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The Ministry of Health in Québec requested the National Institute of Excellence in Health and Social Services to produce clinical and implementation recommendations for the prophylaxis, diagnosis, and treatment of Lyme disease.
(i) Describe the process of trialing different modalities of patient engagement as a means to integrate a diversity of patient perspectives and (ii) Describe the learning process of INESSS regarding the integration of the patient perspective.
All documents were analyzed, and a survey with all advisory committee members and semi-structured interviews with stakeholders were conducted. Each interview was transcribed verbatim and imported into QDA miner software for the purposes of analysis. Data analysis was carried out concurrently with data collection to allow for an iterative approach between data collection and analysis.
Five methods to integrate the perspectives of patients were used: (i) interviews with patients, (ii) inclusion of patient partners within the advisory committee, (iii) literature review, (iv) focus groups with one patient association, and (v) feedback from patient associations on recommendations intended for decision makers and other targeted stakeholders. The patient partners influenced decisions by sharing their experiential knowledge. The patient interviews and the literature review added an in-depth perspective on the disease and experience with the healthcare system. The patient association members shared their perspectives and helped disseminate the recommendation to sustain a practice change.
The combination of methods to collect and integrate patients’ knowledge and patient associations’ perspectives helped develop a comprehensive understanding of a controversial object of evaluation.
Raw milk cheeses are commonly consumed in France and are also a common source of foodborne outbreaks (FBOs). Both an FBO surveillance system and a laboratory-based surveillance system aim to detect Salmonella outbreaks. In early August 2018, five familial FBOs due to Salmonella spp. were reported to a regional health authority. Investigation identified common exposure to a raw goats' milk cheese, from which Salmonella spp. were also isolated, leading to an international product recall. Three weeks later, on 22 August, a national increase in Salmonella Newport ST118 was detected through laboratory surveillance. Concomitantly isolates from the earlier familial clusters were confirmed as S. Newport ST118. Interviews with a selection of the laboratory-identified cases revealed exposure to the same cheese, including exposure to batches not included in the previous recall, leading to an expansion of the recall. The outbreak affected 153 cases, including six cases in Scotland. S. Newport was detected in the cheese and in the milk of one of the producer's goats. The difference in the two alerts generated by this outbreak highlight the timeliness of the FBO system and the precision of the laboratory-based surveillance system. It is also a reminder of the risks associated with raw milk cheeses.
La suicidalité à l’adolescence est une question importante de santé publique, en termes de mortalité, de morbidité. Celle-ci est peu évaluée et quantifiée dans les en Martinique au sujet des adolescents. Notre objectif à travers de notre étude prospective exploratoire est de déterminer de la prévalence des tentatives de suicide chez les adolescents en Martinique consultant au CHUM.
Nous avons inclus tous les adolescents âgés de 11 à 18 ans ayant réalisé une tentative de suicide en Martinique, admis sur les différents services d’urgences et de réanimations du CHUM, sur une période continue de 4 mois.
Quarante-trois tentatives de suicide ont été enregistrées au cours de cette période : 88,4 % des cas impliquaient des filles (avec une récidive sur la période d’inclusion), 58,1 % des jeunes ont utilisé comme méthode l’intoxication médicamenteuse volontaire, la majorité concernait des primosuicidants (60,5 %), près de la moitié des cas avait identifié un événement traumatisant, 34,9 % ont déclaré consommer de façon régulière une substance psychoactive enfin 72,5 % des situations ont fait intervenir le SAMU et 65,2 % de ces adolescents ont bénéficié d’une prise en charge hospitalière.
Cette étude pilote permet de contribuer à la description de la tentative de suicide chez les adolescents, qui s’estimerait à 1 tentative de suicide tous les 3 jours, et confirme bien une problématique suicidaire touchant cette population spécifique dans ce département. Elle suggère par ailleurs la nécessité de renforcer l’offre de soins qui semble insuffisante à ce jour. Au vu des résultats de cette étude, l’implication forte du SAMU dans ce travail pourrait être un partenaire idéal dans le repérage de ces conduites suicidaires dans cette région.
Tobacco smoking rate is high (21%) among Romanian adolescents.
To assess youngsters attitudes and beliefs towards tobacco dependence, their compliance to smoking cessation interventions and success rate of a standard smoking cessation program.
Material and Method
231 subjects participated in the Adolescent Smoking Cessation (ASC) pilot program. Subjects were evaluated based on the ASC questionnaire, a validated set of questions about personal data, nicotine addiction profile, willingness to involve in ASC whether current smoker or not. Smoking status was validated by carbon monoxide determination in exhaled air. Participants were delivered 6 interactive ASC sessions about smoking hazards and methods to quit smoking. A final evaluation was done to assess program's impact and to reward quitters and reducers by prizes.
Study group was made of 52.4% every day smokers, 10.4% at least once/week but not every day smokers, 6% less than once/week smokers, 23.4% never smokers and 7.8% ex-smokers. Abstinence rate was 12.3% in every day smokers and 16.6 % in at least once a week but not every day smokers. The program registered a high attendance rate/sessions as 85.2 % of subjects were present in all sessions. Also, significant changes occured in participants beliefs about addiction to tobacco, as evaluated by standard personal smoking and cessation beliefs questionnaire.
ASC was appreciated as an efficient program with 12.3% of daily smokers to quit smoking and its positive impact on personal nicotine addiction beliefs in 90 % of participants.
Smokers with psychiatric comorbidities are prevalent in our current practice. Varenicline (Champix) is a first line pharmacotherapy indicated to treat nicotine addiction.
To assess efficacy and safety of varenicline in current practice of a smoking cessation center treating smokers with high prevalence of psychiatric disorders.
Material and method
128 smokers with concurrent stable psychiatric, respiratory or cardiovascular disorders (study group) and 124 healthy smokers (control group) were treated with varenicline and counseling, for 12 weeks to stop smoking. Abstinence rate was assessed in both groups at 12 weeks. Varenicline safety, cessation profile and compliance to treatment were monitored in psychiatric disorders smokers compared to other co-morbidities and to controls.
54.6 % smokers with comorbidities (12/22 cardiovascular, 14/30 respiratory, 44/76 psychiatric) and 33.8 % healthy smokers successfully quit smoking. Withdrawal symptoms and adverse effects picture did not differ significantly between groups. The figure shows compliance to treatment and number of adverse events in healthy and psychiatric, respiratory and cardiovascular disease smokers.
Compliance to treatment (%)
Adverse effects (n)
Healthy smokers (n=124)
Smokers with psychiatric disorders (n=76)
Smokers with respiratory disorders (n=30)
Smokers with cardiovascular disorders (n=22)
Smokers with psychiatric co-morbidities achieved a higher abstinence rate, compared to respiratory and cardiovascular disease smokers and to control group. Varenicline proved comparable safety in both study and control groups.<a name="_GoBack"></a>
Depression, anxiety and panic disorders are often encountered in chronic respiratory disorders, like chronic obstructive pulmonary disease (COPD), especially in severe disease stages with impaired quality of life.
To assess anxiety, depression and panic disorders among patients diagnosed with COPD and to correlate them with respiratory disease severity and quality of life.
Material and method
We investigated the profile of anxiety, depression and panic attacks in relation to patients’ medical history, demographic data, smoking status, COPD staging and disease severity (estimated by CAT quality of life questionnaire, GOLD guideline staging).
A total of 60 COPD patients were enrolled. Smoking profile showed more intensive smoking in men (35.81 mean packs-years versus 24.38 in women). The COPD high-risk group type D was predominant, with severe dyspnea, decreased lung function, frequent exacerbations and low quality of life (mean CAT score: 21.75). Mean distribution of anxiety and depression symptoms among COPD subjects was corresponding to a 10.65 ± 3.54 SD anxiety score, respectively to 9.93 ± 3.80 SD depression score. Panic attacks were found in 43.3% of the patients.
Anxiety, depression and panic attacks were frequent findings among severe, unstable COPD patients. More carefully screening for anxiety, depression and panic attacks in this category of patients, thus adding a specific psychotherapeutic component to the COPD general treatment plan, would improve patients’ health benefits.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
14C and U/Th methods were used to date three thin carbonate layers deposited on decorated walls of Nerja Cave (Malaga, southern Spain) in order to constrain the age of the parietal non-figurative marks situated under these carbonate layers. Modern formations were also dated to estimate the detritic contribution for the U/Th method and the dead carbon proportion for 14C dating. We sampled two locations with ocher painting marks. In one case (mark 1), the good agreement between the ages obtained by the two methods suggests that the sample was not subjected to post-deposition alteration and that the results are reliable. In the other case (mark 2), the age discrepancy between the two methods reached 30,000 yr, indicating that geochemical alteration had affected the sample and that one or both results were inaccurate. The ages for mark 1 indicate that this type of non-figurative representation is older than 25,000 cal BP and that it can be associated with the oldest attested Paleolithic occupation of Nerja Cave.
Objectives: Medical devices are ubiquitous in modern medical care. However, little is known about the epidemiology of medical devices in the healthcare marketplace, including the rate at which medical devices are subject to recalls or other advisories. We sought to study the epidemiology of medical devices in Canada, focusing on device recalls. In Canada, a recall may signify a variety of events, ranging from relatively minor field safety notifications, to removal of a product from the marketplace.
Methods: We used data from Health Canada to study medical device recalls in Canada from 2005 to 2015. We analyzed the risks of medical device recalls according to the risk class of the device (I lowest; IV highest) and the hazard priority of the recall (Type I highest potential harm; Type III lowest potential harm).
Results: During a 10-year period, there were 7,226 medical device recalls. Most recalls were for intermediate risk class (Class II, 40.1 percent; Class III, 38.7 percent) medical devices. Among recalled devices, 5.0 percent were judged to have a reasonable probability of serious adverse health consequences or death (Type I recall Hazard Priority classification). While the number of medical devices marketed in Canada is not known, over a similar 10-year period, 24,849 new Class II, II, and IV medical device licenses were issued by Health Canada.
Conclusions: Several hundred medical device recalls occur in Canada each year. Further research is needed to characterize the nature of medical device recalls, and to explore how consumers use information about recalls.
Hepatitis C virus (HCV) infection is a public health issue worldwide. Injecting drug use remains the major mode of transmission in developed countries. Monitoring the HCV transmission dynamic over time is crucial, especially to assess the effect of harm reduction measures in drug users (DU). Our objective was to estimate the prevalence and incidence of HCV infection in DU in France using data from a repeated cross-sectional survey conducted in 2004 and 2011. Age- and time-dependent HCV prevalence was estimated through logistic regression models adjusted for HIV serostatus or injecting practices. HCV incidence was estimated from a mathematical model linking prevalence and incidence. HCV prevalence decreased from 58·2% [95% confidence interval (CI) 49·7–66·8] in 2004 to 43·2% (95% CI 38·8–47·7) in 2011. HCV incidence decreased from 7·9/100 person-years (95% CI 6·4–9·4) in 2004 to 4·4/100 person-years (95% CI 3·3–5·9) in 2011. HCV prevalence and incidence were significantly associated with age, calendar time, HIV serostatus and injecting practices. In 2011, the highest estimated incidence was in active injecting DU (11·2/100 person-years). Given the forthcoming objective of generalizing access to new direct antiviral agents for HCV infection, our results contribute to decision-making and policy development regarding treatment scale-up and disease prevention in the DU population.
To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida.
An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted.
An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions.
Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.
Limiting the post-weaning intake of the young rabbit is known to improve its resistance to digestive disorders, whereas a degradation of its housing hygiene is assumed to have a negative impact on its health. This study aims at providing insights into the mechanism of digestive health preservation regarding both host (growth and immune response) and its symbiotic digestive microbiota. A 2×2 factorial design from weaning (day 28) to day 64 was set up: ad libitum intake or restricted intake at 70% of ad libitum, and high v. low hygiene of housing (n=105 per group). At day 36 and day 45, 15 animals/group were subcutaneously immunized with ovalbumin (OVA) to assess their specific immune response. Blood was sampled at 36, 45, 57 and 64 days of age to determine total and anti-OVA immunoglobulin type G (IgG) and haptoglobin levels. The cecal bacterial community was explored (18 per group) by 454 pyrosequencing of genes coding for the 16S ribosomal RNA, whereas cecal pH, NH3 and volatile fatty acid (VFA) concentrations were measured to characterize fermentative activity. A 30% reduction in feed intake reduced the growth by only 17% (P<0.001), and improved the feed conversion ratio by 15% (P<0.001), whereas the degradation of hygiene conditions slightly decreased the feed intake in ad libitum fed rabbits (−3.5%, P<0.02). As poor hygiene conditions did not affect weight gain, feed conversion was improved from day 42 (P<0.05). Restricted feeding led to a lower mortality between day 28 and day 40 (P=0.047), whereas degraded hygiene conditions decreased overall morbidity (7.8% v. 16.6%; P<0.01). Both a reduced intake and low hygiene conditions of housing affected microbiota composition and especially dominant genera belonging to the Ruminococcaceae family (P<0.01). Moreover, low hygiene was associated with a higher Ruminococcaceae/Lachnospiraceae ratio (3.7 v. 2.4; P<0.05). Cecal total VFA and pH were increased (+19%; P<0.001) and decreased (−0.1 pH unit; P<0.05), respectively, in feed-restricted rabbits. Neither specific anti-OVA IgG nor haptoglobin was affected by treatments. Total IgG concentrations were the highest in animals raised in poor hygiene conditions after 8 days of restriction, but decreased after 19 days of restriction in high hygiene conditions (−2.15%; P<0.05). In conclusion, the degradation of hygiene conditions failed to induce a systematic specific and inflammatory response in rabbit, but reduced morbidity instead. Our results suggest that the microbiota composition would be a helpful source of biomarkers of digestive health.
Severe depression can be a life-threatening disorder, especially in
elderly patients. A fast-acting treatment is crucial for this group.
Electroconvulsive therapy (ECT) may work faster than medication.
To compare the speed of remission using ECT v.
medication in elderly in-patients.
The speed of remission in in-patients with a DSM-IV diagnosis of major
depression (baseline MADRS score $20) was compared between 47
participants (mean age 74.0 years, s.d. = 7.4) from an ECT randomised
controlled trial (RCT) and 81 participants (mean age 72.2 years, s.d. =
7.6) from a medication RCT (nortriptyline v.
Mean time to remission was 3.1 weeks (s.d. = 1.1) for the ECT group and
4.0 weeks (s.d. = 1.0) for the medication group; the adjusted hazard
ratio for remission within 5 weeks (ECT v. medication)
was 3.4 (95% CI 1.9–6.2).
Considering the substantially higher speed of remission, ECT deserves a
more prominent position in the treatment of elderly patients with severe
Ruthenium-nitrosyl (RuII(NO)) complexes are stable in the dark, but exhibit a unique photoreactivity which can lead either to a solid state isomerization from RuII(NO) to RuII(ON), or to a nitric oxide (NO·) release in solution. From our recent discovery of a high yield of isomerization (> 92%) in [RuII(py)4Cl(NO)](PF6)2, we have developed a computational strategy aimed at designing switchable nonlinear optical (NLO) material with high contrast (large difference in the on / off NLO response) in the solid state. Our synthetic targets are terpyridine based RuII chromophores in which various substituents can be introduced to adjust the NLO response which, at best, should be vanishing in the off state. Alternatively, these complexes can undergo a photo-induced NO· release in solution, a possibility which becomes increasingly appealing in relation to the discovery of the numerous biological roles of NO·, in the context of the emergence of the photodynamic therapy. A promising fluorene-terpyridine RuII(NO) complex was investigated, which could find an additional interest in relation to its capability for releasing NO· by a two-photon absorption process.
Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention.