Bulletin de veille « Focus sur 12 pathologies graves
Transcription
Bulletin de veille « Focus sur 12 pathologies graves
Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Service de Documentation Le Service Documentation de l’EHESP édite mensuellement un bulletin de veille. Celui-ci signale les articles récents, parus dans des revues scientifiques de renommée internationale, autour de 12 pathologies graves, ainsi que sur la pandémie grippale. Ce bulletin signale également des rapports officiels et institutionnels disponibles en texte intégral. Vous pouvez consulter les archives du bulletin de veille sur le site Internet de l’école http://www.ehesp.fr/ rubrique Portail EHESP. Si vous souhaitez vous abonner afin de recevoir le bulletin de veille tous les mois par e-mail, contactez le Service Documentation de l’EHESP. (par mail : [email protected] / par téléphone : 02 99 02 29 66) EHESP Avenue du Professeur Léon Bernard CS 74312 – 35043 Rennes Cedex Tél : +33 (0)2 99 02 22 00 Fax : +33 (0)2 99 02 26 25 www.ehesp.fr École des hautes études en santé publique Établissement public à caractère scientifique, culturel et professionnel. Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Bulletin de veille – Octobre 2010 « Focus sur 12 pathologies graves » Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques autour des pathologies suivantes : Bronchite chronique obstructive Cancer du poumon Dengue Dépression Diabète Grippe A Maladie d’Alzheimer Maladies cardio-vasculaires Maladies liées à l’alcool Paludisme Pathologies liées à l’obésité SIDA Tuberculose La recherche documentaire est effectuée dans la base de données Medline et porte sur les 12 titres de revues suivants : American journal of epidemiology American journal of public health BMC public health BMJ (Clinical research ed.) - British medical journal International journal of epidemiology JAMA : the journal of the American Medical Association Lancet Nature Risk analysis : an official publication of the Society for Risk Analysis Science Social science & medicine The New England journal of medicine Des rapports officiels et institutionnels en ligne sont également signalés en fin de bulletin. L’accès aux documents est mentionné pour chaque référence selon les critères suivants : Accès libre L’accès en ligne au texte intégral est gratuit et possible pour tous Collection papier accessible à la bibliothèque. Accès réservé EHESP L’accès en ligne au texte intégral est réservé au personnel de l’EHESP depuis les postes de l’école par reconnaissance IP Accès payant L’accès en ligne au texte intégral est payant. Le personnel de l’EHESP peut obtenir l’article en contactant le Service Documentation [email protected] Service de Documentation EHESP 2 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Articles scientifiques issus de l’interrogation de la base Medline (interrogée le 1/10/2010) Bronchite chronique obstructive ........................................................................................... 4 Cancer du poumon ................................................................................................................. 5 Dengue ................................................................................................................................... 7 Diabète ................................................................................................................................... 7 Dépression ............................................................................................................................. 15 Grippe A ................................................................................................................................. 20 Maladies d’Alzheimer ............................................................................................................ 22 Maladies cardio-vasculaires ................................................................................................. 23 Maladies liées à l'alcool ........................................................................................................ 29 Paludisme ............................................................................................................................. 29 Pathologies liées à l'obésité ................................................................................................. 30 SIDA ..................................................................................................................................... 37 Tuberculose ......................................................................................................................... 39 Rapports, dossiers en ligne et articles supplémentaires Nouvelles publications ......................................................................................................... 43 Bronchite chronique obstructive............................................................................................. 43 Cancer du poumon ............................................................................................................... 43 Dépression ............................................................................................................................. 45 Dengue ................................................................................................................................. 46 Diabète ................................................................................................................................. 46 Grippe A ................................................................................................................................. 46 Maladie d'Alzheimer .............................................................................................................. 47 Maladies cardio-vasculaires ................................................................................................. 48 Maladies chroniques ............................................................................................................. 48 Maladies infectieuses ........................................................................................................... 48 Paludisme ......................................................................................................................... 49 Pathologies liées à l’alcool ................................................................................................... 50 SIDA ..................................................................................................................................... 50 Tuberculose ......................................................................................................................... 51 Service de Documentation EHESP 3 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Articles scientifiques Bronchite chronique obstructive sommaire (1) PALA G, PIGNATTI P, GENTILE E, CAMINATI M, et al. [Professional eosinophilic bronchitis: considerations and new diagnostic methods in a clinical case]. G Ital Med Lav Ergon. 2010 Apr., vol. 32, n° 2, pp.145-148 http://www.ncbi.nlm.nih.gov/pubmed/20684434 Nonasthmatic eosinophilic bronchitis (NAEB) is a condition characterized by corticosteroidresponsive chronic cough, sputum eosinophilia and absence of symptoms or objective evidence of variable airflow obstruction and airway hyper-responsiveness. Like asthma, NAEB can be associated with exposure to occupational sensitizers and can be considered as being a variant of occupational asthma when it develops as a consequence of work exposure. Few case reports of NAEB caused by workplace exposure have been reported. Bakers are at high risk of developing occupational respiratory disorders and three cases of occupational NAEB have been described. We describe the first case of occupational NAEB due to storage mites in a baker in which the offending agent was identified by means of the basophil activation test (BAT), a new tool which has never been proposed in diagnostic procedures of occupational respiratory allergy. BAT's results allowed the recognition of the offending agent, that is mandatory for diagnosis (2) RODRIGUEZ-TELLEZ M, RROYO-MARTINEZ Q, LIZARRALDE C, PELLICER FJ, et al. Transnasal endoscopy in a patient with cicatricial pemphigoid. Rev Esp Enferm Dig. 2010 May, vol. 102, n° 5, pp.329-330 http://www.ncbi.nlm.nih.gov/pubmed/20524762 (3) ZHONG XN, GUO SM. [An experimental study on pulmonary vascular inflammation in a rat model of chronic bronchitis and emphysema]. Zhonghua Jie He He Hu Xi Za Zhi. 2006 July, vol. 29, n° 7, pp.435-439 http://www.ncbi.nlm.nih.gov/pubmed/17045040 OBJECTIVE: To study the characteristics of intra-acinar pulmonary artery inflammation in rats with chronic bronchitis (CB) and emphysema and to evaluate the protective and therapeutic effects of erythromycin (EM). METHODS: Eighteen male Wistar rats were divided into 3 groups randomly, 6 rats per group, a normal control group (group A), a CB and emphysema group (group B), and an EM-treatment group (group C). The rat model of CB and emphysema was established by intratracheal instillation of lipopolysaccharide (LPS) and daily exposure to cigarette smoke. After 8 weeks the pathological and morphometric changes in the lung were analyzed. RESULTS: (1) The inflammation in intra-acinar pulmonary arteries, described as total inflammatory cells per square millimeter of adventitia (cell/mm(2)), was different among the three groups, (33 +/- 6) cell/mm(2) in group A, (158 +/- 68) cell/mm(2) in group B, and (54 +/- 7) cell/mm(2) in group C; the difference being significant between group A and group B and between group B and group C (t = 9.6, 9.2, all P < 0.01). (2) The morphometric characteristics of intra-acinar pulmonary muscular arteries: the thickness of intra-acinar pulmonary muscular arteries, described as intimal area per total area, was significantly different among the groups (t = 9.7, 9.4, all P < 0.01), (21 +/- 4)% in group A, (37 +/- 3)% in group B, and (30 +/- 1)% in group C. CONCLUSIONS: There was inflammatory reaction largely of lymphocyte infiltration in the adventitia of intra-acinar pulmonary arteries in rats with CB and emphysema. Inflammatory reaction in intra-acinar pulmonary arteries plays an important role in vascular remodeling. EM may prevent the inflammation and remodeling of intra-acinar pulmonary arteries to some degree Service de Documentation EHESP 4 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Cancer du poumon Octobre 2010 sommaire (1) AKL EA, GADDAM S, GUNUKULA SK, HONEINE R, et al. The effects of waterpipe tobacco smoking on health outcomes: a systematic review. Int J Epidemiol. 2010 June, vol. 39, n° 3, pp.834-857 http://dx.doi.org/10.1093/ije/dyq002 (accès réservé EHESP) BACKGROUND: There is a need for a comprehensive and critical review of the literature to inform scientific debates about the public health effects of waterpipe smoking. The objective of this study was therefore to systematically review the medical literature for the effects of waterpipe tobacco smoking on health outcomes. METHODS: We conducted a systematic review using the Cochrane Collaboration methodology for conducting systematic reviews. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS: Twenty-four studies were eligible for this review. Based on the available evidence, waterpipe tobacco smoking was significantly associated with lung cancer [odds ratio (OR) = 2.12; 95% confidence interval (CI) 1.32-3.42], respiratory illness (OR = 2.3; 95% CI 1.1-5.1), low birth-weight (OR = 2.12; 95% CI 1.08-4.18) and periodontal disease (OR = 35). It was not significantly associated with bladder cancer (OR = 0.8; 95% CI 0.2-4.0), nasopharyngeal cancer (OR = 0.49; 95% CI 0.20-1.23), oesophageal cancer (OR = 1.85; 95% CI 0.95-3.58), oral dysplasia (OR = 8.33; 95% CI 0.78-9.47) or infertility (OR = 2.5; 95% CI 1.0-6.3) but the CIs did not exclude important associations. Smoking waterpipe in groups was not significantly associated with hepatitis C infection (OR = 0.98; 95% CI 0.80-1.21). The quality of evidence for the different outcomes varied from very low to low. CONCLUSION: Waterpipe tobacco smoking is possibly associated with a number of deleterious health outcomes. There is a need for high-quality studies to identify and quantify with confidence all the health effects of this form of smoking (2) CRAWFORD SM. UK cancer survival statistics. Reflect NHS clinical realities. BMJ. 2010, vol. 341, p.c5134 http://www.ncbi.nlm.nih.gov/pubmed/20861104 (accès réservé EHESP)(accès réservé EHESP) (3) DOS SS, I, DE STAVOLA BL, PIZZI C, MEADE TW. Circulating levels of coagulation and inflammation markers and cancer risks: individual participant analysis of data from three long-term cohorts. Int J Epidemiol. 2010 June, vol. 39, n° 3, pp.699-709 http://dx.doi.org/10.1093/ije/dyq012 (accès réservé EHESP) BACKGROUND: Basic and clinical research support the hypothesis that activation of the coagulation and inflammation pathways may affect cancer onset, but there is limited epidemiological data to support this. METHODS: We examined a large range of haemostatic and inflammation markers, including fibrinogen, in 19 303 male participants from three English cohorts followed for up to 30 years. After excluding the first 3 years of follow-up, 2908 incident cancers were accrued. Competing risk models were fitted to estimate rate ratios (RRs) for cancer incidence, adjusting for age and other confounders. RESULTS: Baseline white blood cell (WBC) count and circulating levels of fibrinogen, C-reactive protein (CRP), factor VII antigen (VIIa) and prothrombin fragment F1.2 were positively associated with risk of smoking-related cancers, particularly lung cancer. The magnitude of these associations was highest for persistently raised fibrinogen levels. There was, however, substantial confounding by smoking with risk being fully (WBC, CRP and VIIa) or partially (fibrinogen) removed after adjustment. The pooled RRs (95% confidence interval) per one standard deviation increase in fibrinogen levels before and after adjustment for smoking habits were 1.23 (1.12, 1.36) and 1.12 (1.05, 1.20), respectively. The fibrinogen associations were present only among current smokers at entry. The effect of smoking on smoking-related cancers was partly mediated by fibrinogen levels. CONCLUSIONS: Our results are consistent with elevated circulating levels of fibrinogen and F1.2 being predictors of risk of smoking-related cancers. Further research is necessary to clarify whether elevated levels of fibrinogen and F1.2 are causally relevant or simply correlates of the smoking-cancer association Service de Documentation EHESP 5 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (4) KELLEY AS, MEIER DE. Palliative care--a shifting paradigm. N Engl J Med. 2010 Aug. 19, vol. 363, n° 8, pp.781-782 http://dx.doi.org/10.1056/NEJMe1004139 (accès libre, collection papier de la bibliothèque) (5) KLAUS EM. Images in clinical medicine. Velvet palms. N Engl J Med. 2010 Aug. 5, vol. 363, n° 6, p.573 http://dx.doi.org/10.1056/NEJMicm0911773 (accès libre, collection papier de la bibliothèque) (6) MARGOLIS M, KAISER L, CHRISTIE J. Patient decisions to undergo surgery for early-stage lung cancer. JAMA. 2010 Sept. 15, vol. 304, n° 11, p.1165 http://dx.doi.org/10.1001/jama.2010.1311 (accès réservé EHESP) (7) RABE KF, DECRAMER M, SIAFAKAS N. The year of the lung. Lancet. 2010 Sept. 4, vol. 376, n° 9743, pp.753-754 http://dx.doi.org/10.1016/S0140-6736(10)61347-5 (accès réservé EHESP) (8) TEMEL JS, GREER JA, MUZIKANSKY A, GALLAGHER ER, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug. 19, vol. 363, n° 8, pp.733-742 http://dx.doi.org/10.1056/NEJMoa1000678 (accès libre, collection papier de la bibliothèque) BACKGROUND: Patients with metastatic non-small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease. METHODS: We randomly assigned patients with newly diagnosed metastatic non-small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records. RESULTS: Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02). CONCLUSIONS: Among patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, NCT01038271.) Service de Documentation EHESP 6 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Dengue (1) Octobre 2010 sommaire SCHMIDT AC. Response to dengue fever--the good, the bad, and the ugly? N Engl J Med. 2010 July 29, vol. 363, n° 5, pp.484-487 http://dx.doi.org/10.1056/NEJMcibr1005904 (accès libre, collection papier de la bibliothèque) Diabète sommaire (1) Effective approach. Nature. 2010 July 22, vol. 466, n° 7305, pp.413-414 http://dx.doi.org/10.1038/466413b (accès payant) (2) BAILEY S, GODFREY-FAUSSETT P. Where is diabetes in The Lancet's tuberculosis Series? Lancet. 2010 Aug. 28, vol. 376, n° 9742, p.683 http://dx.doi.org/10.1016/S0140-6736(10)61331-1 (accès réservé EHESP) (3) BENCK U, KRUGER B, KRAMER BK. Blood pressure control in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, p.696 http://www.ncbi.nlm.nih.gov/pubmed/20842775 (accès libre, collection papier de la bibliothèque) (4) BHATT DL, EAGLE KA, OHMAN EM, HIRSCH AT, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010 Sept. 22, vol. 304, n° 12, pp.1350-1357 ou http://dx.doi.org/10.1001/jama.2010.1322 (accès réservé EHESP) CONTEXT: Clinicians and trialists have difficulty with identifying which patients are highest risk for cardiovascular events. Prior ischemic events, polyvascular disease, and diabetes mellitus have all been identified as predictors of ischemic events, but their comparative contributions to future risk remain unclear. OBJECTIVE: To categorize the risk of cardiovascular events in stable outpatients with various initial manifestations of atherothrombosis using simple clinical descriptors. DESIGN, SETTING, AND PATIENTS: Outpatients with coronary artery disease, cerebrovascular disease, or peripheral arterial disease or with multiple risk factors for atherothrombosis were enrolled in the global Reduction of Atherothrombosis for Continued Health (REACH) Registry and were followed up for as long as 4 years. Patients from 3647 centers in 29 countries were enrolled between 2003 and 2004 and followed up until 2008. Final database lock was in April 2009. MAIN OUTCOME MEASURES: Rates of cardiovascular death, myocardial infarction, and stroke. RESULTS: A total of 45,227 patients with baseline data were included in this 4-year analysis. During the follow-up period, a total of 5481 patients experienced at least 1 event, including 2315 with cardiovascular death, 1228 with myocardial infarction, 1898 with stroke, and 40 with both a myocardial infarction and stroke on the same day. Among patients with atherothrombosis, those with a prior history of ischemic events at baseline (n = 21,890) had the highest rate of subsequent ischemic events (18.3%; 95% confidence interval [CI], 17.4%-19.1%); patients with stable coronary, cerebrovascular, or peripheral artery disease (n = 15,264) had a lower risk (12.2%; 95% CI, 11.4%-12.9%); and patients without established atherothrombosis but with risk factors only (n = 8073) had the lowest risk (9.1%; 95% CI, 8.3%-9.9%) (P < .001 for all comparisons). In addition, in multivariable modeling, the presence of diabetes (hazard ratio [HR], 1.44; 95% CI, 1.36-1.53; P < .001), an ischemic event in the previous year (HR, 1.71; 95% CI, 1.57-1.85; P < .001), and polyvascular disease (HR, 1.99; 95% CI, 1.78-2.24; P < .001) each were associated with a significantly higher risk of the primary end point. CONCLUSION: Clinical descriptors can assist clinicians in identifying high-risk patients within the broad range of risk for outpatients with atherothrombosis Service de Documentation EHESP 7 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (5) CARTER P, GRAY LJ, TROUGHTON J, KHUNTI K, et al. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010, vol. 341, p.c4229 http://www.ncbi.nlm.nih.gov/pubmed/20724400 (accès réservé EHESP) OBJECTIVE: To investigate the independent effects of intake of fruit and vegetables on incidence of type 2 diabetes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, British Nursing Index (BNI), and the Cochrane library were searched for medical subject headings and keywords on diabetes, prediabetes, fruit, and vegetables. Expert opinions were sought and reference lists of relevant articles checked. STUDY SELECTION: Prospective cohort studies with an independent measure of intake of fruit, vegetables, or fruit and vegetables and data on incidence of type 2 diabetes. RESULTS: Six studies met the inclusion criteria; four of these studies also provided separate information on the consumption of green leafy vegetables. Summary estimates showed that greater intake of green leafy vegetables was associated with a 14% (hazard ratio 0.86, 95% confidence interval 0.77 to 0.97) reduction in risk of type 2 diabetes (P=0.01). The summary estimates showed no significant benefits of increasing the consumption of vegetables, fruit, or fruit and vegetables combined. CONCLUSION: Increasing daily intake of green leafy vegetables could significantly reduce the risk of type 2 diabetes and should be investigated further (6) CHOI JH, BANKS AS, ESTALL JL, KAJIMURA S, et al. Anti-diabetic drugs inhibit obesitylinked phosphorylation of PPARgamma by Cdk5. Nature. 2010 July 22, vol. 466, n° 7305, pp.451-456 http://dx.doi.org/10.1038/nature09291 (accès payant) Obesity induced in mice by high-fat feeding activates the protein kinase Cdk5 (cyclin-dependent kinase 5) in adipose tissues. This results in phosphorylation of the nuclear receptor PPARgamma (peroxisome proliferator-activated receptor gamma), a dominant regulator of adipogenesis and fat cell gene expression, at serine 273. This modification of PPARgamma does not alter its adipogenic capacity, but leads to dysregulation of a large number of genes whose expression is altered in obesity, including a reduction in the expression of the insulin-sensitizing adipokine, adiponectin. The phosphorylation of PPARgamma by Cdk5 is blocked by anti-diabetic PPARgamma ligands, such as rosiglitazone and MRL24. This inhibition works both in vivo and in vitro, and is completely independent of classical receptor transcriptional agonism. Similarly, inhibition of PPARgamma phosphorylation in obese patients by rosiglitazone is very tightly associated with the anti-diabetic effects of this drug. All these findings strongly suggest that Cdk5mediated phosphorylation of PPARgamma may be involved in the pathogenesis of insulinresistance, and present an opportunity for development of an improved generation of anti-diabetic drugs through PPARgamma (7) COHEN D. Rosiglitazone: what went wrong? BMJ. 2010, vol. 341, p.c4848 http://www.ncbi.nlm.nih.gov/pubmed/20819889 (accès réservé EHESP) (8) COX H, FORD N, MCDERMID C, VAN CG, et al. Extensively drug-resistant tuberculosis in South Africa. Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.681-682 http://dx.doi.org/10.1016/S0140-6736(10)61327-X (accès réservé EHESP) (9) DE GALAN BE. Blood pressure control in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.695-696 http://www.ncbi.nlm.nih.gov/pubmed/20842774 (accès libre, collection papier de la bibliothèque) (10) DRAZEN JM, WOOD AJ. Don't mess with the DSMB. N Engl J Med. 2010 July 29, vol. 363, n° 5, pp.477-478 http://dx.doi.org/10.1056/NEJMe1007445 (accès libre, collection papier de la bibliothèque) Service de Documentation EHESP 8 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (11) FOSTER GD, LINDER B, BARANOWSKI T, COOPER DM, et al. A school-based intervention for diabetes risk reduction. N Engl J Med. 2010 July 29, vol. 363, n° 5, pp.443-453 http://dx.doi.org/10.1056/NEJMoa1001933 (accès libre, collection papier de la bibliothèque) BACKGROUND: We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes. METHODS: Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels. RESULTS: There was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools. CONCLUSIONS: Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.) (12) FREEMANTLE N. Commentary: What can we learn from the continuing regulatory focus on the thiazolidinediones? BMJ. 2010, vol. 341, p.c4812 http://www.ncbi.nlm.nih.gov/pubmed/20819888 (accès réservé EHESP) (13) GILLETT M, DALLOSSO HM, DIXON S, BRENNAN A, et al. Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. BMJ. 2010, vol. 341, p.c4093 http://www.ncbi.nlm.nih.gov/pubmed/20729270 (accès réservé EHESP) OBJECTIVES: To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes. DESIGN: We undertook a cost-utility analysis that used data from a 12 month, multicentre, cluster randomised controlled trial and, using the Sheffield type 2 diabetes model, modelled long term outcomes in terms of use of therapies, incidence of complications, mortality, and associated effect on costs and health related quality of life. A further cost-utility analysis was also conducted using current "real world" costs of delivering the intervention estimated for a hypothetical primary care trust. SETTING: Primary care trusts in the United Kingdom. PARTICIPANTS: Patients with newly diagnosed type 2 diabetes. INTERVENTION: A six hour structured group education programme delivered in the community by two professional healthcare educators. MAIN OUTCOME MEASURES: Incremental costs and quality adjusted life years (QALYs) gained. RESULTS: On the basis of the data in the trial, the estimated mean incremental lifetime cost per person receiving the DESMOND intervention is pound209 (95% confidence interval - pound704 to pound1137; euro251, -euro844 to euro1363; $326, -$1098 to $1773), the incremental gain in QALYs per person is 0.0392 (-0.0813 to 0.1786), and the mean incremental cost per QALY is pound5387. Using "real world" intervention costs, the lifetime incremental cost of the DESMOND intervention is pound82 (- pound831 to pound1010) and the mean incremental cost per QALY gained is pound2092. A probabilistic sensitivity analysis indicated that the likelihood that the DESMOND programme is cost effective at a threshold of pound20 000 per QALY is 66% using trial based intervention costs and 70% using "real world" costs. Results from a one way sensitivity analysis suggest that the DESMOND intervention is cost effective even under more modest assumptions that include the effects of the intervention being lost after one year. CONCLUSION: Our results suggest that the DESMOND intervention is likely Service de Documentation EHESP 9 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered (14) GRIMALDI-BENSOUDA L, MARTY M, POLLAK M, CAMERON D, et al. The international study of insulin and cancer. Lancet. 2010 Sept. 4, vol. 376, n° 9743, pp.769-770 http://dx.doi.org/10.1016/S0140-6736(10)61374-8 (accès réservé EHESP) (15) HARDER T, PLAGEMANN A, HARDER A. Birth weight and risk of neuroblastoma: a metaanalysis. Int J Epidemiol. 2010 June, vol. 39, n° 3, pp.746-756 http://dx.doi.org/10.1093/ije/dyq040 (accès réservé EHESP) BACKGROUND: Neuroblastoma is the most common solid tumour in infancy but its aetiology is largely unknown. Prenatal factors might play a key role in its pathogenesis. Previous studies investigated whether birth weight is associated with risk of neuroblastoma, with conflictive results. We conducted a meta-analysis to quantitatively summarize the published evidence. METHODS: Results from 10 case-control studies and one cohort study (1966 to December 2008) were included, involving a total of 3004 children with neuroblastoma. We constructed random-effects and fixed-effects models, performed 'pool-first' analyses, assessed heterogeneity and publication bias and performed sensitivity and influence analyses. RESULTS: High birth weight (>4000 g) was associated with increased risk of neuroblastoma [odds ratio (OR) 1.19; 95% confidence interval (CI) 1.04-1.36]. Results for high birth weight were highly homogenous (I(2) = 0%). Low birth weight (<2500 g) was also related to increased risk of neuroblastoma (OR 1.24; 95% CI 1.01.55), but results were more heterogeneous (I(2 )= 30%). No evidence for particularly influential studies or for publication bias was found. However, sensitivity analysis indicated the presence of bias in studies on the association with low birth weight. Above 2500 g each 1000-g increase in birth weight was associated with a 13% (95% CI 3-25) increase in risk of neuroblastoma. CONCLUSIONS: This meta-analysis shows that high birth weight is highly reproducibly associated with increased risk of neuroblastoma. The association with low birth weight was found to be less robust and deserves further studies (16) HOUTKOOPER RH, AUWERX J. Obesity: New life for antidiabetic drugs. Nature. 2010 July 22, vol. 466, n° 7305, pp.443-444 http://dx.doi.org/10.1038/466443a (accès payant) (17) JAMES WP, CATERSON ID, COUTINHO W, FINER N, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, pp.905-917 http://dx.doi.org/10.1056/NEJMoa1003114 (accès libre, collection papier de la bibliothèque) BACKGROUND: The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. METHODS: We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). RESULTS: The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The Service de Documentation EHESP 10 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. CONCLUSIONS: Subjects with preexisting cardiovascular conditions who were receiving longterm sibutramine treatment had an increased risk of nonfatal myocardial infarction and nonfatal stroke but not of cardiovascular death or death from any cause. (Funded by Abbott; ClinicalTrials.gov number, NCT00234832.) (18) KAVANAGH A, BENTLEY RJ, TURRELL G, SHAW J, et al. Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes. Soc Sci Med. 2010 Sept., vol. 71, n° 6, pp.1150-1160 http://dx.doi.org/10.1016/j.socscimed.2010.05.038 (accès réservé EHESP) Socio-economic gradients in cardiovascular disease (CVD) and diabetes have been found throughout the developed world and there is some evidence to suggest that these gradients may be steeper for women. Research on social gradients in biological risk factors for CVD and diabetes has received less attention and we do not know the extent to which gradients in biomarkers vary for men and women. We examined the associations between two indicators of socio-economic position (education and household income) and biomarkers of diabetes and cardiovascular disease (CVD) for men and women in a national, population-based study of 11,247 Australian adults. Multi-level linear regression was used to assess associations between education and income and glucose tolerance, dyslipidaemia, blood pressure (BP) and waist circumference before and after adjustment for behaviours (diet, smoking, physical activity, TV viewing time, and alcohol use). Measures of glucose tolerance included fasting plasma glucose and insulin and the results of a glucose tolerance test (2 h glucose) with higher levels of each indicating poorer glucose tolerance. Triglycerides and High Density Lipoprotein (HDL) Cholesterol were used as measures of dyslipidaemia with higher levels of the former and lower levels of the later being associated with CVD risk. Lower education and low income were associated with higher levels of fasting insulin, triglycerides and waist circumference in women. Women with low education had higher systolic and diastolic BP and low income women had higher 2 h glucose and lower HDL cholesterol. With only one exception (low income and systolic BP), all of these estimates were reduced by more than 20% when behavioural risk factors were included. Men with lower education had higher fasting plasma glucose, 2 h glucose, waist circumference and systolic BP and, with the exception of waist circumference, all of these estimates were reduced when health behaviours were included in the models. While low income was associated with higher levels of 2-h glucose and triglycerides it was also associated with better biomarker profiles including lower insulin, waist circumference and diastolic BP. We conclude that low socioeconomic position is more consistently associated with a worse profile of biomarkers for CVD and diabetes for women (19) KLEIN WOOLTHUIS EP, DE GRAUW WJ, VAN WC. Opportunistic screening for type 2 diabetes in primary care. Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.683-684 http://dx.doi.org/10.1016/S0140-6736(10)61332-3 (accès réservé EHESP) (20) LAMIA KA, EVANS RM. Metabolism: Tick, tock, a beta-cell clock. Nature. 2010 July 29, vol. 466, n° 7306, pp.571-572 http://dx.doi.org/10.1038/466571a (accès payant) (21) LEDFORD H. Diabetes drugs offered fresh start. Nature. 2010 July 22, vol. 466, n° 7305, pp.420-421 http://dx.doi.org/10.1038/466420a (accès payant) (22) LEHMAN R, YUDKIN JS, KRUMHOLZ H. Licensing drugs for diabetes. BMJ. 2010, vol. 341, p.c4805http://www.ncbi.nlm.nih.gov/pubmed/20819887 (accès réservé EHESP) Service de Documentation EHESP 11 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (23) LENTINE KL, SCHNITZLER MA, XIAO H, SAAB G, et al. Racial variation in medical outcomes among living kidney donors. N Engl J Med. 2010 Aug. 19, vol. 363, n° 8, pp.724-732 http://dx.doi.org/10.1056/NEJMoa1000950 (accès libre, collection papier de la bibliothèque) BACKGROUND: Data regarding health outcomes among living kidney donors are lacking, especially among nonwhite persons. METHODS: We linked identifiers from the Organ Procurement and Transplantation Network (OPTN) with administrative data of a private U.S. health insurer and performed a retrospective study of 4650 persons who had been living kidney donors from October 1987 through July 2007 and who had post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007. We ascertained post-nephrectomy medical diagnoses and conditions requiring medical treatment from billing claims. Cox regression analyses with left and right censoring to account for observed periods of insurance benefits were used to estimate absolute prevalence and prevalence ratios for diagnoses after nephrectomy. We then compared prevalence patterns with those in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) for the general population. RESULTS: Among the donors, 76.3% were white, 13.1% black, 8.2% Hispanic, and 2.4% another race or ethnic group. The median time from donation to the end of insurance benefits was 7.7 years. After kidney donation, black donors, as compared with white donors, had an increased risk of hypertension (adjusted hazard ratio, 1.52; 95% confidence interval [CI], 1.23 to 1.88), diabetes mellitus requiring drug therapy (adjusted hazard ratio, 2.31; 95% CI, 1.33 to 3.98), and chronic kidney disease (adjusted hazard ratio, 2.32; 95% CI, 1.48 to 3.62); findings were similar for Hispanic donors. The absolute prevalence of diabetes among all donors did not exceed that in the general population, but the prevalence of hypertension exceeded NHANES estimates in some subgroups. End-stage renal disease was identified in less than 1% of donors but was more common among black donors than among white donors. CONCLUSIONS: As in the general U.S. population, racial disparities in medical conditions occur among living kidney donors. Increased attention to health outcomes among demographically diverse kidney donors is needed. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.) (24) LUAN FL. Effect of valsartan on the incidence of diabetes. N Engl J Med. 2010 Aug. 19, vol. 363, n° 8, pp.792-793 http://dx.doi.org/10.1056/NEJMc1005899 (accès libre, collection papier de la bibliothèque) (25) LUFT HS, EATON LJ. Physician cost profiling. N Engl J Med. 2010 July 29, vol. 363, n° 5, pp.491-493 http://dx.doi.org/10.1056/NEJMc1004716 (accès libre, collection papier de la bibliothèque) (26) MAGEE C, GOENKA N, KERRIGAN D. Nutrition in type 2 diabetes. Metabolic surgery may be more effective. BMJ. 2010, vol. 341, p.c4446 http://www.ncbi.nlm.nih.gov/pubmed/20724409 (accès réservé EHESP) (27) MANN J, AUNE D. Can specific fruits and vegetables prevent diabetes? BMJ. 2010, vol. 341, p.c4395 http://www.ncbi.nlm.nih.gov/pubmed/20724401 (accès réservé EHESP) (28) MARCHEVA B, RAMSEY KM, BUHR ED, KOBAYASHI Y, et al. Disruption of the clock components CLOCK and BMAL1 leads to hypoinsulinaemia and diabetes. Nature. 2010 July 29, vol. 466, n° 7306, pp.627-631 http://dx.doi.org/10.1038/nature09253 (accès payant) The molecular clock maintains energy constancy by producing circadian oscillations of ratelimiting enzymes involved in tissue metabolism across the day and night. During periods of feeding, pancreatic islets secrete insulin to maintain glucose homeostasis, and although rhythmic control of insulin release is recognized to be dysregulated in humans with diabetes, it is not known how the circadian clock may affect this process. Here we show that pancreatic islets possess selfsustained circadian gene and protein oscillations of the transcription factors CLOCK and BMAL1. The phase of oscillation of islet genes involved in growth, glucose metabolism and insulin Service de Documentation EHESP 12 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 signalling is delayed in circadian mutant mice, and both Clock and Bmal1 (also called Arntl) mutants show impaired glucose tolerance, reduced insulin secretion and defects in size and proliferation of pancreatic islets that worsen with age. Clock disruption leads to transcriptome-wide alterations in the expression of islet genes involved in growth, survival and synaptic vesicle assembly. Notably, conditional ablation of the pancreatic clock causes diabetes mellitus due to defective beta-cell function at the very latest stage of stimulus-secretion coupling. These results demonstrate a role for the beta-cell clock in coordinating insulin secretion with the sleep-wake cycle, and reveal that ablation of the pancreatic clock can trigger the onset of diabetes mellitus (29) MAYOR S. NICE approves liraglutide for diabetic patients not achieving glucose control. BMJ. 2010, vol. 341, p.c5062 http://www.ncbi.nlm.nih.gov/pubmed/20843934 (accès réservé EHESP) (30) PERKINS WJ, JR. Combination lipid therapy in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.694-695 http://www.ncbi.nlm.nih.gov/pubmed/20842773 (accès libre, collection papier de la bibliothèque) (31) PIERCE BL, AHSAN H. Clinical assessment incorporating a personal genome. Lancet. 2010 Sept. 11, vol. 376, n° 9744, pp.869-870 http://dx.doi.org/10.1016/S0140-6736(10)61404-3 (accès réservé EHESP) (32) ROSEN CJ. Revisiting the rosiglitazone story--lessons learned. N Engl J Med. 2010 Aug. 26, vol. 363, n° 9, pp.803-806 http://dx.doi.org/10.1056/NEJMp1008233 (accès libre, collection papier de la bibliothèque) (33) SACKS FM, CAREY VJ, FRUCHART JC. Combination lipid therapy in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.692-694 http://www.ncbi.nlm.nih.gov/pubmed/20842772 (accès libre, collection papier de la bibliothèque) (34) SAELY CH, REIN P, DREXEL H. Combination lipid therapy in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.692-695 http://dx.doi.org/10.1056/NEJMc1006407 (accès libre, collection papier de la bibliothèque) (35) SCHRIER RW. Blood pressure control in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.696-697 http://www.ncbi.nlm.nih.gov/pubmed/20842783 (accès libre, collection papier de la bibliothèque) (36) SKOLNIK N. Guidelines for glycemic control and individualized targets. JAMA. 2010 Sept. 8, vol. 304, n° 10, pp.1069-1070 http://dx.doi.org/10.1001/jama.2010.1257 (accès réservé EHESP) (37) SOLOMON SD, UNO H, LEWIS EF, ECKARDT KU, et al. Erythropoietic response and outcomes in kidney disease and type 2 diabetes. N Engl J Med. 2010 Sept. 16, vol. 363, n° 12, pp.1146-1155 http://dx.doi.org/10.1056/NEJMoa1005109 (accès libre, collection papier de la bibliothèque) BACKGROUND: Non-placebo-controlled trials of erythropoiesis-stimulating agents (ESAs) comparing lower and higher hemoglobin targets in patients with chronic kidney disease indicate Service de Documentation EHESP 13 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 that targeting of a lower hemoglobin range may avoid ESA-associated risks. However, targetbased strategies are confounded by each patient's individual hematopoietic response. METHODS: We assessed the relationship among the initial hemoglobin response to darbepoetin alfa after two weight-based doses, the hemoglobin level achieved after 4 weeks, the subsequent darbepoetin alfa dose, and outcomes in 1872 patients with chronic kidney disease and type 2 diabetes mellitus who were not receiving dialysis. We defined a poor initial response to darbepoetin alfa (which occurred in 471 patients) as the lowest quartile of percent change in hemoglobin level (<2%) after the first two standardized doses of the drug. RESULTS: Patients who had a poor initial response to darbepoetin alfa had a lower average hemoglobin level at 12 weeks and during follow-up than did patients with a better hemoglobin response (a change in hemoglobin level ranging from 2 to 15% or more) (P<0.001 for both comparisons), despite receiving higher doses of darbepoetin alfa (median dose, 232 mug vs. 167 mug; P<0.001). Patients with a poor response, as compared with those with a better response, had higher rates of the composite cardiovascular end point (adjusted hazard ratio, 1.31; 95% confidence interval [CI], 1.09 to 1.59) or death (adjusted hazard ratio, 1.41; 95% CI, 1.12 to 1.78). CONCLUSIONS: A poor initial hematopoietic response to darbepoetin alfa was associated with an increased subsequent risk of death or cardiovascular events as doses were escalated to meet target hemoglobin levels. Although the mechanism of this differential effect is not known, these findings raise concern about current target-based strategies for treating anemia in patients with chronic kidney disease. (Funded by Amgen; ClinicalTrials.gov number, NCT00093015.) (38) SYKES RA. Nutrition in type 2 diabetes. Individual dietary intervention is cost effective. BMJ. 2010, vol. 341, p.c4443 http://www.ncbi.nlm.nih.gov/pubmed/20724407 (accès réservé EHESP) (39) VILES J, MONTE D, GAWKRODGER DJ. Vitiligo. BMJ. 2010, vol. 341, p.c3780 http://www.ncbi.nlm.nih.gov/pubmed/20729269 (accès réservé EHESP) (40) VILLEGAS R, YANG G, GAO YT, CAI H, et al. Dietary patterns are associated with lower incidence of type 2 diabetes in middle-aged women: the Shanghai Women's Health Study . Int J Epidemiol. 2010 June, vol. 39, n° 3, pp.889-899 http://dx.doi.org/10.1093/ije/dyq008 (accès réservé EHESP) BACKGROUND: Data linking risk of type 2 diabetes (T2D) and dietary patterns in Chinese populations are scarce. METHODS: A population-based prospective study of 64,191 middle-aged women in urban Shanghai, China, who were free of T2D and other chronic diseases at study recruitment, was conducted. Dietary intake, physical activity and anthropometric measurements were assessed through in-person interviews. Dietary patterns were assessed by using K-means cluster analysis. Cox regression model was used to evaluate the association of dietary patterns with the risk of T2D. RESULTS: We identified three dietary clusters in this population. Cluster 1 (56.3%; N = 36,159) had the highest intake of staples, cluster 2 (40.4%: N = 25,948) had the highest intake of dairy milk, and cluster 3 (2.9%; N = 1843) had the highest energy intake. Participants in cluster 2 had lower prevalence of obesity, central obesity and hypertension at baseline. Using cluster 1 as the reference, participants in cluster 2 had a lower incidence of T2D after 6.9 years of follow-up [relative risk (RR) 0.78; 95% confidence interval (CI) 0.71-0.86]. The RR for the incidence of T2D for cluster 3 compared with cluster 1 was 1.05 (95% CI 0.81-1.35). The association was not modified by age category, body mass index category, waist-to-hip ratio category or exercise participation. CONCLUSIONS: We identified and characterized dietary patterns in middle-aged Chinese women by using cluster analysis. We identified a dietary pattern low in staple foods and high in dairy milk, which was associated with lower risk of T2D. Study of dietary patterns will help elucidate links between diet and disease, and contribute to the development of healthy eating guidelines for health promotion (41) WETZELS JF. Blood pressure control in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, p.695 http://dx.doi.org/10.1056/NEJMc1006411 (accès libre, collection papier de la bibliothèque) Service de Documentation EHESP 14 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (42) YUEN MM, TAM TC, LAU WW, CHAN JF, et al. An "unforeseen" complication of urinary tract infection in a patient with diabetes. BMJ. 2010, vol. 341, p.c3073 http://www.ncbi.nlm.nih.gov/pubmed/20719842 (accès réservé EHESP) (43) ZHANG X, SHU XO, XIANG YB, YANG G, et al. Resting heart rate and risk of type 2 diabetes in women. Int J Epidemiol. 2010 June, vol. 39, n° 3, pp.900-906 http://dx.doi.org/10.1093/ije/dyq068 (accès réservé EHESP) BACKGROUND: Resting heart rate has been shown to predict risk of cardiovascular disease; its association with diabetes remains unclear, particularly in non-Western populations. METHODS: We evaluated the association between resting heart rate and risk of type 2 diabetes in the Shanghai Women's Health Study, a population-based prospective cohort study. The analysis included 47 571 Chinese women with no prior history of diabetes, cancer, cardiovascular disease or thyroid dysfunction at the time when resting heart rate was measured. Incident diabetes was ascertained through biennial in-person interviews. RESULTS: During a mean follow-up of 4.9 years, 849 women developed type 2 diabetes. For heart rate categories of < or =68, 69-72, 73-76, 77-80 and >80 beats/min, the incidence rates of diabetes per 1000 person-years were 2.91, 3.31, 3.71, 4.16 and 5.34, respectively. The multivariable-adjusted hazard ratios (HRs) [95% confidence intervals (CIs)] for diabetes across increasing heart rate categories were 1, 1.21 (0.99-1.47), 1.30 (1.05-1.62), 1.37 (1.12-1.69) and 1.60 (1.28-2.00), respectively. Further analyses of the joint effects of heart rate with body mass index (BMI), waist-hip ratio (WHR) and blood pressure (BP) showed increased risk of diabetes with increasing heart rate in all categories of BMI, WHR or BP. The combinations of the highest heart rate category with highest BMI, WHR or BP category were associated with the highest HRs, ranging from 4.81 to 6.34. CONCLUSIONS: A high resting heart rate is independently associated with an increased risk of type 2 diabetes in women. The combinations of high heart rate with high BMI, WHR or BP level are associated with a substantially increased risk Dépression sommaire (1) ARANA A, WENTWORTH CE, YUSO-MATEOS JL, ARELLANO FM. Suicide-related events in patients treated with antiepileptic drugs. N Engl J Med. 2010 Aug. 5, vol. 363, n° 6, pp.542-551 http://dx.doi.org/10.1056/NEJMoa0909801 (accès libre, collection papier de la bibliothèque) BACKGROUND: A previous meta-analysis of data from clinical trials showed an association between antiepileptic drugs and suicidality (suicidal ideation, behavior, or both). We used observational data to examine the association between the use or nonuse of antiepileptic drugs and suicide-related events (attempted suicides and completed suicides) in patients with epilepsy, depression, or bipolar disorder. METHODS: We used data collected as part of the clinical care of patients who were representative of the general population in the United Kingdom to identify patients with epilepsy, depression, or bipolar disorder and to determine whether they received antiepileptic drugs. We estimated the incidence rate of suicide-related events and used logistic regression to compute odds ratios, controlling for confounding factors. RESULTS: In a cohort of 5,130,795 patients, the incidence of suicide-related events per 100,000 person-years was 15.0 (95% confidence interval [CI], 14.6 to 15.5) among patients without epilepsy, depression, bipolar disorder, or antiepileptic-drug treatment, 38.2 (95% CI, 26.3 to 53.7) among patients with epilepsy who did not receive antiepileptic drugs, and 48.2 (95% CI, 39.4 to 58.5) among patients with epilepsy who received antiepileptic drugs. In adjusted analyses, the use of antiepileptic drugs was not associated with an increased risk of suicide-related events among patients with epilepsy (odds ratio, 0.59; 95% CI, 0.35 to 0.98) or bipolar disorder (1.13; 95% CI, 0.35 to 3.61) but was significantly associated with an increased risk among patients with depression (1.65; 95% CI, 1.24 to 2.19) and those who did not have epilepsy, depression, or bipolar disorder (2.57; 95% CI, 1.78 to 3.71). CONCLUSIONS: The current use of antiepileptic drugs was not associated with an increased risk of suicide-related events among patients with epilepsy, but it was associated with an increased risk of such events among patients with depression and among those who did not have epilepsy, depression, or bipolar disorder Service de Documentation EHESP 15 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (2) CISLO AM, SPENCE NJ, GAYMAN MD. The mental health and psychosocial adjustment of Cuban immigrants in south Florida . Soc Sci Med. 2010 Sept., vol. 71, n° 6, pp.1173-1181 http://dx.doi.org/10.1016/j.socscimed.2010.06.001 (accès réservé EHESP) Given documented variation in pre-migration and migration-related experiences, Cuban immigrants in the U.S. who arrived during or subsequent to 1980 may be disadvantaged in mental health and psychosocial adjustment relative to earlier arrivals. Using wave 1 of the Physical Challenge and Health study, we compare earlier and later arriving immigrants in levels of depression, anxiety, and self-esteem and test whether adversity and social support, acculturationrelated factors, or pre-migration conditions account for any differences observed among a sample of adults living in South Florida (N = 191). Bivariate analyses reveal that later arrivals are relatively disadvantaged in anxiety and self-esteem and marginally so in depression. While later arrivals do not report more adversity in the U.S., they have lower levels of family support to cope with any adversity experienced. Later arrivals are also less likely to interview in English or to have a strong American identity, and they were more likely to have arrived as adults. Relative disadvantages in anxiety and self-esteem are best explained by indicators of acculturation and family support. Policies and programs that address acculturation difficulties and increase family support could improve the health and adjustment of these and similar immigrants (3) COYNE JC. Preventing dementia. Targeting depressive symptoms is unlikely to help. BMJ. 2010, vol. 341, p.c4697 http://www.ncbi.nlm.nih.gov/pubmed/20823016 (accès réservé EHESP) (4) DYRBYE LN, MASSIE FS, JR., EACKER A, HARPER W, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010 Sept. 15, vol. 304, n° 11, pp.1173-1180 http://dx.doi.org/10.1001/jama.2010.1318 (accès réservé EHESP) CONTEXT: The relationship between professionalism and distress among medical students is unknown. OBJECTIVE: To determine the relationship between measures of professionalism and burnout among US medical students. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of all medical students attending 7 US medical schools (overall response rate, 2682/4400 [61%]) in the spring of 2009. The survey included the Maslach Burnout Inventory (MBI), the PRIME-MD depression screening instrument, and the SF-8 quality of life (QOL) assessment tool, as well as items exploring students' personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, and attitudes regarding physicians' responsibility to society. MAIN OUTCOME MEASURES: Frequency of self-reported cheating/dishonest behaviors, understanding of appropriate relationships with industry as defined by American Medical Association policy, attitudes about physicians' responsibility to society, and the relationship of these dimensions of professionalism to burnout, symptoms of depression, and QOL. RESULTS: Of the students who responded to all the MBI items, 1354 of 2566 (52.8%) had burnout. Cheating/dishonest academic behaviors were rare (endorsed by <10%) in comparison to unprofessional conduct related to patient care (endorsed by up to 43%). Only 14% (362/2531) of students had opinions on relationships with industry consistent with guidelines for 6 scenarios. Students with burnout were more likely to report engaging in 1 or more unprofessional behaviors than those without burnout (35.0% vs 21.9%; odds ratio [OR], 1.89; 95% confidence interval [CI], 1.59-2.24). Students with burnout were also less likely to report holding altruistic views regarding physicians' responsibility to society. For example, students with burnout were less likely to want to provide care for the medically underserved than those without burnout (79.3% vs 85.0%; OR, 0.68; 95% CI, 0.55-0.83). After multivariable analysis adjusting for personal and professional characteristics, burnout was the only aspect of distress independently associated with reporting 1 or more unprofessional behaviors (OR, 1.76; 95% CI, 1.45-2.13) or holding at least 1 less altruistic view regarding physicians' responsibility to society (OR, 1.65; 95% CI, 1.35-2.01). CONCLUSION: Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools (5) HOU B, JIANG T, LIU R. Deep-brain stimulation for Parkinson's disease. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, pp.987-988 http://www.ncbi.nlm.nih.gov/pubmed/20830819 (accès libre, collection papier de la Service de Documentation EHESP 16 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 bibliothèque) (6) JEWKES R. Emotional abuse: a neglected dimension of partner violence. Lancet. 2010 Sept. 11, vol. 376, n° 9744, pp.851-852 http://dx.doi.org/10.1016/S0140-6736(10)61079-3 (accès réservé EHESP) (7) LUDERMIR AB, LEWIS G, VALONGUEIRO SA, DE ARAUJO TV, et al. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010 Sept. 11, vol. 376, n° 9744, pp.903-910 http://dx.doi.org/10.1016/S0140-6736(10)60887-2 (accès réservé EHESP) BACKGROUND: Partner violence against women is common during pregnancy and might have an adverse effect on the mental health of women after delivery. We aimed to investigate the association of postnatal depression with psychological, physical, and sexual violence against women by their intimate partners during pregnancy. METHODS: In a prospective cohort study undertaken in Recife, northeastern Brazil, between July, 2005, and December, 2006, we enrolled pregnant women (aged 18-49 years) in their third trimester of pregnancy who were attending primary health-care clinics. The women were interviewed during pregnancy and after delivery. The form of partner violence in pregnancy was assessed with a validated questionnaire, and the Edinburgh postnatal depression scale was used to measure postnatal depression. Associations were estimated with odds ratios (ORs), adjusted for confounding factors contributing to the association between postnatal depression and intimate partner violence. FINDINGS: 1133 pregnant women were eligible for inclusion in the study, of whom 1045 had complete data for all variables and were included in the analysis. 270 women (25.8%, 95% CI 23.2-28.6) had postnatal depression. The most common form of partner violence was psychological (294 [28.1%, 25.431.0]). Frequency of psychological violence during pregnancy was positively associated with occurrence of postnatal depression, and although this association was attenuated after adjustment, women reporting the highest frequency of psychological violence were more likely to have postnatal depression even after adjustment (adjusted OR 2.29, 95% CI 1.15-4.57). Women who reported physical or sexual violence in pregnancy were more likely to develop postnatal depression (OR 3.28, 2.29-4.70), but this association was substantially reduced after adjustment for psychological violence and confounding factors. INTERPRETATION: Psychological violence during pregnancy by an intimate partner is strongly associated with postnatal depression, independently of physical or sexual violence. This finding has important policy implications since most social policies focus on prevention and treatment of physical violence. FUNDING: Departamento de Ciencia e Tecnologia da Secretaria de Ciencia, Tecnologia, e Insumos Estrategicos, and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (Brazil) (8) NAJMAN JM, HAYATBAKHSH MR, CLAVARINO A, BOR W, et al. Family poverty over the early life course and recurrent adolescent and young adult anxiety and depression: a longitudinal study. Am J Public Health. 2010 Sept., vol. 100, n° 9, pp.1719-1723 http://dx.doi.org/10.2105/AJPH.2009.180943 (accès réservé EHESP) OBJECTIVES: We determined whether exposure to family poverty over a child's early life course predicts adolescent and young adult anxiety and depression. METHODS: We used a birth cohort study of a sample of women in Brisbane, Australia, who were recruited in early pregnancy and whose children were followed up on at ages 14 and 21 years. Some 2609 mothers and adolescents provided usable data at the 14- and 21-year follow-ups. RESULTS: After adjustment for poverty at other phases, poverty at the 14-year follow-up was the strongest predictor of adolescent and young adult anxiety and depression. The more frequently the child was exposed to poverty, the greater was the risk of that individual being anxious and depressed at both the 14and 21-year follow-ups. CONCLUSIONS: Family poverty predicts higher rates of adolescent and young adult anxiety and depression. Increased frequency of child exposure to poverty is a consistent predictor of adolescent and young adult anxiety and depression. Repeated experiences of poverty over a child's early life course are associated with increased levels of poor mental health Service de Documentation EHESP 17 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (9) ROBERTS LW. Understanding depression and distress among medical students. JAMA. 2010 Sept. 15, vol. 304, n° 11, pp.1231-1233 http://dx.doi.org/10.1001/jama.2010.1347 (accès réservé EHESP) (10) SCHWENK TL, DAVIS L, WIMSATT LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010 Sept. 15, vol. 304, n° 11, pp.1181-1190u http://dx.doi.org/10.1001/jama.2010.1300 (accès réservé EHESP) CONTEXT: There is a concerning prevalence of depression and suicidal ideation among medical students, a group that may experience poor mental health care due to stigmatization. OBJECTIVE: To characterize the perceptions of depressed and nondepressed medical students regarding stigma associated with depression. DESIGN, SETTING, AND PARTICIPANTS: Crosssectional Web-based survey conducted in September-November 2009 among all students enrolled at the University of Michigan Medical School (N = 769). MAIN OUTCOME MEASURES: Prevalence of self-reported moderate to severe depression and suicidal ideation and the association of stigma perceptions with clinical and demographic variables. RESULTS: Survey response rate was 65.7% (505 of 769). Prevalence of moderate to severe depression was 14.3% (95% confidence interval [CI], 11.3%-17.3%). Women were more likely than men to have moderate to severe depression (18.0% vs 9.0%; 95% CI for difference, -14.8% to -3.1%; P = .001). Third- and fourth-year students were more likely than first- and second-year students to report suicidal ideation (7.9% vs 1.4%; 95% CI for difference, 2.7%-10.3%; P = .001). Students with moderate to severe depression, compared with no to minimal depression, more frequently agreed that "if I were depressed, fellow medical students would respect my opinions less" (56.0% vs 23.7%; 95% CI for difference, 17.3%-47.3%; P < .001), and that faculty members would view them as being unable to handle their responsibilities (83.1% vs 55.1%; 95% CI for difference, 16.1%-39.8%; P < .001). Men agreed more commonly than women that depressed students could endanger patients (36.3% vs 20.1%; 95% CI for difference, 6.1%-26.3%; P = .002). First- and second-year students more frequently agreed than third- and fourth-year students that seeking help for depression would make them feel less intelligent (34.1% vs 22.9%; 95% CI for difference, 2.3%-20.1%; P < .01). CONCLUSIONS: Depressed medical students more frequently endorsed several depression stigma attitudes than nondepressed students. Stigma perceptions also differed by sex and class year (11) SCOTT M, WILCOX H, HUO Y, TURNER JB, et al. School-based screening for suicide risk: balancing costs and benefits. Am J Public Health. 2010 Sept., vol. 100, n° 9, pp.1648-1652 http://dx.doi.org/10.2105/AJPH.2009.175224 (accès réservé EHESP) OBJECTIVES: We examined the effects of a scoring algorithm change on the burden and sensitivity of a screen for adolescent suicide risk. METHODS: The Columbia Suicide Screen was used to screen 641 high school students for high suicide risk (recent ideation or lifetime attempt and depression, or anxiety, or substance use), determined by subsequent blind assessment with the Diagnostic Interview Schedule for Children. We compared the accuracy of different screen algorithms in identifying high-risk cases. RESULTS: A screen algorithm comprising recent ideation or lifetime attempt or depression, anxiety, or substance-use problems set at moderate-severity level classed 35% of students as positive and identified 96% of high-risk students. Increasing the algorithm's threshold reduced the proportion identified to 24% and identified 92% of high-risk cases. Asking only about recent suicidal ideation or lifetime suicide attempt identified 17% of the students and 89% of high-risk cases. The proportion of nonsuicidal diagnosis-bearing students found with the 3 algorithms was 62%, 34%, and 12%, respectively. CONCLUSIONS: The Columbia Suicide Screen threshold can be altered to reduce the screen-positive population, saving costs and time while identifying almost all students at high risk for suicide (12) SINGH A, SYAL M, GRADY SC, KORKMAZ S. Effects of green buildings on employee health and productivity. Am J Public Health. 2010 Sept., vol. 100, n° 9, pp.1665-1668 http://dx.doi.org/10.2105/AJPH.2009.180687 (accès réservé EHESP) We investigated the effects of improved indoor environmental quality (IEQ) on perceived health and productivity in occupants who moved from conventional to green (according to Leadership in Service de Documentation EHESP 18 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Energy and Environmental Design ratings) office buildings. In 2 retrospective-prospective case studies we found that improved IEQ contributed to reductions in perceived absenteeism and work hours affected by asthma, respiratory allergies, depression, and stress and to self-reported improvements in productivity. These preliminary findings indicate that green buildings may positively affect public health (13) TEMEL JS, GREER JA, MUZIKANSKY A, GALLAGHER ER, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug. 19, vol. 363, n° 8, pp.733-742 http://dx.doi.org/10.1056/NEJMoa1000678 (accès libre, collection papier de la bibliothèque) BACKGROUND: Patients with metastatic non-small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease. METHODS: We randomly assigned patients with newly diagnosed metastatic non-small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records. RESULTS: Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02). CONCLUSIONS: Among patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, NCT01038271.) (14) THOMBS BD, ROSEMAN M, ARTHURS E. Prenatal and postpartum depression in fathers and mothers. JAMA. 2010 Sept. 1, vol. 304, n° 9, pp.961-962 http://dx.doi.org/10.1001/jama.2010.1238 (accès réservé EHESP) (15) THOMEE S, DELLVE L, HARENSTAM A, HAGBERG M. Perceived connections between information and communication technology use and mental symptoms among young adults - a qualitative study. BMC Public Health. 2010, vol. 10, p.66 http://dx.doi.org/10.1186/1471-2458-10-66 (accès libre) BACKGROUND: Prospective associations have been found between high use of information and communication technology (ICT) and reported mental symptoms among young adult university students, but the causal mechanisms are unclear. Our aim was to explore possible explanations for associations between high ICT use and symptoms of depression, sleep disorders, and stress among young adults in order to propose a model of possible pathways to mental health effects that can be tested epidemiologically. METHODS: We conducted a qualitative interview study with 16 women and 16 men (21-28 years), recruited from a cohort of university students on the basis of reporting high computer (n = 28) or mobile phone (n = 20) use at baseline and reporting mental symptoms at the one-year follow-up. Semi-structured interviews were performed, with open-ended questions about possible connections between the use of computers and mobile phones, and stress, depression, and sleep disturbances. The interview data were analyzed with qualitative content analysis and summarized in a model. RESULTS: Central factors appearing to explain high quantitative ICT use were personal dependency, and demands for achievement and availability originating from the domains of work, study, social life, and individual aspirations. Consequences Service de Documentation EHESP 19 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 included mental overload, neglect of other activities and personal needs, time pressure, role conflicts, guilt feelings, social isolation, physical symptoms, worry about electromagnetic radiation, and economic problems. Qualitative aspects (destructive communication and information) were also reported, with consequences including vulnerability, misunderstandings, altered values, and feelings of inadequacy. User problems were a source of frustration. Altered ICT use as an effect of mental symptoms was reported, as well as possible positive effects of ICT on mental health. CONCLUSIONS: The concepts and ideas of the young adults with high ICT use and mental symptoms generated a model of possible paths for associations between ICT exposure and mental symptoms. Demands for achievement and availability as well as personal dependency were major causes of high ICT exposure but also direct sources of stress and mental symptoms. The proposed model shows that factors in different domains may have an impact and should be considered in epidemiological and intervention studies (16) VATTAKATUCHERY JJ, JOY J. Hyperintensities on MRI. White matter and depression. BMJ. 2010, vol. 341, p.c4611 http://www.ncbi.nlm.nih.gov/pubmed/20736280 (accès réservé EHESP)(accès réservé EHESP) Grippe A sommaire (1) Pandemic influenza--(some) reasons to be cheerful? Lancet. 2010 Aug. 21, vol. 376, n° 9741, p.565 http://dx.doi.org/10.1016/S0140-6736(10)61277-9 (accès réservé EHESP) (2) BELONGIA EA, IRVING SA, WARING SC, COLEMAN LA, et al. Clinical characteristics and 30day outcomes for influenza A 2009 (H1N1), 2008-2009 (H1N1), and 2007-2008 (H3N2) infections. JAMA. 2010 Sept. 8, vol. 304, n° 10, pp.1091-1098 http://dx.doi.org/10.1001/jama.2010.1277 (accès réservé EHESP) CONTEXT: The clinical characteristics of pandemic 2009 influenza A(H1N1) infections have not been compared directly with illnesses caused by other influenza A strains. OBJECTIVE: To compare clinical features and outcomes for 2009 H1N1, seasonal H1N1, and H3N2 influenza in a population-based cohort. DESIGN, SETTING, AND PARTICIPANTS: Active surveillance with 30day follow-up for influenza cases among children and adults living in a 14-zip code area in Wisconsin. Patients with subjective fever, chills, or cough of fewer than 8 days' duration were screened for eligibility during an outpatient or inpatient encounter. Consenting patients were interviewed and tested for influenza A during the 2007-2008 and 2008-2009 influenza seasons and from May to November 2009; 6874 patients (70%-86% of eligible patients) agreed to participate. Medical records were reviewed to assess outcomes. MAIN OUTCOME MEASURES: Hospital admission, radiographically confirmed pneumonia, and clinical characteristics of influenza A by strain. RESULTS: We identified 545 2009 H1N1, 221 seasonal H1N1, and 632 H3N2 infections. The median ages of infected participants were 10, 11, and 25 years, respectively (P < .001). Hospital admission occurred within 30 days for 6 of 395 children with 2009 H1N1 (1.5%; 95% confidence interval [CI], 0.6%-3.1%), 5 of 135 with seasonal H1N1 (3.7%; 95% CI, 1.4%8.0%), and 8 of 255 with H3N2 (3.1%; 95% CI, 1.5%-5.9%). Among adults, hospital admission occurred in 6 of 150 with 2009 H1N1 (4.0%; 95% CI, 1.6%-8.1%), 2 of 86 with seasonal H1N1 (2.3%; 95% CI, 0.3%-8.1%), and 17 of 377 with H3N2 (4.5%; 95% CI, 2.7%-7.0%). Pneumonia occurred in 10 children with 2009 H1N1 (2.5%; 95% CI, 1.3%-4.5%), 2 with seasonal H1N1 (1.5%; 95% CI, 0.2%-5.2%), and 5 with H3N2 (2.0%; 95% CI, 0.7%-4.3%). Among adults, pneumonia occurred in 6 with 2009 H1N1 (4.0%; 95% CI, 1.6%-8.1%), 2 with seasonal H1N1 (2.3%; 95% CI, 0.3%-8.1%), and 4 with H3N2 (1.1%; 95% CI, 0.3%-2.7%). CONCLUSIONS: In this population, individuals with 2009 H1N1 infection were younger than those with H3N2. The risk of most serious complications was not elevated in adults or children with 2009 H1N1 compared with recent seasonal strains Service de Documentation EHESP 20 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (3) BIRD SM. Like-with-like comparisons? Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.684-685 http://dx.doi.org/10.1016/S0140-6736(10)61333-5 (accès réservé EHESP) (4) DOMS RW. Immunology. Prime, boost, and broaden. Science. 2010 Aug. 27, vol. 329, n° 5995, pp.1021-1022 http://dx.doi.org/10.1126/science.1195116 (accès réservé EHESP) (5) GESUALDO F, ROMANO M, PANDOLFI E, RIZZO C, et al. Surfing the web during pandemic flu: availability of World Health Organization recommendations on prevention. BMC Public Health. 2010 Sept. 20, vol. 10, n° 1, p.561 http://dx.doi.org/10.1186/1471-2458-10-561 (accès libre) ABSTRACT: BACKGROUND: People often search for information on influenza A(H1N1)v prevention on the web. The extent to which information found on the Internet is consistent with recommendations issued by the World Health Organization is unknown. METHODS: We conducted a search for "swine flu" accessing 3 of the most popular search engines through different proxy servers located in 4 English-speaking countries (Australia, Canada, UK, USA). We explored each site resulting from the searches, up to 4 clicks starting from the search engine page, analyzing availability of World Health Organization recommendations for swine flu prevention. RESULTS: Information on hand cleaning was reported on 79% of the 147 websites analyzed; staying home when sick was reported on 77.5% of the websites; disposing tissues after sneezing on 75.5% of the websites. Availability of other recommendations was lower. The probability of finding preventative recommendations consistent with World Health Organization varied by country, type of website, and search engine. CONCLUSIONS: Despite media coverage on H1N1 influenza, relevant information for prevention is not easily found on the web. Strategies to improve information delivery to the general public through this channel should be improved (6) WEI CJ, BOYINGTON JC, MCTAMNEY PM, KONG WP, et al. Induction of broadly neutralizing H1N1 influenza antibodies by vaccination. Science. 2010 Aug. 27, vol. 329, n° 5995, pp.10601064 http://dx.doi.org/10.1126/science.1192517 (accès réservé EHESP) The rapid dissemination of the 2009 pandemic influenza virus underscores the need for universal influenza vaccines that elicit protective immunity to diverse viral strains. Here, we show that vaccination with plasmid DNA encoding H1N1 influenza hemagglutinin (HA) and boosting with seasonal vaccine or replication-defective adenovirus 5 vector encoding HA stimulated the production of broadly neutralizing influenza antibodies. This prime/boost combination increased the neutralization of diverse H1N1 strains dating from 1934 to 2007 as compared to either component alone and conferred protection against divergent H1N1 viruses in mice and ferrets. These antibodies were directed to the conserved stem region of HA and were also elicited in nonhuman primates. Cross-neutralization of H1N1 subtypes elicited by this approach provides a basis for the development of a universal influenza vaccine for humans (7) YU H, LIAO Q, YUAN Y, ZHOU L, et al. Effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1: opportunistic retrospective study of medical charts in China. BMJ. 2010, vol. 341, p.c4779 http://www.ncbi.nlm.nih.gov/pubmed/20876641 (accès réservé EHESP) OBJECTIVE: To describe the clinical features and effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A(H1N1) virus infection. DESIGN: Opportunistic retrospective review of medical charts of patients with confirmed 2009 H1N1 identified through the national surveillance system in China from May to July 2009. SETTING: Under coordination of the Ministry of Health, local health departments were asked to collect medical records of confirmed patients and send them to the Chinese Centre for Disease Control and Prevention on a voluntary basis as part of the public health response. Population 1291 patients with confirmed 2009 H1N1 infection and available data for chart review. MAIN OUTCOME MEASURES: Demographic characteristics, comorbidities, symptoms and signs, Service de Documentation EHESP 21 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 laboratory tests, findings on chest radiography, antiviral treatment, duration of fever, and duration of viral RNA shedding. RESULTS: The median age of 1291 patients was 20 years (interquartile range 12-26); 701 (54%) were male. The most common symptoms were fever (820, 64%), cough (864, 67%), sore throat (425, 33%), sputum (239, 19%), and rhinorrhoea (228, 18%). Of 920 patients who underwent chest radiography, 110 (12%) had abnormal findings consistent with pneumonia. Some 983 (76%) patients were treated with oseltamivir from a median of the third day of symptoms (2-4). No patients required admission to the intensive care unit or mechanical ventilation. 2009 H1N1 was shed from one day before onset of symptoms to up to eight days after onset in most (91%) patients, with a median of 5 (3-6) days of shedding after onset. Treatment with oseltamivir significantly protected against subsequent development of radiographically confirmed pneumonia (odds ratio 0.12, 95% confidence interval 0.08 to 0.18), and treatment started within two days of symptom onset reduced the duration of fever and viral RNA shedding. CONCLUSIONS: Chinese patients with 2009 H1N1 infection predominantly presented with features of uncomplicated, self limiting acute respiratory illness. 2009 H1N1 might be shed longer than seasonal influenza virus. Treatment with oseltamivir was associated with a significantly reduced development of radiographically confirmed pneumonia and a shorter duration of fever and viral RNA shedding. Though these patients benefited from treatment, the findings should be interpreted with caution as the study was retrospective and not all patients underwent chest radiography Maladies d’Alzheimer sommaire (1) Why are drug trials in Alzheimer's disease failing? Lancet. 2010 Aug. 28, vol. 376, n° 9742, p.658 http://dx.doi.org/10.1016/S0140-6736(10)61316-5 (accès réservé EHESP) (2) GEORGE DR. Overcoming the social death of dementia through language. Lancet. 2010 Aug. 21, vol. 376, n° 9741, pp.586-587 http://www.ncbi.nlm.nih.gov/pubmed/20734467 (accès réservé EHESP) (3) HE G, LUO W, LI P, REMMERS C, et al. Gamma-secretase activating protein is a therapeutic target for Alzheimer's disease. Nature. 2010 Sept. 2, vol. 467, n° 7311, pp.95-98 http://dx.doi.org/10.1038/nature09325 (accès payant) Accumulation of neurotoxic amyloid-beta is a major hallmark of Alzheimer's disease. Formation of amyloid-beta is catalysed by gamma-secretase, a protease with numerous substrates. Little is known about the molecular mechanisms that confer substrate specificity on this potentially promiscuous enzyme. Knowledge of the mechanisms underlying its selectivity is critical for the development of clinically effective gamma-secretase inhibitors that can reduce amyloid-beta formation without impairing cleavage of other gamma-secretase substrates, especially Notch, which is essential for normal biological functions. Here we report the discovery of a novel gammasecretase activating protein (GSAP) that drastically and selectively increases amyloid-beta production through a mechanism involving its interactions with both gamma-secretase and its substrate, the amyloid precursor protein carboxy-terminal fragment (APP-CTF). GSAP does not interact with Notch, nor does it affect its cleavage. Recombinant GSAP stimulates amyloid-beta production in vitro. Reducing GSAP concentrations in cell lines decreases amyloid-beta concentrations. Knockdown of GSAP in a mouse model of Alzheimer's disease reduces levels of amyloid-beta and plaque development. GSAP represents a type of gamma-secretase regulator that directs enzyme specificity by interacting with a specific substrate. We demonstrate that imatinib, an anticancer drug previously found to inhibit amyloid-beta formation without affecting Notch cleavage, achieves its amyloid-beta-lowering effect by preventing GSAP interaction with the gamma-secretase substrate, APP-CTF. Thus, GSAP can serve as an amyloid-beta-lowering therapeutic target without affecting other key functions of gamma-secretase Service de Documentation EHESP 22 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (4) LEDFORD H. Key Alzheimer's findings questioned. Nature. 2010 Aug. 26, vol. 466, n° 7310, p.1031 http://dx.doi.org/10.1038/4661031a (accès payant) (5) ST GEORGE-HYSLOP P, SCHMITT-ULMS G. Alzheimer's disease: Selectively tuning gamma-secretase. Nature. 2010 Sept. 2, vol. 467, n° 7311, pp.36-37 http://dx.doi.org/10.1038/467036a (accès payant) Maladies cardio-vasculaires sommaire (1) AITHAL JK, ULRICH M. Images in clinical medicine. Subclavian steal syndrome. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, p.e15 http://www.ncbi.nlm.nih.gov/pubmed/20830823 ( accès libre, collection papier de la bibliothèque) (2) BENCK U, KRUGER B, KRAMER BK. Blood pressure control in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, p.696 http://www.ncbi.nlm.nih.gov/pubmed/20842775 (accès libre, collection papier de la bibliothèque) (3) BERGER K, EVERS S. Migraine with aura and the risk of increased mortality. BMJ. 2010, vol. 341, p.c4410 http://www.ncbi.nlm.nih.gov/pubmed/20736272 (accès réservé EHESP) (4) BHATT DL, EAGLE KA, OHMAN EM, HIRSCH AT, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010 Sept. 22, vol. 304, n° 12, pp.1350-1357 http://dx.doi.org/10.1001/jama.2010.1322 (accès réservé EHESP) CONTEXT: Clinicians and trialists have difficulty with identifying which patients are highest risk for cardiovascular events. Prior ischemic events, polyvascular disease, and diabetes mellitus have all been identified as predictors of ischemic events, but their comparative contributions to future risk remain unclear. OBJECTIVE: To categorize the risk of cardiovascular events in stable outpatients with various initial manifestations of atherothrombosis using simple clinical descriptors. DESIGN, SETTING, AND PATIENTS: Outpatients with coronary artery disease, cerebrovascular disease, or peripheral arterial disease or with multiple risk factors for atherothrombosis were enrolled in the global Reduction of Atherothrombosis for Continued Health (REACH) Registry and were followed up for as long as 4 years. Patients from 3647 centers in 29 countries were enrolled between 2003 and 2004 and followed up until 2008. Final database lock was in April 2009. MAIN OUTCOME MEASURES: Rates of cardiovascular death, myocardial infarction, and stroke. RESULTS: A total of 45,227 patients with baseline data were included in this 4-year analysis. During the follow-up period, a total of 5481 patients experienced at least 1 event, including 2315 with cardiovascular death, 1228 with myocardial infarction, 1898 with stroke, and 40 with both a myocardial infarction and stroke on the same day. Among patients with atherothrombosis, those with a prior history of ischemic events at baseline (n = 21,890) had the highest rate of subsequent ischemic events (18.3%; 95% confidence interval [CI], 17.4%-19.1%); patients with stable coronary, cerebrovascular, or peripheral artery disease (n = 15,264) had a lower risk (12.2%; 95% CI, 11.4%-12.9%); and patients without established atherothrombosis but with risk factors only (n = 8073) had the lowest risk (9.1%; 95% CI, 8.3%-9.9%) (P < .001 for all comparisons). In addition, in multivariable modeling, the presence of diabetes (hazard ratio [HR], 1.44; 95% CI, 1.36-1.53; P < .001), an ischemic event in the previous year (HR, 1.71; 95% CI, 1.57-1.85; P < .001), and polyvascular disease (HR, 1.99; 95% CI, 1.78-2.24; P < .001) each were associated with a significantly higher risk of the primary end point. CONCLUSION: Clinical descriptors can assist clinicians in identifying high-risk patients within the broad range of risk for outpatients with atherothrombosis Service de Documentation EHESP 23 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (5) GINATH S, GOLAN A. Images in clinical medicine. Gestational pituitary-tumor apoplexy. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, p.e10 http://www.ncbi.nlm.nih.gov/pubmed/20842779 (accès libre, collection papier de la bibliothèque) (6) GRUENEWALD TL, COHEN S, MATTHEWS KA, TRACY R, et al. Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Soc Sci Med. 2009 Aug., vol. 69, n° 3, pp.451-459 http://dx.doi.org/10.1016/j.socscimed.2009.05.018 (accès réservé EHESP) Inflammatory processes are implicated in a number of diseases for which there are known socioeconomic status (SES) disparities, including heart disease and diabetes. Growing evidence also suggests SES gradients in levels of peripheral blood markers of inflammation. However, we know little about potential gender and racial/ethnic differences in associations between SES and inflammation, despite the fact that the burden of inflammation-related diseases varies by gender and race. The present study examines SES (education and income) gradients in levels of two inflammatory biomarkers, C-reactive protein (CRP) and interleukin-6 (IL-6), in a biethnic (White and Black) sample of men and women (n=3549, aged 37-55 years) in the USA from the CARDIA Study. Health status, behavioral and psychosocial variables that may underlie SES differences in inflammatory biomarker levels were also examined. Age-adjusted CRP and IL-6 levels were inversely associated with education level in each race/gender group except Black males. Income gradients were also observed in each race/gender group for IL-6 and in White females and males for CRP. In general, differences in CRP and IL-6 levels between low and high SES groups were reduced in magnitude and significance with the addition of health status, behavioral, and psychosocial variables, although the impact of the addition of model covariates varied across race/gender groups and different SES-inflammation models. Overall, findings indicate SES gradients in levels of inflammation burden in middle-aged White and Black males and females (7) JAMES WP, CATERSON ID, COUTINHO W, FINER N, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, pp.905-917 http://dx.doi.org/10.1056/NEJMoa1003114 (accès libre, collection papier de la bibliothèque) BACKGROUND: The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. METHODS: We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). RESULTS: The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. CONCLUSIONS: Subjects with preexisting cardiovascular conditions who were receiving longterm sibutramine treatment had an increased risk of nonfatal myocardial infarction and nonfatal stroke but not of cardiovascular death or death from any cause. (Funded by Abbott; ClinicalTrials.gov number, NCT00234832.) Service de Documentation EHESP 24 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (8) KALANTRI A, KALANTRI S. Distinguishing hemorrhagic stroke from ischemic stroke. JAMA. 2010 Sept. 22, vol. 304, n° 12, pp.1327-1328 http://dx.doi.org/10.1001/jama.2010.1341 (accès réservé EHESP) (9) KNOSALLA C, DANDEL M, HETZER R. Duration of clopidogrel therapy with drug-eluting stents. N Engl J Med. 2010 July 29, vol. 363, n° 5, pp.489-490 http://www.ncbi.nlm.nih.gov/pubmed/20830830 (accès libre, collection papier de la bibliothèque) (10) KO SB, LEE K. Images in clinical medicine. Acute optic-nerve infarction in carotid dissection. N Engl J Med. 2010 Aug. 19, vol. 363, n° 8, p.765 http://dx.doi.org/10.1056/NEJMicm0909070 (accès libre, collection papier de la bibliothèque) (11) KURTH T, KASE CS, SCHURKS M, TZOURIO C, et al. Migraine and risk of haemorrhagic stroke in women: prospective cohort study. BMJ. 2010, vol. 341, p.c3659 http://www.ncbi.nlm.nih.gov/pubmed/20736268 (accès réservé EHESP) OBJECTIVES: To examine the association between migraine and migraine aura status with risk of haemorrhagic stroke. DESIGN: Prospective cohort study. SETTING: Women's Health Study, United States. PARTICIPANTS: 27,860 women aged >or=45 who were free from stroke or other major disease at baseline and had provided information on self reported migraine, aura status, and lipid values. MAIN OUTCOME MEASURES: Time to first haemorrhagic stroke and subtypes of haemorrhagic stroke. RESULTS: At baseline, 5130 (18%) women reported any history of migraine; of the 3612 with active migraine (migraine in the previous year), 1435 (40%) described having aura. During a mean of 13.6 years of follow-up, 85 haemorrhagic strokes were confirmed after review of medical records. Compared with women without a history of migraine, there was no increased risk of haemorrhagic stroke in those who reported any history of migraine (adjusted hazard ratio 0.98, 95% confidence interval 0.56 to 1.71, P=0.93). In contrast, risk was increased in women with active migraine with aura (2.25, 1.11 to 4.54, P=0.024). The age adjusted increased risk was stronger for intracerebral haemorrhage (2.78, 1.09 to 7.07, P=0.032) and for fatal events (3.56, 1.23 to 10.31, P=0.02). Four additional haemorrhagic stroke events were attributable to migraine with aura per 10 000 women per year. Women who reported active migraine without aura had no increased risk for haemorrhagic stroke. CONCLUSION: Migraine with aura might, in addition to ischaemic events, also be a risk factor for haemorrhagic stroke. The relatively low number of events and attributable risk should caution against definitive conclusions and call for further confirmation of these observations (12) MEHTA SR, BASSAND JP, CHROLAVICIUS S, DIAZ R, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, pp.930-942 http://dx.doi.org/10.1056/NEJMoa0909475 (accès libre, collection papier de la bibliothèque) BACKGROUND: Clopidogrel and aspirin are widely used for patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). However, evidencebased guidelines for dosing have not been established for either agent. METHODS: We randomly assigned, in a 2-by-2 factorial design, 25,086 patients with an acute coronary syndrome who were referred for an invasive strategy to either double-dose clopidogrel (a 600-mg loading dose on day 1, followed by 150 mg daily for 6 days and 75 mg daily thereafter) or standard-dose clopidogrel (a 300-mg loading dose and 75 mg daily thereafter) and either higher-dose aspirin (300 to 325 mg daily) or lower-dose aspirin (75 to 100 mg daily). The primary outcome was cardiovascular death, myocardial infarction, or stroke at 30 days. RESULTS: The primary outcome occurred in 4.2% of patients assigned to double-dose clopidogrel as compared with 4.4% assigned to standard-dose clopidogrel (hazard ratio, 0.94; 95% confidence interval [CI], 0.83 to 1.06; P=0.30). Major bleeding occurred in 2.5% of patients in the double-dose group and in 2.0% in the standard-dose group (hazard ratio, 1.24; 95% CI, 1.05 to 1.46; P=0.01). Double-dose clopidogrel was associated with a significant reduction in the secondary outcome of stent thrombosis among the 17,263 patients Service de Documentation EHESP 25 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 who underwent PCI (1.6% vs. 2.3%; hazard ratio, 0.68; 95% CI, 0.55 to 0.85; P=0.001). There was no significant difference between higher-dose and lower-dose aspirin with respect to the primary outcome (4.2% vs. 4.4%; hazard ratio, 0.97; 95% CI, 0.86 to 1.09; P=0.61) or major bleeding (2.3% vs. 2.3%; hazard ratio, 0.99; 95% CI, 0.84 to 1.17; P=0.90). CONCLUSIONS: In patients with an acute coronary syndrome who were referred for an invasive strategy, there was no significant difference between a 7-day, double-dose clopidogrel regimen and the standarddose regimen, or between higher-dose aspirin and lower-dose aspirin, with respect to the primary outcome of cardiovascular death, myocardial infarction, or stroke. (Funded by Sanofi-Aventis and Bristol-Myers Squibb; ClinicalTrials.gov number, NCT00335452.) (13) MEMTSOUDIS SG, SHARROCK NE. Duration of clopidogrel therapy with drug-eluting stents. N Engl J Med. 2010 July 29, vol. 363, n° 5, pp.488-489 http://www.ncbi.nlm.nih.gov/pubmed/20830828 (accès libre, collection papier de la bibliothèque ) (14) MUSUNURU K, STRONG A, FRANK-KAMENETSKY M, LEE NE, et al. From noncoding variant to phenotype via SORT1 at the 1p13 cholesterol locus. Nature. 2010 Aug. 5, vol. 466, n° 7307, pp.714-719 http://dx.doi.org/10.1038/nature09266 (accès payant) Recent genome-wide association studies (GWASs) have identified a locus on chromosome 1p13 strongly associated with both plasma low-density lipoprotein cholesterol (LDL-C) and myocardial infarction (MI) in humans. Here we show through a series of studies in human cohorts and human-derived hepatocytes that a common noncoding polymorphism at the 1p13 locus, rs12740374, creates a C/EBP (CCAAT/enhancer binding protein) transcription factor binding site and alters the hepatic expression of the SORT1 gene. With small interfering RNA (siRNA) knockdown and viral overexpression in mouse liver, we demonstrate that Sort1 alters plasma LDL-C and very low-density lipoprotein (VLDL) particle levels by modulating hepatic VLDL secretion. Thus, we provide functional evidence for a novel regulatory pathway for lipoprotein metabolism and suggest that modulation of this pathway may alter risk for MI in humans. We also demonstrate that common noncoding DNA variants identified by GWASs can directly contribute to clinical phenotypes (15) NAZIR T, PUNEKAR S. Images in clinical medicine. Pneumothorax--an uncommon complication of a common procedure. N Engl J Med. 2010 July 29, vol. 363, n° 5, p.462 http://dx.doi.org/10.1056/NEJMicm0912444 (accès libre, collection papier de la bibliothèque) (16) NG AK, ABRAMSON JS, DIGUMARTHY SR, REINGOLD JS, et al. Case records of the Massachusetts General Hospital. Case 24-2010. A 56-year-old woman with a history of Hodgkin's lymphoma and sudden onset of dyspnea and shock. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.664-675 http://dx.doi.org/10.1056/NEJMcpc1004087 (accès libre, collection papier de la bibliothèque) (17) OKURA H. Duration of clopidogrel therapy with drug-eluting stents. N Engl J Med. 2010 July 29, vol. 363, n° 5, p.488 http://dx.doi.org/10.1056/NEJMc1005624 (accès libre, collection papier de la bibliothèque) (18) RENNINGS AJ, SCHOUWENBERG BJ, VAN ONZENOORT HA. Duration of clopidogrel therapy with drug-eluting stents. N Engl J Med. 2010 July 29, vol. 363, n° 5, p.489 http://www.ncbi.nlm.nih.gov/pubmed/20830829 (accès libre, collection papier de la bibliothèque) Service de Documentation EHESP 26 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (19 ) RODONDI N, DEN ELZEN WP, BAUER DC, CAPPOLA AR, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010 Sept. 22, vol. 304, n° 12, pp.1365-1374 http://dx.doi.org/10.1001/jama.2010.1361 (accès réservé EHESP) CONTEXT: Data regarding the association between subclinical hypothyroidism and cardiovascular disease outcomes are conflicting among large prospective cohort studies. This might reflect differences in participants' age, sex, thyroid-stimulating hormone (TSH) levels, or preexisting cardiovascular disease. OBJECTIVE: To assess the risks of coronary heart disease (CHD) and total mortality for adults with subclinical hypothyroidism. DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE and EMBASE (1950 to May 31, 2010) were searched without language restrictions for prospective cohort studies with baseline thyroid function and subsequent CHD events, CHD mortality, and total mortality. The reference lists of retrieved articles also were searched. DATA EXTRACTION: Individual data on 55,287 participants with 542,494 person-years of follow-up between 1972 and 2007 were supplied from 11 prospective cohorts in the United States, Europe, Australia, Brazil, and Japan. The risk of CHD events was examined in 25,977 participants from 7 cohorts with available data. Euthyroidism was defined as a TSH level of 0.50 to 4.49 mIU/L. Subclinical hypothyroidism was defined as a TSH level of 4.5 to 19.9 mIU/L with normal thyroxine concentrations. RESULTS: Among 55,287 adults, 3450 had subclinical hypothyroidism (6.2%) and 51,837 had euthyroidism. During follow-up, 9664 participants died (2168 of CHD), and 4470 participants had CHD events (among 7 studies). The risk of CHD events and CHD mortality increased with higher TSH concentrations. In age- and sexadjusted analyses, the hazard ratio (HR) for CHD events was 1.00 (95% confidence interval [CI], 0.86-1.18) for a TSH level of 4.5 to 6.9 mIU/L (20.3 vs 20.3/1000 person-years for participants with euthyroidism), 1.17 (95% CI, 0.96-1.43) for a TSH level of 7.0 to 9.9 mIU/L (23.8/1000 person-years), and 1.89 (95% CI, 1.28-2.80) for a TSH level of 10 to 19.9 mIU/L (n = 70 events/235; 38.4/1000 person-years; P <.001 for trend). The corresponding HRs for CHD mortality were 1.09 (95% CI, 0.91-1.30; 5.3 vs 4.9/1000 person-years for participants with euthyroidism), 1.42 (95% CI, 1.03-1.95; 6.9/1000 person-years), and 1.58 (95% CI, 1.10-2.27, n = 28 deaths/333; 7.7/1000 person-years; P = .005 for trend). Total mortality was not increased among participants with subclinical hypothyroidism. Results were similar after further adjustment for traditional cardiovascular risk factors. Risks did not significantly differ by age, sex, or preexisting cardiovascular disease. CONCLUSIONS: Subclinical hypothyroidism is associated with an increased risk of CHD events and CHD mortality in those with higher TSH levels, particularly in those with a TSH concentration of 10 mIU/L or greater (20) ROFFI M. Is there a role for revascularisation in asymptomatic carotid stenosis? Yes. BMJ. 2010, vol. 341, p.c4898 http://www.ncbi.nlm.nih.gov/pubmed/20843932 (accès réservé EHESP)(accès réservé EHESP) (21) SABATINE MS, JAFFER FA, STAATS PN, STONE JR. Case records of the Massachusetts General Hospital. Case 28-2010. A 32-year-old woman, 3 weeks post partum, with substernal chest pain. N Engl J Med. 2010 Sept. 16, vol. 363, n° 12, pp.1164-1173 http://dx.doi.org/10.1056/NEJMcpc1000966 (accès libre, collection papier de la bibliothèque) (22) SACKS FM, CAREY VJ, FRUCHART JC. Combination lipid therapy in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.692-694 http://www.ncbi.nlm.nih.gov/pubmed/20842772 (accès libre, collection papier de la bibliothèque) (23) SAELY CH, REIN P, DREXEL H. Combination lipid therapy in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, pp.692-695 http://dx.doi.org/10.1056/NEJMc1006407 (accès libre, collection papier de la bibliothèque) (24) SHULDINER AR, POLLIN TI. Genomics: Variations in blood lipids. Nature. 2010 Aug. 5, vol. 466, n° 7307, pp.703-704 http://dx.doi.org/10.1038/466703a (accès payant) Service de Documentation EHESP 27 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (25) SIMON C, KUMAR S, KENDRICK T. Cohort study of informal carers of first-time stroke survivors: profile of health and social changes in the first year of caregiving. Soc Sci Med. 2009 Aug., vol. 69, n° 3, pp.404-410=u http://dx.doi.org/10.1016/j.socscimed.2009.04.007 (accès réservé EHESP) Informal carers underpin community care policies. An initial cohort of 105 informal live-in carers of new stroke patients from the South Coast of England was followed up before discharge, six weeks after discharge and 15 months after stroke with face-to-face interviews assessing physical and psychological health, and social wellbeing. The carer cohort was compared to a cohort of 50 matched non-carers over the same time period. Carer distress was common (37-54%), started early on in the care-giving experience and continued until 15 months after stroke. Carers were 2.5 times as likely as non-carers to have significant psychological distress. Presence of early distress predicted 90% of those significantly distressed 15 months after stroke. Female carers were likely to develop distress earlier than male carers and in anticipation of the care-giving situation. Male carers developed similar levels of distress but only once the care-giving situation became reality. Further research is needed to establish ways to screen for psychological distress early after onset of caregiving, to find ways to tailor proven support interventions to the individual carer, and to evaluate the effect of early detection and support provision on later carer distress (26) SOLOMON SD, UNO H, LEWIS EF, ECKARDT KU, et al. Erythropoietic response and outcomes in kidney disease and type 2 diabetes. N Engl J Med. 2010 Sept. 16, vol. 363, n° 12, pp.1146-1155 http://dx.doi.org/10.1056/NEJMoa1005109 (accès libre, collection papier de la bibliothèque) BACKGROUND: Non-placebo-controlled trials of erythropoiesis-stimulating agents (ESAs) comparing lower and higher hemoglobin targets in patients with chronic kidney disease indicate that targeting of a lower hemoglobin range may avoid ESA-associated risks. However, targetbased strategies are confounded by each patient's individual hematopoietic response. METHODS: We assessed the relationship among the initial hemoglobin response to darbepoetin alfa after two weight-based doses, the hemoglobin level achieved after 4 weeks, the subsequent darbepoetin alfa dose, and outcomes in 1872 patients with chronic kidney disease and type 2 diabetes mellitus who were not receiving dialysis. We defined a poor initial response to darbepoetin alfa (which occurred in 471 patients) as the lowest quartile of percent change in hemoglobin level (<2%) after the first two standardized doses of the drug. RESULTS: Patients who had a poor initial response to darbepoetin alfa had a lower average hemoglobin level at 12 weeks and during follow-up than did patients with a better hemoglobin response (a change in hemoglobin level ranging from 2 to 15% or more) (P<0.001 for both comparisons), despite receiving higher doses of darbepoetin alfa (median dose, 232 mug vs. 167 mug; P<0.001). Patients with a poor response, as compared with those with a better response, had higher rates of the composite cardiovascular end point (adjusted hazard ratio, 1.31; 95% confidence interval [CI], 1.09 to 1.59) or death (adjusted hazard ratio, 1.41; 95% CI, 1.12 to 1.78). CONCLUSIONS: A poor initial hematopoietic response to darbepoetin alfa was associated with an increased subsequent risk of death or cardiovascular events as doses were escalated to meet target hemoglobin levels. Although the mechanism of this differential effect is not known, these findings raise concern about current target-based strategies for treating anemia in patients with chronic kidney disease. (Funded by Amgen; ClinicalTrials.gov number, NCT00093015.) (27) SPENCE JD. Is there a role for revascularisation in asymptomatic carotid stenosis? No. BMJ. 2010, vol. 341, p.c4900 http://www.ncbi.nlm.nih.gov/pubmed/20843933 (accès réservé EHESP)(accès réservé EHESP) (28) TESLOVICH TM, MUSUNURU K, SMITH AV, EDMONDSON AC, et al. Biological, clinical and population relevance of 95 loci for blood lipids. Nature. 2010 Aug. 5, vol. 466, n° 7307, pp.707-713 http://dx.doi.org/10.1038/nature09270 (accès payant) Plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides are among the most important risk factors for coronary Service de Documentation EHESP 28 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 artery disease (CAD) and are targets for therapeutic intervention. We screened the genome for common variants associated with plasma lipids in >100,000 individuals of European ancestry. Here we report 95 significantly associated loci (P < 5 x 10(-8)), with 59 showing genome-wide significant association with lipid traits for the first time. The newly reported associations include single nucleotide polymorphisms (SNPs) near known lipid regulators (for example, CYP7A1, NPC1L1 and SCARB1) as well as in scores of loci not previously implicated in lipoprotein metabolism. The 95 loci contribute not only to normal variation in lipid traits but also to extreme lipid phenotypes and have an impact on lipid traits in three non-European populations (East Asians, South Asians and African Americans). Our results identify several novel loci associated with plasma lipids that are also associated with CAD. Finally, we validated three of the novel genes-GALNT2, PPP1R3B and TTC39B-with experiments in mouse models. Taken together, our findings provide the foundation to develop a broader biological understanding of lipoprotein metabolism and to identify new therapeutic opportunities for the prevention of CAD Maladies liées à l'alcool sommaire (1) GAMA R, MANIKAM L, ASHBY HL. Mildly abnormal liver tests. Myth of gamma glutamyltransferase. BMJ. 2010, vol. 341, p.c4604 http://www.ncbi.nlm.nih.gov/pubmed/20736278 (accès réservé EHESP)(accès réservé EHESP) (2) MAYOR S. New figures show major increase in alcohol related hospital admissions in England. BMJ. 2010, vol. 341, p.c4790 http://www.ncbi.nlm.nih.gov/pubmed/20813829 (accès réservé EHESP)(accès réservé EHESP) Paludisme sommaire (1) ENSERINK M. Profile: Francois Nosten. The dour Frenchman on malaria's frontier. Science. 2010 Sept. 3, vol. 329, n° 5996, pp.1142-1143 http://dx.doi.org/10.1126/science.329.5996.1142 (accès réservé EHESP) (2) HOEKSTRA JD. Mosquitoes: first evaluate impacts of eradicating them. Nature. 2010 Aug. 26, vol. 466, n° 7310, p.1041 http://dx.doi.org/10.1038/4661041b (accès payant) (3) LUZZATTO L. The rise and fall of the antimalarial Lapdap: a lesson in pharmacogenetics. Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.739-741 http://www.ncbi.nlm.nih.gov/pubmed/20599264 (accès réservé EHESP) ou http://dx.doi.org/10.1016/S0140-6736(10)60396-0 (accès réservé EHESP) (4) RODRIGUES J, BRAYNER FA, ALVES LC, DIXIT R, et al. Hemocyte differentiation mediates innate immune memory in Anopheles gambiae mosquitoes. Science. 2010 Sept. 10, vol. 329, n° 5997, pp.1353-1355 http://dx.doi.org/10.1126/science.1190689 (accès réservé EHESP) Mosquito midgut invasion by ookinetes of the malaria parasite Plasmodium disrupts the barriers that normally prevent the gut microbiota from coming in direct contact with epithelial cells. This triggers a long-lived response characterized by increased abundance of granulocytes, a subpopulation of hemocytes that circulates in the insect's hemocoel, and enhanced immunity to bacteria that indirectly reduces survival of Plasmodium parasites upon reinfection. In mosquitoes, differentiation of hemocytes was necessary and sufficient to confer innate immune memory Service de Documentation EHESP 29 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (5) ROTTMANN M, MCNAMARA C, YEUNG BK, LEE MC, et al. Spiroindolones, a potent compound class for the treatment of malaria. Science. 2010 Sept. 3, vol. 329, n° 5996, pp.1175-1180 http://dx.doi.org/10.1126/science.1193225 (accès réservé EHESP) Recent reports of increased tolerance to artemisinin derivatives--the most recently adopted class of antimalarials--have prompted a need for new treatments. The spirotetrahydro-beta-carbolines, or spiroindolones, are potent drugs that kill the blood stages of Plasmodium falciparum and Plasmodium vivax clinical isolates at low nanomolar concentration. Spiroindolones rapidly inhibit protein synthesis in P. falciparum, an effect that is ablated in parasites bearing nonsynonymous mutations in the gene encoding the P-type cation-transporter ATPase4 (PfATP4). The optimized spiroindolone NITD609 shows pharmacokinetic properties compatible with once-daily oral dosing and has single-dose efficacy in a rodent malaria model (6) SIVA N. Malaria is on the rise in Pakistan, health workers warn. BMJ. 2010, vol. 341, p.c4752 http://www.ncbi.nlm.nih.gov/pubmed/20813826 (accès réservé EHESP)(accès réservé EHESP) (7) VAN NR. Demand for malaria drug soars. Nature. 2010 Aug. 5, vol. 466, n° 7307, pp.672-673 http://dx.doi.org/10.1038/466672a (accès payant) (8) WELLS TN. Microbiology. Is the tide turning for new malaria medicines? Science. 2010 Sept. 3, vol. 329, n° 5996, pp.1153-1154 http://dx.doi.org/0.1126/science.1194923 (accès réservé EHESP) Pathologies liées à l'obésité sommaire (1) ASTRUP A. Is cardiometabolic risk improved by weight-loss drugs? Lancet. 2010 Aug. 21, vol. 376, n° 9741, pp.567-568 http://dx.doi.org/10.1016/S0140-6736(10)60999-3 (accès réservé EHESP) (2) BURNS EM, NASEEM H, BOTTLE A, LAZZARINO AI, et al. Introduction of laparoscopic bariatric surgery in England: observational population cohort study. BMJ. 2010, vol. 341, p.c4296 http://www.ncbi.nlm.nih.gov/pubmed/20798224 (accès réservé EHESP) OBJECTIVES: To describe national trends in bariatric surgery and examine the factors influencing outcome in bariatric surgery in England. DESIGN: Observational population cohort study. SETTING: Hospital Episode Statistics database. PARTICIPANTS: All patients who had primary gastric bypass, gastric banding, or sleeve gastrectomy procedures between April 2000 and March 2008. MAIN OUTCOME MEASURES: 30 day mortality, mortality at one year after surgery, unplanned readmission to hospitalwithin 28 days, and duration of stay in hospital. RESULTS: 6953 primary bariatric procedures were carried out during the study period, of which 3649 were gastric band procedures, 3191 were gastric bypass procedures, and 113 were sleeve gastrectomy procedures. A marked increase occurred in the numbers of bariatric procedures done, from 238 in 2000 to 2543 in 2007, with an increase in the percentage of laparoscopic procedures over the study period (28% (66/238) laparoscopic procedures in 2000 compared with 74.5% (1894/2543) in 2007). Overall, 0.3% (19/6953) patients died within 30 days of surgery. The median length of stay in hospital was 3 (interquartile range 2-6) days. An unplanned readmission to hospital within 28 days of surgery occurred in 8% (556/6953) of procedures. No significant increase in mortality or unplanned readmission was seen over the study period, despite the exponential increase in minimal access surgery and consequently bariatric surgery. CONCLUSIONS: Bariatric surgery has increased exponentially in England. Although postoperative weight loss and reoperation rates were not evaluated in this observational population cohort study, patients selected for gastric banding had lower postoperative mortality and readmission rates and a shorter length of stay than did those selected for gastric bypass Service de Documentation EHESP 30 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (3) CHOI JH, BANKS AS, ESTALL JL, KAJIMURA S, et al. Anti-diabetic drugs inhibit obesitylinked phosphorylation of PPARgamma by Cdk5. Nature. 2010 July 22, vol. 466, n° 7305, pp.451-456 http://dx.doi.org/10.1038/nature09291 (accès payant) Obesity induced in mice by high-fat feeding activates the protein kinase Cdk5 (cyclin-dependent kinase 5) in adipose tissues. This results in phosphorylation of the nuclear receptor PPARgamma (peroxisome proliferator-activated receptor gamma), a dominant regulator of adipogenesis and fat cell gene expression, at serine 273. This modification of PPARgamma does not alter its adipogenic capacity, but leads to dysregulation of a large number of genes whose expression is altered in obesity, including a reduction in the expression of the insulin-sensitizing adipokine, adiponectin. The phosphorylation of PPARgamma by Cdk5 is blocked by anti-diabetic PPARgamma ligands, such as rosiglitazone and MRL24. This inhibition works both in vivo and in vitro, and is completely independent of classical receptor transcriptional agonism. Similarly, inhibition of PPARgamma phosphorylation in obese patients by rosiglitazone is very tightly associated with the anti-diabetic effects of this drug. All these findings strongly suggest that Cdk5mediated phosphorylation of PPARgamma may be involved in the pathogenesis of insulinresistance, and present an opportunity for development of an improved generation of anti-diabetic drugs through PPARgamma (4) CLAYTON S, CHIN T, BLACKBURN S, ECHEVERRIA C. Different setting, different care: integrating prevention and clinical care in school-based health centers. Am J Public Health. 2010 Sept., vol. 100, n° 9, pp.1592-1596 http://dx.doi.org/10.2105/AJPH.2009.186668 (accès réservé EHESP) School-based health centers (SBHCs) are widely credited with increasing students' access to care by making health services affordable and convenient. SBHCs can also provide a qualitatively different type of health care for children and adolescents than that delivered by community providers. Health services offered in a school setting can integrate clinical care with public health interventions and environmental change strategies. This ability to reach outside the walls of the exam room makes SBHCs uniquely positioned to address the multiple determinants of health. We describe innovative California SBHC programs focusing on obesity prevention, asthma, mental health, and oral health that represent new models of health care for children and adolescents (5) CURFMAN GD, MORRISSEY S, DRAZEN JM. Sibutramine--another flawed diet pill. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, pp.972-974 http://dx.doi.org/10.1056/NEJMe1007993 (accès libre, collection papier de la bibliothèque) (6) DE SILVA-SANIGORSKI AM, BOLTON K, HABY M, KREMER P, et al. Scaling up communitybased obesity prevention in Australia: background and evaluation design of the Health Promoting Communities: Being Active Eating Well initiative. BMC Public Health. 2010, vol. 10, p.65 http://dx.doi.org/10.1186/1471-2458-10-65 (accès libre) BACKGROUND: There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and wholeof-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative. METHODS/DESIGN: A mixed method and multilevel evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and Service de Documentation EHESP 31 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a crosssectional, quasi-experimental design. The evaluation will capture process, weight status, sociodemographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults). DISCUSSION: This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally. TRIAL REGISTRATION: ACTRN12609000892213 (7) FOSTER GD, LINDER B, BARANOWSKI T, COOPER DM, et al. A school-based intervention for diabetes risk reduction. N Engl J Med. 2010 July 29, vol. 363, n° 5, pp.443-453 http://dx.doi.org/10.1056/NEJMoa1001933 (accès libre, collection papier de la bibliothèque) BACKGROUND: We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes. METHODS: Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels. RESULTS: There was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools. CONCLUSIONS: Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.) (8) GIBSON PG, MCDONALD VM, MARKS GB. Asthma in older adults. Lancet. 2010 Sept. 4, vol. 376, n° 9743, pp.803-813 http://dx.doi.org/10.1016/S0140-6736(10)61087-2 (accès réservé EHESP) Asthma in older people is common and is characterised by underdiagnosis and undertreatment. Ageing is associated with unique issues that modify expression, recognition, and treatment of the disease. In particular, asthma and chronic obstructive pulmonary disease (COPD) both overlap and converge in older people. This concurrence, together with absence of precise diagnostic methods, makes diagnosis complex. A multidimensional assessment that addresses airway problems, comorbidities, risk factors, and management skills will draw attention to key needs for intervention. Increased attention to the complications of asthma and obstructive airway disease in older people is needed, specifically to develop effective systems of care, appropriate clinical practice guidelines, and a research agenda that delivers improved health outcomes (9) GREENWAY FL, FUJIOKA K, PLODKOWSKI RA, MUDALIAR S, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2010 Aug. 21, vol. 376, n° 9741, pp.595-605 http://dx.doi.org/10.1016/S0140-6736(10)60888-4 (accès réservé EHESP) BACKGROUND: Despite increasing public health concerns regarding obesity, few safe and Service de Documentation EHESP 32 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 effective drug treatments are available. Combination treatment with sustained-release naltrexone and bupropion was developed to produce complementary actions in CNS pathways regulating bodyweight. The Contrave Obesity Research I (COR-I) study assessed the effect of such treatment on bodyweight in overweight and obese participants. METHODS: Men and women aged 18-65 years who had a body-mass index (BMI) of 30-45 kg/m(2) and uncomplicated obesity or BMI 27-45 kg/m(2) with dyslipidaemia or hypertension were eligible for enrolment in this randomised, double-blind, placebo-controlled, phase 3 trial undertaken at 34 sites in the USA. Participants were prescribed mild hypocaloric diet and exercise and were randomly assigned in a 1:1:1 ratio to receive sustained-release naltrexone 32 mg per day plus sustained-release bupropion 360 mg per day combined in fixed-dose tablets (also known as NB32), sustainedrelease naltrexone 16 mg per day plus sustained-release bupropion 360 mg per day combined in fixed-dose tablets (also known as NB16), or matching placebo twice a day, given orally for 56 weeks. The trial included a 3-week dose escalation. Randomisation was done by use of a centralised, computer-generated, web-based system and was stratified by study centre. Coprimary efficacy endpoints at 56 weeks were percentage change in bodyweight and proportion of participants who achieved a decrease in bodyweight of 5% or more. The primary analysis included all randomised participants with a baseline weight measurement and a post-baseline weight measurement while on study drug (last observation carried forward). This study is registered with ClinicalTrials.gov, number NCT00532779. FINDINGS: 1742 participants were enrolled and randomised to double-blind treatment (naltrexone 32 mg plus bupropion, n=583; naltrexone 16 mg plus bupropion, n=578; placebo, n=581). 870 (50%) participants completed 56 weeks of treatment (n=296; n=284; n=290, respectively) and 1453 (83%) were included in the primary analysis (n=471; n=471; n=511). Mean change in bodyweight was -1.3% (SE 0.3) in the placebo group, -6.1% (0.3) in the naltrexone 32 mg plus bupropion group (p<0.0001 vs placebo) and -5.0% (0.3) in the naltrexone 16 mg plus bupropion group (p<0.0001 vs placebo). 84 (16%) participants assigned to placebo had a decrease in bodyweight of 5% or more compared with 226 (48%) assigned to naltrexone 32 mg plus bupropion (p<0.0001 vs placebo) and 186 (39%) assigned to naltrexone 16 mg plus bupropion (p<0.0001 vs placebo). The most frequent adverse event in participants assigned to combination treatment was nausea (naltrexone 32 mg plus bupropion, 171 participants [29.8%]; naltrexone 16 mg plus bupropion, 155 [27.2%]; placebo, 30 [5.3%]). Headache, constipation, dizziness, vomiting, and dry mouth were also more frequent in the naltrexone plus bupropion groups than in the placebo group. A transient increase of around 1.5 mm Hg in mean systolic and diastolic blood pressure was followed by a reduction of around 1 mm Hg below baseline in the naltrexone plus bupropion groups. Combination treatment was not associated with increased depression or suicidality events compared with placebo. INTERPRETATION: A sustained-release combination of naltrexone plus bupropion could be a useful therapeutic option for treatment of obesity. FUNDING: Orexigen Therapeutics (10) HOSSEINPANAH F, BARZIN M, ESKANDARY PS, MIRMIRAN P, et al. Trends of obesity and abdominal obesity in Tehranian adults: a cohort study. BMC Public Health. 2009, vol. 9, p.426 http://dx.doi.org/10.1186/1471-2458-9-426 (accès libre) BACKGROUND: Considering the increasing trend of obesity reported in current data, this study was conducted to examine trends of obesity and abdominal obesity among Tehranian adults during a median follow-up of 6.6 years. METHODS: Height and weight of 4,402 adults, aged 20 years and over, participants of the Tehran Lipid and Glucose Study (TLGS), were measured in 1999-2001(phase I) and again in 2002-2005(phase II) and 2006-2008 (phase III). Criteria used for obesity and abdominal obesity defined body mass index (BMI) >or= 30 and waist circumference >or= 94/80 cm for men/women respectively. Subjects were divided into 10-year groups and the prevalence of obesity was compared across sex and age groups. RESULTS: The prevalence of obesity was 15.8, 18.6 and 21% in men and 31.5, 37.7 and 38.6% in women in phases I, II and III respectively (p < 0.001). The prevalence of abdominal obesity in men was 36.5, 57.2 and 63.3% and in women was 76.7, 83.8 and 83.6% in the three periods mentioned (p < 0.001). Men aged between 20-29 years had highest increase rates of obesity and abdominal obesity in phase III in comparison with phase I (with a respective rates of 2.2- and 3.3-fold). In both sexes, an increased trend was observed between phases I and II, whereas between phases II and III, this trend was observed in men, but not in women. CONCLUSION: This study demonstrates alarming rises in Service de Documentation EHESP 33 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 the prevalences of both obesity and abdominal obesity in both sexes especially in young men, calling for urgent action to educate people in lifestyle modifications (11) HOUTKOOPER RH, AUWERX J. Obesity: New life for antidiabetic drugs. Nature. 2010 July 22, vol. 466, n° 7305, pp.443-444 http://dx.doi.org/10.1038/466443a (accès payant) (12) JAMES WP, CATERSON ID, COUTINHO W, FINER N, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, pp.905-917 http://dx.doi.org/10.1056/NEJMoa1003114 (accès libre, collection papier de la bibliothèque) BACKGROUND: The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. METHODS: We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). RESULTS: The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. CONCLUSIONS: Subjects with preexisting cardiovascular conditions who were receiving longterm sibutramine treatment had an increased risk of nonfatal myocardial infarction and nonfatal stroke but not of cardiovascular death or death from any cause. (Funded by Abbott; ClinicalTrials.gov number, NCT00234832.) (13) MAGEE C, GOENKA N, KERRIGAN D. Nutrition in type 2 diabetes. Metabolic surgery may be more effective. BMJ. 2010, vol. 341, p.c4446 http://www.ncbi.nlm.nih.gov/pubmed/20724409 (accès réservé EHESP) (14) MAK KK, HO SY, LO WS, THOMAS GN, et al. Health-related physical fitness and weight status in Hong Kong adolescents. BMC Public Health. 2010, vol. 10, p.88 http://dx.doi.org/10.1186/1471-2458-10-88 (accès libre) BACKGROUND: This study was designed to investigate the relation between health-related physical fitness and weight status in Hong Kong adolescents. METHODS: 3,204 students aged 12-18 years participated in the Hong Kong Student Obesity Surveillance (HKSOS) project in 2006-2007. Anthropometric measures (height, weight) and health-related fitness (push-up, sit-up, sit-and-reach, 9-minute run) were assessed. Body mass index (BMI) was computed to classify participants into normal weight, underweight (Grade I, II/III), overweight, and obese groups. The associations of health-related physical fitness with BMI and weight status were examined by partial correlation coefficients and analysis of covariance, respectively. RESULTS: More boys than girls were overweight or obese (18.0% vs 8.7%), but more girls than boys were underweight (22.3% vs 16.7%). Boys performed significantly (P < 0.001) better in sit-up (38.8 vs 31.6 times/min) and 9-minute run (1632.1 vs 1353.2 m), but poorer in sit-and-reach (27.4 vs 32.2 cm) than girls. All four physical fitness tests were significantly positively correlated with each other in Service de Documentation EHESP 34 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 both sexes, and BMI was only weakly correlated with sit up and sit-and-reach tests in boys. Decreasing performance (P for trend < 0.05) was observed from normal weight to overweight and obese for push-up, sit-up, and 9-minute run in both sexes. From normal weight to Grade I and Grade II/III underweight, decreasing performance (P for trend < 0.05) for sit-up and sit-and-reach in both sexes and for push-up in boys was observed. CONCLUSIONS: The relations between BMI and health-related physical fitness in adolescents were non-linear. Overweight/obese and underweight adolescents had poorer performance in push-up and sit-up tests than normal weight adolescents. Different aspects of health-related physical fitness may serve as immediate indicators of potential health risks for underweight and overweight adolescents (15) MCGAURAN A. More obesity surgery in England would save money, economic analysis shows. BMJ. 2010, vol. 341, p.c4915 http://www.ncbi.nlm.nih.gov/pubmed/20826523 (accès réservé EHESP) (16) MOHAPATRA PR, JANMEJA AK. Images in clinical medicine. Asymptomatic mediastinal lipomatosis. N Engl J Med. 2010 Sept. 23, vol. 363, n° 13, p.1265 http://dx.doi.org/10.1056/NEJMicm1000714 (accès libre, collection papier de la bibliothèque) (17) NYGAARD I. Clinical practice. Idiopathic urgency urinary incontinence. N Engl J Med. 2010 Sept. 16, vol. 363, n° 12, pp.1156-1162 http://dx.doi.org/10.1056/NEJMcp1003849 (accès libre, collection papier de la bibliothèque) (18) PATEL AV, BERNSTEIN L, DEKA A, FEIGELSON HS, et al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol. 2010 Aug. 15, vol. 172, n° 4, pp.419-429 http://dx.doi.org/10.1093/aje/kwq155 (accès réservé EHESP) The obesity epidemic is attributed in part to reduced physical activity. Evidence supports that reducing time spent sitting, regardless of activity, may improve the metabolic consequences of obesity. Analyses were conducted in a large prospective study of US adults enrolled by the American Cancer Society to examine leisure time spent sitting and physical activity in relation to mortality. Time spent sitting and physical activity were queried by questionnaire on 53,440 men and 69,776 women who were disease free at enrollment. The authors identified 11,307 deaths in men and 7,923 deaths in women during the 14-year follow-up. After adjustment for smoking, body mass index, and other factors, time spent sitting (> or = 6 vs. <3 hours/day) was associated with mortality in both women (relative risk = 1.34, 95% confidence interval (CI): 1.25, 1.44) and men (relative risk = 1.17, 95% CI: 1.11, 1.24). Relative risks for sitting (> or = 6 hours/day) and physical activity (<24.5 metabolic equivalent (MET)-hours/week) combined were 1.94 (95% CI: 1.70, 2.20) for women and 1.48 (95% CI: 1.33, 1.65) for men, compared with those with the least time sitting and most activity. Associations were strongest for cardiovascular disease mortality. The time spent sitting was independently associated with total mortality, regardless of physical activity level. Public health messages should include both being physically active and reducing time spent sitting (19) SEPPANEN-NUIJTEN E, LAHTI-KOSKI M, MANNISTO S, KNEKT P, et al. Fat free mass and obesity in relation to educational level. BMC Public Health. 2009, vol. 9, p.448 http://dx.doi.org/10.1186/1471-2458-9-448 (accès libre) BACKGROUND: The aim of the study was to describe the body composition of Finnish adults, especially by education, and to investigate whether fat-free mass (FFM) can explain educational gradients relating to body mass index (BMI) and waist-to-hip ratio (WHR). METHODS: Data for this cross-sectional study were based on data collected in 2000-2001 for the Health 2000 Survey. Of the nationally representative sample of 8,028 Finnish men and women aged 30 years and older, 6,300 (78.5%) were included in the study. Body composition measurements were carried out in the health examination, where FFM was assessed with eight-polar bioelectrical impedance analysis. Questions on education were included in the health interview. RESULTS: The mean FFM varied by education in older (>or= 65 y.) men only. In the middle-aged group (30-64 y.), highly educated men were less likely to belong to the lowest quintile of FFM (OR 0.67, 95%CI Service de Documentation EHESP 35 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 0.48-0.93) compared with the least educated subjects. The level of education was inversely associated with the prevalence of high BMI and WHR in middle-aged men. In women, the respective associations were found both in middle-aged women and their older counterparts. Adjustment for FFM slightly strengthened the associations of education with BMI and WHR. CONCLUSIONS: The association between education and FFM is weak. Educational gradients of high BMI and high WHR cannot be explained by FFM (20) THE NS, ADAIR LS, GORDON-LARSEN P. A study of the birth weight-obesity relation using a longitudinal cohort and sibling and twin pairs. Am J Epidemiol. 2010 Sept. 1, vol. 172, n° 5, pp.549-557 http://dx.doi.org/10.1093/aje/kwq169 (accès réservé EHESP) Sibling and twin study designs provide control for confounding factors that are typically unmeasured in traditional cohort studies. Using nationally representative data from the National Longitudinal Study of Adolescent Health collected at 3 visits during 1994-2002, the authors evaluated the longitudinal association between birth weight and later obesity in a traditional cohort study (n = 13,763; ages 11-21 years at baseline), controlling for sex, age, race/ethnicity, and parental education. Among persons with a nonobese mother, high birth weight (>4 kg) participants were more likely than normal birth weight (>/=2.5-</=4 kg) participants to become obese later in life (incidence rate ratio = 1.46, 95% confidence interval: 1.28, 1.67). In a matched sibling pair sample (full siblings: n = 513; monozygotic twins: n = 207; dizygotic twins: n = 189), the authors examined longitudinal within-pair differences. Birth weight difference was positively associated with body mass index difference later in life for female monozygotic pairs only (beta = 2.67, 95% confidence interval: 0.99, 4.35). Given the null associations observed in the sibling sample, the commonly observed positive association between birth weight and later obesity from cohort analyses may be attributed to confounding by maternal characteristics. Further research is needed to identify specific factors that contribute to the birth weight-obesity relation (21) VALLEJO-TORRES L, MORRIS S. The contribution of smoking and obesity to incomerelated inequalities in health in England. Soc Sci Med. 2010 Sept., vol. 71, n° 6, pp.1189-1198 http://dx.doi.org/10.1016/j.socscimed.2010.06.008 (accès réservé EHESP) Reducing avoidable inequalities in health is a priority in many health care systems, including the NHS in Great Britain. Evidence suggests that lifestyle factors may play a role in explaining socioeconomic inequalities in health. In this paper we measure the contribution of smoking and obesity to income-related inequality in health. We use the corrected concentration index to measure inequality across time and areas of England, and decomposition methods to quantify directly the contribution of smoking and obesity to income-related inequality. Instrumental variables regression is used to test the endogeneity of smoking and obesity. We use data from nine rounds of the Health Survey for England (1998-2006). The results show that there are significant income-related health inequalities in England, that the extent of the inequality varies by area, and that in some areas it has increased over time. Nationally, smoking and obesity make a significant but modest contribution to income-related inequality in health (2.3% and 1.2%, respectively). Despite the reduction in smoking prevalence, the contribution of smoking has slightly increased over time, due to its increasing concentration among the poor and its negative effect on health. While the prevalence of obesity is increasing, it is more equally distributed across society. The prevalence of these problems varies between areas, and so does the contribution they make to income-related inequalities in health (22) WILSON AJ, PRAPAVESSIS H, JUNG ME, CRAMP AG, et al. Lifestyle modification and metformin as long-term treatment options for obese adolescents: study protocol. BMC Public Health. 2009, vol. 9, p.434u http://dx.doi.org/10.1186/1471-2458-9-434 (accès libre) BACKGROUND: Childhood obesity is a serious health concern affecting over 155 million children in developed countries worldwide. Childhood obesity is associated with significantly increased risk for development of type 2 diabetes, cardiovascular disease and psychosocial functioning problems (i.e., depression and decreased quality of life). The two major strategies for management of obesity and associated metabolic abnormalities are lifestyle modification and Service de Documentation EHESP 36 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 pharmacologic therapy. This paper will provide the background rationale and methods of the REACH childhood obesity treatment program. METHODS/DESIGN: The REACH study is a 2-year multidisciplinary, family-based, childhood obesity treatment program. Seventy-two obese adolescents (aged 10-16 years) and their parents are being recruited to participate in this randomized placebo controlled trial. Participants are randomized to receive either metformin or placebo, and are then randomized to a moderate or a vigorous intensity supervised exercise program for the first 12-weeks. After the 12-week exercise program, participants engage in weekly exercise sessions with an exercise facilitator at a local community center. Participants engage in treatment sessions with a dietitian and social worker monthly for the first year, and then every three months for the second year. The primary outcome measure is change in body mass index and the secondary outcome measures are changes in body composition, risk factors for type 2 diabetes and cardiovascular disease, changes in diet, physical activity, and psychosocial wellbeing (e.g., quality of life). It is hypothesized that participants who take metformin and engage in vigorous intensity exercise will show the greatest improvements in body mass index. In addition, it is hypothesized that participants who adhere to the REACH program will show improvements in body composition, physical activity, diet, psychosocial functioning and risk factor profiles for type 2 diabetes and cardiovascular disease. These improvements are expected to be maintained over the 2-year program. DISCUSSION: The findings from this study will advance the knowledge regarding the long-term efficacy and sustainability of interventions for childhood obesity. TRIAL REGISTRATION: ClinicalTrials.gov number NCT00934570 SIDA sommaire (1) ABDOOL KQ, BDOOL KARIM SS, FROHLICH JA, GROBLER AC, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010 Sept. 3, vol. 329, n° 5996, pp.1168-1174 http://dx.doi.org/10.1126/science.1193748 (accès réservé EHESP) The Centre for the AIDS Program of Research in South Africa (CAPRISA) 004 trial assessed the effectiveness and safety of a 1% vaginal gel formulation of tenofovir, a nucleotide reverse transcriptase inhibitor, for the prevention of HIV acquisition in women. A double-blind, randomized controlled trial was conducted comparing tenofovir gel (n = 445 women) with placebo gel (n = 444 women) in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural KwaZuluNatal, South Africa. HIV serostatus, safety, sexual behavior, and gel and condom use were assessed at monthly follow-up visits for 30 months. HIV incidence in the tenofovir gel arm was 5.6 per 100 women-years (person time of study observation) (38 out of 680.6 women-years) compared with 9.1 per 100 women-years (60 out of 660.7 women-years) in the placebo gel arm (incidence rate ratio = 0.61; P = 0.017). In high adherers (gel adherence > 80%), HIV incidence was 54% lower (P = 0.025) in the tenofovir gel arm. In intermediate adherers (gel adherence 50 to 80%) and low adherers (gel adherence < 50%), the HIV incidence reduction was 38 and 28%, respectively. Tenofovir gel reduced HIV acquisition by an estimated 39% overall, and by 54% in women with high gel adherence. No increase in the overall adverse event rates was observed. There were no changes in viral load and no tenofovir resistance in HIV seroconverters. Tenofovir gel could potentially fill an important HIV prevention gap, especially for women unable to successfully negotiate mutual monogamy or condom use (2) COOVADIA A, ABRAMS EJ, STEHLAU R, MEYERS T, et al. Reuse of nevirapine in exposed HIV-infected children after protease inhibitor-based viral suppression: a randomized controlled trial. JAMA. 2010 Sept. 8, vol. 304, n° 10, pp.1082-1090 http://dx.doi.org/10.1001/jama.2010.1278 (accès réservé EHESP) CONTEXT: Protease inhibitor (PI)-based therapy is recommended for infants infected with human immunodeficiency virus (HIV) who were exposed to nevirapine for prevention of mother-to-child HIV transmission. However, there are limitations of continuing PI-based therapy indefinitely and reuse of nevirapine has many advantages. OBJECTIVE: To test whether nevirapine-exposed infants who initially achieve viral suppression with PI-based therapy can maintain viral suppression when switched to nevirapine-based therapy. DESIGN, SETTING, AND PATIENTS: Randomized trial conducted between April 2005 and May 2009 at a hospital in Johannesburg, South Africa, among 195 children who achieved viral suppression less than 400 copies/mL for 3 Service de Documentation EHESP 37 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 or more months from a cohort of 323 nevirapine-exposed children who initiated PI-based therapy before 24 months of age. INTERVENTIONS: Control group children continued to receive ritonavirboosted lopinavir, stavudine, and lamivudine (n = 99). Switch group children substituted nevirapine for ritonavir-boosted lopinavir (n = 96). MAIN OUTCOME MEASURES: Children were followed up for 52 weeks after randomization. Plasma HIV-1 RNA of greater than 50 copies/mL was the primary end point. Confirmed viremia greater than 1000 copies/mL was used as a criterion to consider regimen changes for children in either group (safety end point). RESULTS: Plasma viremia greater than 50 copies/mL occurred less frequently in the switch group (KaplanMeier probability, 0.438; 95% CI, 0.334-0.537) than in the control group (0.576; 95% CI, 0.4700.668) (P = .02). Confirmed viremia greater than 1000 copies/mL occurred more frequently in the switch group (0.201; 95% CI, 0.125-0.289) than in the control group (0.022; 95% CI, 0.004-0.069) (P < .001). CD4 cell response was better in the switch group (median CD4 percentage at 52 weeks, 34.7) vs the control group (CD4 percentage, 31.3) (P = .004). Older age (relative hazard [RH], 1.71; 95% CI, 1.08-2.72) was associated with viremia greater than 50 copies/mL in the control group. Inadequate adherence (RH, 4.14; 95% CI, 1.18-14.57) and drug resistance (RH, 4.04; 95% CI, 1.40-11.65) before treatment were associated with confirmed viremia greater than 1000 copies/mL in the switch group. CONCLUSION: Among HIV-infected children previously exposed to nevirapine, switching to nevirapine-based therapy after achieving viral suppression with a ritonavir-boosted lopinavir regimen resulted in lower rates of viremia greater than 50 copies/mL than maintaining the primary ritonavir-boosted lopinavir regimen. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00117728 (3) GARCIA-PEREZ JL, MORELL M, SCHEYS JO, KULPA DA, et al. Epigenetic silencing of engineered L1 retrotransposition events in human embryonic carcinoma cells. Nature. 2010 Aug. 5, vol. 466, n° 7307, pp.769-773 http://dx.doi.org/10.1038/nature09209 (accès payant) Long interspersed element-1 (LINE-1 or L1) retrotransposition continues to affect human genome evolution. L1s can retrotranspose in the germline, during early development and in select somatic cells; however, the host response to L1 retrotransposition remains largely unexplored. Here we show that reporter genes introduced into the genome of various human embryonic carcinomaderived cell lines (ECs) by L1 retrotransposition are rapidly and efficiently silenced either during or immediately after their integration. Treating ECs with histone deacetylase inhibitors rapidly reverses this silencing, and chromatin immunoprecipitation experiments revealed that reactivation of the reporter gene was correlated with changes in chromatin status at the L1 integration site. Under our assay conditions, rapid silencing was also observed when reporter genes were delivered into ECs by mouse L1s and a zebrafish LINE-2 element, but not when similar reporter genes were delivered into ECs by Moloney murine leukaemia virus or human immunodeficiency virus, suggesting that these integration events are silenced by distinct mechanisms. Finally, we demonstrate that subjecting ECs to culture conditions that promote differentiation attenuates the silencing of reporter genes delivered by L1 retrotransposition, but that differentiation, in itself, is not sufficient to reactivate previously silenced reporter genes. Thus, our data indicate that ECs differ from many differentiated cells in their ability to silence reporter genes delivered by L1 retrotransposition (4) STEPHENSON J. AIDS conference: encouraging advances amid funding worries for global treatment. JAMA. 2010 Sept. 8, vol. 304, n° 10, pp.1053-1055 http://dx.doi.org/10.1001/jama.2010.1292 (accès réservé EHESP) (5) WAYNE CK, BERKLEY SF. The renaissance in HIV vaccine development--future directions. N Engl J Med. 2010 July 29, vol. 363, n° 5, p.e7 http://www.ncbi.nlm.nih.gov/pubmed/20830827 (accès libre, collection papier de la bibliothèque) Service de Documentation EHESP 38 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Tuberculose Octobre 2010 sommaire (1) BAILEY S, GODFREY-FAUSSETT P. Where is diabetes in The Lancet's tuberculosis Series? Lancet. 2010 Aug. 28, vol. 376, n° 9742, p.683 http://dx.doi.org/10.1016/S0140-6736(10)61331-1 (accès réservé EHESP) (2) BHUNIYA S. Extensively drug-resistant tuberculosis in South Africa. Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.681-682 http://dx.doi.org/10.1016/S0140-6736(10)61328-1 (accès réservé EHESP) (3) BLOMBERG B, LANGELAND N. Tuberculous meningitis and resistance to isoniazid. BMJ. 2010, vol. 341, p.c4677 http://www.ncbi.nlm.nih.gov/pubmed/20819876 (accès réservé EHESP) (4) BOEHME CC, NABETA P, HILLEMANN D, NICOL MP, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010 Sept. 9, vol. 363, n° 11, pp.10051015 http://dx.doi.org/10.1056/NEJMoa0907847 (accès libre, collection papier de la bibliothèque) BACKGROUND: Global control of tuberculosis is hampered by slow, insensitive diagnostic methods, particularly for the detection of drug-resistant forms and in patients with human immunodeficiency virus infection. Early detection is essential to reduce the death rate and interrupt transmission, but the complexity and infrastructure needs of sensitive methods limit their accessibility and effect. METHODS: We assessed the performance of Xpert MTB/RIF, an automated molecular test for Mycobacterium tuberculosis (MTB) and resistance to rifampin (RIF), with fully integrated sample processing in 1730 patients with suspected drug-sensitive or multidrug-resistant pulmonary tuberculosis. Eligible patients in Peru, Azerbaijan, South Africa, and India provided three sputum specimens each. Two specimens were processed with N-acetyl-Lcysteine and sodium hydroxide before microscopy, solid and liquid culture, and the MTB/RIF test, and one specimen was used for direct testing with microscopy and the MTB/RIF test. RESULTS: Among culture-positive patients, a single, direct MTB/RIF test identified 551 of 561 patients with smear-positive tuberculosis (98.2%) and 124 of 171 with smear-negative tuberculosis (72.5%). The test was specific in 604 of 609 patients without tuberculosis (99.2%). Among patients with smear-negative, culture-positive tuberculosis, the addition of a second MTB/RIF test increased sensitivity by 12.6 percentage points and a third by 5.1 percentage points, to a total of 90.2%. As compared with phenotypic drug-susceptibility testing, MTB/RIF testing correctly identified 200 of 205 patients (97.6%) with rifampin-resistant bacteria and 504 of 514 (98.1%) with rifampinsensitive bacteria. Sequencing resolved all but two cases in favor of the MTB/RIF assay. CONCLUSIONS: The MTB/RIF test provided sensitive detection of tuberculosis and rifampin resistance directly from untreated sputum in less than 2 hours with minimal hands-on time. (Funded by the Foundation for Innovative New Diagnostics.) (5) COX H, FORD N, MCDERMID C, VAN CG, et al. Extensively drug-resistant tuberculosis in South Africa. Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.681-682 http://dx.doi.org/10.1016/S0140-6736(10)61327-X (accès réservé EHESP) (6) HOLDEN E, RANU H, MADDEN BP. A case of progressive breathlessness. BMJ. 2010, vol. 341, p.c4655 http://www.ncbi.nlm.nih.gov/pubmed/20861100 (accès réservé EHESP) (7) JACK A. MPs step in to save the UK's only mobile tuberculosis detection unit. BMJ. 2010, vol. 341, p.c4597 http://www.ncbi.nlm.nih.gov/pubmed/20729273 (accès réservé EHESP) Service de Documentation EHESP 39 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (8) KIRBY T. Heather Zar--improving lung health for children in Africa. Lancet. 2010 Sept. 4, vol. 376, n° 9743, p.763 http://dx.doi.org/10.1016/S0140-6736(10)61366-9 (accès réservé EHESP) (9) LEVISON JH, BARBIERI RL, KATZ JT, LOSCALZO J. Clinical problem-solving. Hard to conceive. N Engl J Med. 2010 Sept. 2, vol. 363, n° 10, pp.965-970 http://dx.doi.org/10.1056/NEJMcps0810360 (accès libre, collection papier de la bibliothèque) (10) MENZIES HJ, WINSTON CA, HOLTZ TH, CAIN KP, et al. Epidemiology of tuberculosis among US- and foreign-born children and adolescents in the United States, 1994-2007. Am J Public Health. 2010 Sept., vol. 100, n° 9, pp.1724-1729 http://dx.doi.org/10.2105/AJPH.2009.181289 (accès réservé EHESP) OBJECTIVES: We examined trends in tuberculosis (TB) cases and case rates among US- and foreign-born children and adolescents and analyzed the potential effect of changes to overseas screening of applicants for immigration to the United States. METHODS: We analyzed TB case data from the National Tuberculosis Surveillance System for 1994 to 2007. RESULTS: Foreignborn children and adolescents accounted for 31% of 18,659 reported TB cases in persons younger than age 18 years from 1994 to 2007. TB rates declined 44% among foreign-born children and adolescents (20.3 per 10,000 to 11.4 per 100,000 population) and 48% (2.1 per 100,000 to 1.1 per 100,000) among those who were born in the United States. Rates were nearly 20 times as high among foreign-born as among US-born adolescents. Among foreign-born children and adolescents with known month of US entry (88%), more than 20% were diagnosed with TB within 3 months of entry. CONCLUSIONS: Marked disparities in TB morbidity persist between foreign- and US-born children and adolescents. These disparities and the high proportion of TB cases diagnosed shortly after US entry suggest a need for enhanced pre- and postimmigration screening (11) MORAN E, MCGOWN A, CONLON C. Persistent Baltic cough. BMJ. 2010, vol. 341, p.c3756 http://www.ncbi.nlm.nih.gov/pubmed/20810480 (accès réservé EHESP) (12) MU XD, WANG GF. Images in clinical medicine. Miliary tuberculosis. N Engl J Med. 2010 Sept. 9, vol. 363, n° 11, p.1059= http://dx.doi.org/10.1056/NEJMicm1001480 (accès libre, collection papier de la bibliothèque) (13) NATHANSON E, NUNN P, UPLEKAR M, FLOYD K, et al. MDR tuberculosis--critical steps for prevention and control. N Engl J Med. 2010 Sept. 9, vol. 363, n° 11, pp.1050-1058 http://dx.doi.org/10.1056/NEJMra0908076 (accès libre, collection papier de la bibliothèque) (14) RABE KF, DECRAMER M, SIAFAKAS N. The year of the lung. Lancet. 2010 Sept. 4, vol. 376, n° 9743, pp.753-754 http://dx.doi.org/10.1016/S0140-6736(10)61347-5 (accès réservé EHESP) (15) ROSS JJ, LEVISON JH, BARBIERI RL. Interactive medical case. Hard to conceive. N Engl J Med. 2010 Aug. 12, vol. 363, n° 7, p.e11 http://www.ncbi.nlm.nih.gov/pubmed/20842776 (accès libre, collection papier de la bibliothèque) (16) SMALL PM, PAI M. Tuberculosis diagnosis--time for a game change. N Engl J Med. 2010 Sept. 9, vol. 363, n° 11, pp.1070-1071 http://dx.doi.org/10.1056/NEJMe1008496 (accès libre, collection papier de la bibliothèque) Service de Documentation EHESP 40 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 (17) STEPHENSON J. AIDS conference: encouraging advances amid funding worries for global treatment. JAMA. 2010 Sept. 8, vol. 304, n° 10, pp.1053-1055 http://dx.doi.org/10.1001/jama.2010.1292 (accès réservé EHESP) (18) TAGEJA N, SHARMA V. Multidrug-resistant tuberculosis in India. Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.682-683 http://dx.doi.org/10.1016/S0140-6736(10)61330-X (accès réservé EHESP) (19) VINNARD C, WINSTON CA, WILEYTO EP, MACGREGOR RR, et al. Isoniazid resistance and death in patients with tuberculous meningitis: retrospective cohort study. BMJ. 2010, vol. 341, p.c4451 http://www.ncbi.nlm.nih.gov/pubmed/20819874 (accès réservé EHESP) OBJECTIVE: To determine whether initial isoniazid resistance is associated with death during the treatment of tuberculous meningitis. DESIGN: Retrospective cohort study. SETTING: National Tuberculosis Surveillance System at the Centers for Disease Control in the United States. PARTICIPANTS: Patients with a clinical diagnosis of tuberculous meningitis, reported to the National Tuberculosis Surveillance System between 1 January 1993 and 31 December 2005. MAIN OUTCOME MEASURE: All cause mortality during antituberculous treatment. RESULTS: Between 1993 and 2005, 1896 patients had a clinical diagnosis of tuberculous meningitis and positive cultures from any site. In 123 (6%) of these patients, isoniazid resistance was present on initial susceptibility testing. The unadjusted association between initial isoniazid resistance and subsequent death among these 1896 patients did not reach statistical significance (odds ratio 1.38, 95% confidence interval 0.94 to 2.02). However, among 1614 patients with positive cerebrospinal fluid cultures, a significant unadjusted association was found between initial isoniazid resistance and subsequent death (odds ratio 1.61, 1.08 to 2.40). This association increased after adjustment for age, race, sex, and HIV status (odds ratio 2.07, 1.30 to 3.29). CONCLUSIONS: Isoniazid resistance on initial susceptibility testing was associated with subsequent death among cases of tuberculous meningitis with positive cerebrospinal fluid cultures. Randomised controlled trials are needed to evaluate the optimal empirical regimen for treating patients with tuberculous meningitis who are at high risk for both initial isoniazid resistance and poor clinical outcomes (20) YIMER S, HOLM-HANSEN C, YIMALDU T, BJUNE G. Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: a community-based study. BMC Public Health. 2009, vol. 9, p.454 http://dx.doi.org/10.1186/1471-2458-9-454 (accès libre) BACKGROUND: Health care seeking is a dynamic process that is influenced by sociodemographic, cultural and other factors. In Ethiopia, there are limited studies regarding the health seeking behaviour of tuberculosis (TB) suspects and TB patients. However, a thorough understanding of patients' motivation and actions is crucial to understanding TB and the treatment of disease. Such insights would conceivably help to reduce delay in diagnosis, improve treatment adherence and thereby reduce transmission of TB in the community. The objective of this study was to describe and analyze health care seeking among TB suspects and pulmonary TB (PTB) cases in a rural district of the Amhara Region in Ethiopia. METHODS: Study kebeles were randomly selected in a cross-sectional study design. House-to-house visits were conducted in which individuals aged 15 years and above in all households of the kebeles were included. Subjects with symptoms suggestive of TB were interviewed about their health seeking behaviour, socio-demographic and clinical factors using a semi-structured questionnaire. Logistics regression analysis was employed to assess associations between the independent and outcome variables. RESULTS: The majority, 787 (78%), TB suspects and 33 (82.5%) PTB cases had taken health care actions for symptoms from sources outside their homes. The median delay before the first action was 30 days. In logistics regression, women (AOR 0.8, 95% CI 0.6, 0.9) were found to be less likely to visit a medical health provider than men. Those with a long duration of cough (AOR 1.5, 95% CI 1.03, 2.1) and those with a previous history of TB (AOR 1.5, 95% CI 1.03, 2.3) were more likely to visit a medical health provider compared to those with a shorter duration of cough Service de Documentation EHESP 41 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 and with no history of TB. CONCLUSION: The majority of TB suspects and PTB cases had already taken health care actions for their symptoms at the time of the survey. The availability of a simple and rapid diagnostic TB test for use at the lowest level of health care and the involvement of all health providers in case finding activities are imperative for early TB case detection Service de Documentation EHESP 42 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Rapports, dossiers en ligne et articles supplémentaires Nouvelles publications sommaire Rapport annuel 2009. Institut de veille sanitaire. Septembre 2010. Le mal-être au travail : passer du diagnostic à l'action (rapport). Rapport d'information de M. Gérard DÉRIOT, fait au nom de la Mission d'information sur le mal-être au travail et de la commission des affaires sociales n° 642 tome I (2009-2010) - 7 juillet 2010 Rapport Rapport européen sur la prévention de la violence et de la criminalité au couteau chez les jeunes /European report on preventing violence and knife crime among young people.Organisation Mondiale de la Santé. Bureau Régional de l’Europe. Rapport (en anglais) Trends in Maternal Mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and The World Bank Rapport MENTALHEALTH ANDDEVELOPMENT: Targeting people with mental health conditions as a vulnerable group. World Health Organization 2010. Rapport Evaluation of certain food additives. World Health Organization. 15 September 2010 Rapport Women’s Health Research : Progress, Pitfalls, and Promise. Institute of medicine of national academies. Septembre 2010. Report brief Bronchite Obstructive Chronique sommaire Guideline on clinical investigation of medicinal products in the treatment of Chronic Obstructive Pulmonary Disease (COPD) European Medicines Agency, 2010. Fin de consultation : mars 2011. Document John R. Hurst, Jørgen Vestbo, Antonio Anzueto, et al. Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease. N Engl J Med 2010; 363:1128-38. Article (accès libre, collection papier de la bibliothèque) Cancer du poumon sommaire Articles supplémentaires : les articles en (accès réservé) qui suivent sont accéssibles par l’interface de sciencedirect Louisa G Gordon, Nicholas G Hirst, Robert P Young, et al. Within a smoking-cessation program, what impact does genetic information on lung cancer need to have to demonstrate cost-effectiveness?. Cost Effectiveness and Resource Allocation, Vol. 8(1), 2010 http://dx.doi.org/10.1186/1478-7547-8-18 (accès libre) Service de Documentation EHESP 43 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 John P Pierce,Karen S. Messer,Martha M White, et al. Forty Years of Faster Decline in Cigarette Smoking in California Explains Current Lower Lung Cancer Rates. Cancer Epidemiology, Biomarkers and Prevention, Advance Access 17September 2010 résumé Susan Peters, Roel Vermeulen,Adrian Cassidy, et al. Comparison of exposure assessment methods for occupational carcinogens in a multi-centre lung cancer case–control study Occupational and Environmental Medicine, Online First 24 septembre 2010 http://dx.doi.org/10.1136/oem.2010.055608 Isabelle Soerjomataram, Esther de Vries, Gerda Engholm, et al. Impact of a smoking and alcohol intervention programme on lung and breast cancer incidence in Denmark: An example of dynamic modelling with Prevent . European Journal of Cancer, vol. 46 (14), pp. 2617-2624, 2010 http://dx.doi.org/10.1016/j.ejca.2010.07.051 (accès réservé) Tram Kim Lam,Ingo Ruczinski,Kathy J. Helzlsouer, et al. Cruciferous Vegetable Intake and Lung Cancer Risk: A Nested Case-Control Study Matched on Cigarette Smoking. Cancer Epidemiology, Biomarkers and Prevention, Advance Access 14 septembre 2010 http://dx.doi.org/10.1158/1055-9965.EPI-10-0475 Gwenn Menvielle, Isabelle Soerjomataram, Esther de Vries, et al. Scenarios of future lung cancer incidence by educational level: Modelling study in Denmark European Journal of Cancer, vol. 46 (14), pp. 2625-2632, 2010 http://dx.doi.org/10.1016/j.ejca.2010.07.027 (accès réservé) Isabelle Soerjomataram, Dian Oomen, Valery Lemmens, et al. Increased consumption of fruit and vegetables and future cancer incidence in selected European countries.European Journal of Cancer, vol. 46 (14), pp. 2563-2580, 2010 http://dx.doi.org/10.1016/j.ejca.2010.07.026 (accès réservé) H. Dean Hosgood, III, Paolo Boffetta, Sander Greenland, et al. In-home Coal and Wood Use and Lung Cancer Risk: A Pooled-Analysis of the International Lung Cancer Consortium Environmental Health Perspectives, Article Online 15 septembre 2010 http://dx.doi.org/10.1289/ehp.1002217 Mehta AJ, Malloy EJ, Applebaum KM, et al. Reduced lung cancer mortality and exposure to synthetic fluids and biocide in the auto manufacturing industry. Scandinavian Journal of Work Environmental Health, Online First 13 septembre 2010 Résumé Eiji Yano, Xiaorong Wang, Mianzhen Wang ; et al. Lung cancer mortality from exposure to chrysotile asbestos and smoking: a case–control study within a cohort in China. Occupational and Environmental Medicine, Online first 10 septembre 2010 http://dx.doi.org/10.1136/oem.2009.051615 (accès libre) William Matsui, et al. Tumor-Initiating Cells Are Rare in Many Human Tumors . Cell Stem Cell, vol. 7(3), pp. 279-282, 2010 http://dx.doi.org/10.1016/j.stem.2010.08.009 (accès réservé) Frederike L. Büchner,H. Bas Bueno-de-Mesquita,Martine M. Ros,et al. Variety in Fruit and Vegetable Consumption and the Risk of Lung Cancer in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiology, Biomarkers and Prevention, Advance Access 31 août 2010 http://dx.doi.org/10.1158/1055-9965.EPI-10-0489 Service de Documentation EHESP 44 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Agnihotram V Ramanakumar,Marie-Élise Parent,Lesley Richardson, et al. Exposures in paintingrelated occupations and risk of lung cancer among men: results from two case–control studies in Montreal. Occupational and Environmental Medicine, Advance Access 4 septembre 2010 (résumé) http://dx.doi.org/10.1136/oem.2009.049957 Michelle K. McHugh, Sumesh Kachroo,et al. Assessing environmental and occupational risk factors for lung cancer in Mexican–Americans. Cancer Causes and Control Advance Access 2 septembre 2010 (résumé) http://dx.doi.org/10.1007/s10552-010-9635-1 A. Rosalie David & Michael R. Zimmerman.Cancer: an old disease, a new disease or something in between? Nature Reviews Cancer, Advance Online 3 septembre 2010 (résumé) http://dx.doi.org/10.1038/nrc2914 Hiroyuki Yasudaa, Kenzo Soejimaa,Sohei Nakayama, et al. Bronchoscopic Microsampling is a Useful Complementary Diagnostic Tool for Detecting Lung Cancer. Lung Cancer, Articles in Press 2 septembre 2010 http://dx.doi.org/10.1016/j.lungcan.2010.07.016 (accès réservé) Dépression sommaire Juan Ángel Bellón, Juan de Dios Luna, Berta Moreno, et al. Psychosocial and sociodemographic predictors of attrition in a longitudinal study of major depression in primary care: the predictDSpain study. J Epidemiol Community Health 2010;64:874-884 http://dx.doi.org/10.1136/jech.2008.085290 (Accès libre) H K Jensen, J Wieclaw, T Munch-Hansen,et al. Does dissatisfaction with psychosocial work climate predict depressive, anxiety and substance abuse disorders? A prospective study of Danish public service employees . J Epidemiol Community Health 2010;64:796-801 http://dx.doi.org/10.1136/jech.2008.083980 (accès libre) Julie A. Phillips, PhD / Ashley V. Robin, BA / Colleen N. Nugent, MA, et al. Understanding Recent Changes in Suicide Rates Among the Middle-aged: Period or Cohort Effects?. Public health reports. Volume 125, Issue Number 5 p680-688 (Accès libre ) Article Amelia R. Gavin, PhD, Tessa Rue, MS, David Takeuchi. Racial/Ethnic Differences in the Association Between Obesity and Major Depressive Disorder: Findings from the Comprehensive Psychiatric Epidemiology Surveys. Public health reports. Volume 125, Issue Number 5 p698-708 Article (Accès libre) Service de Documentation EHESP 45 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Dengue Octobre 2010 sommaire K Vainio, S Noraas, M Holmberg, et al. Fatal and mild primary dengue virus infections iportes to norway from africa and south-east asia, 2008-2010. Eurosurveillance, volume 15, issue 38, 23 septembre 2010 Communication (accès libre) Rekol Huy , Philippe Buchy , Anne Conan, et al.Research: National dengue surveillance in Cambodia 1980–2008: epidemiological and virological trends and the impact of vector control. Bulletin of the World Health Organization Volume 88, Number 9, September 2010, 641-716 Article (accès libre) Diabète sommaire K F Lynch, S V Subramanian, H Ohlsson, et al. Context and disease when disease risk is low: the case of type 1 diabetes in Sweden . J Epidemiol Community Health 2010;64:789-795 http://dx.doi.org/10.1136/jech.2008.083667 (accès libre) Oddvar Solli, Trond Jenssen and Ivar S Kristiansen. Diabetes: cost of illness in Norway. BioMed Central Endocrine Disorders 2010, 10:15, on line 20 Septemmber 2010 http://dx.doi.org/10.1186/1472-6823-10-15 M. Schuur, P. Henneman, J. C. van Swieten, et al. Insulin-resistance and metabolic syndrome are related to executive function in women in a large family-based study. European Journal of Epidemiology , Volume 25, Number 8, 561-568 http://dx.doi.org/10.1007/s10654-010-9476-y (accès réservé EHESP en ligne) (accès libre, collection papier de la bibliothèque) Grippe A sommaire Grippe A (H1N1) : Dossier documentaire. Service Documentation de l’EHESP Mise à jour Octobre 2010. Dossier documentaire La grippe : retours d’expérience. Dossier trimestriel. IASS, La revue. Association professionnelle des inspecteurs de l’action sanitaire et sociale. N° 64 juin 2010. (Accès libre, collection papier de la bibliothèque) Avis relatif à l'actualisation de la stratégie vaccinale grippe, saison 2010-2011, suite à la déclaration officielle de fin de pandémie par l'OMS. Haut Conseil de Santé Publique. Mis en ligne le septembre 2010. Avis du 23 avril 2010 Avis du 25 juin 2010 Avis du 25 juin 2010 relatif à la stratégie menée à La Réunion, saison 2010 Numéro thématique – Épidémie de grippe A(H1N1)2009 : place de la surveillance et de l’investigation des cas groupés. Institut de Veille Sanitaire, 21 septembre 2010 BEH n°34-35-36 20 septembre 2010 - Etat de circulation de grippe A (H1N1) 2009 dans plusieurs pays et territoires de l'hémisphère Sud. Note du 14 septembre 2010. Institut de Veille sanitaire. 20 Septembre 2010. Document Service de Documentation EHESP 46 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Bulletins de veille sanitaire Limousin-Poitou-Charentes, septembre 2010 Numéro spécial : grippe A (H1N1) 2009 : bilan de la vague épidémique. Institut de Veille sanitaire. 22 Septembre 2010 Bulletin Bulletin de veille sanitaire Aquitaine, août 2010. Numéro spécial : bilan épidémiologique de la grippe A (H1N1) 2009 en Aquitaine, 2009-2010. Institut de Veille sanitaire. 21 Septembre 2010. Bulletin Insuffisance de couverture vaccinale grippale A(H1N1)2009 en population générale et dans les groupes à risque durant la pandémie 2009-2010 en France. BEH Web n°3, 16 Septembre 2010.Institut de Veille Sanitaire. BEH Web N°3 France Meslé. Recul spectaculaire de la mortalité due à la grippe : le rôle de la vaccination. Population et société.n°471, septembre 2010. Bulletin mensuel d’information de l’institut national d’etudes démographiques Bulletin Amy B. LaFrance,Natalie Vestin, Kristine Moore, et al. Creating an Online “Promising Practices” Clearinghouse for Pandemic Influenza.Public health reports. Volume 125, Issue Number 5 p634-641. Article (accès libre) M Uddin, G C Cherkowski, G Liu, et al. Demographic and socioeconomic determinants of influenza vaccination disparities among university students. J Epidemiol Community Health 2010;64:808-813 http://dx.doi.org/10.1136/jech.2009.090852 (Accès libre) P Santa-Olalla Peralta, M Cortes-García, M Vicente-Herrero, et al. on behalf of the Surveillance Group for New Influenza A(H1N1) Virus Investigation and Control. Risk factors for disease severity among hospitalised patients with 2009 pandemic influenza A (H1N1) in Spain, April – December 2009 Team in Spain. Eurosurveillance, volume 15, issue 38, 23 septembre 2010 Article (Accès libre) M Nishiyama, Y Yoshida, M Sato, et al.Characteristics of paediatric patients with 2009 pandemic influenza A(H1N1) and severe, oxygen-requiring pneumonia in the Tokyo region, 1 September–31 October 2009. Eurosurveillance, Volume 15, Issue 36, 09 September 2010 Article Maladie d'Alzheimer sommaire RÉUNION SUR LE PLAN ALZHEIMER 2008-2012. Vendredi 17 septembre 2010. PALAIS DE L’ÉLYSÉE Compte-Rendu Circulaire DGCS-SD-3A no 2010-206 du 16 juin 2010 relative à la remontée des indicateurs de suivi des mesures 1 et 16 du plan Alzheimer 2008-2012 (UHR/PASA et accueil de jour). Ministère du travail , de la solidarité et de la fonction publique. Ministère de la santé et des sports. Circulaire World Alzheimer Report 2010. Alzheimer's Disease International. 21 Septembre 2010. World Alzheimer Report 2010 - résumé World Alzheimer Report 2010 Service de Documentation EHESP 47 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Maladies cardio-vasculaires sommaire Marqueurs cardiaques dans la maladie coronarienne et l’insuffisance cardiaque en médecine ambulatoire -. Haute Autorité de Santé - 21/09/2010 Rapport d'évaluation M. Carolina Pardo Silva, Omer T. Njajou, Behrooz Z. Alizadeh,et al. HFE gene mutations increase the risk of coronary heart disease in women. European Journal of Epidemiology. Volume 25, Number 9, 643-649 http://dx.doi.org/10.1007/s10654-010-9489-6O (accès libre) T Kiran, A Hutchings, I A Dhalla, et al. The association between quality of primary care, deprivation and cardiovascular outcomes: a cross-sectional study using data from the UK Quality and Outcomes Framework.J Epidemiol Community Health 2010;64:927-934 http://dx.doi.org/10.1136/jech.2009.098806 (accès libre) David H Rehkopf, William H Dow, Luis Rosero-Bixby. Differences in the association of cardiovascular risk factors with education: a comparison of Costa Rica (CRELES) and the USA (NHANES) J Epidemiol Community Health 2010;64:821-828 http://dx.doi.org/10.1136/jech.2009.086926 (accès libre) Hervé Decousus, Paolo Prandoni, Patrick Mismetti, et al. Fondaparinux for the Treatment of Superficial-Vein Thrombosis in the Legs. N Engl J Med, 2010, 23 septembre, p. 1222-1232. Article (accès libre, collection papier de la bibliothèque) Hermann Nabi, Martin J Shipley, Jussi Vahtera, et al. Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study. Heart and Education in heart. Online first 15 Septembre 2010 http://dx.doi.org/110.1136/hrt.2010.198507 Clyde S. Crumpacker. Invited Commentary: Human Cytomegalovirus, Inflammation, Cardiovascular Disease, and Mortality. American Journal of Epidemiology, Volume172, Issue 4, pp. 372-374 http://dx.doi.org/10.1093/aje/kwq174 (accès réservé EHESP) (accès libre, collection papier de la bibliothèque) Maladies chroniques sommaire Julie Jacobs, MPH / Elizabeth A. Dodson, PhD / Elizabeth A. Baker,et al. Barriers to Evidence-Based Decision Making in Public Health: A National Survey of Chronic Disease Practitioners. Public health report. Volume 125, Issue Number 5 p736-742 Article (Accès libre) Maladies infectieuses sommaire 22 septembre 2010 - Surveillance des bactéries multirésistantes dans les établissements de santé en france - Réseau BMR-Raisin - Résultats 2008. Institut de Veille Sanitaire. 22 septembre 2010 Document Elias Mossialos, Chantal M. Morel, Suzanne Edwards, et al. Policies and incentives for promoting innovation in antibiotic research. World Health Organization 2010, on behalf of the European Observatory on Health Systems and Policies.2010 Rapport Service de Documentation EHESP 48 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 Surveillance des infections invasives à méningocoque en France métropolitaine en 2005 : Évaluation quantitative par la méthode de capture-recapture à trois sources. Institut de Veille Sanitaire. 6 Septembre 2010. Rapport Zoonoses : pour une approche intégrée de la santé à l’interface Homme-Animal. BEH Hors-série 14 septembre 2010, Institut de Veille sanitaire. BEH Hors-série Évaluation du signalement des infections nosocomiales dans les établissements de santé d’Île-deFrance de 2004 à 2008. Institu t de Veille Sanitaire. 7 septembre 2010 BEH n°33 Recommandations pour surveiller et prévenir les infections associées aux soins. Haut Comité de Santé Publique, 18 Mai 2010. Rapport Chiara de Waure, Consuelo Cefalo, Giacomina Chiaradia, et al. Intrafamilial transmission of hepatitis C virus in Italy: a systematic review. J Epidemiol Community Health 2010;64:843-848 http://dx.doi.org/10.1136/jech.2009.087965 (Accès libre, collection papier de la bibliothèque) E Delisle, S Larrieu, J Simões, et al Community outbreak of group B meningococcal disease in southwest France – December 2008 to September 2009. Eurosurveillance, Volume 15, Issue 37, 16 September 2010 Article MS Faber, K Heckenbach, E Velasco, et al. Antibiotics for the common cold: expectations of Germany’s general population. Eurosurveillance, volume 15, issue 35, 2 september 2010 Article L Brouwers, M Boman, M Camitz , et al. Micro-simulation of a smallpox outbreak using official register data. Eurosurveillance, volume 15, issue 35, 2 september 2010 Article Guidance for Industry Chronic Hepatitis C Virus Infection: Developing Direct-Acting Antiviral Agents for Treatment. U.S. Food & Drug Administration (FDA).September 2010. Report Paludisme sommaire Lutte contre le paludisme et vies sauvées : sur la voie des Objectifs du Millénaire pour le développement.Collection progrès et impact. N°3-septembre 2010. Roll Back Malaria. Rapport (Version langue anglaise) Saving Lives with Malaria Control : Counting Down to the Millennium Development Goals. PROGRESS & IMPACT SERIES Number 3. September 2010. Roll Back Malaria. Report Kathrine R. Tan, Sonja Mali, Paul M. Arguin. Malaria Risk Information and Prophylaxis, by Country : Table 2-24. Malaria risk information and prophylaxis, by country. Center for Disease Control. Septembre 2010 Page Service de Documentation EHESP 49 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Pathologies liées à l’alcool Octobre 2010 sommaire Alcohol-use disorders - preventing harmful drinking. The National Institute for health and clinical Excellence. Rapport Lars Møller and Srdan Matic. The European Commission’s Communication on alcohol, and the WHO framework for alcohol policy – Analysis to guide development of national alcohol action plans. World Health Organization 2010, on behalf of the European Observatory on Health Systems and Policies. 2010 Rapport Governments confront drunken violence. Bulletin of the World Health Organization. Volume 88, Number 9, September 2010, 641-716 Article Alexander C. Wagenaar, Amy L. Tobler, Kelli A. Komro. Effects of Alcohol Tax and Price Policies on Morbidity and Mortality: A Systematic Review. American Journal of Public Health, Advance Access 23 septembre 2010 (résumé) http://dx.doi.org/10.2105/AJPH.2009.186007 SIDA sommaire Vers un accès universel, étendre les interventions prioritaires liées au VIH/sida dans le secteur de la santé, rapport de situation 2010 : extraits du rapport / UNICEF , France, OMS ,Suisse, ONUSIDA. septembre 2010 Document Sous la présidence du professeur Patrick YENI et équipe d’expert BOURLIERE M, BOURDILLON F, YENI P, BLANCHE S, et al. Rapport 2010, prise en charge médicale des personnes infectées par le VIH : recommandations du groupe d'experts La documentation française.Mis en ligne septembre 2010 Document HIV among African Americans. Center for Disease Control, september 2010. Rapport South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008 The health of our children. HSRC, Afrique du sud . 2010 document Progress report on Kenya's voluntary medical male circumcision programme. 2008-09 summary / Ministry of Health. NASCOP, Kenya , 2010 . document Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector. World Health Organization, septembre 2010. Rapport Implementing Dublin declaration on partnership to fight HIV/aids in Europe and Central Asia : 2010 progress report. ECDC , Stockholm. 2010 Document Service de Documentation EHESP 50 / 51 Bulletin de veille « Focus sur 12 pathologies graves » Octobre 2010 DE WIT J, BOGIE M, BLATTMAN T, et al. Gay community periodic survey : Canberra 2009 /. , NCHECR , Australie, NCHSR , Australie . 2010 Document HIV prevalence estimates from the demographic and health surveys, updated june 2010 / USAID / 2010 Document Champions of hope : a collection of stories / World Vision International,Etats-Unis Document Matthew J. Page, MPP ; Kathleen McDavid Harrison ; Xiangming Wei ; H. Irene Hall. Federal Funding for Reporting Cases of HIV Infection in the United States, 2006 Public health report. Volume 125, Issue Number 5 p718-727 Article (Accès libre) Justin O Parkhurst . Understanding the correlations between wealth, poverty and human immunodeficiency virus infection in African countries. Bulletin of the World Health Organization Volume 88, Number 7, July 2010, 481-560 http://dx.doi.org/.2471/BLT.09.070185 (Accès libre) M-F Anaky et al.Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme Bulletin of the World Health Organization Volume 88, Number 7, July 2010, 481-560 http://dx.doi.org/10.2471/BLT.09.068015 (Accès libre) Tuberculose sommaire Rapport d'évaluation du programme national de lutte contre la tuberculose 2007-2009. Haut Conseil de la Santé Publique. Juin 2010. 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