Les départements d’outre-mer, confrontés aux cyclones, ont développé une expertise particulière dans la prévention et l’organisation des secours lors de ces catastrophes. Des aspects originaux de cette approche pourraient être appliqués lors des graves tempêtes qui surviennent de plus en plus fréquemment en France hexagonale, tempêtes vraisemblablement liées au réchauffement climatique et à son effet sur les océans. La force des vents et l’importance des pluies, principaux effets des cyclones, caractérisent aussi ces tempêtes, avec les mêmes conséquences potentielles. Si les concepts traditionnels de la médecine de catastrophe sont applicables à l’organisation des secours, la notion de secours impossible avec ses conséquences éthiques et médicolégales pourrait être transposable un jour. De même, la nécessité d’identifier et de sécuriser en amont toute une frange de malades pris en charge à domicile pourrait aussi se poser un jour.

Abstract Background Chest pain is a frequent reason for calls in emergency medical communication centre (EMCC). Detecting a coronary origin by phone is a challenge. This is especially so as the presentations differ according to gender. We aimed to establish and validate a sex-based model to predict a coronary origin of chest pain in patients calling an EMCC. Methods This prospective cohort study enrolled patients at 18 years of age or older who called the EMCC because of non-traumatic chest pain. The main outcome was the diagnosis of acute coronary syndrome (ACS) determined by expert evaluation of patient files. Results During 18 months, 3727 patients were enrolled: 2097 (56%) men and 1630 (44%) women. ACS was diagnosed in 508 (24%) men and 139 (9%) women. For men, independent factors associated with an ACS diagnosis were age, tobacco use, severe and permanent pain; retrosternal, breathing non-related and radiating pain; and additional symptoms. The area under the receiver operating characteristic curve (AUC) was 0.76 (95% confidence interval [CI] 0.73–0.79) for predicting ACS. The accuracy of the male model to predict ACS was validated in a validation dataset (Hosmer-Lemeshow test: p = 0.554); the AUC was 0.77 (95%CI 0.73–0.80). For women, independent factors associated with an ACS diagnosis were age ≥ 60 years, personal history of coronary artery disease, and breathing non-related and radiating pain. The AUC was 0.79 (95%CI 0.75–0.83). The accuracy of the female model to predict ACS was not validated in the validation dataset (Hosmer-Lemeshow test: p = 0.035); the AUC was 0.67 (95%CI 0.60–0.74). Conclusions Predictors of an ACS diagnosis in patients calling an EMCC for chest pain differ between men and women. We developed an accurate predictive model for men, but for women, the accuracy was poor. Trial registration This study is registered with ClinicalTrials.gov (NCT02042209).

Identification of the coronary origin of a thoracic pain by the emergency physician in charge of telephone triage at the pre-hospital emergency service is a key element of prognosis. To build a gender-specific telephone score for predicting ACS for patients calling for non-traumatic thoracic pain. Observational multicenter prospective study. Patients ≥18 years old calling the telephone triage center for a non-traumatic chest pain were included. The outcome was ACS diagnosis estimated by two independent experts. Separate models were built for men and women. Multivariable analyses were carried out to identify predictive items of ACS using a stepwise logistic regression. Models performances were assessed (c-statistic). Data were randomly divided into a derivation and a validation sample. In three medical centers, 3727 patients were included (2097 men, 1630 women). ACS were diagnosed in 24.2% of men and 8.5% of women. Among men, variables independently associated with ACS were age, smoking, pain intensity, persistence of pain, retrosternal pain, lack of increased intensity with inspiration, pain irradiations, pain association to other signs. The area under the receiver operator characteristic (ROC) curve (AUC) was 0.76 (95% confidence interval (CI) 0.73-0.79). A 48 point score was built. The AUC of the score applied to the validation sample was 0.77 (95% CI 0.73-0.80). Among women, variables independently associated with ACS were age, previous coronary artery disease, lack of increased pain intensity with inspiration, pain irradiations. The AUC was 0.79 (0.75-0.83). A 23 point score was built. The AUC of the score applied to the validation sample was 0.67 (95% CI 0.60-0.74). Predictive characteristics of ACS in patients who call medical dispatch centre for chest pain are different for women and men. The predictive accuracy of the models we developed was better among men than women.

In Reunion Island, alcohol is a major public health problem. Syndromic surveillance system based on ED data was used for describe alcohol intoxication visits between 2010-2012 and factors associated with their variations. During the study period, alcohol intoxication was the second leading cause of all visits in ED. Time-series models showed a robust association between ED visits and days of minimum social benefits payment, weekends, public holidays. These results will be transmitted to health authorities in order to orient the public health policies.

The "Grand Raid de la Réunion" is one of the hardest ultra trails in the world. This endurance running race has consequences on health's runners. We used syndromic surveillance to estimate the health impact of this sporting event on the Emergency Departments (ED) of Reunion Island. During the race's period, a global increase of the ED visits all causes was observed. The syndromic surveillance system detected a significant ED visits' increase for hydro-electrolytic disorders. These results highlight the usefulness of syndromic surveillance to estimate the impact on health of a mass gathering on a sporting event of great magnitude.

During the past years, syndromic surveillance based on emergency visits allowed to monitor seasonal epidemics in Reunion Island and to measure their health impact. Nevertheless, its ability to detect minor unusual events still had to be demonstrated. Between 2011 and 2012, several small scale unusual health events were detected (autochthonous cases of measles, family foodborne illness etc.), leading to health alerts and requiring immediate control measures.

Automatic Selection of clinical Trial based on Eligibility Criteria (ASTEC) project is to automate, so as to make it systematic, the search of cancer clinical trials, by reusing the patient data contained into an oncologic electronic health record. ASTEC project tackles two major scientific challenges for medical informatics: 1) the syntactic and semantic interoperability between information systems. The oncologic electronic medical records and the recruitment decision system must be interoperable. The ASTEC project proposes a framework of syntactico-semantic interoperability based on international standards. Generic methods of mediation and reasoning based on ontologies are developed to match data from the electronic medical records to the inclusion/exclusion criteria of clinical trials; 2) a decision support system for recruitment. We have developed inference methods on the electronic medical records adapted to the data structure as well as the eligibility criteria, this paper, we present and justify our choices, concerning the medical process in oncology and the scientific and technical aspects. Furthermore the system will be evaluated in real time. The aim is to demonstrate a significative improvement of the prescreening rate of patient. (C) 2012 Published by Elsevier Masson SAS.

On Reunion Island, in response to the threat of emergence of the pandemic influenza A(H1N1)2009 virus, we implemented enhanced influenza surveillance from May 2009 onwards in order to detect the introduction of pandemic H1N1 influenza and to monitor its spread and impact on public health. The first 2009 pandemic influenza A(H1N1) virus was identified in Réunion on July 5, 2009, in a traveller returning from Australia; seasonal influenza B virus activity had already been detected. By the end of July, a sustained community pandemic virus transmission had been established. Pandemic H1N1 influenza activity peaked during week 35 (24-30 August 2009), 4 weeks after the beginning of the epidemic. The epidemic ended on week 38 and had lasted 9 weeks. During these 9 weeks, an estimated 66 915 persons who consulted a physician could have been infected by the influenza A(H1N1)2009 virus, giving a cumulative attack rate for consultants of 8.26%. Taking into account the people who did not consult, the total number of infected persons reached 104 067, giving a cumulative attack rate for symptomatics of 12.85%. The crude fatality rate (CFR) for influenza A(H1N1)2009 and the CFR for acute respiratory infection was 0.7/10 000 cases. Our data show that influenza pandemic did not have a health impact on overall mortality on Réunion Island. These findings demonstrate the value of an integrated epidemiological, virological and hospital surveillance programme to monitor the scope of an epidemic, identify circulating strains and provide some guidance to public health control measures.

First infections with the 2009 pandemic H1N1 influenza virus were identified on Reunion Island in July 2009. By the end of July, sustained community transmission of the virus was established. Pandemic H1N1 influenza activity peaked during week 35 (24 to 30 August), five weeks after the beginning of the epidemic and has been declining since week 36. We report preliminary epidemiological characteristics of the pandemic on Reunion Island in 2009 until week 37 ending September 13.

Les maisons de naissance font partie intégrante de l'offre de soins en périnatalité dans la plupart des pays à haut niveau de ressources économiques. Elles proposent un changement de paradigme en offrant un modèle continu de soins, patient-centré, innovant, avec un accouchement réalisé en ambulatoire et qui valorise la salutogenèse. La France a récemment autorisé l'ouverture de huit établissements qui sont en cours d'expérimentation. Le rapport sur la qualité des soins qui y sont prodigués est riche d'enseignements.Midwifery units are an integral part of the perinatal care provision in most countries with high levels of economic resources. They propose a paradigm shift by providing a continuous, patient-centred, innovative care model with outpatient delivery that values salutogenesis. France recently authorized the opening of eight units which are currently at the experimental stage. The report on the quality of care provided there is rich in information.

Comment construire un questionnaire de psychologie ? Souvent peu détaillée dans les études, l'étape de construction d'un questionnaire est pourtant un aspect méthodologique essentiel du travail de mesure des phénomènes psychologiques. Au-delà des précautions prises ultérieurement lors de sa validation, un questionnaire ne peut mesurer que ce pourquoi il a été créé, d'où l'importance cruciale de cette étape. À l'aide de l'exemple de la SChool REfusal EvaluatioN (SCREEN), un questionnaire visant à mesurer le refus scolaire anxieux, cet article présente pas à pas et discute les différentes phases de sa création : (a) rédaction des items ; (b) évaluation et pré-sélection des items ; et (c) structuration du questionnaire dans sa forme pilote (avant validation). Outre ces aspects techniques, pour chaque phase sont présentées les différentes contraintes à envisager, de manière à construire un questionnaire pertinent sur le terrain selon l'objet d'étude choisi.What should we pay attention to when designing a psychological scale? Often sketchily outlined in studies, the design phase is an essential aspect of any study measuring phenomena in psychology. Using the example of the School Refusal EvaluatioN (SCREEN), a scale designed to assess school refusal, this article details the design phase step by step and discuss the different stages of its creation: (a) writing of items; (b) assessment and pre-selection of items and (c) structuring the questionnaire in its pilot form before validation. Besides these technical aspects, this article discusses how the constraints inherent to each stage are to be addressed so that a scale relevant to the field and topic of study can be correctly developed.

Avec plus de 260000 cas estimés, l’épidémie de Chikungunya a provoqué au début de l’année 2006 une crise sanitaire d’une ampleur sans précédent sur l’île de la Réunion. L’alerte avait été donnée en 2005 mais le nombre important de patients au début de l’année 2006 prit les autorités sanitaires par surprise. Cette arbovirose transmise par le moustique Aedes albopictus était alors peu connue et était alors considérée comme bénigne, ce qui a été réfuté par l’apparition de formes graves et même mortelles qui n’avaient jamais été décrites auparavant. Plus du tiers de la population réunionnaise a été atteinte. Les structures de soins ont été rapidement engorgées et ont dû adapter quotidiennement l’offre de soins aux besoins des patients. Les acteurs de santé ont dû gérer cette crise sanitaire particulièrement longue à près de dix mille kilomètres de la métropole. La gestion de cette épidémie démontre toute l’importance de l’anticipation de telles crises sanitaires.