36 research outputs found
Financial and relational impact of having a boy with posterior urethral valves
IntroductionChildhood chronic diseases affect family functioning and well-being. The aim of this study was to measure the impact of caring for a child with PUV, and the factors that most impact the burden of care.Patients and methodWe gave a questionnaire on the familial impact of having a child with posterior urethral valves to all parents of a child included in the CIRCUP trial from 2015 onwards. The questionnaire included questions about the parents' demographics, health, professional, financial and marital status and how these evolved since the child's birth as well as the âimpact on family scaleâ (IOFS), which gives a total score ranging from 15 (no impact) to 60 (maximum impact). We then analyzed both the results of the specific demographic questions as well as the factors which influenced the IOFS score.ResultsWe retrieved answers for 38/51 families (74.5% response rate). The average IOFS score was 23.7 (15â51). We observed that the child's creatinine level had an effect on the IOFS score (pâ=â0.02), as did the parent's gender (pâ=â0.008), health status (pâ=â0.015), being limited in activity since the birth of the child (pâ=â0.020), being penalized in one's job (pâ=â0.009), being supported in one's job (pâ=â0.002), and decreased income (pâ=â0.004). Out of 38 mother/father binomials, 8/33 (24.2%) declared that they were no longer in the same relationship afterwards.ConclusionIn conclusion, having a boy with PUV significantly impacts families. The risk of parental separation and decrease in revenue is significant. Strategies aiming to decrease these factors should be put in place as soon as possible
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and lowâmiddle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of âsingle-useâ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for lowâmiddle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both highâ and lowâmiddleâincome countries
Caractérisation du systÚme nerveux entérique et de la barriÚre épithéliale intestinale dans la maladie de Hirschsprung : source de biomarqueurs prédictifs de complications ?
La maladie de Hirschsprung (MH) est une maladie congĂ©nitale rare avec une incidence estimĂ©e Ă 1/5000 naissances vivantes. Elle est secondaire Ă une anomalie dĂ©veloppementale du systĂšme nerveux entĂ©rique (SNE) et est caractĂ©risĂ©e par une absence de cellules ganglionnaires (neurones et cellules gliales entĂ©riques) dans les plexus myentĂ©rique et sous-muqueux prĂ©dominant au niveau de la partie distale du tube digestif (Langer, 2013). Câest une neurocristopathie qui provient dâun dĂ©faut de colonisation, migration et diffĂ©renciation des cellules progĂ©nitrices de la crĂȘte neurale (CPCN) qui a lieu chez lâhomme entre le 5Ăšme et la 12Ăšme semaine de gestation (Obermayr et al, 2012; Lake and Heuckeroth, 2013). Cette anomalie est responsable dâune contraction permanente de lâintestin atteint entrainant une perte du pĂ©ristaltisme intestinal et une occlusion digestive fonctionnelle se rĂ©vĂ©lant majoritairement en pĂ©riode nĂ©onatale. Le traitement est chirurgical et consiste en la rĂ©section des zones aganglionnaire et de transition avec rĂ©tablissement de la continuitĂ© digestive en zone ganglionnaire dite « saine ».Absen
A Wzx-Wzy-like Polysaccharide Biosynthetic Pathway Contributes to Virulence in Brucella abortus 2308 through an Unknown Mechanism
Brucella abortus is an intracellular pathogen that causes spontaneous abortion in cattle and undulant fever in humans. As a member of the a-proteobacteria, B. abortus is closely related to the bacterial species Caulobacter crescentus and Agrobacterium tumefaciens, which have been shown to produce a holdfast and a unipolar polysaccharide (UPP), respectively, at one pole of the bacterial cell. Although little is currently known about exopolysaccharide production and function in Brucella species, recent evidence suggests that these bacteria are capable of producing exopolysaccharides, and with the exception of a flippase gene, B. abortus 2308 carries the genes for a complete UPP biosynthetic pathway.
In A. tumefaciens, UPP can be detected by crystal violet, Congo red, or lectin staining; however, UPP production was not detected in B. abortus 2308 using these assays. UPP production can also be increased in A. tumefaciens by overexpressing the diguanylate cyclase PleD, which regulates intracellular cyclic di-GMP levels, but we were unable to demonstrate that UPP is regulated by cyclic di-GMP in B. abortus 2308.
Nonetheless, upp homologs in B. abortus 2308 are able to restore biofilm production in A. tumefaciens. In A. tumefaciens, knockout mutants of the outer membrane transporter uppC
and the polyisoprenylphosphate hexose-1-phosphate transferase uppE result in strong biofilm phenotypes, wherein the ability of A. tumefaciens to produce a biofilm is nearly abrogated. B. abortus 2308 uppC and uppE homologs restore biofilm production in the respective Agrobacterium upp mutants, indicating that uppC and uppE from B. abortus 2308 produce functional proteins.
A uppCE mutant in B. abortus 2308 also exhibits significant attenuation in mice and an altered intracellular replication profile in cultured murine macrophages. Accordingly, uppCE appears to be required for virulence in B. abortus 2308, although by a currently unknown mechanism. Additional studies will be needed to determine whether B. abortus 2308 produces an authentic UPP as well as define the mechanisms by which the putative upp genes contribute to virulence
A Wzx-Wzy-like Polysaccharide Biosynthetic Pathway Contributes to Virulence in Brucella abortus 2308 through an Unknown Mechanism
Brucella abortus is an intracellular pathogen that causes spontaneous abortion in cattle and undulant fever in humans. As a member of the a-proteobacteria, B. abortus is closely related to the bacterial species Caulobacter crescentus and Agrobacterium tumefaciens, which have been shown to produce a holdfast and a unipolar polysaccharide (UPP), respectively, at one pole of the bacterial cell. Although little is currently known about exopolysaccharide production and function in Brucella species, recent evidence suggests that these bacteria are capable of producing exopolysaccharides, and with the exception of a flippase gene, B. abortus 2308 carries the genes for a complete UPP biosynthetic pathway.
In A. tumefaciens, UPP can be detected by crystal violet, Congo red, or lectin staining; however, UPP production was not detected in B. abortus 2308 using these assays. UPP production can also be increased in A. tumefaciens by overexpressing the diguanylate cyclase PleD, which regulates intracellular cyclic di-GMP levels, but we were unable to demonstrate that UPP is regulated by cyclic di-GMP in B. abortus 2308.
Nonetheless, upp homologs in B. abortus 2308 are able to restore biofilm production in A. tumefaciens. In A. tumefaciens, knockout mutants of the outer membrane transporter uppC
and the polyisoprenylphosphate hexose-1-phosphate transferase uppE result in strong biofilm phenotypes, wherein the ability of A. tumefaciens to produce a biofilm is nearly abrogated. B. abortus 2308 uppC and uppE homologs restore biofilm production in the respective Agrobacterium upp mutants, indicating that uppC and uppE from B. abortus 2308 produce functional proteins.
A uppCE mutant in B. abortus 2308 also exhibits significant attenuation in mice and an altered intracellular replication profile in cultured murine macrophages. Accordingly, uppCE appears to be required for virulence in B. abortus 2308, although by a currently unknown mechanism. Additional studies will be needed to determine whether B. abortus 2308 produces an authentic UPP as well as define the mechanisms by which the putative upp genes contribute to virulence
Analgésie postopératoire aprÚs chirurgie modérément douloureuse (paracétamol plus kétoprofÚne versus parécoxib)
LIMOGES-BU MĂ©decine pharmacie (870852108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
A Wzx-Wzy-like Polysaccharide Biosynthetic Pathway Contributes to Virulence in Brucella abortus 2308 through an Unknown Mechanism
Brucella abortus is an intracellular pathogen that causes spontaneous abortion in cattle and undulant fever in humans. As a member of the a-proteobacteria, B. abortus is closely related to the bacterial species Caulobacter crescentus and Agrobacterium tumefaciens, which have been shown to produce a holdfast and a unipolar polysaccharide (UPP), respectively, at one pole of the bacterial cell. Although little is currently known about exopolysaccharide production and function in Brucella species, recent evidence suggests that these bacteria are capable of producing exopolysaccharides, and with the exception of a flippase gene, B. abortus 2308 carries the genes for a complete UPP biosynthetic pathway. \nIn A. tumefaciens, UPP can be detected by crystal violet, Congo red, or lectin staining\; however, UPP production was not detected in B. abortus 2308 using these assays. UPP production can also be increased in A. tumefaciens by overexpressing the diguanylate cyclase PleD, which regulates intracellular cyclic di-GMP levels, but we were unable to demonstrate that UPP is regulated by cyclic di-GMP in B. abortus 2308. \nNonetheless, upp homologs in B. abortus 2308 are able to restore biofilm production in A. tumefaciens. In A. tumefaciens, knockout mutants of the outer membrane transporter uppC \nand the polyisoprenylphosphate hexose-1-phosphate transferase uppE result in strong biofilm phenotypes, wherein the ability of A. tumefaciens to produce a biofilm is nearly abrogated. B. abortus 2308 uppC and uppE homologs restore biofilm production in the respective Agrobacterium upp mutants, indicating that uppC and uppE from B. abortus 2308 produce functional proteins.\nA uppCE mutant in B. abortus 2308 also exhibits significant attenuation in mice and an altered intracellular replication profile in cultured murine macrophages. Accordingly, uppCE appears to be required for virulence in B. abortus 2308, although by a currently unknown mechanism. Additional studies will be needed to determine whether B. abortus 2308 produces an authentic UPP as well as define the mechanisms by which the putative upp genes contribute to virulence
A Wzx-Wzy-like Polysaccharide Biosynthetic Pathway Contributes to Virulence in Brucella abortus 2308 through an Unknown Mechanism
Brucella abortus is an intracellular pathogen that causes spontaneous abortion in cattle and undulant fever in humans. As a member of the a-proteobacteria, B. abortus is closely related to the bacterial species Caulobacter crescentus and Agrobacterium tumefaciens, which have been shown to produce a holdfast and a unipolar polysaccharide (UPP), respectively, at one pole of the bacterial cell. Although little is currently known about exopolysaccharide production and function in Brucella species, recent evidence suggests that these bacteria are capable of producing exopolysaccharides, and with the exception of a flippase gene, B. abortus 2308 carries the genes for a complete UPP biosynthetic pathway. \nIn A. tumefaciens, UPP can be detected by crystal violet, Congo red, or lectin staining\; however, UPP production was not detected in B. abortus 2308 using these assays. UPP production can also be increased in A. tumefaciens by overexpressing the diguanylate cyclase PleD, which regulates intracellular cyclic di-GMP levels, but we were unable to demonstrate that UPP is regulated by cyclic di-GMP in B. abortus 2308. \nNonetheless, upp homologs in B. abortus 2308 are able to restore biofilm production in A. tumefaciens. In A. tumefaciens, knockout mutants of the outer membrane transporter uppC \nand the polyisoprenylphosphate hexose-1-phosphate transferase uppE result in strong biofilm phenotypes, wherein the ability of A. tumefaciens to produce a biofilm is nearly abrogated. B. abortus 2308 uppC and uppE homologs restore biofilm production in the respective Agrobacterium upp mutants, indicating that uppC and uppE from B. abortus 2308 produce functional proteins.\nA uppCE mutant in B. abortus 2308 also exhibits significant attenuation in mice and an altered intracellular replication profile in cultured murine macrophages. Accordingly, uppCE appears to be required for virulence in B. abortus 2308, although by a currently unknown mechanism. Additional studies will be needed to determine whether B. abortus 2308 produces an authentic UPP as well as define the mechanisms by which the putative upp genes contribute to virulence
: [French-style bundled payments ? Feedback on an experiment in episode-based payment in orthopaedics and oncology to improve coordination]
International audienceThis article presents the initial results of a national experiment aimed at introducing episode-based bundled payments in the French healthcare system. Launched in 2019, restricted for the moment to three pathologies (hip and knee replacement and colectomy for cancer) and to around 40 hospitals, this experiment is presented as a step to move away from a much criticized activity-based payment system and to promote value-based payment. Episodes of careâs financing aims to pay healthcare organizations on the basis of a flat rate payment for a group of acts and services associated with a pathology upstream, during and downstream of in hospital surgery. Coupled with quality objectives, bundled payments are expected to support both quality and efficiency gains by incentivizing hospitals to optimize patientsâ pathways and care coordination between acute care hospitals and primary care providers. Based on a qualitative empirical study, this article analyzes the extent to which the incentives associated with the introduction of this payment method participate to transform care practices at the hospital level. Building on a multidisciplinary approach (health policy and management and health sociology) and reflecting on the literature on management tools, policy instruments and algorithmic regulation, we show that the financing framework used to calculate the reimbursement package does not yet produce the expected incentives in terms of care coordination.Cet article rend compte des premiers rĂ©sultats dâune expĂ©rimentation, lancĂ©e en France en 2019, portant sur lâintroduction dâun mode de financement des soins Ă lâĂ©pisode de soins (EDS). Le principe de ce mode de financement est de rĂ©munĂ©rer les organisations de soin sur la base dâun forfait couvrant un ensemble dâactes et de prestations associĂ©s Ă une pathologie (lâĂ©pisode de soins) en amont, pendant et en aval des soins dĂ©livrĂ©s Ă lâhĂŽpital. CensĂ© permettre Ă la fois des gains de qualitĂ© et des gains dâefficience, il vise Ă rĂ©pondre aux critiques portĂ©es Ă la tarification Ă lâactivitĂ©, notamment en termes de coordination des soins entre ville et hĂŽpital. AppuyĂ© sur une enquĂȘte qualitative menĂ©e auprĂšs des Ă©tablissements participants, cet article propose dâanalyser le dĂ©ploiement du paiement Ă lâĂ©pisode de soins en France en posant la question de la congruence entre les objectifs de coordination ville-hĂŽpital, les incitatifs tels que Ă©laborĂ©s par les Ă©quipes techniques nationales et les rĂ©ceptions locales par les Ă©tablissements participants. AprĂšs avoir prĂ©sentĂ© la singularitĂ© de ce mode de financement en mobilisant la littĂ©rature sur les outils de gestion, les instruments dâaction publique et la sociologie de la quantification, nous montrons quâEDS produit une sĂ©rie dâincitatifs rĂ©pondant, Ă lâheure actuelle, seulement partiellement aux objectifs de coordination ville-hĂŽpital
Semaphorin 3A controls enteric neuron connectivity and is inversely associated with synapsin 1 expression in Hirschsprung disease
International audienceMost of the gut functions are controlled by the enteric nervous system (ENS), a complex network of enteric neurons located throughout the wall of the gastrointestinal tract. The formation of ENS connectivity during the perinatal period critically underlies the establishment of gastrointestinal motility, but the factors involved in this maturation process remain poorly characterized. Here, we examined the role of Semaphorin 3A (Sema3A) on ENS maturation and its potential implication in Hirschsprung disease (HSCR), a developmental disorder of the ENS with impaired colonic motility. We found that Sema3A and its receptor Neuropilin 1 (NRP1) are expressed in the rat gut during the early postnatal period. At the cellular level, NRP1 is expressed by enteric neurons, where it is particularly enriched at growth areas of developing axons. Treatment of primary ENS cultures and gut explants with Sema3A restricts axon elongation and synapse formation. Comparison of the ganglionic colon of HSCR patients to the colon of patients with anorectal malformation shows reduced expression of the synaptic molecule synapsin 1 in HSCR, which is inversely correlated with Sema3A expression. Our study identifies Sema3A as a critical regulator of ENS connectivity and provides a link between altered ENS connectivity and HSCR