Actus Santé

Occupational challenges of health care workers during the COVID-19 pandemic. A qualitative study

Background The COVID-19 pandemic has placed a significant burden on health care systems worldwide with health care workers (HCWs) delivering care under unprecedented conditions. This study deals with HCWs' physical, mental, emotional and professional challenges of working during the COVID-19 pandemic and seeks to understand structural determinants of those challenges. Methods We carried out an exploratory qualitative study in public and private hospitals in Vienna, Austria. HCWs such as medical doctors, qualified nursing staff, nurse assistants, technical and cleaning staff in direct and indirect contact with COVID-19 patients were included. Collected data was analyzed using content analysis. Findings We conducted 30 semi-structured interviews in person and per phone from June 2020 to January 2021. Three overall themes resulted as relevant: challenges due to lack of preparedness, structural conditions, and physical and mental health of HCWs. Lack of preparedness included missing or delayed infection prevention and control (IPC) guidelines, shortages of personal protective equipment (PPE) combined with structural conditions such as staff shortages and overworked personnel. Physical and mental strains resulted from being overworked and working permanently on alert. Further, working in PPE, facing medical uncertainties and the critical conditions of patients were challenging factors. HCWs lacked recognition on multiple levels and dealt with social stigma and avoidance behavior of colleagues, especially in the beginning of the pandemic. Interpretation To mitigate HCWs' occupational health risks and staff turnover, we propose the following context-specific recommendations: Required medical personnel in care of COVID-19 patients, especially nursing staff, should be carefully planned and increased to avert chronic work overload. Intensive training and education in palliative care, as well as in IPC for all HCWs is important. Providing supportive supervision is as essential as appropriate recognition by higher level management and the public. Funding This article has received funding from The Vienna Science and Technology Fund (WWTF) COVID-19 Rapid Response Funding 2020. The funders did not play a role in the decision to publish the article.
Catégories: Actus Santé

Humoral immunogenicity of the seasonal influenza vaccine before and after CAR-T-cell therapy

Recipients of chimeric antigen receptor-modified T (CAR-T) cell therapies for B-cell malignancies are immunocompromised and at risk for serious infections. Vaccine immunogenicity is unknown in this population. We conducted a prospective observational study of the humoral immunogenicity of 2019-2020 inactivated influenza vaccines (IIV) in children and adults immediately prior to (n=7) or 13-57 months after (n=15) CD19-, CD20-, or BCMA-targeted CAR-T-cell therapy, as well as controls (n=8). Individuals post-CAR-T-cell therapy were in remission. We tested for antibodies to 4 vaccine strains at baseline and [≥]1 time point after IIV using neutralization and hemagglutination inhibition assays. An antibody response was defined as a [≥]4-fold titer increase from baseline at the first post-vaccine time point. Baseline A(H1N1) titers in the CAR-T cohorts were significantly lower compared to controls. Antibody responses to [≥]1 vaccine strain occurred in 2 (29%) individuals before CAR-T-cell therapy; one individual maintained a response for >3 months post-CAR-T-cell therapy. Antibody responses to [≥]1 vaccine strain occurred in 6 (40%) individuals vaccinated after CAR-T-cell therapy. An additional 2 (29%) and 6 (40%) individuals had [≥]2-fold increases (at any time) in the pre- and post-CAR-T cohorts, respectively. There were no identified clinical or immunologic predictors of antibody responses. Neither severe hypogammaglobulinemia nor B-cell aplasia precluded antibody responses. These data support consideration for vaccination before and after CAR-T-cell therapy for influenza and other relevant pathogens such as SARS-CoV-2, irrespective of hypogammaglobulinemia or B-cell aplasia. Larger studies are needed to determine correlates of vaccine immunogenicity and durability in CAR-T-cell therapy recipients.
Catégories: Actus Santé

Risk of COVID-19 infection and work place exposure of front-line mass media professionals

Introduction: Mass media plays a crucial role in creating awareness and knowledge sharing in this Corona virus disease 2019 (COVID-19) pandemic. However, the risk of exposure and extent of COVID-19 infection among media professional are less elucidated yet. Therefore, this study was intended to investigate the workplace-related risk of COVID-19 exposure and the association between exposure to COVID-19 and participant's characteristics, including various forms of respiratory protection for mass-media professionals. Methods: This closed web-based cross-sectional survey was conducted among 199 mass-media professionals in Bangladesh by snowball sampling approach. A multivariate logistic regression model was used for the analytical exploration. Adjusted and Unadjusted Odds Ratio (OR) with 95% confidence intervals (95% CI) were calculated for the specified exposures. Chi-square test was used to observe the association. Ethical issues were maintained according to the guidance of the declaration of the Helsinki. Results: Of all, 39.2% of mass-media professionals were tested positive for COVID-19, whereas 6% of symptomatic or suspected participants did not do the test. Mass media professionals who worked in electronic media reported more COVID-19 infection (adjusted odds ratio, AOR= 6.25; 95% Confidence interval: Lower limit 1.43, upper limit 27.43; P =0.02). However, no significant relationship was found between the type of job role and COVID-19 infection. Furthermore, infected colleagues (OR/P=1.92/0.04) were identified as significant contact of acquiring infection. However, the study result showed that reused/new medical mask, homemade/cloth-made mask (vs. use of respirator mask) was not significantly (p=0.82) associated with mass media professional's infection. Conclusions: Professionals working in electronic media were at higher risk of being infected by COVID-19 and mostly acquired from infected colleagues. Using a respirator mask was not associated with a lower risk of test positive infection in mass media professionals. This study will aid the policy maker and public health authorities during the COVID-19 pandemic to make proper implementation strategies. Keywords: COVID-19 infection, Work place exposure, Mass media professionals, Front-liners, SARS-CoV-2.
Catégories: Actus Santé

Precision Medicine Approach to Alzheimer's Disease: Successful Proof-of-Concept Trial

Abstract Importance: Effective therapeutics for Alzheimer's disease and mild cognitive impairment are needed. Objective: To determine whether a precision medicine approach to Alzheimer's disease and mild cognitive impairment, in which potential contributors to cognitive decline are identified and targeted therapeutically, is effective enough in a proof-of-concept trial to warrant a larger, randomized, controlled clinical trial. Rationale: Previous clinical trials for Alzheimer's disease have pre-determined a single treatment modality, such as a drug candidate or therapeutic procedure, that may be unrelated to the primary drivers of the neurodegenerative process. Therefore, increasing data set size to include the potential contributors to cognitive decline for each patient, and addressing the identified potential contributors, may represent a more effective therapeutic strategy. Hypothesis: Alzheimer's disease is a multi-factorial network dysfunction that results from a chronic or repeated insufficiency of support for a neuroplasticity network; thus factors that increase demand -- such as infections or toxin exposure -- or reduce support -- such as reduced energetics or trophic support -- may contribute to the neurodegenerative process. Rectifying this hypothesized network dysfunction represents a rational approach to the treatment of the cognitive decline associated with Alzheimer's disease and mild cognitive impairment. Design: Twenty-five patients with Alzheimer's disease or mild cognitive impairment, with Montreal Cognitive Assessment (MoCA) scores of 19 or higher, were evaluated for markers of inflammation, chronic infection, dysbiosis, insulin resistance, protein glycation, vascular disease, nocturnal hypoxemia, hormone insufficiency or dysregulation, nutrient deficiency, toxin or toxicant exposure (metals, organic toxicants, and biotoxins), genetic predisposition to cognitive decline, and other biochemical parameters associated with cognitive decline. Brain magnetic resonance imaging with volumetrics was performed at baseline and study conclusion. Patients were treated for nine months with a personalized, precision medicine protocol that addressed each patient's identified potentially contributory factors, and cognition was assessed at t = 0, 3, 6, and 9 months. Trial registration and IRB approval: The clinical trial was registered at clinicaltrials.gov (NCT03883633), 1 and approved by the Advarra IRB. Support for the trial: The trial was supported by a grant from the Four Winds Foundation via Evanthea, LLC, and we are grateful to Diana Merriam and Gayle Brown for their interest, discussions, and support. Main Outcome Measures: Trained external raters evaluated the study subjects with the Montreal Cognitive Assessment (MoCA), CNS Vital Signs (a computerized cognitive assessment battery), AQ-21 (a subjective scale completed by the significant other or study partner), and AQ-C change scale (a subjective scale of cognitive improvement or decline, completed by the significant other or study partner). Follow-up brain MRI with volumetrics was carried out at the completion of the trial. Results: All outcome measures revealed improvement: statistically highly significant improvement in MoCA scores, CNS Vital Signs Neurocognitive Index, and AQ-C were documented. No serious adverse events were recorded. Conclusions and Relevance: Based on the cognitive improvements observed in this study of patients with Alzheimer's disease or mild cognitive impairment, a larger, randomized, controlled trial of the precision medicine therapeutic approach described herein is warranted.
Catégories: Actus Santé

Cerebrovascular Response to an Acute Bout of Short Interval High Intensity Interval Exercise and Recovery in Healthy Adults

Introduction: High intensity interval exercise (HIIE) is performed widely. However, the field possesses limited knowledge regarding the acute HIIE cerebrovascular response. Our objective was to characterize the middle cerebral artery blood velocity (MCAv) response during an acute bout of short interval HIIE in healthy adults. We hypothesized MCAv would decrease below BL 1) during HIIE, 2) following HIIE, 3) and 30-minutes after HIIE. As a secondary objective, we investigated sex differences in the MCAv response during HIIE. Methods: Fourteen healthy adults (7 male) completed the HIIE session. The 10-minute HIIE session included alternating 1-minute bouts of high-intensity and low-intensity intervals. MCAv, mean arterial pressure (MAP), heart rate (HR), and expired end tidal carbon dioxide (PETCO2), were recorded at BL, during HIIE, following HIIE, and 30-minutes after HIIE. Results: Contrary to our hypothesis, MCAv remained above BL for the HIIE duration. MCAv peaked at the third minute then decreased concomitantly with PETCO2. MCAv was lower than BL after HIIE (p=0.03). Thirty minutes after HIIE, MCAv returned to near BL values (p = 0.47). Women showed higher BL MCAv (x = 70.9 {+/-} 8.1 cm/s) compared to men (x = 59.3 {+/-} 5.8 cm/s, p = 0.01). A greater magnitude of MCAv response was observed in men resulting in non-significant differences during HIIE secondary to higher workload (p = 0.03). Conclusions: Collectively, these findings show that in healthy adults, MCAv remained above BL during a 10-minute short-interval HIIE and returned to resting values 30 minutes after exercise.
Catégories: Actus Santé

Severity assessment of single dose Oxford-AstraZeneca vaccinated individuals infected with SARS CoV-2 in the Southeast Bangladesh

The present global endeavor to uncover the most effective vaccines against severe acute respiratory syndrome coronavirus (SARS-CoV-2) that can tremendously prevent transmission, infection and significantly reduce public health risk. COVID-19 vaccination program is underway in different parts of the world including Bangladesh but till to date there is no available health data revealed among the vaccinated peoples. We conducted a cross-sectional study from February 15 to April 15, 2021 to assess the health status of 1st dose Oxford-AstraZeneca vaccinated individuals infected with SARS CoV-2. Standard virological method, real-time reverse transcriptase-polymerase chain reaction (RT-qPCR) was performed to detect SARS-CoV-2 and the different health parameters from vaccinated individuals were collected through direct mobile phone contact using pre-structured questionnaires. A total of 6146 suspected samples were tested and 1752 were found positive for SARS-CoV-2, of them 200 individuals were identified who received 1st dose of COVID-19 vaccine. Within the test period, majority of male (65.6%) and female (34.4%) carried moderate numbers of viruses which comprise between 30.01-35 cyclic threshold (ct) values. Among the vaccinated individuals, 165 (82.5%; 95% CI: 76.51 - 87.5) persons were not hospitalized and 177 (88.5%; 95% CI: 83.24 - 92.57) did not show any respiratory difficulties. Only a few (16) (8%; 95% CI: 4.64 - 12.67) of COVID-19 positive patients needed extra oxygen support and 199 (99.5%; 95% CI: 97.25 - 99.99) individuals did not require any intensive care unit (ICU) interference. Overall, oxygen saturation was recorded around 96.8% and respiratory difficulties did not extend more than 5 days, irrespective of age and sex during the infection period. Within the vaccinated COVID-19 positive individuals 113 (56.5%; 95% CI: 49.33 - 63.48) and 111(55.5%; 95% CI: 48.32 - 62.51) persons have normal physiological taste and smell. However, we have found a larger proportion of vaccinated persons (129) (64.5%; 95% CI: 57.44 - 71.12) carrying different comorbidity, among them high blood pressure 36 (27.9%; 95% CI, 20.37 - 36.48) and diabetes 32 (24.8%; 95% CI: 17.63 - 33.18) were found more prevalent. Moreover, the significant finding of the present study was 199 (99.5%; 95% CI: 97.25 - 99.99) vaccinated individuals survived with good health conditions and became negative in RT-qPCR. The authors suggest that health risk assessment among the COVID-19 vaccinated persons when infected with SARS-CoV-2 is crucial and time demanding task for the whole world. However, the present study illustrates that the administration of the 1st dose Oxford-AstraZeneca vaccine significantly reduces health risk during the COVID-19 infection period.
Catégories: Actus Santé

Development and Initial Validation of the Duke Misophonia Questionnaire

Misophonia is characterized by decreased tolerance and accompanying defensive motivational system responding to certain aversive sounds and contextual cues associated with such stimuli, typically repetitive oral (e.g., eating sounds) or nasal (e.g., breathing sounds) stimuli. Responses elicit significant psychological distress and impairment in functioning, and include acute increases in (a) negative affect (e.g., anger, anxiety, and disgust), (b) physiological arousal (e.g., sympathetic nervous system activation), and (c) overt behavior (e.g., escape behavior and verbal aggression toward individuals generating triggers). A major barrier to research and treatment of misophonia is the lack of rigorously validated assessment measures. As such, the primary purpose of this study was to develop and psychometrically validate a self-report measure of misophonia, the Duke Misophonia Questionnaire (DMQ). There were two phases of measure development. In Phase 1, items were generated and iteratively refined from a combination of the scientific literature and qualitative feedback from misophonia sufferers, their family members, and professional experts. In Phase 2, a large community sample of adults (n = 424) completed DMQ candidate items and other measures needed for psychometric analyses. A series of iterative analytic procedures (e.g., factor analyses and IRT) were used to derive final DMQ items and scales. The final DMQ is 86 items, and includes subscales: (1) Trigger frequency (16 items), (2) Affective Responses (5 items), (3) Physiological Responses (8 items), (4) Cognitive Responses (10 items), (5) Coping Before (6 items), (6) Coping During (10 items), (7) Coping After (5 items), (8) Impairment (12 items), and Beliefs (14 items). Composite scales were derived for overall Symptom Severity (combined Affective, Physiological, and Cognitive subscales) and Coping (combined the three Coping subscales). The analytic procedures used enable administration of the total DMQ, individual subscales, or the derived composite scales.
Catégories: Actus Santé

Resuming In-Person Classes under COVID-19: Evaluating Assigned Seating Protocols in Limiting Contacts at Postsecondary Institutions

In order to limit the spread of COVID-19, Canadian postsecondary institutions are offering the majority of classes online for the 2020-21 academic year. The goal of Canada's public health pandemic response is to reduce severe illness and mortality from COVID-19 while minimizing social disruption. To achieve this goal, post secondary institutions need practical tools to limit COVID-19 spread and facilitate contact tracing while returning students to in-person instruction. In this paper, we explore the impact of assigned seating for students attending in-person classes in reducing potential contacts. We conduct a variety of seating simulations using student enrollment data and measure the number of potential contacts under each scenario. We find that assigning seats to students significantly reduces the expected number of contacts relative to random seating, making the return to in-person classes more feasible under these scenarios.
Catégories: Actus Santé

Physical activity promotion is lacking in local treatment protocols for patients hospitalized with myocardial infarction: A cross-sectional study

Objectives: To describe the content and methodological quality of local physiotherapy and nursing treatment protocols specifically regarding physical activity promotion in patients hospitalised with myocardial infarction. Design: Cross-sectional study comprising the analysis of 18 physiotherapy and 14 nursing protocols. Setting: Protocols from twenty Dutch hospitals were used. Main outcome measures: Data were extracted from protocols for patients hospitalised with myocardial infarction according to a standardized data-extraction procedure. Descriptive statistics were used to describe the content of protocols, in specific, treatment goals, interventions, clinimetrics and discharge criteria. Methodological quality of the protocols was examined using the AGREE-II tool. Results: Therapeutic goals concerning physical activity were described in 83% of the physiotherapy protocols and in 7% of the nursing protocols. Therapeutic interventions concerning physical activity were described in 100% of the physiotherapy protocols and in 57% of the nursing protocols. Two (14%) of the fourteen interventions described in the physiotherapy protocols and none in the nursing protocols, were interpreted as physical activity promotion. All protocols were rated as having low methodological quality, mainly due to a lack of supporting scientific evidence. The overall quality was rated with an average score of 3 out of 7 (range: 1-5). Conclusions: Physiotherapy and nursing protocols for hospitalized patients with myocardial infarction are primarily aimed at physical activity under supervision, rather than physical activity promotion. Our work provides physiotherapists and nurses insights in how to further improve the content and methodological quality of their local treatment protocols for patients hospitalised with myocardial infarction.
Catégories: Actus Santé

An Atomic Approach to the Design and Implementation of a Research Data Warehouse

Objective As a long-standing Clinical and Translational Science Awards (CTSA) Program hub, the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) developed and implemented a modern research data warehouse (RDW) to efficiently provision electronic patient data for clinical and translational research. Methods Because UPMC is one of the largest health care systems in the US with multiple vendors' electronic health record (EHR) systems, we designed and implemented an RDW named Neptune to serve the specific needs of our CTSA. Neptune uses an atomic design where data is stored at a high level of granularity as represented in source systems. Neptune contains robust patient identity management tailored for research; integrates patient data from multiple sources, including EHRs, health plans, and research studies; and includes knowledge for mapping to standard terminologies. Neptune enables efficient provisioning of data to large analytics-oriented data models and to individual investigators. Results Neptune contains data for more than 5 million patients longitudinally organized as HIPAA Limited Data with dates and includes structured EHR data, clinical documents, health insurance claims, and research data. Neptune is used as a source for patient data for hundreds of IRB-approved research projects by local investigators and for national projects such as the Accrual to Clinical Trials (ACT) network, the All of Us Research Program, and the National Patient-Centered Clinical Research Network. Discussion The design of Neptune was heavily influenced by the large size of UPMC, the varied data sources, and the rich partnership between the University and the healthcare system. It features several desiderata of an RDW, including robust protected health information management, an extensible information storage model, and binding to standard terminologies at the time of data delivery. It also includes several unique aspects, including the physical warehouse straddling the University of Pittsburgh and UPMC networks and management under a HIPAA Business Associates Agreement.
Catégories: Actus Santé

multiSero: open multiplex-ELISA platform for analyzing antibody responses to SARS-CoV-2 infection

Serology has provided valuable diagnostic and epidemiological data on antibody responses to SARS-CoV-2 in diverse patient cohorts. Deployment of high content, multiplex serology platforms across the world, including in low and medium income countries, can accelerate longitudinal epidemiological surveys. Here we report multiSero, an open platform to enable multiplex serology with up to 48 antigens in a 96-well format. The platform consists of three components: ELISA-array of printed proteins, a commercial or home-built plate reader, and modular python software for automated analysis (pysero). We validate the platform by comparing antibody titers against the SARS-CoV-2 Spike, receptor binding domain (RBD), and nucleocapsid (N) in 114 sera from COVID-19 positive individuals and 87 pre-pandemic COVID-19 negative sera. We report data with both a commercial plate reader and an inexpensive, open plate reader (nautilus). Receiver operating characteristic (ROC) analysis of classification with single antigens shows that Spike and RBD classify positive and negative sera with the highest sensitivity at a given specificity. The platform distinguished positive sera from negative sera when the reactivity of the sera was equivalent to the binding of 1 ng mL-1 RBD-specific monoclonal antibody. We developed normalization and classification methods to pool antibody responses from multiple antigens and multiple experiments. Our results demonstrate a performant and accessible pipeline for multiplexed ELISA ready for multiple applications, including serosurveillance, identification of viral proteins that elicit antibody responses, differential diagnosis of circulating pathogens, and immune responses to vaccines.
Catégories: Actus Santé

The performance of the SARS-CoV-2 RT-PCR test as a tool for detecting SARS-CoV-2 infection in the population. A survey of routine laboratory RT-PCR test results from the region of Muenster, Germany

Objectives: To evaluate the population-based performance of the SARS-CoV-2 RT-PCR test as a tool for detecting SARS-CoV-2 infection during the pandemic in 2020. Methods: We analysed SARS-CoV-2 RT-PCR results of 162,457 people living in Muenster, Germany screened at nursing homes, testing sites, at schools, regional hospitals, and by general practitioners. All PCRs were done with the same cobas SARS-CoV-2 RT-PCR system (Roche Diagnostics). We stratified positive RT-PCR results by cycle threshold (Ct) values, periods of the national test strategy, age, sex, and symptoms. Results: Among 162,457 individuals, 4164 (2.6%) had a positive RT-PCR test result, defined as Ct<40. Depending on the national test strategy, higher positive rates were associated with testing predominantly symptomatic people. Children (0-9 years) and older adults (70+ years). Only 40.6% of test positives showed low Ct values < 25 (potentially infectious). The percentage of Ct values below 25 was lower among children (0-9), adolescents (10-19), and among the elderly (70+ years). Conclusions: RT-PCR testing as a tool for mass screening should not be used alone as a base for pandemic decision making including measures such as quarantine, isolation, and lockdown.
Catégories: Actus Santé

Single dose of BNT162b2 mRNA vaccine against SARS-CoV-2 induces high frequency of neutralising antibody and polyfunctional T-cell responses in patients with myeloproliferative neoplasms

Encouraging results have been observed from initial studies evaluating vaccines targeting the novel beta coronavirus which causes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, concerns have been raised around the efficacy of these vaccines in immunosuppressed populations, including patients with haematological malignancy. Myeloproliferative neoplasms (MPN), in particular myelofibrosis (MF), are associated with heterogenous immune defects which are influenced by patient age, disease subtype and the use of cytoreductive therapies. Patients with a WHO defined diagnosis of an MPN presenting to our clinic were recruited following first injection of 30g BNT162b2. A positive anti-S IgG ELISA was seen in 76.1% (16) of patients following vaccination with positive neutralising antibodies detected in 85.7% (18) of patients. A memory T cell response was observed in 80% (16) of patients, with a CD4+ T cell response in 75% (15) and a CD8+ T cell response in 35% (7). These results, for the first time, provide some reassurance regarding the initial immune response to the BNT162b2 vaccine amongst patients with MPN, with response rates similar to that observed in the general population.
Catégories: Actus Santé

ADVANCED AUTOLOGOUS LOWER DERMAL SLING TECHNIQUE FOR IMMEDIATE BREAST RECONSTRUCTION SURGERY IN SMALL AND NON-PTOTIC BREASTS

Background: Breast reconstruction with an autologous lower dermal sling (ALDS) is an established one-stage procedure in patients with moderate to large ptotic breasts. However, this technique is difficult to perform in small and non/minimally ptotic breasts. We describe our experiences from a single institution about a novel Advanced Autologous Lower Dermal Sling (A-ALDS) technique for reconstruction in small breasts. Methods: We performed one stage nipple/skin sparing mastectomies in 61 patients with immediate reconstruction either by conventional immediate breast reconstruction surgery or A-ALDS technique. Results: Mean age of study patients was 46.9 years. We observed significantly better cosmetic score and lower immediate complication rate vis-a-vis skin necrosis, implant loss with the A-ALDS technique (i.e., nil versus 3 in Conventional Immediate Breast Reconstruction Surgery -IBRS). 40 patients completed 12 months follow-up. The PROMs- Patient Reported Outcomes Measures (Breast-Q) revealed good to excellent scores for satisfaction with breast, cosmetic outcome and psychosocial well-being in patients operated with both these techniques. However, sexual well-being was significantly better in the A-ALDS group. Conclusion: The A-ALDS is a novel, cost-effective and safe technique for immediate one stage implant-based reconstruction for small breasts. It provides a dermal barrier flap and hence, ensures less complications, excellent cosmetic results and patient satisfaction.
Catégories: Actus Santé

Sunshine on KOL : a retrospective study about financial ties between medical key opinion leaders and pharmaceutical industry in France

Objective To investigate the nature, extent and evolution of financial relationships between key opinion leaders (KOL) or non-KOL physicians and pharmaceutical and device companies in France. Design Retrospective and descriptive study Setting All doctors practicing in France, with a focus on 548 KOL defined as board members of all the professional medical associations having published clinical practice guidelines in 2018 or 2019. These 99 associations were identified by the cross-checking of 3 databases. Main outcome measures The number and the amount of gifts (year by year since 2014), remunerations and agreements (year by year since 2017). Results Physicians had 818m Euros (936m dollars, 741m pounds) of gifts declared from 2014 to 2019. 83% of KOL had such links of interest. The 548 identified KOL represented 0.24% of physicians in France but received 1.5% of the total amount of gifts, i.e. 12.3m euros (14m dollars or 11m pounds / 3,700K euros per capita per year). Physicians had 125m Euros (143m dollars and 114m pounds) of agreements declared from 2017 to 2019. The 548 KOL received 0.72% of the agreements and 2.5% of the value of the agreements, i.e. 3.1m Euros (3.6m dollars, 2.8m pounds) or 1 900 euros per capita per year. Physicians had 156m Euros of remunerations declared from 2017 to 2019. The 548 identified KOL received 4.4% of the total value of remunerations to physicians, i.e. 6.8m Euros or 4 100 Euros per capita per year. Almost every professional medical associations (99%) had in their board at least one KOL with a financial tie. Conclusion Financial relationships between KOL and the industry in France are extensive, KOL have much more financial ties than non-KOL practitioners. The main limit of this study arises from the quality of information provided on the French Transparency in Healthcare database. Pre-registration: osf.io/m8syh
Catégories: Actus Santé

SARS-CoV-2 infection induces autoimmune antibody secretion more in lean than in obese COVID-19 patients

Background/Objectives: Obesity decreases the secretion of SARS-CoV-2-specific IgG antibodies in the blood of COVID-19 patients. How obesity impacts the secretion of autoimmune antibodies in COVID-19 patients, however, is not understood. The serum of adult COVID-19 patients contains autoimmune antibodies generated in response to virus-induced tissue damage and cell death leading to the release of intracellular antigens not known to be immunogenic autoantigens. The objective of this study is to evaluate the presence of autoimmune antibodies in COVID-19 patients with obesity. Subjects/Methods: Thirty serum samples from individuals who tested positive for SARS-CoV-2 infection by RT-PCR were collected from inpatient and outpatient settings. Of these, 15 were lean (BMI<25), and 15 were obese (BMI [≥]30). Control serum samples were from 30 uninfected individuals, age- gender- and BMI-matched, recruited before the current pandemic. Serum IgG antibodies against two autoimmune specificities, as well as against SARS-CoV-2 Spike protein, were measured by ELISA. IgG autoimmune antibodies were specific for malondialdehyde (MDA), a marker of oxidative stress and lipid peroxidation, and for adipocyte-derived protein antigens (AD), markers of virus-induced cell death in the obese AT. Results: Our results show that SARS-CoV-2 infection induces anti-MDA and anti-AD autoimmune antibodies more in lean than in obese patients as compared to uninfected controls. Serum levels of these autoimmune antibodies, however, are always higher in obese versus lean COVID-19 patients. Moreover, because the autoimmune antibodies found in serum samples of COVID-19 patients have been correlated with serum levels of C-reactive protein (CRP), a general marker of inflammation, we also evaluated the association of anti-MDA and anti-AT antibodies with serum CRP and found a significant association between CRP and autoimmune antibodies in our cohort of lean and obese COVID-19 patients. Conclusions: Our results highlight the importance of evaluating the quality of the antibody response in COVID-19 patients with obesity, particularly the presence of autoimmune antibodies, and identify biomarkers of self-tolerance breakdown. This is crucial to protect this vulnerable population that is at higher risk of responding poorly to infection with SARS-CoV-2 compared to lean controls.
Catégories: Actus Santé

No difference in cognitive task-related oscillations between human internal globus pallidus and subthalamic nucleus

Recently it has been acknowledged that the basal ganglia nuclei play a major role in cognitive control; however, the contribution by their network remains unclear. Previous studies have demonstrated the role of the subthalamic nucleus (STN) in cognitive processing and suggested that its connections to cortical and other associated regions regulate response inhibition during conflict conditions. By contrast, the role of the internal globus pallidus (GPi) as the output nucleus before the thalamic relay has not yet been investigated during cognitive processing. We recorded local field potentials (LFPs) from externalized deep brain stimulation (DBS) electrodes implanted bilaterally in the GPi (n=9 participants with dystonia) and STN (n=8 participants with Parkinson's disease (PD)) during a primed flanker task. Both dystonia (GPi group) and PD participants (STN group) responded faster to the congruent trials than the incongruent trials. Overall, the dystonic GPi group was significantly faster than the PD STN group. LFPs showed elevated cue-triggered theta (3-7 Hz) power in GPi and STN groups in a similar way. Response-triggered LFP beta power (13-25 Hz) was significantly increased in the GPi group compared to the STN group. Results demonstrate that GPi activity appears to be critical in the cognitive processing of action selection and response during the presence of conflict tasks similar to the STN group. As both GPi and STN nuclei are involved in cognitive processing; therefore, these nuclei may be targeted for neuromodulation to improve cognitive control via DBS.
Catégories: Actus Santé

Cerebral venous thrombosis and portal vein thrombosis: a retrospective cohort study of 537,913 COVID-19 cases

Objectives: To estimate the absolute risk of cerebral venous thrombosis (CVT) and portal vein thrombosis (PVT) in the two weeks following a diagnosis of COVID-19, and to assess the relative risks (RR) compared to influenza or the administration of an mRNA vaccine against COVID-19. Design: Retrospective cohort study based on an electronic health records network Setting: Linked records between primary and secondary care centres within 59 healthcare organisations, primarily in the USA Participants: All patients with a confirmed diagnosis of COVID-19 between January 20, 2020 and March 25, 2021 were included (N=537,913, mean [SD] age: 46.2 [21.4] years; 54.9% females). Cohorts (matched for age, sex, and race) of participants diagnosed with influenza (N=392,424) or receiving the BNT162b2 or mRNA-1273 vaccine (N=366,869) were used for comparison. Main outcome measures: Diagnosis of CVT (ICD-10 code I67.6) or PVT (ICD-10 code I81) within 2 weeks after a diagnosis of COVID-19. Results: The incidence of CVT after COVID-19 diagnosis was 42.8 per million people (95% CI 28.5-64.2) including 35.3 per million (95% CI 22.6-55.2) first diagnoses. This was significantly higher than the CVT incidence in a matched cohort of patients with influenza (RR=3.83, 95% CI 1.56-9.41, P<0.001) and people who received an mRNA vaccine (RR=6.67, 95% CI 1.98-22.43, P<0.001). The incidence of PVT after COVID-19 diagnosis was 392.3 per million people (95% CI 342.8-448.9) including 175.0 per million (95% CI 143.0-214.1) first diagnoses. This was significantly higher than the PVT incidence in a matched cohort of patients with influenza (RR=1.39, 95% CI 1.06-1.83, P=0.02) and people who received an mRNA vaccine (RR=7.40, 95% CI 4.87-11.24, P<0.001). Mortality after CVT and PVT was 17.4% and 19.9% respectively. Conclusions: The incidence of CVT and PVT is significantly increased after COVID-19. The data highlight the risk of serious thrombotic events in COVID-19 and can help contextualize the risks and benefits of vaccination in this regard.
Catégories: Actus Santé

Is ventilation the ultimate weapon against Covid-19?

CNRS News - lun, 10/05/2021 - 21:00
A group of researchers is set to promote the use of CO2 detectors in classrooms, cafeterias, offices, factories and other enclosed spaces. Their goal is to improve indoor ventilation to help curb the spread of coronavirus.
Catégories: Actus Santé

Vaccination contre la Covid en France : au 10 mai 2021, plus de 26 000 000 injections ont été réalisées


1. Données de vaccination du jour et cumulées

Depuis le début de la campagne de vaccination en France, 18 107 426 personnes ont reçu au moins une injection (soit 27,0 % de la population totale et 34,5 % de la population majeure) et 7 984 274 personnes ont reçu deux injections (soit 11,9 % de la population totale et 15,2 % de la population majeure)[1].

Données provisoires au 10 mai 2021

[1] : Données provisoires en attente de consolidation

2. Quels sont les publics prioritaires ?

- Les personnes âgées de 50 ans et plus – hors professionnels ci-dessous ( 25,9 millions de personnes) ;
- Les professionnels de santé et intervenants d'établissements de santé ou médico-sociaux ( 2,5 millions de personnes) ;
- Les pompiers et aides à domicile au service de personnes handicapées ou âgées ( 0,6 million de personnes) ;
- Les personnes âgées de 18 à 49 ans inclus qui présentent des comorbidités* ( 4,0 millions de personnes) ;
- Les personnes vulnérables à très haut risque de formes graves telles que mentionnées par le conseil d'orientation de la stratégie vaccinale* à partir de 16 ans ( 0,8 million de personnes) ;
- Les personnes handicapées vulnérables hébergées en maisons d'accueil spécialisées, en foyers d'accueil médicalisés, en foyers pour personnes handicapées non médicalisés, ainsi que les personnes hébergées dans les établissements médico-sociaux spécifiques. (< 0,1 million de personnes) ;
- Les femmes enceintes à partir du 2e trimestre ( 0,6 million de personnes) ;
- Les proches à partir de 16 ans (à savoir les personnes vivant sous le même toit ou apportant une aide dans la vie quotidienne) de personnes, adulte ou enfant, immunodéprimées ( 0,7 million de personnes).

* listes disponibles sur solidarites-sante.gouv.fr/vaccin-covid-19

3. Comment prendre rendez-vous pour se faire vacciner ?

Pour rappel, la prise de rendez-vous est possible :
- Via le site internet https://www.sante.fr/ ;
- Chez un pharmacien, un médecin de ville (médecin généraliste, médecin spécialiste, ou médecin du travail) ou une infirmière pour les publics éligibles au vaccin AstraZeneca ;
- Via les dispositifs locaux mis à disposition pour aider à la prise de rendez-vous ;
- En cas de difficulté, via le numéro vert national (0 800 009 110) qui permet d'être redirigé vers le standard téléphonique d'un centre ou d'obtenir un accompagnement à la prise de rendez-vous.
Afin d'accompagner spécifiquement les personnes de 75 ans et plus souhaitant être vaccinées et n'ayant pas encore pu prendre rendez-vous, différents dispositifs nationaux d'aller-vers sont désormais déployés :
- Une campagne d'appels sortants de l'Assurance maladie à destination des personnes de plus de 75 ans qui ne sont pas encore vaccinées ;
- Un numéro coupe-file dédié : depuis le 31/03, ce numéro est indiqué dans un SMS envoyé par l'Assurance maladie aux personnes de 75 ans et plus non vaccinées.

Les personnes de 50 ans et plus peuvent prendre rendez-vous depuis le 7 mai pour une vaccination à partir de ce jour.

Par ailleurs, pour faciliter la vaccination de certains professionnels considérés comme plus exposés au virus, des créneaux dédiés pour les plus de 55 ans ont été ouverts dans plusieurs centres du territoire national.

Liste des professionnels de 55 ans et plus pouvant bénéficier de ces créneaux de vaccination dédiés.

Sur déclaration de leur(s) comorbidité(s), les personnes âgées de 18 à 54 ans présentant une ou plusieurs comorbidités peuvent prendre rendez-vous en centre de vaccination selon les modalités habituelles déjà en vigueur pour les personnes âgées de plus de 50 ans présentant ces comorbidités, sans nécessité de présenter une prescription médicale.

Vaccination pour le grand public
Vaccination pour les professionnels

Contact presse : presse-dgs@sante.gouv.fr

pdf Communiqué de presse - Vaccination contre la Covid en France : au 10 mai (...) Téléchargement (940.5 ko)
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