Stigma and US Nurses' Intentions to Provide the Standard of Maternal Care to Incarcerated Women, 2017.

Objectives. To examine relationships among actionable drivers and facilitators of stigma and nurses' intentions to provide the standard of maternal care recommended by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) for incarcerated women.Methods. We conducted a Web-based survey of perinatal nurses in the United States (n = 665; participation rate 98.0%; completion rate 95.3%) in July through September 2017. We used multivariable logistic regression to predict higher than median intentions to provide the standard of care.Results. Lower stigmatizing individual attitudes and institutional norms and higher perceived autonomy when caring for an incarcerated woman were significantly associated with higher care intentions. Knowledge of the AWHONN position statement on the standard of care or their own state's shackling laws was not associated with higher care intentions.Conclusions. We documented significant associations among actionable drivers and facilitators of stigma and the intentions of a key health care provider group to deliver the standard of maternal care to incarcerated women. Individual- and institutional-level stigma-reduction interventions may increase the quality of maternal care and improve perinatal outcomes for women who give birth while incarcerated.

Salivary Biomarkers of Parenting Stress in Mothers Under Community Criminal Justice Supervision.

BACKGROUND: Community criminal justice supervised mothers are an underserved population who experience high rates of psychological distress and unique parenting challenges, but little is known about physiological stress system function in this population. OBJECTIVE: We tested the salivary biomarkers of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis function as predictors of subjective maternal stress. METHOD: We recruited 23 mothers (age: M = 35.6 years, SD = 9.3 years; 35% Hispanic, 22% Black, 22% White, 22% multiracial) who were court mandated to a residential treatment center. We measured salivary alpha-amylase (AA) and cortisol, which index SNS and HPA activity, respectively, before and after a naturalistic reminder of a stressful parenting experience. We assessed self-reported parenting stress using the Parenting Stress Index-Short Form (PSI-SF) subscales Parental Distress, Parent-Child Dysfunctional Interactions, and Difficult Child. We used regression to test AA and cortisol mean levels and reactivity as predictors of subscale scores. RESULTS: Mean, but not reactive, salivary stress biomarker levels were associated with parenting stress domains. Mean cortisol levels predicted scores on the Parent-Child Dysfunctional Interaction subscale (adj. R = .48), whereas mean AA predicted Difficult Child subscale scores (adj. R = .28). DISCUSSION: Our results demonstrate the potential predictive utility of AA and cortisol as salivary biomarkers of maternal stress in community-supervised mothers. Given that maternal stress is associated with criminal recidivism and child behavioral health in this population, these biomarkers could potentially inform interventions to improve dyadic health and social outcomes.

Individual and contextual risk factors for chikungunya virus infection: the SEROCHIK cross-sectional population-based study.

The purpose of the study was to weigh the community burden of chikungunya determinants on Reunion island. Risk factors were investigated within a subset of 2101 adult persons from a population-based cross-sectional serosurvey, using Poisson regression models for dichotomous outcomes. Design-based risk ratios and population attributable fractions (PAF) were generated distinguishing individual and contextual (i.e. that affect individuals collectively) determinants. The disease burden attributable to contextual determinants was twice that of individual determinants (overall PAF value 89.5% vs. 44.1%). In a model regrouping both categories of determinants, the independent risk factors were by decreasing PAF values: an interaction term between the reporting of a chikungunya history in the neighbourhood and individual house (PAF 45.9%), a maximal temperature of the month preceding the infection higher than 28.5 °C (PAF 25.7%), a socio-economically disadvantaged neighbourhood (PAF 19.0%), altitude of dwelling (PAF 13.1%), cumulated rainfalls of the month preceding the infection higher than 65 mm (PAF 12.6%), occupational inactivity (PAF 11.6%), poor knowledge on chikungunya transmission (PAF 7.3%) and obesity/overweight (PAF 5.2%). Taken together, these covariates and their underlying causative factors uncovered 80.8% of chikungunya at population level. Our findings lend support to a major role of contextual risk factors in chikungunya virus outbreaks.

[Malaria prevention: the general practitioners experience on the Reunion Island]. / Prévention du paludisme : regard sur les pratiques des médecins généralistes réunionnais.

Malaria has been officially eradicated from the Reunion Island since 1979. However, a potentially active vector of the disease - Anopheles arabiensis - persists on the island. The risk of resurgence is quite significant. More than 90%of the patients presenting a malarial infection in Reunion Island after a stay in Madagascar or in the Comoros had followed a chemoprophylaxis that was not in accordance with the guidelines. A survey, that included 100 general practitioners, wasconducted in the Reunion Island regarding their practices concerning the malaria prevention. The upshot of all this is that these doctors themselves do not follow the optimal malaria prevention practices during journeys, and neglect their protection against mosquito bites. Travelers' consultations with the doctors before a journey represent only a modest part of their activity. However, the general practitioner is considered to be the interlocutor of choice for these patients. During these consultations, they do not refer enough to the national references which, according to a number of practitioners, are difficult to obtain. On the contrary, they refer too much to the information delivered by the pharmaceutical industry. With regard to the prescriptions of prophylactic treatments, only 40% of the doctors respect the official recommendations. This gap in the recommendations is sometimes deliberate and justified by the very high cost of a number of treatments. However, a lack of up-to-date knowledge cannot be excluded. Finally, the promotion of the protection against mosquito bites remains very poor. According to these data, it seems important to promote networking between the doctors and the reference centers, which would enhance optimal practices concerning chemoprophylaxis and protection against mosquito bites, especially targeting the "at risk" patients.

Arrest history and psychopathology among veterans at risk for suicide.

While preliminary evidence suggests an association between legal involvement and suicide risk among veterans, no research to date has explored the prevalence and/or correlates of legal involvement among veterans at high risk for suicide. The current study examined the relation of suicide attempt, suicidal ideation, and psychopathology to history of criminal arrest in a sample of 286 veterans at risk for suicide. Results indicated approximately half (47%) of at-risk veterans had a history of arrest. Inconsistent with hypotheses, arrest history was not associated with history of suicide attempt, current suicidal ideation, or severity of psychopathological symptoms. Arrest history was, however, associated with diagnoses of substance use disorder and antisocial personality disorder in this high-suicide risk sample. Further, likelihood of an antisocial personality disorder diagnosis was associated with higher frequency of past arrests. Taken together, results indicate that many veterans at risk for suicide have a history of arrest, and at-risk veterans with such history likely have a specific pattern of psychopathology, including antisocial personality traits and substance use. As such, legal status and history of justice involvement may be important considerations when assessing suicide risk and management of this high-risk population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"It's Not in Your Head": Gaslighting, 'Splaining, Victim Blaming, and Other Harmful Reactions to Microaggressions.

Secondary microaggressions refer to the ways in which people of historically dominant groups negate the realities of people of marginalized groups. Gaslighting describes the act of manipulating others to doubt themselves or question their own sanity; people confronted for committing microaggressions deny the existence of their biases, often convincing the targets of microaggressions to question their own perceptions. 'Splaining (derived from mansplaining/Whitesplaining) is an act in which a person of a dominant group speaks for or provides rationale to people of marginalized groups about topics related to oppression or inequity. Victim blaming refers to assigning fault to people who experience violence or wrongdoing and is used as a tool to discredit people of marginalized groups who speak out against microaggressions or any injustices. Finally, abandonment and neglect refer to a bystander's failure to address or acknowledge microaggressions. Although these terms are commonly known among marginalized communities (and frequently used in popular media), there is a dearth in academic literature that substantiates these phenomena and relates them to microaggressions. The purpose of this article is to review these concepts in the psychological literature and to demonstrate the psychological harm caused by these behaviors on interpersonal and systemic levels.

[Endoscopic surgery and covid 19 disease: case report]. / Chirurgie par voie endoscopique et infection de la maladie a covid 19 a propos d'un cas clinique.

The objective of this work is to raise the issue of contamination of covid 19 disease during endoscopic endonasal surgery for pituitary tumor. This is a 32-year-old patient with a body mass index at 49,38 seen in an outpatient clinic for headache, erectile dysfunction and gynecomania, a CT scan revealed a pituitary macroadenoma. The preoperative workup was unremarkable including the rapid polymerase chain reaction (PCR) test was negative. The endonasal approach was decided for surgery. The tumor was removed by aspiration. The postoperative course was straightforward until the fifth day when the patient presented a dry cough with a fever at 38 ° 5 associated to respiratory discomfort. The thoracic CT-scan showed "ground glass" opacities located at peripheral and bilateral, and essentially posterior suggesting covid 19 disease. A second test was performed. Before the result, the anticoagulant treatment associated with third generation cephalosporin was done. The test results came back after 72 hours and was positive. Azithromycin, hydroxychloroquine, and oral vitamin C have been used for 11 days. The outcome was favorable and the patient was discharged from the hospital on the twelfth day after the negative PCR test.

L'objectif de ce travail est de poser la problématique d'une contamination de la maladie à covid 19 lors L'objectif de ce travail est de poser la problématique d'une contamination de la maladie à covid 19 lors d'une chirurgie endoscopique endonasale pour tumeur hypophysaire. Il s'agissait d'un patient de 32 ans avec un indice de masse corporelle à 49,38 vu en consultation pour céphalées, dysfonctionnement érectile et gynécomanie, la tomodensitométrie avait mis en évidence un macroadénome hypophysaire. Le bilan préopératoire était sans particularité incluant le test rapide « réaction en chaine par Polymérase ¼ (PCR) qui était négatif. La voie endonasale a été décidée pour la chirurgie. La tumeur a été évidée par aspiration. Les suites opératoires ont été simples jusqu'au cinquième jour ou le patient a présenté une toux sèche avec une fièvre à 38°5 associée à une gêne respiratoire. Le scanner thoracique a visualisé des opacités « en verre dépoli ¼ de topographie périphérique et bilatérales et essentiellement postérieure évoquant la maladie à covid 19. Un deuxième test a été effectué.En attendant le résultat le traitement anticoagulant associé à la céphalosporine de troisième génération a été instauré. Les résultats du test sont revenus positifs après 72 heures. L'azithromycine, l'hydroxychloroquine, et la vitamine C par voie orale ont été associées pendent 11 jours. L'évolution a été favorable et le patient est sorti de l'hôpital au douzième jour après la négativité du test PCR de contrôle.

[Migration, health and access to care in Mayotte Island in 2007: lessons learned from a representative survey]. / Migration, santé et recours aux soins à Mayotte en 2007: enseignements d'une enquête représentative en population générale.

BACKGROUND: Mayotte Island, located in the Indian Ocean, is a French overseas departmental community with certain specificities: recent development of sanitary institutions, significant immigration, free access to care for legal residents but with co-payments for irregular residents, the absence of many of the social benefits which exist in mainland France and poor or non-existent health information systems. We report here the first population-based survey describing the links between health, migration and healthcare utilization in this territory. METHODS: Cross sectional population-based study using a three-stage random sample (geographic areas, households, individuals). In all, 2105 individuals were interviewed either in French, Shimaore or Kibushi (response rate=96%), using a questionnaire adapted to the context of Mayotte Island after a preliminary qualitative survey. Descriptive analyses and logistic regression models were performed. RESULTS: Foreigners make up 40% of the Mayotte population (total 186,452 inhabitants), of which one-quarter are children born in Mayotte and 80% have no regular residence status. The median length of residence of migrant foreigners is 10 years. Foreigners represent a majority of the female population, of the 20 to 35 years old population and of the urban areas. Main determinants for migration were economical (50%) or family-related (26%). Health was stated as a cause of migration by 11% of migrants. The social situation of foreigners is more precarious and their perceived health poorer than those of the French. Their access to care is also perceived as more difficult. We did not observe any notable difference in terms of frequency of healthcare attendance over the last 12 months between the two groups, but foreigners have consulted less often private GPs and more often traditional practitioners than French. CONCLUSION: In this overseas French island, the migrant population is numerous and resident for a long time. Their main motivations to immigrate are economic and family-related. They report hurdles to healthcare related with their precarious living conditions, including their illegal residence status.

Perinatal Nurses' Experiences With and Knowledge of the Care of Incarcerated Women During Pregnancy and the Postpartum Period.

OBJECTIVE: To describe perinatal nurses' experiences of caring for incarcerated women during pregnancy and the postpartum period; to assess their knowledge of the 2011 position statement Shackling Incarcerated Pregnant Women published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); and to assess their knowledge of their states' laws regulating nonmedical restraint use, or shackling, of incarcerated women. DESIGN: Cross-sectional survey. SETTING: Online across the United States. PARTICIPANTS: AWHONN members who self-identified as antepartum, intrapartum, postpartum, or mother-baby nurses (N = 923, 8.2% response rate). METHODS: A link to an investigator-developed survey was e-mailed to eligible AWHONN members (N = 11,274) between July and September 2017. RESULTS: A total of 74% (n = 690) of participants reported that they cared for incarcerated women during pregnancy or the postpartum period in hospital perinatal units. Of these, most (82.9%, n = 566) reported that their incarcerated patients were shackled sometimes to all of the time; only 9.7% reported ever feeling unsafe with incarcerated women who were pregnant. "Rule or protocol" was the most commonly endorsed reason for shackling. Only 17.0% (n = 157) of all participants knew about the AWHONN position statement, and 3% (n = 28) correctly identified the conditions under which shackling may ethically take place (risk of flight, harm to self, or harm to others). Only 7.4% (n = 68) of participants correctly identified whether their states had shackling laws. CONCLUSION: Our results suggest critical gaps in nurses' knowledge of professional standards and protective laws regarding the care of incarcerated women during pregnancy. Our findings underscore an urgent need for primary and continuing nursing education in this area.

[Outbreak of measles in Mayotte, Indian Ocean, 2005-2006]. / Epidémie de rougeole à Mayotte, océan Indien, 2005-2006.

OBJECTIVE: An outbreak of measles occurred from 2005 to 2006 in Mayotte, a French territory in the Indian Ocean. The aim of this study was to describe the outbreak, to analyze epidemiologic and sociodemographic characteristic of cases, and to suggest recommendations for measles surveillance and preventive measures in Mayotte. DESIGN: An outbreak investigation was conducted and an enhanced passive surveillance system of incident cases was implemented. RESULTS: During the outbreak, 1269 clinical cases, including 156 (12.3%) biologically confirmed cases, were reported. The attack rate was 0.71% and no death due to measles was recorded. The median age of cases was 12 years and the M/F sex-ratio 1.1. Teenagers and young adults (10-19 years) were the most frequently affected (44.4%) and infants less than one year of age accounted for 21.6% of the cases. In the 1269 clinical cases, 27.3% of patients had received at least one dose of measles vaccine before the outbreak. The immunization coverage in school children reached 59.1% at the end of the vaccination campaign. CONCLUSION: In the future, this vaccinal coverage should be improved to prevent other outbreaks, especially in vulnerable groups like immigrants. A surveillance system with systematical report of the biologically confirmed cases is needed in Mayotte.

[Metastatic epiduritis in neurosurgery: Hospital data from the Abidjan teaching hospital, 2007-2012]. / Les épidurites métastatiques en neurochirurgie : données hospitalières au CHU d'Abidjan de 2007 à 2012.

INTRODUCTION: Metastatic epiduritis is the most frequent extrinsic epidural cause of spinal cord compression. Although neurosurgery is essential to its management, the exact role of this discipline in the treatment of spinal cancer in sub-Saharan Africa has not yet been assessed. AIM: To analyze recent hospital data of patients with metastatic epiduritis managed in the Abidjan neurosurgery department. METHODOLOGY: We conducted a retrospective analysis of files of 56 patients admitted from January 2007 through December 2012. Our data are discussed in the light of the literature. RESULTS: The primary cancers in men were mostly lung (16%) and prostate (34%) cancers, and in women, breast cancer (23%). The two age brackets mainly involved were those aged 31-45 years (21%) and 46-60 years (39%). The reason for admission in all cases was functional disability of the lower limbs. Magnetic resonance imaging (MRI) was performed for 57%. The thoracic topography was dominant (60%), and vertebral damage was often associated with epiduritis (78%). This metastatic epiduritis was the initial sign leading to cancer diagnosis for 39%. Decompressive laminectomy with biopsy or lesionectomy was performed for 62%. Postoperative neurologic improvement was noted for 36%, and remained satisfactory at one year for 14 patients. Prostate-specific hormone therapy was performed for 30%. CONCLUSION: This study underlines the crucial importance of neurosurgery in management of metastatic epiduritis in our center. Our findings emphasize the need to improve access to neuroradiologic diagnostic resources and optimize surgical treatment in the sub-Saharan region.

[The register of activity at the Ebola treatment center in Forecariah (Guinea) from april 23 to june 5, 2015: analysis and thoughts]. / Bilan d'activité du centre de traitement Ebola de Forécariah (Guinée) du 23 avril au 5 juin 2015 : analyse et réflexions.

The register of activity at the Ebola Treatment Center (ETC) in Forecariah (Guinea), from April 23 to June 5, 2015 is presented for analysis. The viral load of each patient is evaluated by the cycle threshold (Ct). One hundred and thirty patients were seen in Triage at the ETC, of which 24 (18.5%) patients who failed to meet theWHO case criteria for viral hemorrhagic fever were excluded from admission to the ETC. Of the 106 patients admitted in the ETC, 72 (67.9%) were declared non-cases after the results of their two PCR (drawn 48 hours apart) tests were negative. Thirty-four patients were tested positive for Ebola virus disease (EVD): 19 women and 15 men (sex ratio: male/female = 0.78), mean age of 33.51 ± 20.1 years (extremes of 42 days to 70 years), of which six children were aged below 8 years. The median initial Ct value was 21.6 ± 6.3 cycles in this group. Enquiry into patient contacts was only able to identify actual contacts in 20 of these patients (58.8%). Thirteen patients were ultimately cured of EVD (six men and seven women) - with a median age of 31.8 years (extremes of 4 to 54 years). These patients presented on admission with a median Ct value of 21.88 ± 6.2 cycles (extremes of 17.6 to 31.7). Of the six children aged below 8 years, only one survived. Twenty-one patients (61.76%) with EVD died (9 men and 12 women) - median age, 34 ± 21 years (extremes of 42 days to 70 years). They presented on admission with a median Ct value of 18 ± 7 cycles (extremes of 12 to 24). The single most important factor associated with lethality was the Ct value at the time of admission to the ETC (P = 0.0004), i.e., the lower the Ct value, the higher the lethality rate or simply stated, the higher the viral load, the greater the lethality. Age, sex, identification of contact, and delay between the onset of symptoms and admission did not prove to be predictive of death outcome in our series.

[Malaria in Mayotte: epidemiology, diagnostic, prevention and treatment]. / Bilan du paludisme à Mayotte. Epidémiologie, diagnostic, prevention et traitement.

Mayotte is a little French island, located in the Indian ocean, between Madagascar and Mozambic. Officially there is a population of 150000 inhabitants, but in fact, there are probably about 200000 people, largely due to numerous illegal immigrants, especially coming from Anjouan the nearest Comorian island. There is only one hospital, with 252 beds. The malaria incidence reaches about 3000 cases per year; and treatments until august 2001 were generally haphazard. This is changing with the use of the Optimal rapid diagnostic test (DiaMed, Cressier Switzerland). More precise statistics should be available in the coming years. In 2000, 252 patients were hospitalised with malaria fever. Preventive measures were scarce. These have been reenforced this year, with the arrival of an entomologist, the use of reenforced pesticide pulverisation in high-risk areas, the distribution of impregnated bednets to pregnant women, and media based information campaigns. Common drugs resistance is becoming a real concern in Mayotte. First-line treatment was: chloroquine; second-line: sulfadoxine-pyrimethamine, and third-line: quinine. In vitro studies have shown high levels of resistance, therefore another antimalarial drug therapy will be introduced at the end of the year: first-line: artemether-lumefantrine, second-line: mefloquine or halofantrine, third-line: quinine. To conclude, solutions exist but a real policy from the decision makers is necessary to implement them. The eradication of malaria remains a dream, but we can expect "zero death" in Mayotte, considering that the fight against this disease may help to start a regional health program.

[Cutaneous, hepatic and hematologic manifestations due to nevirapine: DRESS syndrome?]. / Manifestations cutanées, hépatiques et hématologiques liées à la névirapine: DRESS syndrome?

BACKGROUND: Manifestations similar to DRESS syndrome (drug rash with eosinophilia and systemic symptoms) may be induced by nevirapine. CASE REPORTS: Three patients developed skin rash and general signs of liver dysfunction during the first 5 weeks after starting nevirapine. Laboratory tests showed elevated eosinophil counts and signs of inflammation simulating severe infection. DISCUSSION: The incidence of DRESS syndrome is probably underestimated. No standard treatment has been proposed. In our 3 patients, parenteral corticosteroid therapy was successful, leading to a rapidly favorable clinical course although liver tests took longer to return to normal.

[Availability of antiretroviral agents in the city: a 1-year assessment in the Lille metropolitan area]. / Double dispensation des antirétroviraux en ville: bilan à un an dans l'agglomération lilloise.

OBJECTIVES: Dispensing antiretroviral drugs in private pharmacies has been allowed in France since October 1997. One year after this measure was implemented, we conducted a survey of patients and pharmacists in the Lille metropolitan area to assess its impact. METHOD: Structured interviews with a representative sample of private pharmacists and HIV infected patients in the Lille metropolitan area were carried out. RESULTS: 100 pharmacists were interviewed. Most worked in urban areas and their main clientele were from the neighbourhood. Most felt that HIV infection was a common disease and were interested in dispensing antiretroviral drugs as a public health service despite the marginal income from these sales. Two-thirds had received training on HIV infection and most knew the importance of adhering to the treatment. However, the number of antiretroviral drugs and the classes of these drugs that were available were not well known. Among the 97 patients followed by the Service of Infectious Diseases of the Tourcoing Hospital, 22% received their medications from the local private pharmacy, 62% got them from the hospital pharmacy and 16% got them from both places. However, 39% received at least one drug that was only available from the hospital pharmacy. The patients going to private pharmacies described an improved quality of life and mostly chose their regular pharmacist to get their medications. Most preferred to get their medications openly, as opposed to secretly. Many patients going to the hospital pharmacy made their choice based on better confidentiality. Private pharmacists also expressed the fear of lack of confidentiality. Private pharmacies were seen as friendlier with quicker service, but slightly less competent than the hospital pharmacy. Finally, the topic of adhering to this form of HIV treatment is rarely discussed in private pharmacies. CONCLUSIONS: Both the patients and private pharmacists appreciate the fact that these drugs can be dispensed in private pharmacies, but the impact of this measure is limited by the number of drugs that are only available at the hospital pharmacy. Private pharmacists do not often discuss the importance of adhering to the therapy and progress is needed in this area.

[Investigation of urinary schistosomiasis outbreak in the primary school of the village Guébo 2, Abidjan, Côte d'Ivoire]. / Investigation d'un foyer épidémique de bilharziose urinaire dans l'école primaire du village de Guébo 2, Abidjan, Côte d'Ivoire.

We report the results of an outbreak investigation of urinary schistosomiasis in 2012 among school children at Guébo 2. Among the 250 school children, 107 (42.8%) had confirmed urinary schistosomiasis. Age ≥ 10y (OR = 2.6 [1.1 to 6.2]) and self-reported bathing in the river (OR = 14.0 [4.7 to 42.5]) were associated with the presence of S.h. in the adjusted analyses. A massive deworming of the population of Guébo-1&2 was conducted as epidemic-response.

[Feedback from primary care practitioners two years after the chikungunya epidemic on Reunion Island, 2005-2006]. / Retour d'expérience des médecins généralistes deux ans après l'épidémie de chikungunya de 2005-2006 à La Réunion.

Primary care practitioners constitute key stakeholders in the surveillance and control of epidemic-prone infectious diseases. We carried out a survey in Reunion Island two years after the 2006 chikungunya epidemic using a purposive random sample of 100 general practitioners (GP). The objective was to describe and identity factors associated to GP involvement in case notification during the 2006 chikungunya epidemic. The methods were: administered face-to-face questionnaire and identification of notification determinants by univariate and multivariate analyses. Nearly 60% of participants declared having failed to join the case notification procedure. The main impeding factor was the acknowledgment of limited capacities consecutive to massive influx of patients. Inversely, practicing in group organization tended to show a favorable effect on case notification. In addition, most responders reported the relevance of the information provided by health authorities, despite a perceived limited efficacy of the procedure in the field. Primary care practitioners' involvement in the surveillance of epidemic infectious diseases requires to be reinforced by a preestablished partnership within a proactive network. This goal comprehends relevant training and preparation for epidemic surveillance.

Prevalence of type 2 diabetes and other cardiovascular risk factors in Mayotte in 2008: the MAYDIA study.

AIM: Mayotte, a French overseas territory located in the Indian Ocean, has never had a previous estimate of diabetes prevalence, but has recently undergone socioeconomic changes leading to lifestyle modifications. For this reason, a survey was carried out in 2008 to estimate the prevalence of diabetes and cardiovascular risk factors in the island's population. METHODS: A three-step, randomized sample of 1268 individuals, aged 30-69 years, was home-screened, using capillary blood glucose and capillary HbA(1c), weight, height, waist circumference and two blood-pressure measurements. Those with a history of diabetes, glucose ≥1 g/L (fasting) or ≥1.40 g/L (non-fasting), or HbA(1c)≥6%, and a subgroup of those with normal results were examined at a healthcare centre to measure venous HbA(1c) and glucose, and to diagnose diabetes, using an oral glucose tolerance test. RESULTS: The weighted prevalence of diabetes (venous plasma glucose ≥1.26 g/L at fasting and/or ≥2 g/L at 2 h, or treatment with oral hypoglycaemic agents or insulin) was 10.5% (95% CI: 8.2-13.4%). This increased with age from 3% at age 30-39 years to 26% at age 60-69 years, with no gender differences. Also, more than 50% of those with diabetes were unaware of it, while half of those treated for diabetes still had HbA(1c) levels >7%. The prevalence of overweight (BMI: 25-29 kg/m(2)) was estimated to be 35% in men and 32% in women, while obesity (≥30 kg/m(2)) was estimated to be 17% in men and 47% in women. CONCLUSION: The high prevalence of obesity combined with a high prevalence of diabetes indicates a potential for further increases in the prevalence of diabetes and cardiovascular disease in Mayotte. Preventative action against obesity, diabetes and hypertension is required now, as well as plans for appropriate healthcare delivery in the island.

[Malaria in France: Mainland and territories]. / Le paludisme en France : métropole et outre-mer.

Malaria, which was eliminated first from Metropolitan France (mainland and Corsica), then in the French West Indies and the Reunion Island during the 20(th) century, remains endemic in two French territories: French Guiana and the Indian Ocean Mayotte island. Despite differences in the dominating plasmodial species and epidemiological patterns, these two territories have achieved marked quantitative improvements (in the reported number of cases and severe cases) thanks to efforts undertaken over the past decade. The situation, however, remains a concern from a qualitative standpoint with the emergence of resistance to antimalarial drugs and logistical and administrative issues which hinder access to treatment. Although malaria was eradicated in Metropolitan France half a century ago, competent vectors remain present in part or all of these territories and can give rise to limited outbreaks.