[Management of the COVID-19 epidemic in the carrier battle group (January-April 2020) by the Armed Forces Epidemiology and Public Health Center]. / Gestion de l'épidémie de COVID-19 au sein du groupe aéronaval (janvier­avril 2020) par le Centre d'épidémiologie et de santé publique des armées.

Objectives: Faced with the COVID-19 epidemic that occurred within the naval air group and the nuclear aircraft carrier Charles de Gaulle, the French Armed Forces Epidemiology and Public Health Center (CESPA) carried out an investigation (January - April 2020) whose objectives were: to identify the possible routes of introduction of the virus ; to describe the characteristics of the epidemic and to describe and model the dynamics of the epidemic's spread. Methods: A telephone survey was conducted. The biological diagnoses were transmitted by the medical antennas. A time/place/population analysis was carried out, as well as the description of the clinical pictures with their exposure factors. The instantaneous reproduction rate Rt of the epidemic was modeled. A spatial analysis of the epidemic on board was carried out. Forty-three viral genomes were sequenced and compared to the reference bases. Results: 0f 1767 sailors, 1568 (89%) participated in the telephone survey and 1064 (67.9%) were confirmed cases. Four patient profiles have been described: asymptomatic (13.0%); non-specific symptomatic (8.1%); specific symptomatic (76.3%); severe cases (2.6%). In univariate and multivariate analysis, age, overweight and obesity were significantly associated with the risk of having a severe form. Smoking was a protective factor. The evolution kinetics of Rt was in favor of an introduction of the virus at the end of February with a reintroduction during the stopover in Brest. Analysis of viral genomes ruled out introduction and spread of a single strain. Conclusion: Despite the control measures taken, an epidemic occurred. The often pauci-symptomatic clinical pictures resulted in a delay in identification. CESPA was able to carry out this epidemiological investigation within a highly constrained timeframe, showing all the interest of its integrated public health model.

The burden of hepatitis C virus in Cameroon: Spatial epidemiology and historical perspective.

Cameroon is thought to have one of the highest prevalences of hepatitis C virus (HCV) infection in the world (4.9% among adults). A marked cohort effect exists in several communities where ≈50% of the elderly are infected. Better assessment of HCV distribution is needed for planning treatment programmes. We tested for HCV antibodies 14 150 capillary blood samples collected during the 2011 Demographic and Health Survey, whose participants were representative of the Cameroonian population aged 15-49 (both genders) and 50-59 years (men only). Historical data on exposure to medical care were collected and factors associated with HCV assessed through logistic regression and geospatial analyses. To estimate prevalence in all persons aged ≥15 years, we used data from the survey for the 15-59 years fraction and modelled a cohort effect for older individuals. The nationwide HCV prevalence was 0.81% for the 15-49 years group, and 2.51% for all individuals aged ≥15 years. Only 0.2% of individuals aged 15-19 were seropositive. Among participants aged 15-44 years, HCV was associated with age, rural residence and, for males, with ritual circumcision. For those aged 45-59 years, HCV was associated with age and access to medical care in the late 1950s. Prevalence of HCV seropositivity in Cameroon is half of previous estimates. Nationwide surveys are essential to rationalize resources allocation. The high prevalence among older cohorts, a colonial legacy, has had little spillover into younger cohorts. HCV-free generations might be attainable in countries not plagued with intravenous drug abuse.

From outbreak detection to anticipation.

BACKGROUND: Bioterrorist threats and the emergence of new infectious pathogens force structures and means dedicated to outbreaks detection to evolve. Obtaining early information is becoming a major stake. Development of early warning system and new epidemiological tools open new perspectives in real time management of outbreaks. METHODS: Through several examples, this overview presents a synthesis and reports the recent multidisciplinary evolutions, which occurred in the field of outbreak detection and information useful for outbreaks anticipation. CONCLUSION: Outbreak detection is a multidisciplinary activity which relies on many protean epidemiologic sensors. Detection should not be perceived as a finality, but as a crucial step of a broader process in outbreak management (detection, alarm, alert, acceptability, implementation of countermeasures or not). That is why the evaluation of a monitoring system should not be limited to only its ability to detect an aberration. Today, progress in biology, modeling, remote sensing and environmental detection allow model development with anticipation aiming.

[Sexual exposure to HIV in the French armed forces between 2005 and 2007]. / Expositions sexuelles au VIH dans les armées françaises de 2005 a 2007.

BACKGROUND: Non-occupational HIV exposure in the French forces has been placed under epidemiological surveillance since 2000. This surveillance programme provides an indirect indicator of risky sexual behaviour among military personnel. PATIENTS AND METHODS: All cases of non-occupational exposures in French military personnel that meet the notification criteria, wherever they occur, are reported by a military physician, with data being collected from 2005 to 2007. RESULTS: Between January 2005 and December 2007, 2241 cases of sexual exposure within the French forces were filed. The annual incidence was 214.3 per 100,000 with an average patient age of 26 years. Sexual exposures concerned men in 99.2% of cases and occurred overseas in 92.9% of cases. Partners were sex-workers in 66.7% of cases. Failure to use condoms adequately during sexual intercourse was reported in 15.5% of cases. In cases where condoms were used, exposure to HIV resulted either from condom rupture or slippage. Postexposure HIV prophylaxis was prescribed in 70.5% of cases. DISCUSSION: The majority of cases of sexual exposure reported in the French armed forces involved high risk of HIV transmission. However, since the beginning of surveillance in 2000, no cases of HIV seroconversion have been reported following postexposure antiretroviral prophylaxis. The non-occupational postexposure prophylaxis strategy is not in question.

[Real time epidemiological surveillance within the armed forces: concepts, realities and prospects in France]. / Surveillance épidémiologique en temps réel dans les armées; concepts, réalités et perspectives en France.

BACKGROUND: In 2002, the North Atlantic Treaty Organization took five initiatives in order to enhance the defence capacities against the massive destruction weapons, one of them concerned the development of an interoperable surveillance system, giving in real time some informations permitting early warning to the commanders. Thoughts in France to improve the military surveillance system, methodological constraints and first results are shown. METHODS: Medical, technological, human and organisational aspects had to be taken into account to develop real time surveillance within the armed forces, and also specific military constraints. In order to evaluate the validity of its methodology, the "Institut de médecine tropicale du service de santé des armées" developed a prototype, set up in French Guyana and which took part in a second time at a multinational exercise. RESULTS: The "surveillance spatiale des épidémies au sein des forces armées de Guyane" has been set up in 2004, formed by both a recording and an analysis networks. This system permits to provide in real time some dashboards directly operational for the commanders. The exhaustiveness rate has been evaluated at 104%, compared to the traditional surveillance. It permitted three times to detect outbreaks several weeks before the other systems. Some limits have been identified, as the use of personal digitalized assistants. The involvement in a multinational exercise showed the system's efficacy, by detecting two simulated outbreaks, but also its interoperability. In 2006, it has been decided to extend the concept by deploying its second generation within the French armed forces in Djibouti. The "alerte et surveillance en temps réel" disposal permitted to take into account multiple geographical localizations. CONCLUSION: A real time surveillance system is an essential alarm disposal, however it is only an information tool within the complex activity of piloting the sanitary situation. It must be integrated within the whole situation expertise supports, represented also by medical intelligence, epidemiological investigations and prediction of the epidemiological phenomenon evolution.

Endocarditis in the Mediterranean Basin.

Infective endocarditis is a severe disease with high mortality. Despite a global trend towards an increase in staphylococcal aetiologies, in older patients and a decrease in viridans streptococci, we have observed in recent studies great epidemiologic disparities between countries. In order to evaluate these differences among Mediterranean countries, we performed a PubMed search of infective endocarditis case series for each country. Data were available for 13 of the 18 Mediterranean countries. Despite great differences in diagnostic strategies, we could classify countries into three groups. In northern countries, patients are older (>50 years old), have a high rate of prosthetic valves or cardiac electronic implantable devices and the main causative agent is Staphylococcus aureus. In southern countries, patients are younger (<40 years old), rheumatic heart disease remains a major risk factor (45-93%), viridans streptococci are the main pathogens, zoonotic and arthropod-borne agents are frequent and blood culture-negative endocarditis remains highly prevalent. Eastern Mediterranean countries exhibit an intermediate situation: patients are 45 to 60 years old, the incidence of rheumatic heart disease ranges from 8% to 66%, viridans streptococci play a predominant role and zoonotic and arthropod-borne diseases, in particular brucellosis, are identified in up to 12% of cases.

[Simple procedure for extra-amniotic internal tocography]. / Un procédé simple de tocographie interne extra-amniotique

The authors have developed a method of internal tocography which can be used when the membranes are intact and which is as simple in its conception as procedures that are usually for intra-amniotic tocography.

[Contractile force, work of the uterus, power developed and resistance of the cervix uteri during labor. Measurements in Poissy units]. / Force contractile, travail de l'utérus, puissance développée et résistance á l'ouverture du col au cours du travail mesures en unites Poissy

Apart from records made of uterine contractions in labour and the progress in dilatation of the cervix, the energy exerted by the uterus to open the cervix can be calculated. The power that is developed and the resistance of the factors that combine to inhibit dilatation of the cervix can also be calculated. Examples are given of promiparous women with a dilatation of 5 cm.

[Uncommon form of vesico-uterine fistula]. / Une variété de fistule vésico-utérine de sens inhabituel

A vesico-uterine fistula has been seen after a caesarean section. Unusually, the discharge ran from the bladder to the uterus. The problems of the aetiology, the diagnosis and the treatment are discussed.

[Palliative care for patients with heart failure]. / Soins palliatifs chez les patients en insuffisance cardiaque terminale.

PURPOSE: Heart failure is a common disease and its progression to end-stage heart failure is responsible of high mortality. The aim of this retrospective study was to assess the access to integrated palliative care to the usual management, 6 months prior to their death, and especially during the last hospitalization. PATIENTS AND METHODS: A retrospective study was performed in patients who died of heart failure in 2009 in two hospitals. The analysis was performed on 20 cases of each institution. The records of consecutive patients were included in an anti-chronological order from 31st December 2009. RESULTS: For their last hospitalization, 37 patients (93%) were hospitalized in emergency. Within 3 days prior to death, the most frequent symptoms were dyspnea (n=33, 82%), and pain (n=30, 75%). Therapeutic most frequently used were oxygen (n=31, 77%) and analgesics (n=30, 75%). No patient was seen by a psychologist. The decision to limit treatment for comfort care was reported for 24 patients (60%) and the median of the average time between the decision and death was 2 days (Q1-Q3, 1-5 days). CONCLUSION: Patients with terminal heart failure have many symptoms often requiring multidisciplinary care. This type of study relating practices shows that there is still a lot to do to integrate palliative care in the usual management of patients with heart failure.

[Familial choices and procreative behavior of the clientele of familial planning centers]. / Options familiales et comportement procréateur de la clientele des centres de planning familial.

PIP: This is the final article in a series on a survey of 710 couples who consulted for family planning in Lyons and Paris in 1968, Agreement before marriage on planned family size was correlated with success in achieving this plan, especially in the young, well educated, and in rightists. The number of children was directly related to desired family size, but a large proportion of those without a plan had uuplanned children. Factors tending toward larger desired family size were religious practice, higher education, and income. Factors associated with larger existing families were lower education and income, religous practice, female unemployment, longer duration of marriage, and use of traditional contrceptive methods. Among those with only elementary education, the proportion with 3 or more children remained constant with rising income, but among those with postsecondary education the proportion of large families was closely correlated with income. Couples who considered their families complete or who considered their family planning successful were overrepresented by the well educated, while couples with incomplete families or characterized by imperfect planning were more often secondary school graduates. Success in family planning was only apparent in many cases, since these results were often achieved by abortion.^ieng

[A sociologic approach to abortion]. / Une approche sociologique de l'avortement.

PIP: Of 913 clients who submitted questionaires to the French Movement for Family Planning in Paris and Lyons in 1968, 203 (22.4%) had history of 1 or more abortions; the survey covered age, education, profession of both spouses, religion, politics, income and number children desired. The abortion group were about 10 years older than the nonabortion group. Results are presented in tables showing distributions by numbers of abortions and by subgroups according to answers received. The level of education was inversely proportional to number of abortions. Husbands had lower status jobs in the abortions group, but the percentage of wives working was the same in both groups. Fewer practicing catholics or protestants resorted to abortion. Those who had aborted tended to be leftist policitcally. At low income levels, as financial resources fell because of more children, abortions increased. At middle or upper income level, 2 children was the threshold for seekin g abortion. The abortion groups also desired fewer children. Thus, abortion is a contraceptive method used by families in this population. Its incidence could be decreased by providing information on contraception and by raising the standard of living.^ieng

[Facotrs in adoption of medical contraception and explicit motivation of the users of local and oral contraceptives]. / Facteurs d'adoption de la contraception médicale et motivations explicites des utilisatrices des contraceptifs locaux et oraux.

PIP: Responses to 913 questionnaires received from clients attending clinics of the French Movement for Family Planning in Paris and Lyons in 1968, of whom 288 are current users of medically presecribed contraception, are reported. The results from each topic are tabulated in percentages by duration of use. The population was highly educated, 56% high school or more moreover, the more long-term users were more highly educated. Contraceptive use was correlated with reading a daily newspaper, a professional job for husband and wife, nonaffiliation or Protestant religion, and leftist political persuasion. Duration of use was proportional to number of children, although there was definite trend toward beginning contraception before the 1st child. Long-term users had higher incomes. Slightly more users desired 2-4 year intervals between births than did nonusers. Having an unplanned child encouraged long use of contraception havinn 1 or 2 abortions was associated with contraception, but having 3 or more abortions was not. The most often cited motives for contraception, in order, were to limit or space births (57%), to improve marital harmony (40%), to stop births (30% for users and 28% for nonusers,), to avoid abortion 22.5%, but few because of economic constraints (2%). In general there was relatively little difference between the user and the nonuser groups, since the nonuser population were potential clients.^ieng

[Relationships between contraception and the individual, the society and the culture]. / Incidences de la contraception sur l'individu, la societe et la culture.

PIP: 1025 case records from private Parisian gynecologists and 1166 from hospital gynecology clinics were compared with respect to expressed motives for consulting, previous abortions, desire for contraception, consequences of curettage and effect of contraception on sexuality. 86% of hospital clients asked for contraception during their first visit, probably because they had to choose the appropriate clinic. Only 35.8% of private patients mentioned contraception, while 41.7% requested gynecologic care first, and 15.8% contraception first, probably reflecting the habit of higher classes to seek yearly check-ups. 26% of the private and 15% of the hospital patients admitted having induced abortions. These were figures probably underestimated in the hospital group. The percentage distribution by number of abortions was similar in both groups. The number of women who had had 1 or more abortions and subsequently did not use contraception was much higher (78) in the private than (4) in the hospital population. The authors interpreted this as due to conservative moral values in spite of better contraceptive knowledge in the privileged group. Increasing numbers or abortions, up to 3 prior abortions, increased the likelihood of asking for contraception, but the number of requests decreased as prior abortions increased from 4 to 8 or more. When the abortion (then illegal in France) was followed by dilatation and curettage in a hospital, 54% of private, but 26.5% of hospital patients then requested contraception. On the other hand, 51 and 10.5% of private and hospital patients requested contraception after an abortion that was not followed by curettage. 6 private patients reported their orgasmic performance improved after contraception, while 6 reported it diminished. Implications of this preliminary study for further research were listed.^ieng

Development of a beta-type Ti-12Mo-5Ta alloy for biomedical applications: cytocompatibility and metallurgical aspects.

Ti-based biocompatible alloys are especially used for replacing failed hard tissue. Some of the most actively investigated materials for medical implants are the beta-Ti alloys, as they have a low elastic modulus (to inhibit bone resorption). They are alloyed with elements such as Nb, Ta, Zr, Mo, and Fe. We have prepared a new beta-Ti alloy that combines Ti with the non-toxic elements Ta and Mo using a vacuum arc-melting furnace and then annealed at 950 degrees C for one hour. The alloy was finally quenched in water at room temperature. The Ti-12Mo-5Ta alloy was characterised by X-ray diffraction, optical microscopy, SEM and EDS and found to have a body-centred-cubic structure (beta-type). It had a lower Young's modulus (about 74 GPa) than the classical alpha/beta Ti-6Al-4V alloy (120 GPa), while its Vickers hardness remained very high (about 303 HV). This makes it a good compromise for a use as a bone substitute. The cytocompatibility of samples of Ti-12Mo-5Ta and Ti-6Al-4V titanium alloys with various surface roughnesses was assessed in vitro using organotypic cultures of bone tissue and quantitative analyses of cell migration, proliferation and adhesion. Mechanically polished surfaces were prepared to produce unorientated residual polished grooves and cells grew to a particularly high density on the smoother Ti-12Mo-5Ta surface tested.