Médecine générale en milieu rural (freins à l'installation)

Introduction : L accès aux soins est inégal en France. Les zones rurales sont particulièrement touchées car elles cumulent les départs en retraite massifs des médecins et les réticences d installation des nouveaux diplômés. L objectif de cette étude est de définir les freins à l installation en milieu rural chez les futurs médecins. Matériel et méthodes : Cette étude qualitative a été menée par voie téléphonique auprès de médecins généralistes et d internes travaillant en France métropolitaine. Le recueil des données a été réalisé entre le 27 avril et le 15 août 2013 par entretiens semi-dirigés. Résultats : Dix-huit entretiens ont permis de dégager trois types de freins à l installation en milieu rural. Les premiers étaient liés à la ruralité : problème de la définition de la ruralité, isolement global et difficultés d emploi pour le conjoint. Venaient ensuite les freins liés à la pratique de la médecine en milieu rural : isolement professionnel, surcharge de travail et proximité de la population. Les derniers freins étaient liés à la formation : sélection initiale des étudiants et stage ambulatoire en milieu rural. Conclusion : Les freins à l installation en milieu rural sont nombreux et non résolus par les mesures incitatives actuelles. Cependant les internes semblent porter un intérêt certain à l exercice de la médecine en zone rurale. L enjeu est donc de considérer les attentes des jeunes médecins pour espérer les voir s installer en zone rurale. D autres études pourraient préciser les motivations à l installation en milieu rural et évaluer l impact réel des mesures incitatives.Introduction: Health care access is unequal on the French territory. Rural areas are particularly affected as they accumulate both high level of aging doctor population leaving for retirement and reluctances to settle there from new graduates. The objective of this study is to identify the obstacles to settlement in rural areas for future physicians. Materials and Methods: This qualitative study was conducted by telephone among general practitioners and residents working in France. Data collection was conducted between April 27 and August 15, 2013 by semi-structured interviews. Results: Eighteen interviews were conducted and three types of settlement brakes in rural areas emerged. The first was related to rurality itself: the problem of rurality definition, overall isolation and employment difficulties for the spouses. The second obstacle was related to medical practice in rural areas: professional isolation, heavy workload and proximity with the population. The last brake was related to student s training: initial selection of doctors-to-be and ambulatory care internship in rural areas. Conclusion: Obstacles to settlement in rural areas are numerous and not resolved by the current incentive measures. However residents seem to be interested in the practice of medicine in rural areas. The challenge is therefore to take young doctors expectations into consideration to hope to see them settling in rural areas. Further studies may clarify motivations for settlement in rural area and assess the real impact of incentives.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Factor v Leiden homozygous genotype and pregnancy outcomes.

International audienceOBJECTIVE: To assess the rate of early (first trimester) and late (second and third trimester) fetal loss in women who are factor V Leiden homozygous. METHODS: Between December 1995 and February 2007, consecutive, unrelated white women who were factor V Leiden homozygous and who had been pregnant at least once were recruited from 10 French hemostasis units. For reasons of comparison, we included women who were factor V Leiden heterozygous and a group of noncarriers. The frequency of early and late fetal loss was assessed retrospectively and compared among the three groups. The effect of concomitant thrombophilic abnormalities was evaluated. The overall pregnancy outcome was reported. RESULTS: We analyzed 240 thromboprophylaxis-free pregnancies in 95 women who were factor V Leiden homozygous, 425 in 195 women who were factor V Leiden heterozygous, and 182 in 73 women who were noncarriers. The risk of late fetal loss was higher in women who were homozygous (13/95, 13.7%) compared with those who were noncarriers (1/73, 1.4%, odds ratio 11.41, 95% confidence interval 1.46-89.46, P=.002), whereas it was similar in women who were heterozygous and in noncarriers (6/195, 3.1% compared with 1/73, 1.4%, P=.68). The percentage of women with early fetal loss was similar in the three groups (P=.81). The live-birth rate was 80%, 84%, and 85%, respectively, for women who where homozygous, heterozygous, and noncarriers (P=.88). CONCLUSION: The factor V Leiden homozygous genotype increases the risk of late fetal loss. However, the overall likelihood of a positive outcome is high in our series of women who were homozygous. LEVEL OF EVIDENCE: III

Cultural Influences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States

International audience(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n = 10) or focus groups (n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with “natural” products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered “natural” where idealized and juxtaposed against processed and “industrial” products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations

Cultural Influences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States

(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n = 10) or focus groups (n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with “natural” products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered “natural” where idealized and juxtaposed against processed and “industrial” products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations

pyomeca/bioptim: SpringCleaning

<p>Over the time, dust accumulate to the point you don't see the floor anymore... electronic code does not make exception! Therefore Bioptimn needed a huge dedusting from years of development</p> <p>SpringCleaning is a rewrite of the core dynamics of bioptim, not so much of the API except for few breaking changes. All in all, this is a very welcome breath of fresh air for Bioptim!</p> <h2>What's Changed</h2> <ul> <li>[RTR] fix on live optimization by @Ipuch in https://github.com/pyomeca/bioptim/pull/702</li> <li>[RTM] Bug and BoundsList by @20chupin in https://github.com/pyomeca/bioptim/pull/703</li> <li>[RTM] Ipopt options were problematic by @Ipuch in https://github.com/pyomeca/bioptim/pull/709</li> <li>[RTM] IntegralApproximation -> QuadratureRule by @20chupin in https://github.com/pyomeca/bioptim/pull/704</li> <li>[RTM] restoring the right types for protocols and markervelocities by @Ipuch in https://github.com/pyomeca/bioptim/pull/708</li> <li>BiorrbdModelHolonomic and VariationalBiorbdModel in core by @20chupin in https://github.com/pyomeca/bioptim/pull/699</li> <li>[RTR] some little test on preparing the data for animation of tracked markers. by @Ipuch in https://github.com/pyomeca/bioptim/pull/714</li> <li>[RTR] StochastiOCP merge by @EveCharbie in https://github.com/pyomeca/bioptim/pull/715</li> <li>[RTR] solver options ipopt test by @Ipuch in https://github.com/pyomeca/bioptim/pull/723</li> <li>[RTM] Restoring bounds on graphs by @EveCharbie in https://github.com/pyomeca/bioptim/pull/724</li> <li>[RTM] show bounds test in ocp by @Ipuch in https://github.com/pyomeca/bioptim/pull/728</li> <li>[RTM if tests pass] implicit formulation of the SOCP by @EveCharbie in https://github.com/pyomeca/bioptim/pull/721</li> <li>[RTM] added multi-node penalties to objective plots by @EveCharbie in https://github.com/pyomeca/bioptim/pull/726</li> <li>Made expand modifiable from API by @pariterre in https://github.com/pyomeca/bioptim/pull/727</li> <li>[RTM when answered] Add min power (joint and muscle) - typo in Readme - new strategy of CI by @mickaelbegon in https://github.com/pyomeca/bioptim/pull/733</li> <li>[RTM if tests pass] Cholesky decomposition of the covariance matrix by @EveCharbie in https://github.com/pyomeca/bioptim/pull/731</li> <li>[RTM when #733 is merged] controls piecewise constant with last node by @EveCharbie in https://github.com/pyomeca/bioptim/pull/737</li> <li>change way to report coverage by @mickaelbegon in https://github.com/pyomeca/bioptim/pull/740</li> <li>[RTR] s_scaling good version by @EveCharbie in https://github.com/pyomeca/bioptim/pull/734</li> <li>[RTM] add trapezoidal integrator by @EveCharbie in https://github.com/pyomeca/bioptim/pull/738</li> <li>[RTM] Not compute the defects if not in implicit by @EveCharbie in https://github.com/pyomeca/bioptim/pull/742</li> <li>DMOCC now working entirely with honomic constraints. by @Ipuch in https://github.com/pyomeca/bioptim/pull/736</li> <li>[RTR] Refactor new_variable by @Ipuch in https://github.com/pyomeca/bioptim/pull/730</li> <li>[RTM] collocations for SOCP by @EveCharbie in https://github.com/pyomeca/bioptim/pull/744</li> <li>[RTM when tests pass] changed reshape_to_vector/matrix for good (test breaking) by @EveCharbie in https://github.com/pyomeca/bioptim/pull/750</li> <li>[RTM when tests pass] Including custom functions as built-ins for stochastic problems by @EveCharbie in https://github.com/pyomeca/bioptim/pull/743</li> <li>[RTR] Multi-threading in SOCP_COLLOCATION by @EveCharbie in https://github.com/pyomeca/bioptim/pull/753</li> <li>[RTR] extra models for futher computations by @Ipuch in https://github.com/pyomeca/bioptim/pull/757</li> <li>[To be deleted] Running tests on all platforms by @pariterre in https://github.com/pyomeca/bioptim/pull/758</li> <li>[WIP] Unique dynamic function for time dependent problem by @Kev1CO in https://github.com/pyomeca/bioptim/pull/718</li> <li>[RTR] tiny commit to help everyone debugging by @Ipuch in https://github.com/pyomeca/bioptim/pull/760</li> <li>[RTR] Multimodel, I need animation and displaced the file for more convinience by @Ipuch in https://github.com/pyomeca/bioptim/pull/761</li> <li>[RTM] Wild refactor trying to understand what's going on in compute_values for graphics by @Ipuch in https://github.com/pyomeca/bioptim/pull/762</li> <li>Fixed custom_plot by @pariterre in https://github.com/pyomeca/bioptim/pull/767</li> <li>[RTR] Unit test on helper function. by @Ipuch in https://github.com/pyomeca/bioptim/pull/764</li> <li>Migrating to biorbd 1.10.0 by @pariterre in https://github.com/pyomeca/bioptim/pull/768</li> <li>[RTM when tests pass] Time dependent test correction by @Kev1CO in https://github.com/pyomeca/bioptim/pull/759</li> <li>FIxed a bug of time in plot for multiphase programs by @pariterre in https://github.com/pyomeca/bioptim/pull/769</li> <li>Update README.md with PhaseDynamics instead of assume_phase_dynamics by @Ipuch in https://github.com/pyomeca/bioptim/pull/774</li> <li>get_u isolated as a helper+ unit test by @Ipuch in https://github.com/pyomeca/bioptim/pull/775</li> <li>[RTM when ping] SOCP_COLLOCATION corrections to make it right :) by @EveCharbie in https://github.com/pyomeca/bioptim/pull/771</li> <li>[RTR] removing assume_phase from readme by @Kev1CO in https://github.com/pyomeca/bioptim/pull/777</li> <li>[RTM when tests pass] external forces moved out of ocp too by @Ipuch in https://github.com/pyomeca/bioptim/pull/779</li> <li>[RTM when tests pass] Using integrate_extra_dynamics instead of duplicating code by @EveCharbie in https://github.com/pyomeca/bioptim/pull/780</li> <li>[RTR] Stochastic variables should not be inputs of OCP by @Ipuch in https://github.com/pyomeca/bioptim/pull/765</li> <li>[RTM when tested] Added a multi-node constraint for the total duration of the movement by @EveCharbie in https://github.com/pyomeca/bioptim/pull/782</li> <li>[RTM] Added more complex example of optimal estimation by @EveCharbie in https://github.com/pyomeca/bioptim/pull/784</li> <li>Minibug patch by @Ipuch in https://github.com/pyomeca/bioptim/pull/786</li> <li>some unit test in integration for stability purpose. by @Ipuch in https://github.com/pyomeca/bioptim/pull/785</li> <li>[RTR] Solving a critical issue of codeclimate by @Ipuch in https://github.com/pyomeca/bioptim/pull/788</li> <li>[RTR] Try to refactor a bit the initialisation of Solution by @Ipuch in https://github.com/pyomeca/bioptim/pull/787</li> <li>[RTM when tests pass] Refactor solution with classmethods by @Ipuch in https://github.com/pyomeca/bioptim/pull/789</li> <li>[RTM when tests pass] Breaking up solution in multiple scripts by @Ipuch in https://github.com/pyomeca/bioptim/pull/790</li> <li>[RTR] Udpate min max + test by @Ipuch in https://github.com/pyomeca/bioptim/pull/798</li> <li>[RTR] duplicate_collocation_starting_point by @Ipuch in https://github.com/pyomeca/bioptim/pull/796</li> <li>[RTR] Refactoring solver interface utils for the better by @Ipuch in https://github.com/pyomeca/bioptim/pull/793</li> <li>[RTR] Mayer_TRACK_CONTACT_FORCES by @Alpha2Shahiri in https://github.com/pyomeca/bioptim/pull/797</li> <li>[RTM when tests pass] Reorganize files by @Ipuch in https://github.com/pyomeca/bioptim/pull/792</li> <li>[RTM] Added the commit ID + version to sol by @EveCharbie in https://github.com/pyomeca/bioptim/pull/806</li> <li>Major refactor towards 3.2.0 by @pariterre in https://github.com/pyomeca/bioptim/pull/814</li> <li>[RTM] Commit for mickael by @Ipuch in https://github.com/pyomeca/bioptim/pull/811</li> <li>[RTM] yml code climate by @Ipuch in https://github.com/pyomeca/bioptim/pull/800</li> <li>Final stretch of the reformating! by @pariterre in https://github.com/pyomeca/bioptim/pull/816</li> </ul> <h2>New Contributors</h2> <ul> <li>@Alpha2Shahiri made their first contribution in https://github.com/pyomeca/bioptim/pull/797</li> </ul> <p><strong>Full Changelog</strong>: https://github.com/pyomeca/bioptim/compare/Release_3.1.0...Release_3.2.0</p&gt

pyomeca/biorbd: ObjectifyMe

<p>Don't treat person as objects, but you can for objects! External forces is now a full object in biorbd allowing for multiple interesting stuff such as transporting it from local to global coordinate system, or applying to arbitrary segments</p> <p>Hot fix for an error while there were more than one segment</p> <h2>What's Changed</h2> <ul> <li>Added a swig template for vector<size_t> by @pariterre in https://github.com/pyomeca/biorbd/pull/333</li> <li>Fixed external forces addInSegmentReferenceFrame for segment not being the first by @pariterre in https://github.com/pyomeca/biorbd/pull/335</li> <li>minor doc of Inverse Kinematics by @Ipuch in https://github.com/pyomeca/biorbd/pull/337</li> </ul> <p><strong>Full Changelog</strong>: https://github.com/pyomeca/biorbd/compare/Release_1.10.0...Release_1.10.1</p&gt