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Objective: Environmental factors contribute to more than 25% of all global disease but as medical student, we consider that environmental health is insufficiently taught. We are not armed for facing patient's questions, prevent diseases linked to environmental exposure and adapt care in susceptible population., Material and Methods: We conducted a national French survey, using a web-based questionnaire from October to November 2021. All medical students were interrogated to assess their knowledge on environmental health and their desire to obtain a specific curriculum on this topic., Results: Two hundred and thirty-two students responded to the survey and most (62.7%) had never had any teaching on environmental health during their medical studies. The majority claimed to have no knowledge on environmental health (63.6%), and most had never been read or seen media content about it (59.2%). Those who had knowledge on environmental health, had been informed through social media, questioning the reliability of this content. Most (87.3%) were ready to take a specific course on environmental health issues during their medical studies in order to better inform their patients with evidence-based medicine and identify at risk population., Conclusion: Through a survey, we identified the need and the emergency of implanting a curriculum on environmental medicine in our medical education., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: Indocyanine green (ICG) for axillary sentinel lymph node (SLN) detection in early breast cancer is at least equivalent to radioisotopic and/or colorimetric techniques. This procedure has not yet been recommended by learned societies in France. Following the recent drug approval of Infracyanin ® in this indication, we wished to study the use of ICG in France., Methods: We conducted a web-based survey among members of multiple French breast cancer societies throughout November 2021. The survey assessed the profile of the respondent, the use or not of ICG for the detection of SLN in breast cancer, the technique used and the opinion of non-users and their expectations on the subject., Results: Seventy-five surgeons participated. More than a third (37 %) have been using ICG for the detection of SLN in breast cancer for 2 to 3 years. Technique was highly variable. According to 82.1 % of the respondents, less than 20 procedures are necessary to master the use of ICG. The main advantage reported for this method is the reduction of organizational constraints. The obstacles to the use of the ICG are the near infra-red camera equipment, but also the lack of validation by the French guidelines. Among non-users, 83 % would like to develop this technique in their center and 72.3 % are interested in training on this subject., Conclusion: This work highlights the need for French learned societies to take a stand on this issue but also the need to carry out studies on the technical aspects in order to standardise practices., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Veterinarians' professional jurisdiction is nowadays facing major challenges. Regulatory changes in the prescribing and dispensing of medicines, which have historically been at the heart of veterinary jurisdiction, could fragilize the medical power of this professional group. This article analyses the practices and strategies deployed by veterinarians to preserve and readapt their jurisdiction, by discussing recent work in sociology of professions and reflecting on how the case of veterinarians could help rethink the contrasting case of human doctors. This article is based on two field studies in France (in diverse livestock sectors) made of more than 40 interviews and 70 h of ethnographic observation of veterinary activity. We first show how veterinarians' jurisdiction over medicines was built up and how their professional autonomy is put under pressure by recent injunctions to demedicate livestock and to develop preventive approaches to animal health. We then detail how the economic and medical boundaries of veterinary jurisdiction are being redefined through dynamics of protocolization and contractualization of care which allow veterinarians to impose themselves as health managers. Finally, we demonstrate that this situation favors the emergence of new forms of professional legitimacy based on an "evidence-based veterinary medicine" that their competitors cannot contest, and on the development of economic infrastructures that supports and makes it possible to monetize this new professional expertise. Finally, this article discusses contemporary processes of medical professionalization. It argues that, unlike human medicine, veterinary medicine has been able to maintain its professional power even if its historical jurisdiction has been reshaped. This has required a redefinition of professional activity both as a medical (i.e. approaches to animal health) and economic (i.e. business model of veterinary companies) practice., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer., Patients and Method: We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated., Results: A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement., Conclusion: We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: A nudge corresponds to any procedure that influences choice architecture, without using persuasion or financial incentives. Nudges are effective in increasing vaccination with heterogeneous levels of acceptability., Objective: To evaluate the effectiveness and acceptability of a nudge promoting influenza vaccination for general practice trainees, also called residents., Methods: The hypothesis was that a reminder would be efficient and accepted and that prior exposure to a nudge increases its acceptability. Residents were randomly divided into three parallel experimental arms: a nudge group, a no-nudge group and a control group in order to evaluate the Hawthorne effect. The nudge consisted of providing a paper form for the free delivery of the vaccine and contacts for occupational health services., Results: The analysis included 161 residents. There was a strong consensus among the residents that it is very acceptable to nudge their peers and patients. Acceptability was better with residents exposed to the nudge and with residents included in step 1 (Hawthorne effect). The nudge did not increase vaccination coverage., Conclusion: The failure of this nudge highlights the importance of matching an intervention to the population's needs. The experimental approach is innovative in this context and deserves further attention., Clinicaltrials.gov Pre-Registration: NCT03768596., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Dispersal is a key mechanism enabling species to adjust their geographic range to rapid global change. However, dispersal is costly and environmental modifications are likely to modify the cost-benefit balance of individual dispersal decisions, for example, by decreasing functional connectivity. Dispersal costs occur during departure, transience and settlement, and are levied in terms of energy, risk, time and lost opportunity, potentially influencing individual fitness. However, to the best of our knowledge, no study has yet quantified the energetic costs of dispersal across the dispersal period by comparing dispersing and philopatric individuals in the wild. Here, we employed animal-borne biologgers on a relatively large sample (N = 105) of juvenile roe deer to estimate energy expenditure indexed using the vector of dynamic body acceleration and mobility (distance travelled) in an intensively monitored population in the south-west of France. We predicted that energy expenditure would be higher in dispersers compared to philopatric individuals. We expected costs to be (a) particularly high during transience, (b) especially high in the more fragmented areas of the landscape and (c) concentrated during the night to avoid disturbance caused by human activity. There were no differences in energy expenditure between dispersers and philopatric individuals during the pre-dispersal phase. However, dispersers expended around 22% more energy and travelled around 63% further per day than philopatric individuals during transience. Differences in energy expenditure were much less pronounced during the settlement phase. The costs of transience were almost uniquely confined to the dawn period, when dispersers spent 23% more energy and travelled 112% further than philopatric individuals. Finally, the energetic costs of transience per unit time and the total distance travelled to locate a suitable settlement range were higher in areas of high road density. Our results provide strong support for the hypothesis that natal dispersal is energetically costly and indicate that transience is the most costly part of the process, particularly in fragmented landscapes. Further work is required to link dispersal costs with fitness components so as to understand the likely outcome of further environmental modifications on the evolution of dispersal behaviour., (© 2019 The Authors. Journal of Animal Ecology © 2019 British Ecological Society.)

Background: Psychiatric care is a fruitful setting for exploring the rise of surveillance medicine, which shapes gray zones of uncertainty between health and illness. Predicting psychosis has become a priority in the international mental health field, but French psychiatrists appear reluctant to refer their young patients for standardized assessments or disclose their risks to them., Aim: This research addressed French psychiatrists' attitudes towards risk disclosure about psychosis to adolescents presenting symptoms that might reflect either typical teenager unease or the first signs of psychosis onset., Methods: A mixed-method design included 12 in-depth qualitative interviews followed by an online survey with responses from 487 psychiatrists., Results: French psychiatrists' reluctance to engage in risk disclosure emerges from a professional norm: a belief in the self-fulfilling prophecy. They - especially those with a background in social science and psychology - believe in the optimistic self-fulfilling prophecy. They fear the consequences of pessimistic predictions, struggle to maintain functional optimism, favor long-term inconspicuous medical watchfulness, and systematically understand favorable outcomes as a consequence of medical care, independent of the accuracy of risk detection., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Teenage pregnancy represents a global risk. In France, in 2016, 1.14% of pregnancies concerned 15-17 year olds. Rare in our societies, they are socially condemned. A medical-psychological-sociological literature review shows that, beyond the contraceptive failure or the accidental nature evoked, it is essential to spot high risk situations and focus on the meaning behind these teenage pregnancies., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Aim: Since 1999, the development of more than 100 "Maisons des Adolescents" (MDAs) has enabled young persons to gain access to specific care in integrated youth-friendly facilities in France. To contribute to the development and standardization of international youth-friendly health care services, this review provides insight into the French MDA facilities., Methods: This socio-historical analysis includes a systematic review of articles referring to the MDAs (selection through title and/or abstract), ministry reports and newspaper articles, from 1999 to 2018., Results: If the various medical programmes of MDAs depend on the priorities of local teams rather as well as on official regulations, all MDAs offer the following essential services: a "Health and Prevention Space" open daily; multidisciplinary consultations; a mobile team visiting youth hospitalized in medical units; a mobile team able to meet adolescents at their homes; an open centre for art workshops; refresher and remedial courses for school work; network meetings and parent support groups. The MDAs from the start addressed an age group (young people aged 11-21 years) rather than an illness. They thus provide primary prevention for adolescents according to the World Health Organization definition of health as "a state of complete physical, mental and social well-being." This medical and political movement was shaped by the epistemological background of its first leaders., Conclusion: Although more cohort studies to evaluate their early interventions would be useful, the success of the MDA network is already widely acknowledged by users, professionals and policy makers., (© 2018 John Wiley & Sons Australia, Ltd.)

Background: Intraperitoneal (i.p.) epinephrine was shown to increase the accumulation of i.p. cisplatin in tumours, and thus its antitumour effect in a model of peritoneal carcinomatosis in rats., Methods: To determine the tolerance to i.p. epinephrine with cisplatin, 18 patients with recurrent ovarian carcinoma were intraoperatively treated in this phase 1 study. After maximal cytoreductive surgery, the peritoneal cavity was filled twice for 1 h with 30 mg/l of cisplatin and increasing concentrations of epinephrine (0, 1, 2, 3 mg/l) in 3 l of saline solution at 37 degrees C., Results: No deaths occurred. Three patients were treated at each of the 0, 1 and 2 mg/l epinephrine levels without adverse events. Two of the three patients who received 3 mg/l epinephrine experienced cardiac intolerance. Six additional patients received 2 mg/l of epinephrine without toxicity. A relationship between the serum concentration of epinephrine and occurrence of cardiac toxicity was established. A 60% decrease in serum area under the curve of platinum was calculated in patients receiving i.p. epinephrine compared with i.p. cisplatin alone. Renal toxicity from cisplatin was not increased by epinephrine. No haematological or neurological toxicity was recorded. The other grade 3-4 adverse events [thromboembolism (5), peritonitis (1), abdominal bleeding (1), bowel fistula (1)] occurred as often as usually reported for this heavy surgical procedure., Conclusion: The combination of i.p. epinephrine with cisplatin as intraoperative chemotherapy after optimal cytoreductive surgery is feasible. The recommended concentration for further studies is 2 mg/l for i.p. epinephrine.

Background: Few population-based studies investigate obstructing colorectal cancers. This study was designed to describe trends in their frequency and management., Methods: Data were obtained for 13,331 colorectal cancers registered by the population-based cancer registry of Burgundy, France, between the years 1976 and 2000., Results: Obstructing cancers represented 8.3 percent of all colorectal cancers. This proportion was stable throughout the study. Resection for cure increased from 54.9 percent (1976-1980) to 71.4 percent (1996-2000; P = 0.011). Using multivariate analysis, site of cancer and period of diagnosis were the only factors significantly associated to a curative resection. Postoperative mortality for obstructing colorectal cancers decreased from 32.6 percent (1976-80) to 15.2 percent (1996-2000; P < 0.001). The presence of obstruction was significantly associated with a higher postoperative mortality, independent of age and tumor stage (odds ratio = 2.55; 95 percent confidence interval = 2.13-3.5)., Conclusion: The frequency of obstructing colorectal cancers has remained unchanged for 25 years. Operative mortality is still high, although some improvements have occurred. Efforts must be made to diagnose colorectal cancers before obstruction occurs. Mass screening represents a promising approach.

Objective: The aim of this study is to describe the evolution of therapeutic practices and the evolution of survival between 1982 and 1996 in a population of ovarian carcinomas. All the patients were registered in the "Registre des Cancers Gynécologiques de Côte-d'Or-France"., Population and Methods: During this period, 546 cases of ovarian cancers were registered. Data about FIGO staging at the diagnosis, histologic type, initial surgical procedures and survival were studied., Results: During this period, 61.7% of the patients had a complete resection of their tumor. The frequency of complete removal increased significantly during the period of this study. Complete removal moved from 56%, between 1982 and 1984, up to 75%, between 1993 and 1996. Complete removal was possible in 98.1% of the FIGO stage 1 cases while it was possible in only 18.3% of the stage IV. 76.9% of the patients younger than 50 years old had a complete removal while only 29% of the women older than 80 years old had a complete removal. Fifty percent of stage I received chemotherapy as long as 85% of patients younger than 50 years old. After 1993, only 2.6% of them had radiotherapy. The global survival rate at 5 years was 35.4%., Conclusions: Surgery is the major procedure to obtain a complete remission of ovarian cancer. The efficacy of current chemotherapies may modify the initial management of these tumors, particularly in modifying the chronology of the different therapeutic sequences.

Objectives: The goal of this study was to evaluate the technical feasibility of sentinel node biopsy in breast cancer and its capacity to predict axillary node status., Material and Methods: Between February 2000 and June 2001, 70 patients with invasive breast carcinomas referred to the cancer center of Dijon, underwent lymphatic mapping (patent blue dye and lymphoscintigraphy with a gamma probe) and sentinel node biopsy followed by axillary clearance (Berg's level 1 and 2)., Results: A sentinel node was identified in 94.26% of the patients. We noted 2 false negative sentinel lymph nodes. The sentinel lymph node was involved in 32.8% of the patients and was the only node involved in 14.2% of the patients., Conclusion: This study confirms the feasibility of sentinal node mapping, emphasizing the advantage of using two methods (patent blue dye and gamma probe). A learning curve is required. This procedure is not adapted for tumors larger than 3 cm because of a greater risk of sentinel node involvement and the need for a complete procedure with an axillary clearance.