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Cancer-screening programmes are public health action for a target population. It guarantees an equal access to screening throughout the country with a high level of quality for every person of the target population. Given the heterogeneity of older subjects and the variability of the expected benefits of cancer-screening programmes, this collective public health action may not have a collective benefit for the population. However, for older person with a life expectancy of five years or more, it would be possible to propose an individualized cancer-screening decision. This cancer-screening approach must respect the ethical principles of avoiding harm and supporting autonomy. In addition, it is important to consider the goals and values of patients to take an individualized decision. Patients with the same profile may not take the same decision of individualized cancer screening.

Previous studies have shown controversial results of factors associated with short-term mortality in patients with extended-spectrum beta-lactamase (ESBL)-producing E. coli bacteremia and no research has investigated the impact of the geriatric assessment criteria on short-term mortality. Our objective was to determine whether dementia and walking ability are associated with 30-day mortality in patients with ESBL-producing E. coli bacteremia. All blood bottle cultures, analyzed from January 2008 to April 2015, in the Bacteriology Department of a 2,600-bed, university-affiliated center, Nantes, France, were retrospectively extracted. Factors associated with short-term mortality in patients with ESBL-producing E. coli bacteremia: 140 patients with an ESBL-producing E. coli bloodstream infection were included; 22 (15.7%) patients died within 30 days following the first positive blood bottle culture of ESBL-producing E.coli. In multivariate analysis, a reduced ability to walk (OR = 0.30; p = 0.021), presence of dementia (OR = 54.51; p = 0.040), a high Sepsis-related Organ Failure Assessment (SOFA) score (OR = 1.69; p

Introduction La litteratie en sante est la capacite d’un individu a acceder, comprendre, analyser et utiliser l’information afin de prendre des decisions concernant sa sante. Les outils du numerique occupent une place grandissante dans l’acces a l’information medicale. Des etudes ont montre qu’une faible culture numerique et medicale augmenterait les hospitalisations et les effets indesirables. La population des personnes âgees (PA) avec un cancer est donc susceptible d’etre mise en difficulte par un faible niveau de litteratie. L’objectif principal de cette etude etait d’evaluer la faisabilite pour cette population d’un questionnaire decrivant la litteratie en sante et en sante numerique. Methodes Cette etude transversale sur deux semaines a ete faite aupres de six centres. Les patients âges de 65 ans et plus, atteints d’un cancer et sachant comprendre le francais, devaient completer le questionnaire lors d’une consultation oncogeriatrique ou d’une hospitalisation de jour. Les criteres de jugement principal et secondaire etaient respectivement le taux de refus et la completude du questionnaire. Le questionnaire comprenait la version francaise validee de l’echelle « Functional, Communicative and Critical Health Literacy » (FCCHL) ainsi que cinq questions sur l’usage des outils numeriques. L’echelle est composee de cinq items pour decrire la litteratie fonctionnelle (acceder a l’information), cinq items pour la litteratie interactive (extraire, comprendre et communiquer) et quatre items pour la litteratie critique (analyser et utiliser l’information). Pour chaque sous-echelle du FCCHL, le score de litteratie peut varier de 1 (faible) a 5 (elevee). Ce score est calcule en faisant la somme des scores obtenus a chaque item divise par le nombre d’items. Un score global a ete calcule a partir des scores des trois sous-echelles. Un score ≤ 4 correspond a un faible niveau de litteratie. Les scores ont ete decrits a partir des moyennes et ecart-types. Les questions sur le numerique ainsi que les caracteristiques du patient ont ete decrites a partir d’effectif et de frequence. Resultats Parmi les 126 patients a qui un questionnaire a ete propose, 25 % ont refuse et 13 % etaient dans l’incapacite d’y repondre. Au total, 78 patients (62 %) ont complete le questionnaire, dont 74 % de femmes. L’âge median etait de 78,5 ans (65–95 ans). L’echelle FCCHL etait complete pour 68 % des patients. Les scores moyens de litteratie fonctionnelle, interactive, critique et globale etaient respectivement de 3,5 (± 1), 3,9 (± 0,8), 3,4 (± 1) et 3,6 (± 0,6). Un faible niveau de litteratie etait present chez 72 % des patients. Concernant le numerique, chaque item etait complete par ≥ 95 % des patients. Les 2/3 avaient acces a internet et la moitie a un smartphone. Moins de la moitie realisaient des recherches sur leur sante et 1/3 ne semblaient pas connaitre la telemedecine. Conclusion Cette etude pilote montre une bonne acceptabilite du questionnaire chez les PA avec participation de l’aidant si necessaire. En comparaison avec des donnees francaises chez les adultes, le niveau de litteratie est plus faible dans cette population et la dimension critique est la plus faible. Une etude prospective nationale prendra en compte ces premiers resultats pour ajuster les criteres d’inclusion, les modalites de recueil et l’adaptation des questions sur le numerique. Elle permettra de caracteriser les populations a faible niveau de litteratie en sante pour proposer des actions aupres des centres.

Resume Objectif L’objectif de cette etude retrospective bicentrique etait de decrire l’utilisation de l’azathioprine dans le traitement de l’arterite a cellules geantes et d’apprecier son effet d’epargne cortisonique chez les patients cortico-dependants ou presentant des complications severes de la corticotherapie. Methodes Les dossiers des patients atteints d’une arterite a cellules geantes diagnostiques entre 2000 et 2011 dans les services du CHU de Nantes et des nouvelles cliniques nantaises ont ete etudies. Les donnees sociodemographiques, cliniques, biologiques, radiologiques et therapeutiques ont ete recueillies de facon retrospective et standardisee. Une analyse comparative des doses de prednisone (mg/j) a l’introduction et a 12 mois du traitement par azathioprine a ete effectuee. Resultats Parmi les 28 patients inclus, 21 ont repondu au traitement par azathioprine. Lors du suivi a 1 an, 18 patients (64 %) etaient toujours en reponse prolongee, asymptomatiques, sans syndrome inflammatoire avec une dose journaliere de prednisone Conclusion L’azathioprine pourrait etre utilisee chez les patients atteints d’une arterite a cellules geantes cortico-dependante ou presentant des effets secondaires graves de la corticotherapie afin de permettre une epargne cortisonique. Cependant, les potentiels effets secondaires impliquent une surveillance rapprochee.

Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.

International audience; Background: Transcatheter aortic-valve implantation (TAVI) has been shown to improve survival and quality of life in patients with severe aortic stenosis. However, one-third of patients have poor outcome as death, functional decline or quality of life (QoL) decline. The aim of this study was to determine cardiac and geriatric predictors of physical and mental QoL decline 6 months after a TAVI procedure in patients aged 75 and older.Methods: Between January 2013 and June 2014, we did a prospective and multicenter study including patients ≥ 75 years old referred for TAVI. The primary outcome was the measure of QoL, assessed by the Short Form 36 survey (SF-36), before and 6 months after the intervention. Association between QoL decline and baseline characteristics including cardiac and geriatric factors was analysed by logistic regression models.Results: Mean age of the 150 patients studied was 83.7 years old and 56% were men. The primary end point, mean SF-36 physical summary score, significantly improved between baseline and 6-month (33.6 vs. 36.4, p=0.003) whereas mental component score significantly decreased (48.2 vs. 36.4, p-value

Background To define a core set of geriatric data to be methodically collected in clinical cancer trials of older adults, enabling comparison across trials. Patients and methods Following a consensus approach, a panel of 14 geriatricians from oncology clinics identified seven domains of importance in geriatric assessment. Based on the international recommendations, geriatricians selected the mostly commonly used tools/items for geriatric assessment by domain (January–October 2015). The Geriatric Core Dataset (G-CODE) was progressively developed according to RAND appropriateness ratings and feedback during three successive Delphi rounds (July–September 2016). The face validity of the G-CODE was assessed with two large panels of health professionals (55 national and 42 international experts) involved both in clinical practice and cancer trials (March–September 2017). Results and discussion After the last Delphi round, the tools/items proposed for the G-CODE were the following: (1) social assessment: living alone or support requested to stay at home; (2) functional autonomy: Activities of Daily Living (ADL) questionnaire and short instrumental ADL questionnaire; (3) mobility: Timed Up and Go test; (4) nutrition: weight loss during the past 6 months and body mass index; (5) cognition: Mini-Cog test; (6) mood: mini-Geriatric Depression Scale and (7) comorbidity: updated Charlson Comorbidity Index. More than 70% of national experts (42 from 20 cities) and international experts (31 from 13 countries) participated. National and international surveys showed good acceptability of the G-CODE. Specific points discussed included age-year cut-off, threshold of each tool/item and information about social support, but no additional item was proposed. Conclusion We achieved formal consensus on a set of geriatric data to be collected in cancer trials of older patients. The dissemination and prospective use of the G-CODE is needed to assess its utility.

Discipline Clinique. Introduction et but de l’etude La perte de poids est frequente chez les patients âges atteints de cancer et fortement associee a des evenements pejoratifs. Notre objectif etait d’evaluer la denutrition et la perte de poids chez les patients âges atteints de cancer. Materiel et methodes Une enquete nationale transversale (44 centres d’expertise oncogeriatrique, France) de patients atteints de cancer âges de 70 ans ou plus a ete menee de novembre a decembre 2017. Des donnees demographiques et cliniques ont ete recueillies et une evaluation nutritionnelle a ete realisee par un geriatre. Le critere de jugement principal a ete la perte de poids au cours des six derniers mois precedant le traitement anticancereux. Les patients ont ete ainsi classes en trois groupes selon le pourcentage de perte de poids ( % PDP) : minime (≤ 5 %) ; moderee (> 5 % et Resultats et analyse statistique Cinq cent soixante et onze patients etaient inclus dans l’etude (âge median : 83 ans [intervalle interquartile : 79–87], 50 % des hommes, 43 % avec des metastases). Les principaux types de cancer ont ete le cancer du sein (17 %), colorectal (14 %) et tractus digestif haut/pancreas (10 %). Au total, 124 patients (22 %) avaient une PDP modere (entre 2,5 et 11 kg ; 5,2 en moyenne) et 146 (26 %) avaient une PDP severe (entre 5 et 35 kg ; 12,1 en moyenne). En analyse univariee, les patients presentant une perte de poids moderee ou severe avaient le plus souvent un score de comorbidites plus eleve (Index de Charlson ajuste ; p = 0,018), un cancer du tractus digestif haut/pancreas et du poumon (p = 0,001), des metastases (p = 0,016), un statut de performance altere (PS ≥ 2 ; p Conclusion La moitie de la population etudiee avait perdu plus de 5 % de son poids au cours des six derniers mois. L’enquete se poursuit et sera renouvelee en 2018 permettant une analyse finale multivariee.

Cancer-screening programmes are public health action for a target population. It guarantees an equal access to screening throughout the country with a high level of quality for every person of the target population. Given the heterogeneity of older subjects and the variability of the expected benefits of cancer-screening programmes, this collective public health action may not have a collective benefit for the population. However, for older person with a life expectancy of five years or more, it would be possible to propose an individualized cancer-screening decision. This cancer-screening approach must respect the ethical principles of avoiding harm and supporting autonomy. In addition, it is important to consider the goals and values of patients to take an individualized decision. Patients with the same profile may not take the same decision of individualized cancer screening.

Three treatment options are available for patients with aortic stenosis: surgical aortic valve replacement (SAVR), transcatheter aortic valve implantation (TAVI) and medical treatment (MT). However, little is known about how Heart Team treatment decisions are made under routine conditions. The aim of this study was to identify the cardiac and geriatric components associated with treatment decision-making in older patients with symptomatic severe aortic stenosis.Between 2011 and 2013, 337 consecutive patients ≥75 years old referred for pre-operative evaluation in Nantes University Hospital had a comprehensive cardiac and geriatric assessment. In this observational retrospective study, relationships between treatment decision-making and cardiac or geriatric components were evaluated through multivariable models.Surgical aortic valve replacement was proposed to 108 patients, TAVI to 131 and medical treatment to 98 patients. Mean age was 83±4 years and 51% were women. Geriatric components associated with treatment decision-making between SAVR vs. TAVI were age (p0.001, OR=0.790), comorbidity score (p=0.027, OR=0.86), functional status (p0.001, OR=1.46), and gait speed (p0.001, OR=0.23). Cardiac components associated with decision-making between SAVR vs. TAVI were history of previous cardiac surgery (p0.001, OR=0.09), left ventricular ejection fraction50% (p0.001, OR=0.14), coronary artery disease requiring revascularization (p=0.019, OR=0.4). Between TAVI vs. medical treatment, only history of previous cardiac surgery and presence of another severe valve disease were significant.Comorbidities, functional status and physical performance, were significantly associated with the consensual treatment decision-making, independently of cardiac components in older patients with symptomatic severe aortic stenosis.

La prevention de la decompensation des situations a risque necessite une evaluation du niveau de risque que ce soit par une evaluation geriatrique standardisee ou le reperage de la fragilite, en fonction du contexte. La prevention doit egalement etre consideree dans le cadre plus large des coordinations gerontologiques et des dispositifs de prise en charge a l’echelle des territoires tels que l’integration des services. On distingue la prevention des affections qui peuvent, de maniere isolee, provoquer une decompensation de la situation sanitaire et sociale de la personne âgee. Dans ce cadre la prevention comprend l’arret des conduites a risque (tabac, alcool), le traitement des facteurs de risque cardiovasculaire (hypertension arterielle [HTA], hypercholesterolemie), de la surveillance du diabete, de la prevention des fractures osteoporotiques. Chez la personne âgee souvent polymediquee, la qualite des prescriptions medicamenteuses, l’education therapeutique et l’amelioration de l’observance sont essentielles a la prevention des decompensations liees au risque iatrogene. Chez les sujets âges dont la fragilite represente de fait une elevation potentielle du niveau de risque, la prevention comprend le maintien d’une activite physique adaptee, l’equilibre nutritionnel proteinoenergetique, la correction des deficiences sensorielles, la prevention des risques psychosociaux et, lors d’une alteration cognitive, une stimulation cognitive. L’ensemble devra etre associe a une demarche multidomaine. Les politiques de prevention sociale en sont un complement essentiel.

International audience; BackgroundThe aim of this study was to determine the level of adherence to oral anticoagulants in the population of elderly patients treated for a non-valvular atrial fibrillation (AF) in the era of direct oral anticoagulants.Patients and methodThis transversal study used Morisky scale to assess adherence to oral anticoagulants. We also collected patients’ reviews about the treatment and factors explaining a poor adherence.ResultsBetween January and June 2015, 64 patients were included in Loire Atlantique. Average age was 77.8 years, CHA2DS2-VASc score was 4.06 and treatment (vitamin K antagonists [VKAs] in 78% patients) was prescribed since 4.3 years. According to Morisky scale, 84.4% of patients had a good adherence. There was 88% of good adherence with AVK versus 71% with direct oral anticoagulant, there was no statistically significant difference. The prescriber and the knowledge of anticoagulant treatment role seemed to be determinant factors.ConclusionsThe level of adherence for oral anticoagulant appears higher than in most published studies. Diversification of therapeutic options could constitute an aid to personalize the prescription in order to improve it.; ObjectifL’objectif de cette étude était de déterminer un niveau d’observance du traitement anticoagulant oral, dans la population des patients de plus de 65 ans traités dans le cadre d’une fibrillation atriale (FA) non valvulaire, à l’ère des anticoagulants oraux directs (AOD).Patients et méthodeCette étude transversale utilisait le questionnaire de Morisky pour évaluer l’observance du traitement anticoagulant oral. L’avis du patient sur son traitement ainsi que les facteurs qu’il évoquait pour expliquer une mauvaise observance ont été recueillis.RésultatsEntre janvier et juin 2015, 64 patients ont été interrogés en Loire Atlantique. L’âge moyen était de 77,8 ans, le score CHA2DS2-VASc de 4,06 et le traitement (antivitamine K [AVK] dans 78 % des cas) était prescrit depuis 4,3 ans. Selon le questionnaire de Morisky, 84,4 % des patients étaient « bons observants ». Il y avait 88 % de « bons observants » sous AVK versus 71 % sous AOD, sans différence statistique significative. Le prescripteur initial ainsi que la connaissance du rôle du traitement anticoagulant semblaient être des facteurs déterminants.

International audience; BackgroundThe “Do Not Resuscitate” orders (DNR) are defined as advance medical directives to withhold cardiopulmonary resuscitation during cardiac arrest. Age-related multimorbidity may influence the DNR decision-making process. Our objective was to perform a systematic review and meta-analysis of published data examining the relationship between DNR orders and multimorbidity in older patients.MethodsA systematic Medline and Cochrane literature search limited to human studies published in English and French was conducted on August 2012, with no date limits, using the following Medical Subject Heading terms: “resuscitation orders” OR “do-not-resuscitate” combined with “aged, 80 and over” combined with “comorbidities” OR “chronic diseases”.ResultsOf the 65 selected studies, 22 met the selection criteria for inclusion in the qualitative analysis. DNR orders were positively associated with multimorbidity in 21 studies (95%). The meta-analysis included 7 studies with a total of 27,707 participants and 5065 DNR orders. It confirmed that multimorbidity were associated with DNR orders (summary OR = 1.25 [95% CI: 1.19–1.33]). The relationship between DNR orders and multimorbidity differed according to the nature of morbidities; the summary OR for DNR orders was 1.15 (95% CI: 1.07–1.23) for cognitive impairment, OR=2.58 (95% CI: 2.08–3.20) for cancer, OR=1.07 (95% CI: 0.92–1.24) for heart diseases (i.e., coronary heart disease or congestive heart failure), and OR=1.97 (95% CI: 1.61–2.40) for stroke.ConclusionsThis systematic review and metaanalysis showed that DNR orders are positively associated with multimorbidity, and especially with three morbidities, which are cognitive impairment, cancer and stroke.

International audience; ObjectiveTo determine whether being admitted to emergency department (ED) for social disorders may predict a higher risk of in-hospital mortality among older inpatients.DesignProspective cohort study (mean follow-up: 9.1±10.0 days).SettingAngers University Hospital, France.ParticipantsFour hundred twenty-two inpatients (mean age 84.9±5.6years, 64.2% women).MethodsAt their admission to ED, inpatients aged 75 years and over received an assessment composed of 6 items: age, gender, number of drugs daily taken, history of falls during the past 6 months, usual place of life, and use of formal and/or informal home and social services. The reasons for admission to ED as well the diagnosis at the time of hospital discharge were separated into social and health disorders. The length of hospital stay was calculated in number of days using the hospital registry. Inpatients were separated into 2 groups based on the occurrence or not of death during the hospital stay.ResultsOlder inpatients who died at hospital were more frequently institutionalized (P=0.034) and admitted to ED for social disorders (P=0.002) than those who did not. Multiple Cox regression model revealed that living in institution and social disorders as a reason for admission to ED were significantly associated with the occurrence of death at hospital (P=0.008 and P=0.036). Kaplan-Meier distributions of in-hospital mortality showed that home-living inpatients admitted to ED for social disorders died more and faster during hospitalization than those admitted for health disorders (P=0.016).ConclusionBeing admitted to ED for social disorders and living in institution predicted a higher risk of in-hospital mortality.

The aim of this study was to determine the level of adherence to oral anticoagulants in the population of elderly patients treated for a non-valvular atrial fibrillation (AF) in the era of direct oral anticoagulants.This transversal study used Morisky scale to assess adherence to oral anticoagulants. We also collected patients' reviews about the treatment and factors explaining a poor adherence.Between January and June 2015, 64 patients were included in Loire Atlantique. Average age was 77.8 years, CHAThe level of adherence for oral anticoagulant appears higher than in most published studies. Diversification of therapeutic options could constitute an aid to personalize the prescription in order to improve it.

Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.

BACKGROUND AND PURPOSE: To validate a Short Form of the Mini-Mental State Examination (SMMSE) as a screening test for dementia in older ambulatory individuals followed in a memory clinic for a memory complaint. METHODS: A total of 202 cognitively healthy individuals, 100 individuals with a mild cognitive impairment and 304 demented individuals sent for a memory complaint by their primary care physician to a memory clinic were prospectively included in this cross-sectional study. They were randomized into derivation (n = 303) and validation (n = 303) groups. The SMMSE score was built from six memory items of MMSE, with a score ranging from 0 to 6 (i.e. best performance). RESULTS: The receiver operating characteristic curve showed an area under the curve of 0.98 for the derivation group and 0.97 for the validation group without differences between curves (P = 0.254). The cut-off between the sensitivity and the specificity of the SMMSE score for clinically diagnosed dementia was

This prospective observational study was carried out to assess the annual preventive and curative treatment costs for diabetic foot problems. Measures of resource use over the 1-year study period were taken for 151 patients whose lesions covered the entire Wagner classification. Treatment was provided under the current protocols of a multidisciplinary team. The 1993 market prices for health services were used to convert units of health service utilization to expenditures by the social insurance system and the patients. The severity of the foot problems determined the medical cost. Preventive care (47 cases), represented an average cost per case of US$ 880 (1US$ 1993=BEF 30.65). Curative care (120 cases), including diagnostic tests, wound dressings, antibiotic therapy, revascularization and off loading techniques resulted in a mean cost of US$ 5227 per ulcer. Care for the 16 most severe wounds and amputations involved hospitalization and surgery at a mean cost per ulcer of US$ 31716. The most important cost contributers were hospitalizations (72%), drugs (11%) and diagnostic examinations (4%). Preventive treatment for diabetic foot problems can represent a significant saving for the social insurance system as well as for the patients.

L’allergie necessite un diagnostic precoce qui, outre une prise en charge de la maladie dans sa forme initiale, permettra de prevenir son evolution vers d’autres formes potentiellement plus graves. Les tests de depistage permettent en premiere intention d’explorer la cause sous jacente des symptomes et de confirmer ou infirmer une origine allergique. Ils ont ete dernierement completes par un test specialement dedie au nourrisson, qui prend en compte la predominance des allergenes alimentaires dans cette tranche d’âge. Les dosages d’IgE specifiques contribuent, par l’identification des allergenes en cause, a mettre en place un traitement specifique (en particulier une eviction) et a suivre l’evolution de l’allergie au fur et a mesure que l’enfant grandit. Les dernieres avancees scientifiques et technologiques permettent dorenavant d’affiner la recherche au niveau moleculaire et le developpement recent de tests avec les composants allergeniques ouvre de nouvelles perspectives au diagnostic in vitro qui s’enrichit de nouvelles indications.

In order to determine the current situation and to evaluate the human to human transmission of Mycobacterium tuberculosis in Northern France, the genetic polymorphism of strains was studied by using IS6110 fingerprint. One hundred and fifty-eight cases of bacteriologically confirmed tuberculosis were analyzed. One hundred and twenty-six patients (82%) were infected with genetically different isolates and 28 isolates (18%) were grouped into 14 clusters. No risk factors for recent Mycobacterium tuberculosis infections such as age, HIV status, immigrants, living in big cities were identified. This study shows that there was no major epidemic situation of tuberculosis in Northern France in 1995. Tuberculosis was characterized by a low proportion of HIV positive patients and a high proportion of elderly patients.

Introduction L’infection par le VIH est devenue une maladie chronique. Les patients vieillissants avec le VIH presentent souvent de multiples comorbidites, une polymedication et un syndrome de fragilite. Le personnel, medical et paramedical, des etablissements d’hebergement pour personnes âgees dependantes (EHPAD) est-il favorable a l’admission de personnes seropositives au sein de leurs etablissements ? Materiels et methodes Envoi d’une enquete postale au personnel medical et paramedical de 100 EHPAD de la region PACA tires au sort en 2013. Resultats Le taux de reponse a ete de 54 % avec 49 questionnaires medicaux et 201 questionnaires paramedicaux recueillis a partir des 53 EPHAD qui ont repondu. L’âge moyen des medecins et du personnel soignant etaient respectivement de 53,5 annees (± ecart-type 10,3), 42 annees (± 11,3). Seuls quatre medecins (8,2 %) avaient deja admis des residents VIH dans leur EPHAD. Plus de ¾ du personnel paramedical etaient d’accord d’admettre des patients VIH sans restriction pour 135 (67,2 %) ou avec des restrictions pour 27 (13,4 %). Les principaux motifs de refus d’admission des patients VIH etaient le manque d’enseignement ou de formation sur les personnes seropositives et la crainte de la contamination des residents ou du personnel. Pres d’un tiers des medecins (28,6 %) et deux tiers (64,2 %) des membres du personnel ont repondu qu’ils doivent recevoir un enseignement sur le VIH au prealable. Conclusion Notre etude montre que pres d’un tiers du personnel des EPHAD emet des reserves au sujet de l’admission des patients VIH-positifs. Aujourd’hui, les personnes des EPHAD ne sont pas au courant non seulement des aspects medicaux mais aussi des aspects sociaux et de leurs consequences pour les patients infectes par le VIH. Dans un avenir proche, l’acces aux EPHAD devrait etre propose dans les meilleures conditions possibles pour ces patients si complexes. Il faut preparer le personnel des EHPAD en leur donnant une formation sur cette affection afin de diminuer leurs craintes.

Few studies have examined the effects of physical training programs on gait variability while single and dual tasking, and they reported mixed results. The aim of this study was to compare the stride time variability while single and dual tasking before and after a physical training program developed to improve gait stability in French community-dwelling older adults.A prospective pre-post interventional cohort study.The community-dwelling area of "Pays de la Loire", France.Forty-eight older adults (mean age ± standard deviation 72.2±8 years; 75% female).Physical training program consisted in 12 sessions scheduled to attend physical exercises 1 time a week with total time duration of 3 months. Coefficient of variation (CoV) of stride time under three walking conditions (i.e., walking alone, walking while backward counting, and while performing a verbal fluency task) was determined while steady-state walking using the SMTEC® footswitches system before and after the physical training program. Participants were separated into two groups based on being or not in the highest tertile (i.e., worst performance with cutpoint4.4%) of the CoV of stride time while walking alone.After physical training compared to before period, a significant decrease in CoV of stride time (i.e., better gait performance) while walking alone (2.8±2.8% versus 7±7.1%, P=0.001) but not while dual tasking (P=0.600 for counting backward and P=0.105 for verbal fluency task) was shown in participants who had highest (i.e., worst) gait variability at baseline. In addition, physical training modified the strategy of dual tasking in participants with highest gait variability at baseline compared to the other participants. Before training, a significant decrease in CoV of stride time (7±7.1% versus 4.9±4.6%, P=0.017) while counting backward was shown, but there was a significant increase after training (2.8±2.8% versus 5.4±5.8%, P=0.007).Physical training reduced gait variability while walking alone in participants with gait instability, and influenced their strategy for dual tasking.Physical program training developed in the community to improve gait stability should included participants with high gait variability.

Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate.The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons.Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG).Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice.Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.

International audience; Background: Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. The association between abnormal 4-item GDS score and recurrent falls has not yet been examined. In addition, while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied. Objective: 1) To examine the association between abnormal 4-item GDS score and recurrent falls in community-dwelling older adults using original data from health examination centers (HEC) of French health insurance of Lyon, and 2) to perform a systematic review of studies that examined the association of depressive symptoms with recurrent falls among older adults. Methods: Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1 +/- 5.4years; 49.8% women) were recruited in HEC of Lyon, France. The 4-item GDS score (abnormal if score >= 1) and recurrent falls (i.e., 2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms "Aged OR aged, 80 and over", "Accidental falls", "Depressive disorder" and "Reccurence". The search also included the reference lists of the retrieved articles. Results: A total of 19.0% (n=494) participants were recurrent fillers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, with P

International audience; 1) To confirm that vitamin D deficiency, defined as serum 25-hydroxyvitamin D (25OHD) concentration < 25nmol/L, was associated with long length-of-stay (LOS) among older inpatients admitted to geriatric acute care unit; and 2) to examine which combination of risk factors of longer LOS including vitamin D deficiency best predicted longer LOS.Based on a prospective cohort study with a 25-day follow-up on average, 531 consecutive older inpatients (mean age 85.0 +/- 7.2 years, 59.1% women) admitted to the geriatric acute care unit of Angers University Hospital, France, were included. Linear regression models showed that male gender (P < 0.025), delirium (P < 0.015) and vitamin D deficiency (P < 0.001) were independently associated with a longer LOS. The highest risk of a longer LOS was shown while combining vitamin D deficiency with male gender (Odds ratio (OR)=3.70 with P < 0.001). The risk increased significantly while delirium was associated with these two baseline characteristics (OR=4.76 with P=0.001). Kaplan-Meier distributions of discharge differed significantly between participants who had or not the combination of the 3 criteria (P < 0.007). Vitamin D deficiency, delirium and male gender were significant risk factors for a longer LOS in the studied sample of older inpatients.

International audience; Cumulative Illness Rating Scale (CIRS) remains difficult to use in older patients, especially because of a possible memory bias while declaring a chronic disease among patients with cognitive disorders. Because acute and chronic diseases are usually treated with drugs, we hypothesized that the number of drug classes taken per day could be a surrogate measure of comorbidity burden and, thus, could be positively associated with the CIRS-G score. The aim of this study was to determine whether the CIRS-G score was associated with the number of drug classes taken per day by older inpatients in a geriatric acute care unit. Based on cross-sectional design, 324 older inpatients (85.3±6.4 years, 63.3% female) were prospectively included in this study. Number of drug classes daily taken was recorded using the Anatomical Therapeutic Chemical Classification (ATCC) and the CIRS-G score was also calculated. Among studied older inpatients, the mean CIRS-G score was 8.6±3.6 and the mean number of drug classes daily taken was 7.0±3.7. The linear regressions showed that only the number of drug classes daily taken was significantly and positively associated with the CIRS-G score (coefficient of regression β=0.317 for unadjusted model, β=0.304 for fully adjusted model and β=0.317 for backward model with allP-values&nbsp

Introduction L’âge est un facteur de mauvais pronostic au cours des vascularites associees aux ANCA (VAA) (surmortalite, risque infectieux, decompensation de comorbidite, iatriogenie). A ce jour les scores pronostiques ne prennent en compte que les parametres lies a la maladie et l’âge civil des patients. En oncogeriatrie les echelles d’evaluations geriatriques permettent de guider la therapeutique et les soins de support. Ils sont plus informatifs que le seul âge des patients. Dans les VAA notre approche de l’etat general des patients reste empirique et informelle. Patients et methodes Nous avons realise une etude retrospective de nos patients diagnostiques VAA (type GPA ou MPA) apres 65 ans entre 2000 et 2013. Les comorbidites ont etes evaluees par l’index de Charlson, la fragilite par le CSHA Clinical Frailty Scale (CFS) et la dependance par l’IADL simplifie a 4 items. Ces parametres on ete determine retrospectivement a T−1 (1 an avant le diagnostic), T0 (au diagnostic) et T+1 (a 1 an). Resultats Quarante-quatre patients ont ete inclus, dont 33 MPA et 11 GPA. L’âge median etait de 76 ans (10 patients avaient plus de 80 ans). Le DFG median etait de 49 mL/min/1,73 m2. En premiere ligne, 29 patients (66 %) ont recu une association de corticoides et cyclophosphamide et 12 des corticoides seuls. En analyse multivariee la mortalite etait plus elevee chez les patients avec anti-PR3, en limitation therapeutique ou avec une IADL anterieure alteree. La survie sans progression etait meilleure chez les patients avec un score de fragilite eleve. L’IADL etait le seul facteur qui predisait la survie sans infection. Les facteurs predisant la perte d’autonomie a 1 an etaient la presence d’anti-PR3, le score de Charlson et l’IADL. Conclusion Des outils d’evaluation geriatriques simples semblent pouvoir avoir une valeur pronostique au cours des VAA du sujet âges. Dans cette etude pilote, retrospective, ces parametres avaient souvent une meilleure valeur pronostique que l’âge civil ou que certaines variables cles telles que la fonction renale. Des travaux multicentriques sont souhaitables afin d’etudier les performances de ces outils de facon prospective chez des patients non selectionnes.

Resume Les auteurs etudient les performances analytiques d'une methode chimiluminescente de detection des IgE specifiques (systeme Magic-lite de Ciba-Corning); les tests de repetabilite mettent en evidence une bonne fiabilite de la methode pour la recherche des IgE specifiques des pneumallergenes (allergy-screen) ainsi que pour le dosage des IgE specifiques unitaires. La comparaison de l'allergy-screen avec le test Cap Phadiatop de Pharmacia permet de conclure a une excellente correlation entre les deux tests. Pour le dosage des IgE specifiques, il existe quelques discordances (n'excedant jamais deux classes) entre la methode RAST Pharmacia et le systeme Magic-lite, dues au manque de standardisation des allergenes.

Finding a biomarker of long length-of-stay (LOS) would provide a simple solution to target frail older inpatients at such risk. The aim of this study was to determine whether serum 25-hydroxyvitamin D (25OHD) deficiency, defined as serum concentration 14 days; n=120) versus the other two tertiles combined (

Les comorbidites representent l’ensemble des pathologies qui surviennent dans un contexte donne. La maladie principale est nommee pathologie cible. Les comorbidites comprennent les pathologies chroniques qui sont des facteurs de risque de l’expression clinique de la maladie, les antecedents pouvant avoir des consequences sur l’etat de sante du patient et les pathologies compliquant l’evolution de la pathologie cible. Lorsque la pathologie cible est la maladie d’Alzheimer, les comorbidites representent soit un facteur de risque de survenue d’un syndrome dementiel, soit un accelerateur de l’evolution de la maladie vers le stade severe de la maladie. Parmi les comorbidites considerees comme facteurs de risque de la maladie on peut citer l’hypertension arterielle, qui est presente chez 45% des patients lors de la phase prodromale et dont la prevalence tend a diminuer au cours de l’evolution de la maladie. De meme la depression presente chez 40% des patients est a la fois une pathologie qui precede la phase clinique et qui en favorise l’expression clinique. Les facteurs de risque vasculaire et en particulier le diabete participent a la presentation clinique de la maladie d’Alzheimer dans les atteintes vasculaires cerebrales souvent associees. Les comorbidites qui modifie l’evolution de la maladie comprennent les handicaps sensoriels, presents chez 20% des patients, les pathologies cardiovasculaires et les episodes infectieux. Lors de l’evolution de la maladie, l’incontinence urinaire est la comorbidite la plus representee (@ 60 %). De nombreuses echelles de comorbidites sont validees en geriatrie : le CIRS-G (Cumulative Illness Rating Scale Geriatric), l’indice de Charlson, le TIBI (Total Illness Burden Index), l’indice de Kaplan-Feistein et l’ICED (Index of Coexisting Disease). Seules, le CIRS-G et l’indice de Charlson ont ete utilises dans les population de patients âges presentant un syndrome dementiel. Le CIRS-G se calcule en fonction d’une evaluation clinique organes par organes. Il limite le risque d’erreurs liees a un interrogatoire peu fiable dans cette situation et prend en compte l’hypertension arterielle. L’indice de Charlson est l’echelle la plus utilisee en geriatrie et dans la population des patients ayant une demence. Mais elle ne s’interesse qu’aux comorbidites severes qui ne sont pas les seules a avoir un impact majeur chez les patients âges dements. Les echelles de comorbidites ne sont pas suffisamment utilisees lors de la pratique d’evaluation geriatrique. Elles donnent une description generale du niveau de risque, et permettent, integrees a une evaluation geriatrique, d’evaluer le rapport benefice/risque pour les choix therapeutiques relatifs a la maladie, le suivi et le pronostic.

Mycoplasma hominis surface structures involved in human immune response and in the pathogenesis of this bacterial infection are inadequately defined. Attempts have been made to identify M. hominis surface proteins, to determine the antigenicity of these polypeptides, and to examine antigens which could lead to the development of species-specific diagnostic tests. By means of Western blotting, using a pool of sera from patients with culturally proven vaginal infection, most antigens recognized were surface exposed. Among these proteins, antigens of molecular weights between 102 and 116 kD were most consistently revealed. These polypeptides were recovered by electroelution and assayed in an IgG-ELISA. The electroeluted antigen specificity was examined by ELISA and immunoblotting with different mycoplasma species. Electroeluted proteins may be effective and specific for establishing a reliable diagnosis test.

Resume Nous presentons les resultats d'une evaluation des trousses de dosage immuno-enzymatique Boehringer de la thyroxine libre (FT4) et de la TSH sensible (TSH-S) sur automate ES 600. Nous avons voulu montrer l'interet d'une automatisation complete de l'immunodosage en terme de fiabilite. L'etude de la TSH-S a egalement porte sur le seuil de sensibilite qui joue un role essentiel dans la discrimination des hyperthyroidiens et des euthyroidiens. La FT4 a fait l'objet d'une etude complementaire des valeurs obtenues dans certaines conditions physiopathologiques (patients sous amiodarone ou sous heparine, femmes enceintes, insuffisants hepatiques).