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  • @fil
    Fil @fil 1/06/2017
    4
    @cocoadaemon
    @lyco
    @unagi
    @sinehebdo
    4

    A 1980 Letter on the Risk of Opioid Addiction — NEJM
    ▻http://www.nejm.org/doi/full/10.1056/NEJMc1700150

    http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2017/nejm_2017.376.issue-22/nejmc1700150/20170531/images/medium/nejmc1700150_f1.gif

    We identified 608 citations of the index publication and noted a sizable increase after the introduction of OxyContin (a long-acting formulation of oxycodone) in 1995 (Figure 1FIGURE 1
    Number and Type of Citations of the 1980 Letter, According to Year.). Of the articles that included a reference to the 1980 letter, the authors of 439 (72.2%) cited it as evidence that addiction was rare in patients treated with opioids. Of the 608 articles, the authors of 491 articles (80.8%) did not note that the patients who were described in the letter were hospitalized at the time they received the prescription, whereas some authors grossly misrepresented the conclusions of the letter

    On a donc les noms de 608 auteurs (et plus) qui ont participé par la #désinformation médicale à la prolifération des #opiacés qui aboutit à la #crise_sanitaire actuelle.

    #recherche #bibliométrie #médecine #drogues #États-Unis #pharma

    • #OxyContin
    Fil @fil
    • @cocoadaemon
      alban @cocoadaemon 1/06/2017

      In conclusion, we found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy. In 2007, the manufacturer of OxyContin and three senior executives pleaded guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with the drug.5 Our findings highlight the potential consequences of inaccurate citation and underscore the need for diligence when citing previously published studies.

      alban @cocoadaemon
    • @sinehebdo
      Dror@sinehebdo @sinehebdo 1/06/2017

      voir aussi #Fentanyl la drogue qui a tué #Prince et plein d’anonymes...

      Dror@sinehebdo @sinehebdo
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  • @kassem
    Kassem @kassem CC BY-NC-SA 21/03/2017

    Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease
    ▻http://www.nejm.org/doi/full/10.1056/NEJMoa1615664#t=article

    Pratiquement toujours en prévention secondaire et presque toujours associé à une #statine,

    ▻http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/0/nejm.ahead-of-print/nejmoa1615664/20170317/images/large/nejmoa1615664_t2.jpeg

    Il ressort que la réduction du risque cardio-vasculaire est loin d’être à la hauteur de la réduction du taux de LDL et ... du prix de ce médicament (14.000 USD/an)

    Kassem @kassem CC BY-NC-SA
    • @kassem
      Kassem @kassem CC BY-NC-SA 21/03/2017

      An End to Heart Disease? Not Quite
      ▻https://www.nytimes.com/2017/03/20/health/ldl-cholesterol-heart-disease-drugs-pcsk9-inhibitors.html

      On Friday, investigators reported the results of a highly anticipated trial of a PCSK9 inhibitor called evolocumab (brand name Repatha). This medication reduced LDL levels to an almost unfathomable 30 mg/dl from about 90 mg/dl on average, which is typically considered low.

      Over about two years of study, the researchers found that the new drug, when added to statin therapy, further reduced the risk of heart attack or stroke by about 15 percent. For about every 70 people treated with the drug, one person benefited in this way. This is not far off the size of the benefit that statins provide.

      So the drug works, which is good news for patients. And no safety concerns emerged. But the applause from heart experts has been muted, because expectations were so much higher. Their hope had been that drastically low LDL cholesterol levels would make it difficult — or even impossible — to have a heart attack.

      Kassem @kassem CC BY-NC-SA
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  • @kassem
    Kassem @kassem CC BY-NC-SA 5/03/2017
    1
    @fil
    1

    Conflicts of Interest for Patient-Advocacy Organizations
    ▻http://www.nejm.org/doi/full/10.1056/NEJMsr1610625

    #Conflits_d'intérêts préoccupants chez la très grande majorité des groupes de défense des patients
    ▻http://www.psychomedia.qc.ca/sante/2017-03-02/groupes-de-defense-des-patients-conflits-d-interets

    Plus de 80 % des groupes de défense des patients acceptent des financements des compagnies pharmaceutiques et des fabricants de dispositifs médicaux, selon une étude publiée dans le New England Journal of Medicine, relayée par le New York Times.

    Pour certains groupes, les dons de l’industrie représentent plus de la moitié de leurs revenus annuels. Dans près de 40 % des cas, des représentants de l’industrie siègent au conseil d’administration.

    #corruption #porte_tournante #pharma

    Kassem @kassem CC BY-NC-SA
    • @fil
      Fil @fil 5/03/2017

      pas de ça chez ►http://cancerunion.org

      Fil @fil
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  • @simplicissimus
    Simplicissimus @simplicissimus 28/11/2016
    1
    @colporteur
    1

    Publication du rapport du CSST relatif à l’examen des données cliniques et d’imagerie cérébrale des volontaires sains inclus dans l’essai clinique mené à Rennes - ANSM : Agence nationale de sécurité du médicament et des produits de santé
    ▻http://ansm.sante.fr/S-informer/Actualite/Publication-du-rapport-du-CSST-relatif-a-l-examen-des-donnees-cliniques-e

    Dans le cadre du plan d’action relatif aux essais cliniques annoncé par la Ministre des Affaires sociales et de la santé le 23 mai 2016, un second comité d’experts a été mis en place afin d’examiner les données cliniques et d’imagerie cérébrale des volontaires sains exposés au BIA 10-2474 au cours d’un essai clinique conduit à Rennes. Composé de médecins qui ont travaillé de façon indépendante, ce comité s’est réuni le 21 septembre 2016 et l’ANSM publie aujourd’hui [25/11/2016] leur rapport.

    ▻http://ansm.sante.fr/content/download/98713/1253339/version/2/file/Rapport_CSST_BIAL_Examen-Donnees-Cliniques-Imagerie-Cerebrale_25-11-2016.

    Simplicissimus @simplicissimus
    • @simplicissimus
      Simplicissimus @simplicissimus 28/11/2016

      Les cas publiés dans le NEJM (article derrière paywall)

      Acute Neurologic Disorder from an Inhibitor of Fatty Acid Amide Hydrolase — NEJM
      ►http://www.nejm.org/doi/full/10.1056/NEJMoa1604221

      BACKGROUND
      A decrease in fatty acid amide hydrolase (FAAH) activity increases the levels of endogenous analogues of cannabinoids, or endocannabinoids. FAAH inhibitors have shown analgesic and antiinflammatory activity in animal models, and some have been tested in phase 1 and 2 studies. In a phase 1 study, BIA 10-2474, an orally administered reversible FAAH inhibitor, was given to healthy volunteers to assess safety.

      METHODS
      Single doses (0.25 to 100 mg) and repeated oral doses (2.5 to 20 mg for 10 days) of BIA 10-2474 had been administered to 84 healthy volunteers in sequential cohorts; no severe adverse events had been reported. Another cohort of participants was then assigned to placebo (2 participants) or 50 mg of BIA 10-2474 per day (6 participants). This report focuses on neurologic adverse events in participants in this final cohort. A total of 4 of the 6 participants who received active treatment consented to have their clinical and radiologic data included in this report.

      RESULTS
      An acute and rapidly progressive neurologic syndrome developed in three of the four participants starting on the fifth day of drug administration. The main clinical features were headache, a cerebellar syndrome, memory impairment, and altered consciousness. Magnetic resonance imaging showed bilateral and symmetric cerebral lesions, including microhemorrhages and hyperintensities on fluid-attenuated inversion recovery and diffusion-weighted imaging sequences predominantly involving the pons and hippocampi. One patient became brain dead; the condition of two patients subsequently improved, but one patient had residual memory impairment, and the other patient had a residual cerebellar syndrome. One patient remained asymptomatic.

      CONCLUSIONS
      An unanticipated severe neurologic disorder occurred after ingestion of BIA 10-2474 at the highest dose level used in a phase 1 trial. The underlying mechanism of this toxic cerebral syndrome remains unknown.

      EDIT : je l’avais déjà pointé à la date de sa publication…
      ▻https://seenthis.net/messages/539107

      Simplicissimus @simplicissimus
    • @simplicissimus
      Simplicissimus @simplicissimus 28/11/2016
      @mediapart

      Dans le rapport de l’ANSM, je ne vois pas la «  preuve irréfutable et involontaire  » annoncée. En revanche, la description des symptômes « classiques » chez des cobayes des essais de phase 1 fait vraiment peur. Et c’est jugé normal…
      cf. @mediapart (sous #paywall)
      ▻https://seenthis.net/messages/546310

      Simplicissimus @simplicissimus
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  • @simplicissimus
    Simplicissimus @simplicissimus 3/11/2016

    Essai clinique mortel de Rennes : la toxicité de la molécule en cause
    ▻http://www.lemonde.fr/sante/article/2016/11/03/essai-clinique-mortel-de-rennes-la-toxicite-de-la-molecule-en-cause_5024450_

    L’équipe du CHU de Rennes rend publiques les données médicales de quatre participants aux essais de #Biotrial, dont celui décédé en janvier.
    […]
    « L’analyse conjointe de l’ensemble des séquences aboutit à une signature univoque, avec les mêmes localisations bilatérales et symétriques chez les trois patients 1, 2 et 3, avec une sévérité variable. Cela n’évoque ni un processus ischémique artériel ni immunologique mais un effet toxique direct sur des cibles précises non clairement identifiées », estime le professeur Edan [chef du service de neurologie du CHU de Rennes].
    […]
    Le professeur Didier Dormont [chef du service de neuroradiologie de La Pitié Salpêtrière] estime que « l’atteinte bilatérale relativement symétrique est très évocatrice d’une toxicité de la molécule plutôt que d’un accident vasculaire cérébral. La relation de cause à effet paraît assez évidente même si le mécanisme est encore inconnu. Ce qui étonne, c’est la gravité incroyable des signes apparus avec l’administration d’une dose de 50 mg/J, par rapport à une dose de 20 mg/J. »

    Simplicissimus @simplicissimus
    • @simplicissimus
      Simplicissimus @simplicissimus 3/11/2016

      Le résumé de l’article sur NEJM (l’article est sous #paywall)

      Acute Neurologic Disorder from an Inhibitor of Fatty Acid Amide Hydrolase — NEJM
      ►http://www.nejm.org/doi/full/10.1056/NEJMoa1604221

      BACKGROUND
      A decrease in fatty acid amide hydrolase (FAAH) activity increases the levels of endogenous analogues of cannabinoids, or endocannabinoids. FAAH inhibitors have shown analgesic and antiinflammatory activity in animal models, and some have been tested in phase 1 and 2 studies. In a phase 1 study, BIA 10-2474, an orally administered reversible FAAH inhibitor, was given to healthy volunteers to assess safety.

      METHODS
      Single doses (0.25 to 100 mg) and repeated oral doses (2.5 to 20 mg for 10 days) of BIA 10-2474 had been administered to 84 healthy volunteers in sequential cohorts; no severe adverse events had been reported. Another cohort of participants was then assigned to placebo (2 participants) or 50 mg of BIA 10-2474 per day (6 participants). This report focuses on neurologic adverse events in participants in this final cohort. A total of 4 of the 6 participants who received active treatment consented to have their clinical and radiologic data included in this report.

      RESULTS
      An acute and rapidly progressive neurologic syndrome developed in three of the four participants starting on the fifth day of drug administration. The main clinical features were headache, a cerebellar syndrome, memory impairment, and altered consciousness. Magnetic resonance imaging showed bilateral and symmetric cerebral lesions, including microhemorrhages and hyperintensities on fluid-attenuated inversion recovery and diffusion-weighted imaging sequences predominantly involving the pons and hippocampi. One patient became brain dead; the condition of two patients subsequently improved, but one patient had residual memory impairment, and the other patient had a residual cerebellar syndrome. One patient remained asymptomatic.

      CONCLUSIONS
      An unanticipated severe neurologic disorder occurred after ingestion of BIA 10-2474 at the highest dose level used in a phase 1 trial. The underlying mechanism of this toxic cerebral syndrome remains unknown.

      Simplicissimus @simplicissimus
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  • @simplicissimus
    Simplicissimus @simplicissimus 18/09/2016
    5
    @mad_meg
    @gastlag
    @kassem
    @fil
    @7h36
    5

    Cancer de la prostate : le suivi fait aussi bien que la chirurgie
    ▻http://www.pourquoidocteur.fr/Articles/Question-d-actu/17558-Cancer-de-la-prostate-le-suivi-fait-aussi-bien-que-la-chirurgi

    L’ablation de la prostate n’est pas toujours justifiée lorsqu’un cancer est détecté. L’approche à adopter est régulièrement discutée. Une étude parue en deux volets dans le New England Journal of Medicine pourrait bien trancher ce débat pour de bon. Réalisée par l’université d’Oxford (Royaume-Uni), elle montre qu’entre la chirurgie, la radiothérapie et une surveillance active, aucune différence n’émerge sur la survie. Pourtant, les travaux ont été réalisés pendant une décennie, auprès de 82 429 hommes de 50 à 69 ans.

    Simplicissimus @simplicissimus
    • @simplicissimus
      Simplicissimus @simplicissimus 18/09/2016

      Les conclusions de l’étude du NEJM (acccessible en ligne)

      10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer — NEJM
      ▻http://www.nejm.org/doi/full/10.1056/NEJMoa1606220#Top

      CONCLUSIONS
      At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

      Simplicissimus @simplicissimus
    • @kassem
      Kassem @kassem CC BY-NC-SA 18/09/2016

      Au total (dernier paragraphe de l’article):

      At a median follow-up of 10 years, the ProtecT trial showed that mortality from prostate cancer was low, irrespective of treatment assignment. Prostatectomy and radiotherapy were associated with lower rates of disease progression than active monitoring; however, 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.5 Men with newly diagnosed, localized prostate cancer need to consider the critical trade-off between the short-term and long-term effects of radical treatments on urinary, bowel, and sexual function and the higher risks of disease progression with active monitoring, as well as the effects of each of these options on quality of life. Further follow-up of the ProtecT participants with longer-term survival data will be crucial to evaluate this trade-off in order to fully inform decision making for physicians and patients considering PSA testing and treatment options for clinically localized prostate cancer.

      Kassem @kassem CC BY-NC-SA
    • @kassem
      Kassem @kassem CC BY-NC-SA 18/09/2016

      Une publication antérieure de la même étude permet d’avoir une indication sur la valeur du PSA aux taux retenus comme test de détection d’un cancer, en particulier localisé (versus faux positif)
      ▻http://www.ncbi.nlm.nih.gov/pubmed/25163905?dopt=Abstract

      Of the 8566 men with a PSA concentration of 3·0-19·9 μg/L, 7414 (87%) underwent biopsies. 2896 men were diagnosed with prostate cancer (4% of tested men and 39% of those who had a biopsy), of whom 2417 (83%) had clinically localised disease (mostly T1c, Gleason score 6).

      Kassem @kassem CC BY-NC-SA
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  • @fil
    Fil @fil 30/08/2016
    3
    @reka
    @severo
    @simplicissimus
    3
    @severo

    Mapping internal connectivity through human migration in malaria endemic countries : Scientific Data
    ►http://www.nature.com/articles/sdata201666

    Estimating internal migration flows between administrative units
    Following Garcia et al. a gravity model-based approach was used to estimate the total number of people migrating from one administrative unit to any other administrative unit, between 2005 and 2010, within each malaria endemic country located in Africa, Asia, Latin America and the Caribbean

    http://www.nature.com/article-assets/npg/sdata/2016/sdata201666/images_hires/w926/sdata201666-f6.jpg http://www.nature.com/article-assets/npg/sdata/2016/sdata201666/images_hires/w926/sdata201666-f4.jpg http://www.nature.com/article-assets/npg/sdata/2016/sdata201666/images_hires/w926/sdata201666-f5.jpg

    #migrations_internes #santé #paludisme #afrique #amérique_du_sud #inde etc. #cartographie #mobilité #complexité_visuelle #recherche #visualisation
    @severo
    pour la population voir aussi du même auteur Alessandro Sorichetta ▻http://www.nature.com/articles/sdata201545

    Datasets : ▻http://www.worldpop.org.uk/data/data_sources

    Fil @fil
    • @severo
      severo @severo PUBLIC DOMAIN 30/08/2016
      @louca

      @louca toi qui cherchait des manières de représenter les flux de migrations, ça peut t’intéresser. Cela dit, sur la carte d’Amérique du Sud, c’est peu lisible je trouve. En gros toutes les capitales départementales/provinciales sont reliées par des traits rouges. Ça voudrait dire qu’il y a beaucoup de trafic entre toutes les villes, j’en doute cela dit, parce que ce sont des villes de tailles très différentes.

      severo @severo PUBLIC DOMAIN
    • @fil
      Fil @fil 30/08/2016

      oui moi aussi — la représentation me paraît améliorable, mais le modèle sous-jacent est intéressant, en tout cas c’est la première fois que je le vois

      Fil @fil
    • @simplicissimus
      Simplicissimus @simplicissimus 30/08/2016

      Effectivement, le graphe relie tous les centroïdes des unités administratives immédiatement inférieures aux pays (et non pas leurs capitales).

      Mais bien que les flux soient bien identifiés entre origine et destination, le graphe qui les représente n’est pas orienté. C’est un peu déroutant…

      Simplicissimus @simplicissimus
    • @liotier
      liotier @liotier CC BY-SA 31/08/2016

      La quasi étanchéité des frontières nationales me paraît suspecte... L’absence de flux entre le sud du Mali, le sud-ouest du Burkina et le nord de la Côte d’Ivoire est juste délirante.

      Bon, je vois que la méthode s’intitule « Estimating internal migration flows between administrative unit » et a lieu « within each malaria endemic country » ... C’est une approche qui me paraît totalement invalide - je me demande même commente elle a pu être retenue.

      liotier @liotier CC BY-SA
    • @fil
      Fil @fil 31/08/2016

      je crois que c’est une pièce du puzzle

      Fil @fil
    • @fil
      Fil @fil 13/01/2017

      une piste pour améliorer ce type de graphiques : l’algorithme #FDEB
      ▻https://github.com/upphiminn/d3.ForceBundle
      ►http://bl.ocks.org/Fil/e7c39340eba09b7315759e960ce3a3f9

      Example of d3-ForceEdgeBundling on US airline routes graph. - Example of d3-ForceEdgeBundling on US airline routes graph. - .block

      Fil @fil
    • @fil
      Fil @fil 13/01/2017

      par exemple, pour la Bolivie :
      ►http://bl.ocks.org/Fil/338173f684c195696b440993713d287a

      bolivia internal migrations - bolivia internal migrations. GitHub Gist: instantly share code, notes, and snippets.

      https://gist.githubusercontent.com/Fil/338173f684c195696b440993713d287a/raw/68a4125f0ff8e24d8cbd5facd044db558c26ec0d/thumbnail.png

      Fil @fil
    • @severo
      severo @severo PUBLIC DOMAIN 13/01/2017
      @fil @louca

      Excellent !

      à comparer avec l’exemple suivant (sans le « bundling »)

      ▻http://bl.ocks.org/Fil/2255f5e79b2fc88efacc6df0ea108142

      bolivia internal migrations - bolivia internal migrations. GitHub Gist: instantly share code, notes, and snippets.

      Je me demandais comment étaient estimées les valeurs des flux entre les villes. C’est ... compliqué :

      ▻http://www.nature.com/articles/sdata201666#methods

      @fil : tu as reproduit les calculs, en te basant sur les données suivantes ?

      ▻http://www.nature.com/articles/sdata201666#data-records

      Pour le « bundling », c’est beaucoup plus clair, mais ça fait apparaître des lignes courbes, qui ressemblent à des routes, ce qui peut induire en erreur.

      Autre truc qui m’a paru bizarre : on dirait que les points ne sont pas les villes principales, mais les centroïdes des départements (où il n’y a personne en général).

      En fait je dirais même qu’il y a trop de points ou pas assez (35 points) : il existe 9 départements et 112 provinces, et aucune autre division administrative entre les deux.

      Le fichier de données ne dit pas grand chose :

      ▻http://bl.ocks.org/Fil/raw/338173f684c195696b440993713d287a/ce64e58f8abc767da7d0201c7c98663add099399/BOL_5yrs_InternalMigFlows_2010.csv

      ISO,NODEJ,NODEI,LONFR,LATFR,LONTO,LATTO,PrdMIG
      BOL,101,103,-64.75520521,-18.96055212,-65.32139438,-18.84782587,480.9150057

      Pas d’information de ce que sont ces points (NODEJ, NODEI).

      cc @louca

      severo @severo PUBLIC DOMAIN
    • @fil
      Fil @fil 13/01/2017

      Non je n’ai pas reproduit les calculs ;-)

      J’ai récupéré le fichier de résultats, et me suis contenté dans un premier temps de reproduire le graphique. Je n’aimais pas bien le résultat, mais je ne savais pas trop comment l’améliorer. Et quand je suis tombé sur #FDEB j’y ai repensé.

      Fil @fil
    • @severo
      severo @severo PUBLIC DOMAIN 13/01/2017

      Bonne idée, le résultat est beaucoup plus agréable et compréhensible.

      severo @severo PUBLIC DOMAIN
    • @fil
      Fil @fil 17/01/2017

      Mapping Plasmodium falciparum Mortality in Africa between 1990 and 2015 — NEJM
      ▻http://www.nejm.org/doi/full/10.1056/NEJMoa1606701
      ▻http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2016/nejm_2016.375.issue-25/nejmoa1606701/20161216/images/large/nejmoa1606701_f4.jpeg

      (où l’on voit que les #frontières restent des barrières en matière de santé)

      Fil @fil
    • @simplicissimus
      Simplicissimus @simplicissimus 17/01/2017

      Les frontières administratives sont certainement des délimitations entre des niveaux différents de soins et de couverture médicale mais aussi entre les différents protocoles de collecte de l’information. De ce point de vue l’élément clé de tout l’article c’est évidemment la #cause_de_décès, or celle-ci est connue de façon essentiellement déclarative : l’#autopsie_verbale (cf. ce document de l’OMS de 2009, Normes d’autopsie verbale, établissement et attribution de la cause de décès ▻http://apps.who.int/iris/bitstream/10665/44056/1/9789442547214_fre.pdf )

      Par ailleurs, je ne comprends pas bien comment se fait le passage des nombres bruts de décès aux taux de mortalité. Il ne semble pas dépendre de la connaissance de la population au niveau des mailles géographiques mais résulter du modèle (passage par la part des décès dûs à la malaria dans le total des décès).
      ▻http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2016/nejm_2016.375.issue-25/nejmoa1606701/20161216/images/large/nejmoa1606701_f3.jpeg

      Simplicissimus @simplicissimus
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  • @af_sobocinski
    AF_Sobocinski @af_sobocinski CC BY-NC-ND 4/08/2016

    Pourquoi les enfants #amish sont-ils moins victimes d’#asthme que les autres ?
    ▻http://www.lemonde.fr/sante/article/2016/08/04/pourquoi-les-enfants-amish-sont-ils-moins-victimes-d-asthme-que-les-autres_4

    Une étude publiée jeudi 4 août par le New England Journal of Medicine suggère que la poussière trouvée dans les maisons amish aiderait à développer le système immunitaire des enfants de ces communautés vivant à l’écart de la société moderne.

    L’étude : ▻http://www.nejm.org/doi/full/10.1056/NEJMoa1508749#t=article

    AF_Sobocinski @af_sobocinski CC BY-NC-ND
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  • @simplicissimus
    Simplicissimus @simplicissimus 24/06/2016
    1
    @kassem
    1

    Avoiding Data Dumpsters — Toward Equitable and Useful Data Sharing — NEJM
    ▻http://www.nejm.org/doi/full/10.1056/NEJMp1605148

    The potential health benefits from sharing participant-level clinical research data for the purpose of secondary analysis or meta-analysis have been widely touted. Although some researchers remain wary about sharing data, recent policies and proposals by funders, scientific journals, research institutions, and international health organizations mean that data sharing, in one form or another, is inevitable. Now is therefore the time to focus on developing practices for data sharing that are effective, efficient, equitable, and ethical. In the process, we may need to question the assumption that more is better. Simply making more data openly available may not lead to analyses that are relevant and that are actually applied to improve health.
    […]
    One of the risks posed by these expanding repositories is the production of “data dumpsters”: repositories of data without the metadata, data dictionaries, or documentation needed for meaningful or correct reanalysis. Fulfilling an obligation to share data before good practices in data formatting and documentation have been established and replicated may allow researchers to check the “data shared” box, but it may also result in an epidemic of accessible data of limited usefulness. There is currently inadequate funding and expertise for curating data to a standard and quality suitable for external secondary use; researchers must bear the costs themselves or opt, as many currently do, to make raw data available without the explanatory documentation necessary to make them useful. Most repositories are not equipped to rectify this problem — nor do they see this function as part of their mandate.

    Another concern is the risk of widening the research-output gap between low-resource and high-resource countries. Analysts in rich countries have the skills and resources to use and reanalyze data collected in lower-income countries, whereas the reverse is rarely true. When medical journals mandate data sharing, researchers in low-income countries will have no choice but to allow external access to those who are better equipped to make use of the data. But better equipped does not mean better qualified: if there’s no requirement to involve primary researchers when conducting secondary analyses, misinterpretation of the data is possible — indeed it is likely, especially in the case of data sets for which high-quality data management and descriptors are lacking. Reuse of data that produces incorrect results does not improve health outcomes.

    Simplicissimus @simplicissimus
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  • @simplicissimus
    Simplicissimus @simplicissimus 24/06/2016

    Smartphone use in the dark linked to temporary blindness in 2 cases
    ▻http://mashable.com/2016/06/23/temporary-blindness-tied-to-smartphones/#wUKUpGc1Ckqw

    In Thursday’s New England Journal of Medicine, doctors detailed the cases of the two women, ages 22 and 40, who experienced “transient smartphone blindness” for months.

    The women complained of recurring episodes of temporary vision loss for up to 15 minutes. They were subjected to variety of medical exams, MRI scans and heart tests. Yet doctors couldn’t find anything wrong with them to explain the problem.

    But minutes after walking into an eye specialist’s office, the mystery was solved.

    “I simply asked them, ’What exactly were you doing when this happened?’” recalled Dr. Gordon Plant of Moorfield’s Eye Hospital in London.

    He explained that both women typically looked at their smartphones with only one eye while resting on their side in bed in the dark — their other eye was covered by the pillow.
    […]
    He said the temporary blindness was ultimately harmless, and easily avoidable, if people stuck to looking at their smartphones with both eyes.

    • #smartphone
    Simplicissimus @simplicissimus
    • @simplicissimus
      Simplicissimus @simplicissimus 24/06/2016

      Il s’agit d’un courrier au journal

      Transient Smartphone “Blindness”
      ▻http://www.nejm.org/doi/full/10.1056/NEJMc1514294

      http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2016/nejm_2016.374.issue-25/nejmc1514294/20160617/images/medium/nejmc1514294_f1.gif

      Simplicissimus @simplicissimus
    • @nicolasm
      Nicolas🌱 @nicolasm CC BY-SA 24/06/2016

      C’est effrayant qu’elles subissent une batterie de test sans que personne ne songe à chercher ce qu’elles faisaient à ce moment là.

      Nicolas🌱 @nicolasm CC BY-SA
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  • @fil
    Fil @fil 30/04/2016

    Moonshot to Malawi — NEJM
    ▻http://www.nejm.org/doi/full/10.1056/NEJMp1601982#t=article

    the most basic, decades-old elements of oncology care are absent in Malawi, while cancer-related expenditures are skyrocketing in other parts of the world to levels that are unsustainable even in high-income countries. Allowing such disparities to persist is an ethical choice.

    #cancer #moonshot #inégalités #santé

    • #Malawi
    Fil @fil
    • @cdb_77
      CDB_77 @cdb_77 30/04/2016

      #Malawi

      CDB_77 @cdb_77
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  • @simplicissimus
    Simplicissimus @simplicissimus 15/04/2016
    2
    @monolecte
    @02myseenthis01
    2

    It’s official: #Zika causes fetal defects - POLITICO
    ▻http://www.politico.com/tipsheets/politico-pulse/2016/04/its-official-zika-causes-fetal-defects-early-aco-participants-captured-mor

    A CDC study published in the New England Journal of Medicine definitely links the Zika virus with microcephaly and a range of other serious brain defects in infants, confirming what has been suspected for months.

    — Tom Frieden: “There is no longer any doubt” that the virus is leading to an outbreak of brain problems in infants across South America, Central America and the Caribbean. The CDC director added that “never before in history has there been a situation where a bite from a mosquito could result in a devastating malformation.”

    — What’s still unclear: CDC pointed out that it’s still learning when during pregnancy the virus poses the greatest risk to the fetus, what other types of birth defects Zika causes, and what percentage of Zika-infected women give birth to affected children.

    • #New England Journal
    Simplicissimus @simplicissimus
    • @simplicissimus
      Simplicissimus @simplicissimus 15/04/2016

      article accessible

      Zika Virus and Birth Defects — Reviewing the Evidence for Causality — NEJM
      ▻http://www.nejm.org/doi/full/10.1056/NEJMsr1604338

      SUMMARY
      The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Evidence that was used to support this causal relationship included Zika virus infection at times during prenatal development that were consistent with the defects observed; a specific, rare phenotype involving microcephaly and associated brain anomalies in fetuses or infants with presumed or confirmed congenital Zika virus infection; and data that strongly support biologic plausibility, including the identification of Zika virus in the brain tissue of affected fetuses and infants. Given the recognition of this causal relationship, we need to intensify our efforts toward the prevention of adverse outcomes caused by congenital Zika virus infection. However, many questions that are critical to our prevention efforts remain, including the spectrum of defects caused by prenatal Zika virus infection, the degree of relative and absolute risks of adverse outcomes among fetuses whose mothers were infected at different times during pregnancy, and factors that might affect a woman’s risk of adverse pregnancy or birth outcomes. Addressing these questions will improve our ability to reduce the burden of the effects of Zika virus infection during pregnancy.

      Simplicissimus @simplicissimus
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  • @simplicissimus
    Simplicissimus @simplicissimus 5/11/2015
    1
    @kassem
    1

    Le ver solitaire transmet son cancer au porteur humain.

    A Tapeworm With Cancer Gave Its Tumors to Someone - NBC News
    ▻http://www.nbcnews.com/health/health-news/tapeworm-cancer-gave-its-tumors-someone-n457586

    Tapeworms are bad enough. They get inside people, lay their eggs, and cause symptoms such as diarrhea and weakness. And they can infest a body for a lifetime.

    But doctors were stunned to find out they can do something worse: infect people with tumors.

    La publication et son résumé (qui fait la une du NEJM). L’article entier est accessible.
    Malignant Transformation of Hymenolepis nana in a Human Host — NEJM
    ▻http://www.nejm.org/doi/full/10.1056/NEJMoa1505892#t=abstract

    Neoplasms occur naturally in invertebrates but are not known to develop in tapeworms. We observed nests of monomorphic, undifferentiated cells in samples from lymph-node and lung biopsies in a man infected with the human immunodeficiency virus (HIV). The morphologic features and invasive behavior of the cells were characteristic of cancer, but their small size suggested a nonhuman origin. A polymerase-chain-reaction (PCR) assay targeting eukaryotes identified Hymenolepis nana DNA. Although the cells were unrecognizable as tapeworm tissue, immunohistochemical staining and probe hybridization labeled the cells in situ. Comparative deep sequencing identified H. nana structural genomic variants that are compatible with mutations described in cancer. Invasion of human tissue by abnormal, proliferating, genetically altered tapeworm cells is a novel disease mechanism that links infection and cancer.

    • #cancer
    Simplicissimus @simplicissimus
    • @simplicissimus
      Simplicissimus @simplicissimus 5/11/2015

      Portrait de H. nana, le parasite concerné.

      https://o.quizlet.com/i/PLHI0bnTnWbeF8fjd1MAmw_m.jpg

      Vu sur Phylum : Platyhelminthes, Class Cestoda, Subclass Eucestoda (True Tapeworms) Genus Hymenolepis
      ▻https://quizlet.com/4810479/phylum-platyhelminthes-class-cestoda-subclass-eucestoda-true-tapeworms-genu

      Membre de l’embranchement des Plathelminthes (vers plats), ▻https://fr.wikipedia.org/wiki/Platyhelminthes

      https://upload.wikimedia.org/wikipedia/commons/thumb/5/5c/Pseudobiceros_hancockanus.jpg/290px-Pseudobiceros_hancockanus.jpg

      Classe des Cestodes

      https://classconnection.s3.amazonaws.com/818/flashcards/2373818/jpg/eucestode_anatomy1354663050769.jpg

      Eucestode anatomy

      Simplicissimus @simplicissimus
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  • @kassem
    Kassem @kassem CC BY-NC-SA 28/10/2015

    Peer-Review Fraud — Hacking the Scientific Publication Process — NEJM
    ▻http://www.nejm.org/doi/full/10.1056/NEJMp1512330?query=featured_home&

    it would be a mistake to look at this as a Chinese or Asian problem. The problem is the perverse incentive systems in scientific publishing. As long as authors are (mostly) rewarded for publishing many articles and editors are (mostly) rewarded for publishing them rapidly, new ways of gaming the traditional publication models will be invented more quickly than new control measures can be put in place.

    #publication #quantité #fraude #science

    Kassem @kassem CC BY-NC-SA
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  • @liotier
    liotier @liotier CC BY-SA 15/09/2015
    5
    @fil
    @mad_meg
    @7h36
    @biggrizzly
    @ze_dach
    5

    Early #heart #pacemakers used Pu-238 as power source. After 35 years some were still running well
    ▻http://www.nejm.org/doi/full/10.1056/NEJMc072143
    #plutonium #énergie #energy #nucléaire #nuclear #médecine #health

    liotier @liotier CC BY-SA
    • @simplicissimus
      Simplicissimus @simplicissimus 15/09/2015

      Et pourtant, des 31 pays européens pour lesquels Eurostat donne les informations démographiques collectées, seule la Suède prévoit l’enregistrement de la présence d’un stimulateur dans la déclaration de décès.

      Ma référence Statistiques démographiques : Définitions et méthodes de collecte dans 31 pays européens ►http://ec.europa.eu/eurostat/ramon/statmanuals/files/KS-CC-03-005-FR.pdf
      Cet ouvrage a longtemps été une de mes bibles lorsque j’intervenais sur la « Qualité des données ». Histoire de montrer la diversité des conventions retenues y compris pour des choses « évidentes » (naissances, décès) et la variétés des procédures y compris dans des pays proches…

      Simplicissimus @simplicissimus
    • @vazi
      vazy @vazi CC BY 15/09/2015

      Que sont devenus les 130 piles au plutonium 238 des patients aujourd’hui décédés (dont certains se sont probablement fait incinérer ! ) ?

      vazy @vazi CC BY
    • @nicolasm
      Nicolas🌱 @nicolasm CC BY-SA 16/09/2015

      Dans deux cents ans y aura des légendes sur des malédictions qui se seront abattues (mal étrange) sur les personnes habitant des lieux construits sur les anciens cimetière occidentaux

      Nicolas🌱 @nicolasm CC BY-SA
    • @liotier
      liotier @liotier CC BY-SA 16/09/2015

      “The devices were designed to withstand gunshots and cremation” - ▻http://uk.reuters.com/article/2007/12/20/health-heart-pacemaker-dc-idUKN1960427320071220

      liotier @liotier CC BY-SA
    • @liotier
      liotier @liotier CC BY-SA 16/09/2015

      ▻http://www.implantable-device.com/2011/12/24/medtronics-atomic-pacemaker-1970
      “In the late 1960s Medtronic – today the largest manufacturer of implantable medical devices in the world – teamed up with Alcatel, a French company, to design a nuclear-powered pacemaker. The first human implant of the device took place in Paris in 1970.

      The nuclear battery in the Medtronic device used a tiny 2.5 Ci slug of metallic Plutonium 238 (Pu-238). The radiation produced by the Pu-238 bombarded the walls of its container, producing heat that a thermopile then converted to an electrical current. A thermopile is a stack of thermocouples, which are devices that convert thermal energy directly into electrical energy using Seebeck effect. A thermocouple is made of two kinds of metal (or semiconductors) connected to each other in a closed loop. If the two junctions are at different temperatures, an electric current will flow in the loop.”

      http://i.imgur.com/vQ2HFEL.jpg http://i.imgur.com/8X7QQw1.jpg

      “Disposal authority: C.E.A.” - C’est quoi l’adresse postale du #CEA pour leur renvoyer le bidule quand on le trouve ? #déchets

      liotier @liotier CC BY-SA
    • @simplicissimus
      Simplicissimus @simplicissimus 16/09/2015

      Ouais, en tous cas quand on a testé l’incinération des stimulateurs, par précaution à chaque fois des trous ont été percés dans l’enveloppe. Ce qui, dans certains cas, n’a pas empêché la (micro-)explosion…

      Incinération de stimulateurs cardiaques radioisotopiques (octobre 1974) ▻http://www.iaea.org/inis/collection/NCLCollectionStore/_Public/06/178/6178072.pdf

      Pour le CEA, une recherche de « stimulateur » sur leur site ne donne absolument rien dans le sens de la gestion de déchets.

      Simplicissimus @simplicissimus
    • @biggrizzly
      BigGrizzly @biggrizzly CC BY-NC-SA 16/09/2015

      Z’êtes flippant les gens ;-)))

      BigGrizzly @biggrizzly CC BY-NC-SA
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  • @kassem
    Kassem @kassem CC BY-NC-SA 2/02/2015
    3
    @odilon
    @02myseenthis01
    @biggrizzly
    3

    How a national food policy could save millions of American lives - The Washington Post
    ▻http://www.washingtonpost.com/opinions/how-a-national-food-policy-could-save-millions-of-american-lives/2014/11/07/89c55e16-637f-11e4-836c-83bc4f26eb67_story.html

    http://www.washingtonpost.com/rf/image_2048w/2010-2019/WashingtonPost/2014/05/24/Editorial-Opinion/Images/Food_and_Farm_Seed_Farming-02f58-ATDR.jpg

    The food system and the diet it’s created have caused incalculable damage to the health of our people and our land, water and air. If a foreign power were to do such harm, we’d regard it as a threat to national security, if not an act of war, and the government would formulate a comprehensive plan and marshal resources to combat it. (The administration even named an Ebola czar to respond to a disease that threatens few Americans.) So when hundreds of thousands of annual deaths are preventable — as the deaths from the chronic diseases linked to the modern American way of eating surely are — preventing those needless deaths is a national priority.

    (...)

    Only those with a vested interest in the status quo would argue against creating public policies with these goals. Now weigh them against the reality that our current policies and public investments have given us:

    Because of unhealthy diets, 100 years of progress in improving public health and extending lifespan has been reversed. Today’s children are expected to live shorter lives than their parents. In large part, this is because a third of these children will develop Type 2 diabetes, formerly rare in children and a preventable disease that reduces life expectancy by several years. At the same time, our fossil-fuel-dependent food and agriculture system is responsible for more greenhouse gas emissions than any other sector of the economy but energy. And the exploitative labor practices of the farming and fast-food industries are responsible for much of the rise in income inequality in America.

    We find ourselves in this situation because government policy in these areas is made piecemeal. Diet-related chronic disease, food safety, marketing to children, labor conditions, wages for farm and food-chain workers, immigration, water and air quality, greenhouse gas emissions, and support for farmers: These issues are all connected to the food system. Yet they are overseen by eight federal agencies. Amid this incoherence, special interests thrive and the public good suffers.

    (...)

    The contradictions of our government’s policies around food become clear as soon as you compare the federal recommendations for the American diet, known as MyPlate, with the administration’s agricultural policies. While MyPlate recommends a diet of 50 percent vegetables and fruits, the administration devotes less than 1 percent of farm subsidies to support the research, production and marketing of those foods. More than 60 percent of that funding subsidizes the production of corn and other grains — food that is mostly fed to animals, converted to fuel for cars or processed into precisely the sort of junk the first lady is urging us to avoid.

    How could one government be advancing two such diametrically opposed goals? By failing to recognize that an agricultural policy is not the same as a food policy — and that the former does not necessarily contribute to public health.

    Our food system is largely a product of agricultural policies that made sense when the most important public health problem concerning food was the lack of it and when the United States saw “feeding the world” as its mission. These policies succeeded in boosting the productivity of American farmers, yet today they are obsolete and counterproductive, providing billions in public support to an industry that churns out a surfeit of unhealthy calories — while at the same time undermining the ability of the world’s farmers to make a living from their land.

    These farm policies have nourished an agricultural-industrial complex before which the president and the first lady seem powerless. The administration’s early efforts to use antitrust laws to protect farmers and consumers from agribusiness oligopolies were quietly dropped. Promises to regulate the use of antibiotics in animal agriculture — widely acknowledged as a threat to public health — resulted in toothless voluntary guidelines from the Food and Drug Administration.

    When it came to regulating #methane, one of the most potent greenhouse gases, the Environmental Protection Agency proposed stringent rules for the energy industry — and another voluntary program for agriculture, the single biggest emitter of the gas. And in February the president signed yet another business-as-usual farm bill, which continues to encourage the dumping of cheap but unhealthy calories in the supermarket.

    These policies and the diet they sponsor threaten to undermine President Obama’s Affordable Care Act. The government now finds itself in the absurd position of financing both sides in the war on Type 2 diabetes, a disease that, along with its associated effects, now costs $245 billion, or 23 percent of the national deficit in 2012, to treat each year. The government subsidizes soda with one hand, while the other writes checks to pay for insulin pumps. This is not policy; this is insanity.

    The good news is that solutions are within reach — precisely because the problems are largely a result of government policies. We know that the government has the power to reshape the food system because it has already done so at least once — when President Richard Nixon rejiggered farm policy to boost production of corn and soy to drive down food prices.

    Of course, reforming the food system will ultimately depend on a Congress that has for decades been beholden to #agribusiness, one of the most powerful lobbies on Capitol Hill. As long as food-related issues are treated as discrete rather than systemic problems, congressional committees in thrall to special interests will be able to block change.

    (...)

    Brazil has had a national food policy since 2004. In the city of Belo Horizonte that policy — coupled with an investment of 2 percent of the local budget in food-access and farmer-support programs — has reduced poverty by 25 percent and child mortality by 60 percent, and provided access to credit for 2 million farmers, all within a decade.

    #alimentation #lobbies #lobbying #corruption #santé #obésité #diabète_sucré #Etats-Unis

    • #The Washington Post
    • #food
    • #food policy
    • #food system
    • #greenhouse gas emissions
    • #chronic diseases
    • #diabetes
    • #disease
    • #Ebola
    • #czar
    • #marshal
    • #The Washington Post
    Kassem @kassem CC BY-NC-SA
    • @kassem
      Kassem @kassem CC BY-NC-SA 2/02/2015

      A Potential Decline in Life Expectancy in the United States in the 21st Century — NEJM
      ▻http://www.nejm.org/doi/full/10.1056/NEJMsr043743#t=abstract

      http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2005/nejm_2005.352.issue-11/nejmsr043743/production/images/medium/nejmsr043743_f1.gif

      Kassem @kassem CC BY-NC-SA
    • @nicolasm
      Nicolas🌱 @nicolasm CC BY-SA 3/02/2015

      On est vraiment dans le « peak everything »

      Nicolas🌱 @nicolasm CC BY-SA
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  • @fil
    Fil @fil 14/12/2014
    3
    @allergie
    @reka
    @geneghys
    3

    les mecs sont dopés à mort mais ils sont pas vaccinés contre les oreillons… va comprendre
    ▻http://www.theglobeandmail.com/sports/hockey/penguins-crosby-becomes-latest-nhl-player-to-have-the-mumps/article22077221

    http://static.theglobeandmail.ca/7d9/incoming/article22077745.ece/ALTERNATES/w620/crosby.jpg

    Penguins’ Crosby becomes latest NHL player to have the mumps - The Globe and Mail
    #vaccins #sport

    • #Belgique
    Fil @fil
    • @touti
      vide @touti 14/12/2014

       ??? Ils sont parfaitement vaccinés contre les oreillons.

      Crosby received a booster shot against the virus before travelling to Russia for the Winter Olympics in February and initial tests done a couple of weeks ago indicated Crosby was not in any danger.

      “It came as a bit of a surprise,” team doctor Dharmesh Vyas said. “Every indication was that he was well protected against the disease.”

      C’est juste la preuve que le vaccin ne protège pas toujours. Pour certains contradicteurs, il serait parfois même à l’origine de la maladie en entrainant également une déficience du système immunitaire.

      vide @touti
    • @fil
      Fil @fil 14/12/2014

      ah, hockey :-)

      Fil @fil
    • @simplicissimus
      Simplicissimus @simplicissimus 15/12/2014

      Oreillons — Wikipédia
      ▻http://fr.wikipedia.org/wiki/Oreillons

      La vaccination a presque complètement supprimé les formes de l’enfance et a paradoxalement augmenté le nombre de cas chez l’adulte jeune, souvent ayant reçu une vaccination incomplète, mais parfois correctement vaccinés.

      La note de ce paragraphe renvoie vers un article de 2008
      Recent Resurgence of Mumps in the United States
      ▻http://www.nejm.org/doi/full/10.1056/NEJMoa0706589

      ▻http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2008/nejm_2008.358.issue-15/nejmoa0706589/production/images/large/nejmoa0706589_f1.jpeg

      Simplicissimus @simplicissimus
    • @touti
      vide @touti 15/12/2014

      Le vaccin contre la polio est aussi à l’origine de nouveaux cas comme de la propagation de la maladie via une contamination féco-orale. Le poliovirus se distingue entre un sauvage et un vaccinal.
      Je laisse wiv-isp.be expliquer ce processus particulier de propagation.

      Institut Scientifique de Santé Publique (Belgique)
      Poliomyélite – version Décembre 2013
      ▻https://www.wiv-isp.be/matra/Fiches/Polio.pdf

      Au sujet de la poliomyélite vaccinale

      Les risques associés au Vaccin Polio Oral OPV comprennent la poliomyélite paralytique post-vaccinale (PPPV), les flambées épidémiques causées par des poliovirus circulants dérivés de la souche vaccinale, et le portage à long terme de virus dérivés de la souche vaccinale par les immunodéprimés.
      Lors de la vaccination OPV (vivant atténué), la souche non virulente se réplique dans l’intestin le temps que l’organisme développe des anticorps. Dans les zones d’assainissement inadéquat, la souche vaccinale peut se disséminer dans la population (ce qui permet une vaccination passive de cette population) et qui s’éteint spontanément.
      En de rares cas, si la couverture vaccinale est très faible, la souche peut survivre sur une plus longue période et peut muter (si elle circule au moins 12 mois). Ces modifications génétiques peuvent aboutir à des souches virulentes pouvant provoquer une paralysie. La résolution de ces épidémies passe par une vaccination à large échelle de la population pour obtenir une couverture vaccinale empêchant la propagation du virus.
      Après administration du vaccin atténué oral, une réversion du virus vaccinal ou un terrain immunodéprimé peut être à l’origine de la survenue exceptionnelle de paralysies chez le sujet vacciné (dans les trente jours suivant la vaccination) ou dans son entourage non vacciné (dans les soixante jours). En France, ce risque a été estimé à environ un cas sur 7,8 millions de doses distribuées chez le vacciné et un cas sur 5,5 millions de doses distribuées chez les contacts (surtout poliovirus de sérotype 3). Rappelons que le vaccin oral n’est plus disponible en Belgique, mais qu’il est utilisé par l’OMS dans les campagnes d’éradication de la poliomyélite.
      Le nombre annuel de cas de PPPV est actuellement estimé à 250-500 par an, estimation basée sur le chiffre de 2 à 4 cas de PPPV par million de naissances attendues par an.

      vide @touti
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  • @kassem
    Kassem @kassem CC BY-NC-SA 18/10/2014
    2
    @reka
    @02myseenthis01
    2

    #Ebola #Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections
    ▻http://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=articleBackground

    Although the current epidemic of EVD in West Africa is unprecedented in scale, the clinical course of infection and the transmissibility of the virus are similar to those in previous EVD outbreaks. The incubation period, duration of illness, case fatality rate, and R 0 are all within the ranges reported for previous EVD epidemics.7,13-18 Our estimates of R 0 are similar to other recent estimates for this West Africa epidemic.19-23 The combination of signs and symptoms recorded between symptom onset and clinical presentation is also similar to that in other reports.14,17,24-26 We infer that the present epidemic is exceptionally large, not principally because of the biologic characteristics of the virus, but rather because of the attributes of the affected populations and because control efforts have been insufficient to halt the spread of infection.

    Certain characteristics of the affected populations may have led to the rapid geographic dissemination of infection. The populations of Guinea, Liberia, and Sierra Leone are highly interconnected, with much cross-border traffic at the epicenter and relatively easy connections by road between rural towns and villages and between densely populated national capitals. The large intermixing population has facilitated the spread of infection, but a large epidemic was not inevitable. In Nigeria, the number of cases has so far been limited, despite the introduction of infection into the large cities of Lagos (approximately 20 million people) and Port Harcourt (>1 million people). The critical determinant of epidemic size appears to be the speed of implementation of rigorous control measures.

    (...)

    Notwithstanding the geographic variation in case incidence within and among Guinea, Liberia, and Sierra Leone, the current epidemiologic outlook is bleak. Forward projections suggest that unless control measures — including improvements in contact tracing, adequate case isolation, increased capacity for clinical management, safe burials, greater community engagement, and support from international partners — improve quickly, these three countries will soon be reporting thousands of cases and deaths each week, projections that are similar to those of the Centers for Disease Control and Prevention.

    Experimental therapeutics and vaccines offer promise for the future but are unlikely to be available in the quantities needed to make a substantial difference in control efforts for many months, even if they are proved to be safe and effective. Furthermore, careful assessment of the most effective means of utilizing such interventions (e.g., vaccination or treatment of contacts versus health care workers) will be required while stocks remain limited. For the medium term, at least, we must therefore face the possibility that EVD will become endemic among the human population of West Africa, a prospect that has never previously been contemplated. The risk of continued epidemic expansion and the prospect of endemic EVD in West Africa call for the most forceful implementation of present control measures and for the rapid development and deployment of new drugs and vaccines.

    #Afrique #santé

    • #Guinea
    • #Liberia
    • #Sierra Leone
    • #Ebola virus disease
    • #epidemic
    • #illness
    • #infection
    • #sierra Leone
    • #forward
    • #West Africa
    Kassem @kassem CC BY-NC-SA
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  • @reka
    Phil Reka docs & archives @reka CC BY-NC-SA 17/10/2014
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    @02myseenthis01
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    Emergence of Zaire Ebola Virus Disease in Guinea — NEJM

    ▻http://www.nejm.org/doi/full/10.1056/NEJMoa1404505#t=article

    Outbreaks caused by viruses of the genera ebolavirus and marburgvirus represent a major public health issue in sub-Saharan Africa. Ebola virus disease is associated with a case fatality rate of 30 to 90%, depending on the virus species. Specific conditions in hospitals and communities in Africa facilitate the spread of the disease from human to human. Three ebolavirus species have caused large outbreaks in sub-Saharan Africa: EBOV, Sudan ebolavirus, and the recently described Bundibugyo ebolavirus.1,2 Epidemics have occurred in the Democratic Republic of Congo, Sudan, Gabon, Republic of Congo, and Uganda. Reston ebolavirus circulates in the Philippines. It has caused disease in nonhuman primates but not in humans.3 The fifth species, Tai Forest ebolavirus, was documented in a single human infection caused by contact with an infected chimpanzee from the Tai Forest in Ivory Coast.4 Although this event indicated the presence of Tai Forest ebolavirus in West Africa, this subregion was not considered to be an area in which EBOV was endemic.

    On March 10, 2014, hospitals and public health services in Guéckédou and Macenta alerted the Ministry of Health of Guinea and — 2 days later — Médecins sans Frontières in Guinea about clusters of a mysterious disease characterized by fever, severe diarrhea, vomiting, and an apparent high fatality rate. (Médecins sans Frontières had been working on a malaria project in Guéckédou since 2010.) In Guéckédou, eight patients were hospitalized; three of them died, and additional deaths were reported among the families of the patients. Several deaths were reported in Macenta, including deaths among hospital staff members. A team sent by the health ministry reached the outbreak region on March 14 (Figure 1Figure 1Map of Guinea Showing Initial Locations of the Outbreak of Ebola Virus Disease.). Médecins sans Frontières in Europe was notified and sent a team, which arrived in Guéckédou on March 18. Epidemiologic investigation was initiated, and blood samples were collected and sent to the biosafety level 4 laboratories in Lyon, France, and Hamburg, Germany, for virologic analysis.

    #ebola

    • #AFRICA
    • #Guinea
    • #disease
    • #Ebola virus disease
    • #sub-Saharan Africa
    Phil Reka docs & archives @reka CC BY-NC-SA
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  • @rezo
    Rezo @rezo 28/08/2014
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    @moderne
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    Face to Face with Ebola — An Emergency Care Center in Sierra Leone
    ▻http://www.nejm.org/doi/full/10.1056/NEJMp1410179?query=featured_ebola&&

    At 6 a.m., our medical team arrives at the Ebola case-management center in the Kailahun district of Sierra Leone to take blood samples. At our 80-bed center here near the borders of Liberia and Guinea, 8 new patients were admitted yesterday, 9 need to have a repeat test 72 hours after their symptoms began, and some we hope to discharge today: at least 18 blood samples to obtain. The center currently houses 64 patients in all, 4 of them children less than 5 years of age. We have already seen 2 patients die today. Source: NEJM

    • #Guinea
    • #Liberia
    • #Sierra Leone
    • #Face to face
    • #sierra Leone
    Rezo @rezo
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