Use of neuraminidase inhibitors in primary health care during pandemic and seasonal influenza between 2009 and 2013: Outpatient influenza antiviral treatment

International audienceBACKGROUND:In a context of controversy about influenza antiviral treatments, this study assessed primary health-care physicians' prescription of neuraminidase inhibitors (NIs) in France during pandemic and seasonal influenza between 2009 and 2013.METHODS:This observational study, using data recorded in three national databases, estimated the rate of NI prescription among influenza-like illness (ILI) patients seen in GP and paediatrician consultations, and determined factors associated with this prescription according to a multivariate analysis. NI delivery by pharmacists was also evaluated.RESULTS:Rates of NI prescription were estimated to be 61.1% among ILI patients with a severe influenza risk factor seen in GP consultation during the A(H1N1)pdm2009 pandemic versus an average rate of 25.9% during the three following seasonal influenza epidemics. Factors associated with NI prescription were a chronic disease in patients under 65 years (OR 14.85; 95% CI 13.00, 16.97) and in those aged 65 and older (OR 7.54; 5.86, 9.70), an age ≥65 years in patients without chronic disease (OR 1.35; 1.04, 1.74), a pregnancy (OR 10.63; 7.67, 15.76), obesity (OR 4.67; 3.50, 6.22) and a consultation during the pandemic A(H1N1)pdm2009 (OR 3.19; 2.93, 3.48). The number of antiviral treatments delivered by pharmacists during the A(H1N1)pdm2009 pandemic was 835 per 100,000 inhabitants, and an average of 275 per 100,000 inhabitants during the three following seasonal influenza epidemics.CONCLUSIONS:Although physicians seem to follow the recommended indications for NIs in primary health-care practice, this study confirms the low rate of NI prescription to ILI patients with a severe influenza risk factor, especially during seasonal epidemics

The role of food and land use systems in achieving India’s sustainability targets

The food and land use sector is a major contributor to India's total greenhouse gas (GHG) emissions. On one hand, India is committed to sustainability targets in the Agriculture, Forestry and Other Land Use (AFOLU) sectors, on the other, there is little clarity whether these objectives can align with national developmental priorities of food security and environmental protection. This study fills the gap by reviewing multiple corridors to sustain the AFOLU systems through an integrated assessment framework using partial equilibrium modeling. We create three pathways that combine the shared socio-economic pathways with alternative assumptions on diets and mitigation strategies. We analyze our results of the pathways on key indicators of land-use change, GHG emissions, food security, water withdrawals in agriculture, agricultural trade and production diversity. Our findings indicate that dietary shift, improved efficiency in livestock production systems, lower fertilizer use, and higher yield through sustainable intensification can reduce GHG emissions from the AFOLU sectors up to 80% by 2050. Dietary shifts could help meet EAT-Lancet recommended minimum calorie requirements alongside meeting mitigation ambitions. Further, water withdrawals in agriculture would reduce by half by 2050 in the presence of environmental flow protection and mitigation strategies. We conclude by pointing towards specific cstrategic policy design changes that would be essential to embark on such a sustainable pathway.Norway’s International Climate and Forest Initiative (NICFI)Peer Reviewe

A Spontaneous Mutation of the Rat Themis Gene Leads to Impaired Function of Regulatory T Cells Linked to Inflammatory Bowel Disease

Spontaneous or chemically induced germline mutations, which lead to Mendelian phenotypes, are powerful tools to discover new genes and their functions. Here, we report an autosomal recessive mutation that occurred spontaneously in a Brown-Norway (BN) rat colony and was identified as causing marked T cell lymphopenia. This mutation was stabilized in a new rat strain, named BNm for “BN mutated.” In BNm rats, we found that the T cell lymphopenia originated in the thymus, was intrinsic to CD4 T lymphocytes, and was associated with the development of an inflammatory bowel disease. Furthermore, we demonstrate that the suppressive activity of both peripheral and thymic CD4+ CD25bright regulatory T cells (Treg) is defective in BNm rats. Complementation of mutant animals with BN Treg decreases disease incidence and severity, thus suggesting that the impaired Treg function is involved in the development of inflammatory bowel disease in BNm rats. Moreover, the cytokine profile of effector CD4 T cells is skewed toward Th2 and Th17 phenotypes in BNm rats. Linkage analysis and genetic dissection of the CD4 T cell lymphopenia in rats issued from BNm×DA crosses allowed the localization of the mutation on chromosome 1, within a 1.5 megabase interval. Gene expression and sequencing studies identified a frameshift mutation caused by a four-nucleotide insertion in the Themis gene, leading to its disruption. This result is the first to link Themis to the suppressive function of Treg and to suggest that, in Themis-deficient animals, defect of this function is involved in intestinal inflammation. Thus, this study highlights the importance of Themis as a new target gene that could participate in the pathogenesis of immune diseases characterized by chronic inflammation resulting from a defect in the Treg compartment

Field Effectiveness of Pandemic and 2009-2010 Seasonal Vaccines against 2009-2010 A(H1N1) Influenza: Estimations from Surveillance Data in France

BACKGROUND: In this study, we assess how effective pandemic and trivalent 2009-2010 seasonal vaccines were in preventing influenza-like illness (ILI) during the 2009 A(H1N1) pandemic in France. We also compare vaccine effectiveness against ILI versus laboratory-confirmed pandemic A(H1N1) influenza, and assess the possible bias caused by using non-specific endpoints and observational data. METHODOLOGY AND PRINCIPAL FINDINGS: We estimated vaccine effectiveness by using the following formula: VE  =  (PPV-PCV)/(PPV(1-PCV)) × 100%, where PPV is the proportion vaccinated in the population and PCV the proportion of vaccinated influenza cases. People were considered vaccinated three weeks after receiving a dose of vaccine. ILI and pandemic A(H1N1) laboratory-confirmed cases were obtained from two surveillance networks of general practitioners. During the epidemic, 99.7% of influenza isolates were pandemic A(H1N1). Pandemic and seasonal vaccine uptakes in the population were obtained from the National Health Insurance database and by telephonic surveys, respectively. Effectiveness estimates were adjusted by age and week. The presence of residual biases was explored by calculating vaccine effectiveness after the influenza period. The effectiveness of pandemic vaccines in preventing ILI was 52% (95% confidence interval: 30-69) during the pandemic and 33% (4-55) after. It was 86% (56-98) against confirmed influenza. The effectiveness of seasonal vaccines against ILI was 61% (56-66) during the pandemic and 19% (-10-41) after. It was 60% (41-74) against confirmed influenza. CONCLUSIONS: The effectiveness of pandemic vaccines in preventing confirmed pandemic A(H1N1) influenza on the field was high, consistently with published findings. It was significantly lower against ILI. This is unsurprising since not all ILI cases are caused by influenza. Trivalent 2009-2010 seasonal vaccines had a statistically significant effectiveness in preventing ILI and confirmed pandemic influenza, but were not better in preventing confirmed pandemic influenza than in preventing ILI. This lack of difference might be indicative of selection bias

Staphylococcus aureus infective endocarditis versus bacteremia strains: Subtle genetic differences at stake

AbstractInfective endocarditis (IE)(1) is a severe condition complicating 10–25% of Staphylococcus aureus bacteremia. Although host-related IE risk factors have been identified, the involvement of bacterial features in IE complication is still unclear. We characterized strictly defined IE and bacteremia isolates and searched for discriminant features. S. aureus isolates causing community-acquired, definite native-valve IE (n=72) and bacteremia (n=54) were collected prospectively as part of a French multicenter cohort. Phenotypic traits previously reported or hypothesized to be involved in staphylococcal IE pathogenesis were tested. In parallel, the genotypic profiles of all isolates, obtained by microarray, were analyzed by discriminant analysis of principal components (DAPC)(2). No significant difference was observed between IE and bacteremia strains, regarding either phenotypic or genotypic univariate analyses. However, the multivariate statistical tool DAPC, applied on microarray data, segregated IE and bacteremia isolates: IE isolates were correctly reassigned as such in 80.6% of the cases (C-statistic 0.83, P<0.001). The performance of this model was confirmed with an independent French collection IE and bacteremia isolates (78.8% reassignment, C-statistic 0.65, P<0.01). Finally, a simple linear discriminant function based on a subset of 8 genetic markers retained valuable performance both in study collection (86.1%, P<0.001) and in the independent validation collection (81.8%, P<0.01). We here show that community-acquired IE and bacteremia S. aureus isolates are genetically distinct based on subtle combinations of genetic markers. This finding provides the proof of concept that bacterial characteristics may contribute to the occurrence of IE in patients with S. aureus bacteremia

Evaluation de l anatomie cochléaire et de la position de l électrode CI422 (Cochlear®) par Cone Beam (corrélations avec les performances auditives)

Le positionnement de l électrode dans la rampe tympanique et son angle d insertion seraient corrélés aux performances et à la préservation de l audition résiduelle. Cette corrélation n est pas fiable avec le scanner traditionnel. Le but de ce travail était de valider le Cone Beam (CBCT) dans l analyse de l anatomie cochléaire et du positionnement de l électrode, et de corréler le positionnement de l électrode à l anatomie et aux performances auditives.Huit rochers implantés avec l'électrode CI422 (Cochlear®) ont été analysés en scanner et CBCT en pré et postimplantation, puis contrôlés histologiquement, pour valider l intérêt du CBCT et établir un protocole. Une étude clinique prospective monocentrique a débuté, étudiant les performances auditives en liste de Lafon chez 9 patients (dont une implantation bilatérale) à 6 mois postimplantation, la qualité de vie (questionnaires ERSA et APHAB) et la place de l électrode en CBCT. Malgré la présence d artéfacts, le CBCT a permis de faire une étude précise de l anatomie cochléaires (avec 45 fois moins d irradiation), confirmant les variations de taille complexe du canal cochléaire. Le CBCT permet de visualiser l électrode lorsqu elle est dans la scala tympani ou vestibuli. Lorsqu elle se situe en position intermédiaire, il ne permet pas de dire s il existe une rupture de la membrane basilaire vers la scala media ou une rupture du ligament spiral. Chez les patients, l électrode était située dans la scala tympani dans 2 cas, dans la scala vestibuli dans 1 cas et en position intermédiaire dans 6 cas. Pour un patient ayant bougé les artéfacts ne permettaient pas de conclure. L angle moyen d insertion était de 418,78 [365-486] et était corrélé au pourcentage de réponses correctes en mots (51,6%, R2=0,41, p <=0,05).Cette étude montre que la résolution supérieure du CBCT par rapport au scanner peut permettre une analyse anatomique précise de la cochlée afin de planifier le trajet de l électrode et optimiser les résultats auditifs des patients.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Les formations aux données de la recherche du SCD AMU : une offre pour les chercheur.e.s et doctorant.e.s

International audienc

Facteurs prédictifs d’une lecture labiale fonctionnelle chez les adultes candidats à l’implantation cochléaire

International audienceObjective: The aim of this retrospective study is to highlight the predictive factors for a functional lipreading in cochlear implanted adults. Methods: Our study is based on the data of 232 cochlear-implanted patients collected from pre-implantation speech perception and communication evaluations. Pre-implantation lipreading data have been analyzed according to gender, age, education and profound hearing loss duration. Results: Data analysis showed the older subjects performed worst than younger on lipreading global tests. Women perform better than men for sentence recognition. Globally, a multivariate analysis showed that only age seems to be a predictive factor for a functional lipreading, accounting for 6,7% of the variance. Conclusion: To conclude, this study confirms the significant heterogeneity observed in cochlear implanted adults for lipreading and suggests to complete evaluations with specific testing focused on cognitive skills, surch as memory, attention or flexibility, involved in the development of the lipreading.Objectif : L’objectif de cette étude était de rechercher les causes de variabilité dans les performances en lecture labiale chez les adultes atteints de surdité évolutive, afin d’en dégager des facteurs prédictifs. Méthodes : Les données de 232 patients présentant une surdité sévère à profonde ont été recueillies à partir des bilans orthophoniques effectués dans le cadre de leurs bilans pré-implants. Les performances en lecture labiale ont été analysées en fonction du sexe, de l’âge, du niveau d’études et de la durée de la surdité profonde. Résultats : Les résultats montrent que les sujets plus âgés ont de moins bonnes performances en lecture labiale pour l’intégration globale des informations verbales (mots dissyllabiques et phrases) mais pas pour la perception analytique. De plus, les femmes obtiennent de meilleurs résultats aux tests de reconnaissance de phrases. Au total, l’analyse multivariée des facteurs prédictifs indique un effet de l’âge sur l’acquisition d’une lecture labiale fonctionnelle, expliquant ainsi 6,7 % de la variance observée. Conclusion : Cette étude confirme l’importante hétérogénéité des performances observée pour l’intégration visuelle de la parole avec la lecture labiale chez les sujets adultes candidats à l’implantation cochléaire. L’ensemble de ces données confirme l’intérêt de futures études portant sur l’évaluation des fonctions cognitives et exécutives telles que la mémoire, la flexibilité et l’attention impliquées dans le développement de la lecture labiale