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Une bonne conscience à peu de frais. Le principe d'égalité entre les hommes et les femmes dans le contentieux de la nationalité française.
No full textInternational audienceLe principe d’égalité entre les hommes et les femmes est aujourd’hui inscrit en droit français de la nationalité comme en toute autre matière. Pour autant, sous des apparences de respect absolu et intransigeant, son application et son interprétation par les juridictions, dans un certain nombre de situations, lui retirent toute effectivité, quand il n’est pas utilisé contre les femmes elles-mêmes
Adsorption of methyl paraben by ion exchange resins
No full textInternational audienceIn the first part of the research presented here, a spectrometric study was carried out on methyl paraben (MP), the ion exchange resin AmberLite™ HPR4200OH, and the resin saturated with MP. Infrared spectra and correlation tables were used to investigate the mechanism of MP adsorption by the resin in batch mode. The influence of the initial pH was examined to confirm the proposed adsorption mechanism. In the second part of the study, adsorption isotherms were presented using the Freundlich and Langmuir models. A rapid initial adsorption was observed within 25 min. The maximum sorption capacity, calculated using the Langmuir equation, was 238.1 mg/g. The adsorption process was found to be a monolayer phenomenon. The decrease in the partition coefficient as a function of the initial concentration of MP is also presented and discussed. The results of this study are then compared with those reported in the literature. Finally, adsorption kinetics were investigated. Compared to the pseudo-first-order model, the second-order model proved to be more suitable for describing the variation in the experimental adsorption capacity over time
ICU mortality of post-myocardial infarction ventricular septal defect complicated by cardiogenic shock: a retrospective multicentric cohort.
No full textInternational audiencePurpose: Post myocardial infarction ventricular septal defect (PMI-VSD) complicated by refractory cardiogenic shock is associated with an extremely high mortality rate. We sought to evaluate the factors associated with in-ICU mortality in patients with PMI-VSD-related cardiogenic shock.Methods: Patients with PMI-VSD complicated by cardiogenic shock, admitted in 10 French tertiary centers between 2008 and 2022, were retrospectively included. The primary outcome was in-ICU mortality. The timing of surgery was classified as early (≤ 7 days) or late (> 7 days). Multivariable analysis was performed to identify the variables associated with in-ICU mortality.Results: A total of 138 patients were included (mean age 70 (± 10) years, female sex 54%). Of these, 116 patients (84%) received MCS, including 43 patients (31%) with VA-ECMO. VSD surgical closure was performed in 93 patients (67%, 60 early, 33 late). Only 2 patients had percutaneous closure without surgical repair. A total of 84 patients (61%) died. The type of surgical management strategy was significantly associated with in-ICU mortality (no surgery, 100%; early surgery, 45%; late surgery, 27%; ptrend < 0.001). In all patients, the variables independently associated with in-ICU mortality were: old age (adjusted OR = 1.1, 95%CI [1.02-1.12.], p = 0.004), SOFA score (adjusted OR = 1.2, 95%CI [1.07.-1.37], p = 0.003), and VA-ECMO (adjusted OR = 2.9, 95%CI [1.2-7.7], p = 0.02). In patients with VSD surgical closure, a longer delay between ICU admission and VSD surgical closure was independently associated with decreased in-ICU mortality (adjusted OR = 0.9, 95%CI [0.79-0.96], p = 0.003).Conclusion: Delayed VSD closure is associated with improved outcomes in PMI-VSD complicated by cardiogenic shock
Daily physical activity habits influence surgeons’ stress in the operating room: a prospective cohort study
No full textInternational audienceBackground: Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons’ physical activity habits and their stress, assessed as heart rate variability, at the start of surgery. Materials and methods: This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons. Results: We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42–55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Surgeon professors presented lower lnRMSSD (−0.437, −0.749 to −0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (−0.337, −0.646 to −0.027, P = 0.033), compared to their counterparts. Conclusions: Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons’ stress in the operating room
Comprehensive assessment of the impact of mandatory community-based health insurance in Burkina Faso
No full textInternational audienceHealth coverage for informal workers in Sub-Saharan Africa remains a major challenge. This study evaluates an alternative approach: bundling health insurance with microcredit. We conducted a randomized controlled trial in Ouagadougou, Burkina Faso, to assess the impact of mandatory health insurance linked to microcredit. The study covered 88 microcredit groups (44 treated, 44 control), analyzing outcomes for 1,095 individuals who reported illness episodes in the six months preceding the final survey in January–February 2022. Results show that the insurance requirement did not lead to program dropout, with loan renewal rates remaining stable between groups. Health insurance had a significant positive impact on financial protection: out-of-pocket expenses decreased by over 50% and payment difficulties by 36%. The study also reveals changes in health-seeking behaviors. Use of modern healthcare facilities increased by 7%, while reliance on traditional medicine decreased by 61%. Insured individuals also sought care more quickly, with 23% more seeking care on the same day symptoms appeared. However, no significant impact was observed on physical or psychological health outcomes. These findings suggest that bundling health insurance with other services like microcredit can be a viable solution for deploying mandatory health coverage to populations working in the informal sector. This approach provides significant financial protection against health risks and improves access to healthcare
Zebrock, pratiques et contraintes d’un projet d’émancipation par les musiques populaires en Seine–Saint-Denis
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Avis de l'Anses relatif à la caractérisation et évaluation des impacts sur la santé de la consommation d’aliments dits ultratransformés
No full textAnses. (2024). Avis relatif à la caractérisation et à l'évaluation des impacts sur la santé de la consommation d’aliments dits ultratransformés. (saisine 2022-SA-0155). Maisons-Alfort : Anses, 104 p.L’Anses a été saisie le 27 août 2022 par la Direction générale de l’alimentation (DGAL) et par la Direction générale de la santé (DGS) pour caractériser et évaluer les impacts sur la santé de la consommation d'aliments dits ultratransformés.CONTEXTE ET OBJET DE LA SAISINE : Les résultats de l’étude Inca 3 (2014-2015) de l’Anses, publiée en 2017, ont documenté une augmentation de la consommation de produits transformés par les Français, en particulier ,chez les jeunes, par rapport à ce qui était observé dans l’étude Inca 2 (2006-2007). Cela contribue à « créer une distance entre les individus et leur alimentation, notamment en termes de connaissance de la composition des aliments » (Anses 2017).L’effet des aliments dits ultratransformés sur la santé est une thématique de recherche émergente, qui a conduit certaines agences sanitaires à s’emparer du sujet (AESAN 2020; FAO/OMS 2019; NNR 2023; SACN 2023). Un nombre croissant de publications scientifiques a en effet rapporté une association entre la consommation de produits dits ultratransformés et le risque de maladies chroniques.Si la préoccupation est aujourd’hui internationale et partagée tant au niveau scientifique qu’au niveau sociétal, il n’existe pas à ce jour de définition consensuelle des aliments transformés.La classification Nova, qui est la classification la plus utilisée par la recherche en épidémiologie, différencie les aliments en quatre classes en fonction notamment de leur degré de transformation et la classe Nova 4 correspond aux aliments considérés comme les plus transformés. En France, bien qu’il n’existe pas de définition réglementaire pour les aliments qualifiés d’ultratransformés, plusieurs recommandations officielles y font référence. Ainsi, les objectifs du Haut Conseil de la santé publique pour le Programme national nutrition santé (PNNS) sont « d’interrompre la croissance de la consommation des produits ultratransformés » et Santé publique France recommande « de limiter les boissons sucrées, les aliments gras, sucrés, salés et ultratransformés ». Le Programme national de l’alimentation et de la nutrition (PNAN) prévoit la caractérisation des aliments ultratransformés, l’étude de l’impact pour la santé de leur consommation et la priorisation des actions à mener. De plus, de nombreuses propositions, issues de rapports parlementaires, de la Convention citoyenne pour le climat ou d’initiatives citoyennes, portent sur les aliments ultratransformés, en lien avec l’étiquetage, la taxation, l’interdiction de la publicité ou la limitation en restauration collective.En réponse à la demande de la DGAL et de la DGS, l’Anses a mené une expertise sous les cinq angles suivants, procédant à :1 – la caractérisation des produits dits ultratransformés par une identification des procédés de transformation susceptibles d’induire sur la composition des aliments des modifications présentant un danger pour la santé ;2 – le recensement des classements existants des aliments selon leur degré de transformation et évaluation de leur pertinence au regard des caractéristiques identifiées précédemment ; 3 – l’étude des relations épidémiologiques entre la consommation d’aliments dits ultratransformés et les risques de maladies chroniques non transmissibles (MCNT) ;4 – la détermination, le cas échéant, en fonction des risques identifiés, à l’issue de l’analyse des études épidémiologiques, des facteurs responsables de la nocivité des aliments dits ultratransformés en vue d’identifier des leviers permettant de limiter les risques associés à leur consommation ;5 – l’identification des travaux scientifiques devant être conduits pour mieux caractériser les impacts sanitaires des aliments dits ultratransformés
IMMUNOLOGICAL AND VIROLOGIC OUTCOMES WITHIN TEN YEARS OF COMBINED ANTIRETROVIRAL THERAPY INITIATED BEFORE ONE YEAR OF AGE IN CAMEROONIAN CHILDREN WITH PERINATAL HIV
No full textInternational audienceBackground: We reported immunological and virologic outcomes within 10 years of combined Antiretroviral Therapy (cART) initiated no later than age one year and associated factors in children with perinatal HIV in Cameroon. Setting: This study was conducted in 3 referral hospitals in Cameroon. Methods: We conducted a prospective cohort study, using time-to-event analysis. Probabilities of the following outcomes were assessed within the first 10 years of cART initiation: first Viral Suppression to <400 copies/mL (VS), maintaining first VS, Immunocompetence (IC) - stage 1, CDC Immunological Classification - and mortality. Results: 190 children started cART before one year of age, at an average age of 4.3 months (Standard deviation: ±2.5 months), of whom 45.3% were immunocompetent; 66.8% on nevirapine (NVP)-based versus ritonavir-boosted lopinavir (LPV/r)-based regimens; 37.9% with running water at home. At 10 years of cART initiation, outcomes probabilities estimates were: 22.0% of death mostly in the first 2 years and mainly due to advanced HIV disease, 72.0% of first VS achieved; 70.0% and 50.4% of first VS maintained considering children with first VS achieved and all the study participants, respectively; immunocompetent children increased to 88.6%. Being immunocompetent at cART initiation and receiving LPV/r-based regimens (versus NVP-based ones) over time were significantly associated with maintaining VS. Conclusion: Long term efficacy of early cART in children with perinatal HIV was mainly impaired by high mortality during initial phase. Screening strategies, even community-based, for early detecting HIV in exposed infants before advanced HIV disease had set up, should be implemented
