Prevalence, awareness, treatment and control of high blood pressure in a Swiss city general population: the CoLaus study.

BACKGROUND: This study is aimed to assess the prevalence of awareness, treatment and control of high blood pressure (HBP) and associated factors in a Swiss city. DESIGN: Population-based cross-sectional study of 6182 participants (52.5% women) aged 35-75 years living in Lausanne, Switzerland. METHODS: HBP was defined as blood pressure >/=140/90 mmHg or current antihypertensive medication. RESULTS: The overall prevalence of HBP was 36% (95% confidence interval: 35-38%). Among participants with HBP, 63% were aware of it. Among participants aware of HBP, 78% were treated, and among those treated, 48% were controlled (BP <140/90 mmHg). In multivariate analysis, HBP prevalence was associated with older age, male sex, low educational level, high alcohol intake, awareness of diabetes or dyslipidaemia, obesity and parental history of myocardial infarction. HBP awareness was associated with older age, female sex, awareness of diabetes or dyslipidaemia, obesity and parental history of myocardial infarction. HBP control was associated with younger age, higher educational level and no alcohol intake. Alone or in combination, sartans were the most often prescribed antihypertensive medication category (41%), followed by diuretics, beta-blockers, angiotensin converting enzyme inhibitors and calcium channel blockers. Only 31% of participants treated for HBP were taking >/=2 antihypertensive medications. CONCLUSION: Although more than half of all participants with HBP were aware and more than three-quarters of them received a pharmacological treatment, less than half of those treated were adequately controlled.

Situation et enjeux sanitaires aux Seychelles en 2012

Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have largely completed their demographic and epidemiologic transitions. Major investments in infrastructure and social services have fostered steady economic growth. Health care and education are free. The predominance of chronic non-communicable diseases and rapid aging of the population nonetheless present significant challenges for public health and the health system. Like the other small island states in the region, the Seychelles continue to be threatened by arbovirus outbreaks. Health indicators are good, but the geographic isolation, the small and aging population, and limited resources make a major challenge maintaining and sustaining an effective workforce of health professionals, a constantly evolving technical platform, and increasing amount of medications particularly in view of the increasing burden of chronic diseases.

Fièvre, adénopathie: une situation clinique de toxoplasmose aiguë chez une patiente immunocompétente [Fever and lymphadenopathy: acute toxoplasmosis in an immunocompetent patient].

Toxoplasmosis is an infectious disease caused by the intracellular parasite Toxoplasma gondii. In Switzerland about a third of the population has antibodies against this pathogen and has thus already been in contact with the parasite or has contracted the disease. Immunocompetent patients are usually asymptomatic (80-90%) during primary infection. The most common symptom is neck or occipital lymphadenopathy. Serology is the diagnostic gold standard in immunocompetent individuals. The presence of IgM antibodies is however not sufficient to make a definite diagnosis of acute toxoplasmosis. Distinction between acute and chronic toxoplasmosis requires additional serological tests (IgG avidity test). If required, the most used and probably most effective treatment is the combination of pyrimethamine and sulfadiazine, with folinic acid.

Higher red blood cell distribution width is associated with a worse virologic and clinical situation in HIV-infected patients.

Background A high level of red blood cell distribution width (RDW) is a novel prognostic marker that may reflect an underlying inflammatory state. It has recently shown that when increased, it is related to cardiovascular disease, mortality, and metabolic syndrome (MetS) in the general population. Objectives To analyse the potential relation between high levels of RDW and cardiovascular risk (CVR) and MetS in HIVpatients. Patients and methods Observational, cross-sectional study of a series of HIVoutpatients attended in our Hospital. Demographic, anthropometric, clinical, and fasting lab data were recorded in all cases. CVR at 10 years was evaluated by Framingham equation, and MetS diagnosed according to the National Cholesterol Education Program criteria. Statistic program: SPSS 17.0. Results 666 patients were included, 79.3% were men, and mean age was 44.7 years. Mean CD4 count was 506 cells/ mm3 , 87.5% of the patients were on antiretroviral therapy, and 85.3% had undetectable HIV viral load. Mean RDW was 13.07% (range: 7.7-33.6%; 75th percentile 14,1%), with a prevalence of MetS of 15.7, 9.3, 18.8 and 16.6% first through fourth RDW quartile, and of patients with CVR >20% of 8.4, 4.0, 4.4 and 6.4%, respectively (p>0,05). The highest quartile of RDW (>14.1%) was associated with AIDS (OR 1.6, 95%CI 1.0-2.4; p 0.02), detectable HIV viral load (OR 1.5, 95%CI 1.01-2.4; p 0.04), and hypertension (OR 2.3, 95%CI 1.4-4.0; p 0.001). Conclusions In HIV-infected outpatients, higher RDW is related with detectable HIV viral load and with AIDS. Although it was associated with a traditional CVR factor as hypertension, we found no relation with MetS nor with higher CVR.

Division de l'attention lors d'interventions d'urgence préhospitalière : quelques apports de l'analyse d'activité en situation réelle de travail

Problème : Les ambulanciers effectuent souvent des tâches en contexte de division de l'attention. Cette caractéristique du travail peut contribuer à augmenter les risques d'erreurs ou ralentir le déroulement des interventions. Dans les situations d'urgences préhospitalières, cela peut avoir des conséquences dramatiques pour le patient et pour les intervenants. Méthode : Nous avons analysé l'activité réelle de travail d'ambulanciers en contexte d'intervention d'urgences. Notre démarche a impliqué l'accompagnement d'ambulanciers lors d'interventions réelles qu'il nous a été possible de filmer. Les analyses effectuées par une équipe multidisciplinaire ont de plus été complétées et validées par des séances en auto-confrontation. Résultats : Nos analyses ont permis de constater plusieurs exemples de travail en contexte de division de l'attention. De plus, nous avons aussi été en mesure de documenter certaines stratégies mises en oeuvre par ces professionnels afin de diminuer la charge cognitive attribuable à la division de l'attention. Conclusion : Notre étude pilote a permis de mieux comprendre le travail des ambulanciers. Nous avons constaté que la division de l'attention est fréquente et que les professionnels confrontés à cette exigence développent diverses stratégies pour y faire face. Nous avons aussi montré la faisabilité et la pertinence de l'analyse de l'activité réelle de travail lors d'interventions d'urgences préhospitalières. [Auteurs]

Situation des personnes transgenres par rapport au VIH/IST en Suisse : rapid assessment

Ce rapport permet d'identifier le sous-groupe des personnes transgenres pratiquant ou ayant pratiqué le travail du sexe comme une population clairement exposée à un risque notoirement élevé d'infection par le VIH et les IST. L'ampleur rapportée du phénomène justifie pleinement l'inclusion de cette population dans le dispositif de surveillance comportementale du VIH et des autres IST, mais également la réalisation urgente d'actions de prévention communautaire. Par contre, il ne nous permet pas d'arriver à un consensus fort en ce qui concerne la situation des personnes transgenres non travailleuses du sexe par rapport au VIH et aux autres IST en Suisse. Les données internationales sont cependant suffisamment préoccupantes pour justifier la réalisation d'une recherche sur la santé sexuelle au sein de cette population. Cette recherche devra prendre en compte les contextes de vie souvent hostiles auxquels sont confrontées les personnes transgenres. Par ailleurs, les personnes transgenres devraient pouvoir être reconnues en tant que telles et enregistrées de manière systématique dans les systèmes de déclaration du VIH et des autres IST, dans les outils de suivi statistique des centres de dépistage et de conseil VIH/IST, ainsi que dans l'enquête suisse sur la santé.

Analyse de la situation de l'hépatite C chez les usagers de drogue en Suisse

L'analyse de la situation de l'hépatite C chez les usagers de drogue en Suisse a fait appel à plusieurs méthodes: synthèse de la littérature publiée et grise sur le sujet et analyse secondaire de données disponibles, interviews d'experts nationaux, interviews d'usagers de drogues (UD), études de cas dans 4 cantons (Zurich, Vaud, Argovie, Valais), enquête par internet auprès des institutions prenant en charge des UD en traitement résidentiel et ambulatoire et dans les structures à bas seuil d'accès pour la réduction des risques. La prévalence du VHC estimée sur l'ensemble de la population en Suisse varie selon les auteurs entre 0.7% et 1.75%. Elle est un peu plus élevée (2%) chez les hommes ayant des relations sexuelles avec d'autres hommes (HSH). Chez les ressortissants de pays réputés à plus haute prévalence (Afrique sub-saharienne, certains pays du Moyen-Orient et d'Asie du Sud-Est), la prévalence est probablement plus élevée que dans la population générale mais n'est pas connue. En prison, du fait de la surreprésentation des UD et de populations de pays à plus haute prévalence, la prévalence du VHC est plus élevée que dans la population générale (entre 5 et 10%). On estime qu'environ 2/3 des cas vont évoluer vers la chronicité...

Current situation and perspectives regarding human Chagas disease in midwestern of the state of Minas Gerais, Brazil

Recognising the importance of Chagas disease in Brazil, Bambuí set up epidemiological surveillance for Chagas disease in 1974 and was the first municipality to do so. To ascertain the current epidemiology of Chagas disease in this municipality, 1.782 blood samples from the general population were analysed; 7.7% of samples were found to be seropositive for Chagas disease. A strong positive correlation between increasing age and Chagas disease was evident in both genders, with the highest prevalence in individuals aged over 60 years. Clinically, the cardiodigestive form of Chagas disease was the most common in these samples. These data confirm the interruption of Trypanosoma cruzi transmission, in parallel with a still important residual morbidity of Chagas disease in the county, thus supporting political decisions that will prioritise epidemiological surveillance and medical treatment of Chagas disease in the coming years.

Malaria on the Guiana Shield: a review of the situation in French Guiana

In a climate of growing concern that Plasmodium falciparum may be developing a drug resistance to artemisinin derivatives in the Guiana Shield, this review details our current knowledge of malaria and control strategy in one part of the Shield, French Guiana. Local epidemiology, test-treat-track strategy, the state of parasite drug resistance and vector control measures are summarised. Current issues in terms of mobile populations and legislative limitations are also discussed.

Transitoriness - a concept

Background: The realization of life's transitory nature, i.e., 'transitoriness', is an experience that patients who arediagnosed with cancer may have. Transitoriness constitutesa challenging situation for cancer patients, theirrelatives, and healthcare professionals. Although issuesregarding life's finitude and associated outcomes havebeen described in related concepts such as deathawareness, the concept of transitoriness remains vague.This paper will present attributes, outcomes, and antecedentsof this concept.Review methods: Rodgers' (2000) evolutionary conceptanalysis was utilized to explore the concept of 'transitoriness',which requires the review of at least 20% of theidentified relevant publications. A total of 239 articles wereidentified as being relevant. Of this total number, 27% (66articles) were selected, reviewed and analyzed.Findings: Three main themes emerged that describe theconcept of 'transitoriness'. They were 'awareness oflife's finitude', 'anxiety' and 'change'. On the one hand,the confrontation with life's finitude provokes existentialfear and anxiety in the person. On the other hand,persons have the possibility of re-assessing their lifesituation. Thus, they can identify and explore newavenues for coping.Conclusion and clinical relevance: The identification ofthe attributes of 'transitoriness', i.e., awareness, anxiety,and change, will help clinicians to better understand cancerpatients' experience of their illness situation. It will also bepossible to better support cancer patients in their copingprocess. Research that can foster the development ofinterventions that can enhance patients' healthcare experiencewill be promoted.