Scabies in French Guiana: Quantitative and qualitative factors associated with therapeutic failure.

BACKGROUND: Strategies for the control of scabies should be adapted to local settings. Traditional communities in French Guiana have non-Western conceptions of disease and health. OBJECTIVES: The objectives for this study were to explore knowledge, attitudes and practices to identify potential factors associated with the failure of scabies treatment in these communities. METHODS: Patients with a clinical diagnosis of scabies, seen at either the Cayenne Hospital or one of 13 health centres between 01 April 2021 and 31 August 2021, were included as participants, and were seen again after 6 weeks to check for persistence of lesions. Factors associated with treatment failure were looked for both at inclusion and at 6 weeks. Semi-structured interviews were conducted with a diversified subsample of participants. RESULTS: In total, 164 participants were included in the quantitative component, and 21 were interviewed for the qualitative component. Declaring that the second treatment dose had been taken was associated with therapeutic success. Western treatments were not always affordable. Better adherence was observed with topical treatments than with oral ivermectin, whereas permethrin monotherapy was associated with failure. Scabies-associated stigma was high among Amerindians and Haitians but absent in Ndjuka Maroons. Participants reported environmental disinfection as being very complex. CONCLUSIONS: The treatment of scabies in traditional Guianan communities may vary depending on local perceptions of galenic formulations, disease-associated stigma and differences in access to health care. These factors should be taken into account when devising strategies for the control of scabies aimed at traditional communities living in remote areas, and migrant populations.

One-year Functional Outcomes after Holmium Laser Enucleation of the Prostate (HoLEP): Introduction of a Composite Score (Hexafecta).

OBJECTIVE: To compare the efficiency (micturition symptoms, continence, erection) and safety of Holmium Laser Enucleation of the Prostate (HoLEP) with a single composite score (the Hexafecta score) one year postprocedure. PATIENTS AND METHODS: We conducted a single-center retrospective study including all patients who had undergone HoLEP for the treatment of benign prostate hyperplasia (BPH) between May 2013 and August 2017. Data were obtained preoperatively and at the 6- and 12-month visits. We also reported all 90-day complications. The Hexafecta score included 6 criteria: peak urine flow of at least 15ml/s, 30% reduction in International Prostate Symptoms Score (IPSS) score, quality of life via the IPSS less than 2, no incontinence (International Consultation Incontinence Questionnaire), no significant change in erectile function (International Index of Erectile Function), and no grade III or more complications according to the Clavien-Dindo classification. RESULTS: Two hundred thirty-five patients were included, of whom 197 (83.8%) completed the 12-month visit. Complete data were available to assess the Hexafecta score for 178 of them (75.7%). Most of the missing data were for uroflowmetry and the erectile function assessment. Hundred three patients (58%) met all 6 criteria, while 45 (25%) met 5 of them. None were retreated for BPH in the follow-up period. The de novo incontinence rate was 4.1%. CONCLUSION: The Hexafecta score is a simple, transversal method for comprehensively evaluating functional outcomes after HoLEP surgery. Such an evaluation could be used to compare other types of procedures for BPH treatment. LEVEL OF EVIDENCE: 3.

An ISHLT consensus statement on strategies to prevent and manage hemocompatibility related adverse events in patients with a durable, continuous-flow ventricular assist device.

Life expectancy of patients with a durable, continuous-flow left ventricular assist device (CF-LVAD) continues to increase. Despite significant improvements in the delivery of care for patients with these devices, hemocompatability-related adverse events (HRAEs) are still a concern and contribute to significant morbility and mortality when they occur. As such, dissemination of current best evidence and practices is of critical importance. This ISHLT Consensus Statement is a summative assessment of the current literature on prevention and management of HRAEs through optimal management of oral anticoagulant and antiplatelet medications, parenteral anticoagulant medications, management of patients at high risk for HRAEs and those experiencing thrombotic or bleeding events, and device management outside of antithrombotic medications. This document is intended to assist clinicians caring for patients with a CF-LVAD provide the best care possible with respect to prevention and management of these events.

Spontaneous pulmonary alveolar proteinosis in captive "moustached tamarins" (Saguinus mystax).

Pulmonary alveolar proteinosis is a rare human disease characterized by accumulation of surfactant in alveoli without generating an inflammatory response. Lung lesions resembling pulmonary alveolar proteinosis were observed in 7 adult tamarins (5 males and 2 females). Gross lesions were characterized by areas of discoloration, slight bulging over the lung parenchyma, and occasional consolidation. Histologic examination of tamarin lung samples revealed intra-alveolar accumulation of amorphous, amphophilic, periodic acid-Schiff-positive, finely granular to dense material. In some cases, type II pneumocyte hypertrophy and hyperplasia were observed with pleural and septal thickening and fibrosis. Large numbers of intra-alveolar foamy macrophages were noted surrounding and/or in the vicinity of the lesions. Immunohistochemical analysis of the lung lesions using polyclonal (surfactant proteins A, B, and C) and monoclonal (surfactant protein D) antibodies revealed the granular material to be composed largely of surfactant protein B, followed by surfactant protein A. Surfactant proteins C and D were present in lesser quantities, with the latter observed surrounding the lipoproteinaceous deposits. Transmission electron microscopy of the affected lungs showed numerous, irregularly shaped osmiophilic lamellar bodies in type II pneumocytes. The cytoplasm in alveolar macrophages was expanded, containing ingested surfactant with swollen mitochondria and rough endoplasmic reticulum. Thoracic radiographs, available in 1 animal, depicted the lesions as small multifocal opacities randomly distributed in cranial and diaphragmatic lung lobes. This is, to the authors' knowledge, the first report of spontaneous pulmonary alveolar proteinosis in nonhuman primates.

When local phytotherapies meet biomedicine. Cross-sectional study of knowledge and intercultural practices against malaria in Eastern French Guiana.

ETHNOPHARMACOLOGICAL RELEVANCE: In French Guiana, traditional phytotherapies are an important part of self-healthcare, however, a precise understanding of the interactions between local phytotherapies and biomedicine is lacking. Malaria is still endemic in the transition area between French Guiana and Brazil, and practices of self-treatment, although difficult to detect, have possible consequences on the outcome of public health policies. AIM OF THE STUDY: The objectives of this research were 1) to document occurences of co-medication (interactions between biomedicine and local phytotherapies) against malaria around Saint-Georges de l'Oyapock (SGO), 2) to quantify and to qualify plant uses against malaria, 3) and to discuss potential effects of such co-medications, in order to improve synergy between community efforts and public health programs in SGO particularly, and in Amazonia more broadly. MATERIALS AND METHODS: This cross-sectional study was conducted in 2017 in SGO. Inhabitants of any age and nationality were interviewed using a questionnaire (122 questions) about their knowledge and habits regarding malaria, and their use of plants to prevent and treat it. They were invited to show their potential responses on a poster illustrating the most common antimalarial plants used in the area. In order to correlate plant uses and malaria epidemiology, all participants subsequently received a medical examination, and malaria detection was performed by Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR). RESULTS: A total of 1566 inhabitants were included in the study. Forty-six percent of them declared that they had been infected by malaria at least once, and this rate increased with age. Every person who reported that they had had malaria also indicated that they had taken antimalarial drugs (at least for the last episode), and self-medication against malaria with pharmaceuticals was reported in 142 cases. A total of 550 plant users was recorded (35.1% of the interviewed population). Among them 95.5% associated pharmaceuticals to plants. All plants reported to treat malaria were shared by every cultural group around SGO, but three plants were primarily used by the Palikur: Cymbopogon citratus, Citrus aurantifolia and Siparuna guianensis. Two plants stand out among those used by Creoles: Eryngium foetidum and Quassia amara, although the latter is used by all groups and is by far the most cited plant by every cultural group. Cultivated species accounts for 91.3% of the use reports, while wild taxa account for only 18.4%. CONCLUSIONS: This study showed that residents of SGO in French Guiana are relying on both traditional phytotherapies and pharmaceutical drugs to treat malaria. This medical pluralism is to be understood as a form of pragmatism: people are collecting or cultivating plants for medicinal purposes, which is probably more congruent with their respective cultures and highlights the wish for a certain independence of the care process. A better consideration of these practices is thus necessary to improve public health response to malaria.

[Hypocomplementemic urticarial vasculitis]. / Vascularite urticarienne hypocomplémentémique.

Hypocomplementemic urticarial vasculitis is a rare disorder characterized by the presence of C1q precipitins associated with a syndrome of urticarial vasculitis, arthralgias, ocular inflammation and obstructive-lung disease. We report the case of a 48-year-old woman with hypocomplementemic urticarial vasculitis. Because of dependance to corticosteroids, cyclophosphamide-pulse therapy was started and resulted in significant clinical improvement. Mycophenolate mofetil was effective as maintenance therapy and resulted in complete resolution of rash, arthralgias, arthritis and uveitis, but had no effect on the obstructive-lung disease.

Effects of breakfast-size on short-term memory, concentration, mood and blood glucose.

Effects of breakfast size on blood glucose, mood, short-term memory and concentration were assessed in 319 adolescents (age 13-20 years) in real-life setting. Mean energy increase of 63% over habitual breakfast had no effect on blood glucose or late morning mood. High energy intake from breakfast had a beneficial effect on immediate recall in short-term memory evaluated on the whole sample. However, concentration appeared to be impaired by a high caloric breakfast. There were no differences in the studied parameters according to energy supplement size. The present results are consistent with suggestions that meal size supplement has an effect on cognitive function.

[Heart valve surgery and associated diseases in aged subjects]. / Chirurgie valvulaire et pathologies associées chez les sujets âgés.

The object of this study was to assess the additional risk related to associated pathology in patients aged 70 or over undergoing valvular heart surgery. Two hundred and thirty nine patients aged 70 to 87 years (average 74.6 +/- 3.2) underwent this form of surgery between October 1979 and June 1989. Sixty seven had coronary artery disease, 26 had atherosclerotic occlusive peripheral arterial disease, and 149 had one or more extracardiovascular pathology. Two hundred and thirteen patients underwent monovalvular and 26 bivalvular replacement. Coronary bypass was associated in 25 cases. Eighteen patients (7.5%) died in the 30 days following surgery. The perioperative mortality was not significantly greater in patients with extra-cardiac pathology (9.4% vs 4.4%; NS), in patients with coronary artery disease (11.9% vs 5.8%; NS), in patients with respiratory failure and FEV1 < 1 litre (1 death out of 20 cases) or in patients with renal failure and serum creatinine levels > or = 175 mumol/l (20% vs 6.3%, NS). Respiratory failure was the only extra-cardiac variable identified with increased perioperative morbidity. The perioperative mortality of elderly patients with valvular heart disease is greater than that of patients under 70 years of age (6.4% vs 2.1%) in our experience of the last 6 years p < 0.01). Associated arterial and extra-cardiac pathology does not significantly increase the mortality and strict selection of elderly inoperable patients together with improved surgical techniques and postoperative care has considerably reduced perioperative morbidity and mortality in this group of patients.

Knowledge and participation of general practitioners in cervical cancer screening: survey in a French pilot area.

BACKGROUND: Eighteen months after the beginning of a pilot cervical cancer screening program in a French district of 484,770 inhabitants, a survey was performed among general practitioners (GP). The aim was to assess their knowledge of the screening policy, the factors related to their participation, the difficulties they encounter and their training needs. METHODS: A random sample of 168 GPs was taken from a medical association file. Eighty-seven percent of the physicians agreed to be interviewed by phone. The questionnaire was standardized and made up of open questions. RESULTS: On the whole, screening policy was not well known to the GPs: 58 percent believed screening had to begin before age 21 and could be discontinued before age 61. Sixty percent of GPs declared that they provided women with written information, and 49 percent that they offered Pap smears to all women. Seventy-nine percent said that they took Pap smears, but 39 percent claimed they had difficulty mainly due to women's reluctance or to technical problems. Few GPs expressed training needs. Reported difficulties and expressed need for training increased with the physician's age. GP concern for public health activities increased their participation in the campaign. CONCLUSION: Pilot programs have to implement measures which can help GPs to deal with community care and screening activities since GP involvement is one of the essential conditions of successful organized screening.

[Nutrition behavior in adolescent students (15-19 years of age) in the Nancy metropolitan area. A comparison with the recommended nutritional intake of the French population]. / Comportement alimentaire d'adolescents (15-19 ans) scolarisés dans l'agglomération nancéienne. Comparaison avec les apports nutritionnels conseillés pour la population française.

This paper describes the food behavior of 495 adolescents (15-19 years old) sample living in Nancy (France). The results are compared with the Recommended Dietary Allowances (RDA) for French adolescent population. The RDA are not satisfied for important percentages of girls for the daily energy intake (26.3% of girls have allowances less than 30% RDA), for the calcium intake (28.7% of girls have allowances less than 40% RDA), and for the protein intake (17.6% of girls have allowances less than 20% RDA). Lipids consumption is excessive (19.9% of boys and 23.4% of girls have allowances greater than 20% RDA) and energy intake from breakfast are low (25% of adolescents provide less 10% of daily energy intake by breakfast) for all these teen-agers. These results confirm the data observed in two others studies concerning the food behavior of French adolescents.

What has become of our idiopathic inflammatory pseudo-tumors of the orbit?

OBJECTIVE. We looked for the development of specific systemic disease or malignant lymphoma in patients whose initial diagnosis was idiopathic inflammatory pseudo-tumor of the orbit (IOPT). PATIENTS AND METHODS. IOPT was diagnosed in 24 patients on the basis of imaging findings and surgical biopsies (70%). Nineteen of these 24 patients (10 men and 9 women, age range 19- 83 years) were reassessed 1-12 years after the initial diagnosis. RESULTS. The initial diagnosis described diffuse inflammation (33%), dacryoadenitis (20%) or myositis (47%). At reassessment, 4 patients had developed a specific disease: generalized lymphoma, Wegener's disease, necrotizing vasculitis, and Crohn's disease. All four were recognized within one year of the IOPT diagnosis. A biopsy was obtained in these four patients and was not contributive. One case of non-specific granulomatous proliferation was found 6 years after the initial diagnosis. One case of orbital meningioma occurred 10 years after radiotherapy of the orbit and could not be attributed to a definite cause. The other patients had a common non-specific clinical course; recurrent inflammation required corticosteroid therapy in 55% and complementary external radiotherapy of the orbit in 22%. DISCUSSION AND CONCLUSION. Specific diseases that developed after an initial diagnosis of inflammatory pseudo-tumor of the orbit occurred early and appeared more often in diffuse forms, suggesting the need for more extensive histopathological diagnostic procedures. The clinical course tended to be more quiescent in patients who passed the critical period of the first year.

[Detection, prevention and treatment of postpartum depression: a controlled study of 859 patients]. / Dépistage, prévention et traitement des dépressions du postpartum: une étude contrôlée chez 859 sujets.

This study evaluated the clinical effectiveness of a programme aimed at detecting, preventing and treating postpartum depression. The French version of the EPDS was used to measure the intensity of postpartum blues on a sample of 859 women, during their stay at the obstetrical clinic. Subjects under treatment for psychological problems were excluded from the study. Mothers scoring 9 or above on the EPDS, which is predictive of pospartum depression, were randomly assigned to a prevention and a control group. Written informed consent was obtained from the subjects after the study procedure had been explained. The prevention group received a counselling session integrating supportive, educational and cognitive-behavioral components. Therapists included five female Master's Degree level students in psychology. All therapists participated in didactic and clinical training as wells as weekly supervision from the first author. All subjects were given a second EPDS with written instructions to complete the questionnaire during the period 4 to 6 weeks postpartum and return it for analysis. At four to 6 weeks, women in the prevention group had significant reductions in the frequency of probable depression, as defined by a score of 11 or above on the EPDS (30.2% vs 48.2%, chi 2 = 7.36, dl = 1, p = 0.0067) and in the intensity of depressive symptoms measured by the mean score on the EPDS (8.5, SD = 4 vs 10.3, SD = 4.4, t = 3.06, dl = 209, p = 0.0024). Mothers with a probable depression were interviewed at home and assessed using the MINI (Mini Neuropsychiatric Interview, Lecrubier et al., 1997) to diagnose major depressive episode, the SIGH-D (Structured Interview Guide for the Hamilton Depression Rating Scale, Williams, 1988) and the BDI (Beck Depression Inventory, Beck et al., 1988). The baseline depression rating scores, EPDS (mean = 13.6, SD = 4), BDI (mean = 15.7, SD = 5.9), HDRS (mean = 14.8, SD = 6), were consistent with moderate depression. No significant differences in baseline scores were observed between the two groups on all the rating scales (p < 0.001). Mothers with probable depression in the prevention group were offered a program of 5 to 8 home visits. Most of the mothers in the prevention group (72%) agreed to participate in the program. On the contrary, most of the mothers (83.3%) who scored below 9 on the first EPDS and 11 or above on the second, who so did not received the preventive counselling session, declined to participate. This suggests the importance of the preventive session in establishing therapeutic alliance. The home visits program integrated four components, supportive, educational, cognitive-behavioral and psychodynamic centred on the mother-infant relationship in terms of the mother's personal history. Therapist participated in clinical training and weekly supervision. Fifteen women (71.4%) in the study group demonstrated complete symptom remission, as defined by HDRS score below 7 after the intervention, compared with 4 women (10.5%) in the control group (chi 2 = 23, p < 0.0001). A clearly therapeutic response to treatment was observed in the treated group with a mean reduction in HDRS score of 9.5 (DS = 6.7) from baseline. The improvement in the women in the treated group, as measured by the mean HDRS scores was statistically greater than that in the control group (m = 5.35, SD = 3.5 vs m = 15.8, SD = 4.6, t = 8.24, dl = 52, p < 0.0001). Our results indicate that a program based on an intervention at obstetrical clinics and on home visits is efficacious and well accepted for prevention, detection and treatment of postpartum depression.

[Diet and health of deprived population in developed countries : What is the link.]. / Alimentation et santé des populations défavorisées dans les pays développés : quelle relation ?

The diet is often unbalanced and deficient in poverty situations and deprived populations are becoming larger and larger in developed countries. Negative effects on the health of poor populations are expected in the short or long term. The link between diet and health is well investigated in many epidemiological studies ; however they seldom analyse the link between infectious diseases and diet in western countries and rarely include poverty indicators that could help to provide more information about the situation among poor populations.

[Educational television]. / La télévision éducative.

This author attempted to understand the potential impact of using closed-circuit TV as an educational strategy to meet the learning needs of patients and their families. To do so, she gathered data from two hospitals that offered this avenue for health teaching. Of the 70 patients who participated in the research study, 32 were maternity patients and 38 surgical patients. The data were measured using the MAQSI criteria, which the Ordre des infirmières et infirmiers du Québec uses to measure quality of nursing care. The results revealed that although TV has many practical educational applications, TV in itself did not have a significant impact on learning. The hospital with the most significant learning had integrated closed-circuit TV education into the nursing care plan. The author also found that many factors could influence the impact that educational programming had on patients. Examples include the time selected for viewing or the length of stay in hospital. However, the key to the successful use of TV as an educational tool in the hospital setting seems to lie in the integration of TV learning with other conventional teaching methods.

[Tobacco: knowledge, reasoning and opinion of high school students in Doubs. Reflections on prevention]. / Tabac: connaissances, motivations et souhaits de lycéens du Doubs. Réflexions pour la prévention.

The prevalence of smoking has increased among young people aged 14 to 18 between 1993 and 1999, and most notably among girls within the same period. These observations illustrate the necessity for significant changes in mass media campaigns and education programmes related to the prevention of smoking among youth. The objective of this survey, initiated by the city of Besançon and the French National Mutual Insurance of Doubs, was to describe and analyse the knowledge and rationale of high school students on tobacco and their opinions in terms of prevention. Twelve public and private high schools in Besançon and Morteau (Doubs-France) participated in the survey; the group also represented a mix of general and professional schools. The questionnaire was filled out by 970 students selected at random. 96% of the students indicated cancer as being the main illness linked to tobacco and 94% stated that second-hand smoke constitutes a health risk. 61% admitted to seeking out the psychoactive effects of smoking. The students responses confirm that the types of messages relayed in a smoking prevention campaign which have an impact on them are: evoking fear of death (74%) and the use of humor (16%). One-third of high school students find that it is unacceptable to forbid smoking on school premises. The knowledge of the dangers related to smoking is not sufficient to keep young people from smoking and confirms that an educational approach based solely on knowledge and facts will not be sufficient to decrease their tobacco consumption. It is important to take into account the image that young people have of tobacco as a means to combat stress in future prevention strategies and campaigns.

[School lunch and nutrition of pupils ended in disadvantaged environments: reports, stakes, assistance with the decision]. / Restauration scolaire et alimentation des élèves issus des milieux défavorisés: constats, enjeux, aide à la décision.

Because of a growing poverty in France, the most disadvantaged families are having to give up school lunches for their children, with negative consequences from the point of view of nutrition. The data collected and worked by the authors calls for a more qualified interpretation. A drop in school meal attendance is a reality in some establishments and in some departments. Falling incomes in families experiencing the greatest difficulties undoubtedly influence the choice of expenditure, but it is not possible to generalise it at national level or to confirm any downward trend in attendance. Beside socio-economic factors, it is wide to consider also the food supply, school catering conditions and others factors bound up with changes in eating habits among young and their families. In any case, there is no proof for the moment of any repercussions on pupil's nutritional health, even though this will have to be structurally monitored. Neither has it been proved that pupils who do not take school meals are any the less well fed.

[Frequency of use of school cafeterias in middle and high schools in 3 French districts]. / Fréquentation des restaurants scolaires dans les collèges et lycées de trois départements français.

Reports from the French Ministry of Education warn of a decrease in the use of school food services, especially in sensitive urban areas. They also suggest that this decline has led to cases of malnutrition. This article describes the characteristics of the current supply of school meals and measures the evolution of demand observed between 1992 and 1996 in relation to the economic situation of students' families. The study was carried out in 3 departments in France: Doubs, Herault, and Val de Marne. The administrators of all public and private middle and high schools in the 3 departments received a questionnaire asking them to describe the services offered in their cafeterias and to provide the corresponding statistical and accounting data. External food services near the schools were also taken into account. Seventy-nine percent of schools responded to the survey. Concerning the services offered, 91% of schools have their own cafeterias, of which 81% are managed by the schools. Concerning the evolution of utilisation, a significant decrease in the number of meals served in seen in middle schools. On the other hand, high schools have observed stable utilisation. The positive changes in utilisation are linked, in middle schools, to characteristics of the schools' internal food services (self-service, choice of main courses, modulation of seats). In high schools, positive changes in the utilisation of school services are linked to the lack of external food services near the schools. As middle schools and high schools control the logistics and management of food services offered to students, they are potentially in a position to influence a policy on this issue. The evolution in utilisation is very different among departments and between middle and high schools. While economic precariousness has a negative structural effect on utilisation, it doesn't seem to be a major factor in the evolution of the decrease observed over the past few years.

[Food habits, consumption, and knowledge of a low-income French population]. / Habitudes, consommations et connaissances alimentaires des Français en situation de précarité financière.

Behaviors related to nutrition as well as the eating habits of low-income French people are analyzed from data collected by the Nutrition and Health Barometer of the CFES in 1996. French people with monthly incomes of less than 4000 francs appear to go to fast-food restaurants more often than to other types of restaurant (for leisure or work). They appear to eat their three main meals alone more often, to spend less time over the evening meal, to watch television during their noon and evening meals, to have cheese or another dairy product rather than a main dish, and to limit their evening meal to a single dish. They are less numerous than higher-income people to have the "ideal" breakfast. These economically disavantaged French people do their shopping more often in large of medium-sized supermarkets and more often plan their meals according to the family budget. In terms of food they are more numerous to eat neither fruit nor vegetables; they consume less pork, fish and shellfish, dairy products, alcoholic beverages and especially before-dinner drinks. This study shows that the eating behavior of low-income French people is less in conformity with commonly accepted nutritional recommendations. Likewise, the rate of obesity observed among the women from this households appears high.