Introduction La plupart des patients diabétiques de type 2 sont suivis par leurs médecins généralistes, auprès desquels l’acquisition de connaissances est souvent rendue difficile par le manque de ...temps qu’ils peuvent leur consacrer. Patients et méthodes Nous avons mené une étude prospective multicentrique (8 cabinets de médecine générale) basée sur un questionnaire simple, afin d’explorer les niveaux de connaissances sur leur maladie, d’une population de diabétiques de type 2 de la région Pays de la Loire. Cinq axes ont été explorés : connaissances générales sur le diabète, alimentation, complications, traitements, besoins informatifs et associatifs. Résultats Les caractéristiques cet effectif de 130 patients étaient les suivantes : âge moyen 65,6 ans, 55 % d’hommes, HbA1c moyenne 7,76 %, diabétiques depuis plus de 10 ans pour 43 % d’entre eux. Si leur niveau de connaissance est satisfaisant pour les règles d’hygiène alimentaire (91 %), la compréhension des traitements (89 %), le rôle de l’activité physique (89 %), les risques cardiovasculaires (87 %), il est par contre moyen concernant l’hémoglobine glyquée (35,5 % peuvent la citer) et faible quant à l’impact de la glycémie sur la grossesse (32 %) ou les règles sociales (12 %). Par ailleurs et surtout, la majorité des patients (77 %) pensent qu’un bon équilibre glycémique, ne minore pas le risque ultérieur de complications graves. Discussion Si à l’analyse croisée des résultats, le niveau de connaissances semble meilleur avec l’ancienneté du diabète, le fatalisme de la plupart des diabétiques s’agissant des risques de morbidité reste surprenant. Le collège national des médecins généralistes soutenant l’implication de ses membres en matière d’éducation pour lutter contre une certaine inertie thérapeutique, cette perception biaisée de la maladie doit être soulignée pour qu’une écoute empathique, dans le cadre d’entretiens motivationnels simples mais répétés et décomposés en micro-actions et micro-cibles, soit mieux intégrée dans leur approche des patients.
Advanced bronchoscopy techniques such as electromagnetic navigation (EMN) have been studied in clinical trials, but there are no randomized studies comparing EMN with standard bronchoscopy.
To ...measure and identify the determinants of diagnostic yield for bronchoscopy in patients with peripheral lung lesions. Secondary outcomes included diagnostic yield of different sampling techniques, complications, and practice pattern variations.
We used the AQuIRE (ACCP Quality Improvement Registry, Evaluation, and Education) registry to conduct a multicenter study of consecutive patients who underwent transbronchial biopsy (TBBx) for evaluation of peripheral lesions.
Fifteen centers with 22 physicians enrolled 581 patients. Of the 581 patients, 312 (53.7%) had a diagnostic bronchoscopy. Unadjusted for other factors, the diagnostic yield was 63.7% when no radial endobronchial ultrasound (r-EBUS) and no EMN were used, 57.0% with r-EBUS alone, 38.5% with EMN alone, and 47.1% with EMN combined with r-EBUS. In multivariate analysis, peripheral transbronchial needle aspiration (TBNA), larger lesion size, nonupper lobe location, and tobacco use were associated with increased diagnostic yield, whereas EMN was associated with lower diagnostic yield. Peripheral TBNA was used in 16.4% of cases. TBNA was diagnostic, whereas TBBx was nondiagnostic in 9.5% of cases in which both were performed. Complications occurred in 13 (2.2%) patients, and pneumothorax occurred in 10 (1.7%) patients. There were significant differences between centers and physicians in terms of case selection, sampling methods, and anesthesia. Medical center diagnostic yields ranged from 33 to 73% (P = 0.16).
Peripheral TBNA improved diagnostic yield for peripheral lesions but was underused. The diagnostic yields of EMN and r-EBUS were lower than expected, even after adjustment.
In France, clinical research involving human beings is regulated by the Jardé's law since November 2016. The law distinguishes interventional and non-interventional studies. Both need to be ...authorized by a Persons Protection Committee. Studies performed on medical data collected during standard clinical care are not considered as studies involving human beings. Medical data are personal data. French Data Protection Authority National has an important role, guarantying the respect of regulation on personal data. We summarize in this article the different types of studies and the role of regulatory authorities.
Since the early 1990s, phytoplankton has been studied and monitored in Potter Cove (PC) and Admiralty Bay (AB), King George/25 de Mayo Island (KGI), South Shetlands. Phytoplankton biomass is ...typically low compared to other Antarctic shelf environments, with average spring–summer values below 1 mg chlorophyll a (Chl a) m−3. The physical conditions in the area (reduced irradiance induced by particles originated from the land, intense winds) limit the coastal productivity at KGI, as a result of shallow Sverdrup’s critical depths (Zc
) and large turbulent mixing depths (Zt
). In January 2010 a large phytoplankton bloom with a maximum of around 20 mg Chl a m−3, and monthly averages of 4 (PC) and 6 (AB) mg Chl a m−3, was observed in the area, making it by far the largest recorded bloom over the last 20 yr. Dominant phytoplankton species were the typical bloom-forming diatoms that are usually found in the western Antarctic Peninsula area. Anomalously cold air temperature and dominant winds from the eastern sector seem to explain adequate light : mixing environment. Local physical conditions were analyzed by means of the relationship between Zc
and Zt
, and conditions were found adequate for allowing phytoplankton development. However, a multiyear analysis indicates that these conditions may be necessary but not sufficient to guarantee phytoplankton accumulation. The relation between maximum Chl a values and air temperature suggests that bottom-up control would render such large blooms even less frequent in KGI under the warmer climate expected in the area during the second half of the present century.
Burden of disease studies have been implemented in many countries using the disability-adjusted life year (DALY) to assess major health problems.
We applied methods developed by the World Bank and ...World Health Organization (WHO) to data specific to the United States to compute DALYs. We compared the results of this analysis to international estimates published by WHO for developed and developing regions of the world.
In the mid-1990s, the leading sources of premature death and disability in the United States, as measured by DALYs, were cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the U.S. population, particularly among racial/ethnic minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries.
This analysis provides the first detailed, comprehensive estimates using DALYs of the fatal and nonfatal conditions that exact large health burdens in the United States.
Many patients with lung cancer will develop symptoms related to their disease process or the treatment they are receiving. These symptoms can be as debilitating as the disease progression itself. To ...many physicians these problems can be the most difficult to manage.
A detailed review of the literature using strict methodologic review of article quality was used in the development of this article. MEDLINE literature reviews, in addition to Cochrane reviews and other databases, were used for this review. The resulting article lists were then reviewed by experts in each area for quality and finally interpreted for content.
We have developed recommendations for the management of many of the symptom complexes that patients with lung cancer may experience: pain, dyspnea, airway obstruction, cough, bone metastasis, brain metastasis, spinal cord metastasis, superior vena cava syndrome, hemoptysis, tracheoesophageal fistula, pleural effusions, venous thromboembolic disease, depression, fatigue, anorexia, and insomnia. Some areas, such as dyspnea, are covered in considerable detail in previously created high-quality evidence-based guidelines and are identified as excellent sources of reference. The goal of this guideline is to provide the reader recommendations based on evidence supported by scientific study.
Improved understanding and recognition of cancer-related symptoms can improve management strategies, patient compliance, and quality of life for all patients with lung cancer.
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.
The emergence of SARS-CoV-2 was accompanied by great uncertainty regarding the main epidemiological characteristics of the transmission. In a context where epidemiological surveillance was mainly ...targeted on symptomatic patients, we assessed the extent of SARS-CoV-2 transmission in French Guiana conducting an intra-household transmission study and population-based seroprevalence surveys repeated over time.
Household monitoring included virological and clinical follow-up for all household members for the first 28 days after the date of confirmation of the index case and serological follow-up over a 12-month period. Three seroprevalence surveys were conducted in July and September 2020 and in September 2021.
A total of 57 dwellings including 245 individuals were included in the intra-household study. The average time between the date of onset of symptoms and the date of confirmation of diagnosis and inclusion in the study was 4.2 days and 7.2 days respectively. Secondary transmission was found in three quarters of households with a secondary infection rate of 35%. The highest transmission rate were observed in the most disadvantaged populations, within couples and from adults to children. Population-based seroprevalence studies have made it possible to monitor seroprevalence rates, which have varied from 15% at the time of the epidemic peak of the first epidemic wave to 65% of the population at the beginning of the fourth wave, despite the low impact of vaccination in French Guiana.
The results obtained highlighted a high transmission of the virus in French Guiana associated with a low severity rate linked to the structure of the particularly young population. The project has provided health authorities with useful data to support prevention and control strategies and has allowed to evaluate the impact of interventions implemented during the pandemic.
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.
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.
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).
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%.
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.
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