Training infection control and hospital hygiene professionals in Europe, 2010: agreed core competencies among 33 European countries.

The harmonisation of training programmes for infection control and hospital hygiene (IC/HH) professionals in Europe is a requirement of the Council recommendation on patient safety. The European Centre for Disease Prevention and Control commissioned the 'Training Infection Control in Europe' project to develop a consensus on core competencies for IC/HH professionals in the European Union (EU). Core competencies were drafted on the basis of the Improving Patient Safety in Europe (IPSE) project's core curriculum (CC), evaluated by questionnaire and approved by National Representatives (NRs) for IC/HH training. NRs also re-assessed the status of IC/HH training in European countries in 2010 in comparison with the situation before the IPSE CC in 2006. The IPSE CC had been used to develop or update 28 of 51 IC/HH courses. Only 10 of 33 countries offered training and qualification for IC/HH doctors and nurses. The proposed core competencies are structured in four areas and 16 professional tasks at junior and senior level. They form a reference for standardisation of IC/HH professional competencies and support recognition of training initiatives.

Deep nasal inspirations increase the cough threshold in children with mild asthma.

Asthma is a chronic inflammatory disease characterized by bronchospasms accompanied with frequent coughing, the pathogenesis of which is not clear. In healthy adults deep inspirations (DIs) provide a protective effect against bronchoconstriction triggered by methacholine inhalation, which correlates with the number of accompanying cough efforts. The aim was to study the effect of deep nasal inspirations representing the voluntary equivalent of the sniff-like aspiration reflex on the capsaicin-induced cough in children with mild asthma. The cough reflex sensitivity to capsaicin was determined using a compressed air-driven nebulizer in 21 children (8 girls and 13 boys of median age 13.3 year) suffering from mild asthma (FEV(1)∼80%). The effect of five previous DIs through the nose was examined on the elicitability of two and five or more cough efforts (C2, C5). Under control conditions, the concentration of 20.86 (14.58-29.8) µmol/l of capsaicin provoked two cough efforts (C2). After five DIs similar reaction required significantly higher concentrations of capsaicin: 29.02 (18.88-44.6) µmol/l; P=0.016. Five or more cough efforts (C5) were not significantly changed after previous DIs 161.49 (77.31-337.33) µmol/l and without DIs 141.52 (68.77-291); P=0.54. A series of five deep inspirations decreases the cough reflex sensitivity to evoke two efforts (C2) in children with mild asthma. The inhibitory effect of similar DIs disappeared after repeated applications of increasing doses of capsaicin, aiming to evoke five or more cough efforts, suggesting a reflex character of protective effect of DIs.

Association of selected inflammatory biomarkers with cough reflex sensitivity in asthmatic children.

Bronchial asthma is the most common chronic respiratory disease of childhood. Cough is one of its defining symptoms. This study investigated the associations between selected inflammatory biomarkers and cough reflex sensitivity after capsaicin inhalation in children with mild and moderate well-controlled type 2 endotype asthma compared with non-asthmatic probands. Sensitivity to the cough reflex was measured by recording the cough response after capsaicin inhalation. The sandwich ELISA method was used to measure serum concentrations of the investigated potential inflammatory biomarkers (interleukin 13, interleukin 1beta, eosinophil-derived neurotoxin). The acquired data were statistically evaluated according to descriptive analyses for summarization and comparison between cough reflex sensitivity parameters and individual biomarker values in the observed and control groups modeled by a simple linear regression model. Statistical significance was defined as p<0.05. We showed a statistically significant association (p-value 0.03) between cough reflex sensitivity - C2 value (capsaicin concentration required for two cough responses) and interleukin 1beta serum concentrations in the asthma group compared with the control group of non-asthmatic children. Our results support the possibility of interleukin 1beta as a potential additive inflammatory biomarker used in clinical practice in children with asthma because of its correlation with the activity of the afferent nerve endings in the airways.

Consumption of psychoactive substances among 535 women entering a Lyon prison (France) between June 2004 and December 2008.

BACKGROUND: In France, recent data on the consumption of psychoactive substances (PASs) among women entering prison are virtually nonexistent. The objective of this study was to describe the characteristics of female entrants at Montluc prison in Lyon (France) and to estimate their PAS consumption. METHODS: Between June 1, 2004 and December 31, 2008, of 841 women entering the Lyon correctional facility, 535 had an entrance interview, conducted by a nurse, during which a questionnaire was systematically proposed; 306 detainees did not have this interview and could not be included in the study because of an immediate transfer to another prison or emergency hospitalization. Socioeconomic and incarceration characteristics, PAS consumption, as well as consumption level (occasional, regular, abusive or dependence) and psychological distress of the 535 interviewed detainees were systematically noted. This psychological distress was defined by the presence in the entrant talks or behavior suggesting clinical symptoms such as anxiety, depression, delusion, delirium, and mood or behavior disorders. Descriptive analysis was undertaken with the Chi(2) test and Fisher's exact test for differences between the proportions observed. RESULTS: The average age of the 534 responding detainees was 31.5 years; 59.2% had had no ongoing professional activity in the 12 months prior to incarceration, and 21.6% had already been imprisoned before; 37.5% of the entrants reported dependence on tobacco and 13.7% on alcohol; 6.6% reported regular, abusive use or dependence on cannabis, 20.4% on psychotropic medications, and 7.7% on other drugs (heroin, cocaine, synthetic drugs) in the 6 months preceding their incarceration; 39.2% of the consumers at risk reported using at least two substances; 7.1% of detainees were on opioid substitution treatment. A multiple correspondence factor analysis was used to note specific characteristics of three groups of PAS consumers. CONCLUSIONS: More frequent among young women detainees, overall PAS consumption was quite close to that of male entrants, was greater than in the general female population, and was very often accompanied by psychological distress. Effective screening upon entry into detention should be carried out so that female consumers can be offered psychological and/or psychiatric care adapted to a prison environment.

A randomized trial of viral hepatitis prevention among underprivileged people in the Lyon area of France.

BACKGROUND: We compared the efficacy of two viral hepatitis B and C (VHBC) screening strategies, relative to no intervention, among underprivileged people (UP) living in shelters in the Lyon area. METHODS: Eighteen of 37 shelters were randomly sampled after stratification based on the accommodation capacity and the screening centres/shelters distance. Through randomization, the S0 strategy (no intervention), the S1 strategy [group information (GI) and referral for screening] and the S2 strategy (GI and in situ screening) were each applied in six shelters. A standardized questionnaire was offered to each participant. Follow-up of positive cases was organized via the reference centre of VHBC of Lyon. RESULTS: The screening completion rate (SCR) among 1276 included subjects in S0, S1 and S2 was 1.5, 42.8 and 59.7%, respectively (P < 10(-6)). This rate was higher in S2 regardless of the sociodemographic variable considered. Odds ratios (OR) of screening completion (SC) was significantly higher in S1 versus S0, OR = 49.8 [95% confidence interval (CI): 26.1-102.1], in S2 versus S0, OR = 98.5 (95% CI: 51.9-200.8) and in S2 versus S1, OR = 2.0 (95% CI: 1.3-2.9). Age, country of birth and professional inactivity were independently associated with SC. CONCLUSIONS: Health authorities must ensure widespread screening of UP, which is more effective when conducted in shelters than in screening centres.

[Use of the French medico-administrative database (PMSI) to detect nosocomial infections in the University hospital of Lyon]. / Intérêt de l'utilisation des données du Programme médicalisé des systèmes d'information (PMSI) pour la surveillance des infections nosocomiales aux Hospices Civils de Lyon.

BACKGROUND: Surveillance is an effective element in the fight against nosocomial infections, but the monitoring methods are often cumbersome and time consuming. The detection of infection in computerized databases is a means to alleviate the workload of health care teams. The objective of this study was to evaluate the performance of using discharge summaries in medico-administrative databases (PMSI) for the identification of nosocomial infections in surgery, intensive care and obstetrics. METHODS: The retrospective assessment study included patients who were hospitalized in general surgery, intensive care and obstetrics at different periods of time in 2006 and 2007 depending on the wards. Patients were monitored according to standard protocols which are coordinated at the regional level by the Southeast coordinating centre (CCLIN). The performance of identifying cases of nosocomial infection from discharge diagnoses coded by using the International Classification of Diseases (tenth revision) was evaluated by a study of sensitivity, specificity, positive and negative predictive values with their 95% confidence intervals. RESULTS: Using a limited number of diagnostic codes, the sensitivity and specificity were, respectively, 26.3% (95% CI 13.2-42.1) and 99.5% (95% 98.8-100.0) for the identification of surgical site infections. By expanding the number of diagnostic codes, the sensitivity and specificity were 78.9% (95% CI 65.8-92.1) and 65.7% (95% CI 61.0-70.3). The sensitivity and specificity for case identification of nosocomial infections in intensive care were 48.8% (95% CI 42.6-55.0) and 78.4% (95% CI 76.1-80.1), and were 42.9% (95% CI 25.0-60.7) and 87.3% (95% CI 85.2-89.3) for identification of postpartum infections. CONCLUSION: The PMSI is not a sufficiently efficient method in terms of sensitivity to be used in surveillance of nosocomial infections. A reassessment of the PMSI must be considered, with changes in coding of comorbidity that occurred in 2009.

Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken?

BACKGROUND: The prevalence of hospital-acquired Methicillin-resistant Staphylococcus aureus (MRSA) infections shows a huge variety across Europe. Some countries reported a reduction in MRSA frequency, while in others countries increasing MRSA rates have been observed. To reduce the spread of MRSA in the healthcare setting, a sufficient MRSA management is essential. In order to reflect the MRSA management across Europe, MRSA prevention policies were surveyed in ten countries. MATERIALS AND METHODS: The survey was performed by questionnaires in European intensive care units (ICUs) and surgical departments (SDs) in 2004. Questionnaires asked for availability of bedside alcohol hand-disinfection, isolation precautions, decolonization and screening methods. The study was embedded in the Hospital in Europe Link for Infection Control through Surveillance (HELICS) Project, a European collaboration of national surveillance networks. HELICS was initiated in order to harmonize the national surveillance activities in the individual countries. Therefore, HELICS participants developed surveillance modules for nosocomial infections in ICUs and for surgical site infections (SSI). The coordination of this surveillance has now been transferred to the European Centre for Disease Prevention and Control (ECDC). RESULTS: A total of 526 ICUs and 223 SDs from ten countries sent data on organisational characteristics and policies, demonstrating wide variations in care. Substantial variation existed in availability of bedside alcohol hand-disinfection, which was much higher in participating ICUs rather than in SDs (86 vs. 59%). Surveillance cultures of contact patients were obtained in approximately three-fourths of all SDs (72%) and ICUs (75%). Countries with decreasing MRSA proportions showed especially strict implementation of various prevention measures. CONCLUSION: The data obtained regarding MRSA prevention measures should stimulate infection control professionals to pursue further initiatives. Particularly, the vigorous MRSA management in countries with decreasing MRSA proportions should encourage hospitals to implement preventive measures in order to reduce the spread of MRSA.

[Prevalence of nosocomial infections in 27 hospitals in the Mediterranean region]. / Prévalence des infections nosocomiales dans 27 hôpitaux de la région Méditerranéenne.

A multicentre study was conducted in 27 hospitals in Algeria, Egypt, Italy, Morocco and Tunisia to evaluate the prevalence and characteristics of the nosocomial infections. The study population (4634 patients) was relatively young, mean age 41.1 (standard deviation 23.4) years. The prevalence of nosocomial infections was 10.5%; this was higher in non-teaching centres and moderate-sized hospitals. Overall, urinary tract infections were the most common. Paediatric departments rated particularly high (11.3%). The most commonly isolated organisms were: Escherichia coli (17.2%), Staphylococcus aureus (12.5%), Pseudomonas aeruginosa and Klebsiella pneumoniae (9.2% each). On the day of the study, 40.7% of the patients were under treatment with antibiotics, with nearly half for an empirical indication. Nosocomial infection was significantly associated with mechanical ventilation, hospitalization > or = 8 days, presence of a central or peripheral catheter), urinary catheter, diabetes and age.

Biomarkers of Bronchial Asthma.

Asthma is a complex disease with a variable course. Efforts to identify biomarkers to predict asthma severity, the course of disease and response to treatment have not been very successful so far. Biomarker research has expanded greatly with the advancement of molecular research techniques. An ideal biomarker should be suitable to identify the disease as well the specific endotype/phenotype, useful in the monitoring of the disease and to determine the prognosis, easily to obtain with minimum discomfort or risk to the patient. An ideal biomarker should be suitable to identify the disease as well the specific endotype/phenotype, useful in the monitoring of the disease and to determine the prognosis, easily to obtain with minimum discomfort or risk to the patient - exhaled breath analysis, blood cells and serum biomarkers, sputum cells and mediators and urine metabolites could be potential biomarkers of asthma bronchiale. Unfortunately, at the moment, an ideal biomarker doesn't exist and the overlap between the biomarkers is a reality. Using panels of biomarkers could improve probably the identification of asthma endotypes in the era of precision medicine.

Cough Reflex Sensitivity in Asthmatic Children.

New knowledge about the neural aspects of cough has revealed a complex network of pathways that initiate cough. The effect of inflammation on cough neural processing occurs at multiple peripheral and central sites within the nervous system. Evidence exists that direct or indirect neuroimmune interaction induces a complex response, which can be altered by mediators released by the sensory or parasympathetic neurons and vice versa. The aim of this study was to clarify changes of cough reflex sensitivity - the activity of airway afferent nerve endings - in asthmatic children.25 children with asthma and 15 controls were submitted to cough reflex sensitivity measurement - capsaicin aerosol in doubling concentrations (from 0.61 to 1250 µmol/l) was inhaled by a single breath method. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Asthmatic children' (11 boys and 14 girls, mean age 9 ± 1 yrs) cough reflex sensitivity (geometric mean, with the 95 % CI) for C2 was 4.25 (2.25-8.03) µmol/l vs. control C2 (6 boys and 9 girls, mean age 8 ± 1 yrs) was 10.61 (5.28-21.32) µmol/l (p=0.024). Asthmatic children' C5 was 100.27 (49.30-203.93) µmol/l vs. control C5 56.53 (19.69-162.35) µmol/l (p=0.348). There was a statistically significant decrease of C2 (cough threshold) in the asthmatic patients relative to controls (p-value for the two-sample t-test of log(C2) for the one-sided alternative, p-value = 0.024). The 95 % confidence interval for the difference of the mean C2 in asthma vs. control, [1.004, 6.207]. For C5, the difference was not statistically significant (p-value = 0.348). There was a statistically significant decrease of cough reflex sensitivity (the activity of airway afferent nerve endings) - C2 value in the asthmatic children relative to controls.

Cough reflex sensitivity and fractional exhaled nitric oxide in children with asthma.

Individual studies have suggested the utility of fractional exhaled nitric oxide (FeNO) measurement in detecting cough-variant asthma and eosinophilic bronchitis in patients with chronic cough. The aim of this study was to clarify a correlation of cough reflex sensitivity and fractional exhaled nitric oxide in asthmatic children. 25 children with asthma and 15 controls were submitted to cough reflex sensitivity measurement - capsaicin aerosol in doubling concentrations (from 0.61 to 1250 micromol/l) was inhaled by a single breath method. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Fractional exhaled nitric oxide (FeNO) measurement was included. Asthmatic children' (11 boys and 14 girls, mean age 9+/-1 years) and control group (unconfirmed diagnosis of asthma) (6 boys and 9 girls, mean age 8+/-1 years) were included into the study. FeNO vs. C2 in asthma (Spearman´s rank correlation: -0.146, p=0.49); FENO vs. C5 in asthma (Spearman´s rank correlation: -0.777, p=0.71). We found that there is no correlation between cough reflex sensitivity and fractional exhaled nitric oxide either in children with asthma or in the control group.

National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project.

This study was performed to evaluate associations between organisational characteristics, routine practices and the incidence densities of central venous catheter-associated bloodstream infections (CVC-BSI rates) in European intensive care units (ICUs) as part of the HELICS project (Hospitals in Europe Link for Infection Control through Surveillance). Questionnaires were sent to ICUs participating in the national nosocomial infection surveillance networks in 2004. The national networks were asked for the CVC-BSI rates of the ICUs participating for the time period 2003--2004. Univariate and multivariate risk factor analyses were performed to identify which practices had the greatest impact on CVC-BSI rates. A total of 526 ICUs from 10 countries sent data on organisational characteristics and practices, demonstrating wide variation in care. CVC-BSI rates were also provided for 288 ICUs from five countries. This made it possible to include 1383444 patient days, 969897 CVC days and 1935 CVC-BSI cases in the analysis. Adjusted logistic regression analysis showed that the categorical variables of country [odds ratio (OR) varying per country from OR: 2.3; 95% confidence interval (CI): 0.5-10.2; to OR: 12.8; 95% CI: 4.4-37.5; in reference to the country with the lowest CVC-BSI rates] and type of hospital 'university' (OR: 2.08; 95% CI: 1.02-4.25) were independent risk factors for high CVC-BSI rates. Substantial variation existed in CVC-BSI prevention activities, surveillance methods and estimated CVC-BSI rates among the European countries. Differences in cultural, social and legal perspectives as well as differences between healthcare systems are crucial in explaining these differences.

Factors attributable to the level of exhaled nitric oxide in asthmatic children.

BACKGROUND: Asthma is a heterogeneous disease with variable symptoms especially in children. Exhaled nitric oxide (FeNO) has proved to be a marker of inflammation in the airways and has become a substantial part of clinical management of asthmatic children due to its potential to predict possible exacerbation and adjust the dose of inhalant corticosteroids. OBJECTIVES: We analyzed potential factors that contribute to the variability of nitric oxide in various clinical and laboratory conditions. MATERIAL AND METHODS: Study population consisted of 222 asthmatic children and 27 healthy control subjects. All children underwent a panel of tests: fractioned exhaled nitric oxide, exhaled carbon monoxide, asthma control test scoring, blood sampling, skin prick tests, and basic spirometry. RESULTS: FeNO and other investigated parameters widely changed according to clinical or laboratory characteristics of the tested children. Asthmatics showed increased levels of FeNO, exhaled carbon monoxide, total serum IgE, and higher eosinophilia. Boys had higher FeNO levels than girls. We found a significant positive correlation between FeNO levels and the percentage of blood eosinophils, %predicted of forced vital capacity, total serum IgE levels, and increasing age. CONCLUSIONS: Various phenotypes of children's asthma are characterized by specific pattern of the results of clinical and laboratory tests. FeNO correlates with total serum IgE, blood eosinophilia, age, and some spirometric parameters with different strength. Therefore, the coexistence of atopy, concomitant allergic rhinitis/rhinoconjunctivitis, and some other parameters should be considered in critical evaluation of FeNO in the management of asthmatic children.

[Characteristics of alcohol-dependent male inmates]. / Caractéristiques des personnes alcoolodépendantes incarcérées en maison d'arrêt.

OBJECTIVE: The objective of this study was to compare social and penal characteristics and consumption of psychoactive substances by alcohol-dependent and non-dependent inmates of the Lyon's prison in 2004. METHODS: The study was carried out among 2033 male adults incarcerated between January 1st and December 31st 2004. An administered questionnaire was proposed during the arrival visit to record social, administrative and penal data. Use of tobacco, alcohol and illicit drugs was quantified. RESULTS: In all, 1898 questionnaires were analysed. Comparison between alcohol-dependent (n=356) versus non alcohol-dependent inmates (n=1542), revealed that the alcohol-dependent population was older, mean age (34 years old versus 30 years, p<0.001), and had a higher unemployment rate (50% versus 39.4%, p<0.001). Alcohol addicts were more often repeated offenders (62% versus 50.7%, p=0.001), had a higher rate of Subutex mixture (11% versus 3.2%, p<0.001) and presented more psychic suffering (21% versus 6%, p<0.001). Multivariate analysis identified use of psychotop drugs, use of psychoactive substances, age and familial situation as significantly and independently associated with the abusise alcohol consumption. CONCLUSION: Because of an elevated prevalence of alcohol dependence among arriving penitentiary inmates, effective screening is needed to prevent withdrawal syndrome and propose care adapted to the specific features of this dependent population: social insecurity and polydrug abuse.

Cough reflex sensitivity after exercise challenge testing in children with asthma.

Bronchial challenge tests are commonly used in clinical medicine and research. The aim of this study was to clarify changes of cough reflex sensitivity before and after exercise challenge testing in asthma children. 42 asthmatic children were submitted to cough reflex sensitivity measurement - capsaicin aerosol in doubling concentrations (from 0.61 to 1250 micromol/l) was inhaled by a single breath method - before and after exercise challenge testing. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Children' (31 boys and 11 girls, mean age 14.05 ±â€¯2.08 yrs) cough reflex sensitivity (median, with the 95% CI) for C2 was before exercise challenge testing 9.77 (6.10-10.99) micromol/l vs. children' C2 after it 7.32 (6.10-14.65) (P = 0.58 for the Wilcoxon two sample paired test). Children' C5 was before exercise challenge testing 19.53 (14.65-80.57) micromol/l vs. C5 after it 39.06 (24.42-58.59) micromol/l (P = 0.09 for the Wilcoxon two sample paired test). We conclude that cough reflex sensitivity was not significantly changed after exercise challenge testing in children with asthma.

Nine-year downward trends in surgical site infection rate in southeast France (1995-2003).

The aim of this study was to estimate temporal trends in the incidence of surgical site infection (SSI) using a large SSI surveillance network in southeast France from 1995 to 2003. Data were analysed from 187 surgical wards that had participated in the network for at least two years. The change in SSI rate over time was modelled using a hierarchical logistic regression model with patients clustered within surgical wards. Of the 200 207 patients selected, 3786 (1.9%) had an SSI. The nine-year trend in SSI rate estimated by an odds ratio of 0.95 (95% confidence interval 0.93-0.97) was interpreted as a 5% decrease in SSI rate per year. This decrease was constant over the study period and was observed for almost all of the different types of surgical operations (orthopaedic, gastrointestinal, urology, etc). Overall SSI rates were reduced by 45% over a period of nine years. This trend was maintained even when taking into account the heterogeneity of the surgical wards and the diversity of patient demographics over time. From this, the 5% decrease per year can be reasonably interpreted as a result of preventive measures taken by surgical wards to reduce SSIs.

Multicentre study on hand hygiene facilities and practice in the Mediterranean area: results from the NosoMed Network.

Hand hygiene literature is scarce in the southern Mediterranean area. In order to establish a baseline position, a study was performed in four Mediterranean countries. Seventy-seven hospital wards in 22 hospitals were enrolled and information on hand hygiene practice and facilities were collected. The overall compliance rate was very low (27.6%), and was significantly higher where the perceived risk was considered to be high. Intensive care units showed the highest level of compliance. Analysis by country indicated higher compliance in Egypt (52.8%) and Tunisia (32.3%) compared with Algeria (18.6%) and Morocco (16.9%). Facilities for hand hygiene, particularly consumables, were shown to be deficient. Multi-approach programmes combining the production of official local recommendations, education and regular evaluation of hand hygiene practice are much needed to improve the present situation.

[Psychoactive substance use among newly incarcerated prison inmates]. / Consommation de substances psycho actives chez les personnes entrant en prison.

The objective of this study was to describe the population of incoming prisoners in Lyon's prisons and to estimate the proportion of those who are drug users in order to adapt the psychological care which is made available at the time of entrance. During the entrance interview briefing session, a questionnaire was given to each new adult male inmate between January 1st and December 31st 2003. The mean age of new prisoners was 31 years old: 68.5% did not have regular employment in the last 12 months prior to their incarceration, and 52.8% had already been previously imprisoned. More than 64.0% of inmates declared either a regular use, an abusive use or dependence on tobacco, 16.5% on cannabis, 16.1% on alcohol, 2.5% on psychotropic medication, and 4.1% on other drugs (heroine, cocaine, or synthetic drugs). Moreover, 42.0% of drug users declared either a regular use, abusive consumption or dependence on at least two psycho active substances. These results confirm the need for effective screening for drug use upon entry into prison as a means of ensuring that appropriate psychological and/or psychiatric care of drug users, which is suitably adapted to the prison environment, can be provided.

[Patient education programs in Rhône-Alpes region hospitals]. / L'éducation du patient au sein des hôpitaux de Rhône-Alpes: état des lieux à partir d'une enquête déclarative.

Health education is of growing interest for patients, medicals and health institutions in France. In order to develop this activity in the Rhône-Alpes region (France), a survey of hospital health education programs have been done. A first questionnaire was sent to the medical institutions in the Rhône-Alpes region in order to identify the different projects and their co-ordinators. A second questionnaire was sent to these co-ordinators in order to help them to describe as comprehensively as possible their project. The results were available for public use on a web site. Among the 326 medical institutions contacted, 117 answered from which 217 questionnaires were analysed. The analysis showed the importance attached to this activity, the variety of the institutions that organise it and the diversity of the topics. Management and promotion were less developed in these health education programs.

[Knowledge of hepatitis B and C among underprivileged people]. / Connaissances des populations précaires à propos des hépatites virales B et C.

BACKGROUND: Prevalence for hepatitis B (HBV) and C (HCV) viruses infection are particularly high among underprivileged persons (UPP) related to the use of injecting drug, residence in high endemic countries or a low rate of condom use in case of multiple sexual partners. It is important to know whether these persons are well aware of prevention measures for these infections. The aim of our study was to evaluate the knowledge of preventive measures among UPP and, at the same time, among health- and social-care workers (H/S-CWs). METHODS: The study was conducted in 68 salvation settings. The H/S-CWs filled out once 9-item self-administered questionnaires on HBV and HCV, concerning the illnesses, and their transmission, prevention, and screening. A similar questionnaire was proposed by H/S-CWs, to UPP after each interview. All answers were grouped into 4 categories: true (one right item or more), false, unknown, no answer. RESULTS: One thousand nine hundred twenty one questionnaires were collected: 312 were from H/S-CWs and 1609 from UPP. The answer rate was 100% for H/S-CWs and 92.7% among the UPP population. Knowledge about HBV and HCV was better for H-CWs compared to S-CWs. For HBV, routes of transmission was the best known field (85.2% of right answers) and use of blood sample screening was the least known field (54.2%). Vaccination was advanced by 50.6% of H/S-CWs. For HCV, routes of transmission were also the best known field (65.9%) while preventive measures were frequently unknown (22.0%). Among the UPP, blood sample screening was the best known field for HBV (34.5% of right answers) as for HCV (27.5%). Knowledge about the routes of transmission and the populations at risk was very low for HBV (28.2% and 15.5%) and for HCV (9.4% and 5.1%). The analyses of each response showed that the rates of wrong answers were much higher for H/S-CWs compared to UPP. On the other hand the rates of "unknown" answer were higher in the UPP. This finding suggests that H/S-CWs had a false perception of knowing relevant information on HBV and HCV. The high proportion of no answer among UPP confirmed their ignorance of those diseases. CONCLUSION: The UPP needs appropriate information on HBV and HCV. This information could be delivered by H/S-CWs. However, preliminary training, particularly for S-CWs, might improve their insufficient knowledge at the present time.