Surveillance des effets secondaires du vaccin contre l'influenza : modifications du système, résultats observés et processus décisionnel lors de la campagne de vaccination massive contre l'influenza pandémique

OBJECTIFS : A l'automne 2009, le Québec a procédé à une vaccination de masse de sa population contre la grippe pandémique A(H1N1). Les objectifs de cette étude étaient de décrire le rehaussement du système de surveillance des manifestations cliniques indésirables (MCI) mis en place en vue de la campagne de vaccination contre 1'influenza pandémique et de comparer le profil des MCI rapportées dans le cadre de la surveillance faite durant la campagne de vaccination contre le virus pandémique H1N1 par rapport à ceux de la vaccination saisonnière des années précédentes. MÉTHODE : Pour le rehaussement de la surveillance, les données présentées ont été recueillies à partir des procès verbaux des rencontres des membres du groupe ESPRI depuis juin 2009, des conférences téléphoniques et des documents d'orientation pour le groupe. Pour la comparaison du profil des MCI rapportées dans le cadre de la surveillance faite durant la campagne de vaccination contre la grippe pandémique A(H1N1) par rapport à ceux de la vaccination saisonnière des six saisons précédentes (2003-2004, 2004-2005, 2005-2006, 2006-2007, 2007-2008 et 2008-2009), les données analysées proviennent des informations saisies au fichier ESPRI au 21 mai 2010. RÉSULTATS : Les principales modifications à la surveillance ont été la mise en place d'une surveillance spécifique du syndrome de Guillain Barré et la déclaration directe à la surveillance passive par les infirmières d'info-santé. Le vaccin pandémique a été associé à une fréquence trois plus élevée de MCI que le vaccin saisonnier soit 50,4 et 18,9 par 100 000 doses, respectivement. Les taux de chacune des MCI sont supérieurs avec le vaccin pandémique adjuvante que ceux des vaccins saisonniers. Cette augmentation s'est manifestée principalement pour les allergies (11.8 vs 4.1/100 000 doses), mais aussi pour des manifestations neurologiques de type anesthésie/paresthésie (2.5 vs 0.3/100 000 doses). CONCLUSION : Le Québec a opéré des modifications de sa surveillance des MCI lors de la campagne de vaccination massive de 2009. Bien qu'un taux plus élevé de MCI ait été rapporté, aucune MCI n'a été assez fréquente ou sévère pour mener à des modifications dans le déroulement du programme

Prise de décision des parents à retirer leur enfant de l'école en milieu urbain guinéen : cas de la préfecture de Kindia

Nous assistons actuellement à la naissance d’un phénomène qui a connu une amélioration significative au plan des chiffres, mais qui demeure inquiétant au plan de la réalité vécue. Ce phénomène, auquel les politiques ne prêtent pas attention, prive d’année en année par sa persistance des milliers d’enfants de l’un de leurs droits fondamentaux, celui d’une scolarité primaire complète. La présente recherche examine du point de vue des familles les raisons de la prise de décision de retirer leur enfant de l’école au niveau du second cycle du primaire guinéen. Afin de mieux cerner les raisons qui fondent le choix et l’action posés par les parents, nous avons privilégié une méthodologie de type qualitatif, avec pour technique l’entretien semi-structuré. Pour y parvenir, nous avons constitué un échantillon non probabiliste par choix raisonné basé sur la participation volontaire des parents. Nos critères d’inclusion ont été axés sur trois catégories de parents, c’est-à-dire, être parent résident dans l’un des quartiers où ont eu lieu les entretiens, avoir des enfants inscrits dans l’une des trois écoles ciblées, et avoir retiré un enfant de l’école. Les entrevues ont été menées auprès de 23 parents ayant retiré un ou plus de leurs enfants de l’école. En complément aux informations empiriques, nous avons fait des recherches documentaires pour compléter la problématique, le cadre théorique et conceptuel. Le cadre théorique et conceptuel de la recherche est consacré essentiellement à la compréhension de la rationalité de l’acteur de Boudon (1973, 1979), donc des parents par rapport au retrait des enfants de l’école. Il tient compte des représentations et des attentes des parents par rapport à leur agir sur-le-champ scolaire et sur la réussite sociale des enfants. Quant à l’approche écosystémique de Bronfenbrenner (1979) elle pose l’interrelation qui lie les parents à leur environnement et comment cet environnement peut agir sur leur pouvoir de décision et de fonctionnement. Les résultats ont permis de répondre à trois interrogations soulevées dans cette recherche. Ils démontrent dans un premier temps un agencement significatif des motifs qui servent à la compréhension de la prise de décision des parents de retirer leurs enfants de l’école. Ils font comprendre que le processus de la prise de décision peut venir de plusieurs personnes responsables des enfants et qu’il se fait dans la recherche de compromis et de négociations entre elles, y compris parfois l’enfant. Dans un deuxième temps, le phénomène de retrait des enfants de l’école par les parents se manifeste par diverses raisons, allant des conditions socioéconomiques et culturelles, aux facteurs exogènes à la famille. En effet, quel que soit l’angle d’attaque privilégié, il y a toujours une ou des raisons à l’origine du phénomène qui poussent les parents à agir d’une certaine façon. Enfin, dans un troisième temps, même si les parents interviewés ont dans leur très grande majorité fait preuve d’une bonne perception de l’école, d’autres, plutôt minoritaires, ne sont pas favorables à l’école. Les données collectées sur le terrain révèlent que les familles interviewées empruntent toutes des stratégies différentes pour retirer leurs enfants de l’école. Le discours des parents dans leur grande majorité, quelle que soit leur position sociale, place la réussite sociale des enfants au centre de leurs préoccupations. Aussi, il découle de leurs propos un paradoxe difficile à saisir aux yeux d’un simple observateur, mais qui a tout son sens, car c’est dans cette optique que nous abordons cette recherche, celui d’être conscients des apports considérables que l’éducation scolaire, l’instruction, le français parlé et l’écrit représentent pour eux et pour toute la société. Les parents conscients de toutes ces valeurs que l’école recèle décident quand même de retirer les enfants qui sont déjà inscrits dans le système éducatif. Cette pratique, que nous plaçons dans la logique de la rationalité parentale constitue le noeud de notre travail. Mots-clés : Prise de décision, Représentation sociale, Stratégie de l’acteur, Rationalité de l’acteur, Réussite sociale.We are now witnessing the emergence of a growing phenomenon, which politicians are not paying attention to, and which by their recurrence deprives thousands of children of one of their fundamental rights from year to year, primary schooling complete. This research examines from the families' point of view the reasons for the decision to withdraw their child from school at the upper secondary level of Guinea. To better comprehend the reasoning that lies behind the parents’ decision, we have given preference to a qualitative-type methodology that is based on the semi-structured interview technique. Therefore, we have developed a non-probabilistic sample based on the participants’ voluntary participation. Our inclusion criteria focused on three categories of parents i.e. being a parent residing in one of the neighborhoods where the interviews took place, parents having children enrolled in one of the three targeted schools, parents having removed a child from school. Interviews were conducted with 23 parents who had removed one child or more from school. In addition to empirical information, we have conducted documentary research to complement the theoretical and conceptual framework. This framework is essentially devoted to understanding the rationality of the actor, mainly the parents as regards the removal of children from school. It takes into account the representations and expectations of the parents in relation to their agency on the educational aspect and on the social success of children. As for Bronfenbrenner’s (1979) eco-systemic approach, it poses the interrelationship that binds parents up to their environment and how this environment can have an impact on their decision-making process and their agency. ccording to the results, three questions raised in this research have been answered. First, a significant set of various factors is highlighted, which help understand the parents’ decision to remove their children from school: the removal of children from school is a process that arises clearly from several people in charge of the children, is taken in search for compromise and negotiation between these people, sometimes including the child itself. Then the removal of children from school shows that various reasons are at stake, ranging from the family socioeconomic and cultural conditions to external factors. Indeed, whatever the approach to the problem taken, there is always one or more reasons that would endeavor parents to act as such. Finally, if amongst interviewees, parents are overwhelmingly positive towards school, others, though a fair minority, keep opposing the educational system. At this stage, it is worthwhile recalling that this positive perception parents have about the educational system comes from the understanding parents share that school helps children becoming educated, well brought up and responsible men and women, able in the future to stand up for their country. Not with standing the fact that parents do expect from their children succeeding at school to take financial care of the family one day. Field data reveal that the families who took part in the interview process use different strategies to remove their child from school. The main reason parents give, whatever their social background, is that their children’s social success is at the heart of their concern. To a mere observer, the resulting paradox is far from obvious, but is of utmost importance and meaning since this research has been conducted in taking that paradox into account, i.e. though removing their children from school, parents are fully aware that school features such as education, instruction, knowledge of spoken and written French are as important to us as to the society as a whole. Those values that school develops and which parents are aware of do not prevent parents to remove their children from school. Their agency, which we define as part of a logic parental rationality is at the heart of our study. Keywords: Decision Making, Social Representation, Rationality, Actor, Disappointment, Social Success

Risk assessment model for organizational information security

Information security risk assessment (RA) plays an important role in the organization’s future strategic planning. Generally there are two types of RA approaches: quantitative RA and qualitative RA. The quantitative RA is an objective study of the risk that use numerical data. On the other hand, the qualitative RA is a subjective evaluation based on judgment and experiences which does not operate on numerical data. It is difficult to conduct a purely quantitative RA method, because of the difficulty to comprehend numerical data alone without a subjective explanation. However, the qualitative RA does not necessarily demand the objectivity of the risks, although it is possible to conduct RA that is purely qualitative in nature. If implemented in silos, the limitations of both quantitative and qualitative methods may increase the likelihood of direct and indirect losses of an organization. This paper suggests a combined RA model from both quantitative and qualitative RA methods to be used for assessing information security risks. In order to interpret and apply the model, a prototype of RA for information security risks will be developed. This prototype will be evaluated by information security risk management experts from the industry. Feedback from the experts will be used to improve the proposed RA model. The implementation of an appropriate model ensures a successful RA method and prevent the organization from the natural and causal risks that are related to securing information assets

Kounis Syndrome in a Clinical Case

Kounis syndrome is the grouping of an acute coronary artery disease associated with an anaphylactic allergy, in which there is an antigen-antibody reaction caused by the release of inflammatory mediators and mast cells act by causing degranulation, and in this situation there is the presence of cells of inflammation, causing an anaphylactic reaction. There are several triggers that can trigger an allergic reaction and therefore Kounis syndrome, patients with atopy are more susceptible, it has been associated with insect bites, medications and some foods, environmental contamination and some medical conditions. Any age because it has been described even in children. There are not many clinical studies, nor a larger sample of patients to reach a consensus on this pathology. We present a 46-year-old patient who is admitted to the Emergency service of the national institute of cardiology and cardiovascular surgery in Havana. Cuba; with a history of Systemic Arterial Hypertension (HT), which is an increase in blood  pressure above the upper limits of normality. Grade II obesity, which is a body mass index ≥35. In addition to referred dyslipidemia. In the results according to the diagnostic criteria of Kounis syndrome, the following were found: Signs and symptoms of myocardial ischemia, urticaria, pruritus, dyspnea, sinus tachycardia after bee sting. Electrocardiogram (ECG): With ST segment elevation in 2 or more continuous leads. Echocardiography: Transient segmental motility disorders. Cardiac chambers of preserved size and function. Serum myocardial biomarkers within normal parameters, increased Histamine, Tryptase, leukotriene values. The objective is to describe the clinical characteristics, complementary examinations, their diagnosis, evolution and treatment. It was concluded that the diagnosis of Kounis syndrome is eminently clinical. in itself everything that leads to the activation of mast cells can produce the syndrome. The prognosis depends on the type of Kounis, cardiovascular risk factors and pre‐existing coronary artery disease. Keywords: ischemia, inflammatory response, angina, vasospasm, atherosclerosis, histamine. RESUMEN El síndrome de Kounis es la agrupación de una arteriopatía coronaria aguda asociado a una alergia anafiláctica, en la que hay una reacción antígeno-anticuerpo causado por la liberación de mediadores inflamatorios los mastocitos y estos actúan provocando degranulación, y ante esta situación hay presencia de células de la inflamación, provocando una reacción anafiláctica. Existen varios gatillantes que pueden desencadenar una reacción alérgica y por ende el síndrome de Kounis, son más susceptibles los pacientes con atopia, se le ha relacionado mucho con picaduras de insectos, medicamentos y algunos alimentos, contaminación ambiental y algunas condiciones médicas Se puede presentar a cualquier edad porque se ha descrito incluso en niños. No hay muchos estudios clínicos, ni una muestra más grande de pacientes para realizar un consenso de esta patología. Presentamos una paciente de 46 años de edad que es ingresada al servicio de Emergencia del instituto nacional de cardiología y cirugía cardiovascular de la habana. Cuba; con antecedente de Hipertensión Arterial Sistémica (HTA) que es aumento de la presión arterial por encima de los limites superiores de normalidad. Obesidad grado II que es el índice de masa corporal ≥ 35. además de dislipidemia referida. En los resultados según los criterios diagnóstico del síndrome de Kounis se encontró: Signos y síntomas de isquémica miocárdica, urticaria, prurito, disnea, taquicardia sinusal tras picadura de una abeja. Electrocardiograma (ECG): Con elevación del segmento ST en 2 o más derivaciones continuas. Ecocardiografía: Trastornos de motilidad segmentaria transitorio. cavidades cardiacas de tamaño y función conservada. Los biomarcadores miocárdicos sérico dentro de los parámetros normales, incremento de los valores de Histamina, Triptasa, leucotrienos. El objetivo es describir las características clínicas, exámenes complementarios, su diagnóstico, evolución y tratamiento. Se concluyó que el diagnóstico del síndrome de Kounis es eminentemente clínico. en sí todo lo que conlleve a la activación de mastocitos puede producir el síndrome. El pronóstico depende del tipo de Kounis, de los factores de riesgos cardiovasculares y coronariopatía preexistente. Palabras claves: isquemia, respuesta inflamatoria, angina, vasoespasmo, ateroesclerosis, histamina

The role of cybersecurity on the performance of Malaysian higher education institutions

Cybersecurity, as a security management requirement, is essential to understanding data security in higher institutions. This study aims to explore the role of cybersecurity in the performance of Malaysian higher education institutions through semi-structured qualitative interviews with 10 cybersecurity risk management officers from 10 public universities. The data were analysed using thematic analysis to identify the themes and sub-themes that revealed the strengths and deficiencies of the current cybersecurity frameworks. Results showed that cybersecurity implementation is considered a successful innovation in Malaysian universities and has contributed to protecting the data of students and staff, which in turn allowed the universities to improve their reputation. This study contributed significantly to the understanding of the performance and applicability of cybersecurity in universities. It showed the efficient use of resources, identification and detection of risk exposures, and improved cybersecurity communication between the technical team and top management are essential for a good decision making process

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic.

INTRODUCTION: In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. METHODS: Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019-February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020-February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. RESULTS: Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. CONCLUSION: Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic

Introduction In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. Methods Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. Results Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. Conclusion Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

Introduction Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. Methods Mixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting. Results We identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP. Conclusion Routine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks

Comparaison monothérapie/bithérapie dans le traitement du paludisme en terme de tolérance, efficacité et coût

PARIS-BIUP (751062107) / SudocSudocFranceF