5 research outputs found
J Ultrasound Med
Chest CT is the reference test for assessing pulmonary injury in suspected or diagnosed COVID-19 with signs of clinical severity. This study aimed to evaluate the association of a lung ultrasonography score and unfavorable clinical evolution at 28âdays. The eChoVid is a multicentric study based on routinely collected data that was conducted in 8 emergency units in France; patients were included between March 19, 2020 and April 28, 2020 and underwent lung ultrasonography, a short clinical assessment by 2 emergency physicians blinded to each other's assessment, and chest CT. Lung ultrasonography consisted of scoring lesions from 0 to 3 in 8 chest zones, thus defining a global score (GS) of severity from 0 to 24. The primary outcome was the association of lung damage severity as assessed by the GS at day 0 and patient status at 28âdays. Secondary outcomes were comparing the performance between GS and CT scan and the performance between a new trainee physician and an ultrasonography expert in scores. For the 328 patients analyzed, the GS showed good performance in predicting clinical worsening at 28âdays (area under the receiver operating characteristic curve [AUC] 0.83, sensitivity 84.2%, specificity 76.4%). The GS showed good performance in predicting the CT severity assessment (AUC 0.84, sensitivity 77.2%, specificity 83.7%). A lung ultrasonography GS is a simple tool that can be used in the emergency department to predict unfavorable assessment at 28âdays in patients with COVID-19
Les facteurs associĂ©s aux dommages liĂ©s Ă la consommation dâalcool de tiers, donnĂ©es françaises issues dâune enquĂȘte en population gĂ©nĂ©rale
Les donnĂ©es de lâOMS publiĂ©es en 2018 montrent que 3 millions de dĂ©cĂšs sont attribuables Ă une consommation nocive dâalcool, ce qui reprĂ©sente 5,3% de lâensemble des dĂ©cĂšs mondiaux. Les premiĂšres Ă©tudes dâenvergure qui se sont intĂ©ressĂ©es Ă la problĂ©matique des dommages liĂ©s Ă la consommation dâalcool faits au tiers ont Ă©tĂ© conduites par le Centre for Alcohol Policy Research, situĂ© en Australie, et datent de 2008. Mais depuis ces premiers travaux, lâOMS insiste sur le manque de recherches dĂ©diĂ©es Ă ce sujet. Lâobjectif principal de lâĂ©tude Ă©tait de prĂ©senter la prĂ©valence des dommages liĂ©s Ă la consommation dâalcool de tiers en population française et de rechercher leurs facteurs associĂ©s Ă partir des rĂ©sultats de lâenquĂȘte tĂ©lĂ©phonique SEAS menĂ©e par le collectif europĂ©en RHARA en 2014. AprĂšs une Ă©tape descriptive suivie dâune identification des variables explicatives dâintĂ©rĂȘt lors dâune analyse univariĂ©e, une analyse multivariĂ©e par rĂ©gression logistique a ensuite Ă©tĂ© menĂ©e. La significativitĂ© Ă©tait retenue au seuil de p<0,05. LâĂ©chantillon se composait de 1 701 personnes. Dans lâĂ©chantillon, 49,0% (intervalle de confiance Ă 95% : [46,4 â 52,0]) des rĂ©pondants Ă©taient des hommes. LâĂąge Ă©tait compris entre 18 et 64 ans. Parmi lâensemble des rĂ©pondants, 54,0% [51,0 ; 56,0] ont dĂ©clarĂ© avoir subi au moins un dommage liĂ© Ă la consommation dâalcool dâun tiers au cours des 12 mois ayant prĂ©cĂ©dĂ© lâenquĂȘte. Le dommage le plus reprĂ©sentĂ© Ă©tait le fait dâavoir Ă©tĂ© gĂȘnĂ© au moins une fois par un comportement de type vomissement, miction ou dĂ©gradation dans un espace public, venant dâune personne ayant consommĂ© de lâalcool (27,0%, [24,7 â 29,0]). Le fait dâĂȘtre mariĂ© ou pacsĂ© diminuait significativement le risque de dĂ©clarer chacun des dommages (OR = [0.4 â 0,7]). Pris individuellement, le fait dâĂȘtre un homme diminuait significativement le risque de dĂ©clarer avoir ressenti de la gĂȘne ou un sentiment dâinsĂ©curitĂ© (dommage 7 (OR = 0,5 [0,4 ; 0,7]) et dommage 8 (OR = 0,7 [0,6 ; 0,9]). Les variables relatives aux habitudes de consommation dâalcool Ă©taient rarement significativement associĂ©es avec le risque de dĂ©clarer un dommage contrairement aux variables contextuelles telles que connaĂźtre un gros buveur (actuellement ou pendant lâenfance). Dans ce travail, nous montrons que le contexte et les caractĂ©ristiques socio-dĂ©mographiques des rĂ©pondants sont les facteurs prĂ©fĂ©rentiellement associĂ©s au risque de dĂ©clarer lâexistence dâun dommage liĂ© Ă lâalcoolisation dâun tiers au cours des 12 derniers mois en France. Lâimportante prĂ©valence en France de ces situations va dans le sens de la nĂ©cessitĂ© pointĂ©e par les rapports de lâOMS et des Ă©tudes publiĂ©es de renforcer les actions de prĂ©vention et de prise en considĂ©ration. Enfin, nous pensons quâil serait intĂ©ressant de chiffrer de maniĂšre Ă©conomique afin que les consĂ©quences sociĂ©tales de lâalcool soient mieux caractĂ©risĂ©es
Global burden of mental disorders among children aged 5â14Â years
Abstract Background The global burden of disease (GBD) study provides information about fatal and non-fatal health outcomes around the world. Methods The objective of this work is to describe the burden of mental disorders among children aged 5â14Â years in each of the six regions of the World Health Organisation. Data come from the GBD 2015 study. Outcomes: disability-adjusted life-years (DALYs) are the main indicator of GBD studies and are built from years of life lost (YLLs) and years of life lived with disability (YLDs). Results Mental disorders are among the leading causes of YLDs and of DALYs in Europe and the Americas. Because of the importance of infectious diseases, mental disorders appear marginal in Africa for YLLs although they play an important role in YLDs there. Because the epidemiological transition that has taken place in Europe and the Americas (i.e., a switch from acute and infectious conditions to chronic and mental health issues) is likely to happen sooner or later across the entire planet, mental health problems in youth are likely to become one of the main public health challenges of the twenty-first century. Conclusion These results should improve health care if policy-makers use them to develop health policies to meet the real needs of populations (especially children) today
The use of lung ultrasound in COVID-19
This review article addresses the role of lung ultrasound in patients with coronavirus disease 2019 (COVID-19) for diagnosis and disease management. As a simple imaging procedure, lung ultrasound contributes to the early identification of patients with clinical conditions suggestive of COVID-19, supports decisions about hospital admission and informs therapeutic strategy. It can be performed in various clinical settings (primary care facilities, emergency departments, hospital wards, intensive care units), but also in outpatient settings using portable devices. The article describes typical lung ultrasound findings for COVID-19 pneumonia (interstitial pattern, pleural abnormalities and consolidations), as one component of COVID-19 diagnostic workup that otherwise includes clinical and laboratory evaluation. Advantages and limitations of lung ultrasound use in COVID-19 are described, along with equipment requirements and training needs. To infer on the use of lung ultrasound in different regions, a literature search was performed using key words âCOVID-19â, âlung ultrasoundâ and âimagingâ. Lung ultrasound is a noninvasive, rapid and reproducible procedure; can be performed at the point of care; requires simple sterilisation; and involves non-ionising radiation, allowing repeated exams on the same patient, with special benefit in children and pregnant women. However, physical proximity between the patient and the ultrasound operator is a limitation in the current pandemic context, emphasising the need to implement specific infection prevention and control measures. Availability of qualified staff adequately trained to perform lung ultrasound remains a major barrier to lung ultrasound utilisation. Training, advocacy and awareness rising can help build up capacities of local providers to facilitate lung ultrasound use for COVID-19 management, in particular in low- and middle-income countries