Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Background. The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. Objective. TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. Setting. Eleven ICUs of a French university hospital. Design. We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. Results. Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. Conclusions. ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assesse

First evidence for zooplankton feeding sustaining key physiological processes in a scleractinian cold-water coral

Scleractinian cold-water corals (CWC) represent key taxa controlling deep-sea reef ecosystem functioning by providing structurally complex habitats to a high associated biodiversity, and by fuelling biogeochemical cycles via the release of organic matter. Nevertheless, our current knowledge on basic CWC properties, such as feeding ecology and key physiological processes (i.e. respiration, calcification and organic matter release), is still very limited. Here, we show evidence for the trophic significance of zooplankton, essentially sustaining levels of the investigated key physiological processes in the cosmopolitan CWC Desmophyllum dianthus (Esper 1794). Our results from laboratory studies reveal that withdrawal (for up to 3 weeks) of zooplankton food (i.e. Artemia salina) caused a significant decline in respiration (51%) and calcification (69%) rates compared with zooplankton-fed specimens. Likewise, organic matter release, in terms of total organic carbon (TOC), decreased significantly and eventually indicated TOC net uptake after prolonged zooplankton exclusion. In fed corals, zooplankton provided 1.6 times the daily metabolic C demand, while TOC release represented 7% of zooplankton-derived organic C. These findings highlight zooplankton as a nutritional source for D. dianthus, importantly sustaining respiratory metabolism, growth and organic matter release, with further implications for the role of CWC as deep-sea reef ecosystem engineersPublicado

Molecular Evidence of Interhuman Transmission of Pneumocystis Pneumonia among Renal Transplant Recipients Hospitalized with HIV-Infected Patients

Molecular evidence indicates that P. jirovecii may be nosocomially transmitted to severely immunosuppressed patients

Training infection control and hospital hygiene professionals in Europe, 2010 : agreed core competencies among 33 European countries

The harmonisation of training programmes for infection control and hospital hygiene (IC/HH) professionals in Europe is a requirement of the Council recommendation on patient safety. The European Centre for Disease Prevention and Control commissioned the ‘Training Infection Control in Europe’ project to develop a consensus on core competencies for IC/HH professionals in the European Union (EU). Core competencies were drafted on the basis of the Improving Patient Safety in Europe (IPSE) project’s core curriculum (CC), evaluated by questionnaire and approved by National Representatives (NRs) for IC/HH training. NRs also re-assessed the status of IC/HH training in European countries in 2010 in comparison with the situation before the IPSE CC in 2006. The IPSE CC had been used to develop or update 28 of 51 IC/HH courses. Only 10 of 33 countries offered training and qualification for IC/ HH doctors and nurses. The proposed core competencies are structured in four areas and 16 professional tasks at junior and senior level. They form a reference for standardisation of IC/HH professional competencies and support recognition of training initiatives.peer-reviewe

Gerhard Schwinge, Johann Heinrich Jung-Stilling. Briefe. Ausgewah.lt und herausgegeben von Gerhard Schwinge., 2002

Fabry Jacques. Gerhard Schwinge, Johann Heinrich Jung-Stilling. Briefe. Ausgewah.lt und herausgegeben von Gerhard Schwinge., 2002. In: Dix-huitième Siècle, n°37, 2005. Politiques et cultures des Lumières. pp. 649-650

Gerhard Schwinge, Johann Heinrich Jung-Stilling. Briefe. Ausgewah.lt und herausgegeben von Gerhard Schwinge., 2002

Fabry Jacques. Gerhard Schwinge, Johann Heinrich Jung-Stilling. Briefe. Ausgewah.lt und herausgegeben von Gerhard Schwinge., 2002. In: Dix-huitième Siècle, n°37, 2005. Politiques et cultures des Lumières. pp. 649-650

VERS UN OBSERVATOIRE DES PERSONNES AGEES, DANS LE RHONE

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

LA FORMATION MEDICALE INITIALE ET LA SANTE DES POPULATIONS DEFAVORISEES

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Dépistage de l'hépatite C (un enjeu de santé publique)

La prévalence élevée de l'hépatite C, son évolution sévère et l'existence de traitements efficaces semblent justifier son dépistage. Des recherches, menées par l'association ADHEC, ont contribué à l'organisation du dépistage en médecine de ville dans le cadre d'un Programme National. Les travaux réalisés démontraient la faisabilité du dépistage et le rôle central du généraliste de ville. Mais certaines limites sont apparues (30 % des médecins ne prescrivent aucun test, l'identification de nouveaux cas est de plus en plus rare). Un élargissement du dépistage, notamment en direction des publics "précaires", fréquentant moins les cabinets médicaux, parraît nécessaire. Un dépistage réalisé dans un Centre d'Examen de Santé de la Sécurité Sociale révélait une prévalence de 4,6 % dans cette population, qui semble ignorer très largement la prévention de l'hépatite C, tout en ayant une exposition importante. En 2003, l'ADHEC a organisé un dépistage des publics précaires. A mi campagne, on observait une prévalence de 7 % qui justifie un effort particulier de dépistage dans cette population. D'autres lieux comme les CDAG ou le milieu carcéral ne doivent pas être négligés. Enfin, il manque toujours une évaluation économique approfondie des différentes stratégies de dépistage du VHC et le bénéfice en terme d'amélioration pronostique doit être objectivement mesuré. Toutefois les études menées par l'ADHEC ont contribué à une meilleure appréciation opérationnelle des conditions de succès de l'organisation de ce dépistage dans une région françaiseLYON1-BU.Sciences (692662101) / SudocSudocFranceF