French Survey Research Articles

Evaluating the Internal Labor Migration Effects of Compulsory Peacetime Conscription

ABSTRACT Conscription typically involves migration to the duty base location. According to DaVanzo’s theory of repeat migration, this military-motivated migration might foster post-military migration. This paper investigates this issue empirically using individual-level data drawn from the 1992, 1998, and 2001 editions of the French survey of labor market entrants ‘Génération.’ The methods used to identify the causal effect of compulsory peacetime conscription on the post-military propensity to migrate exploit the abolition of conscription in France in October 1997 plus information on the timing of service among those who served. Conscription stimulated the post-military propensity to migrate for work of French male labor-market entrants with upper-class origins. Furthermore, there is evidence of a previously overlooked anticipatory effect of conscription: French males who were waiting to be called up for military service were approximately 25% less likely to migrate for work than comparable non-conscripts. Some implications of these findings and a consideration of their external validity are also provided.

Treatment as prevention (TasP) and perceived sexual changes in behavior among HIV-positive persons: a French survey in infectious diseases departments in Paris

ABSTRACT We evaluated awareness of treatment as prevention (TasP) among adults people living with HIV (PLHIV) in five infectious disease departments in Paris, then how they perceived its impact on their sexual well-being. This cross-sectional multicenter survey was conducted in 2014 during scheduled clinical appointments using a self-administered questionnaire. We analyzed 520 questionnaires (42% women, 54% men of whom 57% were MSM [men who have sex with men]). 75% of women were born abroad, most commonly in sub-Saharan Africa, whereas 64% of men were French-born. The mean time since HIV diagnosis was 12.8 ± 7.8 years. Eighty-seven percent [84−90%]95 % reported being aware of the impact of ART on HIV transmission, 94% MSM, 86% women, 83% heterosexual men. PLHIV reported that they gained awareness of TasP through medical doctors (86%). The fear of transmission was perceived as alleviated for 73% [69%;78%]95%, more often among MSM; the sexual life was reported to be improved for 28% [24%;33%]95%; and ART adherence to be improved for 45% [40%;50%]95%, more often among women. The awareness of TasP was relatively high, but it seems important to understand the features of male and female populations of PLHIV to adapt counseling during follow-up appointments, as women's answers differed in various regards.

Reports of recovered memories of childhood abuse in therapy in France

ABSTRACTRecovered memories of abuse in therapy are especially controversial if the clients were not aware they were abused before therapy. In the past, such memory recovery has led to legal action, as well as a debate about whether such memories might be repressed, forgotten, or false memories. More than two decades after the height of the controversy, it is unclear to what degree such memories are still recovered today, and to what extent it occurs in France. In our French survey of 1312 participants (Mage = 33; 53% female), 551 reported having done therapy at some point. Of that 551, 33 (6%) indicated they had recovered memories of abuse in therapy that they did not know about before therapy. Sexual abuse was the most commonly reported type that was recovered in therapy (79%). As in past research, discussing the possibility of repressed memories with therapists was associated with reports of recovered memories of abuse. Surprisingly, memory recovery occurred just as much in behavioural and cognitive therapies as it did in therapies focused on trauma. We found recovered memories in a proportion of clients who began therapy recently. Recovered memories in therapy appears to be an ongoing concern in France.

Neonatal end-of-life decision-making almost 20 years after the EURONIC study: A French survey

Nearly 20 years ago the EURONIC study reported that French neonatologists sometimes deemed it legitimate to terminate the lives of newborn infants when the prognosis appeared extremely poor. Parents were not always informed of these decisions. Major change has occurred since then and is described herein. Material and methodsA survey was conducted in the Île-de-France region, from 1 January to 31 January 2016. Professionals from 15 neonatal intensive care units (NICUs) were invited to complete a questionnaire. ResultsA total of 702 questionnaires were collected and 670 responses were analyzed. Knowledge of the law differed according to professional status, with 71% of MDs (medical staff, MS), compared with 28% of nonmedical staff (NMS) declaring that they had good knowledge of the law. Most MDs and NMS believed that withholding or withdrawing life-sustaining treatments (WWLST) could be decided and implemented after a delay. Half of them thought that WWLST would always result in death. Although required by law, a consulting MD attended the collegial meeting required before deciding on WWLST in only half of the cases. Parents were almost always informed of the decision thereafter by the physician in charge of their infant. The most frequent disagreement with parents was observed when WWLST was the option selected. In this case, most professionals suggested postponing WWLST, continuing intensive care and dialogue with parents, aiming at a final shared decision. Major differences were observed between NICUs with regard to the withdrawal of artificial nutrition and hydration. Finally, 14% of MDs declared that infant active terminations of life still occurred in their NICU. Major differences concern WWLST and active termination of life, whose meaning has been partly modified since 2001. ConclusionSeveral major changes were observed in this survey: (1) treatment withdrawal decisions are made today in agreement with the law; (2) parents’ information and involvement in the decision process have profoundly changed; (3) active termination of life (euthanasia) very rarely occurs; only at the end of a process in accordance with ethical principles and within the law is this decision made.

Home dialysis : what are the barriers . A French nephrologist survey

Home dialysis, which includes Peritoneal Dialysis and Home Hemodialysis, provides lots of profit to patients suffering of Chronic Kidney Disease, especially in terms of comfort, life quality and autonomy. However, its use is marginal in France, with an inhomogenous distributaion according to geographical regions. We conducted a French national survey of nephrologists to assess the barriers to the development of home dialysis. After analyzing the responses of the 230 participating nephrologists, the main obstacles to the development of the two techniques were identified and classified according to their reporting rate. The major obstacles that emerge from the survey are : the lack of information among the general public, a lack of acknowledgement of nurses specializing in these techniques, the limited number of structures that practice dialysis at home, and information difficulties among patient about dialysis techniques. The specific peritoneal dialysis-related difficulties reported are : difficulties in management of follow-up care and rehabilitation, the fear of insufficient purification and the difficulties related to the dialysis catheter. Concerning home hemodialysis, the barriers concern fear of autopunction and the need for a third party. This study helps to identify the representations of nephrologists on the major obstacles to the development of home dialysis to develop lines of thought for its promotion, both in terms of training, institutional acknowledgement, and the necessary regulatory evolution.

Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey

BackgroundThis study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice.MethodsAn electronic and anonymous survey with closed-questions about anesthetic management of BDD was distributed to French anesthesiologists via the mailing list of the French Society of Anesthesiology and Intensive Care Medicine.ResultsFour hundred fifty-eight responses were analyzed. Respondents were mainly attending physicians with more than 10 years of clinical experience. 78% of them declared being cognizant of guidelines regarding management of BDD. Advanced hemodynamic monitoring and endocrine substitution were rarely considered by respondents (31 and 35% of respondents, respectively). 98% of the respondents used crystalloids for fluid resuscitation. During the procedure, use of neuromuscular blockers, opioids and sedative agents were considered by respectively 84, 61 and 27% of the respondents. A very high level of agreement (10 [8–10], on a ten-points Likert-style scale) was reported concerning the expected impact of intraoperative anesthetic management on the primary function of grafts.ConclusionsDeclared anesthetic practice appeared in accordance with guidelines concerning organ donor management in the ICU. Further studies are needed to evaluate the specific impact of intraoperative management during this procedure and thus the need for specific anesthetic guidelines.

A French survey of contraceptive implant migration to the pulmonary artery

Objective(s)To quantify implant migration to the pulmonary artery in France since 2012 and to describe the diagnoses and treatments. Study designWe surveyed 780 physicians of the French national implant-referral network, the French Society of Chest and Cardiovascular Surgery, and the French Radiology Society about diagnosis of implant migration to the pulmonary artery vasculature. We evaluated total implant insertions in France using data from the Medic'AM database. ResultsWe identified 12 cases from 2012 to 2017. Ten of the cases were asymptomatic. Five devices were removed via interventional radiology, five surgically, and two were left in place. The number of insertions in France during the same years was approximately 1,200,000. Conclusion(s)Pulmonary artery migration following contraceptive implant insertion is rare with a migration incidence of 1 in 100,000. Most cases were diagnosed incidentally.

Prescribers’ experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey

To assess prescribers' experiences and opinions regarding antimicrobial stewardship programme (ASP) activities. A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 randomly selected large hospitals in France. All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0-1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA's usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%). Prescribers perceived ASP mainly through its 'on-demand' counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.

Graduated compression stockings in prevention of venous thromboembolism among acutely ill medical patients aged over 75 years: a French national survey.

Background: The thromboprophylactic efficacy of graduated compression stockings (GCS) has not yet been demonstrated in acutely ill medical patients, and guidelines vary considerably. Older acutely ill medical patients appear to constitute a distinctive population presenting high risks of both thrombosis and bleeding.Objective: To evaluate the practices and beliefs of a panel of French geriatricians regarding GCS management in acutely ill medical patients aged over 75 years.Methods: A survey was designed to study French geriatric practice concerning GCS use for thromboprophylaxis.Results: A total of 111 geriatricians answered the questionnaire. Among the responders, 46% declared frequent or very frequent prescription of GCS for preventing venous thromboembolism (VTE) in acutely ill, hospitalized medical patients, 54% declaring that they frequently re-evaluated GCS prescription during the patient’s hospitalization. The main reason reported for discontinuing GCS use was patient request. Regarding complications of GCS, 87% of responders declared having already noted adverse effects with the use of GCS, although 80% estimated the risk of complications to be low or very low. In the context considered, the efficacy of wearing GCS was believed to be high or very high for 73% of responders. GCS prescription was judged to be in accordance with evidence-based medicine for 69%.Conclusion: There is a gap between the frequent use of GCS to prevent VTE in older patients presenting an acute medical illness and the availability of data concerning their efficacy, safety, and management by nurses. Prospective trials including clinical and cost effectiveness are needed.

Essure Permanent Birth Control, Effectiveness and Safety: A French Survey

Essure Permanent Birth Control, Effectiveness and Safety: A French Survey

Opportunistic off-target cancer screening in organized programs: The EDIFICE 6 survey.

1535 Background: The efficacy and benefit/risk ratio of organized nationwide cancer screening programs rely on the age range of eligible average-risk populations. We studied the characteristics of off-target populations who underwent opportunistic screening for colorectal (CRC), breast (BC) or cervical (CC) cancer, ≤5y prior to the recommended age. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online (June 26-July 28, 2017) on a core sample of 12 046 individuals (18-69y). Representativeness was ensured by quota sampling on age, sex, profession, and stratification by geographical area/type of urban district. Opportunistic screening for BC (in 533 women, age 45-49y), CRC (in 1331 individuals, age 45-49y) or CC (in 633 women, age 20-24y) was assessed in terms of smoking status (current, former/never smoker), marital status (single, living with a partner), type of residential area (urban, rural), having a close relative with cancer, social vulnerability (EPICES score), and self-reporting own cancer risk (higher, identical/lower than average). Results: In the off-target populations, screening rates were 78% for BC (N = 418, mammogram), 13% for CRC (N = 172, fecal test or colonoscopy) and 42% for CC (N = 264, cervical Pap smear test). Premature BC screening rates were significantly higher (P < 0.05) in non-vulnerable than in vulnerable individuals (84% vs 69%), and among those self-reporting their own BC risk as higher than average (84% vs 76% reporting own BC risk as identical/lower than average). Premature CC screening rates were correlated with: smoking status (66% in current smokers vs 35% in former/never smokers), and marital status (63% in those living with a partner vs 34% single). Lastly, factors correlated with premature CRC screening were: type of residential area (urban, 15% vs rural, 8%), and believing own risk of CRC to be higher than average (27% vs 8% of those who self-reported their own CRC risk as identical/lower than average). Conclusions: This analysis reveals several factors related to premature screening for BC, CRC and CC, provides clear insight into off-target cancer screening uptake profiles, and hints at new strategies to ensure the optimal risk/benefit ratio of screening practices.

Complementary medicine and cancer: A French multicenter survey.

e23127 Background: There have been few reports about Complementary Therapy (TC) use in outpatients who are on active cancer chemotherapy in France. TC may interact with cancer treatments, reduce efficacy, or enhance adverse effects. Methods: This is a cross-sectional survey on TC use in 7 French hospitals (outpatient chemotherapy, conventional hospitalization and medical consultation departments). Eligible patients had to be followed for a cancer and be over 18. Results: 415 patients answered the questionnaire. 54% were female, More than 80% of patients were over 50. 230 patients (55.4%) reported using TCs. TCs were prescribed or recommended for 180 patients. The main TC users were patients with melanoma or other cutaneous cancer (90% of them) and bone and soft tissues sarcomas (86% of them). Most patients used only one TC (52.6%). The most used TCs were Phytotherapy (48%), Homeopathy (40%), supplemental dietary (35%) and aromatherapy (21%). 110 patients (47, 8% of patients with TC) used phytotherapy. The most used plants (≥5% of use) were: Curcuma and its derivative curcumine (13.9%), desmodium (7.4%), thymus (5%). 93 patients used homeopathy (40.4% of patients with TC). Only 48 patients used aromatherapy (20.9% of patients with TCM or 11.6% of the whole population). 81 patients used Supplemental dietary (35.2% of patients with TCM or 19.5% of the whole population). Only 27 patients used oligo-elements (11.7% of patients with TCM or 6.5% of the whole population),). Interestingly, 20% of patients declared to use others TCs (Physical activity, Acupuncture, Somatotherapy, Sophrology, Chinese traditional Medecine, Specific diet, Psychotherapy…). Patient who used TC were mainly under chemotherapy regimen.For each TC, most patients considered that they were useful or very useful. The main reasons for using TCs were “Wellbeing and psychological support” (35.8%), “Clinical symptoms and chemotherapy tolerance improvement” (34.6%) and “Treatment of cancer” (17.7%). Conclusions: To protect cancer patients from the potential hazard of combining their cancer treatment with TCs, patients should systematically be encouraged to report their TC use, while oncologists and pharmacists should be trained on evidence of TC, and patient guidance for a safer TC use.

How far do laypersons believe in the cure of cancer? Results of the EDIFICE6 survey.

11616 Background: Advances in therapy and early detection, by population-based screening in particular, have significantly increased the number of patients cured from cancer. However, cancer patients’ chances of being cured varies strongly from one cancer to another. We studied the understanding of the concept of cure in the lay population and the factors associated with believing that cancer can be cured. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online (June 26-July 28, 2017) on a core sample of 12 046 individuals (age, 18-69y). Representativeness was ensured by quota sampling on age, sex, profession, and stratification by geographical area/type of urban district. This analysis focused on understanding of the meaning of cure in breast (BC), cervical (CC), colorectal (CRC), lung (LC) and bladder (BLC) cancer for individuals with no history of cancer. Results: The majority of respondents believed that cure exists (BC 95%; CC 91%; CRC 89%; BLC 87%, LC 71%). Some agreed with the definition that cure is the disappearance of the disease (BC 42%; CC 38%; CRC 35%; BLC 33%, LC 25%), while others preferred the definition that cure is several years without disease (BC, CC 53%; CRC, BLS 54%; LC 46%). More men than women (P < 0.05) believed that cure exists for CRC, BLC and LC. Socially non-vulnerable individuals were more likely to believe in cure than their vulnerable counterparts (P < 0.05), as were individuals aged 50-69y (P < 0.05) versus those of 18-50y, and for all cancer types except LC. In multivariate analysis, the variable “clinical research enables progress” was correlated with believing that cure exists (BC, OR = 2.93; CC, OR = 1.86; CRC, OR = 2.22; LC, OR = 1.57, BLC, OR = 2.06), as was “progress is rapid” (BC, OR = 1.61; CC, OR = 1.66; CRC, OR = 1.7; LC, OR = 1.84; BLC OR = 1.68), and also social non-vulnerability. However, the variables “prevention”, respectively screening/treatments, “are important for cancer control” had a low impact on the belief in cure (OR~1). Conclusions: The lay population is relatively optimistic about the cure for cancer. Confidence in the existence of cure relies on medical progress. However, factors related to individual behavior, e.g., prevention and screening, did not affect the perception of cure.

A generalized additive model to disentangle age and diagnosis-specific cohort effects in psychological and behavioral outcomes in people living with HIV: the French cross-sectional ANRS-VESPA2 survey

BackgroundUnlike their younger counterparts, some of today’s older HIV patients were diagnosed before the advent of highly active antiretroviral therapy (HAART). The psychosocial and behavioral outcomes of people living with HIV (PLWH) have been widely studied, and associated factors are well known. However, their evolution both in terms of age and diagnosis-specific cohort effects is not well understood.MethodsData from the ANRS-VESPA2 cross-sectional survey, representative of French PLWH, were used to investigate whether psychosocial and behavioral outcomes such as quality of life, need for support and HIV status disclosure, evolve under both the influence of patients’ age and diagnosis-specific cohort effects. A semi-parametric generalized additive model (GAM) was employed. The physical and mental components of health-related quality of life, the need for material and moral support, and HIV-status disclosure, constituted our outcomes.ResultsNon-linear diagnosis-specific cohort effects were found for physical and mental QoL and HIV-status disclosure. Overall, physical QoL was better in recently diagnosed patients than in those diagnosed in the early 1980s. An increasing influence of diagnosis-specific cohort effects between 1983 and 1995 was observed. No cohort effects were noticeable between 1996 and 2000, while an increasing influence was apparent for patients diagnosed with HIV from 2000 to 2011 (year of study). For mental QoL, the only increase was observed in participants diagnosed with HIV between 1983 and 2000. The relationship between diagnosis-specific cohort effects and HIV status disclosure was negative overall: participants diagnosed after 2000 were much less likely to disclose than those diagnosed before 1995. The effect of age was significantly associated with all outcomes, with a non-linear influence on mental QoL and with the need for material/moral support.ConclusionsPsychosocial and behavioral outcomes are complex processes which can be explained in different ways by a combination of the clinical and social contexts which PLWH are exposed to at the time of diagnosis, and by developmental characteristics. A greater understanding of these processes could inform healthcare policy-making for specific HIV generations and different HIV age groups.

Fertility of women with cystic fibrosis: a French survey.

Although the impact of cystic fibrosis on male fertility is well known, very few studies have investigated its effect on female fertility. This study aimed to evaluate the fertility status of women with cystic fibrosis. A questionnaire was sent to 220 women with cystic fibrosis. The questions concerned their desire to become a parent, achievement or not of a pregnancy, the time to become pregnant, the means of achieving pregnancy (spontaneously or with medical assistance) and the outcome of the pregnancy. Ninety-eight patients responded to the questionnaire. Of the 46 women who sought pregnancy, 25 (54%) had at least one live birth without treatment, while 11 (24%) required infertility treatment to obtain a live birth and 10 (22%) had no delivery. The mean time-to-pregnancy was 12 months (1-180). The reasons for preferring not to become pregnant were mainly fear of the interaction between cystic fibrosis and pregnancy and of the transmission of cystic fibrosis to children. Fertility seems to be slightly impaired in women with cystic fibrosis, because 37% of them failed to become pregnant without medical assistance. Because the outcome of pregnancies appears normal, patients should be informed about the possibility of becoming mothers and be made aware of the risk of unwanted pregnancies.

Cancers in France in 2015 attributable to insufficient physical activity

IntroductionInsufficient physical activity is a known risk factor for various co-morbidities, including cancer. Globally, its prevalence has increased markedly over the past decades. The aim of this study was to estimate the proportion and number of cancers that were attributable to insufficient physical activity in France in 2015. MethodsPopulation attributable fractions (PAFs) and numbers of cancer cases attributable to insufficient physical activity (<30 min daily of moderate-to-vigorous physical activity) were estimated by age, sex and cancer site. Assuming a 10-year lag-period, PAFs were calculated using physical activity prevalence from a cross-sectional French population survey and cancer-specific relative risks. ResultsAbout half of all French adults were found to be insufficiently physically active, with great variation by age and sex. In 2015, an estimated 2973 cancer cases diagnosed in French adults aged 30y+ were attributable to insufficient physical activity, corresponding to 0.8% of all cancer cases (0.2% in men and 1.6% in women). This comprised 3.8% of all postmenopausal breast cancers (1620 cases), 3.6% of all colon cancers (902 cases) and 6.0% of all cancers of the corpus uteri (450 cases). If at least half of the recommended physical activity level was achieved, 1095 cancer cases could have been avoided. ConclusionInsufficient physical activity is associated to about 3000 cancer cases in France, a country with comparatively low but increasing prevalence of this risk factor. This result is important for setting priorities in cancer prevention programmes aiming to increase physical activity in France and Europe in general.

PCV43 ECONOMIC VALUATION OF INFORMAL CARE PROVIDED TO PEOPLE AFTER A MYOCARDIAL INFARCTION IN FRANCE

The aim of this study was to estimate the mean cost per caregiver of informal care during the first year after myocardial infarction event in France. We also realized an approximation of the overall mean cost of myocardial infarction management during the first year in order to quantify the relative weight of informal care. We used the Handicap-Santé French survey carried out in 2008 to obtain data about MI victims and their caregivers. After obtaining the total number of informal care hours provided by caregiver during the first year after MI event, we estimated the value of informal care using the contingent valuation method. Then, we carried out a systematic literature review of studies reporting costs associated with the myocardial infarction management in France according to the PRISMA guidelines to estimate an approximate overall mean cost of myocardial infarction management and quantify the proportion of informal care cost. For MI people receiving informal care, an annual mean cost was estimated at €12,798 (SD=13,425) per caregiver during the first year after myocardial infarction event and appears to represent the greatest weight of the approximate overall mean cost of myocardial infarction. The present study suggests that informal care should be included more widely in economic evaluations not only about chronic diseases but also for acute illness in order not to underestimate the cost of diseases which induce disability.

Total femur replacement in non-oncologic indications: Functional and radiological outcomes from a French survey with a mean 6 years’ follow-up

IntroductionThere are few published studies on total femur replacement (TFR) because its indications are rare. Other than malignant diseases, the indications extend to revisions and interprosthetic femur fractures; however, the outcomes of these indications have not been well defined. The aim of this retrospective survey was to analyze the complication rate and functional outcomes of these newer indications. HypothesisThe morbidity and outcomes after TFR are comparable to those reported in the literature for non-cancer indications. Material and methodsBetween 1997 and 2016, 29 TFR procedures were done at 6 French teaching hospitals in 15 women and 14 men, average age 68±14 years [32–85]. The primary indication was degenerative joint disease in the hip and/or knee in 16 cases, mechanical failure of the implant used after tumor resection in 11 cases and femur fracture in 2 cases. The mean number of surgical procedures before TFR was 3.6 (maximum 5) at the hip and 4.5 (maximum 10) at the knee. Six different models were implanted consisting of a rotational hinge knee (except in one case); 20 patients received a dual mobility system and 9 a standard hip replacement bearing. The femoral shaft was partially conserved 21/29 times and the trochanter 25/29 times. ResultsFive patients suffered a general complication and 12 suffered a local complication (including 4 hematomas and 2 hip dislocations). Eight patients (28.6%) suffered a surgical site infection, although three had a prior infection. Among the 12 patients with a history of infection or progressive infection before the TFR, 9 healed and 3 had the infection continue. At a minimum follow-up of 2 years and mean of 6 years, 23 TFR implants were still in place and not infected; the other 6 had been removed or were infected, including one patient who underwent disarticulation. The median survival of the non-infected TFR was 15 years. At 10 years, 70% of TFR implants were still in place and non-infected.Walking was possible with or without a cane in 15 patients (51.7%), with two canes or a walker in 12 patients (41.3%) and impossible in 2 patients. Active knee flexion averaged 79.4°±30.3° [0°–120°]; 17 patients (62.9%) had 90° or more flexion; two patients (7.4%) had no flexion. The extension deficit averaged 3.7°±7°[−20° to 10°] and 20 patients had no flexion deformity. The leg length difference averaged 1.3cm±2.3 [0–10]; 19 patients (67.8%) had no difference in leg length. DiscussionOur starting hypothesis was confirmed for the complication rate and clinical outcomes. The benefits of dual mobility cups are emphasized. While the indications for TFR are rare, they will likely increase in the coming years.Level of evidence: IV, Retrospective cohort study…

Modeled industry-wide food and beverage reformulations reduce the gap between current and nutritionally adequate dietary intakes among French adults.

The objective was to assess the capacity of food reformulations to reduce the required dietary changes to reach overall nutritional adequacy in the French adult population. Reformulation standards, defined using the Nestlé Nutritional Profiling System (NNPS), were applied to the French food composition database (CIQUAL-2013), classifying foods into "PASS" or "FAIL". Baseline nutritional intakes were estimated for 1838 adults of the INCA2 French national survey according to three scenarios based on: (1) the original food composition database (CURRENT), (2) a "reformulated" database in which the nutrient composition of FAIL products was adjusted to the NNPS standards (REFORMULATION), and (3) a "substituted" database in FAIL products were replaced by the most nutritionally similar PASS products from the same NNPS-category (SUBSTITUTION). For each scenario, starting from each baseline diet, a new optimized diet was modeled to fulfill a complete set of nutrient recommendations while remaining closest to the respective baseline diet. To quantify the dietary changes needed to reach nutritional adequacy in the optimized diets, the total dietary deviation (TDD) was calculated as the sum in quantities (grams) of the absolute difference between observed and optimized amount of repertoire foods (i.e., foods already consumed) plus the amount of non-repertoire foods (i.e., new foods added). TDD was significantly lower in the REFORMULATION and the SUBSTITUTION scenarios compared to CURRENT (1269g/day, 1191g/day and 1494g/day, respectively). This was explained by smaller shifts among repertoire foods and less additions of non-repertoire foods. Nutritional reformulation of the food supply may reduce the dietary changes required to achieve nutritionally adequate diets, but would not suffice to reach the complete set of nutrient recommendations.

Type 2 myocardial infarction: A comprehensive descriptive and etiologic analysis from RICO survey

Identifying underlying causes and characteristics of type 2 myocardial infarction (T2MI), defined by an imbalance between demand and supply of oxygen without plaque disruption, and its distinction with type 1 myocardial infarction (T1MI), due to plaque rupture or erosion, remains a critical step to diagnosis and therapeutic strategies. To comprehensively identify T2MI etiologic factors and to compare T2MI vs. T1MI characteristics. Large prospective study in patients included from 2007 to 2017 in the RICO database, a French regional survey of acute MI. Cases were systematically adjudicated according to the 3rd universal MI definition criteria and pre-specified causes of T2MI. Among the 4572 patients included, 3710 (81%) had a T1MI and 862 (19%) a T2MI. Patients with T2MI were markedly older (77 vs 67y, P < 0.001), more frequently female, had more comorbidities and were less frequently STEMI (24 vs. 52%, P < 0.001) than in T1MI group. Clinical presentation was also more severe (median GRACE score: 171 vs. 143, P < 0.001) and left ventricular ejection fraction more altered (50 vs. 55%, P < 0.001). However, median troponin Ic peak was lower (3.5 vs. 17 μg/L, P < 0.001). Underlying mechanisms leading to T2MI highlighted 2 main patterns (Fig. 1), characterized by: – chronic predisposing factors including chronic anemia (10%) and severe aortic stenosis (7%) and; – acute precipitating factors, of which acute infections (39%), mainly respiratory tract infections, were the most frequent factor, followed by tachyarrhythmia (13%) and acute heart failure (10%). The most frequent acute or chronic causes were non-cardiogenic factors. Association of factors concerned 122 patients (14%). In our large contemporary study, one of the largest to date, with a prospective T2MI identification, chronic anemia and severe aortic stenosis frequently predisposed to T2MI, and respiratory infections were the most frequent trigger.