%), shoulder (6%), back (5%), thigh (3%) and leg (3%). The number of keloids per person averaged 1:7 (range: 1-5), that is, approximately 2. Overall, 19% were small (5 cm longest diameter), 32% intermediate (5-10 cm), and 47% large (10 cm). Most patients (79%) did not plan plastic surgery, 44% for financial reasons (lack of money), 18% because they lacked of confidence in the surgery (no favorable prognosis, useless, unreliable), 15% because it would agggravate the lesions, 13% because of fear (dangerous treatment), and 5% because "keloids are a hereditary illness".

International audience; The 2008 Nutrition and Health Barometer, a national cross-sectional survey carried out by the French National Institute for Prevention and Health Education, has enabled to study the physical activity of elderly people aged 55 to 75 years. The amount of physical activity they do is not so different from that of younger adults. They have a better knowledge of the recommendations than the latter, but this does not necessarily fit their practice. This highlights the need to improve also the environment.; Le Baromètre santé nutrition 2008, enquête en population générale menée par l’Institut national de prévention et d’éducation pour la santé (INPES), a permis d’analyser l’activité physique des personnes âgées de 55 à 75 ans sous plusieurs anglesAinsi, leur pratique ne s’avère pas si différente de celle des adultes plus jeunesElles ont une meilleure connaissance des recommandations que ces derniers, mais celle-ci, faiblement liée à leur pratique, montre la nécessité d’agir aussi sur l’environnement.

Osteoporosis concerns 50% of women over 80 years. Prevalence of energizing and protein malnutrition is high as for institutional elderly people as for community dwelling elderly people. Malnutrition, physical inactivity and many etiological factors lead to tissular losses especially on protein compartment, named sarcopenia. Among the common etiological factors, some cytokines have an effect on proteolysis and bone restructuring, interfering with osteoclast metabolism. Inflammation or stress, mechanisms which product cytokines, are responsible for unfavourable bone restructuring and for a loss of protein mass, deteriorating the muscular functional prognostic. We researched articles on Medline® between 1980 and 2010 about relations between protein compartment, malnutrition and bone density. Several studies in literature suggest that increase in protein intake in daily caloric needs could have a positive effect on bone mineral density and functional performances (in primary prevention as in secondary prevention). So, primary and secondary preventive measures must comprise an increase in protein intake and a sufficient physical activity.

The consequences of hypothyroidism on cognition are long known since the description of dementia associated with hypothyroidism. Additional data from experimental studies support the impact of thyroid hormones on the central nervous system and cognition. Cognitive impairment in relation with hypothyroidism (even sub clinical hypothyroidism) in elderly subjects involves memory, attention, and executive functions. Hypothyroidism may be associated with somatic, neurologic, psychiatric, social and environmental data. Cross-sectional and longitudinal studies are frequently heterogeneous but suggest a complex relationship between hypothyroidism and cognition.

Even though the efforts in research have detailed further the physiopathology and the dynamics of the frailty process an operational definition of frailty is still far from being unequivocal. Studies carried out from the SAFEs cohort study allowed a pragmatic approach in the identification of the at-risk groups for the lost of independency during the hospital stay and factors influencing their future at short-, mid- and long-term. Based upon these results, we propose to discuss the relevance of the current operational indicators of frailty in order to show that clinical markers or indicators are insufficient to differentiate the frailty process from normal ageing. Finally we give rise to the imperative necessity to detect frailty at a preclinical stage with the help of biological and more particularly inflammatory markers.

International audience; PurposesTo determine how many patients in a permanent vegetative state or a minimally conscious state are living in healthcare institutions in the Maine-et-Loire county of western France. To evaluate patient management, physical complications, problems encountered by nursing staff and the patient care teams’ wishes. Patients and methods We performed a cross-sectional, descriptive study in physical medicine and rehabilitation departments, nursing homes, geriatric units and local hospitals. All patients and their medical records were examined by the same investigator. A questionnaire for carers was used to evaluate nursing tasks and a second questionnaire for head nurses served to assess staff needs and the patient care teams’ wishes. Results Thirteen patients were identified. Four were in a permanent vegetative state and nine were in a minimally conscious state. Ten patients were cared for in geriatric units, one in a physical medicine and rehabilitation department and two in local hospitals. All patients displayed limited joint angle ranges. All the patient care teams reported practical difficulties and ethical issues. Discussion Our survey highlighted the variety of care scenarios for patients in a permanent vegetative state or a minimally conscious state. It revealed practical difficulties and, above all, ethical questions. The present work could serve as a basis for implementation of a recently issued French government circular on defining specific wards for these patients.

We evaluated the prevalence of allergic rhinitis in a rural population of Settat and its relationship with intestinal parasitosis and living conditions. The sample comprised 336 subjects living in 3 clusters. Rhinitis was evaluated using the ISAAC questionnaire. Prevalence of rhinitis was 37.8%. It was higher in those aged 15-49 years, illiterate subjects, active smokers, those presenting with overweight and those with hypereosinophilia. It was significantly lower in children < 10 years. Rhinitis was associated with sibship size and literacy, but not with intestinal parasitosis and helminth infections.

Summary Introduction Studies of the spirometric profiles of narghile smokers are few, have some methodological limits (i.e. small sample size), and present contradictory conclusions. Aims (i) To determine the percentage of narghile smokers with obstructive ventilatory defect (OVD) and/or restrictive ventilatory defect (RVD) or static hyperinflation (SHI); (ii) to compare the chronological and estimated lung ages. Population and methods Inclusion criteria: men aged 20 to 60 years, narghile smokers (> 1 narghile-year [NY]). Exclusion criteria: cigar or cigarette smokers and comorbidity. Narghile use quantification: NY and kg of cumulative tobacco use (1 NY = 9.125 kg of cumulative tobacco use). Definitions Large airway obstructive ventilatory defect (OVD): forced expired volume in one second (FEV 1 ) / forced vital capacity (FVC) less than lower limit of normal (LLN). Small airway OVD: FVC more than LLN and decrease (less than LLN) of one or more peripheral flows. RVD: total lung capacity (TLC) less than LLN. SHI: residual volume (RV) more than upper limit of normal. Spirometric measures (Vmax 22 Series/6200 Autobox, SensorMedics, Yorba Linda, California, USA with measurement of functional residual capacity by nitrogen washout). Measurements were made according to international recommendations. Results One hundred and ten narghile smokers were included (34 ± 10 years; 1.76 ± 0.07 m; 84 ± 14 kg). Thirty-six percent of the subjects had SHI; 14% had small airway OVD; 14% had RVD, and 6% had large airway OVD. Estimated lung age was higher than chronological lung age (47 ± 18 years vs. 34 ± 10 years, P Conclusion Narghile use accelerates lung ageing. This study provides the health authorities with valid arguments to fight this blight on society, which increasingly involves children and pregnant women.

Health care workers are exposed daily to blood borne injury and infection with a high risk of hepatitis B or C and human immunodeficiency virus (HIV) transmission. In the 1980s, the US Centers for Disease Control and Prevention (CDC) developed a set of protocols and guidelines known as standard precautions (SP) to prevent accidental transmission of pathogens. The SP should be followed for each intervention or delivery of care in order to protect health care workers from risks associated with contact with blood and other biological liquids. A survey was conducted in a Western Algerian university hospital to assess nurses' adherence to SP practices. A questionnaire was administered to 450 nurses in the hospital workplace setting. A field survey was also conducted in order to take into account the means and support available to the nurses in these hospital departments, namely to determine availability of hand washing and drying facilities. A total of 133 nurses, 81 women and 52 men, participated in the survey. Personal and professional data, hand-washing frequency, glove wearing practices were collected as data. A large majority (95%) of nurses reported washing their hands after removing their gloves, and 69% of them reported washing their hands between two patients. Male nurses wear gloves more often than females (respectively 77% and 53%). Sharp instruments were correctly disposed of in a puncture-resistant container more of the time. Recapping needles has been reported by two-thirds of survey respondents. Lack of liquid soap and alcohol-based washing solution were noted as major deficiencies as well as the lack of means to properly dry hands in many health care wards. Lack of SP adherence is primarily due to the lack of awareness and knowledge as well as insufficient supply of equipment and materials for good hand hygiene maintenance. This study highlights the urgent need to implement a programme to improve SP adherence among nurses and to increase the supply of hand washing and drying materials. Greater adherence to SP practices will also reduce the risk of occupational exposure to blood borne injury and infection.