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Abstract Background Autistic individuals often have difficulty flexibly adjusting their behavior. However, laboratory experiments have yielded inconsistent results, potentially due to various influencing factors, which need to be examined in detail. This study aimed to investigate the hypothesis that the social content of stimuli could play a specific role in some of the flexibility challenges faced by autistic individuals. The second aim was to explore sex differences in this context. Methods We analyzed data from 256 adult participants (124 with autism), matched on age, gender, and sex, who performed an emotional shifting task involving unpredictable shifts between positive and negative stimuli. Additionally, the task included both social and non-social conditions. Results Our results revealed a larger switch cost in the social than in the non-social condition, and this was more pronounced in autistic than in non-autistic individuals. Furthermore, we observed that autistic females differed from autistic males in the non-social condition and from non-autistic females in the social condition. Limitations The online nature of the study reduced the control over participant conditions. In addition, further studies are needed to investigate whether these results apply to the broader autism spectrum. Conclusions Building on previous research demonstrating a greater switch cost in autistic than non-autistic individuals for socio-emotional stimuli, our study further extends these findings by highlighting that the social context, rather than the emotional nature of the stimuli alone, may play a significant role in the flexibility challenges faced by autistic individuals. Our findings also contribute to the literature on sex differences in autism.

Purpose – Job insecurity is one of the most hazardous work stressors in the twenty-first century, placing employees between employment and unemployment may threaten employees’ health in the workplaces. Using a systematic review, the first aim of this study is to list the mediators and moderators of the link between job insecurity and health-related outcomes, and second, to explain and discuss the mechanisms that could explain the mediating and moderating effects. Design/methodology/approach – We searched four databases (Science Direct, PubMed, Springer Link and Google Scholar) from 2008 to 2018 to detect these mediators and moderators. Also, as the study was conducted during COVID-19 pandemic, we particularly searched and reported the same associations over this period (2019–2022). Findings – The results of the review suggest that job insecurity negatively influences a wide range of both health- and safety-related outcomes in the workplace. The results also showed that the most studied mediator and moderator of the job insecurity-health link over the past 10 years has been workload and employability. During COVID-19, the number of studies on mediators were more than moderators and coping strategies appeared to gain more research attention. Additionally, this review suggests that, to explain the mediation and moderation effects, a combination of cognitive appraisal theory and the conservation of resources theory can be used. Originality/value – Although this review suggests that job insecurity detrimentally influences employee health, the severity of this impact on health-related outcomes may vary by the effects of various moderators.

ObjectivesTo study the relationship between the occupational stress model, specifically the Job Demand-Control Model of Karasek, physical activity level and sedentary behavior.MethodThis is a cross-sectional, observational, descriptive study. A self-administered questionnaire was distributed to 100 volunteers working at Clermont Auvergne University. The questionnaire included the Karasek questionnaire and the International Physical Activity Questionnaire.ResultsThe results reveal that occupational characteristics play a significant role, with individuals exhibiting high job control showing reduced sitting time and increased physical activity compared to those with low job control. Job strain was associated with increased sitting time and decreased physical activity. Further analysis revealed that being in a state of job strain significantly predicted sitting for more than 7 h per day. Similarly, job strain and isostrain were explanatory factors for having a low to moderate physical activity level. Logistic regression quantified the risks, indicating that sitting for more than 7 h per day increased the risk of job strain by 4.80 times, while high physical activity levels and being male reduced the risk by 79 and 84%, respectively. Job strain also increased the risk of prolonged sitting by 5.06 times and low to moderate physical activity levels by 5.15 times. Additionally, mediation analysis revealed that a substantial portion of the association between sitting time and job strain was mediated by physical activity, and vice versa, emphasizing the interconnected nature of sedentary behavior and physical activity in influencing occupational stress.ConclusionThe study highlights the impact of sedentary behavior on occupational stress, assessed using Karasek’s Job-Demand-Control Model. Despite being less studied, sedentary behavior appears to be a relevant contributor to occupational stress. Furthermore, the results emphasize the significant role of physical activity levels, suggesting that it plays a substantial part in the relationship between sedentary behavior and occupational stress.

Introduction Sedentary behaviour is a public health problem. We mainly have sedentary behaviour at work, transforming them into occupational risk. To our knowledge, there is no intervention study on the reduction of occupational sedentary behaviour in a real work situation and its impact on health and biomarkers of stress. The main objective is to study changes in sedentary behaviour following a behavioural intervention (sit-and-stand desk and cycle ergometer).Methods and analysis This is a randomised controlled trial in cross-over design conducted in a single centre. The study will be proposed to emergency medical dispatchers of Clermont-Ferrand. Each volunteer will be followed during three cycles of 1 week (3 weeks in total). Each 1-week cycle is made up of 12 hours of work (three conditions: a control and two interventions), 12 hours of successive rest and 6 days of follow-up. For each condition, the measurements will be identical: questionnaire, measure of heart rate variability, electrodermal activity and level of physical activity, saliva and blood sampling. The primary outcome is sedentary behaviour at work (ie, number of minutes per day standing/active). Data will be analysed with both intention-to-treat and per protocol analysis. A p

Abstract Background Sedentary behaviour at work is a major cause of atherosclerosis, particularly in tertiary workers. However, no studies have ever assessed the effect of active workstation on lipoprotein subfraction profile. This study aimed to evaluate the effect of 12-week portable pedal machines (PPMs) on lipoprotein subfraction profile among healthy sedentary workers. Methods Healthy administrative workers were randomized into an intervention group using PPMs for 12 weeks or a control group using normal-desk. Lipoprotein subfractions were assessed using Lipoprint® electrophoresis. Main outcomes were explored using mixed models with sensitivity analyses (four models). Results We included 40 participants (43.7 ± 8.6 years old, 100% women, BMI 23.8 ± 3.4 kg/m2; sedentary time at work 7.7 ± 1.8 h/day). Groups did not differ at baseline in any outcomes. 32 participants finished the trial. Changes in lipoprotein subfractions were especially marked for LDL profile. There was an interaction time x group for all parameters related to LDL and their subfractions: total LDL-cholesterol (p = 0.012), LDL particle size (p = 0.027), large LDL subfractions 1 and 2 (p = 0.001), and small dense LDL subfractions 3 to 7 (p = 0.046), using the crude model. The interaction reflects difference in the direction of changes between groups. The LDL particle size significantly increased in the intervention group (from 271.9 ± 2.5 at t0 to 272.8 ± 1.9 Ångström at t1, p = 0.037) while it did not change in the control group (272.5 ± 1.7 at t0 to 271.8 ± 1.5Å at t1, p = 0.52). All interactions were constantly significant whatever the models. Influencing variables were mainly stress at work that was associated with an increase in total LDL-cholesterol (coefficient 3.15, 95CI 0.20 to 6.11 mg/dl, p = 0.038), and BMI that was associated with Large-LDL, Large-HDL, IDL-C and triglycerides. Conclusions Lipoprotein profile was improved after a 12-week PPMs intervention at work in healthy administrative workers. Changes were mainly showed for LDL and LDL subfractions. Lipoprotein profile was worsened by stress at work, BMI and age. Trial registration NCT04153214.

Abstract 24-h shift (24 hS) exposed emergency physicians to a higher stress level than 14-h night shift (14 hS), with an impact spreading on several days. Catecholamines are supposed to be chronic stress biomarker. However, no study has used catecholamines to assess short-term residual stress or measured them over multiple shifts. A shift-randomized trial was conducted to study urinary catecholamines levels of 17 emergency physicians during a control day (clerical work on return from leave) and two working day (14 hS and 24 hS). The Wilcoxon matched-pairs test was utilized to compare the mean catecholamine levels. Additionally, a multivariable generalized estimating equations model was employed to further analyze the independent relationships between key factors such as shifts (compared to control day), perceived stress, and age with catecholamine levels. Dopamine levels were lower during 24 hS than 14 hS and the control day. Norepinephrine levels increased two-fold during both night shifts. Epinephrine levels were higher during the day period of both shifts than on the control day. Despite having a rest day, the dopamine levels did not return to their normal values by the end of the third day after the 24 hS. The generalized estimating equations model confirmed relationships of catecholamines with workload and fatigue. To conclude, urinary catecholamine biomarkers are a convenient and non-invasive strong measure of stress during night shifts, both acutely and over time. Dopamine levels are the strongest biomarker with a prolonged alteration of its circadian rhythm. Due to the relation between increased catecholamine levels and both adverse psychological effects and cardiovascular disease, we suggest that emergency physicians restrict their exposure to 24 hS to mitigate these risks.

Abstract Recent research suggests that autistic females may have superior socio-cognitive abilities compared to autistic males, potentially contributing to underdiagnosis in females. However, it remains unclear whether these differences arise from distinct neurophysiological functioning in autistic males and females. This study addresses this question by presenting 41 autistic and 48 non-autistic adults with a spatially filtered faces oddball paradigm. Analysis of event-related potentials from scalp electroencephalography reveal a neurophysiological profile in autistic females that fell between those of autistic males and non-autistic females, highlighting sex differences in autism from the initial stages of face processing. This finding underscores the urgent need to explore neurophysiological sex differences in autism and encourages efforts toward a better comprehension of compensation mechanism and a clearer definition of what is meant by camouflaging.

IntroductionAttention to work addiction risk is growing; however, more studies are needed to explore the possible impact of work addiction risk on various aspects of employees’ work and life domains. Although several studies have considered the antecedents or consequences of work addiction risk, this study particularly focuses on sleep quality as a potential explanatory underlying mechanism in the relation between work addition risk and three outcome variables including stress at home, stress at work and well-being.MethodThe data was collected using an online platform and participants consisted of 188 French employees who were selected using simple random sampling method. Participants responded to the survey including the Work Addiction Risk Test (WART), stress at work, well-being, and sleep quality. The data was analyzed using JASP and SPSS-26 programs.ResultsThe results revealed that there are significant positive relationships between work addiction risk and both stress at home and at work and negative relationships between work addiction risk and both sleep quality and well-being. In addition, the analyses of the mediation paths suggest the significant mediation role of sleep quality for the link between work addition risk and stress at work as well as the link between work addiction risk and well-being.DiscussionGiven the verified mediating role of sleep quality in the relationship between work addiction, stress and wellbeing, it is recommended that organizations and companies pay particular attention to their employees’ sleep quality.

IntroductionThis study examined social perceptions and rejection towards fifteen mental illnesses, as well as a preliminary test of the SUBAR model, that hypothesized perceptions of both vital forces and burden would be negatively and positively related to social rejection, respectively.MethodsUsing an online survey with participants from France (n = 952), social rejection was assessed using a feeling thermometer and a social distance scale, while social perceptions were measured using visual analog scales.ResultsA stigma map for these different disorders is drawn up, revealing the social perceptions and levels of stigmatization specific to certain mental illnesses. Controlling for relevant social perceptions (i.e., danger, warmth, competence), we found that perception of burden was positively and significantly associated to social distance and negative feeling for 73% and 67% of mental illnesses, respectively. The perception of vital force was negatively and significantly related to social distance and negative feeling for 87% and 20% of mental illnesses, respectively. The change in R2 between model 1 (i.e. perception of danger, warmth, competence) and model 2 (i.e. model 1 + perceptions of vital force and burden) significantly improved in 100% of cases for social distance and 67% of cases for negative feeling.ConclusionThese preliminary data provide support for the SUBAR model and call for further investigations to better understand the social rejection of people with mental illnesses.

BackgroundBurnout is a public health problem with various health consequences, among which cardiovascular disease is the most investigated but still under debate. Our objective was to conduct a systematic review and meta-analysis on the influence of burnout on cardiovascular disease.MethodsStudies reporting risk (odds ratio, relative risk, and hazard ratio) of cardiovascular disease following burnout were searched in PubMed, PsycINFO, Cochrane, Embase, and ScienceDirect. We performed a random-effect meta-analysis stratified by type of cardiovascular disease and searched for putative influencing variables. We performed sensitivity analyses using the most adjusted models and crude risks.ResultsWe included 25 studies in the systematic review and 9 studies in the meta-analysis (4 cross-sectional, 4 cohort, and 1 case–control study) for a total of 26,916 participants. Burnout increased the risk of cardiovascular disease by 21% (OR = 1.21, 95% CI 1.03 to 1.39) using the most adjusted risks and by 27% (OR = 1.27, 95% CI 1.10 to 1.43) using crude risks. Using stratification by type of cardiovascular disease and the most adjusted risks, having experienced burnout significantly increased the risk of prehypertension by 85% (OR = 1.85, 95% CI 1.00 to 2.70) and cardiovascular disease-related hospitalization by 10% (OR = 1.10, 95% CI 1.02 to 1.18), whereas the risk increase for coronary heart disease (OR = 1.79, 95% CI 0.79 to 2.79) and myocardial infarction (OR = 1.78, 95% CI 0.85 to 2.71) was not significant. Results were also similar using crude odds ratio. The risk of cardiovascular disease after a burnout was not influenced by gender. Insufficient data precluded other meta-regressions.ConclusionsBurnout seems to increase the risk of cardiovascular disease, despite the few retrieved studies and a causality weakened by cross-sectional studies. However, numerous studies focused on the pathophysiology of cardiovascular risk linked to burnout, which may help to build a preventive strategy in the workplace.

ABSTRACTThe third, “booster”, vaccination increases the overall immune response against SARS-CoV-2 variants. However, after the initial peak at around 3 weeks post-vaccination, anti-spike antibody levels decline. Post-booster kinetics of cellular response has been less investigated and there is no documented evidence of a true boosting effect. Furthermore, multiple studies underline the less effective immune responses against Omicron, the latest variant of concern, at both humoral and cellular levels. In this letter, we analyse humoral (anti-RBD IgG levels) and cellular (IFN-γ release assay) immune response in 205 health care workers 3 weeks and 3 months after administration of an mRNA-based booster dose, either mRNA-1273 or BNT162b2. Since all subjects were SARS-CoV-2 infection-naïve, we also looked at the incidence of Omicron infection between 3 and 6 months post-booster.At both timepoints, 3x mRNA-1273 vaccination had the highest overall antibody and IFN-γ levels, followed by 3x BNT162b2 vaccination and heterologous mRNA-based regimens. Heterologous ChAdOx1–mRNA-based regimen had the lowest antibody levels while cellular response equal to that of 3x BNT162b2 vaccination and heterologous mRNA-based regimens. Our results show that both humoral and cellular responses waned at 3 months for all vaccination regimens. However, we identified three trajectories of dosage variation. Interestingly, the subgroup of subjects with increasing anti-RBD IgG levels over time had a lower incidence of Omicron infection. Whether increasing humoral response at 3 months post-booster is more indicative of protection than a high initial peak remains to be confirmed in a larger cohort.

BackgroundThe purpose of this scoping review is to stimulate interest and to raise awareness, among researchers, healthcare practitioners, and policymakers regarding the current scientific literature related to exercise prescription for non-communicable diseases (NCDs). Exercise prescription is a safe and cost-effective method that enables physicians to use exercise as a complementary addition to NCDs management and treatment.MethodsThis scoping review followed the PRISMA Extension Guidelines for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Using this framework, we considered information from qualitative and quantitative studies to identify research gaps. We provide feasible suggestions to guide future research for the implementation of exercise prescription in the healthcare environment. The literature search was conducted using SPIDER and PICO tools for qualitative, quantitative, and mixed-study designs. Inclusion criteria included articles that investigated patients with NCDs and considered exercise interventions. Systematic searches of PubMed, Web of Science, MEDLINE, EMBASE, and ScienceDirect were undertaken on 26 July 2022 and all reference lists were manually searched. Data processing was performed using EndNote 2.0 software and data charts were used for numerical summary and thematic analysis.ResultsThere were 10,951 articles retrieved, of which 28 met the inclusion criteria. Based on the evidence, exercise was a feasible, safe, and acceptable method to prevent and manage non-communicable diseases in inpatient and outpatient settings. Six research directions were identified and discussed. In addition, implementation evidence and suggestions for policy-reconfiguration are also provided.ConclusionThis scoping review summarizes the current evidence for the effectiveness of exercise in the treatment of non-communicable diseases. The review provides key findings supporting exercise prescription for the inpatient and outpatient healthcare service. We suggest that governments and healthcare policymakers globally advocate the inclusion of structured exercise prescription within the NCDs treatment setting.

Background: This study aimed to compare acute hemodynamic, metabolic (glucose and blood lactate concentrations), hormonal (growth hormone and normetanephrine), heart rate variability (HRV), and rating of perceived exertion (RPE) responses before and after bouts of a boxing exergame with and without blood flow restriction (BFR) in non-athlete young individuals. Methods: Fourteen participants (age: 30 ± 10 y; BMI: 21 ± 3 kg.m−2) participated in two sessions of a 20 min boxing exergame. During week one, the participants were randomly divided into two groups and played against one another under normal (n = 7) and BFR (n = 7) conditions. Over the next exercise session, participants were then reallocated to the opposite condition (normal vs. BFR) for data collection. Hemodynamic, metabolic, HRV, and hormonal parameters were measured before and immediately after the exercise protocols. Results: Playing exergame led to a significant increase in hemodynamic variables (except for diastolic blood pressure) regardless of BFR condition with no between-group differences. Regarding HRV, significant reductions in total power (TP) and low-frequency (LF) waves were identified in the non-BFR group (p < 0.0001) compared with the BFR group. Conversely, a significant increase in very LF (VLF) waves was noted for the BFR group (p = 0.050), compared with the non-BFR group. Significant increases were observed in serum concentrations of growth hormone, normetanephrine, and blood lactate concentration from pre- to post-exercise under both conditions (p ≤ 0.05), with no significant differences between the groups. Moreover, no statistically significant changes were observed in glucose levels. RPE responses were significantly greater (p ≤ 0.05) in the BFR group compared with the non-BFR group throughout the exercise session. Conclusions: We observed similar hemodynamic, hormonal, and metabolic responses after an acute boxing exergame session in young individuals, whether conducted with or without BFR. However, notable differences were observed in certain HRV markers and RPE. Specifically, the inclusion of BFR resulted in an elevation of VLF and a heightened perceived exertion. These findings suggest that BFR may alter cardiac autonomic and perceptual responses during exergaming. Further research is warranted to understand the long-term implications and potential benefits of incorporating BFR into exergaming routines.

Abstract The purpose of this study was to compare swing time and golf club angle parameters during golf swings using three, two dimensional (2D) low cost, Augmented-Video-based-Portable-Systems (AVPS) (Kinovea, SiliconCoach Pro, SiliconCoach Live). Twelve right-handed golfers performed three golf swings whilst being recorded by a high-speed 2D video camera. Footage was then analysed using AVPS-software and the results compared using both descriptive and inferential statistics. There were no significant differences for swing time and the golf phase measurements between the 2D and 3D software comparisons. In general, the results showed a high Intra class Correlation Coefficient (ICC > 0.929) and Cronbach’s Coefficient Alpha (CCA > 0.924) reliability for both the kinematic and temporal parameters. The inter-rater reliability test for the swing time and kinematic golf phase measurements on average were strong. Irrespective of the AVPS software investigated, the cost effective AVPS can produce reliable output measures that benefit golf analyses.

Abstract Background This paper is a follow‐up study continuing the COVISTRESS network previous research regarding health‐related determinants. Objective The aim was to identify the main consequences of COVID‐19 lockdown on Body Mass Index and Perceived Fragility, related to Physical Activity (PA), for different categories of populations, worldwide. Design The study design included an online survey, during the first wave of COVID‐19 lockdown, across different world regions. Setting and participants The research was carried out on 10 121 participants from 67 countries. The recruitment of participants was achieved using snowball sampling techniques via social networks, with no exclusion criteria other than social media access. Main outcome measures Body Mass Index, Physical Activity, Perceived Fragility and risk of getting infected items were analysed. SPSS software, v20, was used. Significance was set at P

BackgroundDespite the potential detrimental consequences for individuals' health and discrimination from covid-19 symptoms, the outcomes have received little attention. This study examines the relationships between having personally experienced discrimination based on the symptoms of covid-19 (during the first wave of the pandemic), mental health, and emotional responses (anger and sadness). It was predicted that covid-19 discrimination would be positively related to poor mental health and that this relationship would be mediated by the emotions of anger and sadness.MethodsThe study was conducted using an online questionnaire from January to June 2020 (the Covistress network; including 44 countries). Participants were extracted from the COVISTRESS database (Ntotal = 280) with about a half declaring having been discriminated due to covid-19 symptoms (N = 135). Discriminated participants were compared to non-discriminated participants using ANOVA. A mediation analysis was conducted to examine the indirect effect of emotional responses and the relationships between perceived discrimination and self-reported mental health.ResultsThe results indicated that individuals who experienced discrimination based on the symptoms of covid-19 had poorer mental health and experienced more anger and sadness. The relationship between covid-19 personal discrimination and mental health disappeared when the emotions of anger and sadness were statistically controlled for. The indirect effects for both anger and sadness were statistically significant.DiscussionThis study suggests that the covid-19 pandemic may have generated discriminatory behaviors toward those suspected of having symptoms and that this is related to poorer mental health via anger and sadness.

BackgroundEmergency healthcare workers (eHCWs) are particularly at risk of stress, but data using the gold standard questionnaire of Karasek are scarce. We assessed the level of stress of eHCWs and aimed to compare it with the general population.MethodsThis is a cross-sectional nationwide study in French Emergency Departments (EDs), using the job-content questionnaire of Karasek, compared with the 25,000 answers in the French general population (controls from the SUMER study). The descriptions of job demand, job control, and social support were described as well as the prevalence of job strain and isostrain. Putative factors were searched using mixed-method analysis.ResultsA total of 166 eHCWs (37.9 ± 10.5 years old, 42% men) from five French EDs were included: 53 emergency physicians and 104 emergency paramedics, compared to 25,000 workers with other occupations. Job demand was highest for physicians (28.3 ± 3.3) and paramedics (25.9 ± 3.8), compared to controls (36.0 ± 7.2; p < 0.001). Job control was the lowest for physicians (61.2 ± 5.8) and paramedics (59.1 ± 6.8), compared to controls (70.4 ± 11.7; p < 0.001). Mean social support did not differ between groups (23.6 ± 3.4 for physicians, 22.6 ± 2.9 for paramedics, and 23.7 ± 3.6 for controls). The prevalence of job strain was massively higher for physicians (95.8%) and paramedics (84.8%), compared to controls (23.9%; p < 0.001), as well as for isostrain (45.1% for physicians, 56.8% for paramedics, and 14.3% for controls, p < 0.001). We did not find any significant impact of sociodemographic characteristics on job control, job demand, or social support.ConclusionEmergency healthcare workers have a dramatic rate of job strain, necessitating urgent promotion of policy to take care of them.

Introduction: Since adolescents with obesity are prone to bone fragility during weight loss, the aim was to compare the impact of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on bone density, geometry, and strength. Methods: Sixty-one adolescents were randomly assigned to 2 cycling trainings (HIIT and MICT) and a control (CTR, without training) group. Anthropometry, dual-energy X-ray absorptiometry with hip structural analysis and the trabecular bone score (TBS) were assessed before and after the 16-week intervention. Results: Body mass index (BMI) and fat mass (FM) percentage decreased at T1 versus T0 in both training groups (p < 0.001 for HIIT, p = 0.01 for MICT), though to a larger extent in HIIT (p < 0.05). Total body bone mineral density (BMD) and bone mineral content (BMC) increased in both training groups (p < 0.001), but to a greater extent in HIIT for BMC (p < 0.05). Lumbar spine BMD and BMC increased in both training groups (p < 0.001 for HIIT, p < 0.01 for MICT), with a time × group interaction between HIIT and CTR (p < 0.05) only. TBS increased in both training groups (p < 0.01 for HIIT, p < 0.05 for MICT). Hip BMD and BMC increased in both HIIT (p < 0.001 and p < 0.01) and MICT (p < 0.01 and p < 0.05). At the narrow neck (NN), endocortical diameter, width (p < 0.01), cross-sectional moment of inertia, and section modulus (Z) (p < 0.05) increased only in the HIIT group, such as BMD and Z (p < 0.05) at the intertrochanteric region (IT) and average cortical thickness (p < 0.001) and width (p < 0.05) at the femoral shaft. At the NN and IT, the buckling ratio decreased only in the HIIT group (p < 0.05), predicting higher resistance to fracture. Conclusions: In addition to inducing greater BMI and FM percentage decreases in comparison to MICT, HIIT improves multisite bone density, geometry, and strength, which heighten the justification for HIIT as part of weight loss interventions in adolescents with obesity.

BackgroundThe COVID-19 pandemic and the first lockdown were particularly stressful with a major economic impact, but the impact on stress of company directors was not known. Therefore, this study aimed to assess that impact and the characteristics of companies the most at risk.MethodA online questionnaire was sent to 13,114 company. It assessed stress at work, number of employees, sector of activity, business activity rate and geographical location. It studied the mean stress levels, the percentage of stress > 8/10 and carried out an analysis of the characteristics of the most at-risk companies.ResultsA total of 807 company directors responded. Their stress levels increased by 25.9% during lockdown and 28.7% of them had a stress > 8/10. Sectors which had the biggest increase in stress levels during lockdown were retail trade, wholesale trade, and nursing homes. Sectors the most at risk of stress >8/10 during lockdown tended to be nursing homes, pharmacies, and IT activities. Biggest companies had the highest increase in stress levels.ConclusionThe first lockdown of the COVID-19 pandemic had a major impact on the stress of company directors. Directors of large companies were the most exposed to stress as well as medical and IT activities.

ImportanceAlthough the COVID-19 pandemic has had a negative impact on mental health, there is no comprehensive longitudinal study of the entire population of a country without selection bias.ObjectiveThe objective of this study was to evaluate the prescription of psychotropic drugs during the COVID-19 pandemic, using data from the French national health data system (SNDS).Design, settings, and participantsPrescriptions for psychotropic drugs (antidepressants, anxiolytics, hypnotics, and antipsychotics) from 1 January 2015 to 30 September 2021 were collected from administrative data provided by the SNDS. This database includes more than 99% of the French population, i.e., 67 million people. The data were analyzed using an interrupted time series analysis (ITSA) model.Main outcomes and measuresConsumption of psychotropic drugs was aggregated in months and expressed in number of boxes per thousand inhabitants.ResultsDuring the study period, more than 1.3 billion boxes of psychotropic medications were dispensed. Comparison of psychotropic drug dispensing before and after the pandemic showed a relative increase of 0.76 (95 CI 0.57 to 0.95, p

In this article, we tested the respective importance of low spatial frequencies (LSF) and high spatial frequencies (HSF) for conscious visual recognition of emotional stimuli by using an attentional blink paradigm. Thirty-eight participants were asked to identify and report two targets (happy faces) embedded in a rapid serial visual presentation of distractors (angry faces). During attentional blink, conscious perception of the second target (T2) is usually altered when the lag between the two targets is short (200–500 ms) but is restored at longer lags. The distractors between T1 and T2 were either non-filtered (broad spatial frequencies, BSF), low-pass filtered (LSF), or high-pass filtered (HSF). Assuming that prediction abilities could be at the root of conscious visual recognition, we expected that LSF distractors could result in a greater disturbance of T2 reporting than HSF distractors. Results showed that both LSF and HSF play a role in the emergence of exogenous consciousness in the visual system. Furthermore, HSF distractors strongly affected T1 and T2 reporting irrespective of the lag between targets, suggesting their role for facial emotion processing. We discuss these results with regards to other models of visual recognition. .

The D-Day beaches in Normandy are a changing tourist area. Remembrance tourism linked to the D-Day is an essential element for the local economy. For Normandy, it represents a real “trademark” and a sector that energises the whole region. The sports events, which are the focus of our study, have been part of this tourism and remembrance enterprise locally and resolutely for several decades. In an original way, this tries to make the Normandy region more and more attractive. Initiated by “Les Courants de la Liberté” from 1988, then taken up or diversified by various associations or private organisers, “Les Marathons de la Liberté”, the “Ultra D-Day Trail” and other D-Day races have multiplied in recent years and punctuate the annual commemorations of the D-Day Landings. How do these sporting events contribute to the development of territorial resources and participate in the heritage of this coastal area? This article aims to understand the tourism issues and the resonance of these sporting events on the D-Day landing beaches. The various sporting events studied, focusing in particular on running and its variations, are conceived as hybrid events, in the sense that they combine commemoration and sporting challenge. To do this, the organisers work on and insist on the spectacularisation of the events and take part in an ongoing tourist transition.

Abstract Anxiety is recognized as a major health issue and is quite prevalent among older adults. An efficient way to manage anxiety is abdominal breathing. Breathing exercises seem to reduce anxiety and to increase parasympathetic activity assessed by HRV indexes. Yet, the effect of abdominal breathing on physiological stress (HRV) and anxiety in older adults remains poorly understood. Therefore, the aim of this study is to test the effects of deep and slow breathing (DSB, low inhale/exhale ratio) on physiological stress and anxiety in older adults (n = 22) in comparison with younger ones (n = 25). DSB increased significantly HFpower and reduced state anxiety in both younger and older adults. Interestingly, the increased in HF power was significantly higher among older adults than younger ones. As expected, the ratio inhale/exhale being not equal, RMSSD did not increase following DSB. Thus, we provide evidence suggesting that DSB is more beneficial to older adults than younger ones to restore vagal outflow. Despite future work being required, those results provide relevant clinical application leads to manage state anxiety among older adults and to promote successfull aging.

Abstract Non-traumatic intracranial bleeding (NTIB), comprising subarachnoid hemorrhage (SAH) and intra-cranial bleeding (ICH) is a significant public health concern. Tranexamic acid (TXA) is a promising treatment with benefits yet to be fully demonstrated. We conducted a systematic review and meta-analysis on the impact of TXA on mortality in NTIB. We searched the PubMed, Cochrane Library, Google Scholar and ScienceDirect databases for studies reporting mortality data following the use of TXA in NTIB for comparisons with a control group. We computed random-effect meta-analysis on estimates of risk and sensitivity analyses. We computed meta-regression to examine the putative effects of the severity of NTIB, sociodemographic data (age, sex), and publication date. Among potentially 10,008 articles, we included 15 studies representing a total of 4883 patients: 2455 receiving TXA and 2428 controls; 1110 died (23%) during the follow-up. The meta-analysis demonstrated a potential of 22% decrease in mortality for patients treated by TXA (RR = 0.78, 95%CI 0.58–0.98, p = 0.002). Meta-regression did not demonstrate any influence of the severity of NTIB, age, sex, length of treatment or date of publication. Sensitivity analyses confirmed benefits of TXA on mortality. TXA appears to be a therapeutic option to reduce non-traumatic intracranial bleeding mortality, particularly in patients with SAH.

From mid-March through early May 2020, France limited outdoor activities to one hour per day because of the Covid-19 epidemic. This inside lockdown could have a lasting impact on post-lockdown sedentary and physical activities and food choice. The aim of this study is to compare behaviors before and after the lockdown in a sample of French young adult students (sex ratio = 1:1, 22 ± 3 y old). Over a period of 4 days in both April and after mid-May 2020, 50 students used the WellBeNet smartphone application to record accelerometry data to evaluate their sedentary behavior and physical activity, and food consumption. Some behaviors remained stable for both periods: sedentary behavior, light-intensity activity, the number of meals per day, the number of portions of fruits, nuts, dairy products, vegetables, legumes and meat-fish-egg. Moderate-intensity activity duration was higher (+1.4%, p

Introduction There has been a growing interest towards cognitive-training programmes to improve cognition and prevent cognitive impairment despite discrepant findings. Physical activity has been recognised in maintaining or improving cognitive ability. Based on a psychoneurophysiological approach, physiological indexes should partly determine neuronal dynamics and influence cognition as any effects of cognitive training. This study’s primary aim was to examine if improved physiological indexes predict improved cognitive variables in the context of a clinical intervention programme for type 2 diabetes (T2D).Method and analysis PhyCog will be a 22-week randomised controlled trial comparing cognitive performance between three arms: (1) physical activity (1 month), a 15-day wash-out, then cognitive training (1 month), (2) cognitive training (1 month), a 15-day wash-out and physical activity (1 month), and (3) an active breathing condition (psychoeducation and resonance frequency breathing for 1 month), then a 15-day wash-out, and combined physical activity and cognitive training (1 month), allowing to determine the most effective intervention to prevent cognitive impairment associated with T2D. All participants will be observed for 3 months following the intervention. The study will include a total of 81 patients with T2D.Cognitive performance and physiological variables will be assessed at baseline (week 0—W0), during the washout (W5, 72–96 hours after week 4), at the end of the intervention (W10), and at the end of the follow-up (W22). The main variables of interest will be executive function, memory and attention. Physiological testing will involve allostatic load such as heart rate variability, microcirculation, cortisol and dehydroepiandrosterone sulfate levels. Sociodemographic and body composition will also be a consideration. Assessors will all be blinded to outcomes. To test the primary hypothesis, the relationship between improvement in physiological variables and improvement in cognitive variables (executive, memory and attention) will be collected.Ethics and dissemination This protocol was approved by the Est III French Ethics Committee (2020-A03228-31). Results will be published in peer-reviewed journals.Trial registration number NCT04915339.

Introduction: The purpose of this study was to evaluate whether kinematic assessments help to improve golf putting accuracy and precision, and increase the success rate of golf putts. Specifically, this study also investigated the differences in club head velocity and putter face angle at impact (°) between elite and amateur golfers. Methods: A total of 25 articles were used in this review. An initial, broad search of electronic databases including PubMed, SPORT discus, Scopus, Science Direct and Google Scholar was conducted for literature using the keywords “biomechanics” AND “golf putting”. The total number of studies screened for this review was n = 897. Among these articles, only n = 63 were assessed for eligibility. The number of articles were reduced further to n = 25 and included in the qualitative and quantitative synthesis. Results: Out of the initial n = 897, n = 834 records were excluded. After the articles were assessed for eligibility, n = 17 articles were excluded for not meeting the inclusion criteria. The studies included demonstrated that kinematic approaches can help improve accuracy and precision of golf putts which help to increase the success rate of putts and reduce overall scoring. Elite golfers have a more accurate direction and face angle when compared to amateur golfers. Conclusion: This systematic review and meta-analysis suggests that kinematic assessments of face angle at impact, putter path, the vertical spot and backswing are critical determinants of a golfer’s success and are useful indicators to help improve accuracy and precision of golf putts. This study also noted that elite golfers had slightly less velocity but more precise putter face angles at impact which increased their accuracy in completing more successful putts than amateur golfers.

Background: Cannabis use by physicians can be detrimental for them and their patients. We conducted a systematic review and meta-analysis on the prevalence of cannabis use by medical doctors (MDs)/students. Method: PubMed, Cochrane, Embase, PsycInfo and ScienceDirect were searched for studies reporting cannabis use in MDs/students. For each frequency of use (lifetime/past year/past month/daily), we stratified a random effect meta-analysis depending on specialties, education level, continents, and periods of time, which were further compared using meta-regressions. Results: We included 54 studies with a total of 42,936 MDs/students: 20,267 MDs, 20,063 medical students, and 1976 residents. Overall, 37% had used cannabis at least once over their lifetime, 14% over the past year, 8% over the past month and 1.1 per thousand (‰) had a daily use. Medical students had a greater cannabis use than MDs over their lifetime (38% vs. 35%, p < 0.001), the past year (24% vs. 5%, p < 0.001), and the past month (10% vs. 2%, p < 0.05), without significance for daily use (0.5% vs. 0.05%, NS). Insufficient data precluded comparisons among medical specialties. MDs/students from Asian countries seemed to have the lowest cannabis use: 16% over their lifetime, 10% in the past year, 1% in the past month, and 0.4% daily. Regarding periods of time, cannabis use seems to follow a U-shape, with a high use before 1990, followed by a decrease between 1990 and 2005, and a rebound after 2005. Younger and male MDs/students had the highest cannabis use. Conclusions: If more than a third of MDs tried cannabis at least once in their lifetime, this means its daily use is low but not uncommon (1.1‰). Medical students are the biggest cannabis users. Despite being common worldwide, cannabis use is predominant in the West, with a rebound since 2005 making salient those public health interventions during the early stage of medical studies.

Abstract Background Regular participation in moderate-to-vigorous physical activity (MVPA) is related to decreased risk of morbidity and mortality. Among working populations, lack of MVPA may also be a risk factor for absenteeism and presenteeism. Both traditional workplace-based and web-based interventions have been suggested as being effective in promoting participation MVPA, health-related outcomes, and work-related productivity. However, several challenges limit their application in real world contexts. A ‘blended’ intervention approach combining the two intervention strategies is proposed to overcome these limitations. The proposed intervention aims to utilize the blended approach to increase participation in MVPA, health-related outcomes, and work productivity among inactive workers. Methods The study will comprise of a three-group cluster randomized controlled trial (cluster-RCT), comprising a three-month actual intervention and a nine-month behavioral follow-up period. The three groups will be: a web-based intervention group, a blended intervention group combining the web-based components with face-to-face workshops and posters, and a control group. Physically inactive office employees (N = 495) from 33 companies (i.e., clusters) will be recruited and randomly assigned to the three groups by cluster randomization. The intervention mapping (IM) framework will be used for selecting and applying effective health behavioral theories and behavioral change techniques (BCTs) to the development, implementation and assessment of the intervention, which will be personally tailored. The primary outcome variable will be objectively-measured MVPA using an accelerometer. Secondary outcomes will consist of indices of health including adiposity, blood pressure, blood sugar, blood lipids, self-reported depression, anxiety, stress, health-related quality of life and work-related variables including absenteeism and presenteeism. Discussion The proposed study adopts a robust blended intervention approach that is expected to overcome challenges in applying workplace-based and web-based interventions separately and yield larger effects in promoting MVPA participation, health-related outcomes and work productivity. Improvements in work productivity outcomes will be of particular interest to employers. If more effective, the new blended intervention has the potential to be implemented on a larger scale to benefit workplace populations. Trial registration The trial is prospectively registered at the ClinicalTrials.gov PRS (Trial ID: NCT04391270; Date of First Posted: May 18, 2020).

Clinical trials and real-world evidence on COVID-19 vaccines have shown their effectiveness against severe disease and death but the durability of protection remains unknown. We analysed the humoral and T-cell immune responses in 110 healthcare workers (HCWs) vaccinated according to the manufacturer’s recommended schedule of dose 2 three weeks after dose 1 from a prospective on-going cohort in early 2021, 3 and 6 months after full vaccination with the BNT162b2 mRNA vaccine. Anti-RBD IgG titres were lower in HCWs over 60 years old 3 months after the second dose (p=0.03) and declined in all the subjects between 3 and 6 months with a median percentage change of -58.5%, irrespective of age and baseline comorbidities. Specific T-cell response measured by IGRA declined over time by at least 42% (median) in 91 HCWs and increased by 33% (median) in 17 others. Six HCWs had a negative T-cell response at 6 months. Ongoing follow-up should provide correlates of long-term protection according to the different immune response profiles observed. COVIDIM study was registered under the number NCT04896788 on clinicaltrials.gov.

Visual processing is thought to function in a coarse-to-fine manner. Low spatial frequencies (LSF), conveying coarse information, would be processed early to generate predictions. These LSF-based predictions would facilitate the further integration of high spatial frequencies (HSF), conveying fine details. The predictive role of LSF might be crucial in automatic face processing, where high performance could be explained by an accurate selection of clues in early processing. In the present study, we used a visual Mismatch Negativity (vMMN) paradigm by presenting an unfiltered face as standard stimulus, and the same face filtered in LSF or HSF as deviant, to investigate the predictive role of LSF vs. HSF during automatic face processing. If LSF are critical for predictions, we hypothesize that LSF deviants would elicit less prediction error (i.e., reduced mismatch responses) than HSF deviants. Results show that both LSF and HSF deviants elicited a mismatch response compared with their equivalent in an equiprobable sequence. However, in line with our hypothesis, LSF deviants evoke significantly reduced mismatch responses compared to HSF deviants, particularly at later stages. The difference in mismatch between HSF and LSF conditions involves posterior areas and right fusiform gyrus. Overall, our findings suggest a predictive role of LSF during automatic face processing and a critical involvement of HSF in the fusiform during the conscious detection of changes in faces.

Objectives Work-related stress is a major concern. One of the best performing models is the Job Content Questionnaire (JCQ) of Karasek, assessing job demand and job control using 18 items. However, the JCQ is long and complex. Visual Analogue Scales (VASs) are easy to use and quick to implement. VASs have been validated to assess pain and occupational stress; however, VASs demand and control have not been evaluated. Therefore, we aimed to validate the use of VAS demand and control compared with the 18 items of the JCQ.Design We implemented a cross-sectional observational study, by administering a self-reported questionnaire to the users of Wittyfit software, with a second test (retest) proposed 1 week later. In addition to JCQ, VAS demand and control, we measured sociodemographic outcomes, as well as characteristics of work, sleep, well-being, stress, depression and anxiety.Participants 190 volunteers French workers using WittyFit software participated in the study, and 129 completed the test–retest.Results VAS demand and VAS control correlated with the two Karasek domains from the JCQ, respectively, at 0.59 and 0.57 (p

Introduction Hypothyroidism may be associated with changes in the autonomic regulation of the cardiovascular system, which may have clinical implications. Objective To conduct a systematic review and meta-analysis on the impact of hypothyroidism on HRV. Materials and methods PubMed, Cochrane, Embase and Google Scholar were searched until 20 August 2021 for articles reporting HRV parameters in untreated hypothyroidism and healthy controls. Random-effects meta-analysis were stratified by degree of hypothyroidism for each HRV parameters: RR intervals (or normal to normal-NN intervals), SDNN (standard deviation of RR intervals), RMSSD (square root of the mean difference of successive RR intervals), pNN50 (percentage of RR intervals with >50ms variation), total power (TP), LFnu (low-frequency normalized unit), HFnu (high-frequency), VLF (very low frequency), and LF/HF ratio. Results We included 17 studies with 11438 patients: 1163 hypothyroid patients and 10275 healthy controls. There was a decrease in SDNN (effect size = -1.27, 95% CI -1.72 to -0.83), RMSSD (-1.66, -2.32 to -1.00), pNN50 (-1.41, -1.98 to -0.84), TP (-1.55, -2.1 to -1.00), HFnu (-1.21, -1.78 to -0.63) with an increase in LFnu (1.14, 0.63 to 1.66) and LF/HF ratio (1.26, 0.71 to 1.81) (p Conclusions Hypothyroidism is associated with a decreased HRV, that may be explained by molecular mechanisms involving catecholamines and by the effect of TSH on HRV. The increased sympathetic and decreased parasympathetic activity may have clinical implications.

The purpose of this paper was to examine the benefits of dance in providing a realistic and viable alternative to the provision of traditional physical activities for dementia patients. Physical activity, while beneficial for increasing the components of health and fitness in general populations, may not be dementia friendly. Dance seems to be more suited as a physical activity form for dementia patients providing specific benefits including cerebrovascular enhancement. The usefulness of dance in relation to the physiological, psychological, and societal benefits for dementia patients’ needs serious consideration as a future complementary/alternative physical therapy intervention.

Cyclooxygenase 2 (COX2) inhibitors have been demonstrated to protect against hypoxia pathogenesis in several investigations. It has also been utilized as an adjuvant therapy in the treatment of COVID-19. COX inhibitors, which have previously been shown to be effective in treating previous viral and malarial infections are strong candidates for improving the COVID-19 therapeutic doctrine. However, another COX inhibitor, ibuprofen, is linked to an increase in the angiotensin-converting enzyme 2 (ACE2), which could increase virus susceptibility. Hence, inhibiting COX2 via therapeutics might not always be protective and we need to investigate the downstream molecules that may be involved in hypoxia environment adaptation. Research has discovered that people who are accustomed to reduced oxygen levels at altitude may be protected against the harmful effects of COVID-19. It is important to highlight that the study’s conclusions only applied to those who regularly lived at high altitudes; they did not apply to those who occasionally moved to higher altitudes but still lived at lower altitudes. COVID-19 appears to be more dangerous to individuals residing at lower altitudes. The downstream molecules in the (COX2) pathway have been shown to adapt in high-altitude dwellers, which may partially explain why these individuals have a lower prevalence of COVID-19 infection. More research is needed, however, to directly address COX2 expression in people living at higher altitudes. It is possible to mimic the gene–environment interaction of higher altitude people by intermittent hypoxia training. COX-2 adaptation resulting from hypoxic exposure at altitude or intermittent hypoxia exercise training (IHT) seems to have an important therapeutic function. Swimming, a type of IHT, was found to lower COX-2 protein production, a pro-inflammatory milieu transcription factor, while increasing the anti-inflammatory microenvironment. Furthermore, Intermittent Hypoxia Preconditioning (IHP) has been demonstrated in numerous clinical investigations to enhance patients’ cardiopulmonary function, raise cardiorespiratory fitness, and increase tissues’ and organs’ tolerance to ischemia. Biochemical activities of IHP have also been reported as a feasible application strategy for IHP for the rehabilitation of COVID-19 patients. In this paper, we aim to highlight some of the most relevant shared genes implicated with COVID-19 pathogenesis and hypoxia. We hypothesize that COVID-19 pathogenesis and hypoxia share a similar mechanism that affects apoptosis, proliferation, the immune system, and metabolism. We also highlight the necessity of studying individuals who live at higher altitudes to emulate their gene–environment interactions and compare the findings with IHT. Finally, we propose COX2 as an upstream target for testing the effectiveness of IHT in preventing or minimizing the effects of COVID-19 and other oxygen-related pathological conditions in the future.

Background: Psychosocial stress is a significant public health problem inducing consequences for quality of life. Results about the use of dehydroepiandrosterone (DHEA) as a biomarker of acute stress are conflicting. We conducted a systematic review and meta-analysis to demonstrate that DHEA levels could be a biomarker of stress.Methods: PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched on March 19, 2021 using the keywords “acute stress” AND “DHEA” OR “Dehydroepiandrosterone.” Articles needed to describe our primary outcome, i.e., induction of acute stress and at least two measures of DHEA.Results: We included 14 studies, with a total of 631 participants, in our meta-analysis. The DHEA levels increased overtime after acute stress [standardized mean difference (SMD) = 1.56, 95%CI = 1.13–1.99]. Stratification by time showed a main peak at the end of stress (SMD = 2.43, 95%CI = 1.59–3.27), followed by a progressive decrease (coefficient = −0.11, 95%CI = −0.19 to −0.17, p = 0.020). There was no significant change 1 h after the end of acute stress. Metaregressions showed an impact of mental stress (SMD = 2.04, 95%CI = 1.43–2.65), sex (SMD = 0.02, 95%CI = 0.00–0.04), age (SMD = −0.12, 95%CI = −0.2 to −0.05), and obesity (SMD = 0.31, 95%CI = −0.00 to 0.63). There was no difference whatever the type of fluid (blood or saliva) and the measurement technique used.Conclusions: DHEA is a biomarker of acute stress, with a short-term increase (1 h). DHEA increases following acute mental stress, whatever the type and duration of mental stress. Women, young people, and obese individuals had a higher response. Blood and saliva measures were comparable.

Introduction: Running is an extremely popular pastime and competitive sport. There is a general consensus that runners present a high incidence of injury. This study aims to discover the prevalence of injury to the lower extremity among runners and any associated risk factors which correlate with the development of lower extremity injuries. Methods: An inclusion and exclusion criteria were used to screen search results. From an original 184 search results, 24 research papers were selected for the final study. The PRISMA checklist was adhered to in the research process. EndnoteX9 was used to filter through all search results and to achieve the final study selections, in line with the appropriate criteria. Results: Overall, a mean incidence of 37% was displayed for running related injuries to the lower extremity. Females displayed a greater mean incidence of injury than males, 39.7% vs 34.3%. Injury prevalence presented greatest at the knee region (24.3%), but this differed when results were split into male and females. Females presented the greatest prevalence of injury at the calf/lower leg, whilst males presented greatest incidence of injury at the hip/pelvis/upper leg region. Risk factors for developing injury which were identified throughout the research included; having 3 times per week. Conclusion: This systematic review is in agreement with the literature which has repeatedly illustrated that female runners present a greater incidence of injury than male runners.

The reversibility of HRV abnormalities in hyperthyroidism remains contradictory. The design of this study involves conducting a systematic review and meta-analysis on the effect of antithyroid treatments on HRV in hyperthyroidism. PubMed, Cochrane, Embase, and Google Scholar were searched until 4 April 2022. Multiple reviewers selected articles reporting HRV parameters in treated and untreated hyperthyroidism. Independent data extraction by multiple observers was stratified by degree of hyperthyroidism for each HRV parameter: RR intervals, SDNN (standard deviation of RR intervals), RMSSD (square root of the mean difference of successive RR intervals), pNN50 (percentage of RR intervals with >50 ms of variation), total power (TP), LFnu (low-frequency normalized unit) and HFnu (high-frequency), VLF (very low-frequency), and LF/HF ratio. We included 11 studies for a total of 471 treated hyperthyroid patients, 495 untreated hyperthyroid patients, and 781 healthy controls. After treatment, there was an increase in RR, SDNN, RMSSD, pNN50, TP, HFnu, and VLF and a decrease in LFnu and LF/HF ratio (p < 0.01). Overt hyperthyroidism showed similar results, in contrast to subclinical hyperthyroidism. Compared with controls, some HRV parameter abnormalities persist in treated hyperthyroid patients (p < 0.05) with lower SDNN, LFnu, and higher HFnu, without significant difference in other parameters. We showed a partial reversibility of HRV abnormalities following treatment of overt hyperthyroidism. The improvement in HRV may translate the clinical cardiovascular benefits of treatments in hyperthyroidism and may help to follow the evolution of the cardiovascular morbidity.

Childhood obesity continues to be a serious problem. The outbreak of the COVID-19 pandemic has led to great life-changing challenges amongst schoolchildren, which might subsequently aggravate existing childhood obesity issues. We suggest that educators and schools need to provide solutions to the problem.

Dear editor; Emergency Physicians (EPs) work under extreme stress conditions (1). Overcrowding – defined as hospital beds not being available for several patients who need one – has been a significant public health problem for more than a decade and is the consequence of the increase in health care demand and the decrease in bed spaces and number of staff (2). These parameters increase stress at work, which leads EPs to experience significant stress consequences, a feeling of diminished skills, and loss of time control (3). Many studies are interested in the overcrowding problem, like a recent study by Tangkulpanich et al. who found the predictive factors of revisiting in 48 hours (4).

IntroductionThe COVID-19 pandemic has initiated an upheaval in society and has been the cause of considerable stress during this period. Healthcare professionals have been on the front line during this health crisis, particularly paramedical staff. The aim of this study was to assess the high level of stress of healthcare workers during the first wave of the pandemic.Materials and methodsThe COVISTRESS international study is a questionnaire disseminated online collecting demographic and stress-related data over the globe, during the pandemic. Stress levels were evaluated using non-calibrated visual analog scale, from 0 (no stress) to 100 (maximal stress).ResultsAmong the 13,537 individuals from 44 countries who completed the survey from January to June 2020, we included 10,051 workers (including 1379 healthcare workers, 631 medical doctors and 748 paramedical staff). The stress levels during the first wave of the pandemic were 57.8 ± 33 in the whole cohort, 65.3 ± 29.1 in medical doctors, and 73.6 ± 27.7 in paramedical staff. Healthcare professionals and especially paramedical staff had the highest levels of stress (p < 0.001 vs non-healthcare workers). Across all occupational categories, women had systematically significantly higher levels of work-related stress than men (p < 0.001). There was a negative correlation between age and stress level (r = -0.098, p < 0.001). Healthcare professionals demonstrated an increased risk of very-high stress levels (>80) compared to other workers (OR = 2.13, 95% CI 1.87-2.41). Paramedical staff risk for very-high levels of stress was higher than doctors' (1.88, 1.50-2.34). The risk of high levels of stress also increased in women (1.83, 1.61-2.09; p < 0.001 vs. men) and in people aged 50).ConclusionsThe first wave of the pandemic was a major stressful event for healthcare workers, especially paramedical staff. Among individuals, women were the most at risk while age was a protective factor.

BackgroundCardiac autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), that can be measured through heart rate variability (HRV)-known to be decreased in T2DM. Physical exercise can improve HRV in healthy population, however results are under debate in T2DM. We conducted a systemic review and meta-analysis to assess the effects of physical exercise on HRV in T2DM patients.MethodPubMed, Cochrane, Embase, and ScienceDirect databases were searched for all studies reporting HRV parameters in T2DM patients before and after exercise training, until September 20th 2020, without limitation to specific years. We conducted random-effects meta-analysis stratified by type of exercise for each of the HRV parameters: RR-intervals (or Normal to Normal intervals-NN), standard deviation of RR intervals (SDNN), percentage of adjacent NN intervals varying by more than 50 milliseconds (pNN50), root mean square of successive RR-intervals differences (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio. Sensitivity analyses were computed on studies with the highest quality.ResultsWe included 21 studies (9 were randomized) for a total of 523 T2DM patients: 472 had an exercise training and 151 were controls (no exercise). Intervention was endurance (14 studies), resistance (2 studies), endurance combined with resistance (4 studies), and high intensity interval training (HIIT) (4 studies). After exercise training, all HRV parameters improved i.e. an increase in SDNN (effect size = 0.59, 95%CI 0.26 to 0.93), RMSSD (0.62, 0.28 to 0.95), pNN50 (0.62, 0.23 to 1.00), HF (0.58, -0.16 to 0.99), and a decrease in LF (-0.37, -0.69 to -0.05) and LF/HF (-0.52, -0.79 to -0.24). There were no changes in controls. Stratification by type of exercise showed an improvement in most HRV parameters (SDNN, RMSSD, pNN50, LF, HF, LF/HF) after endurance training, whereas mostly LF/HF was improved after both resistance training and HIIT. Supervised training improved most HRV parameters. Duration and frequency of training did not influence the benefits on HRV.ConclusionExercise training improved HRV parameters in T2DM patients which may reflect an improvement in the activity of the autonomic nervous system. The level of proof is the highest for endurance training. Supervised training seemed beneficial.

There is limited research on the biomechanical assessment of the lower limb joints in relation to dynamic movements that occur at the hip, knee, and ankle joints when performing dorsiflexion (DF) and plantarflexion (PF) among males and females. This study investigated the differences in joint angles (including range of motion (ROM)) and forces (including moments) between the left and right limbs at the ankle, knee, and hip joints during dynamic DF and PF movements in both males and females. Using a general linear model employing multivariate analysis in relation to the joint angle, ROM, force, and moment datasets, the results revealed significant main effects for gender, sidedness, phases, and foot position with respect to joint angles. Weak correlations were observed between measured biomechanical variables. These results provide insightful information for clinicians and biomechanists that relate to lower limb exercise interventions and modelling efficacy standpoints.

Background: The management of the psychological consequences of the COVID-19 pandemic is all the more difficult when subjects suffer from a prior psychiatric illness. BV13 is a 54-month prospective longitudinal cohort study of 111 subjects who were present in the Bataclan concert hall during the November 2015 terrorist attack in Paris. Objectives: Our first objective was to investigate the association between stress related to the COVID-19 pandemic and PTSD symptoms, notably with respect to two positive risk factors: trait mindfulness and social support. The second was to explore how PTSD severity mediated the relationship between trait mindfulness and COVID-19-induced stress. Method: The primary endpoint was evaluated using the COVID-19 Peritraumatic Distress Index (CPDI). PTSD symptoms were evaluated using the PTSD Check List Scale (PCL-5) during the sanitary crisis and two years before. Social support was assessed with a Likert scale that measured perceived support from family, friends and the workplace. Trait mindfulness was measured with the 14-item Freiburg Mindfulness Inventory (FMI). Results: 54 months after the attack, a univariate analysis identified a significant positive correlation between COVID-19 stress (CPDI) and PCL-5 (r=0.77, p

BackgroundThe psychophysiological changes for individual suffering from chronic post-traumatic stress disorder (PTSD) raise to the questions of how facilitate recovery and return to work. Negative alterations in neuro-cognition remain a complaint for patients and participate to long-term functional impairments. Neurological soft signs (NSSs) appear as a candidate for better understanding these complaints. They have been reported in several mental disorders. They are found in several behavioral and/or neurocognitive disorders and are taken into account by psychiatric rehabilitation programs to support recovery. As few studies evaluate NSSs in PTSD, our exploratory study aims to assess NSSs in chronic PTSD and their relationships with PTSD severity.MethodTwenty-two patients with a clinical diagnosis of chronic PTSD were evaluated in terms of PTSD severity (post-traumatic checklist scale, PCL5), NSSs (NSSs psychomotor skills scale, PASS), and well-being upon arrival to the hospital and compared with 15 healthy subjects. Statistical non-parametric analyses assessed the relationships between these variables.ResultsPTSD subjects exhibited higher NSSs compared with healthy subjects. NSSs were positively associated with PTSD severity, with negative alterations in cognition and mood, and with impairment in well-being. They were higher in women compared with men. No impact of age was found. Three groups were identified based on the severity of the PTSD. Severe PTSD exhibited NSSs characterized by motor integration alterations.ConclusionsThis pilot study suggests that NSSs might be a biomarker of PTSD severity. This proof of concept highlights the need for further research for better evaluating the clinical neuro-functional impairment. This will be helping for defining neurological remediation for promoting PTSD recovery.

Purpose: To describe the multiplicity of ocular manifestations of COVID-19 patients, we report a case of pseudomembranous and hemorrhagic conjunctivitis related with SARS-CoV-2 pneumonia in a patient of intensive care unit (ICU). Observations: A 63-year-old male was admitted in intensive care unit (ICU), seven days after the beginning of an influenza-like symptoms, to manage an acute respiratory syndrome related with SARS-CoV-2. Chest scan showed interstitial pneumonia with “crazy paving” patterns. At day 19, ocular examination at the patient's bed described petechias and tarsal hemorrhages, mucous filaments and tarsal pseudomembranous. Conjunctival scrapings and swabs did not identify any bacteria or virus. To our knowledge, we described the first case of pseudomembranous conjunctivitis in a COVID-19 patient. Conclusion and importance: Considering that SARS-CoV-2 is present in tears and conjunctival secretions, external ocular infections could be factors of infectious spreading. Physicians should be aware of late (>2 weeks) ocular complications in COVID-19 patients to prevent sequelae.

A lockdown of people has been used as an efficient public health measure to fight against the exponential spread of the coronavirus disease (Covid-19) and allows the health system to manage the number of patients. The aim of this study (clinicaltrials.gov NCT00430818) was to evaluate the impact of both perceived stress aroused by Covid-19 and of emotions triggered by the lockdown situation on the individual experience of time. A large sample of the French population responded to a survey on their experience of the passage of time during the lockdown compared to before the lockdown. The perceived stress resulting from Covid-19 and stress at work and home were also assessed, as were the emotions felt. The results showed that people have experienced a slowing down of time during the lockdown. This time experience was not explained by the levels of perceived stress or anxiety, although these were considerable, but rather by the increase in boredom and sadness felt in the lockdown situation. The increased anger and fear of death only explained a small part of variance in the time judgment. The conscious experience of time therefore reflected the psychological difficulties experienced during lockdown and was not related to their perceived level of stress or anxiety.