Travellers' profile, travel patterns and vaccine practices—a 10-year prospective study in a Swiss Travel Clinic

The travel clinic in Lausanne serves a catchment area of 700 000 of inhabitants and provides pre- and post-travel consultations. This study describes the profile of attendees before departure, their travel patterns and the travel clinic practices in terms of vaccination over time.; We included all pre-travel first consultation data recorded between November 2002 and December 2012 by a custom-made program DIAMM/G. We analysed client profiles, travel characteristics and vaccinations prescribed over time.; Sixty-five thousand and forty-six client-trips were recorded. Fifty-one percent clients were female. Mean age was 32 years. In total, 0.1% were aged <1 year and 0.2% ≥80 years. Forty-six percent of travellers had pre-existing medical conditions. Forty-six percent were travelling to Africa, 35% to Asia, 20% to Latin America and 1% (each) to Oceania and Europe; 19% visited more than one country. India was the most common destination (9.6% of travellers) followed by Thailand (8.6%) and Kenya (6.4%). Seventy-three percent of travellers were planning to travel for ≤ 4 weeks. The main reasons for travel were tourism (75%) and visiting friends and relatives (18%). Sixteen percent were backpackers. Pre-travel advice were sought a median of 29 days before departure. Ninety-nine percent received vaccine(s). The most frequently administered vaccines were hepatitis A (53%), tetanus-diphtheria (46%), yellow fever (39%), poliomyelitis (38%) and typhoid fever (30%).; The profile of travel clinic attendees was younger than the general Swiss population. A significant proportion of travellers received vaccinations that are recommended in the routine national programme. These findings highlight the important role of travel clinics to (i) take care of an age group that has little contact with general practitioners and (ii) update vaccination status. The most commonly prescribed travel-related vaccines were for hepatitis A and yellow fever. The question remains to know whether clients do attend travel clinics because of compulsory vaccinations or because of real travel health concern or both

Deciding to resuscitate extremely premature babies: How do parents and neonatologists engage in the decision?

Parents at risk of delivering a baby at the threshold of viability are faced with a critical decision. When a child is born between 23 and 25 weeks of gestation, parents are asked to decide whether or not to resuscitate their child. In essence, they are faced with a choice between life and death. We conducted a qualitative study to explore how parents and neonatologists engage in decision-making in a context of imminent and unplanned delivery at the threshold of viability. Twelve parents and attending neonatologists in a specialized tertiary care centre in Montreal, Canada were separately interviewed immediately following neonatal consultation. Results highlight how neonatologists and parents engage in decision making from different standpoints: while neonatologists focus on the management of the unborn baby, parents have yet to fully conceptualize their infant as a distinct entity since they are in a process of grieving their pregnancy and their parenthood project. Moreover, in their attempt to ensure an informed decision, neonatologists adopt either of two models through provision of the most up-to-date and objective information available: "remaining as neutral as possible to allow parents to make their own decision", or, "formulating a proposal to which parents can choose or not to assent". Overall, if the provided information fits parents' expectations, they tend to feel confident with their decision. However, if it does not take their experience into account, their decision is experienced as a solitary process. Parents express the need to receive more than just factual information from neonatologists. They also require support and engagement from caregivers to manage the uncertainty. This brings into question the traditional concept of neutral informed consent and suggests the necessity of a shared decision-making model to ensure that the decision to resuscitate extremely premature babies, at the limits of viability, becomes a truly ethical task.Canada Informed consent Threshold of viability Prematurity Decision making Prenatal counseling

Arts contemporains et patrimoine

Comment penser ensemble arts contemporains et patrimoine ? Le numéro 20 de la revue Appareil s’interroge sur la signification et les enjeux d’expositions ou d’installations d’art contemporain dans des lieux patrimoniaux – en particulier l’Hôtel-Dieu de Tonnerre. Lire la suite >

Evidence of gene transfer via Integrative and Conjugative Elements (ICEs) between bacteria in the human small intestine environment using the dynamic in vitro system TIM-1.

International audienceConsumption of food brings large amounts of various bacteria able to interact and exchange genes with the host ones. Gene acquisition can confer novel properties to bacteria (antibiotic resistance, catabolic properties…) which may threat the equilibrium of digestive microbiota or lead to the emergence of new pathogens.Conjugation is the main mechanism of gene acquisition. Gene transfer can occur between strains belonging to the same species but also between very distantly related bacteria. Several classes of mobile genetic elements can be transferred by conjugation, in particular chromosomal elements called Integrative and Conjugative Elements (ICEs), a widespread but poorly known class of elements.To give a first insight on the incidence of gene transfers mediated by ICEs in the human digestive ecosystem, we evaluated their occurrence between dietary and intestinal commensal bacteria during digestion, using the TIM-1 model able to mimic gastric and small intestine environment. Different pairs of ICE donors (Streptococcus thermophilus, S. salivarius) and receptors (S. thermophilus, S. salivarius, Enterococcus faecalis) were immobilized on alginate/agar/chitosan beads and maintained in the jejunum and the ileum of the TIM-1 during milk digestion. Generation of transconjugants (receptors integrating ICE) was evaluated after an exposure of 5h to those conditions, and compared to exposure to undigested milk and M17 broth.Among the 11 pairs tested, 4 gave transconjugants during in vitro digestion whereas all generated conjugates in milk and/or M17. Remarkably, two pairs involved transfer between different genera (S. thermophilus x E. faecalis), whereas the other two involved the same species (S. thermophilus x S. thermophilus). Our study highlights that gene acquisition via transfer of ICEs should occur relatively frequently in the human digestive environment. Moreover, the use of dynamic in vitro models such as the TIM-1 gives a good alternative to in vivo study, to explore such phenomenon easily without ethical constraints

Diagnostic Performance of Individual Symptoms to Predict SARS-CoV-2 RT-PCR Positivity and Symptom Persistence among Suspects Presenting in Primary Care during the First Wave of COVID-19

This study aimed to estimate the diagnostic performance of patient symptoms and to describe the clinical course of RT-PCR-positive compared with RT-PCR-negative patients in primary care. Symptomatic COVID-19 suspects were assessed clinically at the initial consultation in primary care between March and May 2020, followed by phone consultations over a span of at least 28 days. Sensitivity and specificity were estimated for each symptom using the initial RT-PCR result as a reference standard. The proportions of symptomatic patients according to the RT-PCR test results were compared over time, and time to recovery was estimated. Out of 883 patients, 13.9% had a positive RT-PCR test, and 17.4% were not tested. Most sensitive symptoms were cough, myalgia, and a history of fever, while most specific symptoms were fever for ≥4 days, hypo/anosmia, and hypo/ageusia. At the final follow up (median time 55 days, range 28–105 days), 44.7% of patients still reported symptoms in the RT-PCR-positive group, compared with 18.3% in the negative group (p < 0.001), mostly with hypo/anosmia (16.3%), dyspnea (12.2%), and fatigue (10.6%). The discriminative value of individual symptoms for diagnosing COVID-19 was limited. Almost half of the SARS-CoV-2-positive patients still reported symptoms at least 28 days after the initial consultation

Transfer of the Integrative and Conjugative Element ICE St3 of Streptococcus thermophilus in Physiological Conditions Mimicking the Human Digestive Ecosystem

International audienceMetagenome analyses of the human microbiome suggest that horizontal gene transfer (HGT) is frequent in these rich and complex microbial communities. However, so far, only a few HGT studies have been conducted in vivo. In this work, three different systems mimicking the physiological conditions encountered in the human digestive tract were tested, including (i) the TNO gastro-Intestinal tract Model 1 (TIM-1) system (for the upper part of the intestine), (ii) the ARtificial COLon (ARCOL) system (to mimic the colon), and (iii) a mouse model. To increase the likelihood of transfer by conjugation of the integrative and conjugative element studied in the artificial digestive systems, bacteria were entrapped in alginate, agar, and chitosan beads before being placed in the different gut compartments. The number of transconjugants detected decreased, while the complexity of the ecosystem increased (many clones in TIM-1 but only one clone in ARCOL). No clone was obtained in a natural digestive environment (germfree mouse model). In the human gut, the richness and diversity of the bacterial community would offer more opportunities for HGT events to occur. In addition, several factors (SOS-inducing agents, microbiota-derived factors) that potentially increase in vivo HGT efficiency were not tested here. Even if HGT events are rare, expansion of the transconjugant clones can happen if ecological success is fostered by selecting conditions or by events that destabilize the microbial community