Teledermatology in low-resource settings: the MSF experience with a multilingual tele-experise platform

Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system. Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases. Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7–21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26–3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers. Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography

Vitamines et pédiatrie

CLERMONT FD-BCIU-Santé (631132104) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Transitions politiques et culturelles en Europe méridionale (XIXe-XXe siècle)

La construction d’une identité individuelle ou collective passe par la conscience d’appartenir à une époque et par la consommation de préjugés et de symboles. Ce dossier traite de l’impact des transitions politiques sur le culturel et, réciproquement, de l’exploitation politique de certaines affirmations ou renaissances culturelles. Cela revient à s’interroger sur l’écriture de l’histoire, sur la nature et les rythmes du processus de mutation, sur la revendication politique d’un mouvement culturel, ou les implications culturelles d’un mouvement politique. Chaque nouvelle période annoncée ou inventée rétrospectivement ne se traduit pas toujours par ce bouleversement des langages et des mythes que les avant-gardes ont revendiqué. La transition, espace produit entre le passé et le présent, devient alors autant une interprétation du changement historique qu’une organisation de la conscience présente. La construcción de una identidad individual o colectiva pasa por la conciencia de pertenecer a una época y compartir sus símbolos y prejuicios. Este dossier trata del impacto de las transiciones políticas sobre lo cultural y, en sentido inverso, de la explotación política de determinadas afirmaciones o renacimientos culturales. Ello requiere interrogarse sobre la escritura de la historia, sobre la naturaleza y los ritmos del proceso de mutación, sobre las reivindicaciones políticas de un movimiento cultural o las implicaciones culturales de un movimiento político.El anuncio de una nueva época, o su invención retrospectiva, no siempre conlleva esa transformación del discurso y de los mitos reivindicados por las vanguardias. La transición, espacio que se genera entre el pasado y el presente, constituye, pues, tanto una interpretación del cambio histórico como una organización de la conciencia actual. Among the requirements for the construction of an individual or collective identity are an awareness of belonging to an age and the assumption of prejudices and symbols. This dossier deals with the impact of political transitions on culture and, mutatis mutandis, the political exploitation of certain cultural affirmations or renaissances. What this comes down to, then, is a reflection on the writing of history, on the nature and the rhythms of processes of mutation, on the political demands of a cultural movement or the cultural implications of a political movement. Every new period that is retrospectively announced or invented does not always produce the upheaval in language and myths that avant-gardes have claimed. Transition, as a dimension bridging past and present, is thus as much an interpretation of historical change as it is an organisation of present consciousness

La casa medieval en la península ibérica

La presente edición ha sido financiada con el proyecto de excelencia titulado "La arquitectura en Andalucía desde una perspectiva de género" (GENARQ HUM 5709) de la Universidad de Granada y subvencionado por la Junta de Andalucía y cuya investigadora principal es Mª Elena Díez Jorge.El libro se enmarca académicamente en dos proyectos de investigación: La arquitectura en Andalucía desde una perspectiva de género: estudio de casos, prácticas y realidades construidas (Proyecto de Excelencia de la Junta de Andalucía, referencia HUM5709, dirigido por M.ª Elena Díez) y La arquitectura residencial de al-Andalus: análisis tipológico, contexto urbano y sociológico: bases para la intervención patrimonial (Proyecto I+D+i del Plan Nacional de Investigación Científica, referencia HAR20Il-29963, dirigido por Julio Navarro)"

Programme PIREN-Seine - Phase 6 Axe 4 : « Ecologie & Ecotoxicologie » Les déterminants de la qualité écologique du milieu aquatique

[Departement_IRSTEA]Eaux [TR1_IRSTEA]QUASARELes organismes vivants dans le milieu aquatique sont soumis à de multiples pressions combinées : chimique, hydro- morphologique, thermique, trophique (matière organique, eutrophisation...), qui impactent, et éventuellement perturbent leur fonctionnement. La santé des individus qui composent la biocénose peut aussi être altérée par ces différentes pressions. S'il est possible de faire des relations causales entre une pression et une réponse biologique, l'enjeu aujourd'hui est de pouvoir prédire les conséquences sur les différentes composantes de la biocénose de l'ensemble des pressions qui interagissent. L'observation des organismes vivants, à différents niveaux d'organisation (la cellule, l'organe, l'organisme, la population, ou la communauté) est proposée depuis plusieurs années pour renseigner sur l'état de santé des organismes, des communautés (bio- indication de type DCE), sur l'état écologique global du milieu, ou sur l'impact des contaminants chimiques (biomarqueurs en écotoxicologie). Au cours de la phase 6 PIREN -Seine, nous avons étudié à la fois comment les observations faites sur la biocénose peuvent nous renseigner sur les impacts des différentes pressions, y compris la pression chimique (domaine de l'écotoxicologie), mais aussi comment la multiplicité de ces pressions (caractéristique d'un bassin versant très anthropisé comme l'est celui de la Seine), ou les modifications de ces pressions, impactent le vivant

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (>59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P <.001). Overall motor and cognitive performance (P <.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P <.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P <.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P <.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients

Reduced Cancer Incidence in Huntington's Disease: Analysis in the Registry Study

Background: People with Huntington's disease (HD) have been observed to have lower rates of cancers. Objective: To investigate the relationship between age of onset of HD, CAG repeat length, and cancer diagnosis. Methods: Data were obtained from the European Huntington's disease network REGISTRY study for 6540 subjects. Population cancer incidence was ascertained from the GLOBOCAN database to obtain standardised incidence ratios of cancers in the REGISTRY subjects. Results: 173/6528 HD REGISTRY subjects had had a cancer diagnosis. The age-standardised incidence rate of all cancers in the REGISTRY HD population was 0.26 (CI 0.22-0.30). Individual cancers showed a lower age-standardised incidence rate compared with the control population with prostate and colorectal cancers showing the lowest rates. There was no effect of CAG length on the likelihood of cancer, but a cancer diagnosis within the last year was associated with a greatly increased rate of HD onset (Hazard Ratio 18.94, p < 0.001). Conclusions: Cancer is less common than expected in the HD population, confirming previous reports. However, this does not appear to be related to CAG length in HTT. A recent diagnosis of cancer increases the risk of HD onset at any age, likely due to increased investigation following a cancer diagnosis