Grey and harbour seals in France : distribution at sea, connectivity and trends in abundance at haulout sites

Grey (Halichoerus grypus) and harbour seals (Phoca vitulina) are sympatric seal species, but they display distinct strategies of habitat use and connectivity between haulout sites. The distribution patterns and variations in relative abundance of both species were investigated along the French coast of the English Channel, at the southern limit of their range where seal numbers are increasing. Regular censuses conducted at all main haulout sites in mainland France showed significant seasonal variations at most sites, with more harbour seals counted during summer (breeding and moulting seasons), and more grey seals during summer only in the eastern English Channel. Trends in maximum haulout numbers at haulout sites showed a significant increase over the last five years, ranging from 9.7 to 30.9% per year for harbour seals, and from 5.8% (in the western English Channel) to 49.2% (in the eastern English Channel) per year for grey seals. These rates of increase in grey seal numbers are not linked to local pup production and most probably result from seal movements from the southwest British Isles and the North Sea, respectively. Aerial surveys conducted across the English Channel showed that most seal observations at sea were concentrated in the north-eastern English Channel. Telemetry showed that the 28 harbour seals tracked remained highly coastal, within a radius of 100 km from their haulout sites, and did not move to other known colonies. Grey seals moved much greater distances, reaching up to 1200 km from their capture site. More than half of the 45 grey seals tracked crossed the English Channel, especially during the breeding season, moving to known colonies in the southwest British Isles and the North Sea. Combining individual tracks and long-term surveys of the seal populations allowed a better understanding of the dynamics of these populations and their connectivity at a larger regional scale. The findings provide direct information for the management of grey and harbour seals within the frame of the Marine Strategy Framework Directive, and highlight focus areas where potential interactions between the two species should be monitored.PostprintPeer reviewe

Tectonic evolution of the Rehamna metamorphic dome (Morocco) in the context of the Alleghanian-Variscan orogeny

Structural and 40Ar/39Ar geochronological investigations of the Rehamna Massif (Meseta, Moroccan Variscan belt) provide new constraints on the tectonic evolution of the Alleghanian-Variscan orogen during the Upper Paleozoic. Three main tectonic events have been recognized: (1) Southward thrusting of an Ordovician sequence over the Proterozoic basement, its Cambrian sedimentary cover, and the overlying Devono-Carboniferous basin. This event caused subhorizontal shearing and prograde Barrovian metamorphism of the buried rocks. (2) Continuous shortening resulting in the development of a synconvergent extrusion of metamorphosed units to form a dome elongated E-W. This was responsible for synconvergent detachment of the Ordovician upper crustal sequence. The timing of these two episodes is constrained to 310–295 Ma by cooling and metamorphic amphibole and mica ages (3) A NW-WNW convergence in a direction orthogonal to the previous one and characterized by the accretion of the Rehamna dome to the continental basement in the east. Based on 40Ar/39Ar cooling ages from a syntectonic granitoid and its host rocks and metamorphic 40Ar/39Ar ages from greenschist facies mylonite, the timing of this event falls between 295 and 280 Ma. The end of the Variscan orogeny in the Moroccan Meseta is constrained by the 40Ar/39Ar cooling age of a posttectonic pluton dated at ~275 Ma. The tectonic events highlighted in Morocco coincide with the late Variscan-Alleghanian tectonic evolution of southern Europe and North America and can be correlated with the global reorganization of plates that accompanied suturing of Pangaea at around 295 Ma.Peer reviewe

Médicaments et personnes agées en France (quelle consommation en 2011 ?)

PARIS-BIUP (751062107) / SudocSudocFranceF

(De)Prescribing of proton pump inhibitors: what has changed in recent years? an observational regional study from the French health insurance database

Abstract Background Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases. Methods This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were included, defined as patients who has had PPI dispensed for 3 consecutive months with a temporal coverage of at least 80%. Patients under 18 years of age and patients who received parenteral PPIs only were excluded. Results The percentage of chronic treatment discontinuation in 2017 was 12.5% and remained stable to reach 12.4% in 2020. The number of new chronic patients increased from year to year to reach 77,222 patients in 2020, with an increasing rate of 1.2 to 2% between 2017 and 2020. The prevalent patient population increased from year to year to reach 167 751 patients in 2020, with an increasing rate of 4.2 to 4.4% between 2017 and 2020. Regarding the initiation of PPI therapy, in 2020, 87.1% of treatment initiations were done by general practitioners. They renewed 2,402,263 prescriptions (89.3%) between 2017 and 2020. Conclusions This study shows a stagnation over the last 4 years in the deprescribing of chronic PPI treatments in a French region despite the information on their inappropriate use reported by national agencies and in the literature with increasing frequency. This reinforces the interest of setting up a deprescribing project

Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review

International audienceAbstract Background In a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes. Methods We conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist. Results Sixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)—including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders. Conclusions Evidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

International audienceBackground Deprescribing benzodiazepines and related drugs (BZDR) is a challenge due to a lack of time on physicians’ part, a lack of involvement of other health professionals, and the need for adapted tools. This study is based on primary care collaboration, by evaluating the effectiveness of a joint intervention between general practitioners and community pharmacists on the implementation of BZDR deprescribing in older adults. Methods This is a cluster randomized controlled trial in which each cluster will be formed by a physician-pharmacist pair. Within a cluster allocated to the intervention, the pharmacist will be trained in motivational interviewing (MI), and will offer the patient 3 interviews after inclusion by the physician. They will base their intervention on validated deprescribing guidelines. The pharmacist will receive methodological support during the first interviews. Interprofessional collaboration will be encouraged by writing reports for the physician after each interview. The following implementation outcomes will be evaluated: acceptability/adoption, appropriateness, cost, and fidelity. They will be measured by means of sociological interviews, observations, logbooks, and cost-utility analysis. Focus groups with physicians and pharmacists will be carried out to identify levers and barriers experienced in this collaboration. Observations will be conducted with pharmacists to assess their approach of the MIs. Effectiveness outcomes will be based on medication (discontinuation or reduction of BZDR) and clinical outcomes (such as quality of life, insomnia or anxiety), assessed by health insurance databases and validated questionnaires. Discussion This study will determine whether collaboration in primary care between physicians and pharmacists, as well as training and coaching of pharmacists in motivational interviewing, allows the implementation of BZDR deprescribing in the older adults. This study will provide an understanding of the processes used to implement deprescribing guidelines, and the contribution of collaborative practice in implementing BZDR discontinuation. The cluster methodology will allow to assess the experience of the relationship between the different primary care actors, and the related obstacles and levers. The results obtained will make it possible to produce guidelines on the involvement of community pharmacists in the management of substance abuse in older adults, or even to legislate new missions or care pathways. Clinical trial registration ClinicalTrials.gov , identifier, NCT05765656

Reconstruction techniques of the orbit after Brown class III maxillectomy : A systematic review

International audienceThis systematic review aimed to evaluate the surgical techniques used for orbital floor reconstruction after Brown class III maxillectomy for cancer. Three databases were searched from January 1990 to January 2022. Of the 614 studies identified, 20 were retained after eligibility assessment. The surgical techniques were classified into four groups: free bone flaps (A), alloplastic implants (B), bone grafts (C), and soft-tissue reconstructions (D). Ectropion and diplopia concerned 42.6% and 6.6% of the patients, respectively. Soft tissue reconstruction was more likely to cause ectropion (17/27), followed by the reconstruction techniques of group B (34/79), group C (26/70), and group A (1/7). Postoperative enophthalmos was identified in 18 patients (9.6%), mostly in group D (5/35), followed by groups B (8/68), A (3/33), and C (2/52). Free bone flaps and alloplastic implants represent good reconstructive options in terms of postoperative ocular parameters

Evaluation of the acceptability in France of the vaccine against papillomavirus (HPV) among middle and high school students and their parents.

BackgroundThe pathogenic and oncogenic roles of papillomavirus (HPV) infections have been documented and shown to occur in women as well as in men. While other countries have already extended their vaccination guidelines to include boys, in 2019 the French National Authority for Health validated implementation of HPV vaccination in the 2020 vaccination schedule. There is, however, a climate of distrust in regard to vaccination in France, and there have been few studies to date regarding the acceptability of HPV vaccination in boys in France. The aim of this study was, therefore, to evaluate the acceptability of extending the recommendations for HPV vaccination in men, among middle and high school students and their parents.MethodsOur study (HPVac) was a prospective, multicenter, departmental, and descriptive survey applied to a sample of male middle and high school students attending schools in the Loire-Atlantique department and their parents. It took place from January 2017 to January 2018.ResultsWe analyzed the information obtained from 127 parent questionnaires and 145 children questionnaires. In terms of acceptability, 36.6% (n = 53) of the children and 37.8% (n = 48) of the parents were in favour of being vaccinated or of having their children vaccinated against HPV (51.7% (n = 75) and 50.4% (n = 64), respectively, were undecided). The perception of a risk stemming from HPV infection was positively associated with acceptability of the HPV vaccine. Being against vaccines in general, being discouraged by their parents, parents thinking that their child is not at risk, and the belief that the vaccine is not mandatory were arguments cited and significantly associated with a willingness to be vaccinated.ConclusionThis study revealed a lack of information among boys and their parents about HPV and its vaccination. It also clearly showed that taking time to discuss the consequences of an infection and the merits of being vaccinated can help parents overcome their reluctance. The children then generally go along with their parent's choice

Observational and prospective study: evaluation of beliefs and representations of chronic treatments of polymedicated patients hospitalised in a vascular medicine and surgery department

Objectives Today, the involvement of patients in their care is essential. As the population ages increases, the number of patients with chronic diseases is increasing. In the vascular medicine and surgery departments, patients are polymedicated and mostly suffer from several chronic diseases. Approximately 50% of patients with a chronic disease are not adherent. Among the factors that can influence therapeutic adherence are the beliefs and representations of patients.To evaluate the beliefs and representations of chronic treatments in patients with multiple medications and hospitalised in a vascular medicine and surgery department, and to evaluate the medication adherence, the knowledge and the importance patients attach to their treatments.Design Observational, prospective and a single-centre study.Setting The study was conducted in a French tertiary hospital centre of around 3000 beds in 9 institutions.Participants Adult polymedicated (ie, minimum of five chronic treatments) patients hospitalised in a vascular medicine and surgery department were included after application of the exclusion criteria.Methods Patient interviews were carried out in the department and were based on three interviewer-administered questionnaires (a global questionnaire, the Belief Medical Questionnaire and the GIRERD questionnaire).Results Our study showed that patients perceived their treatments as beneficial rather than worrying. A correlation between medication adherence and beliefs was observed. ‘Non-adherent’patients had a more negative overall view of medication than ‘adherent’ patients. The level of compliance and knowledge of our patients was low. Only 11% of the patients were ‘good adherent’, 16% of the patients could perfectly name their treatment and 36% knew all the indications.Conclusion Knowledge of treatment representation and beliefs are central to understanding patient behaviour. Considering patients’ representations will allow the identification of levers, and the development of actions and educational tools adapted to improve their adherence, their knowledge and therefore their drug management