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Work-Related Stressors and Increased Risk of Benzodiazepine Long-Term Use: Findings From the CONSTANCES Population-Based Cohort
Full text linkOBJECTIVES: To examine whether stressful job exposure to the public could be associated with having long-term benzodiazepine use.
METHODS: From the participants included between 2012 and 2016 in the French population-based CONSTANCES cohort, 13 934 men and 19 261 women declared a daily job exposure to the public and rated the frequency of stressful exposure. We examined benzodiazepine long-term use by using drug reimbursement administrative registries. Logistic regressions provided odds ratios (ORs) of benzodiazepine long-term use, with stratification for gender and adjustment for age, education, and area deprivation index. Occupational grade, job strain, depression, self-rated health, and alcohol use disorder were additional stratification variables.
RESULTS: Benzodiazepine long-term use was positively associated with stressful exposure to the public ("often or always" vs "rarely or never") in men (OR = 2.2; 95% confidence interval [CI] = 1.8, 2.8) and women (OR = 1.6; 95% CI = 1.4, 1.9), with dose-dependent relationships (P trends < .001). Adjustments and analyses in subgroups without other individual or environmental vulnerability factors led to similar results.
CONCLUSIONS: Stressful job exposure to the public increases the risk of benzodiazepine long-term use. Prevention programs aiming at reducing the burden of benzodiazepine long-term use would benefit in targeting this specific population
Screening for peripheral artery disease in people with diabetes
Full text linkWe read with interest the recent article by Vriens et al. published in Diabetic Medicine [1]. The authors question the screening tools used to test for the presence of peripheral artery disease in people with diabetic foot ulcers. This is important because the complications of diabetes limit all commonly used, non‐invasive, bedside tests for peripheral artery disease. The utility of these tests in consecutive people presenting with ulceration, with and without infection, provides important information to guide clinical practice in a clinically relevant environment
Intrathoracic Airway Closure Impacts CO <sub>2</sub> Signal and Delivered Ventilation During Cardiopulmonary Resuscitation
No full textRationale Guidelines recommend that end-tidal CO2 (EtCO2) should be used to monitor cardiopulmonary resuscitation (CPR) but its physiological interpretation remains uncertain. Chest compressions induce oscillations in expired CO2, which could reflect variable degrees of intrathoracic airway closure. Objectives To understand the capnogram during CPR and analyze its relationship with airway patency and delivered ventilation. Methods, Measurements 1) Clinical study analyzing capnogram patterns after intubation in patients with out-of-hospital cardiac arrest receiving continuous chest compressions. 2) Two experimental CPR settings (a bench model and human cadavers): constant CO2 flow was added in the lung to simulate CO2 production. Capnograms similar to clinical recordings were obtained and different ventilator settings were tested. EtCO2 was compared with alveolar CO2 (bench). 3) The airway opening index (AOI) quantified chest compressions-induced oscillations in CO2 and was calculated for all settings. Results 89 patients were analyzed (median age 72[59-82] years, 23% female, 12% hospital admission survival): capnograms exhibited various degrees of oscillations, which were quantified by the AOI. CO2 value varied considerably across oscillations related to consecutive chest compressions. In bench and cadavers, similar capnograms were reproduced and generated by airway closure. Differences in airway patency were associated with huge changes in delivered ventilation. AOI increased with PEEP, resulting in increased ventilation without affecting intrathoracic pressure. The maximal EtCO2 value between ventilator breaths reflected alveolar CO2 (bench). Conclusions During chest compressions, the expired CO2 signal is influenced by intrathoracic airway patency and indirectly reflects the delivered ventilation. The maximal CO2 recorded between consecutive ventilator breaths best reflects alveolar CO2
WT1 gene is overexpressed in myeloproliferative neoplasms, especially in myelofibrosis
Full text linkClassical Philadelphia-negative myeloproliferative neoplasms include Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF). They are characterized by the presence of driver mutations of JAK2, CALR or MPL genes. Overexpression of WT1 is used as a marker of minimal residual disease in acute myeloid leukemia, especially after allogeneic stem cell transplantation (SCT). We investigated WT1 expression at diagnosis in 152 MPN patients and showed that the WT1 transcript was overexpressed in PMFs and PVs compared to controls. In particular, WT1 transcript levels were higher in PMF than in ET and PV. WT1 transcript levels were significantly increased during myelofibrotic transformation of ET or PV. Using multivariate linear regression, high WT1 transcript levels in PMF were associated with age over 65, splenomegaly and thrombocytopenia. The ROC curve analysis showed that a level of WT1 transcript >10 WT1 copies/104ABL1 enabled the diagnosis of PMF with a specificity of 95.8% (PMF vs ET; ROC AUC = 0.91). In myelofibrosis, studying follow-ups of WT1 transcript showed that this marker is of interest after allogeneic SCT. These results demonstrate that WT1 overexpression is a simple marker of myelofibrosis in MPN and could be used during patient follow-up
Controlled Anchoring of Iron-Oxide Nanoparticles on Polymeric Nanofibers: Easy Access to Core@Shell Organic-Inorganic Nanocomposites for Magneto-Scaffolds
Full text linkComposites combining superparamagnetic iron oxide nanoparticles (SPIONs) and polymers are largely present in modern (bio)materials. However, while SPIONs embedded in polymer matrices are classically reported, the mechanical and degradation properties of the polymer scaffold are impacted by the SPIONs. Therefore, the controlled anchoring of SPIONs onto polymer surfaces is still a major challenge. Herein, we propose an efficient strategy for the direct and uniform anchoring of SPIONs on the surface of functionalized-polylactide (PLA) nanofibers via a simple free ligand exchange procedure to design PLA@SPIONs core@shell nanocomposites. The resulting PLA@SPIONs hybrid biomaterials are characterized by electron microscopy (SEM and TEM) and EDXS analysis, to probe the morphology and detect elements present at the organic/inorganic interface, respectively. A monolayer of SPIONs with a complete and homogeneous coverage is observed on the surface of PLA nanofibers. Magnetization experiments show that magnetic properties of the nanoparticles are well-preserved after their grafting on the PLA fibers and that the size of the nanoparticles does not change. The absence of cytotoxicity, combined with a high sensitivity of detection in MRI both in vitro and in vivo make these hybrid nanocomposites attractive for the development of magnetic biomaterials for biomedical applications
Test de double tâche sur cyclo-ergomètre : Recherches préliminaires sur l’acceptabilité et l’utilisation
Full text linkLes perturbations motrices en condition de double tâche, visant à explorer le contrôle moteur cérébral, sont majoritairement examinées au moyen de tapis d\u27analyse spatio-temporelle de la marche. Pourtant, les patients âgés qui viennent pratiquer ces examens sont en partie sujets à un risque accru de chute du fait de troubles moteurs et/ou cognitifs probables. L\u27étude consiste donc à pratiquer ces tests de double tâche sur un nouveau dispositif, Cycléo BRAU, qui permet aux patients de réaliser une tâche attentionnelle, surajoutée à une tâche primaire, faire du vélo, en toute sécurité. De plus, le système est équipé d\u27un dispositif de réalité virtuelle qui projette un environnement prédéterminé permettant des tâches attentionnelles plus complexes. Le patient est donc rassuré à l\u27idée de faire son examen, non seulement parce qu\u27il n\u27a plus peur de tomber, mais également parce que cet examen devient ludique. L\u27objectif principal est d\u27établir la concordance des résultats des tests de double tâche obtenus avec le tapis de marche GAITRite et ceux obtenus avec le dispositif Cycléo BRAU. Ceci s\u27effectue grâce à l\u27analyse de la vitesse et de la variabilité de la vitesse de marche et de pédalage durant ces examens. Les résultats espérés sont l\u27obtention d\u27une bonne faisabilité, d\u27une bonne reproductibilité et de trouver une corrélation entre l\u27analyse de la marche et l\u27analyse avec Cycléo BRAU. Avec cette étude, les examens de la personne âgée atteinte de troubles moteurs et cognitifs pourront être plus rapides et plus sécurisants pour les patients
Effect of generator load on hybrid heat recovery system
Full text linkHeat recovery is the reutilization of lavished thermal energy. This paper proposes a hybrid heat recovery system that utilizes exhaust gases of a generator to heat water and produce electricity using thermoelectric generators. The system is composed of a concentric tank with a copper tube passing through it. At the inner surface of the tube, a layer of TEGs is located. The main purpose of the paper is to study the effect of changing the load of the generator on the water temperature and power generated. Knowing that 100 TEGs are utilized, results show that 47 °C hot water and 141 W are produced when load is 10 kW. It increases to 97 °C hot water and 1412 W when the generator load is 38 kW (14.12 W per TEG)
Practicing health geography in 2017 IMGS 2017 Editorial
Full text linkThis text is the editorial of a special issue dedicated to the International medical geography symposium held in Angers (France in july 2017). The articles selected for this special issue reflect the dynamics and growth of medical and health geography year after year. In this editorial we describe the trend toward more globalization in health geography which can serve as an opportunity to look back at the topics, trends and innovations observed in prior IMGS meetings. The following is based on the SSM Post IMGS commentaries, published biennially since 2009. Broadly, four trends are observed: (1) topics that are continuously addressed, (2) current topics not appearing in this issue but present during the symposium, (3) shrinking topics, (4) and finally topics still current but that are being reshaped