Espaces sportifs et développement durable : générations passées oubliées, génération future sacrifiée ?

Le développement durable a investi au cours de ces dernières années de nombreux champs de la vie économique et sociale, y compris, récemment, le sport. Or les installations sportives sont souvent très consommatrices d’énergie (éclairage, ventilation, chauffage…), d’eau (arrosage des terrains engazonnés et des golfs, « neige de culture »…), d’espace (terrains, bâtiments, parkings), mais aussi productrices de nuisances (bruit des activités et/ou des spectateurs, encombrements lors des rencontre..

Les équipements sportifs : quels référents architecturaux ? Pour quelle fonction ?

En 1987, lors des quatrièmes "Rencontres d'Angers" consacrées aux "politiques municipales des sports", Nelson Paillou, alors président du CNOSF, déclara : "Le stade qui a été construit au début du xxe siècle et qu’on utilise encore quelquefois avec sa petite tribune de 150 places, ses vestiaires pour accueillir l'adversaire et pour se déshabiller soi-même, est un équipement qu'on est bien content d'avoir, Il est utilisé trois heures le dimanche quand le terrain peut supporter deux matches, et..

L'architecture sportive. De la commémoration du sport au marketing commercial

Is the architecture of sport specific, or does it reflect the city, the society, the politics? This article analyzes numerous sports facilities of various types, in France and in Europe, since the beginning of the XXth century until today. It shows a double evolution of the meaning of the sports architecture: on one hand, from the sport to the show and, on the other hand, from the political power and the culture of the city to the economic power

Safety of Fixed Dose of Antihypertensive Drug Combinations Compared to (Single Pill) Free-Combinations: A Nested Matched Case-Control Analysis

International audienceTo compare serious adverse events of fixed-dose dual antihypertensive drug combination (FIXED) to component-based free-combination (FREE).A population-based nationwide cohort from the French Health Insurance System included subjects over 50 years with first time claims (new user) in the second half of 2009 for a calcium-channel blocker or a thiazide-like diuretic in combination with either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker as FREE or FIXED. We designed a nested matched case-control analysis with 304 cases, hospitalized for hypotension, syncope, or collapse (n = 224), renal failure (n = 19), hyponatremia, hyper- or hypokalemia (n = 61) and 1394 controls matched for gender, age, date of inclusion in the cohort, and administrative county. Subjects with a medical history of cardiovascular disease, chronic renal failure, or cancer were excluded.The mean age ± SD was 73 ± 10 years and 70% were women. Based on the last delivery preceding the index date, 1414 patients (83%) were exposed to FIXED. Homogeneity of FIXED effect compared to FREE across components of the main composite outcome was rejected (P = 0.0099). FIXED formulation significantly increased the odd of the most frequent component (ie, hypotension, syncope, or collapse): OR = 1.88 (95% CI: 1.15-3.05) compared to FREE after adjusting for confounding factors including dose.Serious adverse event occurring in the early phase of treatment deserves attention of physicians because it could alter the benefit/risk ratio of antihypertensive drug combinatio

Terres mégalithes

Le film "Terres Mégalithes" explore le paysage mégalithique vendéen il y a 6500 ans. Le film projeté au CAIRN (http://www.cairn-prehistoire.com/) en Vendée fait découvrir au spectateur un inventaire unique de l'ensemble des monuments mégalithiques du Pays Talmondais, avec ses dolmens et ses menhirs.Le spectateur explore ensuite l'intérieur du Pey de Fontaine, monument funéraire au cairn intégralement restitué en 3D. La symbolique de ces espaces réservés aux morts s'entrecroise avec l'importance de ces architectures puissantes pour les communautés qui les ont érigées.Intégrant numérisations 3D, restitutions 3D et cartes iconographiques, "Terres Mégalithes" évoque le témoignage de 1000 ans d'histoire

Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation

International audienceBackground and objectives - In contrast to shigatoxin-associated (STEC) causing hemolytic uremic syndrome, STEC-unrelated infections associated with thrombotic microangiopathy are less characterized. Design, setting, participants, & measurements - Our retrospective study in a four-hospital institution of 530 consecutive patients with adjudicated thrombotic microangiopathies during the 2009-2016 period studied STEC-unrelated infections' epidemiology and major outcomes (death, acute dialysis, and major cardiovascular events). Results - STEC-unrelated infection was present in 145 of 530 (27%) patients, thrombotic microangiopathies without infection were present in 350 of 530 (66%) patients, and STEC causing hemolytic and uremic syndrome was present in 35 of 530 (7%) patients. They (versus thrombotic microangiopathy without infection) were associated with age >60 years (36% versus 18%), men (53% versus 27%), altered consciousness (32% versus 11%), mean BP <65 mm Hg (21% versus 4%), lower hemoglobin and platelet count, and AKI (72% versus 49%). They were associated with more than one pathogen in 36 of 145 (25%) patients (either isolated [14%] or combined [86%] to other causes of thrombotic microangiopathy); however, no significant clinical or biologic differences were noted between the two groups. They were more frequently due to bacteria (enterobacteria [41%], [11%], and [3%]) than viruses (Epstein-Barr [20%], cytomegalovirus [18%], influenza [3%], hepatitis C [1%], HIV [1%], and rotavirus [1%]). STEC-unrelated infections were independent risk factors for in-hospital death (odds ratio, 2.22; 95% confidence interval, 1.18 to 4.29), major cardiovascular event (odds ratio, 3.43; 95% confidence interval, 1.82 to 6.69), and acute dialysis (odds ratio, 3.48; 95% confidence interval, 1.78 to 7.03). Bacteria (versus other pathogens), and among bacteria, enterobacteria, presence of more than one bacteria, and without shigatoxin were risk factors for acute dialysis. Conclusions - Infections are frequent thrombotic microangiopathy triggers or causes, and they are mostly unrelated to STEC. Infections convey a higher risk of death and major complications. The most frequent pathogens were enterobacteria, , Epstein-Barr virus, and cytomegalovirus. Podcast - This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_09_07_CJN17511120.mp3

Pharmacoepidemiology studies: what levels of evidence and how can they be reached?

International audienceIn pharmacoepidemiology studies, the nature of the research question will dictate the choice of methodological approach and the conditions for optimizing the level of evidence. Thus, to document the treated population and the modes of use of a new drug in real-life prescribing conditions, a descriptive approach through cross-sectional or longitudinal studies conducted on databases, or else ad-hoc studies, will be preferred. On the other hand, evaluation of the real-life "effectiveness" of a new drug will be based on cohort, case-control or scientific modeling, depending on the drug and the disease of interest. For questions involving drug risks and safety, it is the adverse effects profile that will guide the choice of study design, both for identification of the effect (signal) and assessment of causation. In all cases, in the post-marketing authorization (MA) setting, the evidence acquired in pre-MA studies serves as the basis for generating hypotheses. Whatever the research question and the method chosen to address it, the potential biases and their impact on the results need to be identified. In certain cases, a combination of several complementary approaches may prove preferable to a single study

Vers une extension du registre REIN aux patients avec une maladie rénale chronique au stade 5 non traités par dialyse ou greffe ? Étude pilote

International audienceTo date, it is important to know more about the population of CKD stage 5 patients in order to better understand the practices of access to renal replacement therapy (RRT) or conservative treatment and to anticipate future needs. In April 2015, at the instigation of the Scientific Committee of REIN, a working group was formed to reflect on the opportunity and feasibility of a data collection on these patients. Between September 2017 and March 2018, 21 participating centers included 390 patients over a period of at least one month. The data collected included the patient's living conditions, level of study, mode of referral, clinical data and the therapeutic project. The median age at baseline was 71.4years (IQR: 58.4-80.4), 39.9% were diabetic. The median eGFR was 12mL/min/1.73m2 (IQR: 9-14). At inclusion, 77% of the patients were already followed in nephrology, 11% had been referred by a general practitioner. For the majority of patients included (81%), there was a RRT project. In 10% of cases, there was a project of conservative care, in 5% of cases the project was not yet decided and in 7% the project had not been yet discussed. At the latest news (median time 4.0months), 35% of patients were dialyzed, 9 (2%) have been pre-emptively transplanted, 25 (6%) died, 210 (54%) were still with a CKD stage 5. Our pilot study has shown the feasibility and interest of setting up such a data collection. Such a registry will provide important public health information regarding the demographic of nephrologists and advanced practices nurses. At the local level, this information will help the department to organize themselves to set-up pre-RRT information, implementation of care pathway nurses and multidisciplinary meetings for difficult cases. However, our pilot study shows that to ensure the completeness of the collection, the tracking upstream or downstream of nephrology consultations for eligible patients is essential and therefore requires dedicated human time on site