Les opinions publiques à la veille de la guerre

Au moment où éclate la guerre, les opinions publiques sont à la fois surprises par la soudaineté de l’événement et préparées à un éventuel conflit. « Il n’est pas sûr que la Grande Guerre ait eu de véritables causes facilement identifiables », écrivent Jean-Jacques Becker et Gerd Krumeich. Aussi, dans l’enchevêtrement des événements qui marquent l’année 1914, le rôle de l’opinion est-il important. Soif de revanche des uns ? Désir de domination chez d’autres ? Volonté d’effacer des tensions in..

Le travail des champs

À la veille de la Grande Guerre, sur 39 millions de Français, 22 millions (56 %) vivent dans les campagnes. La France compte alors cinq millions d’agriculteurs (42 % de la population active masculine) pour quatorze millions de cotes foncières, dont 90 % sont comprises entre un et cinq hectares et seulement 0,3 % dépassent les cent hectares. Les exploitations agricoles et les cinquante millions d’hectares de la surface agricole utilisée représentent 43 % de la richesse nationale. L’énoncé de c..

Le risque prion lié aux produits de santé (de l'évaluation théorique à l'expertise scientifique : le projet de la Direction des Laboratoires et des Contrôles, Site de Lyon, Agence Française de Sécurité Sanitaire des Produits de Santé)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Analyse des résultats de l’appel à proposition de recherches du programme Primequal-Predit « L’évaluation et la perception de l’exposition à la pollution atmosphérique : une interrogation sociétale »

Le programme Primequal, consacré à l’étude de la qualité de l’air à l’échelle locale, a été créé en 1995 par le ministère en charge de l’Environnement et l’ADEME. Pluridisciplinaire, il s’est essentiellement consacré aux aspects physicochimiques et sanitaires de la pollution atmosphérique. Les sciences humaines et sociales, bien que régulièrement conviées à y prendre part, sont cependant longtemps restées en retrait. Pour répondre à ce manque, a été mis sur pied en 2004 un appel à propositions de recherches qui leur était entièrement consacré. Celui-ci a permis le financement de huit projets dont les résultats sont présentés et discutés ici. Selon les auteurs, l’un des aspects les plus nets mis en évidence par ces recherches est le hiatus persistant entre l’approche institutionnelle de la problématique de la qualité de l’air, essentiellement centrée sur la surveillance et l’encadrement administratif du dispositif national, et le manque d’appréhension concrète, d’implication des populations, lié au déficit de gouvernance face à une question à laquelle elles sont par ailleurs très sensibles et dont elles redoutent les effets sanitaires

Sevoflurane Sedation with AnaConDa-S Device for a Child Undergoing Extracorporeal Membrane Oxygenation

International audienceBackground: Deep sedation in critically ill children undergoing extracorporeal membrane oxygenation (ECMO) can be challenging. Volatile anesthetics like sevoflurane can be a good alternative for patients hospitalized in pediatric intensive care units, in whom adequate sedation is difficult to obtain.Case description: We report here the first pediatric case of a patient under extracorporeal membrane oxygenation receiving sedation by sevoflurane using the AnaConDa-S device. This 2-year-old girl, suffering from congenital diaphragmatic hernia, was put on extracorporeal membrane oxygenation due to a persistent pulmonary hypertension following metapneumovirus infection. Despite high doses of drugs, neither satisfactory sedation nor analgesia could be reached. Sevoflurane allowed her to be released and we were able to wean her from certain drugs. Her physiological parameters and the indicators of pain and sedation improved.Conclusion: Anesthesia using sevoflurane with the AnaConDa-S device is efficient for children under ECMO.Clinical significance: This is the first pediatric report on anesthesia with sevoflurane under ECMO

A twelve‐year neonatal and pediatric high‐frequency oscillatory ventilation transport experience

International audienceObjective: To describe the evolution over a 12-year period of a pediatric intensive care unit transport team's (PICU-TT) experience of pediatric and neonatal interhospital transportation on high-frequency oscillation ventilation (HFOV).Methods: This was a monocentric retrospective observational study from January 2006 to December 2017. All patients aged under 18 years old who were transported on HFOV by the Robert Debré Hospital PICU-TT were included.Results: Over a 12-year period, 125 patients were transported on HFOV, including 107 newborns and 18 children. Median (range) age and weight were 9 days (1 h-9 years) and 3.3 (0.6-39) kg, respectively. Initial median oxygenation index, SpO2 /FiO2 ratio and mean airway pressure were 32, 91, and 18 cmH2 O, respectively, without significant difference between values before and after transport. Adverse events occurred during 28 transportations (22%) including three recovered cardiac arrests and one death. Overall survival rate at discharge was 74%, 78% in neonates and 56% in pediatrics, respectively. HFOV transportation rate increased over the last four years of the study for neonates and remained stable for older children. Extra-corporeal membrane oxygenation (ECMO) initiation rate on arrival decreased and survival rate increased significantly during the last four years of the study (p < .05).Conclusion: This study showed the feasibility of HFOV transportation by a PICU-TT, despite some challenges. A trend towards using ECMO more than HFOV for the most severe respiratory and/or circulatory failures was seen over the 12-year period. The HFOV transportation rate has increased for less severe neonatal patients

Feasibility of open abdomen surgery treatment for near fatal necrotizing enterocolitis in preterm infants

International audienceIntroduction: Necrotizing Enterocolitis (NEC) remained a dramatic complication leading to death or neonatal morbidities in preterms. For some, Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome worsened the multi-organ failure. An open abdomen surgery could be an alternative to conventional surgical treatment to move beyond this stage.Objectives: To retrospectively describe the clinical course, pre- and post-operative features of preterms suffering from severe NEC with IAH treated by open abdomen surgery and referred to our center from October 2007 to September 2019. Our secondary objective is to identify various risk factors for mortality in this population.Methods: Data on neonatal, clinical, biological, pre and post-operative features and outcome were collected. Univariate analyses were performed to compare their pre and post-operative features stratifying on outcome.Results: Among 29 included patients, 14 (48%) survived to discharge without short bowel syndrome. Death was associated with an earlier postnatal age at NEC (16.3 ± 9.1 versus 31.3 ± 25.9 days; p = 0.004) and followed a withdrawal of treatment in 60% of cases. Surgery was associated with a significant improvement of respiratory and hemodynamic features (decrease of mean ventilator pressure from 13.1 ± 5.4 to 11.3 ± 4.0 cmH2O, p < 0.001), oxygen requirement (mean FiO2 decreased from 65.0% ± 31.2 to 49.0% ± 24.6, p < 0.001) and inotropic score (from 38.6 ± 70.1 to 29.9 ± 64.3, p < 0.001). In the survival group, pre and post-operative findings exhibited a significant increase of serum lactate concentrations from 2.7 ± 1.6 to 11.0 ± 20.3 mmol/L (p = 0.02) but a similar pH.Conclusion: Open abdomen surgery could be considered to rescue preterms with near fatal NEC. IAH and Abdominal Compartment Syndrome in these preterms should be investigated through further studies