Contacts homme-eau et schistosomiase urinaire dans un village mauritanien = Water contact and urinary schistosomiasis in a Mauritanian village

Huit jours d'observations directes, de septembre à décembre 1985, dans un village d'endémie bilharzienne à #S. haematobium$ situé en zone sahélienne ont permis d'enregistrer 1226 contacts homme-eau dans la mare du village et d'analyser la responsabilité des diverses activités dans la transmission. Un indice d'exposition, intégrant la durée du contact, la surface corporelle exposée et la probabilité de présence de cercaires dans l'eau a été calculé pour chaque contact. Les activités domestiques, essentiellement féminines, ont représenté 62 % des contacts mais seulement 15 % de l'exposition totale. La situation est inverse pour les activités récréatives qui, impliquant principalement de jeunes garçons, n'étaient responsables que de 14 % des contacts mais de 70 % de l'exposition totale. Entre 6 et 20 ans l'exposition moyenne par contact est plus importante pour le sexe masculin. Une politique de prévention de la maladie par une action sur les contacts semble irréaliste dans le contexte étudié et le traitement sélectif des enfants ou des sujets fortement infectés apparaît comme la stratégie de lutte la mieux adaptée. (Résumé d'auteur

Функції реалій в інтертекстах американських гумористичних новел

Актуальность работы связана с изучением текста в "диалоге" с другими текстами, т.е. в рамках теории интертекстуальности. Реалия рассматривается как элемент интертекста, где она функционируюет в составе аллюзии, цитаты, заголовочного комплекса и является составным элементом американских юмористических новелл 19-20 вв.Актуальність роботи пов'язана з вивченням тексту у "діалозі" з іншими текстами, тобто в рамках теорії інтертекстуальності. Реалія розглядається як елемент інтертексту, де вона функціонує у складі алюзії, цитати, заголовкового комплексу, і є складовим елементом американських гумористичних новел 19-20 ст.The actuality of the work is connected with the study of the text in "in dialogue" with other texts, i.e. within the limits of the intertextuality theory. A piece of realia is examined as an element of intertext where it functions in the structure of allusion, quotation, headline complex, and is a constituent part of the 19th-20th c. American humour short stories

Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya : a modelling study

Background: Multiple prevention interventions, including early antiretroviral therapy initiation, may reduce HIV incidence in hyperendemic settings. Our aim was to predict the short-term impact of various single and combined interventions on HIV spreading in the adult population of Ndhiwa subcounty (Nyanza Province, Kenya). Methods: A mathematical model was used with data on adults (15-59 years) from the Ndhiwa HIV Impact in Population Survey to compare the impacts on HIV prevalence, HIV incidence rate, and population viral load suppression of various interventions. These interventions included: improving the cascade of care (use of three guidelines), increasing voluntary medical male circumcision (VMMC), and implementing pre-exposure prophylaxis (PrEP) use among HIV-uninfected women. Results: After four years, improving separately the cascade of care under the WHO 2013 guidelines and under the treat-all strategy would reduce the overall HIV incidence rate by 46 and 58 %, respectively, vs. the baseline rate, and by 35 and 49 %, respectively, vs. the implementation of the current Kenyan guidelines. With conservative and optimistic scenarios, VMMC and PrEP would reduce the HIV incidence rate by 15-25 % and 22-28 % vs. the baseline, respectively. Combining the WHO 2013 guidelines with VMMC would reduce the HIV incidence rate by 35-56 % and combining the treat-all strategy with VMMC would reduce it by 49-65 %. Combining the WHO 2013 guidelines, VMMC, and PrEP would reduce the HIV incidence rate by 46-67 %. Conclusions: The impacts of the WHO 2013 guidelines and the treat-all strategy were relatively close; their implementation is desirable to reduce HIV spread. Combining several strategies is promising in adult populations of hyperendemic areas but requires regular, reliable, and costly monitoring

Bladder cancer and occupational exposures

A hospital-based cas-referent study was carried out in Lyon with the purpose of generating hypotheses about the role of occupational exposures to 320 compounds in bladder carcinogenesis. Job histories were obtained by questionnaire for 116 cases and 232 reference patients with diseases other than cancer (one referent from the same hospital ward and one from another ward of the same hospital per case) ; the referents were matched for gender, hospital, age, and nationality. Systematic coding of exposures, with a blind analysis of job histories, was carried out by a team of experts in chemistry and occupational health. Significantly elevated odds ratios were observed for exposure to pyrolysis and combustion products [odds ratio (OR) 2.3, 95 % confidence interval (95 % CI) 1.0-4.0] when the general referents were used and for cutting fluids (OR 2.6, 95 % CI 1.2-5.4) when tobacco consumption was adjusted for. The latter was highest among the category consisting of blue-collar and unskilled workers, supervisors, and agricultural workers (OR 4.6, 95 % CI 2.0-10.6), while the odds ratio for the other category was 0.8 (95 % CI 0.3-2.7). An elevated odds ratio for exposure to inks was observed for the women (OR 14.0, 95 % CI 1.8-106.5) on the basis of 14 exposed cases, but confounding factors could have been responsible for this result. Odds ratios for several other exposures (rubber : OR 5.7, nitrates : OR 8.2, coke dust : OR 3.5, meat additives : OR 3.8) were also elevated, but not significantly so when based on a small number of exposed cases. The observations of this investigation should be tested in future studies, in particular since exposures to agents such as cutting fluids or pyrolysis products are ubiquitous in industrial settings and may present an important public health hazard. (Résumé d'auteur

The "Buruli Score": development of a multivariable prediction model for diagnosis of Mycobacterium ulcerans infection in individuals with ulcerative skin lesions, Akonolinga, Cameroon

Background Access to laboratory diagnosis can be a challenge for individuals suspected of Buruli Ulcer (BU). Our objective was to develop a clinical score to assist clinicians working in resource- limited settings for BU diagnosis. Methododology/Principal Findings Between 2011 and 2013, individuals presenting at Akonolinga District Hospital, Cameroon, were enrolled consecutively. Clinical data were collected prospectively. Based on a latent class model using laboratory test results (ZN, PCR, culture), patients were categorized into high, or low BU likelihood. Variables associated with a high BU likelihood in a multivariate logistic model were included in the Buruli score. Score cut-offs were chosen based on calculated predictive values. Of 325 patients with an ulcerative lesion, 51 (15.7%) had a high BU likelihood. The variables identified for the Buruli score were: characteristic smell (+3 points), yellow color (+2), female gender (+2), undermining (+1), green color (+1), lesion hyposensitivity (+1), pain at rest (-1), size >5cm (-1), locoregional adenopathy (-2), age above 20 up to 40 years (-3), or above 40 (-5). This score had AUC of 0.86 (95% CI 0.82-0.89), indicating good discrimination between infected and non-infected individuals. The cut-off to reasonably exclude BU was set at scores = 4 (PPV 69.0%; 95% CI 49.2-84.7). Patients with intermediate BU probability needed to be tested by PCR. Conclusions/Significance We developed a decisional algorithm based on a clinical score assessing BU probability. The Buruli score still requires further validation before it can be recommended for wide use