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Dermatologie et Infections Sexuellement Transmissibles
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Dermatologie et Infections Sexuellement Transmissibles | ScienceDirect
Book Description elsevier masson. Condition: Assez bon. Seller Inventory LYL Book Description Elsevier-Masson, Condition: OKAZ. XIX p. Seller Inventory O Items related to Maladies infectieuses et transmissibles. Maladies infectieuses et transmissibles. Publisher: Elsevier Masson , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. Learn more about this copy. About AbeBooks. A confirmed case was diagnosed either by culture, PCR, or a 4-fold increase in the anti— L.
A probable case was defined by a single anti— L. Case patients who had died by the time that the study was initiated were excluded. Cases were identified using lists provided by the NRC of patients hospitalized between July and February Investigators were not blinded to the case-control status of study subjects. Control subjects were recruited by selecting the first 2 patients on the list of the orthopedic services of the same hospital who satisfied all the matching criteria and who agreed to participate in this study. Telephone-based interviews with both case patients and control subjects were conducted between March and June All study subjects were asked to provide sociodemographic details e.
A backward-step selection procedure was used to obtain the best model, and adjusted ORs aORs were reported. Interaction between having skin lesions and the remaining variables in the final model was tested for.
The etiologic fraction for matched case-control studies was calculated for each of the variables that, in the conditional logistic regression model, were independently associated with leptospirosis. A total of patients with leptospirosis were reported to the NRC between July and February , of whom 22 were excluded from further analysis because they were either not hospitalized 14 patients , had died 5 , resided outside of France 2 , or could not be traced 1.
The matched case-control analysis was performed on subjects 90 case patients and control subjects : 79 case patients were matched with 2 control subjects, and 11 case patients were matched with only 1 control subject. No subjects reported having ever been vaccinated against leptospirosis.
Seventeen variables identified as being associated with leptospirosis by univariable analysis were included in the multivariable conditional logistic regression analysis table 1. Only 4 such variables were independently associated with a case of leptospirosis table 1 : skin lesions aOR, 7. No interaction between having a skin lesion and either canoeing or contact with wild rodents was reported.
The etiologic fraction in the population demonstrated that nearly two-thirds Univariable analysis and conditional logistic regression of risk factors associated with leptospirosis in France, — This study is among the first to identify and quantify the risk factors for sporadic leptospirosis in France.
Of the 4 exposures identified as being independently associated with leptospirosis, none were exclusively professional. This corroborates the evolution of the epidemiology of leptospirosis in developed countries, where the disease is becoming increasingly associated with leisure rather than professional activities [ 1 , 4 , 5 ].
The risk of leptospirosis associated with canoeing is very high, and this may be due to imprecision in the estimate, small sample size only 1 control subject participated in this activity , a longer exposure period because canoeists may spend long periods of time in or near freshwater , and a higher risk of transmission being associated with an increased likelihood of acquiring skin lesions or to the accidental ingestion of contaminated water. Nonetheless, leptospirosis is an important risk in some professions [ 8 ], and the absence of an explicit professional risk factor may be indicative of the success of the control program in France [ 9 ].
The control of leptospirosis is difficult because of the rarity of the disease and the ubiquity of possible exposure. France is one of the few European countries where an inactivated vaccine, which requires a booster dose every 2 years, against the serogroup Leptospira icterohaemorrhagiae is licensed for use in persons in specific professions [ 7 ]. However, its effectiveness is limited because it is serogroup restricted, offers protection against a minority approximately one-third of isolated serovars, and offers a short duration of immunity [ 9 , 10 ].
The current vaccination program in France targets individuals with an identified professional risk through a frequent exposure to Rattus species and, by inference, to L. The results of this study could apparently be used to support the extension of the guidelines for vaccination to include other leisure activities, such as canoeing.
However, although further research is required, the benefits of enlarging the vaccine recommendations remain uncertain because of the small proportion of cases attributable to such activities and the limitations of the available vaccine. Few outbreaks of leptospirosis have been reported in France, and improving surveillance would allow the early detection of outbreaks and the implementation of appropriate control measures [ 11 ]. This would require not only the availability of a sensitive, rapid, and cheap diagnostic assay but also an increased awareness among medical practitioners, as well as risk groups, of the disease [ 4 ].
In an outbreak of leptospirosis in Rochefort, France, an epidemiological investigation combined with an environmental survey, which demonstrated significant leptospiral carriage in feral rodents, led to a swimming ban in waterways identified as being at risk [ 11 ]. Furthermore, chemoprophylaxis with doxycycline was used as a secondary preventive measure in persons known to have been exposed [ 11 ].
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Increasing awareness of leptospirosis among canoeists is an additional control strategy, although such campaigns have met with only limited success [ 12 ]. The public health benefit of widening the recommendations for vaccination to include leisure activities remains doubtful because of the limitations of the available vaccine and the small proportion of cases attributable to canoeing.
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Further research is required, but alternative strategies, particularly increasing awareness of the disease among medical practitioners and water-sport enthusiasts, as well as improved surveillance, must also be considered. Financial support. Oxford University Press is a department of the University of Oxford.
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Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Oxford Academic. Google Scholar. Isabelle Capek. Reprints or correspondence: Dr. Maurice, France i. Guy Baranton. Jean-Claude Desenclos.
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