Correlates of quality of life of pre-obese and obese patients: a pharmacy-based cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>The correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies.</p> <p>Methods</p> <p>A convenience sample of patients with a Body Mass Index ≥ 28 kg/m²were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension.</p> <p>Results</p> <p>QOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index ≥ 35 kg/m²was significantly associated with poorer QOL scores on physical, relational and psychological dimensions.</p> <p>Conclusion</p> <p>Our data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons.</p

Abdominal adipocyte populations in women with visceral obesity

Visceral obesity is independently related to numerous cardiometabolic alterations, with adipose tissue dysfunction as a central feature. Objective: To examine whether omental (OM) and subcutaneous (SC) adipocyte size populations in women relate to visceral obesity, cardiometabolic risk factors and adipocyte lipolysis independent of total adiposity. Design and Methods: OM and SC fat samples were obtained during gynecological surgery in 60 women [mean age: 46.1±5.9 years; mean BMI: 27.1±4.5 kg/m2 (range: 20.3-41.1 kg/m2)]. Fresh samples were treated with osmium tetroxide and were analyzed with a Multisizer Coulter. Cell size distributions were computed for each sample with exponential and Gaussian function fits. Results: Computed tomography-measured visceral fat accumulation was the best predictor of larger cell populations as well as the percentage of small cells in both OM and SC fat (p<0.0000 for all). Accordingly, women with visceral obesity had larger cells in the main population and higher proportion of small adipocytes independent of total adiposity (p≤0.05). Using linear regression analysis, we found that women characterized by larger-than-predicted adipocytes in either OM or SC adipose tissue presented higher visceral adipose tissue area, increased percentage of small cells and HOMAir index as well as higher OM adipocyte isoproterenol-, forskolin- and dibutyryl cAMP- stimulated lipolysis compared to women with smaller-than predicted adipocytes, independent of total adiposity (p≤0.05). Conclusion: Excess visceral adipose tissue accumulation is a strong marker of both adipocyte hypertrophy and increased number of small cells in either fat compartment, which relates to higher insulin resistance index and lipolytic response, independent of total adiposity

Studying Your Own Country. Social Scientific Knowledge For Our Times and Places; Presidential Address to the Canadian Political Science Association, St Catharines, May 28, 2014

Political science is both a generalizing and an anchored, nationally defined, discipline. Too often, the first perspective tends to crowd out the latter, because it appears more prestigious, objective, or scientific. Behind the international/national dichotomy, there are indeed rival conceptions of social science, and important ontological, epistemological and methodological assumptions. This article discusses these assumptions and stresses the critical contribution of idiographic, single-outcome studies, the importance of producing relevant, usable knowledge, and the distinctive implications of studying one’s own country, where a scholar is also a citizen, involved in more encompassing national conversations. The aim is not to reject the generalizing, international perspective, or even the comparative approach, but rather to reaffirm the importance of maintaining as well, and in fact celebrating, the production of social scientific knowledge directly relevant for our own times and places.La science politique est une discipline qui aspire à la fois à la généralisation et à la production de connaissances ancrées localement, sur le plan national. Trop souvent, la première perspective domine la seconde, parce qu’elle apparait plus prestigieuse, objective ou scientifique. La dichotomie international/national recouvre en effet des postulats fort différents en ce qui concerne les fondements ontologiques, épistémologiques et méthodologiques de la discipline. Cet article discute ces postulats et souligne la contribution déterminante des études idiographiques, centrées sur des évènements uniques, l’importance de produire des connaissances pertinentes et utilisables, et le caractère distinctif de l’étude de son propre pays, qui fait aussi du chercheur un citoyen impliqué dans de plus larges conversations. Le but n’est pas de rejeter la généralisation ou même l’approche comparative, mais plutôt de réaffirmer l’importance de maintenir également, et même de célébrer, la production de connaissances directement pertinentes pour nos propres temps et milieux de vie

Evaluation of a knowledge-based system providing ventilatory management and decision for extubation.

International audienceWe evaluated whether a knowledge-based system (KBS) connected to a ventilator in pressure support mode could correctly predict the ability of patients to tolerate total withdrawal from ventilatory support. The KBS was designed to continuously adapt ventilatory assistance to the needs of the patient, to manage a strategy of gradually decreasing ventilatory assistance, and to indicate when the patient was able to breathe without assistance. Thirty-eight patients for whom weaning was being considered were evaluated using a conventional battery of parameters, including weaning criteria, tolerance of a T-piece trial, and outcome 48h after permanent withdrawal of ventilation. The results of this evaluation were compared with the suggestions made by the KBS at the end of a period of KBS-driven mechanical ventilation inserted in the conventional weaning procedure. The positive predictive value of the KBS was 89%, versus 77% for the conventional procedure and 81% for the rapid shallow breathing index alone. The KBS correctly predicted the course of five patients who tolerated a T-piece trial but required ventilation within 48 h. We conclude that our KBS ensured appropriate patient management during the weaning period and improved our ability to predict responses to weaning

Certification ISO 9001 d’un système de management qualité dans un centre d’investigation clinique [ISO 9001certification of a quality management system in a clinical investigation center]

International audienceBeyond the application of legal requirements, clinical trials must have a permanent approach of quality control. The clinical investigation centers (CICs) are academic structures of clinical research certified by the French National institute of health and medical research (Inserm) and whose functioning relies on recommendations of good practice. It is important to accompany this standardization of practices by the implementation of a quality management system. This article presents the process that enabled the CIC of Rennes to become certified ISO 9001 by French standards association (Afnor) certification in May, 2016. The application of the fundamental principles of the standard ISO 9001 in the domain of clinical research is approached. The problem of the perimeter for the certification and the related process mapping are exposed. The activities of methodology, management and analysis of clinical studies were chosen for the initial certification of the CIC of Rennes. The perspectives for the extension of the perimeter of certification are also approached at the end of article

Long-Term Inhaled Corticosteroid Adherence in Asthma Patients with Short-Term Adherence

International audienceBACKGROUND: Although the use of inhaled corticosteroids (ICS) in asthma is known to be overall erratic, the long-term use of ICS by patients selected during an episode of regular use is poorly documented. OBJECTIVE: In a cohort of patients with asthma regularly acquiring ICS therapy over several months, we verified whether these patients remained treated in the following 12 months. The correlates of regular ICS use over this period were investigated. METHODS: A historical cohort of patients with asthma was identified from the Echantillon généraliste de bénéficiaires national French health care reimbursement data (2007-2012). Patients (6-40 years) were selected during a regular ICS use episode, with 3 or more ICS refills within 120 days. Continuous multiple-interval measures of medication availability (CMA) were computed for the 12 months after the third dispensation, and the factors associated with a CMA value of 80% or more (adherent patients) were identified. RESULTS: Among 5096 patients (42.1% children/teenagers, 48.8% females), only 24.0% had a CMA value of 80% or more (mean CMA = 54.4%) over the 12 months following the ICS selection period. Achieving a CMA value of 80% or more was primarily associated with being a child/teenager (P = .002), having more severe or less controlled asthma (P = .007), more previous dispensing of short-acting beta agonists (P \\textless .0001), and receiving devices with 200 unit doses (P \\textless .0001). Adherent patients had more frequent general practitioner visits (P \\textless .0001), more distinct prescribers of respiratory therapy (P = .0002), and more frequent switches of ICS (P \\textless .0001). CONCLUSIONS: Most patients with asthma selected during an episode of regular ICS use did not maintain therapy over the following months. Adherence should be repeatedly monitored, and the reasons for discontinuation should be investigated, at prescriber and patient levels

Comparative analysis of three human adipocyte size measurement methods and their relevance for cardiometabolic risk

OBJECTIVE:To determine whether adipocyte diameters from three measurement methods are similarly associated with adiposity measurements and cardiometabolic variables.METHODS:Surgical samples of omental and abdominal subcutaneous adipose tissue were obtained in a sample of 60 women (age 35-59 years; body mass index 20.3-41.1 kg/m2 ). Median adipocyte diameter of the main cell population was determined by collagenase digestion, osmium tetroxide fixation, and histological analysis. Adiposity and cardiometabolic risk factors were assessed.RESULTS:Adipocyte diameter was consistently smaller with formalin fixation than with collagenase digestion, whereas osmium-fixed cells were larger (P < 0.0001, for all). Median adipocyte diameters derived from all methods were intercorrelated (r = 0.46-0.83, P < 0.001 for all). Positive associations were found between adipocyte diameters from all techniques and regional or total adiposity measurements (P < 0.01 for all). Omental adipocyte diameter was positively associated with fasting glucose, insulin, and homeostatic model assessment of insulin resistance (r = 0.30-0.52, P < 0.05 for all), with osmium-fixed cell size as a stronger correlate. Osmium-fixed cell diameter was also a better correlate of plasma adiponectin and leptin.CONCLUSIONS:Although measurement techniques generated systematic differences in adipocyte size, associations with adiposity were only slightly affected by the technique. Osmium fixation generated stronger associations with cardiometabolic risk factors than collagenase digestion and histological analysis

Taphonomy of early life: Role of organic and mineral interactions

International audienceBiogenicity and taphonomy of the early life fossil records are debated as most of the previous studies focussed mainly on isotopes geochemistry. The non-metamorphosed Paleoproterozoic (~2.1 Ga) sedimentary succession of the Francevillian Basin (Gabon) contains the oldest complex multicellular organisms embedded in black shale facies. Several studies have confirmed the biogenicity of these soft-bodied organisms. Here, we used multi-proxy techniques to show that the preservation of these macro-organisms happened in a close system that limits interaction with their host rocks, which leads to their good preservations. The macro-organisms are present in different shapes and sizes: lobate (L), elongate (E), tubular (T), segmented (S), and circular (C), and are often associated with bacterial mats. Except for the C form, most of the other specimens are pyritized. Sulfur isotopes data confirms that pyritization occurred by bacterial sulfato-reduction during early diagenesis. We compare the clay mineral assemblages between the pyritized specimens and the late-diagenetically formed pure pyritized concretions in the sediments because the early pyritization process could not explain the taphonomic preservation alone. Our clay mineralogical data show that the specimens are dominated mainly by randomly mixed layer Illite-smectite (IS MLMs), illite, and chlorite relative to the host rocks. The abundance of IS MLMs indicates incomplete illitization of smectite, potassium deficiency, and limited mineral reactions in a semi-close local chemical system within the fossils. In addition, the authigenic chlorites are more iron-rich and show vermicular habitus. By contrast, the pyritized concretions mainly consist of well-crystallized illite and less iron-rich chlorite, while the smectite phases are absent. These results confirmed that the diagenetic reaction is controlled by interaction with an open late diagenetic system. We concluded that taphonomic preservation of the ancient fossil record resulted from the early diagenetic growth of pyrite crystals during bacterial sulfato reduction in the fossils, which creates a semi-closed system that drastically reduced fluid-rock interactions with the host sediments

Post-depositional transformations in sedimentary rocks and implications for paleoenvironmental studies: evidence from the Mesoproterozoic (∼1.1 Ga) of the Taoudeni Basin, Mauritania

International audienceUnderstanding paleoenvironmental dynamics linked to biological evolution in Earth history is a major goal within the geological community. The difficulty of achieving this goal, at least in part, lies with the secondary transformations experienced by a majority of ancient rocks, especially through metamorphism and hydrothermal activity. The Mesoproterozoic (∼1.1 Ga) shallow-marine deposits from the Taoudeni Basin, Mauritania, have suffered a complex, multiphase tectonic, and thermal evolutionary history. Representative samples from two drill cores (a background site [S2] and a dolerite intrusion-bearing drill core [S1]) from the El Mreiti Group were evaluated for transformations and overprints of original mineralogies and geochemical compositions. Our results show that the drill core hosting the dolerite intrusion (S1) is characterized by a suite of minerals (that is, pyroxene, graphite, pyrrhotite, garnet, zeolite, and authigenic clay minerals) resulting from contact metamorphism and associated hydrothermal activity. However, compared to the S1, the S2 core shows no evidence of post-depositional transformation. The geochemical data obtained from S1 reveal a striking elevation of iron contents likely delivered from the hydrothermal fluids. Moreover, concentrations of redox-sensitive trace elements (molybdenum, uranium, and vanadium) increased dramatically during hydrothermal and metamorphic activity. This study demonstrates that need for caution when assessing paleoenvironmental conditions in ancient sedimentary rocks, particularly for iron and trace metal approaches commonly used in reconstructions of paleo-redox