Etude épidémiologique descriptive de la prise en charge des enfants VHC positifs dans une population générale (1994-2001)

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude de la mortalité dans une cohorte de patients antigène HBs positifs (registre de Côte d'Or (1994-2004))

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Dans l’hépatite chronique C, les délais entre diagnostic et traitement sont liés à la relation médecins-patients

Une étude épidémiologique menée en 2004 en Côte d’Or et dans le Doubs révélait que parmi 1 251 patients porteurs du VHC, un sur 4 était traité et un sur 6 ne bénéficiait d’aucune prise en charge. Une étude qualitative faite en Bourgogne en 2006-2008 visait à identifier les raisons de l’insuffisance de soins ; 25 médecins ont été interrogés sur leur confrontation à l’infection par le VHC et les difficultés de sa prise en charge, et 27 patients atteints d’hépatite chronique C sur les circonstances du dépistage et du diagnostic, l’itinéraire de soins, la représentation et le vécu de la maladie et du traitement, les relations avec les soignants. L’étude a révélé une grande variabilité dans les délais entre le diagnostic, la consultation en hépatologie et l’instauration du traitement ; celle-ci est en grande partie expliquée par les modalités du fonctionnement de la relation médecinspatients et des choix de prise en charge faits par les médecins impliqués

Detection of the CALR mutation in the diagnosis of splanchnic vein thrombosis

International audienc

Socioeconomic context, distance to primary care and detection of hepatitis C: a French population-based study.

International audiencePrevious research suggests that hepatitis C detection is lower in rural than in urban areas and depends on geographic accessibility to care. To what extent differences in socioeconomic context could explain these disparities remains unknown. This study assessed the respective influence of the socioeconomic context and of the distance to primary care on the hepatitis C detection rates in a well-defined population of 1,005,817 inhabitants covered by a universal health insurance system in the Côte d'Or and the Doubs areas of France. The 1938 cases of hepatitis C newly diagnosed in the survey area between 1994 and 2001 were included. The patients' 'cantons' of residence were classified into six socioeconomic clusters according to 19 quantitative indicators. Age and sex-standardized hepatitis C detection rate ratios (DRR) for the six clusters were estimated and a multilevel Poisson model investigated whether detection rates varied across clusters after adjusting for distance to the nearest general practitioner. Standardized DRR (95% CI) were higher in both "lower-income urban" and "upper-income urban" clusters and lower in the following clusters: "outer suburb", "industrial rural" and economically "dynamic rural". Adjusting for distance to general practitioner reduced the rate difference between socioeconomic clusters: for a distance to general practitioner equalling 0km (practice in the municipality) and compared to the "upper-income urban" cluster, only the "lower-income urban" cluster had higher DRR. In the six clusters, detection rates decreased as the distance to general practitioner increased (DRR 0.89 95% CI 0.84-0.96 for a 1-km change) but the decrease was more marked in both urban clusters. In this population with good primary care affordability, geographic proximity to general practitioner, rather than socioeconomic context of neighborhood, appeared to be the main factor limiting hepatitis C detection

Socioeconomic context, distance to primary care and detection of hepatitis C: A French population-based study

Previous research suggests that hepatitis C detection is lower in rural than in urban areas and depends on geographic accessibility to care. To what extent differences in socioeconomic context could explain these disparities remains unknown. This study assessed the respective influence of the socioeconomic context and of the distance to primary care on the hepatitis C detection rates in a well-defined population of 1,005,817 inhabitants covered by a universal health insurance system in the Côte d'Or and the Doubs areas of France. The 1938 cases of hepatitis C newly diagnosed in the survey area between 1994 and 2001 were included. The patients' 'cantons' of residence were classified into six socioeconomic clusters according to 19 quantitative indicators. Age and sex-standardized hepatitis C detection rate ratios (DRR) for the six clusters were estimated and a multilevel Poisson model investigated whether detection rates varied across clusters after adjusting for distance to the nearest general practitioner. Standardized DRR (95% CI) were higher in both "lower-income urban" and "upper-income urban" clusters and lower in the following clusters: "outer suburb", "industrial rural" and economically "dynamic rural". Adjusting for distance to general practitioner reduced the rate difference between socioeconomic clusters: for a distance to general practitioner equalling 0 km (practice in the municipality) and compared to the "upper-income urban" cluster, only the "lower-income urban" cluster had higher DRR. In the six clusters, detection rates decreased as the distance to general practitioner increased (DRR 0.89 95% CI 0.84-0.96 for a 1-km change) but the decrease was more marked in both urban clusters. In this population with good primary care affordability, geographic proximity to general practitioner, rather than socioeconomic context of neighborhood, appeared to be the main factor limiting hepatitis C detection.Health care access Socioeconomic context Multilevel modelling France Viral hepatitis C General practitioner (GP) Urban Rural

Infliximab treatment for steroid-refractory acute graft-versus-host disease after orthotopic liver transplantation: a case report.

International audienceAcute graft-versus-host disease (GVHD) following orthotopic liver transplantation is a rare but severe disease with a 75% death rate in adults. Various therapeutic strategies have been proposed for steroid-refractory GVHD, but there is still no consensus. Tumor necrosis factor-alpha is a key inflammatory cytokine involved in acute GVHD physiopathology, and infliximab has shown encouraging results for the treatment of acute GVHD following hematopoietic stem cell transplantation. We report the first case of acute GVHD following liver transplantation that was refractory to steroids and anti-lymphocyte globulin but was successfully treated with infliximab

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

International audienc

[Is chronic hepatitis C treatment as efficient in the general population as in randomised trials?].

International audienceThe aim of this population-based study was to determine the effectiveness of antiviral therapy in non selected chronic hepatitis C patients