Int J Environ Res Public Health

BACKGROUND: Female surgeons are exposed to physical and mental stressors that differ from those of other specialties. We aimed to assess whether female surgeons are more at risk of pregnancy complications than women in other medical specialties. METHODS: We used a cross-sectional electronic survey of female physicians working in the French Region Nouvelle-Aquitaine who were pregnant between 2013 and 2018. A pregnancy complication was defined as the occurrence of miscarriage, ectopic pregnancy, fetal growth restriction, prematurity, fetal congenital malformation, stillbirth, or medical termination of the pregnancy. Multivariate logistic regression models were used to evaluate the risk of pregnancy complications for female surgeons relative to women practicing in other medical specialties. RESULTS: Among the 270 women included, 52 (19.3%) experienced pregnancy complications and 28 (10.4%) were surgeons. In the multivariate analysis, female surgeons had a higher risk of pregnancy complications: adjusted odds ratio = 3.53, 95% confidence interval [1.27-9.84]. CONCLUSION: Further research is necessary to identify the hazards specifically involved in the practice of surgery to be able to propose preventive actions targeted to female surgeons during their pregnancy

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

How to determine the place provided to physical activity in a primary school? An attempt to identify objective variables

In the fight against sedentariness, recent meta analyses underlined the determining role of school as a foundation for physical activity (PA) promotion in children and adolescents (Biddle et al. 2012). Consequently, active schools projects are implemented worldwide.. They combine actions on several parallel axes with the physical education (PE) teacher as a corner stone. One of the challenges of such interventions is to follow the modifications and measure their effects. Moreover, it seems that practitioners and researchers still need an instrument to ascertain the real place provided to PA in a school. The aim of this presentation consists in describing the development, validation and testing of an instrument designed to provide such feedback. This study respects a qualitative approach and, by its step by step process, could be considered as an action research approach. Its main goal is to produce an audit instrument rather than providing data. Five successive steps were designed: Analysis of the literature in order to select the main dimensions to analyze; Development of a provisional tool based on objective items; Pilot study; Validation by a group of 13 experts; Testing of the final version in a school. The analysis was focused on the school policy and involved the principal, the PE teacher and the classroom teachers. 335 items were identified and spread across six dimensions. The experts underlined the validity and completeness of the instrument. For the practitioners, participating to the data collection is a means to become aware of what the school (should) propose. This study points out the large range of variables involved in the development of a PA school project, and bring forward the limitation of an assessment using objective data. It underlines that an audit process contributes to a more relevant perception of the reality. Practitioners would also be interested by an easier-to-use tool

Le musée par la scène. Le spectacle vivant au musée. Pratiques, publics, médiations

International audienceDes correspondances. Des étreintes. » Ce sont les mots employés par Patrice Chéreau, invité du Louvre en 2010, pour évoquer la relation entre musée et spectacle vivant, entre l’œuvre d’art et le corps en mouvement. Le Musée par la scène nous éclaire sur les apports du spectacle vivant dans la pratique muséographique et sur l’intérêt dramaturgique ou performatif de telles expériences. Il y est d’abord question de stratégie de programmation, de la conquête de nouveaux territoires de la scène et de nouveaux publics ; l’offre de spectacle vivant — ce recours au vivant dans l’espace muséal — y est examinée à travers ses enjeux socio-esthétiques et économiques. C’est ensuite l’originalité de l’espace scénique au musée qui y est appréhendée, à la croisée de l’exposition, de la collection, de la création et de la performance. La relation entre corps et objets est explorée à partir d’une multitude d’études de cas — des créations en danse, en musique, en théâtre — et croise des « encarts », paroles d’artistes ou de professionnels. Enfin, à partir de nombreux exemples, en France et dans le monde, du Musée Rodin au Mucem, en passant par la pinacothèque nationale de Nauplie en Grèce, le District Six Museum du Cap en Afrique du Sud, le MOMA de New-York et la Tate de Londres, Le Musée par la scène propose à ses lecteurs une réflexion sur la médiation sensorielle et sensible, et sur l’expérience singulière qui s’y joue, sur le rapport entre rhétorique muséale et rhétorique spectaculaire, et sur cette dramaturgie muséale qui s’invente au chevauchement de la scène et du musée

Le musée par la scène. Le spectacle vivant au musée. Pratiques, publics, médiations

International audienceDes correspondances. Des étreintes. » Ce sont les mots employés par Patrice Chéreau, invité du Louvre en 2010, pour évoquer la relation entre musée et spectacle vivant, entre l’œuvre d’art et le corps en mouvement. Le Musée par la scène nous éclaire sur les apports du spectacle vivant dans la pratique muséographique et sur l’intérêt dramaturgique ou performatif de telles expériences. Il y est d’abord question de stratégie de programmation, de la conquête de nouveaux territoires de la scène et de nouveaux publics ; l’offre de spectacle vivant — ce recours au vivant dans l’espace muséal — y est examinée à travers ses enjeux socio-esthétiques et économiques. C’est ensuite l’originalité de l’espace scénique au musée qui y est appréhendée, à la croisée de l’exposition, de la collection, de la création et de la performance. La relation entre corps et objets est explorée à partir d’une multitude d’études de cas — des créations en danse, en musique, en théâtre — et croise des « encarts », paroles d’artistes ou de professionnels. Enfin, à partir de nombreux exemples, en France et dans le monde, du Musée Rodin au Mucem, en passant par la pinacothèque nationale de Nauplie en Grèce, le District Six Museum du Cap en Afrique du Sud, le MOMA de New-York et la Tate de Londres, Le Musée par la scène propose à ses lecteurs une réflexion sur la médiation sensorielle et sensible, et sur l’expérience singulière qui s’y joue, sur le rapport entre rhétorique muséale et rhétorique spectaculaire, et sur cette dramaturgie muséale qui s’invente au chevauchement de la scène et du musée

Cerebrospinal fluid PKR level predicts cognitive decline in Alzheimer's disease.

The cerebrospinal fluid (CSF) levels of the proapoptotic kinase R (PKR) and its phosphorylated PKR (pPKR) are increased in Alzheimer's disease (AD), but whether CSF PKR concentrations are associated with cognitive decline in AD patients remain unknown. In this study, 41 consecutive patients with AD and 11 patients with amnestic mild cognitive impairment (aMCI) from our Memory Clinic were included. A lumbar puncture was performed during the following month of the clinical diagnosis and Mini-Mental State Examination (MMSE) evaluations were repeated every 6 months during a mean follow-up of 2 years. In AD patients, linear mixed models adjusted for age and sex were used to assess the cross-sectional and longitudinal associations between MMSE scores and baseline CSF levels of Aβ peptide (Aβ 1-42), Tau, phosphorylated Tau (p-Tau 181), PKR and pPKR. The mean (SD) MMSE at baseline was 20.5 (6.1) and MMSE scores declined over the follow-up (-0.12 point/month, standard error [SE] = 0.03). A lower MMSE at baseline was associated with lower levels of CSF Aβ 1-42 and p-Tau 181/Tau ratio. pPKR level was associated with longitudinal MMSE changes over the follow-up, higher pPKR levels being related with an exacerbated cognitive deterioration. Other CSF biomarkers were not associated with MMSE changes over time. In aMCI patients, mean CSF biomarker levels were not different in patients who converted to AD from those who did not convert.These results suggest that at the time of AD diagnosis, a higher level of CSF pPKR can predict a faster rate of cognitive decline