Search

Information seeking (IS) has become a critical activity in video‐based environments. Up to now, the effects of support on information seeking (i.e., scaffolding) have seldom been assessed. The twofold aim of the current study was to (a) assess the effects of scaffolding on IS in videos and (b) determine the characteristics of the users' mental models after an IS activity with or without scaffolding. We divided 50 participants into two groups that either did or did not benefit from initial scaffolding during an IS task. Both groups then had to perform a localization task without any further access to scaffolding. Results showed that scaffolding the video by providing a table of contents and markers on a timeline helped students to engage in highly efficient IS, but they had less accurate mental representations of the video than those without scaffolding. The hypothesis that scaffolding provides a usable but external model was therefore supported. Lay Description: What is already known about this topic: Videos are increasingly used in learning.Searching for information in videos may be a complex activity.So far, very few studies have been conducted on the potential effect of scaffolding videos during an information‐seeking (IS) task. What this paper adds: In this study, we put in place the scaffolding of the video by adding a table of contents and markers on the timeline.Structuration and segmentation have positive effects on the performance in IS, in terms of response success, time spent on each search, relevance, and perceived difficulty.Scaffolding has a negative impact on the users' internal representations of the video. Implications for practice: Incorporating a table of contents and a structured timeline into a video facilitates the search activity.Without scaffolding, the search activity is longer and cognitively more costly.Paradoxically, users have a poorer representation of the video (i.e., poorer mental model) after the IS task when they were given scaffolding.Future studies should focus on the benefits of providing structuring and segmentation in learning tasks. [ABSTRACT FROM AUTHOR]

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ABSTRACT Research on ideological attitudes has identified two main dimensions that refer to two fundamental features of group organization: social solidarity and social control. In response to prior research that has studied their relationship mainly from a correlational perspective, this paper introduces a social reality model based on psychological functionality of ideological attitudes. Social position variables (education, income and material vulnerability) and insecurity variables (fear of crime and distrust) are used to predict the interplay between ideological attitudes towards social solidarity and social control. Using K-means cluster analysis, a typology with four patterns of support for solidarity and control ('socials', 'repressives', 'minimalists' and 'social-repressives') was created, on the basis of representative survey data for the UK, France and Germany ( N = 7034). Results from logistic regression analyses show that the proposed social reality model explains membership in typology categories, with similar results across the three countries. Overall, the model underscores the social origins of ideological attitudes as functional responses to perceived social reality. The paper illustrates how the social psychological study of ideological attitudes may be enriched by a typological approach that examines patterns of attitudes rather than single dimensions. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: The objectives of this study were to estimate the age of complementary feeding introduction (CFI) and investigate the related health, demographic, and socio‐economic factors. Analyses were based on 10,931 infants from the French national birth cohort ELFE, born in 2011. Health, demographic, and socio‐economic data concerning infants and parents were collected at birth (face‐to‐face interviews and medical records) and 2 months (telephone interviews). Data on milk feeding and CFI practices were collected at birth and 2 months then monthly from 3 to 10 months using online or paper questionnaires. The associations between both health and social factors and CFI age were tested by multivariable multinomial logistic regressions. The mean CFI age was 5.2 ± 1.2 months; 26% of the infants started complementary feeding before 4 months of age (CF < 4 months), 62% between 4 and 6 months of age, and 12% after 6 months of age (CF > 6 months). CF < 4 months was more likely when mothers smoked, were overweight/obese, younger (<29 years), and used their personal experience as an information source in child caregiving and when both parents were not born in France. CF < 4 months was less likely when the infant was a girl, second‐born, when the mother breastfed longer, and had attended at least one birth preparation class. Mothers of second‐born infants and who breastfed their child longer were more likely to introduce CF > 6 months. Couples in which fathers were born in France and mothers were not born in France were less likely to introduce CF > 6 months. CF < 4 months occurred in more than 25% of the cases. It is important to continue promoting clear CFI recommendations, especially in smoking, overweight, young, not born in France, and nonbreastfeeding mothers. [ABSTRACT FROM AUTHOR]

Breastfeeding is recommended until 6 months of age, but a wide range of infant formula is available for nonbreastfed or partially breastfed infants. Our aim was to describe infant formula selection and to examine social- and health-related factors associated with this selection. Analyses were based on 13,291 infants from the French national birth cohort Etude Longitudinale Française depuis l'Enfance. Infant diet was assessed at Month 2 by phone interview and monthly from Months 3 to 10 via internet/paper questionnaires. Infant formulas were categorized in 6 groups: extensively or partially hydrolysed, regular with or without prebiotics/probiotics, and thickened with or without prebiotics/probiotics. Associations between type of infant formula used at 2 months and family or infant characteristics were assessed by multinomial logistic regressions. At Month 2, 58.1% of formula-fed infants were fed with formula enriched in prebiotics/probiotics, 31.5% with thickened formula, and 1.4% with extensively hydrolysed formula. The proportion of formula-fed infants increased regularly, but the type of infant formula used was fairly stable between 2 and 10 months. At Month 2, extensively hydrolysed formulas were more likely to be used in infants with diarrhoea or regurgitation problems. Partially hydrolysed formulas were more often used in families with high income, with a history of allergy, or with infants with regurgitation issues. Thickened formulas were used more with boys, preterm infants, infants with regurgitation issues, or in cases of early maternal return to work. The main factors related to the selection of infant formula were family and infant health-related ones. [ABSTRACT FROM AUTHOR]

Background: The benefit of a stay in an intensive care unit (ICU) is not certain for older patients, particularly in the surgical context. Aims: The objective of this study was to identify the factors associated with an unfavourable outcome in this population. Design: Prospective, descriptive, monocentric study conducted in the surgical ICU of a French university hospital. Methods: Patients aged ≥75 years admitted in the surgical ICU for a predicted length of stay ≥48 hours were included. Patients received an initial and a 6‐months nutritional and functional assessment performed by physicians and nurses. The outcome was considered as favourable if the Katz Activities of Daily Living (ADL) variation (ADL delta = 6‐months ADL – ICU admission ADL) was between 0 and −0.5 point 6 months after ICU discharge and unfavourable if the ADL delta decreased by more than 0.5 points or if the patient had died 6 months after ICU discharge. Results: Fifty‐six patients—32 (57%) male—aged 79 [77; 83] y were included. ICU mortality was 19%; 6‐month mortality was 22%. Median ADL delta was −0.5 [−0.5–0] points. A low ADL score (P =.0438) and a low albumin level (P =.0213) at admission were the two independent factors associated with an unfavourable outcome. Conclusion: Mortality and loss of independence were high in this elderly population during and after their surgical ICU stay. The benefit of a systematic collaboration between intensive care specialists, ICU nurses, and geriatricians, to assess and manage nutritional and functional problems and to prevent a pejorative outcome in patients over 75 years old admitted in surgical ICU needs to be studied. Relevance to clinical practice: There should be systematic screening for objective markers of undernutrition and frailty on ICU admission of older patients as they are associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

Background: The institutionalization of a patient with Alzheimer's disease or other dementia (ADOD) is the last resort for the latter's family and/or caregivers. We hypothesized that the degree of kinship between the patient and his/her caregiver would influence the likelihood of institutionalization. Objective: To assess the association between institutionalization of patients with ADOD and the degree of kinship with the family caregiver. Methods: A cross‐sectional study of patients with ADOD aged 75 or over attending a memory center in France for the first time between 2011 and 2014, as recorded in the French National Alzheimer Database. Multivariable logistic regression was used to assess factors associated with institutionalization after adjustment for age, sex, the Mini‐Mental State Examination score, educational level, and type of dementia. Results: A total of 52,874 patients were included. The primary caregiver was most often a child (54.8%) or the spouse (36.7%). Compared with the "spouse" reference category, all the other caregiver categories were associated with a significantly greater likelihood of institutionalization; the odds ratio [95% confidence interval] was 4.68 [3.67–5.92] when the carer was a grandchild, 5.48 [4.93–6.09] for a child, 4.93 [4.11–5.91] for a daughter‐/son‐in‐law, 8.76 [7.15–10.70] for a sibling, and 8.93 [7.48–10.65] for a niece/nephew. Conclusion: The likelihood of institutionalization of older patients with ADOD varied with the degree of kinship. Compared with the "spouse" reference category, the likelihood was higher for all other types of caregivers but was especially high when the caregiver was not a direct descendant of the patient. [ABSTRACT FROM AUTHOR]

Background and purpose: Patients with secondary progressive multiple sclerosis (SP MS) and clinical and/or radiological activity could be the more likely to benefit from disease‐modifying treatments. To evaluate the proportions each year after progression onset, patients with SP MS onset between 2002 and 2012 from a population‐based multiple sclerosis registry in northeastern France were studied. Methods: Progression onset was first identified by the neurologist's diagnosis (N cohort), and then by using an automated data‐driven definition (D cohort). In a given year after onset of progression, clinical activity was defined as at least one relapse, and radiological activity as at least one new T2 and/or gadolinium‐enhancing lesion. A multivariate mixed logistic regression was used to assess factors associated with activity during the year. Results: In the N cohort, amongst 833 patients with SP MS with a median follow‐up of 8 years, 10.0%–14.8% had at least one relapse in a year during the first 5 years of progression. Including both clinical and radiological activity increased these proportions to 11.9%–23.7%, with the proportion having a magnetic resonance imaging scan in the year ranging from 29.8% to 40.5%. The first year of progression, a young age and a high relapse rate during the 5 years before progression were associated with activity in a given year. The D cohort results confirmed these findings. Conclusions: A substantial proportion of patients with SP MS present disease activity. Further studies should evaluate the impact of disease‐modifying treatments on the disease course of these patients. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study are to estimate the prevalence of iron deficiency (ID) among French whole‐blood (WB) donors to identify factors associated with ID and to generate decision trees. Study design and methods: A prospective National multicentre study was performed on WB donors from March 11, to April 5th, 2019. Samples were selected randomly to perform serum ferritin. ID was defined as ferritin value under 26 ng/ml. All results were stratified by sex. Factors associated with ID were analysed using multivariate logistic regression model. CART algorithm was used for decision trees. Results: Eleven thousand two hundred fifty eight WB donors were included. ID was more frequent in women (39·5%) than in men (18·0%). Among 7200 repeated donors, women below 50 yo had a higher risk (OR = 2·37; [1·97–2·85] IC95) than those above 50 yo. Factors associated with ID were: haemoglobin level under the threshold at donation n‐1 except for women and n‐2 donation; a low mean corpuscular haemoglobin at n‐1 and n‐2 donations; a shorter interval since n‐1 donation and between n‐1 and n‐2 donations except for women; and women who had given three or four times in the last year. CART algorithm defined high risk of ID subgroups within three populations of donors, new female donors, repeated male donors and repeated female donors. In these identified subgroups, prevalence of ID was up to 72·1%. Conclusions: Our study showed the high prevalence of ID among French WB donors, identified well‐known and new factors associated with ID and defined algorithms predicting ID in three populations. [ABSTRACT FROM AUTHOR]

Background and Aims: Completely substituting e‐cigarettes (EC) for combustible tobacco cigarettes reduces exposure to toxicants and carcinogens. However, a large proportion of EC users (dual users) continue to smoke conventional cigarettes. This study aimed to compare estimated nicotine intake and e‐cigarette use characteristics between exclusive EC users and dual users. Design Web‐based anonymous cross‐sectional survey. Setting: France. Participants: A total of 3189 adults, current users of electronic cigarettes (EC). Data collection between 4 October 2014 and 11 November 2014. Measurements Primary outcome: estimated nicotine intake per day (mg) from participants' reports. Secondary outcomes: duration, frequency of EC use and nicotine content of e‐liquids used/day. Dual use was defined as using at least one cigarette per day while also using EC. Findings A total of 2836 respondents reported exclusive EC use and 353 reported being dual users. Backward stepwise logistic regression showed that dual users had higher estimated combined daily nicotine intake from e‐liquids and cigarettes [estimate: 2.14, standard error (SE) = 0.26, adjusted odds ratio (aOR) = 8.48, 95% confidence interval (CI) = 5.11–14.09, P < 0.001], but lower daily nicotine intake from EC (estimate: –2.14, SE = 0.26, aOR = 0.12, CI = 0.07–0.196, P < 0.001) and reported fewer months of EC use (estimate: −0.31, SE = 0.14, aOR = 0.73, CI = 0.56–0.95, P = 0.022) compared with exclusive EC users. Conclusion: Dual e‐cigarette users in France may have higher nicotine intake overall than exclusive e‐cigarette users, but they may take in less nicotine from their e‐cigarettes. [ABSTRACT FROM AUTHOR]

Context: Previous studies, mainly originating from North America, suggest that women are less likely than men to obtain professorships in academic medical settings. However, research providing a comprehensive picture of such gender disparities in other national contexts and addressing associated contextual factors is lacking. Objectives: Our objectives were to assess gender differences in access to professorships in academic medical settings in France, to determine their evolution across regions and medical specialties and over time, and to identify the factors associated with the likelihood of a professor being a woman. Methods: We carried out a national administrative cohort study of all new professors appointed during 1989–2015 in all medical specialties in the whole of France. We first conducted a descriptive analysis of the percentage of professorships awarded to women and its variations by time, region and specialty. We then ran a logistic regression model to determine factors significantly associated with the likelihood of a professor being a woman. Results: Between 1989 and 2015, 3950 professors were appointed, of whom fewer than one in five were women. Female professors consistently represented a minority in all French regions and specialties over the study period. Although a small increase was observed over the years, women never represented more than 29% of newly appointed professors. After adjustments for other factors, the likelihood of a professor being a woman was significantly higher in specialties with a higher percentage of women among hospital practitioners, in regions with higher numbers of appointed professors and in recent years. Conclusions: Gender inequalities in career evolution exist in academic medical settings in France and have continued over time despite moderate improvements. Increased awareness based on scientific evidence is a first step towards reducing such inequalities. [ABSTRACT FROM AUTHOR]

Aim The role of metformin in lactic acidosis is regularly questioned. Arguments against a causal role for metformin in lactic acidosis occurrence are the lack of correlation between plasma metformin and lactate levels, as well as between metformin plasma levels and mortality. We aim to analyse these correlations in a large series of lactic acidosis cases recorded in the French nationwide pharmacovigilance database. Methods All cases of lactic acidosis spontaneously reported between 1985 and October 2013 associated with metformin exposure were extracted from the pharmacovigilance database. We assessed the statistical correlations between prescribed daily doses of metformin, plasma concentrations of metformin and lactate, pH and plasma creatinine, as well as the relationship between mortality and these variables. Results Seven hundred and twenty-seven cases of lactic acidosis were reported during the period. Metformin plasma concentration was documented for 260 patients, lactate plasma concentration for 556 patients, pH for 502 patients, creatinine for 397 patients and the vital outcome for 713 patients. Metformin plasma concentration, lactate concentration, pH and plasma creatinine were all correlated ( P < 0.001). There were significant differences between surviving and deceased patients in terms of metformin plasma levels (25.2 vs. 37.4 mg/l, P = 0.002) and lactate concentrations (10.8 vs. 16.3 mmol/l, P < 0.001). Thirty per cent of patients died when metformin concentration was > 5 mg/l compared with 11% for patients with concentration < 5 mg/l ( P = 0.003). Conclusions Our data suggest that metformin accumulation contributes to the pathogenesis and prognosis of lactic acidosis. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA).Methods: COMEDRA is a French nationwide cross-sectional multicenter study on comorbidities in RA. Renal function was assessed from the estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease equation. RA characteristics and risk factors for renal impairment were collected. Two logistic regression models, 1 with and 1 without the Framingham Risk Score, were constructed from variables that were significantly associated with an eGFR of <60 ml/minute/1.73 m(2) or were clinically relevant.Results: Of the 970 recruited patients, 931 were analyzed (women 79.6%, mean age 57.8 years, disease duration 11.1 years, Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR] 3.1). A total of 82 patients (8.8%) had an eGFR <60 ml/minute/1.73 m(2) and 9% had proteinuria. In univariate analysis, renal impairment was associated with age (P < 0.001), history of hypertension (P < 0.001), high systolic blood pressure (P = 0.03), and the Systematic Coronary Risk Evaluation (SCORE) equation (P = 0.002), but not with sex, disease duration, disease activity (as assessed by DAS28-ESR), nonsteroidal antiinflammatory drug use, disease severity (erosions, joint replacement), or RA medications. Multivariate analysis models showed that age (odds ratio [OR] 1.05 [95% confidence interval (95% CI) 1.03-1.09]) and hypertension (OR 2.5 [95% CI 1.5-4.3]) were associated with renal impairment. A second model showed that the SCORE equation (OR 1.33 [95% CI 1.06-1.67]) was associated with renal impairment.Conclusion: Renal impairment is relatively common in RA and is associated with cardiovascular risk factors such as age, hypertension, and the SCORE equation but not with disease activity or severity. [ABSTRACT FROM AUTHOR]

Objectives To examine the frequency and determinants of underperception of naps in older adults referred for a sleep assessment. Design Prospective study. Setting Outpatient geriatric sleep clinic. Participants Individuals aged 60 and older referred for insomnia complaints or suspected sleep apnea (N = 135). Measurements Tests included clinical interview, sleepiness scale, anxiety and depression scale, Insomnia Severity Index ( ISI), Mini-Mental State Examination ( MMSE), and overnight polysomnography, followed by multiple sleep latency tests. At the end of each of four nap opportunities, participants answered whether they had slept during the test. Nap underperception was defined as two or more unperceived naps. Results Of the 105 participants who napped at least twice, 42 (40%) did not perceive at least two naps. These participants had lower MMSE scores ( P = .01) and were more likely to be taking benzodiazepines ( P = .008) than the 63 participants who did not underperceive their naps but had similar demographic characteristics, sleep diagnoses, depression and anxiety scores, and polysomnography measures. Both groups had similarly short mean daytime sleep latencies (9.7 ± 4.5 minutes and 9.8 ± 3.7 minutes), but participants who underperceived their naps scored lower on the Epworth Sleepiness Scale (5.6 ± 4.0, vs 9.6 ± 4.8, P < .001). An ISI of 11 or greater, a MMSE score of 26 or less, and a sleepiness score of 8 or less were each independently associated with underperception of naps. The combination of these three factors yielded a positive predictive value of 93% and a negative predictive value of 71% for nap underperception. Conclusion Older adults referred for sleep consultation with cognitive impairment and greater insomnia symptoms frequently underperceive naps, leading them to underestimate their level of sleepiness. In such cases, objective measures of daytime sleepiness would be better than the Epworth Sleepiness Scale. [ABSTRACT FROM AUTHOR]

Background Baclofen is a GABA-B receptor agonist currently used in the treatment of spasticity. In recent years, baclofen has been used to reduce craving, voluntary alcohol intake and withdrawal syndrome of alcoholic patients. To date, there are no data available to estimate the relationship between baclofen exposure and the variation of craving. The first objective of this study was to investigate the variation of craving as a function of exposure, and the second was to explore the possible existence of baclofen responders and nonresponders. Methods Sixty-seven outpatients, 43 men/24 women (weight: 73 kg [42 to 128]; age: 49 years old [29 to 68]) followed in the addictology unit, were studied during 3 months after treatment initiation. Baclofen was administered by oral route. Therapeutic drug monitoring enabled the measurement of plasma concentrations. Craving level was assessed by the Obsessive-Compulsive Drinking Scale ( OCDS). A population pharmacokinetic ( PK)-pharmacodynamic analysis of the OCDS variation following baclofen administration was performed. Demographic data, biological data, and tobacco consumption were tested for their influence on the parameters. Results Data were modeled with a 1-compartment model with first-order absorption and elimination. PK analysis confirms the results of our previous study. An Emax model best-described the exposure- OCDS relationship. None of the covariates tested was able to improve the fit or decrease intersubject variability. However, 2 subpopulations were defined for the exposure corresponding to half the maximal effect ( BE50). The proportion of patients being classified as responders was 38% (95% confidence interval [CI] 7 to 76), the maximal decrease in OCDS ( Emax) was 72% (95% CI 25 to 85), and the BE50 was 12.6 (95% CI 0.02 to 74.3) or 4,390 (95% CI 20.4 to 31,800) h mg/l for responders and nonresponders, respectively. Conclusions We defined the relationship between baclofen exposure and craving in patients with alcohol use disorder. Baclofen treatment decreased craving in all patients. However, we drew up the hypothesis of 2 subpopulations of patients differentiated by their speed of response. A wide interindividual variability in response was depicted, making it currently impossible to predict which group a patient will belong to. [ABSTRACT FROM AUTHOR]

Background The predictive factors of secondary postpartum hemorrhage (PPH) are little known. Our principal objective was to determine if immediate PPH is a risk factor for severe secondary PPH. We also sought to identify other factors associated with severe secondary PPH. Methods Our historical cohort study included all women who gave birth (≥ 22 weeks) in our level III hospital from 2004 through 2013. The hospital discharge database enabled us to identify all women readmitted during the 42-day postpartum period or who underwent a surgical, medical, or interventional radiology procedure during their immediate postpartum hospitalization. We then examined all medical records to identify the cases involving severe secondary PPH. We studied the known risk factors of secondary PPH and assessed other potential ones: maternal age, multiple pregnancy, induction of labor, cesarean birth, preterm birth, and stillbirth. Results The study included 63 women with a severe secondary PPH and 25,696 women without a secondary PPH. Immediate PPH (aOR 2.7 [95% CI 1.3-5.6]) and maternal age ≥ 35 years (aOR 2.0 [95% CI 1.1-3.7]) were the only factors associated with severe secondary PPH. Discussion This cohort study confirms that immediate PPH is a risk factor for severe secondary PPH and reports for the first time an association between secondary PPH and advanced maternal age. It is likely that risk factors for immediate PPH are also risk factors for severe secondary PPH and thus that immediate PPH may be an intermediate factor between its own known risk factors and secondary PPH. [ABSTRACT FROM AUTHOR]

Objectives To examine the associations between amyloid- β brain deposition and physical activity ( PA) in elderly adults without dementia and to investigate whether the association has a dose-response relationship. Design Cross-sectional study. Setting French community-dwelling people. Participants Elderly adults with normal or mildly impaired cognition (mean age 74.7 ± 4.2; 60.4% female) with available information on current self-reported PA and amyloid- β brain deposition measured using positron emission tomography ( PET) using the PET-ligand florbetapir F 18 (n = 268). Measurements A standardized uptake value ratio ( SUVR) was obtained for each subject. Participants were divided according to amyloid plaque cortical retention defined according to a SUVR cutoff of 1.10 ( SUVR+ vs SUVR−). Results Bivariate and multivariate analyses showed that PA was not significantly associated with SUVR. SUVR+ and SUVR− participants did not differ in terms of volume (continuous PA variables) and levels (categorical PA variables) of PA. PA was not correlated with SUVR in apolipoprotein E ε4 carriers or noncarriers. PA was not associated with cognitive function. Conclusion Although PA protects against dementia, there is no solid evidence that this protection involves a reduction in amyloid- β brain deposition. Further studies are needed to determine whether PA (ideally measured at several time-points using objective measures) is involved in the pathophysiology of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to investigate the association between body-weight ( BW) perception, weight preoccupation and behaviour, including weight control practices and compulsive over-eating episodes, across gender and actual BW classes. Design This study used a cross-sectional observational study. Participants A large, nationally representative sample of 6404 ninth-grade French adolescents was randomly selected from schools throughout France. Methods Weight and height were measured, and BW preoccupation, BW control practices and compulsive over-eating were self-reported using standardized questionnaires. Results Nearly one-third of adolescents misperceived their BW. Misperception was more frequent among girls than boys (42.2% vs. 27.3%, P < 0.01). Underestimation of BW among overweight adolescents, like BW overestimation among underweight adolescents, was associated with less preoccupation with weight and fewer weight control practices than accurate perception of BW. Normal weight adolescents who overestimated their BW were more likely to declare weight preoccupations ( ORa = 8.66 [6.67-11.25]), dieting ( ORa = 4.81 [3.68-6.27]) and recurrent compulsive over-eating episodes ( ORa = 2.36 [1.72-3.23]) compared with their counterparts who correctly estimated their BW. Conclusion Our study underlines the role of these associations in each category of actual BW (underweight, normal weight and overweight) in a large national sample. [ABSTRACT FROM AUTHOR]

Objectives To demonstrate the association between carotid central structure changes and frailty. Design Cross-sectional study. Setting The Three-City Study, a French prospective cohort designed to evaluate the risk of cognitive decline attributable to vascular risk factors. Participants Community-dwelling individuals aged 65 to 95 (N = 4,257). Measurements Frailty was defined as proposed by Fried and colleagues. Carotid intima-media thickness ( IMT), diameter of the common carotid arteries, and the presence of plaques in both carotid arteries were determined using carotid Doppler ultrasonography. Multinomial logistic regression models, including adjustment for traditional cardiovascular and dementia risk factors, were used to evaluate the independent association between the central arterial structure and frailty. Results 6.8% of participants were classified as frail. Multivariate regression models showed an independent association between carotid IMT and frailty and between carotid diameter and frailty after adjusting for sociodemographic factors, cardiovascular risk factors, disability, and apolipoprotein E ε4 genotype. A 1-standard deviation ( SD) increase in IMT (odds ratio ( OR) = 1.15; P = .04) and a 1- SD increase in carotid diameter ( OR = 1.23; P = .006) were associated with greater probability of being frail. Conclusion The association between carotid structure changes and frailty suggests that frail elderly adults have vascular damage, which may explain, at least partly, why several adverse health-related outcomes are frequently observed in frail elderly adults. [ABSTRACT FROM AUTHOR]

Older patients represent an increasing population in emergency department (ED) with underlying diseases and longer ED length of stay, which are potential risk factors of pressure ulcers (PUs). The aim of the study was to determine the prevalence and incidence rates of PUs in an Emergency Department and to analyse variables related to PUs occurrence. The study was carried out in the Emergency Department of Bordeaux (France), and included 602 patients from 1 to 15 June 2010. All the potential body sites of pressure were examined at admission and discharge for all the patients by trained nurses. Comorbidity score, list of treatment, length of stay (hours), PUs (including stage I) and C-reactive protein (CRP) level were systematically recorded. A total of 47 (7·8%) patients had prevalent PUs at admission and 74 (12·3%) at discharge. The cumulative incidence was 4·9% and the incidence density was 5·4 per 1000 patients per hour. In multivariate analysis, higher comorbidities (OR 1·3; P = 0·014) and CRP levels (OR 1·005; P = 0·017) were both independent risk factors for developing PU. In conclusion, these data show that even a very short stay to the ED is sufficient to induce PUs especially stage I. [ABSTRACT FROM AUTHOR]

We described the introduction of complementary food (ICF) during the first year of life and identify associations observed with maternal and infant characteristics. We studied 3368 children included in the Epifane cohort, France, 2012. Maternal and infant characteristics and age at introduction of 28 complementary foods were collected at birth and at 1, 4, 8 and 12 months. Kaplan-Meier plots were used to represent probabilities of ICF. A score was used as tertiles in multinomial logistic regression to identify maternal and infant factors associated with ICF agreement with French recommendations. Median age of ICF was 152 days. While 12.6% of infants received complementary food before the age of 4 months, 95% of them were introduced after 7 months. Recommendations were generally followed, except for eggs and added fats, introduced in only 23.2% and 53.1% of 1-year-old infants, respectively. Factors significantly associated with the first ICF score tertile (low agreement with recommendations) vs. third tertile were as follows: maternal age 18-24 years (OR = 2.24 [1.49-3.35]) or 25-29 years (OR = 1.57 [1.21-2.04]), education less than or equal to high school graduation (OR = 1.94[1.51-2.48]), birthplace in France (OR = 2.13 [1.41-3.21]), three or more children (OR = 1.70 [1.15-2.51]), no follow-up antenatal classes (OR = 1.58 [1.22-2.04]), unemployment before and after pregnancy (OR = 1.64 [1.04-2.59]), unemployment before pregnancy and return to work within 12 months (OR = 2.06 [1.05-4.02]), no breastfeeding (OR = 2.08 [1.55-2.79]) or lasting <28 days (OR = 1.68 [1.22-2.31]) or 1-4 months (OR = 1.45 [1.08-1.96]). Recommendations concerning complementary food were generally followed. However, guidelines should be clarified and adapted to families who have difficulties in adopting them. [ABSTRACT FROM AUTHOR]