L'activité physique pour la prévention des effets indésirables du traitement adjuvant du cancer du sein : quelle efficacité en recherche interventionnelle ?

L'activité physique (AP) constitue un espoir important pour soulager les patientes des effets indésirables liés aux traitements du cancer du sein. L'objectif de cette thèse est d'analyser l'efficacité des interventions en AP chez des patientes traitées par chimiothérapie et radiothérapie. Une méta-analyse incluant 33 études randomisées contrôlées a montré une efficacité des interventions en AP sur la fatigue, l'anxiété, la dépression, et la qualité de vie. Toutefois, ces bénéfices reposaient plutôt sur des études présentant des faiblesses méthodologiques. La réalisation d'un essai randomisé contrôlé (nommé APAD1) de bonne qualité testant une intervention couplant AP adaptée et conseil diététique a montré des bénéfices sur les critères subjectifs, i.e., fatigue, anxiété, dépression, et qualité de vie, en fin de chimiothérapie et radiothérapie. Cependant, aucun impact n'a été constaté sur les critères objectifs, i.e., poids, masse grasse, fatigue cognitive et musculaire. Notons que les améliorations des critères subjectifs dans le groupe intervention vs contrôle étaient observées quel que soit le niveau d'AP des patientes, et préférentiellement chez les femmes de poids normal et socialement favorisées. L'ensemble des résultats suggère que l'effet d'une intervention en AP pendant les traitements adjuvants du cancer du sein reposerait plutôt sur des mécanismes psychologiques liés aux croyances et attentes des patientes vis-à-vis de l'intervention et à l'accompagnement qu'elle leur procure. Le biais d'efficacité mis en évidence en faveur des études de moins bonne qualité interroge les limites de la méthodologie expérimentale dans le champ des interventions non médicamenteuses.Physical activity represents an important hope to relieve patients from the side effects related to breast cancer therapy. The objective of this PhD thesis is to analyze the efficacy of exercise interventions in breast cancer patients receiving chemotherapy and radiotherapy. By pooling 33 randomized controlled studies, a meta-analysis showed that exercise interventions resulted in significant improvements of fatigue, anxiety, depression, and quality of life. However, these benefits were rather based on studies with methodological weaknesses. The realization of a randomized controlled trial (named APAD1) respecting good quality standards and testing an intervention of exercise associated with dietary counseling showed benefits on self-declared subjective outcomes, i.e., fatigue, anxiety, depression, and quality of life, at the end of chemotherapy and radiotherapy. However, no effect was observed on objective outcomes such as body weight, fat mass, and cognitive and muscle fatigue. It should be noted that improvements of subjective outcomes in intervention vs. control group were observed whatever the patients' physical activity level, and also, primarily in normal weight and socially favored women. The overall results suggest that the efficacy of an exercise intervention during breast cancer adjuvant therapy to be rather based on psychological mechanisms related to beliefs and expectations of patients regarding the intervention and the care effect it provides them. The efficacy bias seen in studies of lower methodological quality calls the limitations of the experimental design for testing non-pharmacological interventions into questions

Matched or nonmatched interventions based on the transtheoretical model to promote physical activity. A meta-analysis of randomized controlled trials

The aim of this study was to examine whether the efficacy of transtheoretical model (TTM)–based interventions on physical activity (PA) varied according to the following criteria: (1) interventions targeted the actual stages of change (SOCs) or did not; (2) participants were selected according to their SOC or were not; and (3) its theoretical constructs (decisional balance, temptation, self-efficacy, processes of change). Thirty-three randomized controlled trials assessing TTM-based interventions promoting PA in adults were systematically identified. The between-group heterogeneity statistic (Qb) did not reveal any differential efficacy either in interventions targeting the actual SOC compared with those that did not (Qb = 1.28, p = 0.22) or in interventions selecting participants according to their SOC compared with those that did not (Qb = 0.01, p = 0.91). TTM-based interventions enhanced PA behavior whether they targeted the actual SOC (Cohen's d = 0.36; 95% confidence interval (CI): 0.22–0.49)) or not (d = 0.23; 95% CI: 0.09–0.38) and whether they selected their participants according to their SOC (d = 0.33; 95% CI: 0.13–0.53) or not (d = 0.32; 95% CI: 0.19–0.44). The moderators of the efficacy of TTM-based interventions were the number of theoretical constructs used to tailor the intervention (Qb = 8.82, p = 0.003), the use of self-efficacy (Qb =6.09, p = 0.01), and the processes of change (Qb = 3.51, p = 0.06). TTM-based interventions significantly improved PA behavior, and their efficacy was not moderated by SOC but by the TTM theoretical constructs

Circulating Metabolites Associated with Alcohol Intake in the European Prospective Investigation into Cancer and Nutrition Cohort.

Identifying the metabolites associated with alcohol consumption may provide insights into the metabolic pathways through which alcohol may affect human health. We studied associations of alcohol consumption with circulating concentrations of 123 metabolites among 2974 healthy participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Alcohol consumption at recruitment was self-reported through dietary questionnaires. Metabolite concentrations were measured by tandem mass spectrometry (BIOCRATES AbsoluteIDQTM p180 kit). Data were randomly divided into discovery (2/3) and replication (1/3) sets. Multivariable linear regression models were used to evaluate confounder-adjusted associations of alcohol consumption with metabolite concentrations. Metabolites significantly related to alcohol intake in the discovery set (FDR q-value < 0.05) were further tested in the replication set (Bonferroni-corrected p-value < 0.05). Of the 72 metabolites significantly related to alcohol intake in the discovery set, 34 were also significant in the replication analysis, including three acylcarnitines, the amino acid citrulline, four lysophosphatidylcholines, 13 diacylphosphatidylcholines, seven acyl-alkylphosphatidylcholines, and six sphingomyelins. Our results confirmed earlier findings that alcohol consumption was associated with several lipid metabolites, and possibly also with specific acylcarnitines and amino acids. This provides further leads for future research studies aiming at elucidating the mechanisms underlying the effects of alcohol in relation to morbid conditions

La sage-femme : un acteur incontournable de la périnatalité en France

The medical profession in which skills are limited to the practice of physiological obstetrics— midwifery— is underrated. The four-year training is based on alternating between theoretical and clinical teaching. Midwives’ skills are defined by the code of professional conduct. Midwives practise in various activity sectors: public and private hospitalization (prenatal consultations, ultrasound, pathological pregnancy and post-partum period services, preparation for childbirth, birthing room), midwifery schools, mother and infant protection and the private sector. Their role varies according to the structures and, in particular, between the public and private sectors. Because of their skills and broad scope of activities, midwives are key players in perinatal care and can take additional courses, for example university courses, to acquire new skills.Profession médicale dont les compétences sont limitées à la pratique de l’obstétrique physiologique, la profession de sage-femme est méconnue. D’une durée de cinq ans, la formation est basée sur l’alternance de l’enseignement théorique et clinique. Les compétences des sages-femmes sont définies par le code de déontologie. Elles exercent dans différents secteurs d’activités: l’hospitalisation publique et privée (consultations prénatales, échographie, service de grossesses pathologiques et de suites de couches, préparation à la naissance, salle de naissance), les écoles de sages-femmes, la protection maternelle et infantile et le secteur libéral. Leur rôle varie selon les structures, et notamment entre le secteur public et le secteur privé. De par leurs compétences et l’étendue de leur champ d’activités, les sagesfemmes sont des acteurs incontournables de la périnatalité. Elles peuvent suivre des enseignements complémentaires, notamment universitaires, qui leur permettent d’acquérir de nouvelles compétences.Carayol Marion. La sage-femme : un acteur incontournable de la périnatalité en France. In: Santé, Société et Solidarité, n°1, 2004. Naître en France et au Québec. pp. 97-103

Evaluation du mode d accouchement en cas de présentation du siège à terme

L accouchement des présentations du siège à terme (3 à 4% des naissances) est potentiellement dystocique. Pour réduire ce risque, certains proposent de réaliser systématiquement une césarienne programmée (CP) mais cette intervention est aussi associée à un risque de mortalité et morbidité maternelles et néonatales. Afin d évaluer le mode d accouchement dans ce cas, une enquête observationnelle (PREMODA) a été réalisée dans 138 maternités françaises et belges. Le taux de tentative d accouchement par voie basse (TVB) était de 32,2%. Elle a surtout conclu qu il n existait pas d excès de risque périnatal dans le groupe TVB par rapport à celui des CP (ORa : 1.40 [0.89-2.23]). Le principal motif de CP était de principe pour siège (44,3%), les principaux facteurs maternels associés étaient la parité (ORa: 2.56 [2.29-2.88]) et l âge maternel 35 ans (ORa: 1.38 [1.18-1.61]). La décision de CP n était pas associée aux caractéristiques des maternités, bien qu un effet centre ait été identifié (p<0.001). Dans les conditions de pratique décrites dans PREMODA, la TVB semble une option raisonnable à proposer aux femmes présentant des conditions obstétricales optimales.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

A commentary on the importance of controlling for medication use within trials on the effects of exercise on depression and anxiety

Antidepressant and anxiolytics drugs may confound our understanding of the effects of exercise on anxiety and depression which may occur through biological pathways (some may act synergistically while others may be antagonistic), behavioural pathways (with indications of poorer exercise adherence for drug users), and indirect pathways (driven by deteriorated health status affecting the exercise capabilities of medication users). Therefore, the use of antidepressant or anxiolytic medications needs to be carefully considered in future studies assessing the effects of exercise on anxiety or depression

Mode d'accouchement des femmes avec une présentation du siège à terme dans l'étude PREMODA (PREsentation et MODe d'Accouchement)

Objectives. The purpose of this work was to report labor and birth management practices for term breech presentation in France and Belgium in 2001-2002 and to describe indications for cesarean sections (before labor, emergency situations) in breech presentations. Material and methods. The PREMODA cohort is a survey population which included 19408 deliveries, 8108 of which were term breech presentations. Results. Infants were delivered by cesarean section before labor (59.1%), emergency cesarean section during labor (18.4%) or vaginally (22.5%). The decision for cesarean section before labor was empirical (breech presentation) in 44.3% of the cases. Half of the cesarean sections performed during labor (nCombining double low line704, 49.3%) were planned C-sections. Overall, 67.8% of the breech presentations were delivered during planned cesarean sections (before or during labor). When vaginal delivery was attempted, the rate of vaginal birth was 70%. Conclusion. These early results reveal a high rate of cesarean section as well as differences in inter-regional practices. Considering all cesarean sections performed before labor, the most frequent indication was an empirical decision because of the breech presentation. An increased rate of planned cesarean section does not reduce the rate of vaginal delivery when attempted. © Masson, 2004.SCOPUS: no.jinfo:eu-repo/semantics/publishe

Mode d'accouchement des femmes avec une présentation du siège à terme dans l'étude PREMODA (PREsentation et MODe d'Accouchement)

Objectives. The purpose of this work was to report labor and birth management practices for term breech presentation in France and Belgium in 2001-2002 and to describe indications for cesarean sections (before labor, emergency situations) in breech presentations. Material and methods. The PREMODA cohort is a survey population which included 19408 deliveries, 8108 of which were term breech presentations. Results. Infants were delivered by cesarean section before labor (59.1%), emergency cesarean section during labor (18.4%) or vaginally (22.5%). The decision for cesarean section before labor was empirical (breech presentation) in 44.3% of the cases. Half of the cesarean sections performed during labor (n=704, 49.3%) were planned C-sections. Overall, 67.8% of the breech presentations were delivered during planned cesarean sections (before or during labor). When vaginal delivery was attempted, the rate of vaginal birth was 70%. Conclusion. These early results reveal a high rate of cesarean section as well as differences in inter-regional practices. Considering all cesarean sections performed before labor, the most frequent indication was an empirical decision because of the breech presentation. An increased rate of planned cesarean section does not reduce the rate of vaginal delivery when attempted.SCOPUS: cp.jinfo:eu-repo/semantics/publishe

Impact of maternity unit closures on access to obstetrical care: the French experience between 1998 and 2003

International audienc

A systematic review of exercise modalities that reduce pro-inflammatory cytokines in humans and animals' models with mild cognitive impairment or dementia

International audiencePurpose: To investigate which type, frequency, duration, intensity, and volume of chronic exercise might more strongly reduce pro-inflammatory cytokines and enhance anti-inflammatory cytokines in human and animal models with Mild Cognitive Impairment (MCI) or dementia.Design: A systematic review.Data source: English-language search of 13 electronic databases: Web of Science, PubMed/Medline, Sport Discus, Scopus, Cochrane, Psych Net, Springer, ScienceDirect, Pascal & Francis, Sage journals, Pedro, Google Scholar, and Sage.Inclusion criteria: (i) human and animal studies that included exercise, physical activity, or fitness training as an experimental intervention, (ii) studies that addressed MCI, dementia, or AD, (iii) studies that focused on measuring cytokines and/or other inflammatory and/or neuroinflammatory immune markers, (iii) studies that examined inflammatory indicators in blood, CSF (Cerebrospinal Fluid), and brain tissue.Results: Of the 1290 human and animal studies found, 38 were included for qualitative analysis, 11 human articles, 27 animal articles, and two articles addressing both human and animal protocols. In the animal model, physical exercise decreased pro-inflammatory markers in 70.8 % of the articles and anti-inflammatory cytokines: IL -4, IL -10, IL-4β, IL -10β, and TGF-β in 26 % of articles. Treadmill running, resistance exercise, and swimming exercise reduce pro-inflammatory cytokines and increase anti-inflammatory cytokines. In the human model, 53.9 % of items reduced pro-inflammatory proteins and 23 % increased anti-inflammatory proteins. Cycling exercise, multimodal, and resistance training effectively decreased pro-inflammatory cytokines.Conclusion: In rodent animal models with AD phenotype, treadmill, swimming, and resistance training remain good interventions that can delay various mechanisms of dementia progression. In the human model, aerobic, multimodal, and resistance training are beneficial in both MCI and AD. Multimodal training of moderate to high intensity multimodal exercise is effective for MCI. Voluntar