Vaccine hesitancy throughout the COVID-19 vaccination trajectory among immigrant and non-immigrant older adults: a cohort study.

OBJECTIVES: The aims of this study were to examine vaccine hesitancy for COVID-19 vaccinations, comparing immigrant and non-immigrant older adults (aged ≥60 years), after accounting for group-level and individual-level characteristics, and the interaction between immigrant and socio-economic status. STUDY DESIGN: This study used a retrospective cohort design. METHODS: Analyses were conducted using R version 4.3.2. Logistic regression models had the dependent variables of obtained any COVID-19 vaccinations vs not and obtained all four required COVID-19 vaccinations vs not. The linear regression model's dependent variable was the interval in days between the COVID-19 vaccination availability and the date of obtaining the first COVID-19 vaccination. RESULTS: In the cohort of older adults (n = 35,109), immigrants were less likely than non-immigrants to obtain a single COVID-19 vaccination (P < 0.001) or the full series of required COVID-19 vaccinations (P < 0.001); however, immigrants vs non-immigrants delayed only in obtaining the first vaccination (P < 0.001) but not the remaining required COVID-19 vaccinations. In the linear regression model, a longer interval before obtaining the first COVID-19 vaccination was associated with immigrant status (P < 0.001), lower socio-economic status (SES; P < 0.001), and the interaction between immigrant status and low SES (P < 0.001), while a shorter interval was associated with preventive behaviours of obtaining seasonal influenza (P < 0.001) or pneumococcal (P < 0.001) vaccinations previously. CONCLUSIONS: Immigrant status in general, and especially when combined with low SES, is a major risk factor for vaccination hesitancy. Reorienting immigrants to embrace preventive healthcare behaviours is key. Culturally appropriate communication campaigns may improve the dissemination of effective vaccination-related information to immigrant communities.

Early metabolic defects in Arab subjects with strong family history of Type 2 diabetes.

AIMS AND OBJECTIVE: It is widely accepted that the genetic make-up of the subject plays a pivotal role in the development of insulin resistance and ß cell failure. The objective of this study was to examine whether the same or distinct genetic backgrounds contribute to the development of insulin resistance and ß cell failure. METHODS: We examined insulin sensitivity and ß cell function in lean normal glucose tolerance subjects from 3 multigeneration Arab families. Families 1 and 2 had strong history of Type 2 diabetes (T2DM), while no member of family 3 had T2DM. RESULTS: Subjects in family 1 manifested increased basal plasma free fatty acid (FFA) concentration and impaired suppression of plasma FFA during the OGTT compared to subjects in family 3. Subjects in family 2 had comparable fasting plasma FFA and suppression of plasma FFA during the OGTT to family 3. Both the absolute plasma glucose concentrations, and incremental area under the plasma glucose curve (ΔG0-120) during the OGTT were comparable in subjects of families 1 and 2, and were decreased in subjects of family 3. Whole body and muscle insulin sensitivity were comparable in subjects from families 2 and 3, and both were significantly decreased in subjects of family 1. Beta cell function was comparable in subjects of families 1 and 3 and was significantly decreased in subjects of family 2. CONCLUSION: These results demonstrate that distinct genetic background contributes to the development of insulin resistance and ß cell dysfunction in Arab individuals.

[Respiratory infections: Additional transmission-based precautions in healthcare facilities]. / Les infections respiratoires : prévention de la transmission en milieu de soins.

INTRODUCTION: In health care, measures against cross-transmission of microorganisms are codified by standard precautions, and if necessary, they are supplemented by additional precautions. STATE OF THE ART: Several factors impact transmission of microorganisms via the respiratory route: size and quantity of the emitted particles, environmental conditions, nature and pathogenicity of the microorganisms, and degree of host receptivity. While some microorganisms necessitate additional airborne or droplet precautions, others do not. PROSPECTS: For most microorganisms, transmission patterns are well-understood and transmission-based precautions are well-established. For others, measures to prevent cross-transmission in healthcare facilities remain under discussion. CONCLUSIONS: Standard precautions are essential to the prevention of microorganism transmission. Understanding of the modalities of microorganism transmission is essential to implementation of additional transmission-based precautions, particularly in view of opting for appropriate respiratory protection.

Nosocomial outbreak of Pseudomonas aeruginosa associated with a drinking water fountain.

Over a four-month period, ten patients were suspected of having acquired nosocomial infection to P. aeruginosa in the ear, nose, and throat department. Environmental and clinical isolates were compared. Only water from a drinking water fountain was contaminated by P. aeruginosa. This isolate and those of three patients had indistinguishable random amplified polymorphic DNA profiles. These patients had serious oncology diseases. The drinking water fountain was used for their alimentation by percutaneous endoscopic gastrostomy and was the origin of the outbreak. Another type of drinking fountain with a terminal ultraviolet treatment was installed, following which no new infections linked to drinking water were identified.

Nosocomial legionnaires' disease in a bone marrow transplant unit.

We report the outcome of nosocomial legionnaires' disease in three patients who were isolated in the same sterile unit after allogeneic bone marrow transplantation. In all three cases the disease presented with dramatic pulmonary symptoms, and diagnosis was ascertained by direct immunofluorescence on bronchoalveolar fluids. None of the patients underwent seroconversion. This report draws attention to: (1) the fact that bacteriological filters do not ensure absolute security; (2) the need for frequent monitoring of the two factors governing legionella growth, water temperature and chlorination; and (3) the effectiveness of quinolones as a curative and prophylactic treatment of legionnaires' disease in transplanted patients avoiding pharmacological cyclosporin interaction.

The effect of 10% povidone--iodine solution on contaminated bone allografts.

The aim of this study was to determine the efficacy of 10% povidone--iodine solution for the decontamination of bone allografts. Bone samples were prepared and tested for sterility using a femoral head removed at the time of primary hip replacement. They were contaminated by a suspension of Staphylococcus epidermidis and ground to measure the quantity of micro-organism attached to the bone. Two levels of contamination were used (1 x 10(3) vs. 1 x 10(4)CFU/mL) to check the efficiency of our method of measurement. Samples of the two groups were decontaminated with 10% povidone--iodine solution using different exposure times. Before decontamination, the count of bacteria attached to the bone was proportional to the bacterial concentration of the contaminating solution. The microbiocidal activity of 10% povidone--iodine solution was the same in both groups. The decontamination time was proportional to the bacterial concentration of the contaminating solution. The results of this preliminary study suggest that a 10% povidone--iodine solution can decontaminate inoculated bone grafts, but a sufficient time of exposure according to the level of contamination must be allowed.

Evaluation of closed sterile prefilled humidification.

A closed sterile prefilled humidifier ('Aquapak 310') and a multiple-use humidifier ('Nebal 2') were evaluated in hospital departments to determine their susceptibility to bacterial contamination and cost. No bacterial contamination was found in the 389 samples of 'Aquapak 310' water. However, 54/164 (32.9%) samples of 'Nebal 2' water were found to be contaminated. Pseudomonas aeruginosa was the bacterium most often isolated. The cost analysis was highly influenced by the average use time. In the haemodialysis and respiratory medicine departments the average use times for the 'Aquapak 310' +/- SD were 61.6 +/- 36.2 days and 4.1 +/- 1.7 days, respectively. Using the 'Aquapak 310' system, there was a 51% financial saving in the haemodialysis department but a 2% loss in the respiratory medicine department. In these two departments we found a similar cost saving as far as staff time was concerned (88% vs. 89%). The major difference came from the cost of consumables: 26% saving in the haemodialysis department vs. 70% loss in the respiratory medicine department. Use of the prefilled sterile humidifiers represents a three-fold benefit, a lower infection risk for the patient, an important financial saving in the haemodialysis department and a decreased staff work load.

[Improvement of the diagnostic value of exercise test by heart-rate adjusted segment depression. Value of ST 20/HR index]. / Amélioration de la valeur diagnostique de l'épreuve d'effort par le sous-décalage du segment ST rapporté à la fréquence cardiaque. Intérêt de l'index ST 20/FC.

One of the new criteria of positivity of exercise stress testing proposed by Detrano and Kligfield is the ST/HR index, obtained by calculating the ratio of additional ST depression on exercise over the corresponding variation in the heart rate. These authors reported that this ratio improved the diagnostic value of the exercise stress test with respect to the traditional ST segment depression, but that the proportion depended on whether the index was measured 80 or 60 ms after the J point. The object of this study was to assess the diagnostic performance of the ST/HR index measured 0, 20, 40, 60 and 80 ms after the J point by automatic analysis and to compare these five diagnostic indices with the classical ST segment depression (standard criterion) by ROC graphs and the Mac Nemar test. One hundred consecutive patients (73 men and 27 women) all symptomatic, underwent submaximal or symptom-limited exercise stress testing and accepted coronary angiography. The prevalence of greater than or equal to 50% coronary stenosis on at least one main vessel was 48%. None had previous myocardial infarction. The ROC graphs and areas under the curve demonstrated generally the superiority of the ST/HR index over the standard criteria. The optimal diagnostic performance was observed when the index was calculated 20 ms after the J point (ST 20/HR index).(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of ELISA using A60 antigen from Mycobacterium bovis BCG: specific IGG and IGM in mycobacterial infections]. / Evaluation d'un ELISA utilisant l'antigène A60 de Mycobacterium bovis BCG: IgG et IgM spécifiques au cours des infections mycobactériennes.

The authors have evaluated an ELISA (A60-Tb, Anda biologicals) allowing the detection of specific IgG and IgM against A60 antigen from Mycobacterium bovis BCG during mycobacterial infections. This study included sera from 110 african subjects and from 71 French subjects distributed in 4 clinical groups: 55 tuberculous patients (I), 41 leprous patients (II), 33 pneumopathies (III) and 52 healthy subjects (IV). Serological results were compared taking as reference for the diagnosis of tuberculosis the positivity of culture and/or that of a direct examination, and for leprosy the positivity of a direct examination associated either with a Mitsuda's reaction or with an histopathological examination. IgG were found to be more discriminative than IgM. Considering together the results of groups I and II, the authors found a sensitivity of 95.8 p. cent and a specificity of 75.3 p. cent with threshold of 200 U/ml for specific IgG. Anti-A60 antigen antibodies obtained for groups I and II were significantly higher (IgG: p less than 0.0001; IgM: p less than 0.001) than those observed in other groups. African subjects presented IgG titers higher than those obtained by French subjects (p less than 0.0001). IgM response was more frequent among group II (97.6 p. cent) than group I (21.8 p. cent). However, IgG (26.9 p. cent) and IgM titers (30.8 p. cent) were detected among group IV. This test would allow a control of therapeutic efficacy with an additional interest for classifying borderline forms of leprosy.

[Study of methicillin-resistant Staphylococcus aureus colonization among intermediate-care facility patients]. / Etude de la colonisation par Staphylococcus aureus résistant à la méticilline dans des services de soins de suite.

PURPOSE: Prevalence of methicillin-resistant Staphylococcus aureus is high in the Poitiers teaching hospital, particularly in the intermediate care facilities. We performed a survey of methicillin-resistant Staphylococcus aureus colonization in the intermediate care facilities and 265 patients were included. METHODS: Nasal, cutaneous and wound swab cultures were done at the time of admission and at the time of the patients' departure. A decolonization procedure of methicillin-resistant Staphylococcus aureus carriers was performed using nasal application of fusidic acid and different soaps for the skin. At entry, 17.7% of patients were methicillin-resistant Staphylococcus aureus carriers (of at least one location). At departure, 30.4% were methicillin-resistant Staphylococcus aureus carriers. Among methicillin-resistant Staphylococcus aureus non-carriers at entry, 24.3% became methicillin-resistant Staphylococcus aureus carriers. RESULTS: The principal risk factor of carriage was the initial presence of a wound (RR = 3.6). The incidence rate of methicillin-resistant Staphylococcus aureus infection among the 265 patients included was 3%. CONCLUSION: The systematic screening of patients at the time of admission is expensive and isolation technically hard to manage in the intermediate care facilities. The risk factor we found in this study allow us to propose a 'light' screening limited to patients with wounds.

[Nosocomial infection in psychiatry: myth or reality...?]. / L'infection nosocomiale en psychiatrie: mythe ou réalité...?

The absence of nosocomial infections control in the hospital Henri-Laborit, specialized in mental medicine, has brought ourselves to answer the question: is the nosocomial infection in psychiatric hospital a myth or a reality? A retrospective study of global nosocomial infections incidence has been realized from ten years of microbiology laboratory data. During this time, 716 patients have contracted one or several nosocomial infections. The incidence rate is 3%, the incidence density rate 0.3/1000. The urinary infections represent half of the infections, followed by the septic wounds. Some infections like septicaemia implicate the patient vital prognosis.

[Assessment of three filters for respiratory function tests]. / Evaluation de trois filtres destinés aux explorations fonctionnelles respiratoires.

Several filters specific for respiratory function tests have been on the market for several years. Recommended by the manufacturers to avoid contaminating the equipment and thus improve patient safety, these filters require a considerable financial investment. We studied the passage of diluted blood into artificial saliva in a patient model simulating inspiration tests and rapid forced expiration to assess the retention capacity of three filters used for respiratory function tests: Multi SPIRO MI-90016 (MultiSPIRO), PF 30S (Pall Biomedical) and Spirobac (Dar. S.p.A). The mean percentage of passage was 1.48% through the MI-90016 filter, 57.15% through the PF 30 S filter and 70.45% through the Spirobac filter. These findings provide further elements for choosing filters for respiratory function tests. Indeed, despite the manufacturers' commercial arguments, the technical documents provided do not give necessary information on the filtering capacity of the filters on the market. We have observed that two out of the three filters tested do no meet the standards expected by clinicians.

[Assessing the cost of occupational exposures to blood, in a French university hospital]. / Evaluation du coût de la prise en charge des accidents exposant au sang dans un centre hospitalo-universitaire en 2000.

UNLABELLED: The management of occupational exposure to blood has an important economic impact. Few studies have estimated the real cost of these exposures. METHOD: This retrospective study was made on occupational exposures to blood reported in the Poitiers University Hospital, in 2000. Items concerning the management of these accidents were listed: consultations, post-exposure prophylaxis, laboratory testing, leave time for health care workers (HCW). RESULTS: In 2000, 243 occupational exposures to blood were reported to the Department of Occupational Medicine. Nurses (39.5%), physicians (21.8%), and students (13.6%) were the most frequently concerned. Most of these accidents occurred in the Department of Surgery (29.2%) and Department of Internal Medicine (24.3%). Deep needle-stick injuries accounted for 48.7% of occupational exposures to blood. The source patient serology was unknown in 15.6% of the cases. This study showed that the cost of these occupational exposures to blood was high in 2000 (68310 Euros). This global cost was due to consultations (11122 Euros), laboratory testing (45995 Euros), and post-exposure prophylaxis (5067 Euros). The cost of leave time for injured workers was 6126 Euros. CONCLUSION: The economic impact of occupational exposures to blood is high for a hospital. Before the introduction of safety devices, a cost-benefit analysis must be made to assess the benefits brought about by preventing accidents.

Bacteria and vampirism in cinema.

A vampire is a non-dead and non-alive chimerical creature, which, according to various folklores and popular superstitions, feeds on blood of the living to draw vital force. Vampires do not reproduce by copulation, but by bite. Vampirism is thus similar to a contagious disease contracted by intravascular inoculation with a suspected microbial origin. In several vampire films, two real bacteria were staged, better integrated than others in popular imagination: Yersinia pestis and Treponema pallidum. Bacillus vampiris was created for science-fiction. These films are attempts to better define humans through one of their greatest fears: infectious disease.

Control of multi-drug-resistant Acinetobacter baumannii outbreaks in an intensive care unit: feasibility and economic impact of rapid unit closure.

From January to May 2006, a nosocomial outbreak caused by a multi-drug-resistant strain of Acinetobacter baumannii (MDRAB) occurred in a multi-specialty surgical ICU (SICU). During this episode, 20 patients were colonized by an identical MDRAB strain. Despite introduction of control measures, the outbreak was only stopped after complete closure of the unit. When a second MDRAB outbreak was confirmed in the same unit in January 2009, the SICU was closed as soon as possible. This measure allowed faster control of the outbreak, which only involved seven patients and lasted for 25 days. The economic impact of the outbreak was also considerably lower; estimated costs were €202,214 in 2009 compared with €539,325 in 2006. This study found that rapid closure of the SICU, with patients cohorted elsewhere, was a cost-effective way of controlling an MDRAB outbreak.

[Quantitative assessment of fungal risk in the case of construction works in healthcare establishments: Proposed indicators for the determination of the impact of management precautions on the risk of fungal infection]. / Appréciation quantitative du risque fongique en cas de travaux en établissements de santé : propositions d'indicateurs d'impact des mesures de gestion du risque infectieux fongique.

Construction works in healthcare establishments produce airborne fungal spores and considerably increase the risk of exposure of immunosuppressed patients. It is necessary to reinforce protective measures, or even to implement specific precautions, during this critical phase. The aim of these precautions is to protect both those areas, which are susceptible to dust, and patients at risk of a fungal infection particularly invasive aspergillosis. When construction works are planned in healthcare establishments, the first step consists in the characterisation of the environmental fungal risk and the second one in proposing risk management methods. It is then essential to establish impact indicators in order to evaluate the risk management precautions applied. The working group promoted by the French societies of medical mycology and hospital hygiene (SFMM & SF2H) details here both environmental and epidemiological impact indicators that can be used.

[Good antibiotic use policy assessment in healthcare institutions of the French Poitou-Charentes region]. / Evaluation sur 2006 et 2007 de la politique de bon usage des antibiotiques dans les établissements de santé de la région Poitou-Charentes.

METHOD: In 2007, a questionnaire covering all items of a Ministry of Health circular was sent to healthcare institutions in the French Poitou-Charentes region to assess the good antibiotic use policy. RESULTS: A comparison with the Nosocomial Infection Committee 2006 activity report concerning measures included in the ICATB (antibiotic use) indicator revealed widespread implementation of surveillance and of protocols for first-line antibiotics and surgical antibiotic prophylaxis (88% of all healthcare institutions). The assessment of protocol monitoring and of professional practice was to be implemented. Antibiotic therapy training sessions were deficient because of a shortage of expert physicians (50% of healthcare institutions), and mirrored by a lack of treatment re-evaluation at 48 or 72hours (58% of healthcare institutions). However, nominative prescription use was widespread (90% of healthcare institutions). Securing drugs circuit with online drug prescriptions, computerized patient file, sharing data with other services (microbiology laboratory, pharmacy) were difficult to integrate to hospital information systems. Pharmaceutical-economic indicators used to monitor antibiotic consumption were rarely given to units using antibiotics. The average ICATB indicator in 2006 ranged between 6 and 8/20. COMMENTS: Antibiotic therapy training sessions and evaluation of professional practices must be improved. Computerizing the drug circuit should improve interdisciplinary practices.

Evaluation of two media for antibiotic susceptibility testing of anaerobic bacteria using the receiver operating characteristic procedure.

Wilkins-Chalgren agar and Meat-Yeast agar were evaluated as media for antibiotic susceptibility testing using 112 anaerobic bacterial strains. The results obtained with the two media using the diffusion method were compared with those obtained by the dilution method as reference method. The results were analyzed by the receiver operating characteristic (ROC) procedure allowing a graphic representation of sensitivity and specificity of the technique for each cut-off value. The area under the ROC curves was calculated to compare the accuracy of the two methods. Six antibiotics were tested including amoxicillin, cefoxitin, piperacillin, doxycycline and clindamycin. For amoxicillin and clindamycin, the two methods showed a high and identical discriminative power for distinguishing susceptible bacteria from the others. Diffusion in Wilkins-Chalgren agar appeared better than diffusion in Meat-Yeast agar for separating resistant bacteria from bacteria of intermediate susceptibility (amoxicillin p less than 0.005; clindamycin p less than 0.04). For other drugs, diffusion in Wilkins-Chalgren agar always had a discriminative power higher than that obtained with diffusion in Meat-Yeast agar for separating susceptible bacteria from the others (cefoxitin p less than 0.0005; piperacillin p less than 0.02; doxycycline p less than 0.05). The Wilkins-Chalgren agar medium thus appeared superior to the Meat-Yeast agar medium using the ROC evaluation method, which would deserve wider utilization in the field of microbiology.