Predictors of breast-feeding in a developing country: results of a prospective cohort study.

OBJECTIVE: Data on the prevalence and predictors of breast-feeding remain scarce in Lebanon. Moreover, no study has previously addressed the effect of the paediatrician's sex on breast-feeding. The present study aimed to assess the prevalence and predictors of breast-feeding at 1 and 4 months of infant age while exploring the potential role of the sex of the paediatrician. DESIGN: Prospective cohort study. Predictors of breast-feeding significant at the bivariate level were tested at 1 and 4 months through two stepwise regression models. SETTING: Infants were enrolled through the clinics and dispensaries of 117 paediatricians located in Beirut, Lebanon, and its suburbs. SUBJECTS: A total of 1,320 healthy newborn infants born between August 2001 and February 2002 were prospectively followed during the first year. FINDINGS: Breast-feeding rates at 1 and 4 months were 56.3 % and 24.7 %, respectively. Early discharge, high parity and religion were significantly associated with higher breast-feeding rates at 1 and 4 months of age. Maternal age proved significant only at 1 month, while maternal working status and sex of the paediatrician were significant at 4 months. A novel finding of our study was the positive effect of female paediatricians on breast-feeding continuation until 4 months of age (OR = 1.49; 95 % CI 1.03, 2.15). CONCLUSIONS: Breast-feeding rates are low at 1 and 4 months of infant age in Beirut. Further research to investigate the interactions between female physicians and lactating mothers in maintaining breast-feeding in other populations is warranted. The results constitute the basis for designing interventions targeting policy makers, health professionals and mothers

Équilibres : Réflexions, actions et opportunités pour la promotion de l'activité physique ou sportive

International audienceThe increase of sedentary lifestyle in the French population and the decrease in the timedaily devoted to physical activity has raised public concerns. Promotional campaigns to raiseenergy expenditure and health awareness have recently increased. Nevertheless, although therecognition of such an imbalance is becoming more evident in the population, a real beneficialmodification is still far from a full success. Numerous working groups are seeking to broaden thescope of action and take advantage of environments that facilitate the application of strategies.Local settings such as schools, businesses, urban authorities and sports representatives (clubs,leagues and associations) progressively increase their engagement. Through large collectiveparticipations gathered in the PNNS initiative (Plan National Nutrition Santé 2011-2015), wemay witness a growing investment in the energy balance, an area that has been neglected so far.L’augmentation de la sédentarité des français et la diminution de la pratique des activitésphysiques ou sportives (APS) favorables à la santé suscitent de nombreuses tentativespubliques et campagnes de promotion visant à favoriser la dépense énergétique. Mais sila conscience de ce déséquilibre apparaît de plus en plus clairement dans la population,le passage à l’acte est encore loin d’être réussi. C’est pourquoi se mettent en place denombreux groupes de travail et de réflexion cherchant à élargir les champs d’action maissurtout à tirer parti de tous les environnements favorables à cette remise en forme. L’école,l’entreprise, les collectivités territoriales ou les acteurs du sport (clubs, ligues, associations)sont de plus en plus impliqués dans la participation à ce grand mouvement, qui verra,par le biais du PNNS 2011-2015, croître l’investissement dans un domaine un peu négligéjusque là : celui de l’équilibre énergétique

Psychological Balance in High Level Athletes: Gender-Based Differences and Sport-Specific Patterns

OBJECTIVES: Few epidemiological studies have focused on the psychological health of high level athletes. This study aimed to identify the principal psychological problems encountered within French high level athletes, and the variations in their prevalence based on sex and the sport practiced. METHODS: Multivariate analyses were conducted on nationwide data obtained from the athletes' yearly psychological evaluations. RESULTS: A representative sample of 13% of the French athlete population was obtained. 17% of athletes have at least one ongoing or recent disorder, generalized anxiety disorder (GAD) being the most prevalent (6%), followed by non-specific eating disorders (4.2%). Overall, 20.2% of women had at least one psychopathology, against 15.1% in men. This female predominance applied to anxiety and eating disorders, depression, sleep problems and self-harming behaviors. The highest rates of GAD appeared in aesthetic sports (16.7% vs. 6.8% in other sports for men and 38.9% vs. 10.3% for women); the lowest prevalence was found in high risk sports athletes (3.0% vs. 3.5%). Eating disorders are most common among women in racing sports (14% vs. 9%), but for men were found mostly in combat sports (7% vs. 4.8%). DISCUSSION: This study highlights important differences in psychopathology between male and female athletes, demonstrating that the many sex-based differences reported in the general population apply to elite athletes. While the prevalence of psychological problems is no higher than in the general population, the variations in psychopathology in different sports suggest that specific constraints could influence the development of some disorders

Success in Developing Regions: World Records Evolution through a Geopolitical Prism

A previous analysis of World Records (WR) has revealed the potential limits of human physiology through athletes' personal commitment. The impact of political factors on sports has only been studied through Olympic medals and results. Here we studied 2876 WR from 63 nations in four summer disciplines. We propose three new indicators and show the impact of historical, geographical and economical factors on the regional WR evolution. The south-eastward path of weighted annual barycenter (i.e. the average of country coordinates weighting by the WR number) shows the emergence of East Africa and China in WR archives. Home WR ratio decreased from 79.9% before the second World War to 23.3% in 2008, underlining sports globalization. Annual Cumulative Proportions (ACP, i.e. the cumulative sum of the WR annual rate) highlight the regional rates of progression. For all regions, the mean slope of ACP during the Olympic era is 0.0101, with a maximum between 1950 and 1989 (0.0156). For European countries, this indicator reflects major historical events (slowdown for western countries after 1945, slowdown for eastern countries after 1990). Mean North-American ACP slope is 0.0029 over the century with an acceleration between 1950 and 1989 at 0.0046. Russia takes off in 1935 and slows down in 1988 (0.0038). For Eastern Europe, maximal progression is seen between 1970 and 1989 (0.0045). China starts in 1979 with a maximum between 1990 and 2008 (0.0021), while other regions have largely declined (mean ACP slope for all other countries  = 0.0011). A similar trend is observed for the evolution of the 10 best performers. The national analysis of WR reveals a precise and quantifiable link between the sport performances of a country, its historical or geopolitical context, and its steps of development

Athlete Atypicity on the Edge of Human Achievement: Performances Stagnate after the Last Peak, in 1988

The growth law for the development of top athletes performances remains unknown in quantifiable sport events. Here we present a growth model for 41351 best performers from 70 track and field (T&F) and swimming events and detail their characteristics over the modern Olympic era. We show that 64% of T&F events no longer improved since 1993, while 47% of swimming events stagnated after 1990, prior to a second progression step starting in 2000. Since then, 100% of swimming events continued to progress

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mesure de l'impact sanitaire des stratégies de promotion de l'activité physique ou sportive

The prevalence of sedentary behavior is constantly increasing. Physical inactivity is the 4th causeof preventable death with 1.9 million deaths worldwide. Several studies have proven the needand interest in promoting physical activity in different settings. However, there still exists a largevoid between theory, policies, practice and behavior change.The objective of this thesis is to analyze and develop specific evaluation tools in order toreinforce the proof and utility of recommendations that promote physical activity anddiscourage sedentary behavior.Our first study analyses the data of a physical fitness monitoring tool applied on a large Frenchsample of 31 133 individuals aged between 8 and 60 years old. We first tested the reliability andthe reproducibility of the tool. Thereafter, we analyzed the relation between body mass index,age and the different physiological dimensions measured. Results revealed a goodreproducibility of the physical fitness test and the presence of a strong correlation between theperformances, age and body mass index. This suggests the possibility of using this test as areliable epidemiological tool capable of evaluating the effectiveness of physical activitypromotion interventions.Our second study analyses the effect of an intervention promoting physical activity in theworkplace on subjects suffering from chronic lower back pain. This study has been done incollaboration with the department of occupational medicine in the company. The sampleconsisted of 37 subjects that followed exercise sessions three times per week during twomonths and of 38 subjects in the control group. Physical, psychological, health and socialmeasures were analyzed at three time points (beginning, 2 months, and 6 months). Followingthis intervention, we observed a significant improvement in the physical, psychological andhealth outcome measures that persisted at 6 months. In consequence, this study reinforces thepromotion of physical activity in the workplace in order to assist those at risk and result inmultiple health benefits.Our third study is in relation to the promotion physical activity through active transportation.Our work is related to health impact assessment following a change in transportation mode.This study is in collaboration with the CREAL (Center for Research and EnvironmentalEpidemiology) in Barcelona and six European cities. The study proposes methods to measureenergy expenditure in function of the transportation mode and associates it to a health gain.In conclusion, this thesis offers a new methodological approach as well as specific evaluationtools that may help in advancing the field of prevention by physical activity.La prévalence de la sédentarité ne cesse d’augmenter et de progresser. L’inactivité physique est laquatrième cause de décès évitable: 1.9 millions de décès lui sont attribués dans le monde. Plusieursétudes ont montré l’intérêt et le besoin de promouvoir l’activité physique dans différents milieux.Néanmoins, il reste un grand vide à combler entre la théorie, les politiques et le passage à l’acte.Cette thèse a pour but d’analyser et de développer des outils d’évaluations spécifiques afin d’apporterla preuve de l’utilité des recommandations de promotion d’activité physique et de lutte contre lasédentarité.Notre première étude analyse les données d’un outil de mesure de condition physique en populationgénérale sur un échantillon de 31 133 individus français âgés entre 8 et 60 ans. Nous avons évalué lafiabilité et la reproductibilité de l’outil. Par la suite, nous avons analysé le lien entre l’indice de massecorporelle, l’âge et les performances des différentes dimensions physiologiques mesurées. Les résultatsmontrent une bonne reproductibilité du test et une forte corrélation entre les performances, l’âge etl’indice de masse corporelle. Ceci suggère que l’outil pourrait servir comme instrumentépidémiologique pour évaluer l’efficacité des interventions de promotion d’activité physique.Notre deuxième étude évalue une intervention de remise en forme pour des salariés souffrant dedouleur lombaire chronique en collaboration avec leur service de médecine de travail. Les mesuresd’accompagnement ajustent l’activité physique sur le lieu même de l’entreprise. L’échantillon estconstitué de 37 sujets qui ont suivi des séances d’exercices trois fois par semaine pendant 2 mois et de38 sujets dans le groupe témoin. Les paramètres physiques, psychologiques, sanitaires et sociaux ontété analysés en trois temps (début, 2 mois et 6 mois). Suite à cette intervention, nous avons observéchez le groupe expérimental une amélioration significative des paramètres physiques, psychologiqueset sanitaires, qui persiste à 6 mois. Cette étude renforce donc la promotion d’activité physique enmilieu de travail afin de mieux accompagner les sujets à risques de troubles musculo – squelettiques.Notre troisième étude porte sur les méthodes de promotion d’activité physique à travers les transportsactifs en milieu urbain. Nos travaux sont reliés aux outils d’évaluation d’impact sanitaire suite à unreport modal de transport. Cette étude est réalisée en collaboration avec le CREAL (Center forResearch in Environmental Epidemiology) à Barcelone et six grandes villes européennes. Elle proposedes méthodes de mesure de la dépense énergétique en fonction du mode, associant ces indicateurs àleur gain sanitaire.En conclusion cette thèse fournit une nouvelle méthodologie d’approche ainsi que des outilsd’évaluation spécifiques qui pourront aider à promouvoir la prévention par l’activité physique

Sédentarité et Activité Physique ou Sportive : les enjeux

National audienc

Se dépenser plus pour gagner en qualité de vie

National audienceNotre mode de vie actuel privilégie les déplacements motorisés et incite à augmenter le temps passésans stimulation physique. Ceci est responsable de l’augmentation de la sédentarité1. Lesrecommandations en vigueur préconisent 30 minutes d’activité physique d’intensité modérée chaquejour, mais 54 % de la population française ne parvient pas à se maintenir à ce niveau minimumfavorable à la santé [1]. La sédentarité est l’un des facteurs de risque favorisant le développement detrès nombreuses maladies chroniques, et son niveau est tel désormais que les bénéfices sanitairesde la réactivation physique sont importants dès le premier pas pour toutes ces pathologies et à tousleurs stades. Le défi auquel sont maintenant confrontés les pouvoirs publics est de pouvoir rétablir,pour l’ensemble de la population, un niveau d’activité correspondant à notre bagage génétique etadapté à nos besoins de santé. Ceci nécessite d’une part de comprendre les déterminants de l’activitéphysique, et d’autre part d’en mesurer les répercussions sur l’état de santé des populations