Low Acceptability of A/H1N1 Pandemic Vaccination in French Adult Population: Did Public Health Policy Fuel Public Dissonance?

International audienceBACKGROUND: In July 2009, French public health authorities embarked in a mass vaccination campaign against A/H1N1 2009 pandemic-influenza. We explored the attitudes and behaviors of the general population toward pandemic vaccination. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional online survey among 2,253 French representative adults aged 18 to 64 from November 17 to 25, 2009 (completion rate: 93.8%). The main outcome was the acceptability of A/H1N1 vaccination as defined by previous receipt or intention to get vaccinated ("Yes, certainly", "Yes, probably"). Overall 17.0% (CI 95%, 15.5% to 18.7%) of respondents accepted A/H1N1 vaccination. Independent factors associated with acceptability included: male sex (p = .0001); older age (p = .002); highest or lowest level of education (p = .016); non-clerical occupation (p = .011); having only one child (p = .008); and having received seasonal flu vaccination in prior 3 years (p<.0001). Acceptability was also significantly higher among pregnant women (37.9%) and other at risk groups with chronic diseases (34.8%) (p = .002). Only 35.5% of respondents perceived A/H1N1 influenza illness as a severe disease and 12.7% had experienced A/H1N1 cases in their close relationships with higher acceptability (p<.0001 and p = .006, respectively). In comparison to 26.0% respondents who did not consult their primary care physician, acceptability was significantly higher among 8.0% respondents who were formally advised to get vaccinated, and lower among 63.7% respondents who were not advised to get vaccinated (respectively: 15.8%, 59.5% and 11.7%- p<.0001). Among respondents who refused vaccination, 71.2% expressed concerns about vaccine safety. CONCLUSIONS/SIGNIFICANCE: Our survey occurred one week before the peak of the pandemic in France. We found that alarming public health messages aiming at increasing the perception of risk severity were counteracted by daily personal experience which did not confirm the threat, while vaccine safety was a major issue. This dissonance may have been amplified by having not involved primary care physicians in the mass vaccination campaign

Prévention des évènements thrombo-emboliques précoces après plastie mitrale chez les patients en rythme sinusal (étude prospective multicentrique de 185 patients entre 2002 et 2005)

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

Le champ visuel des patients hémianopsiques est-il intègre ?

International audienceIntroductionL’hémianopsie latérale homonyme (HLH) est l’amputation du champ visuel la plus fréquente à la suite d’une lésion cérébrale unilatérale. Alors que la perception dans l’hémichamp contralésionnel a été très étudiée, les capacités visuelles au sein de l’hémichamp ipsilésionnel, considéré comme intact, restent méconnues. Pourtant, il semblerait que les patients hémianopsiques présentent un déficit subtil au sein de l’hémichamp ipsilésionnel.MéthodeL’objectif de la présente étude est de caractériser ce trouble ipsilésionnel en fonction (1) de la tâche visuelle à réaliser : détection ou catégorisation de scènes, (2) de la nature du stimulus visuel à traiter : filtré en basses ou en hautes fréquences ou résolu, (3) de la latéralisation de la lésion occipitale.Le pourcentage de réponses correctes ainsi que les temps de réponse en ms ont été enregistrés chez 10 patients ayant présenté un AVC : 5 patients cérébro-lésés gauche (HLH droite), 5 patients cérébro-lésés droit (HLH gauche) et 16 participants témoins, à qui nous avons proposé une tâche de détection (indiquer la présence d’une image de scènes naturelle) et une tâche de catégorisation (indiquer si la scène présentée est une ville ou une forêt).Résultats et DiscussionLes performances obtenues confirment la présence d’un déficit subtil mais significatif dans le champ visuel ipsilésionnel des patients hémianopsiques qui semble dépendre de la nature de la tâche, de la nature du stimulus et de la latéralisation de la lésion. Les patients porteurs d’une lésion occipitale droite (HLH Gauche) sont plus sévèrement atteints dans leur champ visuel ipsilésionnel que les patients porteurs d’une lésion occipitale gauche (HLH droite). Ces données confirment qu’une lésion occipitale unilatérale est à même d’entraîner une amputation du champ visuel contralésionnel ainsi qu’un déficit subtil dans le champ visuel ipsilésionnel.ConclusionCes résultats confirment l’hypothèse d’une supériorité de l’hémisphère droit dans le traitement visuo-spatial. Ces résultats suggèrent qu’il pourrait exister une spécialisation hémisphérique au niveau occipital, à même de déterminer l’expression des troubles non seulement dans le champ visuel contralésionnel mais également ipsilésionnel. Cette étude souligne également l’intérêt de stimuler les patients hémianopsiques dans leur champ ipsilésionnel

Hemisphere-dependent ipsilesional deficits in hemianopia: Sightblindness in the ‘intact’ visual field

International audienceIn addition to exhibiting a severe contralesional deficit, hemianopic patients may also show a subtle ipsilesional visual deficit, called sightblindness (the reverse case of 'blindsight). We have tested for the presence, nature and extent of such an ipsilesional visual field (IVF) deficit in hemianopic patients that we assigned to perform two visual tasks. Namely, we aimed to ascertain any links between this ipsilesional deficit, the lesion side, and the tasks performed or the stimuli used. We tested left and right homonymous hemianopic (right brain-damaged RBD and left brain-damaged LBD, respectively) patients and healthy controls. Natural-scene images, either non-filtered or filtered in low or high spatial frequency (LSF or HSF, respectively) were presented in the IVF of each subject. For the two tasks, detection ("Is an image present?") and categorization ("Is the image of a forest or a city?"), accuracy and response time were recorded. In the IVF the RBD (left hemianopes) patients made more errors on the categorization task than did their matched controls, regardless of image type. In contrast, the only task in which the LBD (right hemianopes) patients made more errors than did the controls was the HSF-images task. Furthermore, in both tasks (detection and categorization), the RBD patients performed worse than did the LBD patients. Homonymous hemianopic patients do indeed exhibit a specific visual deficit in their IVF, which was previously thought to be unaffected. We have demonstrated that the nature and severity of this ipsilesional deficit is determined by the side of the occipital lesion as well as by the tasks and the stimuli. Our findings corroborate the idea of hemispheric specialization at the occipital level, which might determine the nature and severity of ipsilesional deficits in hemianopic patients

Eye Involvement in Wilson’s Disease: A Review of the Literature

Wilson’s disease (WD) is an autosomal recessive genetic disorder due to a mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and accumulation in various tissues. Ocular findings are one of the hallmarks of the disease. Many ophthalmological manifestations have been described and new techniques are currently available to improve their diagnosis and to follow their evolution. We have performed a systematic PubMed search to summarize available data of the recent literature on the most frequent ophthalmological disorders associated with WD, and to discuss the newest techniques used for their detection and follow-up during treatment. In total, 49 articles were retained for this review. The most common ocular findings seen in WD patients are Kayser–Fleischer ring (KFR) and sunflower cataracts. Other ocular manifestations may involve retinal tissue, visual systems and eye mobility. Diagnosis and follow-up under decoppering treatment of these ocular findings are generally easily performed with slit-lamp examination (SLE). However, new techniques are available for the precocious detection of ocular findings due to WD and may be of great value for non-experimented ophthalmologists and non-ophthalmologists practitioners. Among those techniques, anterior segment optical coherence tomography (AS-OCT) and Scheimpflug imaging are discussed

Positive attitudes of French general practitioners towards A/H1N1 influenza-pandemic vaccination: a missed opportunity to increase vaccination uptakes in the general public?: Acceptability of pandemic vaccination among GPs

International audienceAttitudes of general practitioners (GPs) towards A/H1N1 pandemic vaccination are unknown. We conducted a cross-sectional survey with computer-assisted telephone interviewing in the French Regional Panel of General Practices from June 16 to September 22, 2009. Of 1434 respondents representative of GPs in four French regions, 885 (61.7%) were willing to accept A/H1N1 pandemic vaccination for themselves. The personal history of seasonal flu vaccination was the strongest independent predictive factor of willingness to accept A/H1N1 pandemic vaccination (p<.0001). GPs receiving seasonal vaccines every year were more likely to accept A/H1N1 pandemic vaccination than those who were never vaccinated in the prior 3 years (adjusted OR=4.38; 95% CI, 2.44-4.67). Willingness to accept pandemic vaccination was also significantly associated with being on call for emergencies; positive attitudes towards other protective measures against A/H1N1 influenza virus in the practice; and a higher readiness to provide additional consultations in response to the pandemic. In conclusion, GPs showed a high acceptability of A/H1N1 pandemic vaccination. GPs' involvement in the mass vaccination campaign, which has been neglected by French public health authorities, may have increased uptake rates in the general public

Acceptability of A/H1N1 pandemic vaccination in French adult population (18-64 years) and its determinants (online survey, November 17 to 25, 2009, N = 2,167).

<p>*<i>60 with asthma (43%); 19 with chronic bronchitis (14.7%); 46 with diabetes (33.3%); 13 with cardiac condition (9.4%).</i></p><p>†<i>chi² test p-values (Cochran-Armitage test for age).</i></p><p>‡<i>p-values for type III tests. Hosmer-Lemeshow test (p = 0.46) and deviance (p = 1.00) suggest that the goodness of fit was adequate for the final multivariate logistic model.</i></p><p>#<i>covariates forced into multivariate model.</i></p><p><i>NS: Non significant after backward selection process, OR not provided.</i></p

Preserved auditory cognitive ERPs in severe akinetic mutism: a case report.

kinetic mustism is a dramatic deficit in spontaneous initiation of voluntary motor and speech acts, usually secondary to bilateral lesions of the anterior cingulate cortices and supplementary motor areas [Principles of Neurology, McGraw-Hill, New York, 1989]. Given the obvious limitations of traditional neuropsychological testing in this clinical context, the use of neurophysiological tools such as bedside auditory cognitive event-related potentials (ERPs), recently proven to be relevant to evaluate comatose and vegetative patients [Clin. Neurophysiol. 110 (9) (1999) 1601; News Physiol. Sci. 17 (2002) 38], may constitute an interesting alternative. Here, we present the ERPs of a 38-year-old right-handed woman with severe akinetic mutism recorded in a passive auditory odd-ball paradigm. In spite of this severe clinical state, we could observe the presence of a "Mismatch Negativity", and of a larger P300 in rare trials than in frequent ones. By revealing a high level of cognitive integration of environmental auditory information, our study emphasizes the potential clinical relevance of MMN and P300 recordings in akinetic mutism to assess patient cognitive functioning