Search

Background: Many patients admitted to general emergency departments (EDs) have a pattern of drinking that could lead to future alcohol-related complications. However, it is often difficult to screen these patients in the context of emergency. The aim of this study is to analyze whether reasons for admission could help to screen patients who have an unhealthy alcohol use. Method: Patients were recruited among six public hospital ED in France, between 2012 and 2014. During a one-month period in each hospital, anonymous questionnaires including sociodemographic questions, AUDIT-C and RAPS4-QF were administered to each patients visiting the ED. The reason for admission of each patient was noted at the end of their questionnaire by the ED practitioner. Results: Ten thousand Four hundred twenty-one patients were included in the analysis. Patients who came to the ED for injuries and mental disorders were more likely to report unhealthy alcohol use than non-harmful use or no use. Among male patients under 65  years old admitted to the ED for a mental disorder, 24.2% drank more than four drinks (40  g ethanol) in typical day at least four time a week in the last 12  months. Among these patients, 79.7% reported daily or almost daily heavy episodic drinking (HED, 60  g ethanol), and all were positive on the RAPS4-QF. Conclusion: This study highlights that unhealthy alcohol use is frequent among ED patients and particularly among those who come for injuries or mental disorders. Men under 65  years old with a mental disorder require special attention because of their increased prevalence of daily or almost daily HED. [ABSTRACT FROM AUTHOR]

Background: The French National Observatory for Physical Activity and Sedentary Behaviors conducted a national survey aiming to evaluate the potential effects of confinement on the population's physical activity levels and sedentary behaviors. Methods: In close collaboration with the French Ministry of Sports and a selected expert committee, 3 different questionnaires investigating 3 subgroup populations were included in the survey: (1) children, (2) adolescents, and (3) adults. Results: Forty-two percentage of children, 58.7% of adolescents, 36.4% of adults, and 39.2% of older people had reduced physical activity levels. Particularly, active transportation and endurance practices showed a significant decrease, while domestic, muscular strengthening, and flexibility activities increased. Sitting time and screen time increased, respectively, in 36.3% and 62.0% of children, 25.5% and 69.0% in adolescents, 24.6% and 41.0% in adults, and 36.1% and 32.1% in seniors. Conclusion: The COVID-19 confinement period led to important modifications in individual movement behaviors at all ages, particularly favoring decreased physical activity and increased sedentariness. These findings suggest that the authors need to inform and encourage people to maintain and improve their physical activities and to change their sedentary time habits during postconfinement and during the period of a potential future lockdown. [ABSTRACT FROM AUTHOR]

We set out to identify factors of non-compliance with a protocol for the oral administration of misoprostol 25 µg (Angusta®) every 2 h (up to eight tablets), for the induction of labor (IOL). We conducted a retrospective study on IOL at term, on singleton pregnancies from 2019 to 2021, in a university hospital. The study included 195 patients, comprising 144 compliant protocols. Pain was statistically more frequent in the non-compliance group (92.2% vs. 62.5%, p < 0.001), and when a midwife was unavailable (15.7% vs. 0.7%, p < 0.001). A multivariable analysis found factors of good response (defined as going into labor before the administration of the median number of tablets, i.e., six) to be an indication for PROM (OR: 12.03, 95% CI: 5.42–26.71), and gestational age at induction (OR: 1.54, 95% CI: 1.19–2.01), independently of BMI, initial Bishop score, and parity. Patients with pain who were able to follow the protocol delivered 9 h earlier than patients with pain who interrupted the protocol and 16 h earlier than patients who experienced no pain. We identified two key elements that favored compliance: (i) providing the next tablet in advance; and (ii) offering patients early epidural analgesia when in pain in order to continue the protocol and go into labor promptly. [ABSTRACT FROM AUTHOR]

Purpose Blood pressure (BP) is measured at almost every general practitioner (GP) consultation in the region of Auvergne, France. A 2018 qualitative study shows that GPs measure BP to satisfy patients, whereas patients declare themselves indifferent to the absence of the measurement. The objective was to validate the results of a qualitative study, to quantitatively assess patient satisfaction when BP is not measured, and to study the factors associated with the degree of patient satisfaction. Methods This was a quantitative observational study conducted using self-questionnaires among patients in medical practices in Auvergne. Results Four hundred and ninety-two questionnaires were evaluated in 20 medical practices. Sixty percent of patients had indifferent or favorable feelings in the absence of BP measurement. In bivariate analysis, young age, male sex, absence of pathology, and low frequency of visits were associated with indifferent or favorable feelings in the absence of BP measurement. In multivariable analysis, a history of hypertension and psychiatric history were associated with unfavorable feelings. The intraclass correlation coefficient for practice-related variability was 5.6%. Patients' susceptibility to having particularly favorable or unfavorable feelings could be related to their GP (physician effect). Conclusion The hypothesis put forward in the qualitative study is confirmed: the majority of patients are in favor of or indifferent to the absence of BP measurement in general practice. General practice could be more efficient by measuring BP less frequently and better. [ABSTRACT FROM AUTHOR]

There is a growing interest regarding the effect of exercise on appetite and energy intake in youth. While the role of exercise intensity has been a primary focus of study, the effect of exercise duration on subsequent food intake has not been fully examined in obese adolescents. On three separate mornings in a randomly assigned order, obese adolescent girls (n = 20) aged 12–15 years old were asked to perform a rest session (control, CON) or two cycling sessions for 20 (EX20) or 40 min (EX40) set at their ventilatory threshold. Absolute and relative energy intake were measured from an ad libitum lunch meal 30 min after rest or exercise and appetite feelings assessed using visual analogue scales throughout the day. Hunger, satiety, and prospective food consumption were not significantly different between conditions. Absolute energy intake (kcal) did not differ between conditions, while relative energy intake on EX40 (571 ± 381 kcal) was significantly lower than during CON (702 ± 320 kcal; p <.05) and EX20 (736 ± 457 kcal; p <.05). Fat ingestion (in grams) was significantly lower on CON (7.8 ± 3.2 g) compared with EX20 (10.3 ± 4.6 g; p <.01). Protein intake (in grams) was higher on EX20 (37.0 ± 16.6 g) compared with both CON (29.5 ± 11.7 g; p <.01) and EX40 (33.1 ± 10.9 g; p <.05). However, the percentage of total energy derived from each macronutrient was not different between conditions. Obese adolescent girls do not compensate for an acute bout of exercise set at their ventilatory threshold by increasing energy intake, regardless of the exercise duration. [ABSTRACT FROM AUTHOR]

Public health issues related to chronic pain management and the risks of opioid misuse and abuse remain a challenge for practitioners. Data on the prevalence of disorders related to the use of prescribed opioids in patients suffering from chronic pain remains rather patchy, in particular because of the absence of a gold standard for their clinical assessment. We estimated the prevalence of prescription opioid misuse (POM), using a specific and validated opioid misuse scale (POMI-5F scale), in adults with chronic non-cancer pain. Nine-hundred-fifty-one (951) patients with opioids prescription and followed-up in pain clinics and addictology centers for chronic non-cancer pain (CNCP) completed the survey interview. The results suggest that 44.4% of participants have POM, accompanied by overuse (42.5%), use of opioids for effects other than analgesia (30.9%), withdrawal syndrome (65.7%), and craving (6.9%). The motivations cited for POM, apart from pain relief, were to calm down, relax and improve mood. POM was shown to be related to male sex (OR 1.52), young age (OR 2.21) and the presence of nociplastic pain (OR 1.62) of severe intensity (OR 2.31), codeine use (OR 1.72) and co-prescription of benzodiazepines (OR 1.59). Finally, despite the presence of three subgroups of misusers, no factor was associated with the intensity of misuse, reinforcing the view that distinguishing between strong and weak opioids is not appropriate in the context of use disorder. Almost half of patients with CNCP misuse their prescribed opioid. Practitioners should be attentive of profiles of patients at risk of POM, such as young, male patients suffering from severe nociplastic pain, receiving prescription for codeine and a co-prescription for benzodiazepine. We encourage French-speaking practitioners to use the POMI-5F scale to assess the presence of POM in their patients receiving opioid-based therapy. [ABSTRACT FROM AUTHOR]

Résumé: Le développement des filières gériatriques permet une hospitalisation en entrée directe évitant le passage par les urgences. À Clermont-Ferrand, depuis 2011, une ligne téléphonique dédiée permet une régulation des entrées. L'objectif de cette étude est d'évaluer l'impact du mode d'entrée (directe ou urgences) sur la durée moyenne de séjour (DMS) chez les patients hospitalisés en court séjour gériatrique (CSG). Méthodes: La DMS, ainsi que les données socio démographiques, le score d'autonomie, le MMS, les comorbidités, le mode de sortie, la survenue d'une hospitalisation dans l'année précédente et la polymédication ont été recueillis de manière rétrospective chez les patients âgés de plus de 75 ans. Résultats: 272 patients ont été inclus (88 « entrées directes » et 184 « urgences »). Les caractéristiques des groupes étaient comparables. La durée médiane de séjour pour le groupe « urgences » était de 14 [9,5 ; 20] contre 12 [8,5 ; 18] pour l'autre groupe (p = 0,03). En analyse multivariée, le score d'ADL et le mode de vie étaient corrélés à la DMS avec respectivement p = 0,009 et p = 0,018. Conclusion: La création de filières d'entrées directes en CSG par la mise en place de lignes téléphoniques dédiées permet une réduction de la DMS. Introduction: Development of the geriatric care allows direct hospitalization and avoid unnecessary emergency admissions. In Clermont-Ferrand, a specific hotline regulates direct entry from home and emergencies in the geriatric acute care unit. The aim of this study was to evaluate the impact of the entry mode (home or emergency) on the length of stay of patients hospitalized in acute care geriatric unit. Materials and methods: We have retrospectively collected data on hospitalization of patients over 75 years in the Geriatric Acute care unit from January to March 2019. We also collected socio-demographic data, autonomy score, MMS, co-morbidity score, exit mode, previous year's hospitalization and polymedication on hospitalization reports. Results: We included 88 patients in the "direct" group and 184 patients in the "emergency" group. The characteristics of the two groups were comparable. The median length of stay for the "emergency" group was 14 days [9.5; 20] versus 12 [8.5; 18] for the "direct" group (p=0.03). In multivariate analysis, ADL score and home lifestyle were correlated with duration of stay. Conclusion: The development of direct entrance pathways into the geriatric short-stay department by establishing specific hotlines decreases length of stay. [ABSTRACT FROM AUTHOR]