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Vine training and pruning are cultural strategies that can be deployed to manage grapevine trunk diseases (GTDs). Forty-year-old commercial vineyards in the Cognac region, France, trained to either Guyot-Arcure (severe pruning) or Guyot-Poussard (minimal pruning), were studied to determine how the two systems affected trunk disease symptomatology. Effects of pruning practices on the pathobiome and mycobiome of asymptomatic grapevines were also assessed, using culture-and amplicon-based Illumina sequencing approaches. The hypothesis examined was that severe pruning of Guyot-Arcure increases trunk diseases incidence and severity, and causes higher pathogen load and microbial diversity, compared to Guyot-Poussard. Numbers of symptomatic and asymptomatic vines for the two training systems were recorded over 3 years, including numbers of vines with esca foliar symptoms, and partially unproductive and dead vines. Six asymptomatic vines from each pruning method were selected, and culturing and sequencing data were obtained from 27 samples per vine. Fungi in the Phaeomoniellaceae, Togniniaceae, and Botryosphaeriaceae were the most frequently identified. The data indicated that severe pruning increased risk of pathogen infections, with Phaeomoniella chlamydospora, Phaeoacremonium minimum and Diplodia sp. being the most commonly identified fungi. Greater numbers of dead or dying vines were recorded in the severely pruned vineyard, indicating that this strategy shortens vine longevity. Results also showed that severe pruning increased endophytic microbial diversity, and that the pruning methods influenced mycobiome community composition. This knowledge will improve recommendations to growers for practical and cost-effective ways to manage GTDs. [ABSTRACT FROM AUTHOR]

Background: Rare diseases, also referred to as orphan diseases, are characterised by their low prevalence with majority of them are chronically debilitating and life threatening. Given the low prevalence and the widely dispersed but very small patient base for each disease, there may often be a disproportion in the availability of treatments and resources to manage patients, spur research and train experts. This is especially true in Southeast Asian countries that are currently in the process of implementing or revising their universal health coverage schemes. This paper aims to examine the status of rare disease management in Southeast Asian countries. It will serve as the basis for a more active discussion on how countries in the region can address an under-recognised rare disease burden and enhance national and regional capacities.Methods: The study consists of literature reviews and key stakeholders interviews in six focus countries, including the Philippines, Singapore, Malaysia, Indonesia, Vietnam, and Thailand and five countries as best practice, comprising of France, Canada, Australia, Taiwan, and South Korea. Rare disease management initiatives across each country were examined based on the World Health Organization's framework for action in strengthening health systems.Results: The results suggest rare disease management remains challenging across Southeast Asia, as many of the focus countries face fundamental issues from basic healthcare systems to funding. Nonetheless, there are substantial improvement opportunities, including leveraging best practices from around the world and organising a multi-stakeholder and regional approach and strategy.Conclusions: Southeast Asian countries have made significant progress in the management of rare disease, but there remain key areas for substantial development opportunities. [ABSTRACT FROM AUTHOR]

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Abstract: Objectives: To develop recommendations about treatment (except anti-TNF agents) of psoriatic arthritis with peripheral joint involvement (PsA) seen in everyday practice, using evidence from the literature, supplemented with expert opinion when needed. Methods: The recommendations were based on evidence from the literature. First, a scientific committee used a Delphi procedure to select five focal points of interest. Then, a literature task force looked for relevant publications in the following: Cochrane, Pubmed, and Ovid databases and abstracts from the French Society for Rheumatology, European League against Rheumatism and American College of Rheumatology. Based on the data from these publications, recommendations were drafted and then validated by a group of 68 experts. The strength of each recommendation was determined, as well as the extent of agreement among the experts. Results: The evidence extracted from 73 selected papers was presented to experts during interactive workshops. At the end of the workshops, the experts drafted six recommendations, which were then validated by a final vote including all participants. These six recommendations displayed various strength from B to D. Conclusion: These recommendations should help to improve practice uniformity and, ultimately, to improve the management of PsA in France. [Copyright &y& Elsevier]

Context: Despite numerous examples of health policy transfer in Western health systems, the nature of such "inspired" reforms has received little detailed attention. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms using the theoretical frameworks of transfer and translation. Methods: The design is based on a comparative case study: the introduction of disease manage- ment programs (DMPs) for diabetes in Germany in 2002 and in France in 2008, drawing on a literature review and semistructured interviews. Findings: In introducing its DMR Germany chose and combined several components in a process of selective borrowing, while France opted for copying a specific foreign program and adapting it. Such differences in process are linked to distinct system structures, in particular the setup of health insurance and the representation of physicians. Furthermore. the displayed versus actual degree of inspiration varied signi ficantly. with a branding strategy in Germany (high display of foreign influence) and the inverse picture in France (high degree of actual inspiration). Conclusions: This analysis has applied the dual perspective of transfer and translation. Both perspectives proved complementary and necessary, and translation appeared as a main determinant of implementation success. [ABSTRACT FROM AUTHOR]

Objective To set priorities to improve consultations, care structures and the healthcare system from the perspective of patients with chronic conditions, care professionals, hospital administrators and health policy makers. Methods Adult patients with chronic conditions recruited from the ComPaRe e- cohort in France ranked their 15 most important areas of improvement among 147 previously defined by patients. Priorities at a population level were obtained by using logit models for sets of ranked items in a data set calibrated to represent the French population of patients with chronic conditions. Care professionals, hospital managers and health policy makers rated the complexity involved in improving the areas identified. We calculated the number of patients who considered as a priority at least one of the areas considered easy to implement. Results Between September 2018 and May 2019, 3002 patients (84% women, 47% with multimorbidity) and 149 professionals (including 50 care professionals, 79 hospital directors, 11 health policy decision makers) were recruited. Patients' top priorities were (1) Transforming care to be holistic and personalised, at a consultation level; (2) Smoothing patients' journey in the care system, increasing their knowledge of their own health and improving care coordination, at a care structure level (3) Training clinicians in better interpersonal skills and knowledge of specific conditions/treatments, reducing stigma and making care more affordable, at a healthcare system level. In total, 48%, 71% and 57% patients ranked in their top priorities one area considered easy to improve by professionals at consultation, care structure and health system levels, respectively. Conclusion This is the first comprehensive map of patients' priorities to improve the management of chronic conditions. Implementing simple actions could benefit a large number of patients. [ABSTRACT FROM AUTHOR]

In this study, the concussion mechanisms were analyzed in male professional competition football, with the main objective to specify the frequency of head‐to‐head impact, and immediate management of the concussed players was described in order to check its compliance with the recommendations of football's governing bodies. Based on continuously recorded data from the French Football Federation (FFF), a retrospective database of all reported concussions during matches in the 1st and 2nd French Male leagues was generated comprising seasons 2015/16‐2018/19. Injury mechanisms, playing action, immediate medical assessment and management of concussed players, and foul play—referee's decision, were analyzed from video recordings. In total, 41 concussions were reported (incidence rate of 0.44/1000 hours of match exposure [95% CI: 0.40 to 0.49]) of which 36 were identified and analyzed on video sequences. The commonest playing action leading to concussion was aerial challenge (61%), and the main mechanism was head‐to‐head impact (47%). Following the head impact, 28% of concussed players were not medically assessed on pitch and 53% returned to play the same match. Head‐to‐head impact was not associated with systematic medical assessment, nor with foul play. In conclusion, the main cause of concussions involved head‐to‐head impact occurring when two players challenge for heading the ball in the air. The detection of potential concussive head impacts and the immediate management of players possibly concussed during matches remain insufficient according to the international recommendations. Some rules changes, with particular vigilance in case of head‐to‐head impact, should be discussed. [ABSTRACT FROM AUTHOR]

Background: Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to deep carious lesion (DCL) management in permanent teeth, and there is a lack of data in primary teeth. Aim: A cross‐sectional questionnaire survey was undertaken to describe the management strategies for DCL of vital primary teeth, focusing on the different caries removal techniques, among dentists practicing pediatric dentistry (DPPDs) in France. Their behavior was compared to members one registered to European Academy of Pediatric Dentistry (EAPD). Design: A questionnaire was electronically administrated (2018–2019) to members of the Collège des Enseignants en Odontologie Pédiatrique (CEOP), the Société Française d'Odontologie Pédiatrique (SFOP), and the EADP. Descriptive and statistical analyses were performed. Results: Response rate was, respectively, for CEOP, SFOP, and EAPD about 74%, 29%, and 15%. About half of the respondents (53%) would perform a complete caries removal into one step when 12% would indicate a stepwise technique: 68% of the DPPDs practicing in France would perform complete caries removal in one step when the preferred option in the other EAPD members was the selective excavation (44%) (P <.001). Conclusions: Complementary education of French dentists in the domain of caries management appears necessary regarding current recommendations. [ABSTRACT FROM AUTHOR]

ObjectiveRecent studies highlighted that many HIV-positive migrants in Europe acquired their infections post-migration. However, the timing of these infections is not always known. This study aims to estimate the timing of post-migration HIV acquisition among sub-Saharan migrants in France and to understand the correlates of post-migration infection.Methods: Within the PARCOURS retrospective survey conducted in 2012-2013 in 74 healthcare facilities in the Paris region, life-event data were collected among a random sample of 926 patients living with HIV in HIV services and 763 patients undiagnosed with HIV in primary care centres born in sub-Saharan Africa (reference group). Based on previous analysis, we considered the first 6 years in France after migration as a settlement period. Among the persons who acquired HIV after migration, we estimated the proportion of persons infected during settlement (0-6 years after migration) and after settlement (>6 years after migration) by using an algorithm that combines life-event data and a modelisation of CD4+ T-cell count decline. We then assessed the determinants of HIV acquisition during settlement and after settlement using bivariate logistic regression models.Results: Overall, 58% of sub-Saharan migrants who acquired HIV after migration were infected during the first 6 years in France. HIV acquisition during settlement was found to be linked to short/transactional partnerships and lack of a resident permit. 42% of migrants had contracted HIV after settlement. After settlement, HIV acquisition was associated with short/transactional but also with concurrent partnerships and not with social hardship.Conclusion: Two profiles of HIV post-migration acquisition emerged. The majority of HIV post-migration acquisition occurs during the settlement period: comprehensive combination prevention programmes among recently arrived migrants are needed. However, long-term migrants are also at risk for HIV through multiple partnerships. Prevention programmes should address the different profiles of migrants at risk for post-migration HIV acquisition. [ABSTRACT FROM AUTHOR]

Background: Management of adolescent and young adults (AYAs) cancer is very heterogeneous. In the case of lymphomas, outcomes are mostly favorable but there is still room for improvement. Design: We retrospectively collected the pattern of care of all institutional 13- to 25-year-old AYAs patients with classical Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) diagnosed in the Rhône-Alpes region between the years 2000 and 2005. Management, including adherence to Clinical Practice Guidelines (CPGs), and long-term survival were analyzed by comparing adult units (AU) and pediatric units (PU). Results: 278 patients were included: 198 treated for HL (median age of 19 years), 80 treated for NHL (median age of 20 years). Among them, 74% were managed in AU and 26% in PU. The median time between diagnosis and starting treatment was significantly lower in PU than in AU. Sixty-five patients (23%) were included in clinical trials, mostly in AU. Five-year overall survival was 96% for HL [14 deaths, median follow-up 91 months (9–180)] and 90% for NHL [nine deaths, median follow-up 80 months (3–180)]. Secondary cancers occurred for 2% (n = 3) of HL patients and for none in NHL. Other major late complications included cardiovascular accidents in two patients and fatal pulmonary fibrosis in one patient. Major differences in chemotherapy and radiotherapy use are emphasized. Global management conformed to CPGs by 56%. Conclusions: Important differences between adult and pediatric management were reported, without any impact on survival. A few patients can be included in clinical trials: Homogeneity in management could improve specific care for AYAs. [ABSTRACT FROM AUTHOR]

Aim: To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years.Methods and Results: From the 1997-2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes [Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality] and predictors of in-ICU mortality. Of the 316 905 ICU admissions, 19 416 (6.1%) exhibited CS, with incidence increasing from 4.1% to 7.7% (P < 0.001). Over time, the age of admitted patients decreased by 2.7 years [95% confidence interval (CI), -2.0 to -3.4] and SAPS-II increased by 5.8% (95% CI 4.8-6.8) from 58.7 ± 25.3 to 64.5 ± 23.3 (P < 0.001). Crude in-ICU mortality declined from 50% to 45% (-5.6%; 95% CI -7.7 to -3.5) as SAPS-II Standardized ICU mortality rates decreased from 56.5% to 44.2% (P < 0.001). A more recent time-period was an independent correlate of decreased mortality in multivariate analyses. The decrease in mortality rate was more marked in patients with decompensated heart failure, cardiac arrest, or acute myocardial infarction.Conclusions: Patients with CS represent a greater proportion of patients admitted to ICUs over the past 15 years, having become younger but more critically ill. Although their mortality has decreased, suggesting improved overall patient management, it remains particularly high, warranting further research specifically focused on this population. [ABSTRACT FROM AUTHOR]

What is new and objectives Trends in the care of glioblastoma in actual practice settings are poorly described. In a previous pharmacoepidemiologic study, we highlighted changes in the management of patients with glioblastoma ( GBM) newly diagnosed between 2004 and 2008. Our aim was to complete and to extend the previous report with a study of a cohort of patients diagnosed in 2011 to emphasize the trends in the pharmacotherapy of GBM over the last decade. Methods A single-centre study was undertaken of three historic cohorts of GBM patients newly diagnosed during years 2004, 2008 and 2011 (corresponding to groups 1, 2 and 3, respectively) but limited to patients eligible for radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total cost from diagnosis to death or the last follow-up date. Cost analysis was performed from the French sickness fund perspective using tariffs from 2014. Results Two hundred and seventeen patients (49 in Group 1, 73 in Group 2, 95 in Group 3) were selected with similar baseline characteristics. Fluorescence-guided surgery using 5- ALA was increasingly used over the three periods. There was a strong trend towards broader use of temozolomide radiochemotherapy (39%, 73% and 83% of patients, respectively) as first-line treatment as well as bevacizumab regimen at recurrence (6%, 48% and 58% of patients, respectively). The increase in overall survival between Group 2 and Group 1 was confirmed for patients in Group 3 (17·5 months vs. 10 months in Group 1). The mean total cost per patient was 53368 € in Group 1, 70 201 € in Group 2 and 78355 € in Group 3. Hospital care represented the largest expenditure (75%, 59% and 60% in groups 1, 2 and 3, respectively) followed by chemotherapy drug costs (11%, 30% and 29%, respectively). What is new and conclusion This is the first study to report on changes in the management of GBM in real-life practice. The ten-year study indicates an improvement in overall survival but also an increase in total cost of care. The data should be useful for informing the care of GBM patients in settings similar to ours. [ABSTRACT FROM AUTHOR]

Background: Currently, little data is available about the management of asthma in the working population. The aim of this study was to describe asthma control and severity among workers according to current or previous allergic rhinitis comorbidity.Methods: A network of occupational physicians participated in this pilot study on a voluntary basis. They included a random sample of salaried workers during their systematic occupational medical check-up. All subjects completed a self-administered questionnaire based on the European Community Respiratory Health Survey screening questionnaire, and if they reported any respiratory symptoms including allergic rhinitis, the physician filled in a medical questionnaire. Current asthma control and severity were evaluated according to 2006 Global Initiative for Asthma guidelines.Results: A total of 110 occupational physicians from two French regions participated. Out of the 6906 employees screened, 3102 identified respiratory symptoms and completed the medical questionnaire and performed spirometry. Overall, 374 were identified as current asthmatics, including 271 (72.5%) with allergic rhinitis. Among current asthmatics with current allergic rhinitis (n = 95), 68.8% had partially controlled asthma or uncontrolled asthma, including 51.6% who received insufficient anti-asthmatic treatment. Partly or no control asthma was not associated with current rhinitis (OR = 1.4; 95% CI: 0.8-2.7). Current asthmatics with current or previous allergic rhinitis had a significantly lower risk of emergency department visits than current asthmatics without allergic rhinitis (respectively 11.6, 17.1 and 29.1%; P = 0.002).Conclusions: Most current asthmatics both with and without allergic rhinitis had uncontrolled asthma, with inappropriate treatment. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace. [ABSTRACT FROM AUTHOR]

Rationale In nephrology, the NEOERICA project assessed the feasibility of the diagnosis scheme based on a general practice database. This approach opened a new area where routinely collected data could be used for purposes other than patient management, such as epidemiological analysis and professional practice evaluation. In Lyon, the TIRCEL network is made up of a coordination team and an online database. In 2008, a total of 468 professionals participated and 983 patients were in the database corresponding to 4114 consultations and 9250 biological assessments. Objective To investigate the impact of a quality control process on the data from operational databases. Methods We set up a quality control process and we described the impact of this process on data. We also specifically investigated the role of measurement scales in error frequency and we studied the impact of data quality on variables which could be used for professional practice evaluation. Results Quality control allowed us to detect as inconsistent data 7.5% of tested data. This rate is linked to the parameters and varied from less than 1% (weight, diastolic blood pressure and urinary sodium) to more than 30% (serum iron and ferritin). Quality control led mainly to the validation of the identified data for 80.4%, a direct correction was realized for 12.9%, 5.6% by the lab and only 1.2% were set to missing. Average proteinuria was modified with the quality control process (2.09 g per 24 hours vs. 0.82 g per 24 hours); however, the median remained stable (0.21 g per 24 hours). Conclusion Specialty databases such as TIRCEL could not be used for epidemiological research or for the extraction of indicators for professional practice evaluation without strict quality control or the set-up of data-entering limits and alarms. [ABSTRACT FROM AUTHOR]

Although numerous mathematical models focusing on measles dynamics have been proposed in the literature, efforts in this area have concentrated essentially on the mechanisms of measles propagation. If present, vaccination diffusion is treated as an exogenous factor. Here we propose a model focused on the course of measles in France in which the mechanisms of vaccination diffusion are explicitly modeled. The parameters in this model are estimated by an original method based on an expectation-maximization algorithm. This model gives indications of the way in which measles propagation and vaccination diffusion interact. It also allows discussion of the possibility of eliminating this disease in France in the near future. [ABSTRACT FROM AUTHOR]

Given the need to reduce pesticide use and rising consumer demand for healthy food, organic vineyard areas have increased since 2000. Converting to organic farming requires numerous changes in pest and disease management, fertilization and weeding techniques. These changes can lead to difficulties in sustaining yields. Some studies have highlighted higher yields in conventional farming than in organic agriculture, but knowledge on yield dynamics during conversion is lacking. A set of 26 plots, under conventional management and in conversion to organic farming, were monitored from 2013 to 2016 in southern France throughout the three-year conversion phase to investigate the dynamics of grape yield and yield components. The survey showed that the yield and yield components remained similar levels as in conventional farming from the third year of conversion. However, the first two years of conversion were a transitional and less successful period during which yield and yield components decreased. Based on the in-depth analysis of the yield components, we have put forwards hypotheses on the processes at play and technical advice that could support winegrowers as they convert to organic farming. [ABSTRACT FROM AUTHOR]