Methacholine-Induced Variations in Airway Volume and the Slope of the Alveolar Capnogram Are Distinctly Associated with Airflow Limitation and Airway Closure

<div><p>Mechanisms driving alteration of lung function in response to inhalation of a methacholine aerosol are incompletely understood. To explore to what extent large and small airways contribute to airflow limitation and airway closure in this context, volumetric capnography was performed before (n = 93) and after (n = 78) methacholine provocation in subjects with an intermediate clinical probability of asthma. Anatomical dead space (VDaw), reflecting large airway volume, and the slope of the alveolar capnogram (slope3), an index of ventilation heterogeneity linked to small airway dysfunction, were determined. At baseline, VDaw was positively correlated with lung volumes, FEV₁ and peak expiratory flow, while slope3 was not correlated with any lung function index. Variations in VDaw and slope3 following methacholine stimulation were correlated to a small degree (R² = -0.20). Multivariate regression analysis identified independent associations between variation in FEV₁ and variations in both VDaw (Standardized Coefficient-SC = 0.66) and Slope3 (SC = 0.35). By contrast, variation in FVC was strongly associated with variations in VDaw (SC = 0.8) but not Slope3. Thus, alterations in the geometry and/or function of large and small airways were weakly correlated and contributed distinctly to airflow limitation. While both large and small airways contributed to airflow limitation as assessed by FEV1, airway closure as assessed by FVC reduction mostly involved the large airways.</p></div

Relationships between methacholine-induced variations in volumetric capnography variables and the FEV1 dose-response curve in patients without BHR (empty circles) and in patients with BHR (filled grey circles).

<p>A: Variations in airway volume (VDaw). B: Variation in the slope of the alveolar capnogram (slope3). Scales are linear to a value of 100 and exponential thereafter. ΔVDaw / Mch: Fractional change in aiway volume reported to the methacholine dose, expressed as -% / mg. Δslope3 / Mch: Fractional change in the slope of the alveolar capnogram reported to the methacholine dose, expressed as % / mg.</p

Characteristics of subjects before methacholine testing.

<p>*: p < 0.05,</p><p>**: p<0.001,</p><p>***: p<0.0001 between subjects with and without BHR.</p><p>FEV1: Forced expiratory volume in 1 second. FVC: Forced vital capacity. FEF25-75: Mean forced expiratory flow between 25% and 75% of FVC. PEF: Peak expiratory flow. TLC: Total lung capacity. RV: Residual volume. Raw: Airway resistance. sRaw: Specific airway resistance. VDaw: Airway volume. Slope3: Slope of the alveolar capnogram.</p

Multivariate analysis of relationships between the FEV1 and FVC dose-response and Mch-induced variations in capnographic variables.

<p>SC: Standardized coefficient.</p

Correlation between baseline lung function parameters and baseline airway volume (VDaw) and the slope of the alveolar capnogram (slope3) in 93 subjects.

<p>Linear regression was performed with VDaw and slope3 as dependent variables.</p

Additional file 1: of Assessment of coping: a new french four-factor structure of the brief COPE inventory

Replication on patient and caregiver subsamples. Table S1. Characteristics of patients and caregivers. Table S2. Dimensions’ characteristics of Brief COPE for patients and caregivers. Table S3. Relationships between Brief COPE and sociodemographics and quality of life for patients and caregivers. (DOCX 53 kb

Toward Meeting the Needs of Homeless People with Schizophrenia: The Validity of Quality of Life Measurement

<div><p>Objective</p><p>To provide new evidence regarding the suitability of using quality of life (QoL) measurements in homeless people with schizophrenia, we assess the acceptability and psychometric properties of a specific QoL instrument (S-QoL 18) in a population of homeless people with schizophrenia, and we compare their QoL levels with those observed in non-homeless people with schizophrenia.</p> <p>Methods</p><p>This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Two hundred and thirty-six homeless patients with schizophrenia were recruited over a 12 month-period. The S-QoL 18 was tested for construct validity, reliability, external validity and sensitivity to change. The QoL of the 236 homeless patients was compared with 236 French age- and sex-matched non-homeless patients with schizophrenia.</p> <p>Results</p><p>The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA = 0.035, CFI = 0.95, GFI = 0.99 and SRMR = 0.015). Internal consistency, reliability and sensitivity to change were satisfactory. External validity was confirmed via correlations between S-QoL 18 dimension scores and SF-36, symptomatology and recovery scores. The percentage of missing data did not exceed 5%. Finally, homeless patients had significantly lower QoL levels than non-homeless patients with schizophrenia.</p> <p>Conclusions</p><p>These results demonstrate the satisfactory acceptability and psychometric properties of the S-QoL 18, suggesting the validity of QoL measurement among homeless patients with schizophrenia. Our study also reported that QoL levels in homeless patients with schizophrenia were dramatically low, highlighting the need for new policies to eradicate homelessness and tackle poverty.</p> </div

Comparisons of S-QoL 18 score means (SD) between homeless (n=236) and non-homeless individuals with schizophrenia (n=236) matched by age and gender.

<div><p>S-QoL 18—PsW: psychological well-being; SE: self-esteem; RFa: family relationships; RFr: relationships with friends; RE: resilience; PhW: physical well-being; AU: autonomy; and SL: sentimental life.</p> <p>* p < 0.05; ** p < 0.01.</p></div

Unmasking the triad of burnout, absenteeism, and poor sleep among healthcare workers during the third wave of COVID-19 pandemics. Results from the national AMADEUS study.

Background: Burnout and absenteeism are prevalent among healthcare workers, reflecting prolonged work-related stress and dissatisfaction with their job. Identifying poor sleep as a contributing factor can assist in developing targeted interventions. This study explored the relationship between burnout, absenteeism, and sleep among healthcare workers.Methods: A nationwide online cross-sectional study was conducted among healthcare professionals in France during the third wave of COVID-19, from May 2021 to June 2021. Recruitment strategies included outreach through social and professional networks and email invitations. Burnout was assessed using the Maslach Burnout Inventory, absenteeism through self-reported days absent in the preceding 12 months, and sleep quality using the Pittsburgh Sleep Quality Index. The association between burnout, absenteeism, and poor sleep was analyzed using multivariate logistic regression, accounting for individual and professional variables. The study also explored various sleep dimension abnormalities.Results: Of 10,087 healthcare workers, 55.2 % reported burnout, 20.5 % absenteeism, and 64.8 % poor sleep. Burnout and absenteeism were more frequent in individuals with poor sleep compared to those with good sleep (74.2 % vs. 25.8 % and 75.6 % vs. 24.4 %, respectively). The multivariate analyses confirmed the associations between burnout, absenteeism, and poor sleep (Adjusted Odds Ratio [aOR] = 2.15, 95 % CI [1.97–2.35], p Interpretation: The study highlighted the intricate relationship between burnout, absenteeism, and poor sleep among healthcare professionals, informing workforce management and policy decisions to foster a supportive work environment and enhance their well-being.</p

<i>In vitro</i> antigen recall experiments.

<p>Spleen homogenates from mice immunized via the nasal route with promastigote lysate (PL) plus either wild-type CNF1 (PL + WT CNF1) or catalytically inactive CNF1 (PL + mCNF1) and infected with 10⁸ stationary phase <i>L</i>. <i>infantum</i> metacyclic parasites were challenged with 50 μg/ml PL for 48 hours. The supernatants were collected and assayed for IL-2 (A), IFN-γ (B) and IL-4 (C) by ELISA. The bars represent the mean cytokine production ± SEM. *: p<0.05, **: p<0,01, ***: p<0,001. n = 7.</p