Le Raincy, France
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Horri J.,Center Detudes Perinatales Of Locean Indien Cepoi | Cransac A.,Pharmacy | Quantin C.,Biostatistique et Informatique Medicales | Abrahamowicz M.,McGill University | And 4 more authors.
Journal of Clinical Pharmacy and Therapeutics | Year: 2014

What is known and objective: The risk of dosage Prescription Medication Error (PME) among manually written prescriptions within 'mixed' prescribing system (computerized physician order entry (CPOE) + manual prescriptions) has not been previously assessed in neonatology. This study aimed to evaluate the rate of dosage PME related to manual prescriptions in the high-risk population of very preterm infants (GA < 33 weeks) in a mixed prescription system. Methods: The study was based on a retrospective review of a random sample of manual daily prescriptions in two neonatal intensive care units (NICU) A and B, located in different French University hospitals (Dijon and La Reunion island). Daily prescription was defined as the set of all drugs manually prescribed on a single day for one patient. Dosage error was defined as a deviation of at least ±10% from the weight-appropriate recommended dose. Results and discussion: The analyses were based on the assessment of 676 manually prescribed drugs from NICU A (58 different drugs from 93 newborns and 240 daily prescriptions) and 354 manually prescribed drugs from NICU B (73 different drugs from 131 newborns and 241 daily prescriptions). The dosage error rate per 100 manually prescribed drugs was similar in both NICU: 3·8% (95% CI: 2·5-5·6%) in NICU A and 3·1% (95% CI: 1·6-5·5%) in NICU B (P = 0·54). Among all the 37 identified dosage errors, the over-dosing was almost as frequent as the under-dosing (17 and 20 errors, respectively). Potentially severe dosage errors occurred in a total of seven drug prescriptions. None of the dosage PME was recorded in the corresponding medical files and information on clinical outcome was not sufficient to identify clinical conditions related to dosage PME. Overall, 46·8% of manually prescribed drugs were off label or unlicensed, with no significant differences between prescriptions with or without dosage error. The risk of a dosage PME increased significantly if the drug was included in the CPOE system but was manually prescribed (OR = 3·3; 95% CI: 1·6-7·0, P < 0·001). What is new and conclusion: The presence of dosage PME in the manual prescriptions written within mixed prescription systems suggests that manual prescriptions should be totally avoided in neonatal units. © 2014 John Wiley & Sons Ltd.


Cardinale E.,CIRAD - Agricultural Research for Development | Cardinale E.,French National Institute for Agricultural Research | Esnault O.,Groupement de Defense sanitaire de la Reunion | Beral M.,CIRAD - Agricultural Research for Development | And 3 more authors.
PLoS Neglected Tropical Diseases | Year: 2014

Q fever is a widespread zoonosis that is caused by Coxiella burnetii (C. burnetii), and ruminants are identified as the main sources of human infections. Some human cases have been described, but very limited information was available about Q fever in ruminants on Reunion Island, a tropical island in the Indian Ocean. A cross-sectional study was undertaken from March 2011 to August 2012 to assess the Q fever prevalence and to identify the major risk factors of C. burnetii infection in ruminants. A total of 516 ruminants (245 cattle, 137 sheep and 134 goats) belonging to 71 farms and localized in different ecosystems of the island were randomly selected. Samples of blood, vaginal mucus and milk were concomitantly collected from females, and a questionnaire was submitted to the farmers. Ticks from positively detected farms were also collected. The overall seropositivity was 11.8% in cattle, 1.4% in sheep and 13.4% in goats. C. burnetii DNA was detected by PCR in 0.81%, 4.4% and 20.1% in cow, sheep and goat vaginal swabs, respectively. C. burnetii shedding in milk was observed in 1% of cows, 0% in sheep and 4.7% in goats. None of the ticks were detected to be positive for C. burnetii. C. burnetii infection increased when the farm was exposed to prevailing winds and when there were no specific precautions for a visitor before entering the farm, and they decreased when a proper quarantine was set up for any introduction of a new ruminant and when the animals returned to the farm at night. MLVA genotyping confirmed the role of these risk factors in infection. © 2014 Cardinale et al.


Larrieu S.,French national public health agency | Filleul L.,French national public health agency | Reilhes O.,Agence de Sante Ocean Indien | Jaffar-Bandjee M.,Center National Of Reference Des Arbovirus | And 13 more authors.
Eurosurveillance | Year: 2016

Zika virus (ZIKV) has recently spread widely and turned into a major international public health threat. Réunion appears to offer conditions particularly favourable to its emergence and therefore prepared to face possible introduction of the virus. We designed a scaled surveillance and response system with specific objectives, methods and measures for various epidemiological phases including a potential epidemic. Several tools were developed in order to (i) detect individual cases (including a large information campaign on the disease and suspicion criteria), (ii) monitor an outbreak through several complementary systems allowing to monitor trends in disease occurrence and geographic spread and (iii) detect severe forms of the disease in collaboration with hospital clinicians. We put the emphasis on detecting the first cases in order to contain the spread of the virus as much as possible and try to avoid progress towards an epidemic. Our two main strengths are a powerful vector control team, and a close collaboration between clinicians, virologists, epidemiologists, entomologists and public health authorities. Our planned surveillance system could be relevant to Europe and island settings threatened by Zika virus all over the world. © 2016, European Centre for Disease Prevention and Control (ECDC). All rights reserved.


PubMed | Brest University Hospital Center, Center Hospitalier Of Chambery Hotel Dieu, Nancy University Hospital Center, CHU de La Reunion and 18 more.
Type: Journal Article | Journal: Human mutation | Year: 2015

Beckwith-Wiedemann syndrome (BWS) is an imprinting disorder associating macroglossia, abdominal wall defects, visceromegaly, and a high risk of childhood tumor. Molecular anomalies are mostly epigenetic; however, mutations of CDKN1C are implicated in 8% of cases, including both sporadic and familial forms. We aimed to describe the phenotype of BWS patients with CDKN1C mutations and develop a functional test for CDKN1C mutations. For each propositus, we sequenced the three exons and intron-exon boundaries of CDKN1C in patients presenting a BWS phenotype, including abdominal wall defects, without 11p15 methylation defects. We developed a functional test based on flow cytometry. We identified 37 mutations in 38 pedigrees (50 patients and seven fetuses). Analysis of parental samples when available showed that all mutations tested but one was inherited from the mother. The four missense mutations led to a less severe phenotype (lower frequency of exomphalos) than the other 33 mutations. The following four tumors occurred: one neuroblastoma, one ganglioneuroblastoma, one melanoma, and one acute lymphoid leukemia. Cases of BWS caused by CDKN1C mutations are not rare. CDKN1C sequencing should be performed for BWS patients presenting with abdominal wall defects or cleft palate without 11p15 methylation defects or body asymmetry, or in familial cases of BWS.


Cournot M.,Center dInvestigations Cliniques | Cournot M.,French Institute of Health and Medical Research | Cournot M.,Center Hospitalier Gabriel Martin | Lenclume V.,French Institute of Health and Medical Research | And 5 more authors.
Blood Pressure | Year: 2016

A better knowledge of prevalence, management and determinants of hypertension is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention, and to reduce the burden of cardiovascular diseases. We conducted a prospective cohort study including 4610 participants aged between 18 and 69 years and representative of the general population of La Réunion, a French overseas island located in the western Indian Ocean. The median time between inclusion and follow-up was 7.4 years. Blood pressure data at baseline and follow-up of 3087 participants were analyzed. We found a high prevalence of hypertension, especially in women (36.7% [34.5–39.0]) and in men (40.3% [37.6–43.0]) and in the under 30s (17.1% [14.0–20.5]), with an increase of 10% at follow-up. Treatment rates were very low in men (19.5% versus 39.1% in women) as was awareness of their condition (25.7% versus 44.6%). Blood pressure control rates were similar (18% at baseline and 34% at follow-up for both sexes). Diagnosis of hypertension at follow-up among subjects normotensive at baseline was independently associated with obesity at baseline (relative risk (RR) = 1.40 [1.12–1.75] for BMI between 27 and 30 kg/m2 and 1.72 [1.33–2.25] for BMI ≥30 kg/m2 as compared with BMI <27 kg/m2) and HbA1C (RR =1.12 [1.05–1.19] per %), suggesting a prominent role of insulin resistance in our population. Our study provides original data that cannot be assimilated to any existing model and should guide the implementation of original community-based programs in such countries. © 2016 Informa UK Ltd, trading as Taylor & Francis Group


Naze F.,CHU de la Reunion | Desvars A.,CHU de la Reunion | Desvars A.,Umeå University | Picardeau M.,Institute Pasteur Paris | And 2 more authors.
PLoS ONE | Year: 2015

Background Leptospirosis is a worldwide zoonosis that is endemic in tropical areas, such as Reunion Island. The species Leptospira interrogans is the primary agent in human infections, but other pathogenic species, such as L. kirschner and L. borgpetersenii, are also associated with human leptospirosis. Methods and Findings In this study, a melting curve analysis of the products that were amplified with the primer pairs lfb1 F/R and G1/G2 facilitated an accurate species classification of Leptospira reference strains. Next, we combined an unsupervised high resolution melting (HRM) method with a new statistical approach using primers to amplify a two variable-number tandemrepeat (VNTR) for typing at the subspecies level. The HRM analysis, which was performed with ScreenClust Software, enabled the identification of genotypes at the serovar level with high resolution power (Hunter-Gaston index 0.984). This method was also applied to Leptospira DNA from blood samples that were obtained from Reunion Island after 1998. We were able to identify a unique genotype that is identical to that of the L. interrogans serovars Copenhageni and Icterohaemorrhagiae, suggesting that this genotype is the major cause of leptospirosis on Reunion Island. Conclusions Our simple, rapid, and robust genotyping method enables the identification of Leptospira strains at the species and subspecies levels and supports the direct genotyping of Leptospira in biological samples without requiring cultures. © 2015 Naze et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Abbo O.,Toulouse University Hospital Center | Mouttalib S.,Toulouse University Hospital Center | L'Kaissi M.,CHU de La Reunion | Sauvat F.,CHU de La Reunion | And 2 more authors.
Pediatric Neurosurgery | Year: 2014

Spinal cord injuries are a well-known cause of neurological bladder and a well-known complication of high-velocity trauma. They can, however, be difficult to diagnose in young children, in whom the absence of initial neurological symptoms and normality of the radiological workup can be falsely reassuring. Management of associated injuries can further delay diagnosis. We present 2 cases of spinal cord injuries without radiological abnormality revealed by delayed bladder retention. © 2014 S. Karger AG, Basel.


Dionne F.,University of Quebec at Trois - Rivieres | Blais M.C.,University of Quebec at Trois - Rivieres | Monestes J.L.,CHU de la Reunion.
Santé mentale au Québec | Year: 2013

The purpose of this article is to present the characteristics of the Acceptance and Commitment Therapy (ACT) for the treatment of chronic pain. The historical context of the development of cognitive and behavioural therapy (CBT) for chronic pain will be described and the theoretical aspects of ACT will be introduced. The components of an acceptance and mindfulness based treatment will also be presented by exploring various processes of the psychological flexibility model. Finally, the article will summarize the scientific evidence supporting ACT based on experimental, correlational and clinical studies in the field of chronic pain. The theoretical aspects underlying ACT, as well as its clinical components in the specific domain of chronic pain were described based on major books in this area, such as McCracken (2005) and Dahl et al. (2005). A descriptive literature review was undertaken to explore the data on the efficacy of ACT for the treatment of chronic pain. Psycinfo and Medline, as well as the Association for Contextual Science website were analyzed for relevant articles. The key search terms were: "Acceptance and Commitment Therapy" or "ACT" or "acceptance" or "mindfulness" or "defusion" and "chronic pain" or "pain." The reference lists of the articles retrieved were also analyzed. The articles that were not in English or French were excluded as well as those that were not specific to ACT and chronic pain. Results show that ACT is a relevant and empirically supported approach that may be used as a complement to CBT strategies in the treatment of chronic pain. There is growing evidence stemming from experimental and correlational studies that support the majority of the ACT processes. Clinical studies undertaken in the field of chronic pain from different backgrounds support the efficacy of ACT for the management of this condition. ACT is a promising and evidence-based approach for the treatment of chronic pain. More research is needed to further validate its theoretical model and further refine our understanding of how ACT could be effective for the management of chronic pain and enhance quality of life for people who suffer from this health condition. For now, ACT is considered to be as effective as traditional cognitive and behavioral therapy for chronic pain.


Harper L.,CHU de La Reunion | Delforge X.,CHU de La Reunion | Maurin S.,CHU de La Reunion | Leroy V.,CHU de La Reunion | And 4 more authors.
Pediatric Nephrology | Year: 2016

Background: The benefit of post-urinary tract infection (UTI) sonography to detect clinically significant renal abnormalities remains a subject open to debate. Decision curve analysis (DCA) is a novel method for evaluating the clinical usefulness of diagnostic tests. Our objective was to determine, using DCA, the benefit of post-UTI sonography and of post-UTI sonography with biological markers of inflammation to predict the risk of recurrence of febrile UTI in children aged 2 to 24 months without known uropathy. Methods: We retrospectively analyzed all children aged 2 to 24 months, without known uropathy, who presented with a first episode of febrile UTI between 2009 and 2012 and followed them for 30 months. We then used DCA to estimate the benefit of post-UTI sonography or post-UTI sonography + biological markers of inflammation for detecting the risk of recurrence. Results: A total of 318 children [144 boys (45.3 %) and 174 girls (54.7 %)], with a mean age of 6.9 ± 5.6 months, were identified. Of these, 210 children presented with a significant inflammation [66.2 %; 95 % confidence interval (CI) 61.0–71.4], and 30 (9.4 %; 95 % CI 6.2–12.6) presented with abnormal post-UTI sonographic findings. Eighteen (5.7 %; 95 % CI 3.1–8.2) children presented with recurrent UTI at 30 months. Conclusions: There were significantly more recurrences in those children who presented with abnormal sonographic findings than in those who did not (relative risk 7.68; 95 % CI 3.03–19.46). However, taking into account the effect of false-positives and false negatives, the DCA revealed that for threshold probabilities of >30 %, at which patients/doctors are concerned about unnecessary interventions (whether tests or treatments), neither post-UTI sonography nor post-UTI sonography + biological markers of inflammation have sufficient value to improve care. © 2016 IPNA


PubMed | Unite de Soutien Methodologique and CHU de La Reunion
Type: Journal Article | Journal: Pediatric nephrology (Berlin, Germany) | Year: 2016

The benefit of post-urinary tract infection (UTI) sonography to detect clinically significant renal abnormalities remains a subject open to debate. Decision curve analysis (DCA) is a novel method for evaluating the clinical usefulness of diagnostic tests. Our objective was to determine, using DCA, the benefit of post-UTI sonography and of post-UTI sonography with biological markers of inflammation to predict the risk of recurrence of febrile UTI in children aged 2 to 24months without known uropathy.We retrospectively analyzed all children aged 2 to 24months, without known uropathy, who presented with a first episode of febrile UTI between 2009 and 2012 and followed them for 30months. We then used DCA to estimate the benefit of post-UTI sonography or post-UTI sonography + biological markers of inflammation for detecting the risk of recurrence.A total of 318 children [144 boys (45.3 %) and 174 girls (54.7%)], with a mean age of 6.95.6months, were identified. Of these, 210 children presented with a significant inflammation [66.2%; 95% confidence interval (CI) 61.0-71.4], and 30 (9.4%; 95% CI 6.2-12.6) presented with abnormal post-UTI sonographic findings. Eighteen (5.7%; 95% CI 3.1-8.2) children presented with recurrent UTI at 30months.There were significantly more recurrences in those children who presented with abnormal sonographic findings than in those who did not (relative risk7.68; 95% CI 3.03-19.46). However, taking into account the effect of false-positives and false negatives, the DCA revealed that for threshold probabilities of >30%, at which patients/doctors are concerned about unnecessary interventions (whether tests or treatments), neither post-UTI sonography nor post-UTI sonography + biological markers of inflammation have sufficient value to improve care.

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