Medecine et maladies infectieuses最新文献

Introduction

The optimal management of men who have sex with men (MSM) requires active involvement of family physicians (FP). We assessed knowledge and practices of Parisian FPs related to the management of MSM for sexually transmitted infections (STIs) and pre-exposure prophylaxis for HIV (PrEP).

Method

We conducted an observational prospective study between June 20 and July 31, 2017, with a sample of FPs practicing in Paris. The questionnaire posted via the Google Form website included 42 questions on sexual health management of MSM patients. A statistical analysis was then performed.

Results

One hundred and four FPs took part in the study. The median age was 34 and 68% were women. Overall, 86.5% of FPs had already heard about PrEP, but only 36% of them were familiar with the indication for therapy and 77.9% of FPs declared to be willing to renew PrEP prescription. Overall, 89.4% of respondents declared to be willing to attend additional training on sexual health of MSM patients, including 73% on PrEP.

Conclusion

FPs have an important role in the management of MSM patients. They showed strong interest in PrEP despite limited knowledge of indications and methods of administration. They declared to be willing to attend additional training for further involvement.

Objective

To study Ebola virus disease (EVD) in children aged 15 years and below, and to identify risk factors associated with death.

Patients and methods

Retrospective, multicenter, descriptive, and analytical study of files of children aged 15 years and below in Ebola treatment centers (ETC) of Donka from March 2014 to May 2015. We included all files of children aged 15 years and below hospitalized for EVD in the two ETCs.

Results

A total of 739 patients hospitalized in both ETCs, 146 children aged 15 years and below (20%) were registered during the study period. The mean age of children was 6.73 ± 4.26 years. Most children were aged above five years (65.8%) and the mean time to consultation was 4.34 ± 3.21 days. The main clinical signs were asthenia (78.8%), fever (75.3%), anorexia (53.4%), headache (45.9%), vomiting (41.8%), abdominal pain (29.5%), and diarrhea (28.8%). The case fatality was 48%, including 54.3% in Coyah and 45% in Conakry. Older age (aOR = 0.83, 95% CI [0.76–0.95]), fever (aOR = 3.28, 95% CI [1.22–8.87]), diarrhea (aOR = 2.98, 95% CI [1.19–4.48]), and hemorrhage (aOR = 3.13, 95% CI [1.00–10.38]) were independently associated with death due to EVD.

Conclusion

EVD remains serious especially in children, with high case fatality. Risk factors independently associated with death were young age, diarrhea, hemorrhage, and fever. Particular attention to these risk factors and vaccination will contribute to improving the prognosis of EVD in children.

HIV infection has evolved into a chronic disease with comorbidities since the combination antiretroviral therapy era. Complications still occur and patients may need to be admitted to an intensive care unit. Acute respiratory failure is the first cause of these admissions, questioning the administration of solid oral dosage formulations. This issue is also observed in geriatric units where the prevalence of dysphagia is high and underestimated. The problem of antiretroviral administration is critical: altered solid oral dosage formulations and/or administration via enteral feeding tubes are sometimes the only option. The aim is to help manage antiretroviral treatment in unconscious or intubated patients and those with swallowing disorders who are hospitalized in intensive care units or geriatric units. This review provides information on the main antiretroviral regimens and on practical and legal aspects of manipulating solid oral dosage formulations and administration via enteral feeding tubes. Alternatives to the solid formulation are available for most of the 27 oral antiretrovirals available, or manufacturers provide recommendations for patients who are unable to swallow. Manipulation of solid oral dosage formulations such as crushing tablets or opening capsules and administration via feeding tubes are frequently reported but should be the last option for safety and liability issues. Before any off-label administration of a drug, physicians should consider alternatives to the solid oral dosage formulation and check whether the drug can be altered. Therapeutic monitoring is important in this particular setting as the pharmacokinetic profile of drugs is difficult to predict.

Objectives

To identify patterns of use, perceived benefits, and barriers among people living with HIV (PLHIV) of online searches for health information and via social media.

Methods

Online multicentre observational survey (October 15th–19th, 2018).

Results

Study participation was accepted by 838/1377 PLHIV followed in 46 centres, of which 325 (39%) responded online: 181 (56%) had already used the Internet to search for health information; 88/181 (49%) on HIV infection and 78 (43%) on nutrition. These 56% were characterised by a higher educational level (OR = 1.82 ± 0.50; P = 0.028) and more often consulted other specialists (OR = 3.14 ± 1.26; P = 0.004). A subset of 87/180 (48%) PLHIV had changed the way they looked after their health based on their online research, and were more often in material/social deprivation (P = 0.02) and diabetic (P = 0.02). A small subset of 19/180 (11%) had already asked or answered a question on a forum; these people tended to be women (P = 0.03) in material/social deprivation (P = 0.009). 296/322 (92%) PLHIV trusted their physician whereas only 206 (64%) trusted information sourced on medical websites. 238/323 (74%) PLHIV expected their physicians to recommend websites if asked, whereas only 23/323 (7%) had actually been given this guidance.

Conclusion

More than half of PLHIV surveyed had already searched for health information on the Internet, and one in two had changed their behaviour based on the online search. PLHIV did not see the Internet as an alternative to physicians but they wanted their physicians to guide them on how to find quality health information to better self-manage their condition.

Objectives

To evaluate the patterns of use and perceived benefits and barriers among people living with HIV and their physicians concerning telemedicine and the collection of computerized personal information.

Methods

Multicenter online observational survey from October 15 to 19, 2018.

Results

Study participation was accepted by 229 physicians and 838/1,377 PLHIV followed in 46 centers, of which 325 (39%) responded online. We found that while 226/302 (75%) PLHIV accept online prescription renewals and 197/302 (65%) accept online medical certificates, 182/302 (60%) PLHIV − who were more often in material/social deprivation (OR = 1.70 ± 0.45; P = 0.045), less often born in Île-de-France (OR = 0.43 ± 0.15; P = 0.018), with lower CD4 T-cell counts (OR = 0.999 ± 0.0004; P = 0.038), and less often on psychiatric treatment (OR = 0.50 ± 0.18; P = 0.047) − were receptive to teleconsultations. However, 137/225 (61%) physicians would be uncomfortable teleconsulting due to inadequate data security without it reducing the number of consultations or offering economic benefit. Asked about collection of computerized personal information, 197/296 (67%) PLHIV and 139/223 (62%) physicians agreed it improved quality of care, but 144 (49%) PLHIV and 94/222 (42%) physicians thought it was not sufficiently framed by the law. eHealth was seen as improving coordination between health professionals by 240/296 (81%) PLHIV and seen as a good thing by 181/225 (81%) physicians.

Conclusion

More than half of PLHIV were ready for telemedicine. PLHIV and physicians endorsed the advantage of e-health in terms of better coordination across health professionals but mistrust the data collection factor, which warrants either clarification or stronger legal protections.

Objectives

To evaluate patterns of use and perceived benefits and barriers to health/wellness applications (apps) and smart devices among people living with HIV (PLHIV) and their physicians.

Methods

Online multicenter observational survey (October 15–19, 2018).

Results

Study participation was accepted by 229 physicians and 838/1377 PLHIV followed in 46 centers, of which 325 (39%) responded online. Overall, 83/288 (29%) PLHIV had already downloaded at least one app: these ‘downloaders’ were younger (OR 0.96 ± 0.01, P = 0.004), educated to at least university entry level (OR 2.27 ± 0.86, P = 0.03), and more frequently used geolocation-based dating websites (OR 3.00 ± 1.09, P = 0.002). However, 227/314 (72%) PLHIV claimed they were ready to use an app recommended by a physician. For the 60/83 PLHIV who answered, the ideal app would be a vaccination tracker (76%) to better communicate with their physician (68%). However, 96/277 (42%) physicians were unable to answer this question and for 94/227 (41%) of them, the ideal patient app would be for schedule management. Although PLHIV used smart devices, 231/306 (75%) would want to report the data to their physicians and 137/225 (61%) of physicians would welcome this exchange. The main physician-side barrier to this exchange was concerns over data security.

Conclusion

mHealth apps and smart devices have failed to garner adoption by PLHIV. There is a case for good-quality health data sharing and exchange if PLHIV are provided with appropriately secure tools and physicians are backed up by adapted legislation.

Introduction

We assessed family physicians’ (FP) willingness to integrate PrEP into their clinical practice in Montpellier and its surroundings.

Method

We aimed to randomly assess 92 FPs.

Results

Ninety-six FPs were interviewed from May to December 2018: 78% (95% CI [69; 86]) were willing to integrate PrEP, 65% to be trained, and 52% to be the first providers. Of the 65 (6%) with some knowledge of PrEP, 21 were not aware of targeted populations and 39 never talked about PrEP with their patients. Nearly all FPs declared HIV prevention as part of their job and felt at ease talking about sexuality. Considering HIV prevention as part of their job was associated with increased likelihood to integrate PrEP into their practice (P = 0.015).

Conclusions

Most FPs were willing to integrate and be trained on PrEP. Lack of PrEP prescription seemed related to a lack of knowledge.