Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Evaluation psychosociale de la qualité de vie des patients infectés par le VIH

AIX-MARSEILLE1-BU Lettres (130012101) / SudocSudocFranceF

Vivre avec l'infection par le VIH (étude réalisée en France et au Gabon)

NANTES-BU Lettres (441092102) / SudocSudocFranceF

Radiation protection in mammography for breast cancer screening: not covered by the French press

International audienceBackground: In the context of major exposure to medical-based ionizing radiation (IR), French health institutions agree that adopting a precautionary approach is essential. A number of scientific studies have highlighted the risk of developing breast cancer after exposure to IR, even from low doses. However, the information circulating on the subject is varied.Objectives: A study of the mainstream press was performed to better understand the elements constitutingwomen's representations of IR in mammography for breast cancer screening.Study design: The data used came from a corpus created with the mainstream press database ‘Europresse.’The keyword ‘mammography’ was chosen. The software package Iramuteq was used to perform astatistical analysis of textual data using the Reinert method.Results: This study highlights a paradox between the social principle of prevention and the discourseelements on mammography screening present in the mainstream press.Conclusion: The general French press does not take into account radiation protection in cancer screeningdiscourses. A greater effort to provide information on this subject is needed

Etude de la texture de la surface coffrée des parements verticaux en béton

L étude de la texture de la surface coffrée des parements verticaux en béton est divisée en trois volets : l uni, les vides de compaction et le bullage de surface. L étude de l influence du coffrage et du démoulant sur l uni des surfaces montre que la texture de la surface des pâtes dépends de celle de la surface coffrante utilisée. L étude de l influence des propriétés rhéologiques des bétons sur les vides de compaction montre que la quantité de vide de surface dépend du volume de granulats et des propriétés rhéologiques du mortier. L étude théorique du bullage des surfaces, validée expérimentalement montre que les bulles d air sont toujours plus stables sur la paroi du coffrage. La possibilité de mouvement des bulles formées dépend du seuil de cisaillement des mélanges, de la technique de mise en place utilisée et de la rugosité de la surface coffrante utilisée.Study of the texture of vertical formed concrete surface is divide in three parts: concrete surfaces, compaction voids and blowholes on concrete surfaces. Study of the influence of release agent and form face on concrete surfaces show that texture of pates depends on texture of formwork faces. Study of the influence of rheological properties of concrete on compactions voids show that compaction voids depends on aggregates volume and mortar rheological properties. Theoretical study of blowhole confirmed by experimentation, show that blowhole are more stable at the formwork interface. Blowhole can move and quit concrete it depend on yield stress, vibration and formworks roughness.CERGY PONTOISE-BU Neuville (951272102) / SudocSudocFranceF

Sexual Difficulties in People Living with HIV in France—Results from a Large Representative Sample of Outpatients Attending French Hospitals (ANRS-EN12-VESPA)

International audienceWe analysed sexual difficulties in a nationally representative sample of HIV-infected outpatients in France. Analyses were restricted to the 1,812 HIV-treated participants who reported at least one sexual partner during the 12 months prior to the study. The sample included 40.6% homosexual men and 24.4% women; 68.1% had a steady partner and 48.2% reported casual partners. Sexual difficulties were reported by 33.3% of the selected individuals and were more frequent in those with low sexual activity. Immuno-virological outcomes were not associated with sexual difficulties. After multiple adjustment for sexual frequency and antidepressant consumption , it was found that a larger HIV-network, reporting HIV-discrimination from friends and/or sexual partners, suffering from lipodystrophy and reporting very disturbing HIV-related symptoms were all significantly associated with sexual difficulties. HIV and HIV-treatment experience are associated with sexual difficulties. Psychological support focused on HIV-experience should be tested as a possible tool for improving sexual quality of life

Infertility induced by cancer treatment: inappropriate or no information provided to majority of French survivors of cancer

International audienceObjective: To describe patients who reported treatment-induced infertility 2 years after cancer diagnosis and to highlight what factors are related to the patients' lack of information on this topic before starting therapy. Design: Cross-sectional study by telephone interview. Setting: Representative French national sample of survivors 2 years after cancer diagnosis. Patient(s): 282 women (<45 years) and 1137 men (<71 years). Intervention(s): None. Main Outcome Measure(s): Self-reported treatment-induced infertility, and what information was provided on this issue before starting treatment, including information on systematic sperm cryopreservation. Result(s): Among the participants, 104 women (37%) and 346 men (30%) reported having treatment-induced infertility. Among them, 31 women (30%) and 45 men (13%) reported that they had not been informed about the risk of infertility before they started treatment. Logistic regressions showed that a lack of information was associated with older age and treatment without hormone therapy among women and older age, cancers other than prostate, and a lack of participation in treatment decision-making among men. Conclusion(s): Information about infertility risks and preservation methods should be provided more systematically to all treated patients, irrespective of their age. (Fertil Steril Ò 2007;-:-–-. Ó2007 by American Society for Reproductive Medicine.

The past and present of triangulation and social representations theory: A crossed history

International audienceThis paper examines some of the main processes in the evolution of triangulation in qualitative research (QR) and social representations theory (SRT) in social psychology in recent decades. By adopting a cross-historical approach, we seek to outline how SRT can strengthen its epistemological approach by embracing triangulation, and to highlight that an examination of past and current debates on SRT can provide relevant insights for QR in psychology. We show how, progressively over time, in both fields (SRT and QR), discrepancies between data obtained by different methods were no longer considered a threat to scientific validity of the data but as a way to deepen understanding of the phenomenon being studied. Thus, developing systematic triangulation, which combines the various epistemological, theoretical, and methodological backgrounds of different methods (data collection and/or analysis), enables SRT to fulfill its potential even more in contributing to a societal social psychology. Reciprocally, SRT provides a framework in which QR can develop some of its full potential, for example, in the areas of multi-method studies, multidisciplinarity, and engagement with social change

Unprotected sex in regular partnerships among homosexual men living with HIV: a comparison between sero-nonconcordant and seroconcordant couples (ANRS-EN12-VESPA Study)

International audienceObjective: We investigated factors associated with unprotected sex in regular partnershipsamong homosexual men living with HIV.Method: We used data from a French national representative sample of people livingwith HIV (ANRS-EN12-VESPA survey). This analysis included men in a regular partnershipwith another man for at least twelve months. Unprotected sex was defined asreporting at least one episode of sexual intercourse without a condom with this regularpartner in the previous 12 months. Separate analyses were conducted in sero-nonconcordantcouples and in HIV-positive seroconcordant couples.Results: 285 and 193 homosexual men respectively reported a regular sero-nonconcordantand seroconcordant partner. Unprotected sex was reported by a higher numberof respondents within seroconcordant (46.7%) than within sero-nonconcordant couples(15.6%).In both seroconcordant and sero-nonconcordant partnerships, unprotected sex wassignificantly more frequent when episodes of unprotected sex with casual partners werereported. In seroconcordant couples, those who had more than four casual partnerswere also more likely to practise unprotected sex with their regular partner. Amongsero-nonconcordant couples, binge drinking and absence of disclosure of one’s HIVpositivestatus to the partner were also independently associated with unprotected sex.Conclusions: A limited number of sero-nonconcordant homosexual couples persist inreporting risky sexual behaviour. Prevention messages should encourage communicationand HIV disclosure. The relationship between unprotected sex with both casualand regular partners also calls attention about the underlying psycho-social andinteractional factors that may influence sexual behaviours of people living with HIVin regular relationships, independently of the status of the partner

The Effect of Foot Reflexology on Chemotherapy-Induced Nausea and Vomiting in Patients With Digestive or Lung Cancer: Randomized Controlled Trial

BackgroundCancer is a chronic disease with an incidence of 24.5 million and 9.6 million deaths worldwide in 2017. Lung and colorectal cancer are the most common cancers for both sexes and, according to national and international recommendations, platinum-based chemotherapy is the reference adjuvant treatment. This chemotherapy can be moderately to highly emetogenic. Despite antiemetic therapy, chemotherapy-induced nausea and vomiting (CINV) may persist. Moreover, cancer patients are increasingly interested in alternative and complementary medicines and have expressed the desire that nonpharmacological treatments be used in hospitals. Among alternative and complementary medicines, foot reflexology significantly decreases the severity of CINV in patients with breast cancer. ObjectiveThe primary aim of this study was to assess the benefits of foot reflexology as a complement therapy to conventional treatments regarding the severity of acute CINV in patients with digestive or lung cancer. The secondary objectives assessed were the frequency and severity of delayed CINV, quality of life, anxiety, and self-esteem. MethodsThis study was conducted between April 2018 and April 2020 in the Hospices Civils de Lyon, France. This was an open-label randomized controlled trial. Participants were randomized into two groups: the intervention group (ie, conventional care with foot reflexology; n=40) and the control group (ie, conventional care without foot reflexology; n=40). Foot reflexology sessions (30 minutes each) were performed on outpatients or inpatients. Eligible participants were patients with lung or digestive cancer with an indication for platinum-based chemotherapy. ResultsThe severity of acute nausea and vomiting was assessed with a visual analog scale during the second cycle of chemotherapy. A significant increase of at least 2 points was observed for the control group (7/34, 21%; P=.001). Across all cycles, the foot reflexology group showed a trend toward less frequent delayed nausea (P=.28), a significantly less frequent consumption of antiemetic drugs (P=.04), and no significant difference for vomiting (P=.99); there was a trend toward a perception of stronger severity for delayed nausea in the control group (P=.39). Regarding quality of life and anxiety, there was no significant difference between the intervention group and the control group (P=.32 and P=.53, respectively). ConclusionsThis study’s results indicate that foot reflexology provides significantly better management of acute nausea severity and decreased consumption of antiemetic drugs in patients with lung or digestive cancer. In order to fulfill patients’ desires to use nonpharmacological treatments and complementary and alternative medicines in hospitals, foot reflexology could be provided as a complementary intervention to conventional antiemetic drugs. Foot reflexology did not result in adverse effects. To assess the benefits of foot reflexology in routine practice, a larger study with several health care centers would be needed with a cluster randomized controlled trial. Trial RegistrationClinicalTrials.gov NCT03508180; https://clinicaltrials.gov/ct2/show/NCT03508180 International Registered Report Identifier (IRRID)RR2-10.2196/1723