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Biomedical subjects

R Salamon

Publications and source records attributed to R Salamon.

At least 163 records · Page 9Linked to original sources
PubMed1975

[Trial of use of computer technology for the assistance of neurologic diagnosis].

This article describes our experience of computer-assisted diagnosis. The original aspects of this work are both the subject chosen and the method used. Our study of clinical and semiological data included the whole of neurological signs above the spinal cord. The interest of the method, based on Bayes theory was in the use of auto-learning and the sample of patients studied as our experience increased. The preliminary results are encouraging, with 85 % correct results, if one considers the first three replies.

Bayes Theorem↗
PubMedDate not supplied

Increased occurrence of depression in psychosis-prone subjects: a follow-up study in primary care settings.

A follow-up survey was performed with a network of general practitioners (GPs) to examine whether a higher proneness for psychosis predicts a greater incidence of depression in subjects with no history of mood disorder. At the first stage of the survey (T1), a self-report questionnaire exploring delusional ideation (Peters et al. Delusional Inventory [PDI-21]) was administered to the patients of the GPs. Information on psychiatric status at the baseline and conclusion of the 12-month follow-up period was provided by the GPs. The present study was restricted to 425 subjects with no lifetime history of depression. An incident depression was diagnosed in 18 subjects. Most items exploring delusional beliefs and hallucinations were more frequently endorsed by subjects with incident depression. Subjects with a PDI-21 score above the 90th percentile at T1 were nine times more likely to present with an incident depression during the follow-up period than those with PDI-21 scores below the 10th percentile. Psychosis proneness is associated with a greater risk for depression, suggesting that a continuum of vulnerability may exist between affective disorder and nonaffective psychosis.

Adult↗
PubMedDate not supplied

Telematics and sentinel health information system with general practitioners in Aquitaine, southwest France.

A sentinel health information system using a telematics system to collect epidemiological data from a network of general practitioners (GPs) making up 5% of the GP population was set up in October 1986 in Aquitaine, France. In the first year, four topics were under surveillance. The GPs reported data for each case diagnosed by filling out a questionnaire displayed on their home terminal (Minitel), which transmitted the data by standard telephone lines to a central minicomputer located in the Bordeaux University Medical Centre. Regular feedback was provided to the participating GPs, public health officials and the Bordeaux Medical School. A detailed report of GP participation is presented, the reliability of our findings is discussed in terms of the motivational factors of participants, and the usefulness of the system is evaluated both for immediate teaching implications and for future research possibilities.

Computer Communication Networks↗
PubMedDate not supplied

[Evaluation of the incidence of hospitalization of patients with psychotic disorders].

The aim of this study was to assess the administrative incidence of psychotic disorders, i.e. the incidence of first hospitalization for such disorders. Consecutively first-admitted patients hospitalized in 4 departments of Bordeaux's psychiatric hospital were included. Patients fulfilled the following inclusion criteria: no previous psychiatric hospitalization; aged 60 years or less; at least one overt psychotic symptom; clear consciousness. Patients were drawn from a 250,000 inhabitants urban catchment area, with an at risk population of 161,698 inhabitants. DSM IV diagnoses were made using the Mini International Neuropsychiatric Instrument (MINI) as well as all available information collected from the patient, the relatives, and from any other informant. A complementary study was performed in the private psychiatric institutions and in the military Hospital of Bordeaux in order to assess the representativeness of the patients hospitalized in the state hospital. 59 patients were included during one year in the state hospital. The raw incidence rate was 0.37 per 1,000 (95% CI; 0.28-0.46). We used a direct standardization on age to calculate the incidence rates ratio to gender. Men were over-representated in the sample, with a standardized incidence ratio in men compared to women equal to 1.87 (95% CI; 1.25-2.8). Psychotic mood disorders had the highest incidence, with an incidence rate equal to 0.15 per 1,000 inhabitants (95% CI; 0.09-0.21). The incidence rate of DSM IV schizophrenia was lower than that of psychotic mood disorders, and was equal to 0.13 per 1,000 (95% CI; 0.08-0.18). Several studies conducted in European and North-American countries have recently suggested that the incidence of schizophrenia may have decreased in the past decades. Since few French studies on the incidence of such disorders have been carried out, it is not possible to assess whether the incidence of schizophrenia is or not decreasing in France. Further studies on the incidence of psychotic disorders are required in other French regions in order to assess the reproductibility of our results, and to have reference data on the incidence of psychotic disorders in the nineties.

Adolescent↗
PubMedDate not supplied

[Education in public health in Mauritius. Presentation of an experience].

In December 1991, fourteen physicians in the public sector received a degree entitled "Methods in public health", awarded by the dean of Université de Bordeaux II (France) and the Mauritius minister of health. The ceremony crowned a two-year course consisting of 350 hours of lectures and other teaching exercises, broken down into 12 subject areas (epidemiology, biostatistics, medical informatics, demographics, health care, planning, health economics, etc.). The graduates did an average of 10 year's field work in a primary health care center. The degree was awarded after completion of a mini-thesis based on an original study of a selected Mauritian public health problem. In 1992 and 1993, a new, shorter course in community health was offered to other Mauritian physicians by staff from Université de Bordeaux II. We consider that such initiatives would be profitable in other countries like Mauritius, where commonly encountered health care problems of the developing countries coexist with those found in the industrialized world. This will also be an important initiative in countries where initial training in various contexts and therefore can benefit from a common continuing medical education, particularly in public health. One key factor in the success of such projects is their full integration within the medical sciences.

Curriculum↗
PubMedDate not supplied

[Attitudes to counseling related to HIV infection screening in Bobo-Dioulasso, Burkina Faso].

Two approaches, a questionnaire administered to pregnant women and interviews independently with selected individuals in posts of responsibility, were used to assess (i) the perception of HIV screening among patients attending a Maternal and Child Health Clinic and (ii) the attitudes of health staff and local authorities. One hundred and thirty five pregnant women were individually interviewed in their native language at the Farakan Maternal and Child Health Clinic, Bobo Dioulasso. Ninety six percent accepted the principle of being screened for HIV, and 91% wanted to be given the result, 46% in the presence of a family member. The person most often chosen to share the announcement of the result was the regular partner. Three physicians, two midwives, a hospital director, a parish priest and a politician were interviewed. One midwife did not approve of offering screening tests in the absence of available treatment. Four of these individuals suggested that the presence of a member of the family during counselling would be valuable to promote a sense of partnership. Many reasons were given to explain the difficulties associated with announcing the results of tests. They included: the absence of treatment; the cost of the test; the lack of confidentiality; psychosocial consequences; the reaction, particularly fear, of the patient; difficulties associated with communication and with changing behavior. These observations contribute to a basis for analysis to develop a local and national consensus about HIV testing and counselling for pregnant woman.

Adolescent↗
PubMedDate not supplied

[The development of public health education: the Mauritius experience].

A public course has been initiated in 1990 in Mauritius for covering the national growing needs of public health specialists. This training course was organized jointly by the Ministry of Health, the University of Bordeaux II and the French Cooperation. After 3 sessions dedicated specifically to the Mauritian physicians, the course has been re-designed for the needs of the other countries of the region. A feasibility study performed in 1994 in the countries of the Indian ocean region showed that during the past decade, the district level had become the focus point to integrate the health programs. This process has progressively transferred a wider and stronger part of the responsibilities from the central level to the district level and the survey showed that most of the health district managers were physicians that did not have the proper background for carrying such responsibilities. According to these results, a course curriculum was created by the Mauritian Ministry of Health and the University of Bordeaux II and submitted to various organisms supporting health program development in the region. This proposal was strongly supported by several agencies (the french Cooperation, Unicef, WHO, World Bank...) who agreed to sponsor candidates for that training course. The first session was organized in 1995, a second one in 1996. This training course is targeted to the medical doctors who are in charge of the management of health services at the district level. It is divided in two parts: A six-weeks intensive training course performed in Mauritius that include formal teaching and practical exercises in small groups for a total of 210 hours. The curriculum is mainly targeted on the various aspects of management as the management of health information (biostatistics epidemiology and computing), the management of human resources, financial resources and material resources. In addition to these main topics, there is an introduction to pedagogy, communication skills and applied research methodology. Following this six-weeks, training the students come back to work in their country and have 8 months to perform a thesis supervised by a local public health specialist. The subject of the thesis has to be closely related with one of the topic taught and should provide an obvious improvement for the public health situation in the district where this physician is acting. In 1995, 22 candidates attend to the course (13 from Madagascar, 4 from Mauritius, 3 from Comoros, 1 from Angola, 1 from Equatorial Guinea and 1 from Tchad), 19 had successively completed all the modules and got the diploma of public health delivered by the University of Bordeaux II. This diploma has been recognized as an equivalent to a master in public health in Mauritius. The evaluation of the courses-performed by the students, the teachers and the financial agencies gave a very positive results although the workload was considered as too important for a six-weeks training course. The recommendations of the 1995 session were included in the 1996 programs which is still on going for 23 candidates. The 97 session will probably extend the number of students up to 40, divided in 4 subgroups for practical exercises. In parallel to the course, a quarterly bulletin will be created and sent to the present and past candidates of this course in order to support a continuous medical education training program targeted to the district physicians.

Communication↗
PubMedDate not supplied

[Statistical results: which method of presentation to chose?].

Hypothesis testing and significance is currently the most widely used method in the medical literature to report statistical results. However, this method has several limitations. The main one is linked to the risk of misinterpretation of the p value. The arbitrariness of the 5 percent value used to determine whether a result is or not statistically significant is not always kept in mind, and the concept of statistical significance might therefore be confused with that of clinical or biological relevance. The misinterpretation pitfalls are mostly linked to the fact that the p value does not give precise indications on the strength of the association and its direction, or on the variability in the sample. Therefore, some experts claim that hypothesis testing and significance should be avoided in reporting statistical results, and that the method based upon estimation and confidence interval should be more widely used. By this latter method, it is possible to know the direction of the association and the effect size (i.e. the strength of the association). The precision of the estimation, i.e. the variability of the estimation in the sample, can be assessed by the width of the confidence interval: the narrower the confidence interval, the more precise the estimation. Therefore, the clinical relevance of the findings is easier to infere from such results than from those only reporting p values. However, the estimation and confidence interval method is not without its own limitations. This method is difficult to apply to non-parametric tests, and for some results, such as the comparison of mortality ratios, the p value is highly informative. On the other hand, the misinterpretation risk is not totally ruled out when estimation and confidence interval method is used. In the situations where both methods can be employed, there is not yet in the scientific community a definite consensus on which method is the best one to report statistical results, hence some experts suggest that both methods can be presented simultaneously, especially for clinical and epidemiological studies.

Confidence Intervals↗
PubMedDate not supplied

[Human immunodeficiency virus infection and AIDS in Aquitaine. 10 years' experience of a hospital information system, 1985-1995. Le Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA)].

OBJECTIVES: To describe the hospital-based information system developed by the GESCA (Clinical epidemiology group on AIDS in Aquitaine) and evaluate the main results obtained over the last 10 years, specifically data related to epidemiological monitoring, medico-economic analysis and clinical research in HIV infection. METHODS: Inclusion criteria were HIV-1 seropositivity confirmed by Western blot, age over 13 years, consultation or hospitalization is one of the 18 participating units. Follow-up data were collected at each hospital visit. RESULTS: On December 31, 1995, 4268 subjects had been registered in the GECSA system, including 25.7% women. Contamination categories were homosexuals 33.4%, intravenous drug abusers 32.8%, heterosexuals 13.9%. A clear drop in the number of new cases in intravenous drug abusers and an increase in the number with heterosexual transmission was observed after 1988. The medico-economic analysis showed that patients followed in the system were in a more advanced stage at registry since 1992. More than half of the subjects are now taking antiretroviral therapy and prophylaxis for opportunistic infections. Clinically, after adjusting data for the major known prognosis factors, the risk of progression to AIDS is higher in homosexuals and intravenous drug abusers than in heterosexuals. Transmission route does not however have any significant effect on survival after development of AIDS. There is no significant difference in outcome of HIV infection between men and women and pregnancy is not associated with poorer outcome. CONCLUSION: This regional registry provides valuable data for epidemiological monitoring, medico-economic analysis, hospital management and clinical research.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[The reduction of mother-child transmission of HIV infection in developing countries: potential intervention strategies, obstacles to implementation and perspectives. The Reduction of Mother-Child Transmission of HIV Infection in Africa Group].

Mother to child transmission (MCT) of Human Immunodeficiency Virus (HIV) is the main cause of the spread of the HIV epidemic in the pediatric population. It is estimated that to date, three million children worldwide have been infected by HIV. The epidemic burden in developing countries is dramatic. Ninety-five percent of the world's HIV-infected women are living in developing countries. In industrialized countries, antiretroviral treatment of pregnant women and newborns with azidothymidine (AZT, ACTG 076 regimen) and discouraging breast feeding by HIV-infected mothers are effectively reducing MCT of HIV. However, there are three major obstacles to the systematic application of these strategies in developing countries: (a) difficulties in implementing the complex AZT administration and its corollary the avoidance of breast feeding; (b) the complexity of the logistics of the ACTG 076 regimen; (c) cost. Indeed, in developing countries the socioeconomic situation of the populations are precarious and health structures and services are underdeveloped. In addition, the anxiety and the reluctance of general population in the face of the HIV problem and the high prevalence of maternal anemia reduce the acceptability and safety of AZT treatment for pregnant women in developing regions. Only interventions that are applicable, acceptable, safe, affordable, of low cost and integrated into health system will be able to reduce HIV MCT. We now know that MCT occurs mostly during the perinatal period and the maternal viral load in blood, in cervical secretions and in breast milk appears to be the main determinant of transmission. Maternal vitamin A deficiency may also favor MCT of HIV. It is however possible that this association is confounded by the relationship between advanced maternal HIV disease (a known risk factor for transmission) and vitamin A deficiency. In spite of these uncertainties concerning determinants of MCT of HIV, several interventions have been designed. The first involves treating the mother with antiretroviral drugs for the perinatal period. The second is vaginal disinfection by application of virucidal antiseptics during the perinatal period. The third is to give vitamin A supplements to pregnant women and children. Finally, passive immunotherapy with anti-HIV antibodies applied to pregnant women and/or new born, may be beneficial. The feasibility, safety and efficacy of these potential interventions have not yet been demonstrated in developing countries. In view of the dramatic spread of HIV infection in these countries, the evaluation of these interventions is of utmost priority. These trials are necessary because of the public health emergency but should be performed in strict respect of human rights and medical ethics.

Anemia↗
PubMedDate not supplied

[Primary chemoprevention of tuberculosis in HIV-infected patients in non-industrialized countries].

In randomized placebo-controlled trials in Haïti, Zambia and Uganda, prophylactic use of isoniazid (INH) for 6 to 12 months reduced the annual incidence of tuberculosis in HIV-infected patients by more than 50 per cent. For several years, WHO, IUTATLD and CDC have recommended that HIV-positive patients testing positive in a PPD test should be treated with INH as a form of anti-tuberculosis chemoprophylaxis (ATC). Whilst these recommendations are easy to follow in industrialized countries, widespread use of ATC in developing countries remains problematic because: (i) It is unknown what proportion of patients are likely to be re-infected at the end of ATC in countries where TB is endemic; (ii) It is possible that resistant bacilli may be selected due to the incomplete exclusion from the ATC program of patients with active TB at enrollment; (iii) It is difficult to identify asymptomatic carriers of M. tuberculosis at enrollment; (iv) It is doubtful that all patients will comply with a treatment regime which lasts several months; (v) The cost of a widespread ATC program, whose full benefit remains to be evaluated, may be difficult to justify. This paper attempts to review these issues and demonstrates the need for more population-based clinical trials in the field.

AIDS-Related Opportunistic Infections↗