Journal Article > LetterFull Text
Lancet Infect Dis. 30 April 2024; Volume S1473-3099 (Issue 24); 00237-8.; DOI:10.1016/S1473-3099(24)00237-8
Finger F, Heitzinger K, Berendes D, Ciglenecki I, Dominguez M, et al.
Lancet Infect Dis. 30 April 2024; Volume S1473-3099 (Issue 24); 00237-8.; DOI:10.1016/S1473-3099(24)00237-8
Journal Article > CommentaryFull Text
PLOS Med. 27 June 2022; Volume 19 (Issue 6); e1004050.; DOI:10.1371/journal.pmed.1004050
Grais RF, Baron E
PLOS Med. 27 June 2022; Volume 19 (Issue 6); e1004050.; DOI:10.1371/journal.pmed.1004050
Journal Article > CommentaryFull Text
Lancet. 1 May 2016; Volume 387 (Issue 10034); DOI:10.1016/S0140-6736(16)00656-5
Baron E
Lancet. 1 May 2016; Volume 387 (Issue 10034); DOI:10.1016/S0140-6736(16)00656-5
“We are not England, we are not France”, said Hillary Clinton about health-care insurance during a recent US presidential debate. European models of health care have their own history in which redistribution forms the cornerstone of social solidarity. Aiming to guarantee social cohesion, France's Etat Providence is rooted in models of a welfare state that developed in Germany and the UK. Ensuring universal health coverage and financed through payroll taxes, and increasingly through a general social contribution on all types of income, French health insurance is characterised by a strong redistributive scheme that benefits the poorest and the most sick.
Journal Article > ResearchFull Text
BMC Pediatr. 20 January 2014; Volume 133 (Issue 2); DOI:10.1542/peds.2013-2112
Page AL, de Rekeneire N, Sayadi S, Aberrane S, Janssens AC, et al.
BMC Pediatr. 20 January 2014; Volume 133 (Issue 2); DOI:10.1542/peds.2013-2112
Early recognition of bacterial infections is crucial for their proper management, but is particularly difficult in children with severe acute malnutrition (SAM). The objectives of this study were to evaluate the accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for diagnosing bacterial infections and assessing the prognosis of hospitalized children with SAM, and to determine the reliability of CRP and PCT rapid tests suitable for remote settings.
Journal Article > ResearchAbstract Only
Prehosp Disaster Med. 15 January 2014; Volume 29 (Issue 1); 21-26.; DOI:10.1017/S1049023X13009278
Teicher CL, Alberti KP, Porten K, Elder G, Baron E, et al.
Prehosp Disaster Med. 15 January 2014; Volume 29 (Issue 1); 21-26.; DOI:10.1017/S1049023X13009278
INTRODUCTION
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting.
PROBLEM
There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.
METHODS
Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010.
RESULTS
Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%).
CONCLUSION
The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting.
PROBLEM
There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.
METHODS
Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010.
RESULTS
Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%).
CONCLUSION
The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.
Journal Article > CommentaryAbstract
Nature. 27 October 2011; Volume 478 (Issue 7370); DOI:10.1038/478458a
Guerrier G, Baron E, Fakri R, Mouniaman I
Nature. 27 October 2011; Volume 478 (Issue 7370); DOI:10.1038/478458a
The burden of war-related mental disorders is well documented among US veterans (Nature 477, 390–393; 2011), but not among civilians in Iraq. This oversight must be rectified so that adequate medical support can be provided to the Iraqi people. US combat troops will soon depart Iraq, leaving Iraqis to cope with the consequences of the 2003 invasion. Although the number of violent deaths is falling, civilians have been killed almost every day this year, most of them in coordinated bomb attacks. Roadside blasts cause long-term disabilities and societal effects among injured civilians. However, these have been largely neglected by the media and no systematic surveillance has been undertaken.
Journal Article > CommentaryFull Text
Bull World Health Organ. 1 September 2012; Volume 90 (Issue 9); 635-635A.; DOI:10.2471/BLT.12.109504
Isanaka S, Schaefer MM, Vasset B, Baron E, Grais RF
Bull World Health Organ. 1 September 2012; Volume 90 (Issue 9); 635-635A.; DOI:10.2471/BLT.12.109504
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 1 November 2004; Volume 98 (Issue 11); DOI:10.1016/j.trstmh.2004.01.005
Guerin PJ, Brasher C, Baron E, Mic D, Grimont F, et al.
Trans R Soc Trop Med Hyg. 1 November 2004; Volume 98 (Issue 11); DOI:10.1016/j.trstmh.2004.01.005
From December 1999 to the end of February 2000, 4218 cases of dysentery were reported in Kenema district, southeastern Sierra Leone, by a Médecins Sans Frontières team operating in this region. Shigella dysenteriae serotype 1 was isolated from the early cases. The overall attack rate was 7.5% but higher among children under 5 years (11.2%) compared to the rest of the population (6.8%) (RR = 1.6; 95% CI 1.5-1.8). The case fatality ratio was 3.1%, and higher for children under 5 years (6.1% vs. 2.1%) (RR = 2.9; 95% CI 2.1-4.1). A case management strategy based on stratification of affected cases was chosen in this resource-poor setting. Patients considered at higher risk of death were treated with a 5 day ciprofloxacin regimen in isolation centres. Five hundred and eighty-three cases were treated with a case fatality ratio of 0.9%. Patients who did not have signs of severity when seen by health workers were given hygiene advice and oral rehydration salts. This strategy was effective in this complex emergency.
Journal Article > ResearchFull Text
Sci Rep. 2 June 2017; Volume 7 (Issue 1); DOI:10.1038/s41598-017-02741-w
Page AL, Boum Y II, Kemigisha E, Salez N, Nanjebe D, et al.
Sci Rep. 2 June 2017; Volume 7 (Issue 1); DOI:10.1038/s41598-017-02741-w
Infections of the central nervous system (CNS) are severe conditions, leading to neurological sequelae or death. Knowledge of the causative agents is essential to develop guidelines for case management in resource-limited settings. Between August 2009 and October 2012, we conducted a prospective descriptive study of the aetiology of suspected CNS infections in children two months to 12 years old, with fever and at least one sign of CNS involvement in Mbarara Hospital, Uganda. Children were clinically evaluated on admission and discharge, and followed-up for 6 months for neurological sequelae. Pathogens were identified from cerebrospinal fluid (CSF) and blood using microbiological and molecular methods. We enrolled 459 children. Plasmodium falciparum (36.2%) and bacteria in CSF (13.3%) or blood (3.3%) were the most detected pathogens. Viruses were found in 27 (5.9%) children. No pathogen was isolated in 207 (45.1%) children. Patterns varied by age and HIV status. Eighty-three (18.1%) children died during hospitalisation, and 23 (5.0%) during follow-up. Forty-one (13.5%) children had neurological sequelae at the last visit. While malaria remains the main aetiology in children with suspected CNS infections, no pathogen was isolated in many children. The high mortality and high rate of neurological sequelae highlight the need for efficient diagnosis.
Journal Article > ResearchFull Text
Journal of the American Medical Association (JAMA). 12 August 2015; Volume 150 (Issue 11); 1080-1085.; DOI:10.1001/jamasurg.2015.1928
Trudeau MO, Baron E, Herard P, Labar AS, Lassalle X, et al.
Journal of the American Medical Association (JAMA). 12 August 2015; Volume 150 (Issue 11); 1080-1085.; DOI:10.1001/jamasurg.2015.1928
IMPORTANCE
Little is known about the scope of practice and outcomes in pediatric surgery performed by humanitarian organizations in resource-poor settings and conflict zones. This study provides the largest report to date detailing such data for a major nongovernmental organization providing humanitarian surgical relief support in these settings.
OBJECTIVE
To characterize pediatric surgical care provision by a major nongovernmental organization in specialized humanitarian settings and conflict zones.
DESIGN, SETTING AND PARTICIPANTS
A retrospective cohort study was conducted from August 15, 2014, to March 9, 2015, of 59 928 surgical interventions carried out from January 1, 2012, to December 31, 2013, by the Médecins Sans Frontières Operational Centre Paris (MSF-OCP) program in 20 locations, including South Sudan, Yemen, Syria, Gaza, Pakistan, Nigeria, Central African Republic, Democratic Republic of Congo, and the Philippines. Surgical interventions were primarily for general surgical, traumatic, and obstetric emergencies and were categorized by mechanism, type of intervention, American Society of Anesthesia risk classification, and urgency of intervention.
MAIN OUTCOMES AND MEASURES
Operative indications, type of intervention, and operative case mortality.
RESULTS
Among all age groups, 59 928 surgical interventions were performed in dedicated trauma, obstetric, and reconstructive centers for 2 years. Nearly one-third of interventions (18 040 [30.1%]) involved preteen patients (aged <13 years) and 4571 (7.6%) involved teenaged patients (aged 13-17 years). The proportion of violence-related injuries in the preteen group was significantly lower than in the teenage group (4.8% vs 17.5%; P < .001). Burns (50.1%), other accidental injuries (16.4%), and infections (23.4%) composed the bulk of indications in the preteen group. Interventions in the teenage group were principally caused by trauma-related injuries (burns, 22.9%; traffic accidents, 10.1%; gunshot wounds, 8.0%). Crude perioperative case mortality rates were 0.07% in the preteen group, 0.15% in the teenage group, and 0.22% in the adult group (>17 years) (P = .001). One-third of the cases (33.4%) were deemed urgent, while most of the remaining cases (57.7%) were deemed semielective (surgical intervention to be performed within 48 hours).
CONCLUSIONS AND RELEVANCE
When examining surgical interventions in a population of pediatric patients cared for in the specialized setting of humanitarian aid and conflict zones, burns, other accidental injuries, and infection composed the bulk of indications in the preteen group; interventions in the teenage group were principally caused by trauma-related injuries. Crude perioperative case mortality rates in the preteen group were significantly lower than in the adult group. Further work is needed to examine long-term outcomes of pediatric operations in these settings and to guide context-specific surgical program development.
Little is known about the scope of practice and outcomes in pediatric surgery performed by humanitarian organizations in resource-poor settings and conflict zones. This study provides the largest report to date detailing such data for a major nongovernmental organization providing humanitarian surgical relief support in these settings.
OBJECTIVE
To characterize pediatric surgical care provision by a major nongovernmental organization in specialized humanitarian settings and conflict zones.
DESIGN, SETTING AND PARTICIPANTS
A retrospective cohort study was conducted from August 15, 2014, to March 9, 2015, of 59 928 surgical interventions carried out from January 1, 2012, to December 31, 2013, by the Médecins Sans Frontières Operational Centre Paris (MSF-OCP) program in 20 locations, including South Sudan, Yemen, Syria, Gaza, Pakistan, Nigeria, Central African Republic, Democratic Republic of Congo, and the Philippines. Surgical interventions were primarily for general surgical, traumatic, and obstetric emergencies and were categorized by mechanism, type of intervention, American Society of Anesthesia risk classification, and urgency of intervention.
MAIN OUTCOMES AND MEASURES
Operative indications, type of intervention, and operative case mortality.
RESULTS
Among all age groups, 59 928 surgical interventions were performed in dedicated trauma, obstetric, and reconstructive centers for 2 years. Nearly one-third of interventions (18 040 [30.1%]) involved preteen patients (aged <13 years) and 4571 (7.6%) involved teenaged patients (aged 13-17 years). The proportion of violence-related injuries in the preteen group was significantly lower than in the teenage group (4.8% vs 17.5%; P < .001). Burns (50.1%), other accidental injuries (16.4%), and infections (23.4%) composed the bulk of indications in the preteen group. Interventions in the teenage group were principally caused by trauma-related injuries (burns, 22.9%; traffic accidents, 10.1%; gunshot wounds, 8.0%). Crude perioperative case mortality rates were 0.07% in the preteen group, 0.15% in the teenage group, and 0.22% in the adult group (>17 years) (P = .001). One-third of the cases (33.4%) were deemed urgent, while most of the remaining cases (57.7%) were deemed semielective (surgical intervention to be performed within 48 hours).
CONCLUSIONS AND RELEVANCE
When examining surgical interventions in a population of pediatric patients cared for in the specialized setting of humanitarian aid and conflict zones, burns, other accidental injuries, and infection composed the bulk of indications in the preteen group; interventions in the teenage group were principally caused by trauma-related injuries. Crude perioperative case mortality rates in the preteen group were significantly lower than in the adult group. Further work is needed to examine long-term outcomes of pediatric operations in these settings and to guide context-specific surgical program development.