Analyse des demandes d’appui en matière de prévention et contrôle de l’infection d’un CPias pendant la crise COVID-19

Introduction

Pendant la crise sanitaire liée au SARS-CoV-2, le Centre d’appui pour la Prévention des infections associées aux soins (CPias) a fortement été sollicité par les différents secteurs de l’offre de soins. Un outil informatique commun a été créé en 2019 pour tracer les demandes d’appui du CPias. L’objectif est d’analyser les thèmes abordés, les demandeurs et les réponses émises.

Matériels et méthodes

La saisie de ces données se fait à partir d’un formulaire en ligne. L’analyse des données est réalisée avec le logiciel statistique SAS®. Après un contrôle de la qualité des données, une analyse descriptive des conseils donnés a été réalisée. Ainsi, les variables recensées sont : la date, la fonction des appelants, le statut et le type de leurs établissements (sanitaire, ESMS, secteur libéral…) et les thèmes des demandes. Une fois la base de données exportée et les demandes étiquetées « COVID-19 » filtrées, une seconde analyse qualitative des sous-thèmes a été faite.

Résultats

Entre le 1^er février et le 31 mai 2020, le CPias a répondu à 886 sollicitations sur le thème du COVID-19 contre 640 sur toute l’année 2019 (tous thèmes confondus), avec un pic visible autour de la semaine 12. Ainsi, 64 % (466) des demandes émanent d’établissements médicosociaux, 26 % (189) d’établissements sanitaires, 7 % (48) de tutelles et 3 % (22) de la médecine ambulatoire. Quarante-trois pour cent (363) de ces demandes sont faites par des professionnels de santé (à parts égales entre professionnels médicaux et paramédicaux), 26 % (217) par des personnels non soignants (dont 80 % (174) de directeurs de structures médicosociales), 21 % (175) par des hygiénistes (praticiens et infirmiers) et 10 % (90) d’autres professionnels. Les thèmes les plus souvent abordés concernent pour 30 % (264) les équipements de protection individuelle (conseils pour leur bonne utilisation, gestion de la pénurie), pour 23 % (206) l’environnement (entretien des locaux, gestion du risque environnemental) et pour 21 % (185) la conduite à tenir face à des patients/résidents suspects, positifs ou revenant d’hospitalisation. Viennent ensuite des questions sur la conduite à tenir pour les professionnels soit 14 % (123) (suspects/contact, ceux travaillant en ville ou à domicile) et 14 % (120) sur la maladie elle-même (contagiosité, symptômes, prélèvement, unité dédiée aux patients COVID ou suspects). Parfois ces questions ont été relayées aux infectiologues selon le niveau d’expertise requis. Enfin, 11 % (98) des demandes sont d’ordre organisationnel autour des flux internes et de l’organisation des consultations.

Conclusion

Le CPias a été très investi dans ses missions régionales de prévention et contrôle de l’infection pendant cette crise sanitaire. Nous en tirons que de nombreux acteurs en santé avaient besoin d’une adaptation ou d’une interprétation pratique des doctrines nationales et/ou d’être confortés dans les conduites à tenir. L’analyse montre également la diversité des appelants sortants du cadre habituel de nos interlocuteurs témoignant de l’importance de l’épidémie.

Stress in people at high risk for psychosis

Background

Stress is a key feature of many aetiological models of psychosis and there is considerable empirical evidence implicating stress in the development of psychosis. This paper investigates the role of psychosocial stress in the onset of psychosis by examining the relationship between current and lifetime exposure to traumatic experiences and psychosocial stressors, HPA axis function, and psychopathology in people at high risk of developing psychosis.

Methods

Sixty ‘high risk’ (HR) participants were compared with 50 healthy control (HC) participants on measures of exposure to psychosocial stressors. Subgroups of HR and HC participants which provided saliva samples were compared regarding measures of HPA axis function.

Results

HR participants were exposed to greater levels of psychosocial stress than HC participants. Specifically, HR participants were more likely to have been separated from their parents (p = .003), report severe parental antipathy (p = .011), and have been bullied while growing up (p = .024). HR participants experienced greater levels of perceived stress than HC participants (p = .001) and were more likely to have had a negative life event in the previous 6 months (p < .001). Positive correlations were found between current stress and number of life events and attenuated psychotic symptoms (r = .585, p < .001, and r = .384, p = < .001, respectively) in the HR participants.

Discussion

This study shows that people at high risk of developing psychosis experience greater levels of psychosocial stress than matched healthy control participants throughout the lifetime, from early childhood to the present day, and that current stress is strongly associated with psychotic symptomatology.

Genome-wide association and epidemiological analyses reveal common genetic origins between uterine leiomyomata and endometriosis

Uterine leiomyomata (UL) are the most common neoplasms of the female reproductive tract and primary cause for hysterectomy, leading to considerable morbidity and high economic burden. Here we conduct a GWAS meta-analysis in 35,474 cases and 267,505 female controls of European ancestry, identifying eight novel genome-wide significant (P < 5 × 10^-8) loci, in addition to confirming 21 previously reported loci, including multiple independent signals at 10 loci. Phenotypic stratification of UL by heavy menstrual bleeding in 3409 cases and 199,171 female controls reveals genome-wide significant associations at three of the 29 UL loci: 5p15.33 (TERT), 5q35.2 (FGFR4) and 11q22.3 (ATM). Four loci identified in the meta-analysis are also associated with endometriosis risk; an epidemiological meta-analysis across 402,868 women suggests at least a doubling of risk for UL diagnosis among those with a history of endometriosis. These findings increase our understanding of genetic contribution and biology underlying UL development, and suggest overlapping genetic origins with endometriosis.

Body shape and size in 6-year old children: assessment by three-dimensional photonic scanning

Background:

Body shape and size are typically described using measures such as body mass index (BMI) and waist circumference, which predict disease risks in adults. However, this approach may underestimate the true variability in childhood body shape and size.

Objective:

To use a comprehensive three-dimensional photonic scan approach to describe variation in childhood body shape and size.

Subjects/Methods:

At age 6 years, 3350 children from the population-based 2004 Pelotas birth cohort study were assessed by three-dimensional photonic scanner, traditional anthropometry and dual X-ray absorptiometry. Principal component analysis (PCA) was performed on height and 24 photonic scan variables (circumferences, lengths/widths, volumes and surface areas).

Results:

PCA identified four independent components of children's body shape and size, which we termed: Corpulence, Central:peripheral ratio, Height and arm lengths, and Shoulder diameter. Corpulence showed strong correlations with traditional anthropometric and body composition measures (r>0.90 with weight, BMI, waist circumference and fat mass; r>0.70 with height, lean mass and bone mass); in contrast, the other three components showed weak or moderate correlations with those measures (all r<0.45). There was no sex difference in Corpulence, but boys had higher Central:peripheral ratio, Height and arm lengths and Shoulder diameter values than girls. Furthermore, children with low birth weight had lower Corpulence and Height and arm lengths but higher Central:peripheral ratio and Shoulder diameter than other children. Children from high socio-economic position (SEP) families had higher Corpulence and Height and arm lengths than other children. Finally, white children had higher Corpulence and Central:peripheral ratio than mixed or black children.

Conclusions:

Comprehensive assessment by three-dimensional photonic scanning identified components of childhood body shape and size not captured by traditional anthropometry or body composition measures. Differences in these novel components by sex, birth weight, SEP and skin colour may indicate their potential relevance to disease risks.

Different APC genotypes in proximal and distal sporadic colorectal cancers suggest distinct WNT/β-catenin signalling thresholds for tumourigenesis

Biallelic protein-truncating mutations in the adenomatous polyposis coli (APC) gene are prevalent in sporadic colorectal cancer (CRC). Mutations may not be fully inactivating, instead producing WNT/β-catenin signalling levels 'just-right' for tumourigenesis. However, the spectrum of optimal APC genotypes accounting for both hits, and the influence of clinicopathological features on genotype selection remain undefined. We analysed 630 sporadic CRCs for APC mutations and loss of heterozygosity (LOH) using sequencing and single-nucleotide polymorphism microarrays, respectively. Truncating APC mutations and/or LOH were detected in 75% of CRCs. Most truncating mutations occurred within a mutation cluster region (MCR; codons 1282-1581) leaving 1-3 intact 20 amino-acid repeats (20AARs) and abolishing all Ser-Ala-Met-Pro (SAMP) repeats. Cancers commonly had one MCR mutation plus either LOH or another mutation 5' to the MCR. LOH was associated with mutations leaving 1 intact 20AAR. MCR mutations leaving 1 vs 2-3 intact 20AARs were associated with 5' mutations disrupting or leaving intact the armadillo-repeat domain, respectively. Cancers with three hits had an over-representation of mutations upstream of codon 184, in the alternatively spliced region of exon 9, and 3' to the MCR. Microsatellite unstable cancers showed hyper-mutation at MCR mono- and di-nucleotide repeats, leaving 2-3 intact 20AARs. Proximal and distal cancers exhibited different preferred APC genotypes, leaving a total of 2 or 3 and 0 to 2 intact 20AARs, respectively. In conclusion, APC genotypes in sporadic CRCs demonstrate 'fine-tuned' interdependence of hits by type and location, consistent with selection for particular residual levels of WNT/β-catenin signalling, with different 'optimal' thresholds for proximal and distal cancers.

Interpersonal sensitivity in the at-risk mental state for psychosis

BACKGROUND

Interpersonal sensitivity is a personality trait described as excessive awareness of both the behaviour and feelings of others. Although interpersonal sensitivity has been found to be one of the vulnerability factors to depression, there has been little interest in its relationship with the prodromal phase of psychosis. The aims of this study were to examine the level of interpersonal sensitivity in a sample of individuals with an at-risk mental state (ARMS) for psychosis and its relationship with other psychopathological features.

METHOD

Sixty-two individuals with an ARMS for psychosis and 39 control participants completed a series of self-report questionnaires, including the Interpersonal Sensitivity Measure (IPSM), the Prodromal Questionnaire (PQ), the Ways of Coping Questionnaire (WCQ) and the Depression and Anxiety Stress Scale (DASS).

RESULTS

Individuals with an ARMS reported higher interpersonal sensitivity compared to controls. Associations between interpersonal sensitivity, positive psychotic symptoms (i.e. paranoid ideation), avoidant coping and symptoms of depression, anxiety and stress were also found.

CONCLUSIONS

This study suggests that being 'hypersensitive' to interpersonal interactions is a psychological feature of the putatively prodromal phase of psychosis. The relationship between interpersonal sensitivity, attenuated positive psychotic symptoms, avoidant coping and negative emotional states may contribute to long-term deficits in social functioning. We illustrate the importance, when assessing a young client with a possible ARMS, of examining more subtle and subjective symptoms in addition to attenuated positive symptoms.

Impaired verbal self-monitoring in individuals at high risk of psychosis

BACKGROUND

Cognitive models suggest that auditory verbal hallucinations arise through defective self-monitoring and the external attribution of inner speech. We used a paradigm that engages verbal self-monitoring (VSM) to examine whether this process is impaired in people experiencing prodromal symptoms, who have a very high risk of developing psychosis.

METHOD

We tested 31 individuals with an At-Risk Mental State (ARMS) and 31 healthy volunteers. Participants read single adjectives aloud while the source and pitch of the online auditory verbal feedback was manipulated, then immediately identified the source of the speech they heard (Self/Other/Unsure). Response choice and reaction time were recorded.

RESULTS

When reading aloud with distorted feedback of their own voice, ARMS participants made more errors than controls (misidentifications and unsure responses). ARMS participants misidentified the source of their speech as 'Other' when the level of acoustic distortion was severe, and misidentification errors were inversely related to reaction times.

CONCLUSIONS

Impaired VSM is evident in people with an ARMS, although the deficit seems to be less marked than in patients with schizophrenia. Follow-up of these participants may clarify the extent to which the severity of this impairment predicts the subsequent onset of psychosis and development of positive symptoms.

The Scottish Borders general practitioners exercise referral scheme (GPERS)

OBJECTIVE

This article describes the Scottish Borders General Practitioners Exercise Referral Scheme (GPERS). Results from a survey carried out three to five years after participants were first referred to the scheme are described.

DESIGN

A semi-structured postal questionnaire was sent out with a pre-paid reply envelope.

SETTING

Participants who had been referred to GPERS centres in Peebles and Hawick between 1994-1996 inclusive.

SUBJECTS

Three hundred and twenty four participants who were referred to GPERS who were known to be still alive or living in the area.

RESULTS

Forty percent of questionnaires were returned. Over 40% of these respondents were still significantly active at least twice a week. Almost two-thirds of respondents were either a lot or a little more active than when they were first referred. GPERS had helped respondents make other changes to their lives, and almost 90% were either satisfied or very satisfied with GPERS.

CONCLUSION

The features which make GPERS different from most exercise referral schemes are likely to have contributed to its success. GPERS does enable many participants to become more active, independently, for at least three to five years after referral, which will have significant health improvement consequences.

Protection conferred by a fully recombinant sub-unit vaccine against Yersinia pestis in male and female mice of four inbred strains

In this paper, we describe for the first time the use of a fully recombinant sub-unit vaccine for plague. We have compared the protection afforded by the recombinant vaccine against Yersinia pestis in male and female mice of four inbred strains. We also determined the in vivo cellular memory and antibody response after one year. The recombinant vaccine was capable of inducing protective immunity, against subcutaneous and aerosol challenge, in mice from all four strains. Although, there was some breakthrough in the CBA males challenged with 10(7) median lethal dose (MLDs) the other mice regardless of sex or strain were well protected even at this extreme challenge dose. In both male and female mice, the specific IgG titres to both antigens peaked at day 28 and 35 and in female mice these titres were maintained for >1 year.

Iontophoretic vincristine in the treatment of postherpetic neuralgia: a double-blind, randomized, controlled trial

The effect of iontophoretic administration of vincristine in the treatment of postherpetic neuralgia (PHN) was investigated in a prospective, double-blind, placebo-controlled trial. Twenty patients with intercostal or lumbar PHN for more than 6 months that was unresponsive to conventional medical therapy were randomized to receive vincristine 0.01% (n = 11) or saline (n = 9), by iontophoresis over 1 hour daily for 20 days. Demographics and median duration of pain were similar in both groups. Pain scores decreased over the treatment period and were significantly lower on day 20 compared to baseline in both groups. Pain relief was described as moderate or greater in 40% of patients with vincristine and 55% of patients with placebo. There was no statistical difference an actual pain scores on day 20 between the two groups. Moderate or greater pain relief was maintained in 30% of patients with vincristine and 33% of patients with placebo at follow-up on day 90. We conclude that iontophoresed vincristine is no better than iontophoresed saline in the treatment of PHN. The maintained improvement in both groups at 3 months follow-up may reflect the natural history of PHN, or might possibly by related to a beneficial effect of iontophoresis.

The separation of alginate biosynthesis and acetylation in Pseudomonas syringae

Seaweed alginate was acetylated by resting cells of Pseudomonas syringae subsp. phaseolicola ATCC 19304. Physiological studies on this strain and its UV-induced mutants showed no correlation between bacterial alginate biosynthesis and acetylation. Specific yields of alginate and degree of acetylation in these polymers varied with strain and culture medium. This was indirect evidence that alginate biosynthesis is separate from polysaccharide acetylation. It indicated that the enzyme system involved in alginate biosynthesis was not directly linked to alginate acetylation and explained why microbial acetylation of seaweed alginates was possible.Key words: resting cell, Pseudomonas syringae, acetylation, bacterial alginate, seaweed alginate.

The separation of alginate biosynthesis and acetylation in Pseudomonas syringae

Seaweed alginate was acetylated by resting cells of Pseudomonas syringae subsp. phaseolicola ATCC 19304. Physiological studies on this strain and its UV-induced mutants showed no correlation between bacterial alginate biosynthesis and acetylation. Specific yields of alginate and degree of acetylation in these polymers varied with strain and culture medium. This was indirect evidence that alginate biosynthesis is separate from polysaccharide acetylation. It indicated that the enzyme system involved in alginate biosynthesis was not directly linked to alginate acetylation and explained why microbial acetylation of seaweed alginates was possible.

Patient attitudes to perioperative suppository administration for postoperative analgesia

Four hundred surgical patients were questioned preoperatively to ascertain their attitudes to suppository analgesia. Given a choice, 82 per cent of patients expressed a preference for intramuscular administration of diclofenac, with 18 per cent choosing a suppository. Males were more likely than females to choose an intramuscular injection. Males choosing a suppository were more likely to belong to a higher socio-economic group while females choosing a suppository were more likely to be married. Twenty-three per cent of patients who initially opted for intramuscular administration changed to suppository administration when the possibility of pain or discomfort at the injection site was explained. Females who changed to suppository administration were more likely to belong to a higher socio-economic group and to be married. Twenty-seven per cent of patients choosing an intramuscular injection expressed concern if a suppository were to be inserted without consent. Eleven per cent of patients choosing a suppository expressed similar concern. There is an overall reluctance, particularly within the male population to accept suppository analgesia. Patients from higher socio-economic groups may be more willing to accept what they perceive to be less traditional forms of treatment.

The impact of a guideline-driven computer charting system on the emergency care of patients with acute low back pain

Federal guidelines for the treatment of acute low back pain were locally modified and made more specific. These guidelines were then programmed into a rule-based computer charting system which provides real-time advice regarding documentation, testing, treatment, and disposition of emergency department patients with this condition. In a time-series off-on experiment the system was shown to significantly improve documentation of the medical record and discharge instructions. There was little effect on the appropriateness of testing and treatment and the cost of care. These findings contrast with our previous experiment using a similar program for the care of health care workers exposed to body fluids. In that study both the appropriateness of care and the cost-effectiveness of care were substantially improved.

Granular and extra-granular forms of immunoreactive calcitonin in normal rat "C" cells

The intracellular localization of the intermediate calcitonin-related peptides produced during calcitonin maturation (CT, 3.4 Kd) from the polyprotein precursor (15 Kd) has been studied by means of subcellular fractionation of normal adult rat thyroid using a continuous hypertonic Percoll gradient. A fraction B (Bottom), containing the secretory granules, was separated from a fraction T (Top) constituted of rough and smooth membranes devoid of granules. Immunoreactive calcitonin extracted from both fractions was heterogeneous when analysed by gel electrophoresis followed by radioimmunoassay. In fraction T, the immunoreactive molecules assayed were associated with the membranes. Their apparent molecular weights (lower than 18 Kd) were compatible with the intermediates predicted by the aminoacid sequence of the precursor. However the maturation was not complete, as indicated by the absence of the monomer. The smallest molecular weight detected (4-4.5 Kd) was compatible with a calcitonin-katacalcin uncleaved molecule. These data strongly suggest the occurrence of a cleavage separating the N-terminal part of the molecule during the pre-granular step of calcitonin secretory pathway. In the granular fraction, the monomer constituted the granular matrix, representing 65% of the total immunoreactivity. The remainder was associated with the granules membranes, consisting of the 4-4.5 Kd precursor and some 43 Kd material which has already been demonstrated by others to be covalent polymers of calcitonin [17]. It is thus concluded that a second cleavage could take place in the granules where the major immunoreactive form is the processed calcitonin, either as free monomer or as covalent polymers associated with the membrane of the granules.

Elucidation of the nucleotide sequence of chicken calcitonin mRNA: direct evidence for the expression of a lower vertebrate calcitonin-like gene in man and rat

Calcitonin shows considerable divergence in amino acid sequence between lower vertebrates and higher vertebrates. Immunoreactive salmon-like calcitonin molecules are present in the thyroid of man and rat. Elucidation of the almost complete sequence of chicken calcitonin mRNA revealed that the calcitonin precursor in chickens had the same organisation as in higher vertebrates (man and rat) but showed considerable differences in amino acid sequence. cDNA probes specific for chicken calcitonin mRNA hybridized to poly(A)-rich RNA extracted from a case of medullary carcinoma of the thyroid and from murine thyroid. These results suggest the expression in man and rat of a gene coding for an avian calcitonin-like precursor.