IMI-Type Carbapenemase-Producing Enterobacter cloacae Complex, France and Overseas Regions, 2012-2022.

We characterized a collection of IMI-like-producing Enterobacter spp. isolates (n = 112) in France. The main clone corresponded to IMI-1-producing sequence type 820 E. cloacae subspecies cloacae that was involved in an outbreak. Clinicians should be aware of potential antimicrobial resistance among these bacteria.

Factors associated with mammography screening among Reunionese women : a cross-sectional study.

OBJECTIVE: To explore the factors associated with the uptake of mammography screening in Reunionese women aged 50-65 years. METHODS: This study included all women aged 50 to 65 years participating in a population-based cross-sectional study "FOSFORE". Participants were recruited between March and June 2017 using two sampling frames. The first frame consisted of households with a landline telephone, with or without a mobile line, by first randomly generating a telephone number and then randomly selecting an individual from among all eligible women in the household. The second sampling frame was constituted of women with an exclusive mobile line, who were selected directly if they met the eligibility criteria. Data were weighted for age and socio-professional status to ensure representativeness at the Reunion Island level. Weighted logistic regression was used to calculate odds ratios while adjusting for confounders. RESULTS: 417 women were included in the study; 63.8% were up to date with guidelines on mammography screening and 36.2% were not up to date. Four factors were significantly associated with mammography screening, with an adjusted odds ratio of 2.92 (95% CI 1.51-5.61) for not having an Active Solidarity Income, 1.98 (95% CI 1.22-3.23) for having a regular gynecological follow-up by a physician, 6.53 (95% CI 3.23-13.21) for performing a Pap smear test in the past two years, and 2.07 (95% CI 1.21-3.52) for having an adequate literacy level (HLQ3). CONCLUSION: The findings of this study suggest that higher socio-economic status is an indicator of participation in mammography screening in La Réunion, and future educational and intervention programs should target women in deprived areas.

High prevalence of Bardet-Biedl syndrome in La Réunion Island is due to a founder variant in ARL6/BBS3.

Bardet-Biedl syndrome (BBS) is a rare ciliopathy with variable retinal dystrophy, polydactyly, renal abnormalities, obesity, cognitive impairment, and hypogonadism. Biallelic pathogenic variants have been identified in 24 genes, leading to BBS in an autosomal recessive inheritance pattern. In this study, we investigated a cohort of 16 families (20 individuals) presenting with typical BBS originating from La Réunion Island using sequencing (Sanger and high-throughput methods) and SNP array. In eight families (12 individuals) we identified the same ARL6/BBS3 variation [c.535G > A, p.(Asp179Asn)]. Bioinformatics and functional analyses revealed an effect of this variant on the splicing of ARL6/BBS3. Owing to the relatively high frequency of this variant, a possible founder effect was suspected. Genotyping of six individuals revealed a common 3.8-Mb haplotype and estimated the most recent common ancestor to about eight generations confirmed by the known genealogy. Knowledge of this founder effect modifies our diagnostic strategy and enables a personalized genetic counseling for patients from La Réunion Island. Being the first description of BBS patients from La Réunion Island, we could estimate its prevalence between ~1/45000 and ~ 1/66000 individuals.

Vectorial status of the Asian tiger mosquito Aedes albopictus of La Réunion Island for Zika virus.

La Réunion Island has been the scene of unusually large epidemics of dengue and chikungunya viruses with Aedes albopictus as the sole vector. After experimental oral infection, Ae. albopictus from La Réunion Island can disseminate both dengue and chikungunya viruses but not the Asian genotype of Zika virus, suggesting a strong midgut barrier to dissemination. Autochthonous transmission of the Asian genotype of Zika virus is improbable on La Réunion Island.

[Psychoactive substances use in Réunion Island and Mayotte, French departments in Indian Ocean]. / Consommation de substances psychoactives à la Réunion et à Mayotte, départements français de l'Océan Indien.

INTRODUCTION: The government plan for the fight against drugs and addictive behaviors 2013-2017 includes several actions concerning French overseas territories, in particular to strengthen information on drug addiction. The Interministerial mission for combating drugs and addictive behaviors (MILD&CA) has commissioned the Bordeaux addictovigilance center to strengthen exchanges on addictovigilance with Réunion Island and Mayotte and to make an inventory of problematic drug use in these two French departments of Indian Ocean. METHOD: Two pharmacologists went on an assignment 4.5 days in Reunion and 2 days in Mayotte and met more than fifty people involved in addictology. RESULTS: In Reunion Island, alcohol is the psychoactive substance by far the most used, followed by zamal, the local name for cannabis. There is a strong tradition of medicines diversion, including trihexyphenidyl, barbiturates and more recently, benzodiazepines. Heroin and cocaine are rarely available. Poly drug use is common. In Mayotte, bangué, the local name for cannabis, is the most used psychoactive substance. The use of "chimique" has emerged in 2012-2013. It is used mainly by teenagers and young adults, causing numerous cases of hospitalizations and consultations in addictology in 2015. These could be synthetic cannabinoids bought on the Internet. DISCUSSION: It is important to report new or serious cases to better take into account the particularities of these two departments in the French addictovigilance data and to enable analysis of substances consumed.

Analysis of Solar Irradiation Time Series Complexity and Predictability by Combining Kolmogorov Measures and Hamming Distance for La Reunion (France).

Analysis of daily solar irradiation variability and predictability in space and time is important for energy resources planning, development, and management. The natural variability of solar irradiation is being complicated by atmospheric conditions (in particular cloudiness) and orography, which introduce additional complexity into the phenomenological records. To address this question for daily solar irradiation data recorded during the years 2013, 2014 and 2015 at 11 stations measuring solar irradiance on La Reunion French tropical Indian Ocean Island, we use a set of novel quantitative tools: Kolmogorov complexity (KC) with its derivative associated measures and Hamming distance (HAM) and their combination to assess complexity and corresponding predictability. We find that all half-day (from sunrise to sunset) solar irradiation series exhibit high complexity. However, all of them can be classified into three groups strongly influenced by trade winds that circulate in a "flow around" regime: the windward side (trade winds slow down), the leeward side (diurnal thermally-induced circulations dominate) and the coast parallel to trade winds (winds are accelerated due to Venturi effect). We introduce Kolmogorov time (KT) that quantifies the time span beyond which randomness significantly influences predictability.

Spatial and Temporal Non-Linear Dynamics Analysis and Predictability of Solar Radiation Time Series for La Reunion Island (France).

Analysis of daily solar irradiation variability and predictability in space and time is important for energy resources planning, development, and management. The natural intermittency of solar irradiation is mainly triggered by atmospheric turbulent conditions, radiative transfer, optical properties of cloud and aerosol, moisture and atmospheric stability, orographic and thermal forcing, which introduce additional complexity into the phenomenological records. To address this question for daily solar irradiation data recorded during the period 2011-2015, at 32 stations measuring solar irradiance on La Reunion French tropical Indian Ocean Island, we use the tools of non-linear dynamics: the intermittency and chaos analysis, the largest Lyapunov exponent, Sample entropy, the Kolmogorov complexity and its derivatives (Kolmogorov complexity spectrum and its highest value), and spatial weighted Kolmogorov complexity combined with Hamming distance to assess complexity and corresponding predictability. Finally, we have clustered the Kolmogorov time (that quantifies the time span beyond which randomness significantly influences predictability) for daily cumulative solar irradiation for all stations. We show that under the record-breaking 2011-2012 La Nina event and preceding a very strong El-Nino 2015-2016 event, the predictability of daily incident solar energy over La Réunion is affected.

Prevalence, treatment and control of hypertension in La Réunion: the RÉDIA population-based cohort study.

A better knowledge of prevalence, management and determinants of hypertension is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention, and to reduce the burden of cardiovascular diseases. We conducted a prospective cohort study including 4610 participants aged between 18 and 69 years and representative of the general population of La Réunion, a French overseas island located in the western Indian Ocean. The median time between inclusion and follow-up was 7.4 years. Blood pressure data at baseline and follow-up of 3087 participants were analyzed. We found a high prevalence of hypertension, especially in women (36.7% [34.5-39.0]) and in men (40.3% [37.6-43.0]) and in the under 30s (17.1% [14.0-20.5]), with an increase of 10% at follow-up. Treatment rates were very low in men (19.5% versus 39.1% in women) as was awareness of their condition (25.7% versus 44.6%). Blood pressure control rates were similar (18% at baseline and 34% at follow-up for both sexes). Diagnosis of hypertension at follow-up among subjects normotensive at baseline was independently associated with obesity at baseline (relative risk (RR) = 1.40 [1.12-1.75] for BMI between 27 and 30 kg/m2 and 1.72 [1.33-2.25] for BMI ≥30 kg/m2 as compared with BMI <27 kg/m2) and HbA1C (RR =1.12 [1.05-1.19] per %), suggesting a prominent role of insulin resistance in our population. Our study provides original data that cannot be assimilated to any existing model and should guide the implementation of original community-based programs in such countries.

[Taxation of traditional rums in French overseas territories and public health: The example of Reunion Island]. / Fiscalité des rhums traditionnels en outre-mer et santé publique : l'exemple de l'île de La Réunion.

BACKGROUND: France has a complex system for the taxation of alcoholic beverages. In the French overseas territories (FOT), the system includes little-known specificities whose purpose is to preserve the sugar-cane-rum sector, a pillar for the weak economies in these territories. Taxes are reduced for traditional rums produced and sold locally. This favors the marketing of alcoholic spirits at low prices. In metropolitan France, on the contrary, spirits are heavily taxed drinks and their share in consumption is minor. Reunion Island (RI) is a FOT confronted with significant socioeconomic precariousness and with one of the highest national morbidity and mortality rates associated with alcohol abuse. Spirits account for half of the total consumption of pure alcohol, with a strong predominance for local traditional rums. These products are preferentially consumed by vulnerable subjects, often affected by an alcohol-use disorder. METHODS: This study consists of three parts. First, a comparative analysis of alcoholic beverage prices between RI and mainland France. Second, an analysis of the bibliography on the consequences of preferential consumption of spirits. Third, a literature review on the impact of taxation on alcohol-related morbidity and mortality. RESULTS: In France, the cheapest gram of pure alcohol is found in the FOT. The preferential consumption of spirits is associated with more frequent and more rapid complications. It is correlated with the level of alcoholic psychoses. Taxation is effective in reducing damage caused by the abuse of alcoholic beverages. The World Health Organization recommends the application of a minimum price for alcohol and tax increases. CONCLUSION: The reduced taxation of the traditional rums of the FOT does not take into account public health data. Its purpose is economic. In RI, it contributes to a high level of consumption of spirits and encourages excess mortality through alcohol abuse. It constitutes an inequality of health for these populations. Changes in this tax system is desirable in order to reduce the harm caused by alcohol. It should be closer to the tax system in force in metropolitan France. Alcohol lobbies and lack of political courage have so far inhibited this change to the detriment of the health of the populations.

Oxygen-induced social behaviours in Pristionchus pacificus have a distinct evolutionary history and genetic regulation from Caenorhabditis elegans.

Wild isolates of the nematode Caenorhabditis elegans perform social behaviours, namely clumping and bordering, to avoid hyperoxia under laboratory conditions. In contrast, the laboratory reference strain N2 has acquired a solitary behaviour in the laboratory, related to a gain-of-function variant in the neuropeptide Y-like receptor NPR-1. Here, we study the evolution and natural variation of clumping and bordering behaviours in Pristionchus pacificus nematodes in a natural context, using strains collected from 22 to 2400 metres above sea level on La Réunion Island. Through the analysis of 106 wild isolates, we show that the majority of strains display a solitary behaviour similar to C. elegans N2, whereas social behaviours are predominantly seen in strains that inhabit high-altitude locations. We show experimentally that P. pacificus social strains perform clumping and bordering to avoid hyperoxic conditions in the laboratory, suggesting that social strains may have adapted to or evolved a preference for the lower relative oxygen levels available at high altitude in nature. In contrast to C. elegans, clumping and bordering in P. pacificus do not correlate with locomotive behaviours in response to changes in oxygen conditions. Furthermore, QTL analysis indicates clumping and bordering to represent complex quantitative traits. Thus, clumping and bordering behaviours represent an example of phenotypic convergence with a different evolutionary history and distinct genetic control in both nematode species.

Contrasted accumulation patterns of persistent organic pollutants and mercury in sympatric tropical dolphins from the south-western Indian Ocean.

Due to their high trophic position and long life span, small cetaceans are considered as suitable bioindicators to monitor the presence of contaminants in marine ecosystems. Here, we document the contamination with persistent organic pollutants (POPs) and total mercury (T-Hg) of spinner (Stenella longirostris, n =21) and Indo-Pacific bottlenose dolphins (Tursiops aduncus, n=32) sampled from the coastal waters of La Réunion (south-western Indian Ocean). In addition, seven co-occurring teleost fish species were sampled and analyzed as well. Blubber samples from living dolphins and muscle from teleosts were analyzed for polychlorinated biphenyls (PCBs), DDT and metabolites (DDTs), chlordanes (CHLs), hexachlorocyclohexanes (HCHs), hexachlorobenzene (HCB), and polybrominated diphenyl ethers (PBDEs). Methoxylated PBDEs (MeO-PBDEs), reported as having a natural origin, were also analyzed. T-Hg levels were measured in blubber and skin biopsies of the two dolphin species. Stable isotopes δ(13)C and δ(15)N values were determined in skin of the dolphins and in the muscle of teleosts. For PCBs, HCHs and T-Hg, concentrations were significantly higher in T. aduncus than in S. longirostris. For other POP levels, intra-species variability was high. MeO-PBDEs were the dominant compounds (55% of the total POPs) in S. longirostris, while PCBs dominated (50% contribution) in T. aduncus. Other contaminants showed similar profiles between the two species. Given the different patterns of POPs and T-Hg contamination and the δ(15)N values observed among analyzed teleosts, dietary and foraging habitat preferences most likely explain the contrasted contaminant profiles observed in the two dolphin species. Levels of each class of contaminants were significantly higher in males than females. Despite their spatial and temporal overlap in the waters of La Réunion, S. longirostris and T. aduncus are differently exposed to contaminant accumulation.

[Determinants of human papillomavirus vaccine amongst boys in Reunion Island: Survey of parents and general practitioners]. / Les déterminants de la vaccination anti-papillomavirus humain des garçons à La Réunion : enquête auprès des parents et des médecins généralistes.

OBJECTIVES: To describe the knowledge, barriers and acceptability factors of parents and general practitioners about HPV vaccination amongst boys in Reunion Island, in order to adapt primary prevention locally. METHODS: This was a quantitative, descriptive, cross-sectional, observational study involving 88 parents of boys aged 11 to 19 and 81 general practitioners based in Reunion Island. Both populations volunteered to answer a questionnaire available online or on paper. RESULTS: Parents' knowledge about HPV was insufficient. In Reunion Island, social media and the precarious status of parents play a particularly negative role in the vaccine intention. The number of doctors who have started HPV vaccination on boys is low despite awareness of the recommendation, particularly older doctors who practice alone, in certain sectors of the island. CONCLUSIONS: The young and precarious population of Reunion Island is particularly at risk of pathologies related to HPV and requires adapted prevention to the territory's specificities. It seems necessary to continue to inform general practitioners, in order to promote vaccination and to fight against the misinformation of media about the HPV vaccine.

[Prevalence of menorrhagia among women in Reunion Island]. / Prévalence des ménorragies chez les femmes à la Réunion.

OBJECTIVES: To estimate the prevalence of menorrhagia in women in Reunion Island using the Higham score, to evaluate self-reporting as an alternative diagnostic method, and to study women's level of knowledge about menorrhagia and its impact on their quality of life. METHODS: This was a descriptive, cross-sectional observational study involving 185 adult women with menstrual periods living in Reunion Island. Women volunteered to answer an online self-questionnaire proposed by healthcare professionals from January to May 2023 in Reunion Island. They completed a general information questionnaire, the Higham score, a menorrhagia knowledge questionnaire and a menstrual quality of life questionnaire. RESULTS: The prevalence of menorrhagia in the sample was 48.1% using the Higham score and 46.5% using self-report. Women's level of knowledge about menorrhagia is still insufficient, given the significant impact on quality of life during menstruation among those suffering from this symptom. CONCLUSION: The prevalence of menorrhagia in our sample of women on Reunion Island is high. Measures need to be taken to break the taboos surrounding menstruation, promote menstrual education and foster a better understanding by women of menstrual pathologies, particularly menorrhagia. Early detection of this symptom would enable faster treatment and avoid complications and adverse effects on quality of life.

Consenting rather than choosing. A qualitative study on overseas patients' decision to undergo hematopoietic stem cell transplantation.

OBJECTIVE: Reasons for patients' acceptance of the allogeneic hematopoietic stem cell transplantation (allo-HSCT) proposed and how their decision may be affected by the long distances involved have not been sufficiently investigated so far. We therefore conducted a qualitative study to identify the factors involved in overseas patients' decision to accept allo-HSCT. METHODS: In-depth semi-directive interviews were conducted with overseas allo-grafted patients (n = 22), as well as one non-consenting patient and their caregivers (n = 24). Interviews were analyzed taking an inductive thematic approach. RESULTS: Respondents stated that their decision to undergo the transplantation was constrained by their feeling of being in a therapeutic impasse, the need for a survival strategy, the need to survive for their family's sake, family and doctors' pressures, and the feeling of being managed. The following factors favoring patients' acceptance were the medical information received, their faith, having a family donor, peer testimonies, and positive representations of the transplantation. Factors against patients' acceptance were geographical distance from home to the transplant center, apprehension of protective isolation, fear of dying, and representations of the graft. CONCLUSIONS: These factors, such as patient's personal values and representations, need to be weighed up in order to adapt the information exchanged accordingly. Efforts are required to relieve patients' social isolation and improve the means of providing family support.

[Internet and video games among students of Reunion Island in 2010: uses, misuses, perceptions and associated factors]. / Internet et jeux vidéo chez les étudiants de La Réunion en 2010 : usages, mésusages, perceptions et facteurs associés.

BACKGROUND: Describe the uses of Internet and video games and quantify associated problematic uses. METHODS: Information on student practices concerning the use of the Internet and video games was collected with a self-administered questionnaire. Problematic uses were identified with specific tools (Young criteria and Tejeiro criteria) and with self-evaluative questions. Information on life events with traumatic potential and use of psychoactive substances was also collected. Logistic regression models were applied to identify possible associated factors. RESULTS: Based on a sample of 1119 subjects, this study showed that students in Reunion Island are very concerned by the uses of the Internet and video games (98% and 46% of respondents). The prevalence of problematic use of the Internet accounted for 6% of respondents. Problematic uses of video games involved 8% of students (18% of gamers). Young people seemed unaware of their problematic practices and were seeking informations. The public respondent was also characterized by vulnerable situations (traumatic events induring their lives, consumption of psychoactive substances). Significant associations (with no identified causality) were examined, in particular between problematic uses of Internet and video games, and life events with traumatic potential. CONCLUSION: These first estimates of the prevalence of problematic use of Internet and video games on Reunion Island are important to promote locally collective awareness about these modern addictions. These results will be used to guide local actions of prevention and care, especially among younger generations. But it is necessary to conduct further work to better identify the factors associated with these problematic uses (determinants, comorbidities addictive…).

[Discovery and follow-up of a lead-poisoning outbreak in a shantytown of Le Port, Reunion Island]. / Investigation et gestion d'un foyer de saturnisme infantile dans un quartier de la commune du Port, Île de la Réunion.

BACKGROUND: A national survey conducted in 2008-2009 by the French Institute for Public Health Surveillance for detection of lead impact in childhood identified a high blood lead level in a young boy living in the town of "Le Port", Reunion Island. Previously, cases of lead-poisoning on the island had been exceptional; only a dozen cases were reported in the 1980s in adults, related to the use of lead-containing instruments for food preparations. METHODS: The family of the index case was invited to participate in screening tests and an environmental investigation was conducted using a standardized questionnaire. Screening was then broadened to the neighborhood of the index case and samples of soil outside the home and in the immediate vicinity were taken. The environmental survey was then extended with soil samples taken from the entire geographical area. Information was then provided to local inhabitants (87 families and 287 people) in order to encourage lead blood testing for all children under six years and all pregnant women living in the area. RESULTS: The index case lived in the neighborhood of "The Oasis", a shantytown of Le Port. The results of soil analysis revealed heterogeneous pollution of superficial soils by lead throughout the area of the shantytown, the highest level recorded (5200mg/kg) reached more than 300 times the background level of the natural soils of the island. The screening identified 76 cases of childhood lead-poisoning (blood lead level greater or equal to 100µg/L) among 148 samples (51%). All cases of blood poisoning involved children under the age of 15 years. The median age of children with a positive test was 5.6 years; the median blood lead level was 196µg/L [102-392µg/L]. CONCLUSION: The main hypothesis to explain the contamination of the soil in the area of the shantytown is the presence of waste deposits (car batteries) and diffuse activities of metal recovery. The authorities managed to remove all the families from the environmental exposure to lead by rapidly ensuring rehousing outside the contaminated area.

[Charcot-Marie-Tooth disease associated with periaxin mutations (CMT4F): Clinical, electrophysiological and genetic analysis of 24 patients]. / Maladie de Charcot-Marie-Tooth associée au gène de la périaxine (CMT4F) : description clinique, électrophysiologique et génétique de 24 patients.

Autosomal recessive Charcot-Marie-Tooth disease (AR-CMT) is often characterized by onset in early childhood and severe phenotype compared to the dominant forms. CMT disease associated with periaxin gene (PRX) is rare and characterized by demyelination limited to the major peripheral nerves. Following the discovery of a high frequency of a specific periaxin gene mutation (E1085fsX4 homozygote) in the Reunion Island, we examined all French patients known as carriers of the periaxin gene mutation. There were 24 patients. Eighteen were from the Reunion Island (6 families and 10 sporadic cases). The six remaining patients were in two families, each with two affected individuals, and two sporadic cases. The series included 17 female and seven male patients. Walking was acquired late, on average at 3.4±1.6 years. One patient never learned to walk. The Charcot Marie Tooth Neuropathy Score (CMTNS) averaged 24.5±8.1. Seven patients had been wheelchair-bound since the age of 24±22. Other symptoms were: scoliosis most often observed after the age of 12 years and sometimes complicated by a restrictive respiratory syndrome; foot deformity in 24 patients; strabismus; glaucoma; myopia. When conduction recordings are available, median nerve motor conduction was slow (<10m/s), associated with a major lengthening of distal latencies. Study of the periaxin gene should be considered in patients with severe demyelinating neuropathy associated with early infantile scoliosis. This disease leads to major disability (29% of patients in this series were wheelchair-bound) and to respiratory insufficiency. Genetic counselling is highly recommended for consanguineous families.

Investigation of Dengue Infection in Asymptomatic Individuals during a Recent Outbreak in La Réunion.

The number of dengue cases has increased dramatically over the past 20 years and is an important concern, particularly as the trends toward urbanization continue. While the majority of dengue cases are thought to be asymptomatic, it is unknown to what extent these contribute to transmission. A better understanding of their importance would help to guide control efforts. In 2019, a dengue outbreak in La Reunion resulted in more than 18,000 confirmed cases. Between October 2019 and August 2020, 19 clusters were investigated in the south, west, and east of the island, enabling the recruitment of 605 participants from 368 households within a 200 m radius of the home of the index cases (ICs). No active asymptomatic infections confirmed by RT-PCR were detected. Only 15% were possible asymptomatic dengue infections detected by the presence of anti-dengue IgM antibodies. Only 5.3% of the participants had a recent dengue infection confirmed by RT-PCR. Although the resurgence of dengue in La Réunion is very recent (2016), the rate of anti-dengue IgG positivity, a marker of past infections, was already high at 43% in this study. Dengue transmission was focal in time and space, as most cases were detected within a 100-m radius of the ICs, and within a time interval of less than 7 days between infections detected in a same cluster. No particular demographic or socio-cultural characteristics were associated with dengue infections. On the other hand, environmental risk factors such as type of housing or presence of rubbish in the streets were associated with dengue infections.

[Pediatric medical evacuations from Reunion Island to metropolitan France]. / Évacuations sanitaires pédiatriques en oncologie et en hématologie de l'île de la Réunion vers la France métropolitaine.

BACKGROUND: The only French center for pediatric oncology and hematology outside of the metropolitan territory is in the Indian Ocean, in Saint Denis, on Reunion Island. It welcomes children from Reunion Island but also from Mayotte and neighboring countries. A quarter of them requires a secondary medical transfer to metropolitan France for specific technic care. METHOD: We conducted a retrospective single-center study of all pediatric medical evacuations that occurred between 2015 and 2019 from the pediatric oncology and hematology department of Reunion Island. The purpose of this study is to describe these transfers and the consequences of these care pathways for families and care teams. RESULTS: A total of 189 transfers took place for 105 children: 66 from Reunion Island, 17 from Mayotte and 22 were foreigners. In total, 92 % of the children received the medical care for which they were transferred to metropolitan France. Difficulties were reported: family for 26 % of them, social in 11 % of cases and medical in 10 % of medical records. CONCLUSIONS: This organization allows children in the Indian Ocean to benefit from similar care than metropolitan children. Many difficulties arise in connection with family and societal breakdowns caused by these transfers. These differences and difficulties are important to know to better accompany patients, families and caregivers in this stage of their medical pathways.

[Oncogenetics in the French overseas departments and regions: Situation in Reunion Island]. / Oncogénétique dans les départements et régions d'Outre-mer français : situation à La Réunion.

In view of the use of oncogenetics as a lever for proposing new-targeted therapies whose indications are expanding, this article provides an overview of this discipline in the French overseas departments and regions (DROM). Contrary to the metropolitan departments, where the number of consultations exceeds 100 consultations per 100,000 inhabitants for most centres in 2019, the number of consultations in the DROMs remains insufficient to meet the national average of 117 per 100,000 inhabitants. The financial and structural support offered by the INCa and the DGOS since 2003 has contributed favourably to the deployment of this activity in metropolitan France. This activity, which seems to be suffering in the DROMs, probably requires particular attention in order to understand the difficulties encountered and thus to meet the INCa's objective as well as possible: to identify and support patients with mutations by providing them with appropriate care.