BMJ Open

Objectives Presently, those outcomes that should be prioritised for chronic obstructive pulmonary disease (COPD) exacerbation studies remain unclear. In order to coordinate multicentre studies on eosinophilia-driven corticosteroid therapy for patients hospitalised for acute exacerbation of COPD (AECOPD), we aimed to find consensus among experts in the domain regarding the prioritisation of outcomes. Design A modified Delphi study was proposed to recognised COPD experts. Two brainstorming questionnaires were used to collect potential outcomes. Four subsequent rounds of questionnaires were used to rank items according to a six-point Likert scale for their importance in the protocol, as well as for being the primary outcome. Priority outcome criteria were predefined as those for which ≥70% of experts indicated that the outcome was essential for interpreting study results. Setting COPD exacerbation management in France. Participants 34 experts recommended by the French Language Pulmonology Society were invited to participate. Of the latter, 21 experts participated in brainstorming, and 19 participated in all four ranking rounds. Results 105 outcomes were ranked. Two achieved consensus as candidate primary outcomes: (1) treatment failure defined as death from any cause or the need for intubation and mechanical ventilation, readmission because of COPD or intensification of pharmacologic therapy, and (2) the time required to meet predefined discharge criteria. The 10 secondary priority outcomes included survival, time with no sign of improvement, episodes of hospitalisation, exacerbation, pneumonia, mechanical or non-invasive ventilation and oxygen use, as well as comorbidities during the initial hospitalisation. Conclusions This Delphi consensus project generated and prioritised a great many outcomes, documenting current expert views concerning a diversity of COPD endpoints. Among the latter, 12 reached consensus as priority outcomes for evaluating the efficacy of eosinophil-driven corticosteroid therapy in AECOPD inpatients

Pubertal development of transfusion-dependent thalassemia patients in the era of oral chelation with deferasirox: results from the French registry

Not available

L'allergie à l'ambroisie (état des lieux dans le Puy-de-Dôme)

Adventice originaire d'Amérique du Nord, l'ambroisie (Ambrosia artemisiifolia L.) est une mauvaise herbe de la famille des Astéracées qui s'est répandue en France il y a près d'un siècle. Si sa présence et ses effets sont bien connus dans la région lyonnaise, l'Auvergne, et plus particulièrement le Puy-de-Dôme commencent à prendre conscience de l'envergure de ce fléau. A la fois dotée d'un pouvoir allergisant très important et d'un pollen capable de couvrir de très grandes distances, elle pose un problème majeur en terme de santé publique. Rhinite, conjonctivite et asthme sont les symptômes les plus fréquents de l'hypersensibilité à l'ambroisie. Sa période de pollinisation caractéristique, de la 1ère semaine d'août à la première semaine d'octobre, est une aide précieuse pour diagnostiquer cette allergie. Afin de prévenir des effets de cette invasion, de nombreux moyens sont mis en place de manière à éviter l'implantation ou de procéder à l'éradication de l'ambroisie. Si les agriculteurs et les maîtres d'œuvre sont déjà sensibilisés à ce problème, le grand public a un rôle important à jouer pour lequel il doit être mieux informé, notamment par le pharmacien, en cas d'allergies suspectées ou avérées à l'ambroisie.CLERMONT FD-BCIU-Santé (631132104) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

The problem of suicide among Amerindians in Camopi-Trois Sauts, French Guiana 2008–2015

Abstract Background Suicide within the Amerindian community of Camopi (1741 inhabitants) in French Guiana has been an increasing problem widely reported in the media leading the French Government to mandate a parliamentary mission to investigate the matter. The purpose of the study was to describe this phenomenon and identify factors associated with suicide attempts. Methods A retrospective observational study was conducted from the health centers’ medical records. All suicide attempts and suicides committed between 2008 and 2015 by Amerindians living in Camopi and Trois Sauts were compiled. Contextual factors and suicide representations were also analyzed. Results During the study period, the annual attempted suicide rate and the suicide rate were higher in the last 3 years. The overall annual rate was equal to 6.9/1741 or 396 per 100, 000 inhabitants for attempted suicide and 172 per 100,000 inhabitants for suicide, which is more than 10 times higher than the suicide rate in mainland France. The mortality rate was 30.4% versus 8.2% in mainland France. The 10–20 year-old age group represented 70% of suicide deaths. There was no significant difference between genders. A recent death and interpersonal conflict were the main stressful life events reported by respondents (55 and 52%, respectively). Alcohol addiction (30% of the respondents) was associated with suicide attempts under the influence of alcohol (p = 0.03). Repetition of suicide attempts was associated with cannabis consumption (p = 0.03). Depression was reported among 45% of the respondents. A third of respondents reported having been abused during their childhood. Over half of respondents reported that their suicide attempt was motivated by a spirit (58%). Conclusions Despite limitations due to the small population size and limited time frame, this is the first study to describe the epidemiology of suicide among Amerindians living in Camopi. In contrast with other French territories, the suicide rate was very high, the sex ratio was balanced and younger age groups were most affected

Etude thermodynamique du système albite-orthose par calorimétrie de dissolution et effusion de Knudsen couplée à un spectomètre de masse

The enthalpy of mixing of the vitreous solution of albite and orthoclase were deduced from the thermal effects corresponding to the dissolution of albite, orthoclase and their mixtures in liquid lead metaborate at 970 K. The Gibbs energy of these mixtures was also determined by Knudsen-cell mass-spectrometry. The thermodynamic behavior of the system is characterized by weak negative departures from ideality.Par calorimétrie de dissolution en bain de métaborate de plomb à 970 K, l'enthalpie de formation des mélanges vitreux albite (NaAlSi3O8) orthose (KAlSi3O8) a été mesurée par référence à l'albite et à l'orthose vitreux. L'enthalpie libre de formation de ces mélanges vitreux a été déterminée par rapport à la même référence par effusion de Knudsen couplée à un spectromètre de masse. Le comportement thermodynamique du système albite-orthose se caractérise par des déviations faiblement négatives par rapport à l'idéalité.Rogez Jacques, Chastel Raymond, Bergman Claire, Brousse Christian, Castanet Robert, Mathieu Jean-Claude. Etude thermodynamique du système albite-orthose par calorimétrie de dissolution et effusion de Knudsen couplée à un spectomètre de masse. In: Bulletin de Minéralogie, volume 106, 1-2, 1983. Silicates liquides

Interactions between Gastrointestinal Nematodes and Malaria in a Cohort of Children in an Amazonian Village

International audienceIntroduction: Most studies on nematode-malaria interactions were conducted outside of the Americas. The objective of the present study was thus to study the relation between malaria and nematodes in a cohort of children in an Amazonian village. Methods: Odds ratios for intestinal nematode infections as an explanatory variable to malaria resistant vs. malaria sensitive were computed. Results: Ascaris lumbricoides was significantly more frequent in the ‘resistant’ malaria group than in the ‘sensitive’ one. Conclusions: Despite its low statistical power, the present results find that Ascaris was associated with less malaria, as observed by a number of studies

Prolonged-release buprenorphine formulations: Perspectives for clinical practice

International audienceBuprenorphine and methadone are the two main opioid agonist treatments approved for opioid use disorder. Buprenorphine is a partial agonist of the mu opioid receptors, which has been merely available through sublingual form until now. In practice, the use of buprenorphine is smoother than that of methadone, and it induces reduced risks of overdose. However, sublingual buprenorphine also exposes to risks (e.g., withdrawal, misuse) and constraints (e.g., daily intake). Three new galenic formulations of prolonged-release buprenorphine (PRB) are being commercialized and should allow some improvements in patients' comfort and safety. This narrative review aims to describe the main technical features and efficacy and safety data of these PRBs, as well as patients' and professionals' expectancies and concerns, using data of the scientific literature and the regulatory texts. PRBs consist of one subcutaneous implant and two subcutaneous injection depots. Sixmo(R)/Probuphine(R) is a six-month-long implant which needs to be surgically placed and removed and is approved for subjects previously treated with a maximum daily dose of 8mg of sublingual buprenorphine, and can be used only for two successive periods of six months before the subject needs to be switched back to sublingual form. Sublocade(R) is a one-month-long depot formulation that is indicated in switch from sublingual buprenorphine, and which proposes only two dose schemes, i.e., 100 and 300mg monthly. Buvidal(R)/Brixadi(R) is a one-week- or one-month-long depot formulation with multiple dosages, which can be used in initiation or in switched from sublingual formulations. While opioid users report some concerns with a risk of coercive use of long-acting forms of buprenorphine, both users and professionals deem that these new specialties could be particularly appreciated in stabilized patients bothered with the daily intake of the treatments, or specific situations at risk of treatment dropout (e.g., following hospital discharge or prison release)