Ethique et humanitaire. Mise en œuvre des pratiques de consultation et de participation

Au cours des dernières décennies, l’aide humanitaire a pris un essor considérable. En même temps, elle s’est trouvée confrontée à un nombre croissant de critiques dont la plus significative est celle d'être perçue comme un système défini et imposé par l’occident, fonctionnant sur un mode « descendant » et ayant de ce fait, une capacité d’écoute sélective. Le rôle des populations touchées dans leur propre survie est l'un des défis les plus complexes auquel le monde des acteurs humanitaires doit faire face. En particulier la prise en compte des points de vue, des attentes, des besoins exprimés, des responsabilités, des compétences des populations concernées, durant tout le cycle de la gestion du projet, est une condition indispensable à l'amélioration de la réponse humanitaire vue en tant que processus de réappropriation de la part des populations de leur pouvoir d'agir sur leur vie. A cet égard, l'idée selon laquelle une implication active du public est une condition nécessaire pour assurer le caractère éthique de toute délibération et garantir l’acceptation des interventions par les populations est aujourd'hui reconnue, mais est-elle suffisante, est elle toujours possible

Long-term humoral and cell-mediated immunity after acellular pertussis vaccination compares favourably with whole-cell vaccines 6 years after booster vaccination in the second year of life.

Humoral and cell-mediated immune responses (CMI) were evaluated in subjects 3 and 6 years after primary and booster vaccination with either three-component acellular (Pa) or whole-cell (Pw) vaccines. Low anti-pertussis toxin (PT) antibody levels confirmed the absence of pertussis disease, consistent with ongoing protection. Anti-pertactin (PRN) antibodies, remained at higher levels in Pa-vaccinated subjects. At year 6, CMI responses continued to be present and were higher in Pa-vaccinated than Pw-vaccinated subjects. Long-term protection with Pa vaccines can be expected to be at least as good as that provided by efficacious Pw vaccines

Surveillance of noninvasive group A Streptococcus infections in French ambulatory pediatrics before and during the COVID-19 pandemic: a prospective multicenter study from 2018-2022

ABSTRACT: Objectives: We evaluated the burden of noninvasive group A Streptococcus (GAS) infections in ambulatory pediatrics before and during the COVID-19 pandemic in France. Methods: We analyzed data from a national network of ambulatory pediatricians between 2018 and 2022. Clinicians evaluating children ≤15 years old for tonsillopharyngitis, perianal infections, paronychia/blistering dactylitis, and scarlet fever were invited to perform a rapid antigen detection test (RADT) for GAS. Monthly incidence of noninvasive GAS infections per 10,000 visits was modeled using time series analysis, considering two breakpoints: March 2020 (first national lockdown) and March 2022 (end of mandatory mask-wearing in schools). Results: Over the study period, 125 pediatricians recorded 271,084 infectious episodes. GAS-related illnesses represented 4.3% of all infections. In March 2020, the incidence of GAS diseases decreased by 84.5% (P <0.001), with no significant trend until March 2022. After March 2022, the incidence significantly increased (+23.8% per month, P <0.001), with similar patterns across all monitored GAS-related diseases. Conclusion: By using routine clinical data and RADTs, we have monitored changes in the incidence of noninvasive GAS infections in ambulatory pediatrics. COVID-19 mitigation measures have had a major impact on the epidemiology of noninvasive GAS infections, but their relaxation was followed by a surge above baseline levels

[Performance of the Breastfeeding Assessment Score for the prediction of early weaning in France]

National audienceBACKGROUND: The Breastfeeding Assessment Score (BAS) was derived to help identify mothers at increased risk of early weaning in United States. Data are currently lacking on the accuracy of the BAS for French mother-infant pairs. OBJECTIVE: To assess the accuracy of the BAS in a French validation cohort. METHODS: We used the original data from a prospective cohort study of 488 mothers who were breastfeeding at discharge in 9 maternity wards in 2005. The outcome measures were assessed using structured follow-up telephone interviews at 4 and 26 weeks. RESULTS: The weaning rate was 3% at 14 days of infant age. The corresponding area under ROC curve was 0.73 [0.60-0.85] and was comparable to that observed in the derivation cohort (0.75). For a cut point of 8 recommended by the authors of the BAS, 43% of mother-infant pairs were categorized at high risk and the weaning rate in this subgroup was 5%. The mother-infant pairs with a score lower than 8 had a shorter median breastfeeding duration (18 versus 20 weeks, P=0.02), were more likely to report breastfeeding difficulties after discharge (63% versus 53%, P=0.03), and were less likely to be "very satisfied" with breastfeeding experience (66% versus 77%, P=0.007). CONCLUSION: The intrinsic properties of the BAS are robust. However, its use would be of limited interest in France because of the relatively low rate of early weaning. Randomized trials are needed before recommending routine use of BAS-based breastfeeding support intervention