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Leruste S, Baelen F, Doray B, Maillard T, Marimoutou C, Spodenkiewicz M. Obstacles and facilitators to preventing fetal alcohol spectrum disorder: a qualitative study with general practitioners. Front Med (Lausanne) 2024; 11:1280349. [PMID: 38487023 PMCID: PMC10939062 DOI: 10.3389/fmed.2024.1280349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Background Fetal Alcohol Spectrum Disorders are the leading cause of non-genetic intellectual disability. The damage caused, although completely preventable, is irreversible and requires lifelong support. General Practitioners have an important role in the prevention of Fetal Alcohol Spectrum Disorders. However, evidence suggests that General Practitioners do not monitor systematically alcohol consumption among pregnant women. Objectives The aim of this study was to understand the barriers and motivations of General Practitioners in the prevention of Fetal Alcohol Spectrum Disorders on Reunion Island. Methods A qualitative research study was conducted by conducting semi-structured individual interviews with general practitioners. Participants were selected by random or snowball sampling. General practitioners who worked only in unscheduled care services were excluded from this study. After the interviews were transcribed, a verbatim analysis was performed according to the principles of grounded theory. Results Twenty interviews were conducted by two researchers between November and December 2020. General practitioners expressed discomfort in addressing alcohol consumption and excessive drinking in women. They had inaccurate theoretical knowledge and a lack of practical experience with Fetal Alcohol Spectrum Disorders. They also showed little knowledge of the Fetal Alcohol Spectrum Disorders care pathway available on Reunion Island. Both patients and general practitioners expressed discomfort when discussing women's alcohol consumption. Conflicting government policies were highlighted as alcohol promotion campaigns overshadowed Fetal Alcohol Spectrum Disorders prevention initiatives. Conclusion General practitioners should be open and non-judgmental in their interactions with women and couples, with a focus on early detection and short-term intervention. General practitioners should be better educated about Fetal Alcohol Spectrum Disorders and have a clearer understanding of the Fetal Alcohol Spectrum Disorders care pathway.
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Affiliation(s)
- Sébastien Leruste
- Université de La Réunion—UFR Santé Site de l'IES, CHU de La Réunion, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
| | - François Baelen
- Université de La Réunion—UFR Santé Site de l'IES, CHU de La Réunion, Saint-Pierre, France
| | - Bérénice Doray
- Université de La Réunion—UFR Santé Site de l'IES, CHU de La Réunion, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
- Laboratoire EPI (Etudes pharmaco-immunologiques), UFR Santé, Université de La Réunion, CHU (Centre Hospitalier Universitaire) de La Réunion, Saint-Denis, France
- Service de Génétique, CHU (Centre Hospitalier Universitaire) de La Réunion, La Réunion, Saint-Denis, France
- TSAF (Troubles du Spectre de l’Alcoolisation Foetale), Fondation Père Favron, CHU (Centre Hospitalier Universitaire) de La Réunion, Saint-Pierre, France
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs Sud-Ouest Occitanie Réunion, Site Constitutif de La Réunion, Saint-Denis, France
| | | | - Catherine Marimoutou
- Université de La Réunion—UFR Santé Site de l'IES, CHU de La Réunion, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
| | - Michel Spodenkiewicz
- Université de La Réunion—UFR Santé Site de l'IES, CHU de La Réunion, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
- Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada
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Leruste S, Doray B, Maillard T, Lebon C, Marimoutou C, Spodenkiewicz M. Scoping review on the role of the family doctor in the prevention and care of patients with foetal alcohol spectrum disorder. BMC Prim Care 2024; 25:66. [PMID: 38388880 PMCID: PMC10882789 DOI: 10.1186/s12875-024-02291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Foetal alcohol spectrum disorder (FASD) is the leading preventable cause of nongenetic mental disability. Given the patient care pathway, the General Practitioner (GP) is in the front line of prevention and identification of FASD. Acknowledging the importance of the prevalence of FASD, general practitioners are in the front line both for the detection and diagnosis of FASD and for the message of prevention to women of childbearing age as well as for the follow-up. OBJECTIVES The main objective of the scoping review was to propose a reference for interventions that can be implemented by a GP with women of childbearing age, their partners and patients with FASD. The final aim of this review is to contribute to the improvement of knowledge and quality of care of patients with FASD. METHODS A scoping review was performed using databases of peer-reviewed articles following PRISMA guidelines. The search strategy was based on the selection and consultation of articles on five digital resources. The advanced search of these publications was established using the keywords for different variations of FASD: "fetal alcohol syndrome," "fetal alcohol spectrum disorder," "general medicine," "primary care," "primary care"; searched in French and English. RESULTS Twenty-three articles meeting the search criteria were selected. The interventions of GPs in the management of patients with FASD are multiple: prevention, identification, diagnosis, follow-up, education, and the role of coordinator for patients, their families, and pregnant women and their partners. FASD seems still underdiagnosed. CONCLUSION The interventions of GPs in the management of patients with FASD are comprehensive: prevention, identification, diagnosis, follow-up, education, and the role of coordinator for patients, their families, and pregnant women and their partners. Prevention interventions would decrease the incidence of FASD, thereby reducing the incidence of mental retardation, developmental delays, and social, educational and legal issues. A further study with a cluster randomized trial with a group of primary care practitioners trained in screening for alcohol use during pregnancy would be useful to measure the impact of training on the alcohol use of women of childbearing age and on the clinical status of their children.
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Affiliation(s)
- Sébastien Leruste
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France.
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France.
| | - Bérénice Doray
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
- Service de Génétique - CHU de La Réunion, Saint-Denis, France
- Laboratoire EPI, Université & CHU de La Réunion, Saint-Denis, France
- Centre Ressources, TSAF - Fondation Père Favron - CHU de La Réunion, Saint-Pierre, France
| | | | - Christophe Lebon
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
| | - Catherine Marimoutou
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
| | - Michel Spodenkiewicz
- INSERM CIC-EC 1410, CHU de La Réunion, BP350 - 97 448, Saint-Pierre Cedex, La Réunion, France
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
- Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, Canada
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Leruste S, Pouilley-Bax A, Doray B, Maillard T, Monin F, Loubaresse C, Marimoutou C, Spodenkiewicz M. Actions to prevent and identify fetal alcohol spectrum disorders to be implemented in general practice: a consensus. Front Med (Lausanne) 2024; 11:1278973. [PMID: 38375324 PMCID: PMC10875990 DOI: 10.3389/fmed.2024.1278973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Fetal alcohol exposure is the most common preventable cause of non-genetic intellectual disability. Fetal Alcohol Syndrome (FAS) is characterized by intellectual disability and distinctive facial features and affects 0.1% of live births, representing approximately 800 cases per year in France. Fetal Alcohol Spectrum Disorder (FASD) are 10 times more common than FAS, with an estimated 8,000 cases per year, and are associated with behavioral and social maladjustment in both children and adults, as well as various malformations. General practitioners play a key role in preventing and identifying FASD through their involvement in pregnancy and child monitoring. Methods Qualitative study using the Delphi method. Items were developed from the literature and semi-structured interviews with field professionals and health institutions. A panel of multi-professional experts, mostly general practitioners, was recruited. Results 24 initial actions were submitted to the experts. At the end of the first round, six actions reached a consensus and six were reformulated for the second round. At the end of the second round, three actions reached a consensus, for a total of 11 consensus actions. Four of these actions seem particularly relevant for rapid implementation, namely systematic proposal of pre-conceptional consultations for women planning pregnancy, systematic identification of environmental factors during child monitoring, systematic distribution of information on fetal alcohol exposure during pre-conception or early pregnancy, and the publication of a leaflet for general practitioners on the identification of children with FAS or FASD and the contact details of relevant associations. Conclusion Prevention and identification of FASD can be improved through short and general training supports for general practitioners. Early screening of FASD is crucial for children, and should be maintained throughout their monitoring. This study could be used for communication and dissemination of information based on the consensus obtained.
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Affiliation(s)
- Sébastien Leruste
- Université de La Réunion—UFR Santé, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
| | | | - Bérénice Doray
- Université de La Réunion—UFR Santé, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
- Laboratoire EPI (Etudes pharmaco-immunologiques), UFR Santé, Université de La Réunion, CHU (Centre Hospitalier Universitaire) de La Réunion, Saint-Denis, France
- Service de Génétique, CHU (Centre Hospitalier Universitaire) de La Réunion, Saint-Denis, France
- Centre Ressources TSAF (Troubles du Spectre de l’Alcoolisation Foetale), Fondation Père Favron, CHU (Centre Hospitalier Universitaire) de La Réunion, Saint-Pierre, France
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs Sud-Ouest Occitanie Réunion, Site Constitutif de La Réunion, Saint-Denis, France
| | | | | | | | - Catherine Marimoutou
- Université de La Réunion—UFR Santé, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
| | - Michel Spodenkiewicz
- Université de La Réunion—UFR Santé, Saint-Pierre, France
- INSERM CIC-EC 1410, CHU of Réunion Island, Saint-Pierre, France
- Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
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Leruste S, Delfarguiel L, Doray B, Loubaresse C, Sennsfelder L, Maillard T, Marimoutou C, Spodenkiewicz M. The role of general practitioners in Reunion in detecting alcohol use in pregnant women and identifying fetal alcohol spectrum disorder: a qualitative study. Arch Public Health 2023; 81:210. [PMID: 38057936 DOI: 10.1186/s13690-023-01221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of non-genetic intellectual disability and social maladjustment in children. International guidelines recommend abstinence from alcohol during pregnancy. Réunion is the most affected of all French regions with an estimated Fetal Alcohol Spectrum (FAS) prevalence of 1.2‰ births. General practitioners (GPs) are at the forefront of identifying patients with FASD. OBJECTIVE To understand how GPs identify FASD. METHODS Qualitative study using a grounded theory approach, through semi-structured face-to-face interviews with GPs. Interviews were conducted with the aim of reaching theoretical saturation. These were transcribed verbatim and then analyzed by four researchers to ensure triangulation of the data. RESULTS GPs reported barriers to the identification of FASD: challenges in overcoming social taboos and paradoxical injunctions, the influence of limited knowledge and experience, non-specific and highly variable symptoms, ambiguous classification and method of diagnosis involving the mobilization of a multidisciplinary team and lengthy consultations. Conversely, they felt competent to identify neurodevelopmental disorders of any cause, but were concerned about the long waiting time to access specialized care. From the perspective of GPs, it is crucial to prioritize promotion and training aimed at improving the identification and coordination of care pathways for children diagnosed with neurodevelopmental disorders, such as FASD.
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Affiliation(s)
- Sébastien Leruste
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France.
- INSERM CIC 1410, CHU de La Réunion, Saint-Pierre, France.
| | | | - Bérénice Doray
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
- INSERM CIC 1410, CHU de La Réunion, Saint-Pierre, France
- Service de Génétique - CHU de La Réunion, Saint-Denis, France
- Laboratoire EPI, Université & CHU de La Réunion, Saint-Denis, France
- Centre Ressources TSAF - Fondation Père Favron - CHU de La Réunion, Saint-Pierre, France
| | | | - Laetitia Sennsfelder
- INSERM CIC 1410, CHU de La Réunion, Saint-Pierre, France
- Service de Génétique - CHU de La Réunion, Saint-Denis, France
| | | | - Catherine Marimoutou
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
- INSERM CIC 1410, CHU de La Réunion, Saint-Pierre, France
| | - Michel Spodenkiewicz
- UFR Santé, University of La Réunion, 97410, Saint-Pierre, France
- INSERM CIC 1410, CHU de La Réunion, Saint-Pierre, France
- Moods Team, INSERM UMR-1178, CESP, Le Kremlin-Bicêtre, France
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Canada
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Reynaud D, Laboureur E, Marimoutou C, Cartron E. Experiences of adolescents using sexual health services on Reunion Island: protocol for a qualitative phenomenological study. BMJ Open 2023; 13:e073835. [PMID: 38000830 PMCID: PMC10680011 DOI: 10.1136/bmjopen-2023-073835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Adolescence and early adulthood are often critical periods of sexual development. The discovery of sexual intercourse can lead to sexual risk-taking which may impact the incidence of sexually transmitted infections (STIs) and unwanted pregnancies. Despite available sexual health services on Reunion Island, sexual health indicators for adolescents are very poor showing a high number of teenage pregnancies and abortions, low use of contraception and an upsurge of STIs. In contrast, this French region is equipped with many services and resources that enable young adults to make informed sexual health choices. This study protocol describes the methodology to describe adolescent experiences of using sexual health services on Reunion Island. METHODS AND ANALYSIS A monocentric descriptive qualitative study using a phenomenological approach will be conducted from December 2022 to August 2023 and will be based on face-to-face semistructured interviews with participants aged 15-19 years and residing on Reunion Island. Recruitment will be distributed at various educational institutions and sexual health centres and will be facilitated by the 'snowball' and 'word-of-mouth' effect. Data analysis will be independently carried out by three investigators to increase reliability. An interpretative phenomenological analysis will be performed. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee of the Hospital Center University De Bordeaux (CER-BDX-2022-55). Data generated do not fall within the field of biological or medical knowledge nor into the category of Research Involving the Human Person as defined in Articles L. 1121-1 and R. 1121-1 of the Public Health Code in France. All participants will receive information about the study in verbal and written forms and will give their oral consent before enrolment. Results will be published in a peer-reviewed journal as well as presented and disseminated at the Regional Health Agency of Reunion Island, conferences and in meetings with school directors.
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Affiliation(s)
- Danielle Reynaud
- Centre Hospitalier Universitaire de La Réunion Sites Sud Saint-Pierre, Saint-Pierre, Réunion
| | | | | | - Emmanuelle Cartron
- Département universitaire des Sciences Infirmières, Université Paris Cité, Paris, France
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Flaus-Furmaniuk A, Fianu A, Lenclume V, Chirpaz E, Balcou-Debussche M, Debussche X, Marimoutou C. Attrition and social vulnerability during 2-year-long structured care in type 2 diabetes, the ERMIES randomized controlled trial. BMC Endocr Disord 2022; 22:314. [PMID: 36510180 PMCID: PMC9746115 DOI: 10.1186/s12902-022-01211-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes self-management education is exposed to attrition from services and structured ambulatory care. However, knowledge about factors related to attrition in educational programs remains limited. The context of social vulnerability due to low income may interfere. The aim of this study was to identify the sociodemographic, clinical, psychometric, and lifestyle factors associated with attrition from the ERMIES multicentre randomized parallel controlled trial (RCT) that was interrupted due to the combination of both slow inclusion and high attrition. METHODS The ERMIES trial was performed from 2011 to 2016 on Reunion Island, which is characterized by a multicultural population and high social vulnerability. The original objective of the RCT was to test the efficacy of a2-year structured group self-management education in improving blood glucose in adult patients with nonrecent, insufficiently controlled type 2 diabetes. One hundred participants were randomized to intensive educational intervention maintained over two years (n = 51) versus only initial education (n = 49). Randomization was stratified on two factors: centres (five strata) and antidiabetic treatment (two strata: insulin-treated or not). Sociodemographic, clinical, health-care access and pathway, psychometric and lifestyle characteristics data were collected at baseline and used to assess determinants of attrition in a particular social context and vulnerability. Attrition and retention rates were measured at each visit during the study. Multiple correspondence analysis and Cox regression were performed to identify variables associated with attrition. RESULTS The global attrition rate was 26% during the study, with no significant difference between the two arms of randomization (9 dropouts out of 51 patients in the intervention group and 17 out of 49 in the control group). Male gender, multiperson household, low household incomes (< 800 euros), probable depression and history of hospitalization or medical leave at inclusion were associated with a higher risk of attrition from the study in multivariate regression. CONCLUSIONS Social context, vulnerability, and health care history were related to attrition in this 2-year longitudinal comparative study of structured care. Considering these potential determinants and biases is of importance in scaling up interventions aimed at the optimization of long-term care in type 2 diabetes mellitus. TRIAL REGISTRATION ID_RCB number: 2011-A00046-35, Clinicaltrials.gov number: NCT01425866 (Registration date: 30/08/2011). SOURCE OF FUNDING Ministry of Health, France.
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Affiliation(s)
- Anna Flaus-Furmaniuk
- Endocrinology Department, University Hospital of the Reunion Island, Saint Denis, France.
- INSERM CIC 1410, University Hospital of the Reunion Island, Saint Denis, France.
| | - Adrian Fianu
- INSERM CIC 1410, University Hospital of the Reunion Island, Saint Denis, France
- CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Victorine Lenclume
- INSERM CIC 1410, University Hospital of the Reunion Island, Saint Denis, France
| | - Emmanuel Chirpaz
- INSERM CIC 1410, University Hospital of the Reunion Island, Saint Denis, France
| | - Maryvette Balcou-Debussche
- Icare Research Unit, Institut Coopératif Austral Pour La Recherche en Éducation EA7389, University of Reunion, Saint-Denis, La Réunion, France
| | - Xavier Debussche
- Endocrinology Department, University Hospital of the Reunion Island, Saint Denis, France
- INSERM CIC 1410, University Hospital of the Reunion Island, Saint Denis, France
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Anthony N, Bruneau L, Leruste S, Franco JM, Domercq A, Kowalczyk C, Nobecourt E, Marimoutou C. Diabetes incidence in subjects with PREDIABetes from ReUNion Island: the PREDIABRUN observational cohort study protocol. BMJ Open 2022; 12:e062520. [PMID: 36410808 PMCID: PMC9680172 DOI: 10.1136/bmjopen-2022-062520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Improved knowledge of prediabetic subjects' profile and their risk of developing type 2 diabetes mellitus (T2DM) would enhance secondary prevention. The primary objective is to describe factors associated with incident T2DM in subjects with pre-diabetes diagnosed in primary care. METHODS AND ANALYSIS The study is based on Reunion Island, a French overseas region that experiences a particularly high disease burden of T2DM. This is an observational, non-randomised prospective cohort study conducted in primary care in which private general practitioner (GP) investigators recruit participants with pre-diabetes from their practices regardless of the initial motive for consultation. Pre-diabetes is defined by WHO criteria, that is, fasting plasma glucose between 1.10 g/L and 1.25 g/L and/or plasma glucose 2 hours after ingestion of 75 g of glucose (2-hour post load plasma glucose) between 1.40 g/L and 1.99 g/L. The design is based on an annual follow-up by the GP (according to French National Health Authority recommendations) with collection of clinical and laboratory data and specific lifestyle questionnaires answered by telephone at three time points: inclusion, and at 2-year and 5-year follow-up visits. Follow-up clinical and laboratory data are collected by the investigating GP as part of the study, and study-specific laboratory collections (serum, DNA and urine) will be obtained 2 and 5 years after inclusion. The primary outcome is transition to T2DM. ETHICS AND DISSEMINATION This protocol has been approved by the research ethics committee of Saint Etienne (CPP Saint Etienne reference number: 2019-03). Enrolment began in August 2019. Results will be disseminated in at least three papers published in peer-reviewed medical journals, one oral communication and a large-scale communication to the local population and healthcare policymakers. TRIAL REGISTRATION NUMBER NCT04463160 and ID-RCB 2018-A03106-49.
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Affiliation(s)
- Norah Anthony
- Institut national de la santé et de la recherche, CIC 1410, Saint Pierre, La Réunion, France
- Unité de soutien méthodologique et biostatistique, CHU La Réunion, Saint Denis, La Réunion, France
| | - Léa Bruneau
- Institut national de la santé et de la recherche, CIC 1410, Saint Pierre, La Réunion, France
- Unité de soutien méthodologique et biostatistique, CHU La Réunion, Saint Denis, La Réunion, France
| | - Sebastien Leruste
- Institut national de la santé et de la recherche, CIC 1410, Saint Pierre, La Réunion, France
- Département universitaire de médecine générale (DUMG), Université de La Réunion, France
| | - Jean-Marc Franco
- Institut national de la santé et de la recherche, CIC 1410, Saint Pierre, La Réunion, France
- Département universitaire de médecine générale (DUMG), Université de La Réunion, France
| | - Alain Domercq
- Collège des généralistes enseignants de l'océan indien, La Réunion, France
| | - Christine Kowalczyk
- Union régionale des médecins libéraux Océan Indien (URML), La Réunion, France
| | - Estelle Nobecourt
- Institut national de la santé et de la recherche, CIC 1410, Saint Pierre, La Réunion, France
- Service d'endocrinologie, Diabète et nutrition, CHU de La Réunion, Saint Pierre, La Réunion, France
- Université de la Réunion, INSERM, UMR 1188 Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), Plateforme CYROI), Saint Denis, La Réunion, France
| | - C Marimoutou
- Institut national de la santé et de la recherche, CIC 1410, Saint Pierre, La Réunion, France
- Unité de soutien méthodologique et biostatistique, CHU La Réunion, Saint Denis, La Réunion, France
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Marimoutou C, Quénel P. [Par l'Association des épidémiologistes de langue française (ADELF) et par l'Association pour le développement de l'épidémiologie de terrain (EPITER)]. Rev Epidemiol Sante Publique 2022; 70 Suppl 3:S135. [PMID: 35850877 DOI: 10.1016/j.respe.2022.06.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Coassin S, Chemello K, Khantalin I, Forer L, Döttelmayer P, Schönherr S, Grüneis R, Chong-Hong-Fong C, Nativel B, Ramin-Mangata S, Gallo A, Roche M, Muelegger B, Gieger C, Peters A, Zschocke J, Marimoutou C, Meilhac O, Lamina C, Kronenberg F, Blanchard V, Lambert G. Genome-Wide Characterization of a Highly Penetrant Form of Hyperlipoprotein(a)emia Associated With Genetically Elevated Cardiovascular Risk. Circ Genom Precis Med 2022; 15:e003489. [PMID: 35133173 PMCID: PMC9018215 DOI: 10.1161/circgen.121.003489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lp(a) (lipoprotein [a]) is a highly atherogenic lipoprotein strongly associated with coronary artery disease (CAD). Lp(a) concentrations are chiefly determined genetically. Investigation of large pedigrees with extreme Lp(a) using modern whole-genome approaches may unravel the genetic determinants underpinning this pathological phenotype.
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Affiliation(s)
- Stefan Coassin
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology (S.C., L.F., P.D., S.S., R.G., C.L., F.K.), Medical University of Innsbruck, Austria
| | - Kevin Chemello
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.)
| | - Ilya Khantalin
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.).,CHU de La Réunion, Service de Chirurgie Cardiaque Vasculaire et Thoracique, Saint-Denis, France (I.K.)
| | - Lukas Forer
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology (S.C., L.F., P.D., S.S., R.G., C.L., F.K.), Medical University of Innsbruck, Austria
| | - Patricia Döttelmayer
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology (S.C., L.F., P.D., S.S., R.G., C.L., F.K.), Medical University of Innsbruck, Austria
| | - Sebastian Schönherr
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology (S.C., L.F., P.D., S.S., R.G., C.L., F.K.), Medical University of Innsbruck, Austria
| | - Rebecca Grüneis
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology (S.C., L.F., P.D., S.S., R.G., C.L., F.K.), Medical University of Innsbruck, Austria
| | - Clément Chong-Hong-Fong
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.)
| | - Brice Nativel
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.)
| | - Stéphane Ramin-Mangata
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.)
| | - Antonio Gallo
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.)
| | - Mathias Roche
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.)
| | - Beatrix Muelegger
- Institute of Human Genetics (B.M., J.S.), Medical University of Innsbruck, Austria
| | - Christian Gieger
- Research Unit of Molecular Epidemiology (C.G.), Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Epidemiology (C.G., A.P.), Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany (C.G., A.P.)
| | - Annette Peters
- Institute of Epidemiology (C.G., A.P.), Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany (C.G., A.P.)
| | - Johannes Zschocke
- Institute of Human Genetics (B.M., J.S.), Medical University of Innsbruck, Austria
| | | | - Olivier Meilhac
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.).,CHU de La Réunion, CIC EC1410, Saint-Pierre, France (C.M., O.M.)
| | - Claudia Lamina
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology (S.C., L.F., P.D., S.S., R.G., C.L., F.K.), Medical University of Innsbruck, Austria
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology (S.C., L.F., P.D., S.S., R.G., C.L., F.K.), Medical University of Innsbruck, Austria
| | - Valentin Blanchard
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.).,Department of Medicine, Centre for Heart Lung Innovation, Providence Healthcare Research Institute, St Paul's Hospital, University of British Columbia, Vancouver, Canada (V.B.)
| | - Gilles Lambert
- Université de La Réunion, INSERM UMR 1188 DéTROI, Sainte-Clotilde, France (K.C., I.K., C.C.-H.-F., B.N., S.R.-M., A.G., M.R., O.M., V.B., G.L.)
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Javelle E, Mayet A, Allodji RS, Marimoutou C, Lavagna C, Desplans J, Million M, Raoult D, Texier G. Clinical and Epidemiological Changes in French Soldiers After Deployment: Impact of Doxycycline Malaria Prophylaxis on Body Weight. Mil Med 2021; 188:e1084-e1093. [PMID: 34697624 DOI: 10.1093/milmed/usab434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/21/2021] [Accepted: 10/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibiotics are growth promotors used in animal farming. Doxycycline (DOXY) is a tetracycline antibiotic taken daily and continued 1 month after return to protect against malaria during travel and deployment in endemic areas. We evaluated DOXY impact on body weight in military international travelers. MATERIEL AND METHODS A prospective cohort analysis was conducted in 2016-2018, recruiting 170 French soldiers before a 4-month assignment overseas. Many clinical data including anthropometric measures by an investigator were collected before and after deployment. Weight gain was defined by an increase of 2% from baseline. The study protocol was supported by the French Armed Forces Health Services and approved by the French ethics committee (IRB no. 2015-A01961-48, ref promoter 2015RC0). Written, informed consent was obtained with signature from each volunteer before inclusion. RESULTS After deployment, 84 soldiers were followed up. Overall, 38/84 (45%) were deployed to Mali with DOXY malaria prophylaxis, and others were deployed to Iraq or Lebanon without malaria prophylaxis according to international recommendations. Body weight increased in 24/84 (30%), of whom 14/24 (58%) were exposed to DOXY. In bivariate analysis, DOXY had a positive but not significant effect on weight gain (P-value = .4). In the final logistic regression model (Fig. 3), weight gain after deployment positively correlated with an increase in waist circumference (odds ratio [OR] 1.23 with 95% CI [1.06-1.47]) suggesting fat gain; with sedentary work (OR 5.34; 95% CI [1.07-31.90]); and with probiotic intake (OR 5.27; 95% CI [1.51-20.40]). Weight impact of probiotics was more important when associated with DOXY intake (OR 6.86; 95% CI [1.52-38.1]; P-value = .016). CONCLUSIONS Doxycycline (DOXY) malaria prophylaxis during several months did not cause significant weight gain in soldiers. Further studies are required in older and less sportive traveling populations, and to investigate a cumulative effect over time and recurrent DOXY exposure. Doxycycline (DOXY) may enhance other growth-promoting factors including fatty food, sedentariness, and strain-specific probiotics contained in fermented dairy products which are also used as growth promotors.
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Affiliation(s)
- Emilie Javelle
- Infectious Diseases and Tropical Diseases unit, Laveran Military Teaching Hospital, Marseille 13013, France.,IRD, AP-HM, SSA, VITROME, Aix-Marseille University, Marseille 13385, France.,IHU-Méditerranée Infection, Marseille 13005, France
| | - Aurélie Mayet
- Centre d'Epidémiologie et de Santé Publique des Armées (CESPA), Marseille 13014, France.,INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SITE SANTÉ TIMONE (QuanTIM-SanteRCom) Faculté de Médecine, Aix-Marseille University, Marseille Cedex 5 13385, France
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, CESP, Inserm U1018, Villejuif 94 807, France.,UVSQ, Inserm, CESP, Université Paris-Saclay, Villejuif 94 807, France.,Department of Research, Gustave Roussy, 94805, Villejuif, France
| | - Catherine Marimoutou
- Centre d'Epidémiologie et de Santé Publique des Armées (CESPA), Marseille 13014, France.,INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, SITE SANTÉ TIMONE (QuanTIM-SanteRCom) Faculté de Médecine, Aix-Marseille University, Marseille Cedex 5 13385, France.,CIC Inserm 1410, CHU de La Réunion, Site Sud, Saint Pierre Cedex 97448, France
| | - Chrystel Lavagna
- Centre d'Epidémiologie et de Santé Publique des Armées (CESPA), Marseille 13014, France
| | - Jérôme Desplans
- Centre d'Epidémiologie et de Santé Publique des Armées (CESPA), Marseille 13014, France
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille 13005, France.,IRD, AP-HM, SSA, MEPHI, Aix-Marseille University, Marseille 13385, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille 13005, France.,IRD, AP-HM, SSA, MEPHI, Aix-Marseille University, Marseille 13385, France
| | - Gaëtan Texier
- IRD, AP-HM, SSA, VITROME, Aix-Marseille University, Marseille 13385, France.,Centre d'Epidémiologie et de Santé Publique des Armées (CESPA), Marseille 13014, France
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11
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Javelle E, Mayet A, Million M, Levasseur A, Allodji RS, Marimoutou C, Lavagna C, Desplans J, Fournier PE, Raoult D, Texier G. Gut Microbiota in Military International Travelers with Doxycycline Malaria Prophylaxis: Towards the Risk of a Simpson Paradox in the Human Microbiome Field. Pathogens 2021; 10:pathogens10081063. [PMID: 34451527 PMCID: PMC8400693 DOI: 10.3390/pathogens10081063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Dysbiosis, developed upon antibiotic administration, results in loss of diversity and shifts in the abundance of gut microbes. Doxycycline is a tetracycline antibiotic widely used for malaria prophylaxis in travelers. We prospectively studied changes in the fecal microbiota of 15 French soldiers after a 4-month mission to Mali with doxycycline malaria prophylaxis, compared to changes in the microbiota of 28 soldiers deployed to Iraq and Lebanon without doxycycline. Stool samples were collected with clinical data before and after missions, and 16S rRNA sequenced on MiSeq targeting the V3-V4 region. Doxycycline exposure resulted in increased alpha-biodiversity and no significant beta-dissimilarities. It led to expansion in Bacteroides, with a reduction in Bifidobacterium and Lactobacillus, as in the group deployed without doxycycline. Doxycycline did not alter the community structure and was specifically associated with a reduction in Escherichia and expression of Rothia. Differences in the microbiota existed at baseline between military units but not within the studied groups. This group-effect highlighted the risk of a Simpson paradox in microbiome studies.
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Affiliation(s)
- Emilie Javelle
- Laveran Military Teaching Hospital, Boulevard Alphonse Laveran, 13013 Marseille, France
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, 13000 Marseille, France; (P.E.F.); (G.T.)
- IHU-Méditerranée Infection, 19–21 Boulevard Alphonse Laveran, 13013 Marseille, France; (M.M.); (A.L.); (D.R.)
- Correspondence: ; Tel.: +33-(0)6-32-41-99-03; Fax: +33-(0)4-13-73-24-02
| | - Aurélie Mayet
- Centre d’Epidémiologie et de Santé Publique des Armées (CESPA), 13014 Marseille, France; (A.M.); (C.M.); (C.L.); (J.D.)
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille University, 13000 Marseille, France
| | - Matthieu Million
- IHU-Méditerranée Infection, 19–21 Boulevard Alphonse Laveran, 13013 Marseille, France; (M.M.); (A.L.); (D.R.)
- IRD, AP-HM, SSA, MEPHI, Aix Marseille University, 13000 Marseille, France
| | - Anthony Levasseur
- IHU-Méditerranée Infection, 19–21 Boulevard Alphonse Laveran, 13013 Marseille, France; (M.M.); (A.L.); (D.R.)
- Centre d’Epidémiologie et de Santé Publique des Armées (CESPA), 13014 Marseille, France; (A.M.); (C.M.); (C.L.); (J.D.)
- IRD, AP-HM, SSA, MEPHI, Aix Marseille University, 13000 Marseille, France
| | - Rodrigue S. Allodji
- Radiation Epidemiology Team, CESP, Inserm U1018, 94800 Villejuif, France;
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
- Department of Research, Gustave Roussy, 94800 Villejuif, France
| | - Catherine Marimoutou
- Centre d’Epidémiologie et de Santé Publique des Armées (CESPA), 13014 Marseille, France; (A.M.); (C.M.); (C.L.); (J.D.)
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille University, 13000 Marseille, France
- CIC Inserm 1410, CHU de La Réunion, 97400 La Réunion, France
| | - Chrystel Lavagna
- Centre d’Epidémiologie et de Santé Publique des Armées (CESPA), 13014 Marseille, France; (A.M.); (C.M.); (C.L.); (J.D.)
| | - Jérôme Desplans
- Centre d’Epidémiologie et de Santé Publique des Armées (CESPA), 13014 Marseille, France; (A.M.); (C.M.); (C.L.); (J.D.)
| | - Pierre Edouard Fournier
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, 13000 Marseille, France; (P.E.F.); (G.T.)
- IHU-Méditerranée Infection, 19–21 Boulevard Alphonse Laveran, 13013 Marseille, France; (M.M.); (A.L.); (D.R.)
| | - Didier Raoult
- IHU-Méditerranée Infection, 19–21 Boulevard Alphonse Laveran, 13013 Marseille, France; (M.M.); (A.L.); (D.R.)
- IRD, AP-HM, SSA, MEPHI, Aix Marseille University, 13000 Marseille, France
| | - Gaëtan Texier
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, 13000 Marseille, France; (P.E.F.); (G.T.)
- Centre d’Epidémiologie et de Santé Publique des Armées (CESPA), 13014 Marseille, France; (A.M.); (C.M.); (C.L.); (J.D.)
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Anthony N, Lenclume V, Fianu A, Marimoutou C, Nobecourt E. Influence des définitions biologiques du prédiabète sur le développement du diabète. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Marchi J, Mayet A, Chamonaz C, de Laval F, Paul F, Marimoutou C. Differential Impact According to Mission's Operational Intensity on Psychoactive Substance Use: A Retrospective Cohort of French Male Army Service Members. Subst Use Misuse 2019; 54:841-851. [PMID: 30648459 DOI: 10.1080/10826084.2018.1547908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stressful deployments in combat areas are known to increase the risk of substance abuse in military personnel. OBJECTIVES The aim of the study was to compare deployment on stressful, high-intensity missions (HIMs) to deployment on low-intensity missions (LIMs) in order to understand factors associated with substance use variations across the mission. METHODS A retrospective cohort study based on a one-shot self-questionnaire was performed four months after their return on two samples of male French Army service members: one returning from an HIM and one from an LIM. The questionnaire focused on tobacco, alcohol, cannabis, cocaine, and psychoactive medication use at three times: before, during, and after the mission. RESULTS During an HIM, the frequency of tobacco use increased, alcohol use remained stable - although 38% declared a decrease in consumption - and illicit drug use decreased. During an LIM, tobacco and alcohol use increased, cannabis use remained stable, and only cocaine and medication use decreased. After their return, use levels among both samples reverted to values similar to those reported before the mission, except for a decrease in tobacco use observed at return from an HIM. The main factors perceived as related to variations were stress in an HIM and low cost in an LIM. Conclusions/importance: The study suggests a differential impact of deployment on substance use according to the operational intensity of the mission. Variations in use are predominant during the mission with a washout effect after returning home.
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Affiliation(s)
- Joffrey Marchi
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France
| | - Aurélie Mayet
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France.,b INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ , Marseille , France
| | - Claire Chamonaz
- c Hôpital d'Instruction des Armées Laveran , Marseille , France
| | - Franck de Laval
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France
| | - Frédéric Paul
- c Hôpital d'Instruction des Armées Laveran , Marseille , France
| | - Catherine Marimoutou
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France.,b INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ , Marseille , France
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14
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Gérardin P, Rollot O, Maillard O, Mussard C, Porcherat S, Lenclume V, Fianu A, Bertolotti A, Huiart L, Marimoutou C. Qualité de vie à 10–11 ans d’une épidémie de Chikungunya : étude en population générale. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Le Dault E, Sicard S, Mayet A, Desplans J, Simon F, Marimoutou C, Coton T. Un traitement précoce par ciprofloxacine dose unique diminue la durée de la diarrhée chez les militaires français déployés en opération extérieure en Afrique intertropicale. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Sicard S, Mayet A, Duron S, Richard JB, Beck F, Meynard JB, Deparis X, Marimoutou C. Factor associated with risky sexual behaviors among the French general population. J Public Health (Oxf) 2017; 39:523-529. [PMID: 27222240 DOI: 10.1093/pubmed/fdw049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Despite prevention programs, a rising incidence of sexually transmitted infections is currently reported in France. Aims Research factors associated with risky sexual behaviors (RSBs) among the French population. Methods Subjects aged 15-54 years from the French national survey 'Baromètre santé 2010' were included (n = 16 598). RSB was defined as having multiple partners or failure to use condom at first intercourse with a new partner over past 12 months. Factors associated were identified using one logistic regression by gender. Results The overall RSB prevalence was 9.5%, being higher among men (P < 0.001). Factors associated with RSB for both genders were young age (OR = 1.5), single status (men: OR = 7.1; women: OR = 6.4), homosexual relations (men: OR = 2.0; women: OR = 3.2), low incomes (men: OR = 1.5; women: OR = 1.4), use of cannabis (men: OR = 1.4; women: OR = 3.0). Men-specific factors were history of STI (OR = 2.5) and alcohol drunkenness (OR = 2.2), and women-specific factors history of suicide attempt (OR = 1.6) and history of sexual assault (OR = 1.6). Conclusions Confirming most of known determinants of RSB, this study also identified some specific risky patterns for whom preventive actions can be developed: multiusers of psychoactive substances, people living with low incomes, women having sex with women or presenting history of psychological vulnerability (suicide attempts, sexually harassed).
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Affiliation(s)
- Sébastien Sicard
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille cedex 02 13568, France
| | - Aurélie Mayet
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille cedex 02 13568, France.,UMR 912-SESSTIM, Aix-Marseille University, Marseille 13006, France
| | - Sandrine Duron
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille cedex 02 13568, France.,UMR 912-SESSTIM, Aix-Marseille University, Marseille 13006, France
| | - Jean-Baptiste Richard
- Institut National de Prévention et d'Education Pour la Santé (INPES), Saint Denis 93203, France
| | - François Beck
- Institut National de Prévention et d'Education Pour la Santé (INPES), Saint Denis 93203, France
| | - Jean-Baptiste Meynard
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille cedex 02 13568, France.,UMR 912-SESSTIM, Aix-Marseille University, Marseille 13006, France
| | - Xavier Deparis
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille cedex 02 13568, France.,UMR 912-SESSTIM, Aix-Marseille University, Marseille 13006, France
| | - Catherine Marimoutou
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille cedex 02 13568, France.,UMR 912-SESSTIM, Aix-Marseille University, Marseille 13006, France
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Succo T, De Laval F, Sicard S, Belleoud D, Marimoutou C, Mayet A, Sagaon-Teyssier L, Michel R. Do alcohol-based hand rubs reduce the incidence of acute diarrhea during military deployments? A prospective randomized trial. Travel Med Infect Dis 2017; 15:48-51. [DOI: 10.1016/j.tmaid.2016.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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Attaiaa LA, Beck F, Richard JB, Marimoutou C, Mayet A. Relationships between substance initiation sequence and further substance use: A French nationwide retrospective study. Addict Behav 2016; 57:1-5. [PMID: 26826476 DOI: 10.1016/j.addbeh.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/27/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
The Gateway theory (GT) proposes that tobacco or alcohol use lead to cannabis use, which can itself be followed by other illicit drugs (OID) onset. Aim of this study was to evaluate if the order of initiation sequence could influence further substance use. Data from a 2010 population-based survey were used (22,774 subjects aged 15-64). Using reported ages at initiations, 7 sequences were identified: initiation of tobacco only (T), cannabis or OID only, tobacco followed by cannabis (T-C), cannabis followed by tobacco (C-T), alternative 2-substance sequences, gateway sequence (T-C-OID) and 3-substance alternative sequences. Logistics regressions were performed to study the impact of sequence on further use (tobacco, alcohol, cannabis and OID), and substance use disorders (SUD) (tobacco, alcohol and cannabis). The most observed sequences were T (45.5%), T-C (20.5%), C-T (5.1%) and T-C-OID (3.5%). Further use and SUD likelihoods, whatever the substance considered, increased with the number of substances previously initiated. However, for a same number of substances initiated, current use and SUD likelihoods did not significantly vary according to sequence. Polysubstance initiation appears as a better predictor of further use and SUD than the initiation sequence, questioning the GT and being more in line with a common liability to substance use.
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Rapp C, Géraud C, Ficko C, Verret C, Marimoutou C. TROP-05 - Évaluation des connaissances, attitudes et pratiques concernant le risque rabique dans les armées françaises. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Paul F, Marimoutou C, Pommier de Santi V, Clervoy P. Post-Traumatic Stress Disorder among French Armed Forces Members in Afghanistan: A New Approach. Front Neurol Neurosci 2016; 38:228-236. [PMID: 27035830 DOI: 10.1159/000443221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
During the 20th century, the management of war-related psychological trauma shifted from neurology to psychiatry. After September 11, 2001, the French forces participated in a multinational force deployed in Afghanistan to fight against terrorism. Post-traumatic stress disorder (PTSD) became a priority. We report the daily work of the psychiatrists involved in this mission and the organization developed to psychologically support wounded military personnel. The doctrine of early intervention psychiatrization and the technique of collective debriefing are the key points of this procedure. The psychiatrist is also responsible for the healthcare community, particularly vulnerable when confronted with severe ballistic injuries. One aim of this organization is also to screen PTSD in soldiers returning from Afghanistan. The military general practitioner is a pivotal point of this procedure built to detect PTSD, anxiety, depressive reaction and behavioral problems. The French health service has developed a genuine care strategy aimed at identifying patients, accompanying them in the formalities for recognition and compensation, and offering them treatment locally by arranging clinical psychology consultations near their home.
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Créach MA, Velut G, de Laval F, Briolant S, Aigle L, Marimoutou C, Deparis X, Meynard JB, Pradines B, Simon F, Michel R, Mayet A. Factors associated with malaria chemoprophylaxis compliance among French service members deployed in Central African Republic. Malar J 2016; 15:174. [PMID: 26987358 PMCID: PMC4797250 DOI: 10.1186/s12936-016-1219-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a public health concern in the French armed forces, with 400-800 cases reported every year and three deaths in the past 2 years. However, lack of chemoprophylaxis (CP) compliance is often reported among service members. The aim of this study was to explore factors associated with CP compliance. METHODS A retrospective study (1296 service members) was carried out among troops deployed in Central African Republic. Determinants of CP were collected by self-questionnaire. Socio-demographic variables, behavioural characteristics, belief variables, operational determinants such as troops in contact (TIC) and number of nights worked per week and peer-to-peer reinforcement were studied. Relationships between covariates and compliance were explored using logistic regressions (outcome: compliance as a dummy variable). RESULTS Chemoprophylaxis compliance was associated with other individual preventive measures against mosquito bites (bed net use, OR (odds ratio) = 1.41 (95% CI [1.08-1.84]), and insecticide on clothing, OR = 1.90 ([1.43-2.51]) and malaria-related behaviours (taking chemoprophylaxis at the same time every day, OR = 2.37 ([1.17-4.78]) and taking chemoprophylaxis with food, OR = 1.45 ([1.11-1.89])). High perceived risk of contracting malaria, OR = 1.59 ([1.02-2.50]), positive perception of CP effectiveness, OR = 1.62 ([1.09-2.40]) and the practice of peer-to-peer reinforcement, OR = 1.38 ([1.05-1.82]) were also associated with better compliance. No association was found with TIC and number of nights worked. CONCLUSIONS This study, which shows a positive relationship between peer-to-peer reinforcement and CP compliance, also suggests the existence of two main personality profiles among service members: those who seek risks and those who are health-conscious. Health education should be expanded beyond knowledge, know-how and motivational factors by using a comprehensive approach based on identification of health determinants, development of psychosocial skills and peer-to-peer reinforcement.
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Affiliation(s)
- Marie-Aude Créach
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.
| | - Guillaume Velut
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France
| | - Franck de Laval
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
| | - Sébastien Briolant
- Inter-Army Health Service Directorate, Cayenne, French Guiana, France.,Parasitology Laboratory, Institut Pasteur of French Guiana, Cayenne, French Guiana, France.,Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - Luc Aigle
- Operation Sangaris, Bangui, Central African Republic
| | - Catherine Marimoutou
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
| | - Xavier Deparis
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Jean-Baptiste Meynard
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Bruno Pradines
- Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.,Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.,National Reference Centre for Malaria, Marseille, France
| | - Fabrice Simon
- Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.,Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Rémy Michel
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France
| | - Aurélie Mayet
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
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Mayet A, Lions C, Roux P, Mora M, Maradan G, Morel A, Michel L, Marimoutou C, Carrieri MP. Variations in Cannabis Use Level and Correlates in Opiate-Users on Methadone Maintenance Treatment: A French Prospective Study. J Subst Abuse Treat 2015; 58:100-5. [DOI: 10.1016/j.jsat.2015.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/29/2015] [Accepted: 06/26/2015] [Indexed: 11/15/2022]
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Duron S, Lions C, Mayet A, Michel L, Maradan G, Roux P, Morel A, Carrieri PM, Marimoutou C. Risky sexual behaviours among opioid dependent patients undergoing methadone treatment. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marimoutou C, Mayet A, Lions C, Roux P, Mora M, Maradan G, Morel A, Michel L, Carrieri MP. Cannabis is not used as craving self-medication during methadone maintenance treatment. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Marimoutou C, Ferraro J, Javelle E, Deparis X, Simon F. Chikungunya infection: self-reported rheumatic morbidity and impaired quality of life persist 6 years later. Clin Microbiol Infect 2015; 21:688-93. [PMID: 25752222 DOI: 10.1016/j.cmi.2015.02.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/18/2015] [Accepted: 02/24/2015] [Indexed: 11/17/2022]
Abstract
This study presents the 6-year follow-up of French gendarmes exposed to the chikungunya (CHIK) infection in 2006 on Reunion Island. The aim was to see to what extent the subjective health differences observed in 2008 (30 months after infection) between CHIK infected (CHIK+) and noninfected (CHIK-) gendarmes still persisted in 2012, and to investigate a possible return to a pre-CHIK health status for CHIK+ subjects. Gendarmes were contacted by mail in 2012 and asked to complete a self-questionnaire asking for morbidity, health care and medicines consumption since the last follow-up in 2008. Quality of life (QoL) after 6 years was evaluated using the SF-36 scale. In comparison with CHIK- subjects (n = 171), CHIK+ (n = 81) presented with higher rheumatic but also nonspecific morbidity such as headaches and fatigue associated with a large psychological impact, frequent depressive moods and social disabilities, leading to a significant impairment of the QoL and higher health care consumption. When restricted to CHIK+ subjects, comparing the data with that of 2008 showed persistent but decreasing self-reported rheumatic morbidity, and an increase over time of chronic discomfort (headache, fatigue) and depressive moods, resulting in no overall improvement in QoL. Despite possible cohort attrition bias, the comparability of CHIK+/CHIK- subjects allows the assumption of a long-term impact of CHIK infection with less chance of returning to a previous health status. Although these results may be specific to the 2006 virus strain, we recommend that public health strategies in the epidemic-prone countries include a response to the consequences of chronic post-CHIK disorders.
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Affiliation(s)
- C Marimoutou
- Centre d'Epidémiologie et Santé Publique des Armées (CESPA), Marseille, UMR 912-SESSTIM, Aix-Marseille University, Marseille, France.
| | - J Ferraro
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - E Javelle
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - X Deparis
- Centre d'Epidémiologie et Santé Publique des Armées (CESPA), Marseille, UMR 912-SESSTIM, Aix-Marseille University, Marseille, France
| | - F Simon
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
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Attaiaa LA, Sicard S, Beck F, Marimoutou C, Mayet A. Is the order of substance initiation predictive of further substance use and misuse? A French population-based study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moroge S, Paul F, Milan C, Gignoux-Froment F, Henry JM, Pilard M, Marimoutou C. [Suicidal ideas in psychiatric emergency departments: prospective study comparing self- and hetero-assessment]. Encephale 2014; 40:359-65. [PMID: 25194753 DOI: 10.1016/j.encep.2014.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/14/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Many suicide victims had contacts with an emergency department before their attempt. We aimed to determine whether patients coming to a psychiatric emergency department were well assessed concerning their suicidal risk, and to test an easy to fill in scale rapidly assessing suicidal risk. METHOD We conducted a descriptive epidemiological survey in Marseille. The source population was all patients admitted to the psychiatric emergency department. We used a booklet containing three questionnaires for "nurse", "psychiatrist" and "patient". We estimated the suicidal risk using both a visual analogue scale (similar for patients and caregivers), and validated scales on self-assessment (scale of suicidality SBQ-R and the Beck Hopelessness Scale). RESULTS AND DISCUSSION The questionnaire results have shown that people who visited a psychiatric emergency department presented a significant suicidal risk on several criteria: socio-demographic criteria (social isolation, low level of education, low number of people with a job), psychiatric history (rate of pre-existing psychiatric disorders significantly higher than in the general population, high proportions of family and personal history of suicide attempts, psychiatric hospitalizations, and people with a psychiatrist). Six percent of patients claimed to have come to an emergency unit for suicidal ideas but they were ten times more with a suicidal risk, according to the SBQ-R score. The suicidal risk self-assessed by patients on our visual analogue scale was well correlated with SBQ-R scale and Beck Hopelessness scale, but was not well correlated with the evaluation of caregivers. CONCLUSION Hence, the analog scale we created is easy to use and seems to be a good tool for suicidal risk estimation when it is self-assessed by patients in our study population.
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Affiliation(s)
- S Moroge
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France.
| | - F Paul
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - C Milan
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - F Gignoux-Froment
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - J-M Henry
- Service des urgences du pôle psychiatrique centre, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - M Pilard
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - C Marimoutou
- Centre d'épidémiologie et santé publique des armées (CESPA), GSBdD Marseille-Aubagne, BP 40026, 13568 Marseille cedex 02, France
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Marimoutou C, Milan C, Gobet A, Paul F, Pilard M. Impact psychosocial du rapatriement sanitaire pour raison médicale chez les militaires français en mission en Afghanistan. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.05.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Yaseen HM, Simon F, Deparis X, Marimoutou C. Identification of initial severity determinants to predict arthritis after chikungunya infection in a cohort of French gendarmes. BMC Musculoskelet Disord 2014; 15:249. [PMID: 25059583 PMCID: PMC4121301 DOI: 10.1186/1471-2474-15-249] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/06/2014] [Indexed: 11/27/2022] Open
Abstract
Background The objective was to identify severity characteristics of initial chikungunya infection (CHIKV) stages associated with post-CHIKV arthritis and arthralgia. Methods French gendarmes exposed to the 2005–2006 CHIKV epidemic in Reunion Island who completed the 2006 (self-reporting acute and early chronic [median: 6 months] symptoms) and 2008 (Endpoint [median: 30 months]: self-perceived recovery and rheumatic disorders (RDs)) surveys were included. Multinomial logistic regression and multiple correspondence analysis (MCA) were used. Arthralgia was defined by joint pain and/or stiffness and arthritis by joint swelling in addition to pain and/or stiffness. Results In 2008, 124 (31.3%)/403 participants (101 CHIKV+/302 CHIKV-) reported arthralgia and 57 (14.1%) arthritis. The multivariate model kept CHIKV infection, comorbidity and acute stage depressed mood as independent prognostic factors for both arthralgia and arthritis, but found early chronic stage RD as the main determinant of the same RD two years later. The MCA performed with the 85 CHIKV + patients who answered the question on self-perceived recovery enabled the calculation of severity scores based on initial symptoms that were strongly associated with persistent arthritis and, to a lesser extent, to arthralgia in bivariate analyses. The MCA graph clearly distinguished arthritis as the only RD associated with early severity indicators represented by sick leave, joint swelling and depressed mood during the acute stage, and early chronification of arthritis and depressed mood. Conclusion Initial CHIKV severity predicted recovery, with higher severity associated with arthritis and lower severity with arthralgia. More interestingly, specific markers of post-CHIKV arthritis, which can easily be used by clinicians for case management, were identified.
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Affiliation(s)
| | | | | | - Catherine Marimoutou
- Centre d'Epidémiologie et Santé Publique des Armées (CESPA), BP 40026, Marseille 13568 cedex 02, France.
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Barazzutti H, Miltgen J, Bonnichon A, Massoure PL, Marimoutou C, Simon F. I-05: Un nouveau facteur de risque de mortalité pour les pneumonies aiguës communautaires hospitalisées : la pathologie rythmique cardiaque. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Javelle E, Ribera A, Degasne I, Marimoutou C, Simon F. Clinical spectrum of post-chikungunya rheumatic musculoskeletal disorders and use of disease-modifying antirheumatic drugs to treat the chronic inflammatory entities: 6-year experience from Reunion Island. BMC Infect Dis 2014. [PMCID: PMC4220867 DOI: 10.1186/1471-2334-14-s2-o20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Simon F, Ferraro J, Javelle E, Marimoutou C. Chikungunya infection: six years after, rheumatic morbidity and impaired quality of life persist! BMC Infect Dis 2014. [PMCID: PMC4220868 DOI: 10.1186/1471-2334-14-s2-o21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tello G, Jouvion A, Boulard JF, Marimoutou C, Cazenave N, Théfenne L. Addiction au sport et blessures au Centre national d’entraînement commando. Sci Sports 2012. [DOI: 10.1016/j.scispo.2011.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mayet A, Esvan M, Marimoutou C, Haus-Cheymol R, Verret C, Ollivier L, Meynard JB, Michel R, Boutin JP, Deparis X, Migliani R. The accuracy of self-reported data concerning recent cannabis use in the French armed forces. Eur J Public Health 2012; 23:328-32. [PMID: 23132878 DOI: 10.1093/eurpub/cks108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aims were to evaluate the accuracy of self-report of past-month cannabis use in a representative sample of French military staff members and to evaluate the scale of the prevarication bias. METHOD Data from three cross-sectional surveys conducted between 2005 and 2008 (n = 3493) were used. The characteristics of self-report (sensitivity, specificity, positive predictive value and negative predictive value) were computed using tetrahydrocannabinol detection in urine as the reference. RESULTS The prevalence for past-month cannabis use was 16.1% and for positive testing was 13.4%. The discriminant power of self-report was good, with an area under the receiver operating characteristics curve 0.90. Specificity (94.5%) and negative predictive values (97.8%) were good, but sensitivity (85.7%) and positive predictive values (70.4%) were lower. The lowest sensitivity values were observed in the higher categories of personnel and in the Navy, which could reflect some prevarication in these sub-populations who might believe they were more exposed to sanctions if detected. CONCLUSIONS Despite certain limitations of urine analysis as a reference, because of its poor detection of occasional users, our study is in favour of good accuracy of self-reported data on cannabis use, even among the military. However, our results, derived from a population study, do not enable any assumptions on the validity of self-reported data collected during individual testing procedures for the purpose of improving occupational safety.
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Affiliation(s)
- Aurélie Mayet
- Centre d'Épidémiologie et de Santé Publique des Armées, Ministére de la Défense / Service de Santé des Armées, Saint Mandé, France
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Marimoutou C, Vivier E, Oliver M, Boutin JP, Simon F. Morbidity and impaired quality of life 30 months after chikungunya infection: comparative cohort of infected and uninfected French military policemen in Reunion Island. Medicine (Baltimore) 2012; 91:212-219. [PMID: 22732952 DOI: 10.1097/md.0b013e318260b604] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We compared the morbidity and quality of life of military policemen ("gendarmes") infected with chikungunya virus (CHIKV+) 30 months after contamination. We categorized the subjects in 3 groups: healed patients (n = 48), non-healed patients (n = 37, 44% of CHIKV+), and uninfected subjects (CHIKV-, n = 297). Data were self-recorded in this retrospective cohort study; they included sociodemographic information, clinical symptoms, and the Medical Outcome Study 36-item short-form health survey (MOS-SF36) quality of life questionnaire. The study population was mostly men (92%), with a median age of 42.8 years, regardless of CHIKV status. The main complaints were rheumatic symptoms (pain, stiffness, and swelling), reported 5 times more often by non-healed CHIKV+ subjects and 2-3 times more often by healed CHIKV+ subjects than by CHIKV- subjects, and fatigue. The CHIKV+ patients reported more use of health care services. Thirty months after infection, all rheumatic symptoms were more frequent and intense among CHIKV+ than among CHIKV- subjects, with a gradient of severity between healed and non-healed CHIKV+ subjects. Non-healed CHIKV+ subjects reported subsequent limitation in their activities. All dimensions of MOS-SF36 as well as physical and mental component summaries were impaired in CHIKV+ compared to CHIKV- subjects, with a decreasing gradient of impairment from non-healed to healed CHIKV+ subjects, then to CHIKV- subjects. These observations confirm the long-term impact of CHIKV infection on both physical and mental health. Questions persist regarding the duration of this impairment and the possibility of a return to "before CHIKV" health status for infected patients.
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Affiliation(s)
- Catherine Marimoutou
- From the Clinical Research Unit (CM), Department of Infectious Diseases and Tropical Medicine (EV, FS), and Department of Medical Biochemistry (MO), Laveran Military Teaching Hospital, Marseille; Center for Epidemiology and Public Health for the French Army (CM, J-PB), Marseille; and URMITE, Université de la Méditerranée (FS), Marseille, France
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Abstract
Chikungunya virus (CHIKV) is an alphavirus transmitted by mosquitoes, mostly Aedes aegypti and Aedes albopictus. After half a century of focal outbreaks of acute febrile polyarthralgia in Africa and Asia, the disease unexpectedly spread in the past decade with large outbreaks in Africa and around the Indian Ocean and rare autochthonous transmission in temperate areas. This emergence brought new insights on its pathogenesis, notably the role of the A226V mutation that improved CHIKV fitness in Ae. albopictus and the possible CHIKV persistence in deep tissue sanctuaries for months after infection. Massive outbreaks also revealed new aspects of the acute stage: the high number of symptomatic cases, unexpected complications, mother-to-child transmission, and low lethality in debilitated patients. The follow-up of patients in epidemic areas has identified frequent, long-lasting, rheumatic disorders, including rare inflammatory joint destruction, and common chronic mood changes associated with quality-of-life impairment. Thus, the globalization of CHIKV exposes countries with Aedes mosquitoes both to brutal outbreaks of acute incapacitating episodes and endemic long-lasting disorders.
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Affiliation(s)
- Fabrice Simon
- Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France,
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Rigod V, Pilard M, Paul F, Deparis X, Marimoutou C. Alcohol and Cannabis Consumption in the French Army: Determination of Consumer Profiles to Focus on Prevention and Care. Mil Med 2011; 176:805-10. [DOI: 10.7205/milmed-d-10-00336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Marimoutou C, Pommier de Santi V, Attrait X, Ollivier L, Michel R, Boutin JP. Self-reporting compared to prospective surveillance to evaluate the incidence of diarrhea among French Army personnel deployed to N'djamena, Chad. J Travel Med 2011; 18:217-20. [PMID: 21539667 DOI: 10.1111/j.1708-8305.2011.00510.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-reporting seems more appropriate than medical-based surveillance to estimate true incidence of diarrhea during deployment of military troops. Most soldiers self-reported multiple episodes, 42% leading to medical care, mainly the first episode, resulting in a threefold higher incidence. Mathematical models integrating self-reported data should better predict outbreaks during military deployments and define a more complete assessment of disease burden.
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Affiliation(s)
- Catherine Marimoutou
- Département d'Épidémiologie et de Santé Publique Sud, Institut de Médecine Tropical du Service de Santé des Armées, Institut de Recherche Biomédicale des Armées, Marseille, France.
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Paul F, Pommier de Santi V, Roi JF, Berry X, Rabatel E, Marimoutou C. États de stress post-traumatique chez les militaires : quel questionnaire pour un dépistage au retour d’Afghanistan ? Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Pommier de Santi V, Nicand E, Lagathu G, Michel R, Rosenmayr G, Raingeval JB, Samy J, Boutin JP, Marimoutou C. Incidence, etiology, and determinants associated with acute diarrhea among French forces deployed to Chad. J Travel Med 2011; 18:115-20. [PMID: 21366795 DOI: 10.1111/j.1708-8305.2010.00490.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study assesses, for the first time, the incidence, etiology, and determinants associated with traveler's diarrhea (TD) among French forces deployed to N'Djamena, Chad. METHODS A prospective study was conducted based on physician consultation for diarrhea during a 5-month French forces mandate. Diarrhea was defined as ≥3 loose stools in a 24-hour period or ≥2 loose stools within the last 8 hours. For each diarrheic episode, an anonymous physician-administered questionnaire was completed and a stool sample collected. Samples were tested for parasites, bacteria, and enteric viruses. Global incidence rate was calculated using the mean number of soldiers based in N'Djamena (n = 1,024) over the 5-month period, as denominator. Incidence rates were also estimated for each of the eleven 2-week periods of stay. A case-crossover analysis estimated determinants associated with diarrhea. RESULTS A total of 240 cases of diarrhea were notified by military physicians, resulting in a global incidence rate of 49 cases per 1,000 person-months (PM). The cumulative individual risk of developing diarrhea during the study period was 0.23. The incidence per 2-week stay began at 8.8/1,000 PM, rose to 54.4/1,000 PM after 1 month, and decreased after 2 months. Of the 240 cases reported, stool samples were obtained for 196 cases. Pathogens were identified in 40% of samples; enteric viruses were predominant (28.1%). Three determinants were associated with diarrhea by multivariate analysis: diarrhea in the close circle [OR: 3.8 (2.0-7.0)]; always eating at the military mess [OR: 0.2 (0.1-0.5)]; or staying in a temporary encampment [OR: 0.3 (0.1-0.8)]. CONCLUSIONS This study found a high frequency of enteric viruses and a high risk of person-to-person transmission associated with diarrhea. Eating at the military mess or staying in a temporary encampment conferred a protective effect. In addition to food-borne disease prevention, stringent hygiene measures are required to break transmission of diarrhea during military deployments.
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Affiliation(s)
- Vincent Pommier de Santi
- Département d'Épidémiologie et de Santé Publique Sud, Institut de Recherche Biomédicale des Armées, Marseille, France.
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Marimoutou C, Queyriaux B, Michel R, Verret C, Haus-Cheymol R, Mayet A, Deparis X, Boutin JP. Survey of alcohol, tobacco, and cannabis use in the French army. J Addict Dis 2010; 29:98-106. [PMID: 20390703 DOI: 10.1080/10550880903436028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the current study is to describe the consumption rate of alcohol, tobacco, and cannabis in the French Army. A cross-sectional two strata randomized survey was performed between October 2006 and March 2007 using self-report questionnaires (n = 990) to collect individual characteristics, consumption, and addictive behaviors with urinal tests for cannabis (n = 985). The surveyed sample comprised 59% privates, 26% non-commissioned officers, and 6% officers, was predominantly male (89%) and young (median age: 29 years), and had a low level of education (60% attended secondary school). The consumption rate was high: 54.1% were active tobacco smokers, 56.0% were heavy drinkers, 20.5% declared drunkenness more than once per month, 52.6% at least experienced cannabis while 12.3% were occasional users, 8.2% were regular users, and 15.0% displayed multi-risk behaviors. Consumption was higher in the younger age (18 to 25 years) and lower educational group, leading to a high prevalence among privates and suggesting an "army effect." However, large scale behavioral social studies may help distinguish between personal and peer effect among the targeted population.
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Dray-Spira R, Lert F, Marimoutou C, Bouhnik AD, Obadia Y. Socio-economic conditions, health status and employment among persons living with HIV/AIDS in France in 2001. AIDS Care 2010; 15:739-48. [PMID: 14617496 DOI: 10.1080/09540120310001618595] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To investigate employment levels and identify barriers to work among persons living with HIV/AIDS in France in 2001, we conducted a cross-sectional study among HIV-infected patients seen in the hospital outpatient clinics of the two French regions most affected: Ile-de-France (IDF) and Provence-Alpes-Côte-d'Azur (PACA). Of the 840 outpatients included in the study, 58.8% in IDF and 46.8% in PACA were currently employed, and 28.1 and 47.8%, respectively, were receiving disability benefits. Among unemployed patients, 32.1% in IDF and 29.6% in PACA reported that they planned to (re)enter the workforce. Current and planned employment status were associated with characteristics indicative of the patients' social and demographic situation before the HIV diagnosis (region of residence, educational level, HIV transmission group, age, nationality) and with their health status at the interview (HIV progression, HCV co-infection). Receiving disability benefits was negatively associated with plans to return to work. HIV-related discrimination at work was reported by 11.9% of the patients in IDF and 9.2% in PACA, and was not associated with occupational status. Thus, social interventions should seek to prevent patients, particularly the most socially vulnerable, from leaving their jobs at acute stages of their illness and should promote (re)entry into the workforce among unemployed patients.
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Affiliation(s)
- R Dray-Spira
- Unité INSERM U88-IFR69, Hôpital National de Saint-Maurice, Saint-Maurice, France.
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Zagari A, Oliver M, Marimoutou C, Pommier de Santi V, Lightburne E, Savourey G, Buziaux L, Morand JJ. Gelures en milieu militaire : étude en fonction du phototype. Ann Dermatol Venereol 2009; 136:909-11. [DOI: 10.1016/j.annder.2009.10.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 09/18/2009] [Indexed: 11/17/2022]
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Le Bougeant P, Ramaniraka J, Marimoutou C, Molinier S. Valeur pronostique de 6 marqueurs nutritionnels chez les patients de plus de 70 ans hospitalisés en court séjour. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ollivier L, Romand O, Marimoutou C, Michel R, Pognant C, Todesco A, Migliani R, Baudon D, Boutin JP. Use of short message service (SMS) to improve malaria chemoprophylaxis compliance after returning from a malaria endemic area. Malar J 2009; 8:236. [PMID: 19852811 PMCID: PMC2771031 DOI: 10.1186/1475-2875-8-236] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 10/23/2009] [Indexed: 11/30/2022] Open
Abstract
Background Malaria chemoprophylaxis compliance is suboptimal among French soldiers despite the availability of free malaria chemoprophylaxis and repeated health education before, during and after deployment to malaria endemic areas. Methods In 2007, a randomized controlled study was performed among a cohort of French soldiers returning from Côte d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Malaria chemoprophylaxis consisted of a daily dose of 100 mg doxycycline monohydrate, which began upon arrival in Côte d'Ivoire and was to be continued for 28 days following return to France. Feasibility and acceptability were assessed by questionnaire. Cohort members were followed for a 28 day period, with compliance assessed by use of an electronic medication monitoring device, from which several indicators were developed: daily proportion of compliant individuals, average number of pills taken, and early discontinuation. Results Among 424 volunteers randomized to the study, 47.6% were assigned to the SMS group and 52.3% to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators. Conclusion SMS did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. So the reminder by SMS was noted by all subjects of the study. Another study should be done to confirm these results on soldiers going on holidays from employment after return or with individual travellers.
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Affiliation(s)
- Lénaïck Ollivier
- Institut de médecine tropicale du Service de santé des armées, Département d'épidémiologie et de santé publique Sud, Marseille, France.
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Rigod V, Pilard M, Perez S, Deparis X, Marimoutou C. Caractéristiques socioprofessionnelles des consommateurs d’alcool, de tabac et de cannabis dans l’Armée de Terre. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sum L, Papillault des Charbonneries L, Marimoutou C. Différence de recours aux soins entre les hommes et les femmes appartenant à un régiment de l’Armée de Terre. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Drogoul-Vey MP, Marimoutou C, Robaglia-Schlupp A, Beerli M, Gastaut JA, Cau P, Poizot-Martin I. Determinants and evolution of squamous intraepithelial lesions in HIV-infected women, 1991–2004. AIDS Care 2007; 19:1052-7. [PMID: 17852004 DOI: 10.1080/09540120701295242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study presents a case-control nested analysis of cervical squamous intraepithelial lesions (SIL) in a cohort of 423 HIV-infected women with registered Pap smears between 1991 and 2004. Data on Pap smear results, CDC HIV classification, CD4 cell count and antiretroviral therapy were prospectively collected. Pap smears were classified using the Bethesda classification. Women had a median of three Pap smears registered in the database. The first Pap smear was registered <or=1996 for 57.7%. Two hundred and twenty women were diagnosed with SIL at least once, mainly at their first screening. Compared to women free of SIL and cancer at all Pap smear, they were younger, had lower CD4 cell count and were more likely included <or=1996 and less likely treated with HAART. These differences persisted in multivariate analysis. Among the 142 women with secondary Pap smears after SIL diagnosis, 43 (30.3%) worsen their Pap smear results. No specific characteristics could be identified for these patients compared to those who did not. Finally 21 women were diagnosed with cervix cancer, three at first Pap smear and the others after a previous SIL diagnosis in a median delay of three years. These results reflect the change in gynaecologic management of HIV-infected women after HAART introduction but also underline the necessity to maintain a regular gynaecologic screening for HIV-infected women.
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Poizot-Martin I, Marimoutou C, Drogoul-Vey MP, Vion-Dury F, Frixon-Marin V, Benhaim S, Poggi P, Gastaut JA. Nelfinavir in HIV-HCV coinfected patients: a 24-month follow-up in a cohort of 82 patients. AIDS Res Hum Retroviruses 2005; 21:841-4. [PMID: 16225410 DOI: 10.1089/aid.2005.21.841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This retrospective and longitudinal study evaluated the long-term hepatic tolerance of a nelfinavir (NFV)-antiretroviral combined regimen in 82 patients of the HCV-HIV Cohort of CISIH-Sud of Marseilles. Follow-up data (liver enzyme levels, CD4 cell count, HIV viral load, and metabolic parameters) of patients treated with NFV on inclusion or during the follow-up of the cohort were analyzed under treatment over 24 months. Comparisons were performed with X2 or Kruskal-Wallis tests. At baseline (n = 82), the median exposure to NFV was 4.1 months; 58 patients received NFV combined with NRTI and 24 with NNRTI. The median CD4 cell count was 337/mm3 [interquartile range (IR): 216-480) and 39.7% had an undetectable HIV RNA level. Qualitative HCV PCR was positive in 91% of the patients and 19/51 patients with liver biopsy were F3-F4. Median alanine and aspartate aminotransferase (ALAT, ASAT), gamma-glutamyltransferase (GT), and alkaline phosphatase (ALP) were 46 UI/liter (IR: 36-76), 55 UI/liter (IR: 32-97), 97 UI/liter (IR: 50-194), and 88 UI/liter (IR: 72-104), respectively, with 76% of the patients with ALAT/ASAT grade <2. Median follow-up was 23 months (IR: 13.8-37). No significant difference was observed in the distribution of ALAT, ASAT, GT, and ALP as well as of ALAT/ASAT grades over the 24-month study period. Patients treated with NFV + NNRTI had significantly higher GT and ALP levels at baseline with no significant increase during follow-up. Cholesterol, triglyceride, and glycemia distributions remained stable over time. In conclusion, this study showed a good hepatic and metabolic tolerance of a long-term NFV-combined regimen in HIV-HCV coinfected patients.
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Affiliation(s)
- I Poizot-Martin
- CISIH-SUD, Clinical Research Department, Hôpital Sainte-Marguerite CHU, Marseille, France., INSERM U379, Marseille, France.
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