Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Liposomal amphotericin B (LAmb) may fail to heal Leishmania infantum visceral leishmaniasis (VL) in the immunodeficient host. There are currently no guidelines on how to treat such patients and efficacy of miltefosine monotherapy seems limited in this indication. We present 2 cases of patients with VL and AIDS for which LAmb had to be interrupted (one because of toxicity, one because of treatment failure) and who were treated effectively with pentamidine followed by miltefosine.
ISSN: 1383-5769

hal-01509592
https://hal.archives-ouvertes.fr/hal-01509592
PUBMED : 27353022

Éditeur(s) : HAL CCSD ACSM
Résumé : International audience
A 26-yr-old man with sickle cell trait (SCT) suddenly lost visual acuity in the left eye after a cycling race in hot tropical environment. The cause was massive central retinal vein occlusion (CRVO) with hemorrhaging that rapidly worsened to neovascular glaucoma. Although medically treated, the eye is now marked by total retinal detachment. Cardiovascular function assessment shows no electrocardiographic abnormalities, no anomaly in the supra-aortic tree, and no evidence of structural heart disease. Although normal coagulation markers values (i.e., activated partial thromboplastin time, prothrombin time, fibrinogen concentration, antithrombin III, factor V, proteins C and S) were observed 2.5 months after the clinical event, a transesophageal echocardiogram performed few hours after the incident revealed the presence of four thrombi in the left atrium suggesting a postexercise hypercoagulable state at that time. Hemorheological measurements at distance of the events demonstrated high red blood cell rigidity at baseline. Therefore, marked blood rheological impairment and activation of the coagulation pathway in response to the heavy and prolonged cycling race could have promoted CRVO in this cyclist carrying SCT. These data suggest that SCT could be considered as a risk factor for significant ocular complications when severe exercise is performed and support the idea that SCT is a contributing factor in blood rheology and vascular dysfunctions.
Medicine & Science in Sports & exercise

Droits : info:eu-repo/semantics/OpenAccess
hal-00698572
https://hal.univ-antilles.fr/hal-00698572
https://hal.univ-antilles.fr/hal-00698572/document
https://hal.univ-antilles.fr/hal-00698572/file/Hedreville_et_al_revised_MSSE-D-08-00064R2.pdf
DOI : 10.1249/MSS.0b013e31818313d0

Éditeur(s) : HAL CCSD Springer Verlag (Germany)
Résumé : International audience
A hybrid linear ion-trap Fourier-transform ion cyclotron resonance mass spectrometer was used for top-down characterization of the abundant human salivary Cystatins, including S, S1, S2, SA, SN, C, and D, using collisionally activated dissociation (CAD) after chromatographic purification of the native, disulfide intact proteins from saliva. Post-translational modifications and protein sequence polymorphisms arising from single nucleotide polymorphisms (SNPs) were assigned from precursor and product ion masses at a tolerance of 10 ppm allowing confident identification of individual intact mass tags. Cystatins S, S1, S2, SA and SN were cleaved of a N-terminal 20 amino-acid signal peptide, and Cystatin C a 26-residue peptide, to yield a generally conserved N-terminus. In contrast, Cystatin D isoforms with 24 and 28 amino-acid residue N-terminal truncations were found such that their N-termini were not conserved. Cystatin S1 was phosphorylated at Ser3, while S2 was phosphorylated at Ser1 and Ser3 of the mature protein, in agreement with previous work. Both Cystatin D isoforms carried the polymorphism C46R (SNP: rs1799841). The 14328 Da isoform of Cystatin SN previously assigned with polymorphism P31L due to a SNP (rs2070856) was found only in whole saliva. Parotid secretions contained no detectable Cystatins while whole saliva largely mirrored the contents of submandibular/sublingual (SMSL) secretions. Top-down high-resolution mass spectrometry is a powerful tool for the identification and characterization of potential protein biomarkers in saliva.
ISSN: 1044-0305

hal-00677483
https://hal.archives-ouvertes.fr/hal-00677483
DOI : 10.1016/j.jasms.2010.01.025

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
ISSN: 0342-4642

inserm-01622988
http://www.hal.inserm.fr/inserm-01622988
http://www.hal.inserm.fr/inserm-01622988/document
http://www.hal.inserm.fr/inserm-01622988/file/2017%2C%20Mutricy%20-%20Predictors%20of%20complications%20of%20snake%20enven_omation%20in%20Cayenne%2C%20French%20Guiana%2C%202007%E2%80%932015.pdf
DOI : 10.1007/s00134-017-4929-3

Éditeur(s) : HAL CCSD John Libbey Eurotext
Résumé : International audience
The principal gynaecological cancers (breast, ovary, uterus, and cervix) account for over 40% of cancers found in women worldwide. However, large differences exist, in both their incidence and geographical distribution. The French West Indies, through their location, environment, socio-economic development, lifestyle, nutrition and the origins of their populations, constitute territories with a very particular character in the heart of the Caribbean. These characteristics have an impact on public health and can affect the incidence of tumours. We report for the first time the incidence of these major gynaecological cancers in Guadeloupe. Breast, ovary and uterine cancers have lower incidences in Guadeloupe than in mainland France. By contrast, cervical cancer is more frequent in Guadeloupe than in mainland France. The mortality rates associated with breast cancer, ovary and uterine cancer are also lower in Guadeloupe than in mainland France, whereas the opposite pattern is observed for cervical cancer. These observations may be accounted for in part by a difference in the prevalence of established or suspected risk factors for each of these types of cancer.
ISSN: 0007-4551

inserm-00504624
http://www.hal.inserm.fr/inserm-00504624
DOI : 10.1684/bdc.2008.0810
PUBMED : 19258222

Éditeur(s) : HAL CCSD Instituto de Medicina Tropical
Résumé : International audience
Malaria is a major health problem for people who live on the border between Brazil and French Guiana. Here we discuss Plasmodium vivax distribution pattern in the town of Oiapoque, Amapá State using the circumsporozoite (CS) gene as a marker. Ninety-one peripheral blood samples from P. vivax patients have been studied. Of these, 64 individuals were from the municipality of Oiapoque (Amapá State, Brazil) and 27 patients from French Guiana (August to December 2011). DNA extraction was performed, and a fragment of the P. vivax CS gene was subsequently analyzed using PCR/RFLP. The VK210 genotype was the most common in both countries (48.36% in Brazil and 14.28% in French Guiana), followed by the P. vivax-like (1.10% in both Brazil and French Guiana) and VK247 (1.10% only in Brazil) in single infections. We were able to detect all three CS genotypes simultaneously in mixed infections. There were no statistically significant differences either regarding infection site or parasitaemia among individuals with different genotypes. These results suggest that the same genotypes circulating in French Guiana are found in the municipality of Oiapoque in Brazil. These findings suggest that there may be a dispersion of parasitic populations occurring between the two countries. Most likely, this distribution is associated with prolonged and/or more complex transmission patterns of these genotypes in Brazil, bordering French Guiana.
ISSN: 0036-4665

inserm-01408935
http://www.hal.inserm.fr/inserm-01408935
http://www.hal.inserm.fr/inserm-01408935/document
http://www.hal.inserm.fr/inserm-01408935/file/2016%2C%20Gomes%20-%20Evaluation%20of%20circumsporozoite%20protein%20of%20Plasmodium%20vivax.pdf
DOI : 10.1590/S1678-9946201658072

Éditeur(s) : HAL CCSD
Résumé : International audience
Background: Geographical disparities in breast cancer incidence and outcomes are reported worldwide. Women of African descent show lower incidence, higher mortality rates and earlier age of onset. We analyzed data from the cancer registry of Guadeloupe for the period 2008-2013. Methods: We describe breast cancer characteristics by molecular subtype, as well as estimated observed and net survival. We used Cox proportional hazard models to determine associations between cancer subtypes and death rate, adjusted for variables of interest. Results: Overall, 1275 cases were recorded with a mean age at diagnosis of 57(+/- 14) years. World standardized incidence and mortality were respectively 71.9/100,000 and 14.1/100,000 person-years. Age-specific incidence rates were comparable to European and US populations below the age of 45, and higher in Guadeloupean women aged between 45 and 55 years. Overall, 65.1% of patients were hormone receptor (HR)+ and 20.1% were HR-. Triple negative breast cancers (TNBC) accounted for 14% of all cases, and were more frequent in patients under 40 (21.6% vs. 13.4%, p = 0.02). Five-year net survival was 84.9% [81.4-88.6]. It was higher for HR+/Her2+ and HR+/Her2-subtypes, and lower for HR-/Her2+ and TNBC patients. Conclusion: We found high age-specific incidence rates of breast cancer in women aged 45 to 55 years, which warrants further investigation in our population. However, this population of mainly African descent had good overall survival rates, and data according to subtypes are consistent with those reported internationally. These results may suggest that poorer survival in other African descent populations may not be an inherent feature of the disease but may be amenable to improvement. (C) 2017 Elsevier Ltd. All rights reserved.
Cancer Epidemiology

hal-01519252
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01519252
DOI : 10.1016/j.canep.2017.01.004
PUBMED : 28119121

Éditeur(s) : HAL CCSD
Résumé : National audience
Introduction En France, la proportion de personnes infectées par le VIH et ignorant leur statut était de 25 % en 2010. On estime que ces personnes seraient à l’origine de 60 % des nouvelles contaminations. Les offres et les moyens de dépistagesont régulièrement élargis et améliorés, sollicitant notamment les médecins généralistes. Cependant, les opportunités manquées de diagnostic sont nombreuses : pour 82 % des nouvelles découvertes de séropositivités VIH en 2009-2010. Une étude des pratiques de dépistage a eu lieu auprès des généralistes de métropole en 2009. Aucune étude de ce type n’a été réalisée en Martinique, département pourtant très touché par l’épidémie de VIH. Nous avons voulu réaliser unétat des lieux des pratiques de dépistage de l’infection par le VIH par les généralistes en Martinique.
17es Journées Nationales d’Infectiologie
Lille, France

Droits : info:eu-repo/semantics/OpenAccess
inserm-01410436
http://www.hal.inserm.fr/inserm-01410436
http://www.hal.inserm.fr/inserm-01410436/document
http://www.hal.inserm.fr/inserm-01410436/file/2016%2C%20Lafon-Desmurs%20-%20VIH02.pdf
PUBMED : 27495683

Éditeur(s) : HAL CCSD John Libbey Eurotext
ISSN: 1635-0421

hal-00688468
https://hal.archives-ouvertes.fr/hal-00688468
DOI : 10.1684/ers.2007.0121

Éditeur(s) : HAL CCSD
Société Française de Toxicologie Analytique
Schoelcher, Martinique

hal-00672053
https://hal.archives-ouvertes.fr/hal-00672053

Éditeur(s) : HAL CCSD John Libbey Eurotext
Résumé : International audience
Prostate cancer is the most frequent cancer affecting men in most Western countries. Certain risk factors have been identified (age, family history, ethnic origin), but the aetiology of this cancer remains largely unknown. However, a role for environmental factors is strongly suspected. Questions have been raised concerning the role of the chemical substances generated by human activities in the occurrence of this disease. Diverse studies have consistently demonstrated a higher risk of prostate cancer in agricultural populations than in the general population. The hypothesis that this higher risk is linked to the use of pesticides has been tested in a number of studies, mostly in North America and Europe. However, to date, with a few possible exceptions, it has been impossible to demonstrate a significant association between exposure to pesticides or a chemical family of pesticides and prostate cancer. In the face of these uncertainties, rigorous studies are required, with objective measurements of exposure, taking into account confounding factors and individual risk factors, making it possible to assess gene-environment interactions.
ISSN: 0007-4551

inserm-00504733
http://www.hal.inserm.fr/inserm-00504733
DOI : 10.1684/bdc.2008.0812
PUBMED : 19258224

Éditeur(s) : HAL CCSD BioScientifica
Résumé : International audience
BACKGROUND: Differences in circulating steroid hormone levels have been hypothesized to explain ethnic differences in steroid-related diseases. The aim of this study was to determine the serum levels of a wide panel of steroid hormones, both androgens and estrogens, in healthy middle-aged African-Caribbean and European men. DESIGN AND METHODS: Serum steroid hormone levels were determined in men participating in a systematic public health study funded by the French National Health Insurance system. Blood was collected in the morning from 304 healthy African-Caribbean and European men aged between 40 and 69 years. Serum steroids were measured by mass spectrometry-gas chromatography, except for DHEAS and sex hormone-binding globulin, which were determined by RIA. Data were analyzed in 10-year age intervals by analysis of covariance, with adjustment for age, body mass index, waist-to-hip ratio, tobacco and alcohol consumption, and season of sampling. RESULTS: Compared with Europeans, African-Caribbean men presented significantly higher serum levels of measured bioavailable testosterone, 4-androstenedione (4-dione), and estrone (E1) regardless of the age group, of 5-androstenediol (5-diol) in those aged 40-49 and 50-59 years, and of testosterone (TT) and dihydrotestosterone in those aged 40-49 years. In contrast, European men aged 40-69 years showed significantly higher serum levels of DHEA and DHEAS. CONCLUSIONS: Significant differences in serum steroid hormone levels were observed in middle-aged African-Caribbean and European men. Whether such differences could contribute to ethnic differences in disease risk in adult men remains to be investigated. Some steroids, such as bioavailable TT, 4-dione, 5-diol, and E1, deserve particular attention.
ISSN: 0804-4643

hal-00876034
https://hal.archives-ouvertes.fr/hal-00876034
DOI : 10.1530/EJE-11-0551
PUBMED : 21951700

Éditeur(s) : HAL CCSD Elsevier Elsevier Masson
Résumé : International audience
Prostate cancer is the most frequent cancer affecting men in most Western countries. Certain risk factors have been identified (age, family history, ethnic origin), but the aetiology of this cancer remains largely unknown. However, a role for environmental factors is strongly suspected. Questions have been raised concerning the role of the chemical substances generated by human activities in the occurrence of this disease. Diverse studies have consistently demonstrated a higher risk of prostate cancer in agricultural populations than in the general population. The hypothesis that this higher risk is linked to the use of pesticides has been tested in a number of studies, mostly in North America and Europe. However, to date, with a few possible exceptions, it has been impossible to demonstrate a significant association between exposure to pesticides or a chemical family of pesticides and prostate cancer. Studies have also been carried out on the role of exposure to trace metals, such as cadmium, or to pollutants from industry, such as polychlorobiphenyls. However, no firm conclusions have been drawn. Finally, the effect of chemical substances with endocrine disruptor activity on the occurrence of prostate cancer remains largely unexplored in epidemiological studies. In the face of these uncertainties, rigorous studies are required, with objective measurements of exposure, taking into account confounding factors and individual risk factors, making it possible to assess gene-environment interactions.
ISSN: 1297-9589

inserm-00524579
http://www.hal.inserm.fr/inserm-00524579
DOI : 10.1016/j.gyobfe.2008.07.005
PUBMED : 18693059

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
The seasonal patterns of conceptions and births differ between geographic areas. Several potential determinants of this variation have been identified, including biological, environmental and behavioral elements, but festive events are rarely mentioned. We investigated the possible association between the carnival and seasonal fertility variations in the French West Indies. We ran a retrospective registry-based study. The data were extracted from the registry of all births on Guadeloupe between 2000 and 2011 (n = 74,412), and from the Maternity Birth Register of the University Hospital, for all pregnancies of at least 14 completed weeks of gestation (observable conceptions) with an outcome recorded between 2007 and 2010 (n = 8,425). We compared data during and outside the carnival period for each year, including 2009, when there was no carnival due to a 44-day general strike. In all years other than 2009, the weekly number of births was higher for pregnancies initiated during the carnival period than for pregnancies initiated at other times, and the weekly number of observable conceptions was higher during the carnival period than at other times. Our findings support the hypothesis that carnivals in the French West Indies are associated with an increase in the number of conceptions and subsequent births.
ISSN: 1932-6203

hal-01485778
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01485778
DOI : 10.1371/journal.pone.0173102
PUBMED : 28253323

Éditeur(s) : HAL CCSD
Résumé : International audience
BACKGROUND: There is increasing evidence that reproductive abnormalities are increasing in frequency in both human population and among wild fauna. This increase is probably related to exposure to toxic contaminants in the environment. The use of sentinel species to raise alarms relating to human reproductive health has been strongly recommended. However, no simultaneous studies at the same site have been carried out in recent decades to evaluate the utility of wild animals for monitoring human reproductive disorders. We carried out a joint study in Guadeloupe assessing the reproductive function of workers exposed to pesticides in banana plantations and of male wild rats living in these plantations. METHODS: A cross-sectional study was performed to assess semen quality and reproductive hormones in banana workers and in men working in non-agricultural sectors. These reproductive parameters were also assessed in wild rats captured in the plantations and were compared with those in rats from areas not directly polluted by humans. RESULTS: No significant difference in sperm characteristics and/or hormones was found between workers exposed and not exposed to pesticide. By contrast, rats captured in the banana plantations had lower testosterone levels and gonadosomatic indices than control rats. CONCLUSION: Wild rats seem to be more sensitive than humans to the effects of pesticide exposure on reproductive health. We conclude that the concept of sentinel species must be carefully validated as the actual nature of exposure may varies between human and wild species as well as the vulnerable time period of exposure and various ecological factors.
Environmental health : a global access science source [electronic resource]

hal-00669505
https://hal.archives-ouvertes.fr/hal-00669505
DOI : 10.1186/1476-069X-7-40
PUBMED : 18667078

Éditeur(s) : HAL CCSD American Society of Clinical Oncology
Résumé : International audience
PURPOSE: Determining whether environmental estrogens are associated with the risk of prostate cancer may have important implications for our general understanding of this disease. The estrogenic insecticide chlordecone was used extensively in the French West Indies, contaminating the population for more than 30 years. We analyzed the relationship between exposure to chlordecone and the risk of prostate cancer. PATIENTS AND METHODS: We investigated 623 men with prostate cancer and 671 controls. Exposure was analyzed according to case-control status, using either current plasma concentration or a cumulative exposure index based on years of exposure. We genotyped two single-nucleotide polymorphisms (rs3829125 and rs17134592) in the gene encoding chlordecone reductase. RESULTS: We found a significant increase in the risk of prostate cancer with increasing plasma chlordecone concentration (odds ratio [OR], 1.77; 95% CI, 1.21 to 2.58 for the highest tertile of values above the limit of detection [LD]; P trend = .002) and for cumulative exposure index (OR, 1.73; 95% CI, 1.04 to 2.88 for the highest quartile; P trend = .004). Stronger associations were observed among those with a positive family history of prostate cancer and among those who had lived in a Western country. The rs3829125 and rs17134592 allele variants were in complete linkage disequilibrium and were found at low frequency (0.04). Among subjects with plasma chlordecone concentrations above the LD, carriers of the allele variants had a higher risk of prostate cancer (OR, 5.23; 95% CI, 0.82 to 33.32). CONCLUSION: These findings support the hypothesis that exposure to environmental estrogens increases the risk of prostate cancer.
ISSN: 0732-183X

inserm-00518099
http://www.hal.inserm.fr/inserm-00518099
DOI : 10.1200/JCO.2009.27.2153
PUBMED : 20566993

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
We aimed to assess the impact of a postoperative drainage after RPN. A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)]. Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (> 50 cases: 55.7 vs. 15.1 %; p < 0.0001), and tumors were more complex (RENAL score: 7.6 vs. 6.5; p < 0.0001). Complication rates were similar in both groups (21.9 vs. 20.2 %; p = 0.67). The omission of postoperative drainage did not increase requirement of CT scan (RR = 1.03; 95 % CI 0.64-1.67). Length of hospital stay was shorter in the ND group (4.5 vs. 5.5 days; p = 0.007). There were six urinary fistulas: four in the D group (0.8 %) and two in the ND group (1.4 %; p = 0.49). A CT scan was done to confirm the diagnosis of fistula in every case. In multivariate analysis, the omission of drainage was not associated with increased need of postoperative CT scan or major complications but was a predictor of decreased length of stay. The omission of postoperative drainage does not seem to increase the risk of postoperative complications and could safely be omitted after RPN.
ISSN: 0724-4983

hal-01361502
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01361502
DOI : 10.1007/s00345-015-1721-2
PUBMED : 26511751

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
OBJECTIVE: The aim of the study was to assess whether HIV infection is associated with a higher risk of invasive cervical cancer (ICC). METHODS: We conducted a region-wide, population-based observational cohort study of 1232 HIV-infected women over the age of 15 years in Guadeloupe, a French Caribbean archipelago, during the period 1999-2006. The observed numbers of incident cases of cervical intraepithelial neoplasia (CIN) and ICC were compared with the expected numbers of cases based on the incidence rates for the general population, and the standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated. RESULTS: The incidence rate of CIN was higher in the HIV-infected women than in the general population for all grades (SIR 10.1, 95% CI 6.8-14.6 for CIN grade 1; SIR 9.9, 95% CI 6.1-15.3 for CIN grade 2; and SIR 5.2, 95% CI 3.4-7.7 for CIN grade 3). However, no increase in the risk of ICC was observed (SIR 1.7, 95% CI 0.3-4.9). CONCLUSIONS: Despite an increase in the occurrence of cervical cancer precursors, no increase in the risk of cervical cancer was found in a population of HIV-infected women who receive treatment for their infection and have access to ICC prevention services.
ISSN: 1464-2662

hal-00682744
https://hal.archives-ouvertes.fr/hal-00682744
DOI : 10.1111/j.1468-1293.2011.00939.x
PUBMED : 21819528

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
The status of ethnic minority has been reported to be associated with a tendency toward sedentary behavior. The Guadeloupean population is composed of Afro-Caribbeans and an Asian Indian minority. This study examined the association of ethnicity and physical activity on the island. Energy expenditures (EE), energy intakes (EI), and macronutrient intakes of 122 Guadeloupean workers (60 Indians and 62 controls) were assessed by three consecutive 24-h recalls. Two-way analyses of variance were conducted to test the hypothesis of an effect of ethnicity, taking the potential effect of sex into account, on these variables. Asian Indians reported lower EE (P=0.011), lower EE/EI ratios (P=0.001), and lower physical activity (P=0.003) than their Afro-Carribean counterparts. Their food intakes were not different in terms of EI or macronutrient intake. No sex × ethnicity interactions were significant. The present study reports a tendency toward physical inactivity in Asian Indians of Guadeloupe associated with EI similar to those of controls. Sedentary lifestyles and energetic imbalances are well-documented risk factors for several diseases, including type 2 diabetes and cardiovascular disease, both major public health concerns in Guadeloupe. Strategies to prevent sedentary lifestyles should be considered for Asian Indian Guadeloupeans.
ISSN: 0905-7188

hal-00706161
https://hal.univ-antilles.fr/hal-00706161
DOI : 10.1111/j.1600-0838.2007.00743.x

Éditeur(s) : HAL CCSD
Résumé : National audience
A l'aire des stratégies d'accès aux traitements antirétroviraux mondialisées, la question des inégalités territoriales, questionne leur mise en place. Si les PVVIH sont particulièrement fragiles face aux violences structurelles, sociales et économiques, leur prise en charge aux frontières est souvent oubliée. Ce travail entend donc mettre en exergue une analyse de l'impact des frontières sur les PVVIH en Guyane mais aussi d'interroger de nouveaux modèles de pratiques médicales d'interface. En Guyane française, les configurations territoriales génèrent une situation singulière dans la mesure où les populations gravitent/évoluent entre une instabilité géographique (barrages policiers routiers et fluviaux, nomadisme et mobilité des populations) et des logiques d'intégration. De là, apparaît, un renforcement des vulnérabilités (psychologique, socio-économique, sanitaire, spatiale, (…) etc.), notamment chez les PVVIH. Afin d'améliorer la prise en charge de ces patients un relais avancé a été mis en place au sein du centre de santé à la frontière avec le Brésil à S t Gorges de l'Oyapock. Des médiateurs communautaires en santé sont au centre du dispositif avec les soignants du dispensaire local et un système de délocalisation des examens biologiques et avis spécialisés a été réalisé. En un an la file active de PVVIH suivis a été multipliée par 4. Cette action a permis de diminuer les délais de prise en charge des patients, réduisant également le nombre de perdus de vus. Il a été rendus possible pour exemple une prise en charge « familiale » du dépistage et des traitements impossible jusqu'à alors. Sur le plan médico-social des « staffs » transfrontaliers ont réalisés améliorant la gestion des patients dans leur globalité. Cet exemple de coopération inter-culturelle renforcée avec valorisation de l'espace comme carrefour géographique de différents flux migratoires que constitue la frontière Franco-Brésilienne fait de cet espace un lieu privilégié de médiation médicale.
Congrès 2016 de la Société française de lutte contre le sida
Montpellier, France

inserm-01475951
http://www.hal.inserm.fr/inserm-01475951
http://www.hal.inserm.fr/inserm-01475951/document
http://www.hal.inserm.fr/inserm-01475951/file/2016%2C%20Mosnier%20-%20Fronti%C3%A8res%20%20limites%20ou%20espaces%20innovants%20dans%20la%20lutte%20contre%20le%20VIH.pdf