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Depression and anxiety are two very common psychiatric disorders in late-life. They are markers of poor quality of life and are strongly associated with death among older people. Yet, few studies on these comorbidities have been conducted in the African population. This study aims to present the epidemiology of depression and anxiety among older people in Central Africa.
A cross-sectional population-based study was carried out in Republic of Congo (ROC) and Central African Republic (CAR) between 2011 - 2012 among older people aged ? 65 years (EPIDEMCA study). Data were collected using a standardized questionnaire and participants underwent a brief physical examination. Depression and anxiety symptoms were ascertained using a community version of the Geriatric Mental State (GMS-B3) and the Automated Geriatric Examination for Computer Assisted Taxonomy diagnostic system (AGECAT), probable cases were defined as having a GMS-AGECAT level of 3 or more. Logistic regression models were used to investigate the association between potential risk factors collected and each symptom.
Overall 2002 participants were included in the EPIDEMCA study (500 in Brazzaville and 529 in Gamboma in ROC, 500 in Bangui and 473 in Nola (473) in CAR). Median age of the participants was 72 years [interquartile range: 68 – 78 years] and females were mostly represented (61.8%). Prevalence was 38.1% (95% Confidence Interval: 35.9% - 40.2%) for depression, 7.7% (95% CI: 6.5% - 8.9%) for anxiety and 5.7% (95% CI: 4.6% - 6.7%) for the co-occurrence of both disorders. For all three outcomes, prevalence was significantly higher among females and in rural areas. Only depression increased with age. Preliminary analyses showed that female sex, living in a rural area, and living without a partner were associated with the three outcomes (Odds Ratios from 1.59 to 3.27; p<0.01). In-depth results regarding correlates of depression, anxiety and the co-occurrence of both will be presented.
The prevalence of depression and anxiety was high among Central African older people. Evidence on the epidemiology of these common psychiatric symptoms are of importance for care management and also emphasize the need to maintain and/or strengthen social support around older people in the region.
Lithium (Li) is the gold standard treatment for bipolar disorder (BD). However, its mechanisms of action remain unknown but include neurotrophic effects. We here investigated the influence of Li on cortical and local grey matter (GM) volumes in a large international sample of patients with BD and healthy controls (HC).
We analyzed high-resolution T1-weighted structural magnetic resonance imaging scans of 271 patients with BD type I (120 undergoing Li) and 316 HC. Cortical and local GM volumes were compared using voxel-wise approaches with voxel-based morphometry and SIENAX using FSL. We used multiple linear regression models to test the influence of Li on cortical and local GM volumes, taking into account potential confounding factors such as a history of alcohol misuse.
Patients taking Li had greater cortical GM volume than patients without. Patients undergoing Li had greater regional GM volumes in the right middle frontal gyrus, the right anterior cingulate gyrus, and the left fusiform gyrus in comparison with patients not taking Li.
Our results in a large multicentric sample support the hypothesis that Li could exert neurotrophic and neuroprotective effects limiting pathological GM atrophy in key brain regions associated with BD.
For the 11th version of the International Classification of Diseases, the WHO recommended to rename transgender transidentity as “gender incongruence”, to remove it from the chapter of mental and behavioral disorders, and to put it in a new category titled “Conditions related to sexual health”. This should contribute to reduce stigmatisation while maintaining access to medical care. One argument in favor of depsychiatrisation is to demonstrate that essential features of gender identity disorders, namely psychological distress and functional impairment, are not necessarily reported by every transgender person, and may result from social rejection and violence rather than dysphoria itself. Initially confirmed in Mexico, these hypotheses were tested in a specific French medical context, where access to care does not require any prior mental health evaluation or diagnosis.
In 2017, 72 transgender persons completed retrospective interviews which focused on the period when they became aware that they might be transgender and perhaps would need to do something about it.
Results showed that psychological distress and functional impairment were not reported by every participant, that they may result from rejection and violence, and especially from rejection and violence coming from coworkers and schoolmates. Additional data showed that the use of health services for body transformation did not depend on distress and dysfunction. Finally, participants preferred ICD 11 to employ “transgender” or “transidentity” rather than “gender incongruence”.
Results support depsychiatrisation. They are discussed in terms of medical, ethical, legal, and social, added values and implications of depsychiatrisation.
This study assessed whether S-100β protein could be measured in urine when detectable in plasma after a mild traumatic brain injury (mTBI). Clinical data, plasma and urine samples were collected for the 46 adult patients prospectively enrolled in the emergency department (ED) of a Level 1 trauma center. S-100β protein concentrations were analysed using ELISA. S-100β protein was detectable in 91% and 71% of plasma and urine samples, but values were not correlated (r = 0.002). Urine sampling would have been a non-invasive procedure, but it does not appear to be useful in the ED during the acute phase after an mTBI.
New technological methods, such as rapidly developing molecular approaches, often provide new tools for scientific advances. However, these new tools are often not utilized equally across different research areas, possibly leading to disparities in progress between these areas. Here, we use empirical evidence from the scientific literature to test for potential discrepancies in the use of genetic tools to study parasitic vs non-parasitic organisms across three distinguishable molecular periods, the allozyme, nucleotide and genomics periods. Publications on parasites constitute only a fraction (<5%) of the total research output across all molecular periods and are dominated by medically relevant parasites (especially protists), particularly during the early phase of each period. Our analysis suggests an increasing complexity of topics and research questions being addressed with the development of more sophisticated molecular tools, with the research focus between the periods shifting from predominantly species discovery to broader theory-focused questions. We conclude that both new and older molecular methods offer powerful tools for research on parasites, including their diverse roles in ecosystems and their relevance as human pathogens. While older methods, such as barcoding approaches, will continue to feature in the molecular toolbox of parasitologists for years to come, we encourage parasitologists to be more responsive to new approaches that provide the tools to address broader questions.
Banked human milk (BHM) has inherent infectious risks, even when pasteurized. Because of the ubiquity of Bacillus cereus in the environment and its ability to resist the Holder pasteurization process, there is a concern that BHM might lead to severe B. cereus infections.
We reviewed observed and published cases to determine the potential causal role of BHM as the source of these infections.
Two infants in the province of Québec (Canada) developed a B. cereus neonatal infection, and both had received BHM. We conducted bacteriological studies to compare clinical isolates and those found in these cases.
After extended culture of BHM retention lots, B. cereus was found to have been involved in batches related to the first case. However, molecular typing showed that the strain was different from the clinical isolate, therefore excluding BHM as the source of contamination. In the second case, a Brevibacillus spp was isolated, a species distinct from the clinical isolate.
Based on these cases and others reported in the literature, a causal link between B. cereus contaminated BHM and preterm neonatal infection has never been documented. Therefore, the risk that BHM can cause this infection remains theoretical. Given the widespread presence of B. cereus in the hospital environment and its capacity to resist standard cleaning procedures, it seems likely that airborne or direct or indirect contact are the main sources of most, if not all, cases of severe B. cereus neonatal infections, even in babies exposed to BHM.
Incentive Spirometry is commonly used for respiratory recovery. The literature on incentive spirometry and its impact on patients with rib fracture is unclear and there are no recommendations regarding its use in the Emergency Department (ED), particularly in rib fracture patients, which are known for increasing the risk of pulmonary complication. Therefore, the objective of this study was to assess the use of incentive spirometry and to measure its impacts on delayed complications in patients discharged from the ED with confirmed rib fracture.
This is a planned sub-study of a prospective observational cohort recruited in 4 Canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with at least one confirmed rib fracture on radiographs were included. Prescription of incentive spirometry was left to attending physician. Main outcomes were development of pneumonia, atelectasis, and hemothorax within 14 days. Propensity score matching analyses were performed.
439 patients were included and 182 (41.5%) patients received incentive spirometry. There were 99 cases of hemothorax (22.6%), 103 cases of atelectasis (23.5%) and 4 cases of pneumonia (0.9%). The use of incentive spirometry was not protector for hemothorax [RR = 1.03 (0.66–1.64)] and atelectasis or pneumonia [RR = 1.07 (0.68–1.72)].
Our results suggest that unsupervised incentive spirometry use does not have a protective effect against delayed pulmonary complications after rib fracture. Further research should be conducted to assess the usefulness of incentive spirometry in specific injured population in the ED.
We study the destabilization of a round liquid jet by a fast annular gas stream. We measure the frequency of the shear instability waves for several geometries and air/water velocities. We then carry out a linear stability analysis, and show that there are three competing mechanisms for the destabilization: a convective instability, an absolute instability driven by surface tension and an absolute instability driven by confinement. We compare the predictions of this analysis with experimental results, and propose scaling laws for wave frequency in each regime. We finally introduce criteria to predict the boundaries between these three regimes.
The conduct of high-quality nutrition research requires the selection of appropriate markers as outcomes, for example as indicators of food or nutrient intake, nutritional status, health status or disease risk. Such selection requires detailed knowledge of the markers, and consideration of the factors that may influence their measurement, other than the effects of nutritional change. A framework to guide selection of markers within nutrition research studies would be a valuable tool for researchers. A multidisciplinary Expert Group set out to test criteria designed to aid the evaluation of candidate markers for their usefulness in nutrition research and subsequently to develop a scoring system for markers. The proposed criteria were tested using thirteen markers selected from a broad range of nutrition research fields. The result of this testing was a modified list of criteria and a template for evaluating a potential marker against the criteria. Subsequently, a semi-quantitative system for scoring a marker and an associated template were developed. This system will enable the evaluation and comparison of different candidate markers within the same field of nutrition research in order to identify their relative usefulness. The ranking criteria of proven, strong, medium or low are likely to vary according to research setting, research field and the type of tool used to assess the marker and therefore the considerations for scoring need to be determined in a setting-, field- and tool-specific manner. A database of such markers, their interpretation and range of possible values would be valuable to nutrition researchers.
Remote sensing is a powerful method to reconstruct annual mass-balance series over past decades by exploiting archives of available images, as well as to study glaciers in inaccessible regions. We present the application of a methodological framework based only on optical satellite images to retrieve glacier-wide annual mass balances for 30 glaciers in the French Alps. The glacier-wide annual mass balance for the period 1983–2014 was reconstructed by combining changes in glacier volumes computed from remote-sensing derived DEMs with annual measurements of the snow line altitude on satellite images. Data from direct observations on two of the glaciers confirmed the accuracy of the annual mass balances quantified by remote sensing with an average difference of ~0.3 m w.e., within the uncertainty range of the methods. Our results confirm the significant increase in mass loss since the early 2000s, with a difference >1 m w.e. a−1 between the periods 1983–2002 and 2003–14. The region-wide mass balance for the French Alps over the period 1979–2011 was −0.66 ± 0.27 m w.e. a−1, close to that of the European Alps. We also show that changes in glacier surface area or length are not representative of changes in mass balance at the scale of a few decades.
The best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive.
We developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU.
We modeled the evolution of an outbreak caused by the admission of a single carrier in a 10-bed ICU free of ESBL-PE. Using data obtained from recent muticenter studies, we studied 26 strategies combining different levels of the following 3 interventions: (1) increasing healthcare worker compliance with hand hygiene before and after contact with a patient; (2) cohorting; (3) reducing antibiotic prevalence at admission with or without reducing antibiotherapy duration.
Improving hand hygiene compliance from 55% before patient contact and 60% after patient contact to 80% before and 80% after patient contact reduced the nosocomial incidence rate of ESBL-PE colonization by 91% at 90 days. Adding cohorting to hand hygiene improvement intervention decreased the proportion of ESBL-PE acquisitions by an additional 7%. Antibiotic restriction had the lowest impact on the epidemic. When combined with other interventions, it only marginally improved effectiveness, despite strong hypotheses regarding antibiotic impact on transmission.
Our results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.
Infect. Control Hosp. Epidemiol. 2016;37(3):272–280
Patients with pulmonary regurgitation after tetralogy of Fallot repair have impaired aerobic capacity; one of the reasons is the decreasing global ventricular performance at exercise, reflected by decreasing peak oxygen pulse. The aims of our study were to evaluate the impact of pulmonary valve replacement on peak oxygen pulse in a population with pure pulmonary regurgitation and with different degrees of right ventricular dilatation and to determine the predictors of peak oxygen pulse after pulmonary valve replacement.
The mean and median age at pulmonary valve replacement was 27 years. Mean pre-procedural right ventricular end-diastolic volume was 182 ml/m2. Out of 24 patients, 15 had abnormal peak oxygen pulse before pulmonary valve replacement. We did not observe a significant increase in peak oxygen pulse after pulmonary valve replacement (p=0.76). Among cardiopulmonary test/MRI/historical pre-procedural parameters, peak oxygen pulse appeared to be the best predictor of peak oxygen pulse after pulmonary valve replacement (positive and negative predictive values, respectively, 0.94 and 1). After pulmonary valve replacement, peak oxygen pulse was well correlated with left ventricular stroke and end-diastolic volumes (r=0.67 and 0.68, respectively).
Our study confirms the absence of an effect of pulmonary valve replacement on peak oxygen pulse whatever the initial right ventricular volume, reflecting possible irreversible right and/or left ventricle lesions. Pre-procedural peak oxygen pulse seemed to well predict post-procedural peak oxygen pulse. These results encourage discussions on pulmonary valve replacement in patients showing any decrease in peak oxygen pulse during their follow-up.
Research suggests that exposure to music may enhance autobiographical recall in Alzheimer's Disease (AD) patients. This study investigated whether exposure to music could enhance the production of self-defining memories, that is, memories that contribute to self-discovery, self-understanding, and identity in AD patients.
Twenty-two mild-stage AD patients and 24 healthy controls were asked to produce autobiographical memories in silence, while listening to researcher-chosen music, and to their own-chosen music.
AD patients showed better autobiographical recall when listening to their own-chosen music than to researcher-chosen music or than in silence. More precisely, they produced more self-defining memories during exposure to their own-chosen music than to researcher-chosen music or during silence. Additionally, AD patients produced more self-defining memories than autobiographical episodes or personal-semantics during exposure to their own-chosen music. This pattern contrasted with the poor production of self-defining memories during silence or during exposure to researcher-chosen music. Healthy controls did not seem to enjoy the same autobiographical benefits nor the same self-defining memory enhancement in the self-chosen music condition.
Poor production of self-defining memories, as observed in AD, may somehow be alleviated by exposure to self-chosen music.
On January 2, 2014, Cyclone Bejisa struck Reunion Island (France). This storm led to major material damages, such as power outages, disturbance of drinking water systems, road closures, and the evacuation of residents. In this context, the Regional Office of French Institute for Public Health Surveillance in Indian Ocean (Cire OI) set up an epidemiological surveillance in order to describe short-term health effects of the cyclone.
The assessment of the health impact was based mainly on a syndromic surveillance system, including the activity of all emergency departments (EDs) and the Emergency Medical Service (EMS) of the island. From these data, several health indicators were collected and analyzed daily and weekly. To complete this assessment, all medical charts recorded in the EDs of Reunion Island from January 2, 2014 through January 5, 2014 were reviewed in order to identify visits directly and indirectly related to the cyclone, and to determine mechanisms of injuries.
The number of calls to the EMS peaked the day of the cyclone, and the number of ED visits increased markedly over the next two days. At the same time, a significant increase in visits for trauma, burns, and carbon monoxide poisoning was detected in all EDs. Among 1,748 medical records reviewed, eight visits were directly related to the cyclone and 208 were indirectly related. For trauma, the main mechanisms of injury were falls and injuries by machinery or tools during the clean-up and repair works. Due to prolonged power outages, several patients were hospitalized: some to assure continuity of care, others to take care of an exacerbation of a chronic disease. An increase in leptospirosis cases linked to post-cyclone clean-up was observed two weeks after the cyclone.
Information based on the syndromic surveillance system allowed the authors to assess rapidly the health impact of Cyclone Bejisa in Reunion Island; however, an underestimation of this impact was still possible. In the near future, several lines of work will be planned by the authors in order to improve the assessment.
VilainP, PagèsF, CombesX, Marianne Dit CassouPJ, Mougin-DamourK, Jacques-AntoineY, FilleulL. Health Impact Assessment of Cyclone Bejisa in Reunion Island (France) Using Syndromic Surveillance. Prehosp Disaster Med. 2015;30(2):1-8
Since 1991, in France, studies on the conditioning of iodine were carried out to assess the potential of several specific inorganic host matrices. The apatite family has been mainly studied because of its good chemical durability and its ability to confine iodine over geological time scales. A lead-bearing apatite, Pb10(VO4)4.8(PO4)1.2I2, and a calcium-bearing apatite, Ca10(PO4)6(OH)2-x(IO3)x, were selected on the basis of their incorporation rate (between 7 and 10 wt.%) and a satisfactory resistance to leaching (V0(50 °C, pure water) ∼ 10-2 g.m-2.d-1; Vr(50 °C, pure water) < 10-4 g.m-2.d-1). However, with such materials, the removal of open porosity requires non conventional sintering techniques like spark plasma sintering to decrease the surface exposed to water. This is why, in parallel, other matrices, like silver phosphate glasses, have also been investigated. To improve the chemical durability and thermal properties of these glasses, cross-linking reagents were added to their formulation.
The supply of glacier water to La Paz city, Bolivia, between 1963 and 2006 was assessed at annual and seasonal timescales based on the mass-balance quantification of 70 glaciers located within the drainage basins of La Paz. Glaciers contributed ∼15% of water resources at an annual scale (14% in the wet season, 27% in the dry season). Uncertainties in our estimation are related to the assumed constant precipitation (∼0.5% for ice-free areas and up to 6.5% for glaciated areas), the constant runoff coefficient (∼1%), the surface areas of the glaciers and catchments (∼5%) and the mean mass-balance uncertainty of the 21 glaciers used to obtain the mass balance of the 70 glaciers (12% of the total discharge). Despite the loss of 50% of the glacierized area during the study period, runoff at La Paz did not change significantly, showing that increase in ice melt rates compensated for reduction in the surface area of the glaciers. In the future, assuming complete disappearance of the glaciers and no change in precipitation, runoff should diminish by ∼12% at an annual scale, 9% during the wet season and 24% during the dry season.
One century after its discovery, the Columns Tomb of Kumbi Saleh (Mauritania) remains an archaeological riddle. Since 1914, six field programs have been successively carried out at the medieval urban site of Kumbi Saleh, which now is commonly identified as Ghana. The latter was the famous capital city of the medieval West African state, which controlled the gold mines of West Africa and was involved in the gold trade with North Africa and the Mediterranean Basin. However, interpretation of the tomb, the largest structure from the necropolis, is still an issue as its dating itself has never been firmly established. As a consequence, scholars have usually referred to an unsatisfactory timeframe spanning 1000 years. The study of this monument was recently resumed, motivated by the rediscovery of bones collected in the tomb in 1914 and stored at the Musée de 1'Homme (Paris, France). AMS radiocarbon dating of the bone and tooth apatite fraction of three skulls demonstrates that the three individuals occupying the main vault of the tomb died between the end of the 11th century and the 12th century, precisely at the time of expansion of the Muslim Almoravid movement south of Sahara.