463 research outputs found
Reaching the elderly: understanding of health and preventive experiences for a tailored approach - results of a qualitative study
No full textBACKGROUND Often preventive measures are not accessed by the people who were intended to be reached. Programs for older adults may target men and women, older adults, advanced old age groups and/or chronically ill patients with specific indications. The defined target groups rarely participate in the conception of programs or in the design of information materials, although this would increase accessibility and participation. In the German "Reaching the Elderly" study (2008-2011), an approach to motivating older adults to participate in a preventive home visit (PHV) program was modified with the participatory involvement of the target groups. The study examines how older men and women would prefer to be addressed for health and prevention programs.
METHODS Four focus groups (N = 42 participants) and 12 personal interviews were conducted (women and men in 2 age groups: 65-75 years and ≥ 76 years). Participants from two districts of a major German city were selected from a stratified random sample (N = 200) based on routine data from a local health insurance fund. The study focused on the participants' knowledge about health and disease prevention and how they preferred to be approached and addressed. Videos of the focus groups were recorded and analysed using mind mapping techniques. Interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis.
RESULTS A gender-specific approach profile was observed. Men were more likely to favor competitive and exercise-oriented activities, and they associated healthy aging with mobility and physical activity. Women, on the other hand, displayed a broader understanding of healthy aging, which included physical activity as only one aspect as well as a healthy diet, relaxation/wellness, memory training and independent living; they preferred holistic and socially oriented services that were not performance-oriented. The "older seniors" (76+) were ambivalent towards certain wordings referring to aging.
CONCLUSIONS Our results suggest that gender-specific needs must be considered in order to motivate older adults to participate in preventive services. Age-specific characteristics seem to be less relevant. It is more important to pay attention to factors that vary according to the individual state of health and life situation of the potential participants
Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine (PPV23) against Pneumococcal Disease in the Elderly: Systematic Review and Meta-Analysis.
No full textBackgroundRoutine vaccination of elderly people against pneumococcal diseases is recommended in many countries. National guidelines differ, recommending either the 23-valent polysaccharide vaccine (PPV23), the 13-valent conjugate vaccine (PCV13) or both. Considering the ongoing debate on the effectiveness of PPV23, we performed a systematic literature review and meta-analysis of the vaccine efficacy/effectiveness (VE) of PPV23 against invasive pneumococcal disease (IPD) and pneumococcal pneumonia in adults aged ≥60 years living in industrialized countries.MethodsWe searched for pertinent clinical trials and observational studies in databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. We assessed the risk of bias of individual studies using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. We rated the overall quality of the evidence by GRADE criteria. We performed meta-analyses of studies grouped by outcome and study design using random-effects models. We applied a sensitivity analysis excluding studies with high risk of bias.ResultsWe identified 17 eligible studies. Pooled VE against IPD (by any serotype) was 73% (95%CI: 10-92%) in four clinical trials, 45% (95%CI: 15-65%) in three cohort studies, and 59% (95%CI: 35-74%) in three case-control studies. After excluding studies with high risk of bias, pooled VE against pneumococcal pneumonia (by any serotype) was 64% (95%CI: 35-80%) in two clinical trials and 48% (95%CI: 25-63%) in two cohort studies. Higher VE estimates in trials (follow-up ~2.5 years) than in observational studies (follow-up ~5 years) may indicate waning protection. Unlike previous meta-analyses, we excluded two trials with high risk of bias regarding the outcome pneumococcal pneumonia, because diagnosis was based on serologic methods with insufficient specificity.ConclusionsOur meta-analysis revealed significant VE of PPV23 against both IPD and pneumococcal pneumonia by any serotype in the elderly, comparable to the efficacy of PCV13 against vaccine-serotype disease in a recent clinical trial in elderly people. Due to its broader serotype coverage and the decrease of PCV13 serotypes among adults resulting from routine infant immunization with PCV13, PPV23 continues to play an important role for protecting adults against IPD and pneumococcal pneumonia
Background paper to the updated pneumococcal vaccination recommendation for older adults in Germany
No full textHyaluronic acid levels predict risk of hepatic encephalopathy and liver-related death in HIV/viral hepatitis coinfected patients
No full textBackground: Whereas it is well established that various soluble biomarkers can predict level of liver fibrosis, their ability to predict liver-related clinical outcomes is less clearly established, in particular among HIV/viral hepatitis co-infected persons. We investigated plasma hyaluronic acid’s (HA) ability to predict risk of liver-related events (LRE; hepatic coma or liver-related death) in the EuroSIDA study.
Methods: Patients included were positive for anti-HCV and/or HBsAg with at least one available plasma sample. The earliest collected plasma sample was tested for HA (normal range 0–75 ng/mL) and levels were associated with risk of LRE. Change in HA per year of follow-up was estimated after measuring HA levels in latest sample before the LRE for those experiencing this outcome (cases) and in a random selection of one sixth of the remaining patients (controls).
Results: During a median of 8.2 years of follow-up, 84/1252 (6.7%) patients developed a LRE. Baseline median (IQR) HA in those without and with a LRE was 31.8 (17.2–62.6) and 221.6 ng/mL (74.9–611.3), respectively (p<0.0001). After adjustment, HA levels predicted risk of contracting a LRE; incidence rate ratios for HA levels 75–250 or ≥250 vs. <75 ng/mL were 5.22 (95% CI 2.86–9.26, p<0.0007) and 28.22 (95% CI 14.95–46.00, p<0.0001), respectively. Median HA levels increased substantially prior to developing a LRE (107.6 ng/mL, IQR 0.8 to 251.1), but remained stable for controls (1.0 ng/mL, IQR –5.1 to 8.2), (p<0.0001 comparing cases and controls), and greater increases predicted risk of a LRE in adjusted models (p<0.001).
Conclusions: An elevated level of plasma HA, particularly if the level further increases over time, substantially increases the risk of contracting LRE over the next five years. HA is an inexpensive, standardized and non-invasive supplement to other methods aimed at identifying HIV/viral hepatitis co-infected patients at risk of hepatic complications
Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial
No full textSTUDY QUESTION: Can treatment of the symptoms of uncomplicated urinary tract infection (UTI) with ibuprofen reduce the rate of antibiotic prescriptions without a significant increase in symptoms, recurrences, or complications? METHODS: Women aged 18-65 with typical symptoms of UTI and without risk factors or complications were recruited in 42 German general practices and randomly assigned to treatment with a single dose of fosfomycin 3 g (n=246; 243 analysed) or ibuprofen 3×400 mg (n=248; 241 analysed) for three days (and the respective placebo dummies in both groups). In both groups additional antibiotic treatment was subsequently prescribed as necessary for persistent, worsening, or recurrent symptoms. The primary endpoints were the number of all courses of antibiotic treatment on days 0-28 (for UTI or other conditions) and burden of symptoms on days 0-7. The symptom score included dysuria, frequency/urgency, and low abdominal pain. STUDY ANSWER AND LIMITATIONS: The 248 women in the ibuprofen group received significantly fewer course of antibiotics, had a significantly higher total burden of symptoms, and more had pyelonephritis. Four serious adverse events occurred that lead to hospital referrals; one of these was potentially related to the trial drug. Results have to be interpreted carefully as they might apply to women with mild to moderate symptoms rather than to all those with an uncomplicated UTI. WHAT THIS PAPER ADDS: Two thirds of women with uncomplicated UTI treated symptomatically with ibuprofen recovered without any antibiotics. Initial symptomatic treatment is a possible approach to be discussed with women willing to avoid immediate antibiotics and to accept a somewhat higher burden of symptoms. FUNDING, COMPETING INTERESTS, DATA SHARING: German Federal Ministry of Education and Research (BMBF) No 01KG1105. Patient level data are available from the corresponding author. Patient consent was not obtained but the data are anonymised and risk of identification is low.Trial registration No ClinicalTrialGov Identifier NCT01488955
Optimization of the care pathway for pediatric patients in the pediatric emergency department of Lenval children's hospital in Nice
No full textDepuis de nombreuses années, la prise en charge des patients s’appuyait sur une succession d’actes de soins morcelés, isolés, réalisés par divers professionnels et sans visibilité. Afin de réduire les dépenses en santé, la notion de « parcours de soins » a été instaurée en France en 2004 pour responsabiliser l’ensemble des acteurs mais, d’une part, cette mesure ne concernait pas les patients de moins de 16 ans et, d’autre part, la fréquentation des urgences n’a cessé de croître depuis ces 20 dernières années pour des motifs de recours souvent discutables. L’objectif de cette thèse est d’évaluer les possibilités d’optimiser les parcours des patients aux urgences pédiatriques du CHU-Lenval de Nice, trauma center de niveau 1 classé 4è service en France en termes de fréquentation (>60000 urgences/an). Dans un 1er temps, nous avons étudié le profil clinique des nouveau-nés dits « vulnérables ». Alors que l’HAS a préconisé en 2014 leurs parcours de soin en sortie de maternité, nous avons évalué l’impact de cette mesure sur l’admission de nouveau-nés aux urgences en analysant leurs parcours de soin et le caractère adapté ou non de leurs admissions. Par la suite, en l’absence d’outil de référence en France, nous avons évalué la performance de notre outil informatisé dans le logiciel Terminal Urgences pour le repérage des urgences de haut grade en le comparant au score PEWS (Pediatric Early Warning Score).Enfin, nous avons évalué une stratégie de désengorgement des urgences basée sur l’optimisation des lits d’aval en évaluant l’impact de l‘ouverture de 6 lits d’Unité d’Hospitalisation de Courte Durée au dépend des lits de chirurgie en période épidémique hivernale.For many years, patient care was planned as successive and isolate medical intervention, carried out by many health professionals without any transparency. To reduce health expenditure, the concept of “care pathway” was introduced in France in 2004 to empower all providers and patients, but it did not concern patients under 16 years. However, the number of visits to emergency departments in France has continued to increase over the past 20 years, while their chiefs’ complaints were mainly questionable. This thesis aims to assess solutions in improving patient pathways to the pediatric emergency department (PED) at the Lenval Children’s Hospital in Nice, a level 1 trauma center, ranked as the 4th PED in France (60,000 visits per year).Firstly, we described the clinical profiles of newborns, patients considered vulnerable. We evaluated compliance with the French National Authority for Health’s (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our PED and identified risk factors associated with non-compliance and unnecessary emergency department utilization. Then, in the absence of a reference triage tool in France, we evaluated the validity of our computerized pediatric triage tool of the Terminal Urgences® software for identifying high-level of emergencies comparing to the Pediatric Early Warning Score.Finally, we evaluated a strategy to relieve the flow of patients in our PED based on the optimization of the hospital bed occupancy by converting 6 beds in the pediatric surgical unit into 6 beds for medical conditions during winter
Assessing the value of a histopathological cancer registry : Completeness estimation by capture-recapture by log-linear modeling and on ecological models Mtbh in Bayesian
No full textIntroduction: Les études populationnelles sur le cancer nécessitent un recensement de référence fiable et exhaustif, en théorie possible à partir d'un recueil histologique. Méthode: Depuis 2005, toutes les structures d'anatomopathologie des Alpes-Maritimes adressent les codes ADICAP des tumeurs malignes et invasives et identifiants patients. L'exhaustivité pour les cancers du sein et colorectaux des 50-75 ans a été évalué par méthode de capture recapture en modélisation log-linéaire et en Bayesien à partir des cas communs ou non dépistés et vus en Réunion de Concertation Pluridisciplinaire. RésultatUn programme d'assurance qualité a permis de s'assurer de la fiabilité des données recueillies.L'estimation de l'exhaustivité était de plus de 90 % pour les cancers du sein et colorectaux des 50-75 ans. Les taux observés sur le département des Alpes-Maritimes, comparés aux taux estimés en France, se sont révélés cohérents.Enfin, la base a été utilisée pour déterminer l'existant les lésions prénéoplasiques du col de l'utérus avant la vaccination anti-HPV. ConclusionCe travail conclut à l'intérêt d'un recueil histologique des cas de cancers incidents.Introduction Cancer population studies require reliable and complete baseline data, which should theoretically be available by collecting histopathology records.Method Since 2005, all histopathology laboratories from Alpes-Maritimes address ADICAP codes for invasive cancer and patient identifiers. The completeness of such a collection was evaluated using capture-recapture analysis based on three data sources concerning breast and colorectal cancers with the number of cases which were common or not between sources recording screened, diagnosed and treated cancers in the French Alpes Maritimes districtResult Data quality for the ADICAP code database may be considered satisfactoryThe estimated completeness of cancer records collected from histopathology laboratories was higher than 90%.Rates observed in the Alpes-Maritimes, compared with estimated rates in France have proven consistent. Rates of CIN for the entire female population of the Alpes-Maritimes in 2006 has been established.Conclusion A verified and validated histopathology data collection may be useful for cancer population studies
Jean-Baptiste Oudry and tapestry
No full textDe 1726 à 1755, Jean-Baptiste Oudry (1686-1755), peintre du roi Louis XV, occupa diverses fonctions au sein des manufactures royales de tapisseries : peintre de modèles, directeur entrepreneur de Beauvais, surinspecteur des Gobelins. Selon Louis Gougenot (1761), son biographe de l’Académie royale de peinture et de sculpture, ces nominations lui apportèrent réputation et fortune. La production de Beauvais était destinée pour les riches aristocrates et bourgeois ; celle des Gobelins, pour le roi. La conséquence de cette différenciation peut se percevoir non seulement sur le plan administratif, mais aussi sur le plan artistique. Aussi, les œuvres produites n’avaient pas la même valeur économique et artistique. Par ricochets, la réception des modèles réalisés par Oudry ne fut pas la même. La tenture des Chasses royales tissée à Paris était considérée comme une œuvre majeure de sa carrière. Par ailleurs, son biographe louait les soins et la vigilance que le peintre apporta aux établissements en vue de « faire des tapisseries de première beauté » (Oudry). Dans divers mémoires administratifs, le peintre exprimait ses vues générales en matière d’art des lisses et expliquait les moyens à mettre en œuvre pour perfectionner et « donner aux ouvrages tout l’esprit et toute l’intelligence des tableaux » des maîtres. Or, la réception des tapisseries ne pas fit pas l’unanimité parmi les historiens de l’art au cours des XIXe et XXe siècles. Oudry fut en effet jugé acteur de la décadence de cet art textile décrit comme asservi à la peinture. C’est pourquoi il nous faut comprendre le contexte d’élaboration des principes artistiques développés par le peintre. C’est l’objet de cette étude.From 1726 to 1755, Jean-Baptiste Oudry (1686-1755), painter of the king Louis the XVth, was appointed for different capacities at the royal manufactures of tapestries: painter of models, director of Beauvais, inspector of the Gobelins. According to Louis Gougenot (1761), his biographer at the royal Academy, these appointments gave him reputation and wealth. Tapestries from Beauvais were made for rich aristocrats and the upper middle-classes; tapestries from the Gobelins were for the king. The consequence of this hierarchy was visible not only from an administrative point of view, but also from an artistic point of view. Therefore the different productions did not have the same economical and artistic value. Indirectly, Oudry’s models weren’t considered with a similar attention. For example, the tenture of the Chasses royales woven at Paris was considered one of the most important work in his career. Furthermore, Gougenot praised Oudry for his care and attention to details at these two factories to make beautiful tapestries. In different administrative journals, Oudry expressed his general view of the art and explained the means to perfect and to bring to the tapestries, the spirit and the intelligence of masters’ paintings. Nevertheless, the reception of these tapestries were not favourably unanimous amongst the art historians 19th and 20th centuries. Oudry was indeed judged player of the degradation of this textile art described as subservient to painting. This is the reason why, it is important to understand the context of elaboration of the artistic principles that were developed by the painter. This is the purpose of this study
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