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Biomedical subjects

A Flahault

Publications and source records attributed to A Flahault.

At least 91 records · Page 5Linked to original sources
PubMed1998

Surveillance of influenza-like illness in France. The example of the 1995/1996 epidemic.

STUDY OBJECTIVES: To discover if continuous computerised collection of morbidity data through a medical practice based sentinel network can be used to monitor influenza-like illness (ILI) epidemics. To obtain rough estimates of influenza vaccine effectiveness. DESIGN: Continuous passive surveillance of ILI through a computerised network of voluntary sentinel general practitioners (SGPs) in France (Sentinelle system). SETTING: Five hundred SGPs practices. PARTICIPANTS: Since 1984, SGPs updated a database with information on eight communicable diseases including ILI, via videotext terminals. Each ILI case is defined by the association of a sudden fever of 39 degrees C or above, respiratory symptoms, and myalgias. An ILI epidemic is detected when the national weekly incidence rate exceeds a seasonal threshold for two successive weeks. MAIN RESULTS: An ILI epidemic was reported from November 1995 to January 1996. In total, 13,951 individual cases were reported by SGPs during the epidemic period. The size of the epidemic (number of patients consulting a GP) was estimated to be 2,370,000 subjects. Maps of the epidemic showed that all regions have reported a high level ILI activity. The attack rate was the highest in school age children (13.5/100) and decreased as the age rose. Nearly 6% of the reported ILI cases among adults and elderly were vaccinated. The flu vaccine effectiveness against ILI was estimated to be 66% (95% CI 73%, 92%), ranging between 83% (95% CI 73%, 92%) among the subjects aged 15 to 24 years old to 16% (95% CI -12%, 44%) among the subjects aged 75 years or older. CONCLUSIONS: The Sentinelle system demonstrated adequate sensitivity and timeliness regarding ILI epidemic. Moreover, results of the monitoring were made available on the internet to increase the dissemination of information. Also, estimates of influenza vaccine effectiveness have been easily obtained. Altogether, they represent key points for the control of crisis situation such as ILI epidemics or pandemics.

Adolescent↗
PubMed1998

Epidemiology of chickenpox in France (1991-1995).

STUDY OBJECTIVES: To decide whether a mass immunisation against chickenpox should be or should not be organised, it is important to have up to date data on the disease and to have baseline data to further assess a mass immunisation strategy, if any. DESIGN: Recent chickenpox epidemiology (age and sex distribution, seasonal dynamic and complications) in France are reviewed. SETTING: The system works with about 500 Sentinelle general practitioners (SGPs) and has provided surveillance of frequent communicable diseases in continental France since 1984. PARTICIPANTS: The data were collected by the computerised Sentinelle system. The Sentinelle system uses a videotex server that allows information exchange, data entry, and synthetic return of information. Chickenpox was defined as a sudden onset of typical skin eruption with pruritus, leaving scabs and associated with moderate fever. For each reported case, the SGP gave information on the age of the patient, sex, prevailing childcare for the children, contacts and complications (skin superinfections, lower and upper respiratory infections, conjunctivitis and corneal infections, nervous system injuries, stomatitis and others). Spectral analysis was used to detect cyclical patterns. MAIN RESULTS: Between 1991 and 1995, 15,817 cases of chickenpox were reported and provided the basis for the analysis. The yearly national incidence was 1.0-1.35 cases per 100 inhabitants. A pronounced annual periodicity of the incidence was observed and confirmed by spectral analysis. Ninety two per cent of chickenpox cases occurred in children under 14 years of age with about 5% being under one. Complications were reported in 2% of the cases. Common complications reported were skin superinfections, lower and upper respiratory tract infections. However, 21 cases out of 318 complications were nervous system injuries including six encephalitis or cerebellar ataxia. All these cases recovered completely. CONCLUSIONS: Chickenpox is usually a benign childhood disease. This study affords up to date observations on the disease in France. A large panel of complications has been reported. This paper provides the first attempt to describe the epidemiology of chickenpox in France.

Adolescent↗
PubMed1996

Status of electronic reporting of notifiable conditions in the United States and Europe.

OBJECTIVE: To improve the computer connectivity and network strategies to connect U.S. county health departments (CHDs), state health departments (SHDs), and the Centers for Disease Control (CDC) for reporting notifiable conditions. METHODS: HSPNET-L mailing list discussions and individual Internet communications were used to compare selected features of notifiable conditions networking in the United States, France, and the United Kingdom. RESULTS: In the US, the CHD is the agency that first responds to an infectious disease outbreak on receiving notifications from physicians. Prompt recognition by the SHD that a widespread outbreak has occurred depends on the way in which county data are received, the "age" of the data, and the time taken to analyze them. Similarly, the recognition of the national scale of the outbreak depends on the promptness with which SHDs report to the CDC and the age of the data. An analysis of the French Communicable Disease Network suggests that an expansion of electronic links between US CHDs and SHDs will improve timeliness. Electronic data exchange allows CHDs to set up a local database and reduces transcription errors, mailing costs, and telephone costs. CONCLUSION: A fuller use of e-mail or other electronic communication by US CHDs will allow them to use a local database as a tool for managing local disease outbreaks more effectively and independently. Federal and state agency access to the CHD databases will enable early reporting of epidemic outbreaks. Periodic posting of public health information on Internet servers is recommended for immediate access to the public health data by Internet users worldwide.

Centers for Disease Control and Prevention, U.S.↗
PubMed1996

Increased placental antifibrinolytic potential and fibrin deposits in pregnancy-induced hypertension and preeclampsia.

Preeclampsia is characterized by maternal hypercoagulable state and intravascular coagulation, microthromboses in several organs, and impairment of uteroplacental circulation. Excessive fibrin deposition occurs in the placenta, suggesting that disorders of placental coagulation and fibrinolysis physiologic systems may have a role in hemostasis activation. Term placentas were collected from 17 hypertensive/preeclamptic women and from 17 healthy pregnant women, and processed for both histologic and hemostasis studies. Placental fibrinoid deposition was visualized by cresyl-violet staining and quantified by histomorphometric analysis. The content in hemostasis factors was measured on extracts from homogenized placentas treated by a nonionic detergent. The percentage of villi with fibrinoid deposits was higher in the diseased placentas than in controls: 13.2 +/- 11.2 versus 6.75 +/- 2.7% (p < 0.001) for the total amount of deposits; 4.8 +/- 6.7 versus 1.5 +/- 1.0% (p = 0.04) for perivillous fibrinoid deposits, which are considered as histologic markers of intraplacental fibrin. The content in type 2 plasminogen activator inhibitor (PAI-2) antigen was higher in the diseased placentas than in controls: 124 +/- 8 versus 104 +/- 6 ng/mg placental protein (p = 0.046); there was a negative correlation between PAI-2 antigen and thrombomodulin activity (r = -0.57, p = 0.02) in the diseased placentas. No significant differences were found between the two groups for placental procoagulant tissue factor and anticoagulant thrombomodulin activities, and for the content in plasminogen activators and PAI-1 antigens. Placental antifibrinolytic potential is increased in pregnancy-induced hypertension and preeclampsia. This change, and the association of the highest PAI-2 placental concentrations with the lowest concentrations of thrombomodulin, may contribute to the prethrombotic state and to the excessive placental perivillous fibrin deposition observed in these situations.

Adult↗
PubMed1996

[Management of bronchial infectious episodes in general medicine].

BACKGROUND: Acute bronchitis and chronic obstructive pulmonary disease exacerbations are frequent reasons for consultation with a general practitioner (GP). Since no consensus exists about the use of antibiotics in such indications and little is known about the use of pulmonary function tests in general practice, our objective was to describe GP's attitudes and prescription habits when faced with patients suffering from acute bronchitis (AB) or chronic bronchitis (CB) exacerbation. METHODS: The GPs participating in public health surveillance through the "réseau Sentinelles" (French Communicable Diseases Network) in March 1993 answered a postal questionnaire. This questionnaire collected their clinical attitude and prescriptions for 7 clinical cases of varying severity. RESULTS: 430 (94.7%) of the GPs answered the questionnaire. Of these more than 95% prescribed antibiotics in all the clinical cases, including for common acute bronchitis. Wide spectrum penicillins and macrolides were prescribed significantly less often as the past history increased in severity, whereas tetracyclins and oral cephalosporins were prescribed significantly more often in severe cases. Fluoroquinolones were nearly exclusively reserved for the treatment of advanced CB. Smoking cessation was systematically advised by the GPs. Faced with AB and a smoking history, 44.2% of the GPs prescribed a chest x-ray. In the case of repeat episodes of winter bronchitis, more than 70% of them evoked the diagnosis of CB. 98.% of the GPs had easy access to pulmonary function tests (PFTs) which 69.2% of the GPs prescribed as soon as CB was suspected. CONCLUSION: In the absence of a therapeutical consensus regarding bronchitis, antibiotics were prescribed virtually systematically. PFTs were not yet a routine gesture in general practice even though they were widely available and prescribed.

Acute Disease↗
PubMed1996

The "SentiWeb" method for exploring a database on the Net.

Return of information is one of the main goals of any public health information system. About 25,000 maps and 10,000 graphs may be obtained from the time-series collected in the database of the French Communicable Diseases Network (FCDN). Furthermore, this huge epidemiological atlas is updated each week. What is the optimal way of returning such information? This report discloses the strategies used for enhancing the access facilities to the FCDN database for any users, particularly those without specific training in epidemiology or database query language. The technical options implemented in the SentiWeb server (http:/(/)www.b3e.jussieu.fr) are discussed.

Communicable Diseases↗
PubMed1995

Human papillomavirus infection in the malignant and premalignant head and neck epithelium.

A prospective study was undertaken to determine the prevalence and histological correlates of human papillomavirus infection in the head and neck epithelium. Oral, pharyngeal, and laryngeal paraffin-embedded samples were analyzed by polymerase chain reaction with use of human papillomavirus E6 consensus sequence primers. Human papillomavirus infection was detected in 20 of 126 (15.9%) patients. Twenty-five of 230 (10.9%) samples contained human papillomavirus DNA. Papillomaviruses were detected in 15 of 131 (11.4%) head and neck squamous cell carcinomas, in 3 of 32 (9.4%) dysplasias, and 2 of 19 (10.5%) keratoses. The most commonly identified human papillomavirus in cancerous, precancerous, and keratotic lesions was type 16 (80.0% of the isolates). Five papillomas were shown to contain human papillomavirus type 6. No other lesion in 42 samples contained human papillomavirus. Our data are consistent with the hypothesis that infection with certain types of human papillomavirus contributes to head and neck cancer although this may be so only in a minority of cases. Human papillomavirus infection may play a role in the earliest stages of tumorigenesis, since papillomaviruses can be found in laryngeal premalignant and keratotic lesions, which are closely linked to tobacco use.

Adolescent↗
PubMed1994

A mathematical model for the European spread of influenza.

Following a study modelling the geographical spread of influenza in France, on the basis of population movements through the use of railroad data, we applied the same methodology on a European scale. We simulated an epidemic within a network of 9 European cities (Amsterdam, Berlin, Budapest, Copenhagen, London, Madrid, Milano, Paris, Stockholm), only taking into account regular between-cities air transport. Transportation data were obtained from the International Civil Aviation Organization (1991). The theoretical results show that the time lag for action is probably short (less than one month) after the first detection of an epidemic focus.

Aviation↗
PubMed1993

Resistance to methicillin and virulence of Staphylococcus aureus strains in bacteriemic cancer patients.

OBJECTIVE: To estimate the relation between resistance to methicillin and virulence in strains of Staph. aureus by estimating the survival at day 30. DESIGN: Case control analysis. SETTING: Inpatients at a major Cancer Referral Center. PATIENTS: 21 patients with methicillin-resistant Staph. aureus (MRSA) bactaeremia and 45 patients with methicillin-susceptible Staph. aureus (MSSA) bactaeremia, all treated with vancomycin. MEASUREMENTS AND MAIN RESULTS: Fewer MRSA than MSSA patients were neutropenic (p = 0.04), but more MRSA patients were hospitalized in intensive care units (p = 0.03), had had surgical episodes (p = 0.06). MRSA patients also had more microbiological samples cultured (p = 0.007). The outcome of the bacteriemic episodes in 14 MRSA and 14 MSSA patients matched for these four factors showed that blood cultures from MRSA patients remained positive significantly longer (p = 0.04), but that survival and length of hospital stay were not significantly different. CONCLUSIONS: These results do not indicate that methicillin-resistance in Staph. aureus is associated with increased virulence.

Adolescent↗
PubMed1993

Causality assessment of adverse reactions to drugs--II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge.

Standards are lacking for validation of drug causality assessment methods. An original model is proposed using a positive rechallenge as an external standard. This model was used to validate the novel causality assessment method (RUCAM) described in the previous article (Part I; J Clin Epidemiol 1993; 46: 1323). Seventy seven reports of drug-induced acute liver injuries with positive rechallenge were collected from the medical literature and divided into 49 cases and 28 controls. The RUCAM was applied to information obtained prior to readministration. The score was significantly higher (p < 10(-4)) in cases than in controls with high levels of sensitivity, specificity and predictive values. It is concluded that (1) adverse drug reaction reports with a positive rechallenge can provide a standard for validation of causality assessment methods, (2) RUCAM applied to drug-induced liver injuries has been validated.

Age Factors↗