Bulletin de veille « Focus sur 12 pathologies graves

Transcription

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.
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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 :
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




Bronchite chronique obstructive
Cancer du poumon
Dengue
Dépression
Diabète
Grippe A
Maladie d’Alzheimer
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


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
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
3 / 51
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
(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
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
4 / 51
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
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
5 / 51
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.)
6 / 51
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
(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
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
7 / 51
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
(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
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
8 / 51
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
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
(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
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
9 / 51
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
(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
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
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
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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
(20) LAMIA KA, EVANS RM. Metabolism: Tick, tock, a beta-cell clock. Nature. 2010 July 29, vol.
466, n° 7306, pp.571-572
(21) LEDFORD H. Diabetes drugs offered fresh start. Nature. 2010 July 22, vol. 466, n° 7305,
pp.420-421
(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)
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(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
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
(26) MAGEE C, GOENKA N, KERRIGAN D. Nutrition in type 2 diabetes. Metabolic surgery may
be more effective. BMJ. 2010, vol. 341, p.c4446
(27) MANN J, AUNE D. Can specific fruits and vegetables prevent diabetes? BMJ. 2010, vol. 341,
p.c4395
(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
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
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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
(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
bibliothèque)
(31) PIERCE BL, AHSAN H. Clinical assessment incorporating a personal genome. Lancet. 2010
Sept. 11, vol. 376, n° 9744, pp.869-870
(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
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
(35) SCHRIER RW. Blood pressure control in type 2 diabetes. N Engl J Med. 2010 Aug. 12, vol.
363, n° 7, pp.696-697
bibliothèque)
(36) SKOLNIK N. Guidelines for glycemic control and individualized targets. JAMA. 2010 Sept. 8,
vol. 304, n° 10, pp.1069-1070
(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
BACKGROUND: Non-placebo-controlled trials of erythropoiesis-stimulating agents (ESAs)
comparing lower and higher hemoglobin targets in patients with chronic kidney disease indicate
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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
(39) VILES J, MONTE D, GAWKRODGER DJ. Vitiligo. BMJ. 2010, vol. 341, p.c3780
(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
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
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(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
(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
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
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
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(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
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
(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
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
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bibliothèque)
(6) JEWKES R. Emotional abuse: a neglected dimension of partner violence. Lancet. 2010 Sept.
11, vol. 376, n° 9744, pp.851-852
(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
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
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(9) ROBERTS LW. Understanding depression and distress among medical students. JAMA.
2010 Sept. 15, vol. 304, n° 11, pp.1231-1233
(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
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
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
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
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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
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
(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
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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
Grippe A
sommaire
(1) Pandemic influenza--(some) reasons to be cheerful? Lancet. 2010 Aug. 21, vol. 376, n° 9741,
p.565
(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
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
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Octobre 2010
(3) BIRD SM. Like-with-like comparisons? Lancet. 2010 Aug. 28, vol. 376, n° 9742, pp.684-685
(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
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
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
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,
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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
(2) GEORGE DR. Overcoming the social death of dementia through language. Lancet. 2010
Aug. 21, vol. 376, n° 9741, pp.586-587
(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
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
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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
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
bibliothèque)
(3) BERGER K, EVERS S. Migraine with aura and the risk of increased mortality. BMJ. 2010, vol.
341, p.c4410
(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
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
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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
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
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
363, n° 10, pp.905-917
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Octobre 2010
(8) KALANTRI A, KALANTRI S. Distinguishing hemorrhagic stroke from ischemic stroke. JAMA.
2010 Sept. 22, vol. 304, n° 12, pp.1327-1328
(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
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
(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
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
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
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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
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
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
(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
(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
bibliothèque)
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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
(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
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
(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)
27 / 51
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
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
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
(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
Plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density
lipoprotein cholesterol and triglycerides are among the most important risk factors for coronary
28 / 51
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
(2) MAYOR S. New figures show major increase in alcohol related hospital admissions in
England. BMJ. 2010, vol. 341, p.c4790
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
(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
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
29 / 51
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
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
(7) VAN NR. Demand for malaria drug soars. Nature. 2010 Aug. 5, vol. 466, n° 7307, pp.672-673
(8) WELLS TN. Microbiology. Is the tide turning for new malaria medicines? Science. 2010 Sept.
3, vol. 329, n° 5996, pp.1153-1154
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
(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
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
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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
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
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
(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
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
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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
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
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
BACKGROUND: Despite increasing public health concerns regarding obesity, few safe and
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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
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
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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
363, n° 10, pp.905-917
(13) MAGEE C, GOENKA N, KERRIGAN D. Nutrition in type 2 diabetes. Metabolic surgery may
be more effective. BMJ. 2010, vol. 341, p.c4446
(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
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
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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
(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
(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
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
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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
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
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
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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
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
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
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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
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
(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
bibliothèque)
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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
(2) BHUNIYA S. Extensively drug-resistant tuberculosis in South Africa. Lancet. 2010 Aug. 28,
vol. 376, n° 9742, pp.681-682
(3) BLOMBERG B, LANGELAND N. Tuberculous meningitis and resistance to isoniazid. BMJ.
2010, vol. 341, p.c4677
(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
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
(6) HOLDEN E, RANU H, MADDEN BP. A case of progressive breathlessness. BMJ. 2010, vol.
341, p.c4655
(7) JACK A. MPs step in to save the UK's only mobile tuberculosis detection unit. BMJ. 2010,
vol. 341, p.c4597
39 / 51
Octobre 2010
(8) KIRBY T. Heather Zar--improving lung health for children in Africa. Lancet. 2010 Sept. 4, vol.
376, n° 9743, p.763
(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
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
(12) MU XD, WANG GF. Images in clinical medicine. Miliary tuberculosis. N Engl J Med. 2010
Sept. 9, vol. 363, n° 11, p.1059=
(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
(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
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
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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
(18) TAGEJA N, SHARMA V. Multidrug-resistant tuberculosis in India. Lancet. 2010 Aug. 28, vol.
376, n° 9742, pp.682-683
(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
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
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
41 / 51
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
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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?.
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intervention programme on lung and breast cancer incidence in Denmark: An example of dynamic
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Cancer Risk: A Nested Case-Control Study Matched on Cigarette Smoking. Cancer Epidemiology,
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vegetables and future cancer incidence in selected European countries.European Journal of Cancer,
vol. 46 (14), pp. 2563-2580, 2010
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
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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
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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
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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
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Montreal. Occupational and Environmental Medicine, Advance Access 4 septembre 2010 (résumé)
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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)
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between? Nature Reviews Cancer, Advance Online 3 septembre 2010 (résumé)
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Complementary Diagnostic Tool for Detecting Lung Cancer. Lung Cancer, Articles in Press 2
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Dépression
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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
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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
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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 )
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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
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Dengue
Octobre 2010
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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
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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
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
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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
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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.
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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
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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
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
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Maladie d'Alzheimer
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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
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Octobre 2010
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Marqueurs cardiaques dans la maladie coronarienne et l’insuffisance cardiaque en médecine
ambulatoire -. Haute Autorité de Santé - 21/09/2010
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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
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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
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
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
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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
Maladies infectieuses
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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
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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
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Guidance for Industry Chronic Hepatitis C Virus Infection: Developing Direct-Acting Antiviral
Agents for Treatment. U.S. Food & Drug Administration (FDA).September 2010.
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Paludisme
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développement.Collection progrès et impact. N°3-septembre 2010. Roll Back Malaria.
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(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.
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Kathrine R. Tan, Sonja Mali, Paul M. Arguin. Malaria Risk Information and Prophylaxis, by Country :
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Pathologies liées à l’alcool
Octobre 2010
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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
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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
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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
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The health of our children. HSRC, Afrique du sud . 2010
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Progress report on Kenya's voluntary medical male circumcision programme. 2008-09 summary /
Ministry of Health. NASCOP, Kenya , 2010 .
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Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector. World
Health Organization, septembre 2010.
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Implementing Dublin declaration on partnership to fight HIV/aids in Europe and Central Asia : 2010
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DE WIT J, BOGIE M, BLATTMAN T, et al. Gay community periodic survey : Canberra 2009 /. ,
NCHECR , Australie, NCHSR , Australie . 2010
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HIV prevalence estimates from the demographic and health surveys, updated june 2010 / USAID /
2010
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Champions of hope : a collection of stories / World Vision International,Etats-Unis
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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
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immunodeficiency virus infection in African countries. Bulletin of the World Health Organization
Volume 88, Number 7, July 2010, 481-560
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determinants of survival and loss to programme Bulletin of the World Health Organization Volume 88,
Number 7, July 2010, 481-560
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Tuberculose
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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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Note pour les sources citées :
Ce bulletin de veille a pour objectif de valoriser l’information produite par d’autres sites que l’EHESP et sélectionnée
par les documentalistes de l’EHESP. Si une information de votre site a été mentionnée et que cela ne vous convient
pas, merci de nous contacter par mail
51 / 51

Bulletin de veille « Focus sur 12 pathologies graves

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