RESUMO
A problem of community-acquired Staphylococcus aureus skin infections emerged in the French armed forces in 2004, in a malaria-endemic areas. The high incidence rate led us to evaluate military staff practices. This was a cross-sectional survey of doctors and nurses deployed as officers in French Guyana since 2006. The definition of skin and soft-tissue infection came from the criteria for epidemiological surveillance of the armed forces. We studied the management of antibiotic therapy and its related difficulties. In all, 47 officers responded. At the Military Medical Center (MMC), 23.4% of respondents routinely prescribed antibiotics, compared with 36.2% when stationed in the jungle (p<0.05%). Complication led 68.1 of staff to prescribe antibiotic prescriptions at the MMC, compared with 46.8% in the jungle (p<0.05%). Finally, 22.5% of those at MMC prescribed antibiotic coverage of surgical drainage, compared with 14.8% in the jungle (p<0.05%). Pristinamycin and fusidic acid were the preferred antibiotics. Two-thirds of the staff reported difficulties in jungle management. This first study indicates the need for an update of military medical recommendations. Personnel training must continue to enable them to provide appropriate aggressive management in the current endemic context.
Assuntos
Antibacterianos/uso terapêutico , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Adulto , Estudos Transversais , Feminino , Guiana/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Malária/epidemiologia , Masculino , Militares , Guias de Prática Clínica como Assunto , Padrões de Prática em Enfermagem , Padrões de Prática MédicaRESUMO
BACKGROUND: In 2002, the North Atlantic Treaty Organization took five initiatives in order to enhance the defence capacities against the massive destruction weapons, one of them concerned the development of an interoperable surveillance system, giving in real time some informations permitting early warning to the commanders. Thoughts in France to improve the military surveillance system, methodological constraints and first results are shown. METHODS: Medical, technological, human and organisational aspects had to be taken into account to develop real time surveillance within the armed forces, and also specific military constraints. In order to evaluate the validity of its methodology, the "Institut de médecine tropicale du service de santé des armées" developed a prototype, set up in French Guyana and which took part in a second time at a multinational exercise. RESULTS: The "surveillance spatiale des épidémies au sein des forces armées de Guyane" has been set up in 2004, formed by both a recording and an analysis networks. This system permits to provide in real time some dashboards directly operational for the commanders. The exhaustiveness rate has been evaluated at 104%, compared to the traditional surveillance. It permitted three times to detect outbreaks several weeks before the other systems. Some limits have been identified, as the use of personal digitalized assistants. The involvement in a multinational exercise showed the system's efficacy, by detecting two simulated outbreaks, but also its interoperability. In 2006, it has been decided to extend the concept by deploying its second generation within the French armed forces in Djibouti. The "alerte et surveillance en temps réel" disposal permitted to take into account multiple geographical localizations. CONCLUSION: A real time surveillance system is an essential alarm disposal, however it is only an information tool within the complex activity of piloting the sanitary situation. It must be integrated within the whole situation expertise supports, represented also by medical intelligence, epidemiological investigations and prediction of the epidemiological phenomenon evolution.
Assuntos
Surtos de Doenças/prevenção & controle , Militares , Vigilância da População/métodos , França/epidemiologia , HumanosRESUMO
A "knowledge attitudes and practices" study about malaria treatments was undertaken in French Guiana, along with an ethnopharmacological study. One hundred and seventeen people from five different groups and nationalities (Creole, Palikur, Galibi, Brazilian, and European) answered the questionnaire. The results were analysed using univariate and multivariate statistical analysis. First, we evaluated the overall knowledge about malaria from the interviewed people. According to bio-medical concepts, we noticed that they have a good knowledge of this illness. Secondly, we studied the treatment used by sick people during their last malaria attack. We demonstrated that, although bio-medical treatment is available in this area, people use both modern drugs and traditional remedies. Finally, preventive attitudes have been examined. One-third of the interviewed people drink regularly some herbal remedy to prevent febrile illnesses and malaria, thus displaying a strong concern about this disease. The ethnopharmacological study highlighted the frequent use of traditional remedies, along with their mode of preparation and administration. A total of 34 different species (both from flora and fauna) have been registered as antimalarial. Twenty-seven are used for curative purposes, 20 as preventive and 13 of them are used for both purposes. Quassia amara (Simaroubaceae) whose antimalarial activity has already been demonstrated was the species most frequently used as antimalarial for curative and preventive purposes.
Assuntos
Etnofarmacologia , Conhecimentos, Atitudes e Prática em Saúde , Malária/tratamento farmacológico , Medicina Tradicional , Fitoterapia/métodos , Extratos Vegetais/uso terapêutico , Adulto , Feminino , Guiana Francesa , Humanos , Malária/prevenção & controle , Malária/transmissão , Masculino , Inquéritos e QuestionáriosRESUMO
Dengue fever is a widespread disease that can occur outside tropical areas. Several thousand French military personnel are exposed to this infectious risk each year and exposure is expected to rise with the creation of a professional army and the increasing number of foreign missions. As a result, dengue fever has become a major priority for the Armed Services Health Corps (ASHC). A system of epidemiological surveillance based on the active participation of all military physicians has been designed by the ASHC to collect and analyze all data relevant to cases of dengue fever involving French military personnel stationed overseas or at home. The purpose of this study is to present data compiled for the period from 1996 to 1999. Analysis of these data demonstrated that the incidence of dengue fever peaked in 1997 due to epidemic outbreaks occurring in French Polynesia and Martinique. In response to these outbreaks control measures were adapted especially in regard to vector control. This study shows that the system of surveillance implemented by the ASHC is an effective but still perfectible tool.
Assuntos
Dengue/epidemiologia , Surtos de Doenças , Exposição Ambiental , Militares , Adulto , Animais , França/etnologia , Humanos , Incidência , Insetos Vetores , Masculino , Martinica/epidemiologia , Polinésia/epidemiologia , Medição de Risco , ViagemRESUMO
Guyana is the only department of France in which malaria is a public health problem. The fact that 4,000 new cases including 80% due to Plasmodium falciparum and less than 5 deaths are reported each year shows that the disease is under control but has not been eradicated despite the quantity and quality of the resources that have been implemented. This region of 91,000 km2 with approximately 140,000 inhabitants can be roughly divided into 3 zones. Along the coastline where most of the population lives, malaria is uncommon. In the most remote scarcely populated areas of upper and middle Maroni and upper Oyapock, malaria is stable, perennial and well controlled. In low Maroni and low Oyapock, the impact of malaria is compounded by the high turnover of the population. There is a heavy and poorly controlled movement of migrant people on the two rivers that constitute the natural borders with Brazil and Surinam. Under these conditions strict measures cannot be implemented and malaria remains a problem in Guyana.