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Cooperation in food acquisition is a hallmark of the human species. Given that costs and benefits of cooperation vary among production regimes and work activities, the transition from hunting-and-gathering to agriculture is likely to have reshaped the structure of cooperative subsistence networks. Hunter–gatherers often forage in groups and are generally more interdependent and experience higher short-term food acquisition risk than horticulturalists, suggesting that cooperative labour should be more widespread and frequent for hunter–gatherers. Here we compare female cooperative labour networks of Batek hunter–gatherers of Peninsular Malaysia and Tsimane forager–horticulturalists of Bolivia. We find that Batek foraging results in high daily variation in labour partnerships, facilitating frequent cooperation in diffuse networks comprised of kin and non-kin. By contrast, Tsimane horticulture involves more restricted giving and receiving of labour, confined mostly to spouses and primary or distant kin. Tsimane women also interact with few individuals in the context of hunting/fishing activities and forage mainly with spouses and primary kin. These differences give rise to camp- or village-level networks that are more modular (have more substructure when partitioned) among Tsimane horticulturalists. Our findings suggest that subsistence activities shape the formation and extent of female social networks, particularly with respect to connections with other women and non-kin. We discuss the implications of restricted female labour networks in the context of gender relations, power dynamics and the adoption of farming in humans. This article is part of the theme issue ‘Cooperation among women: evolutionary and cross-cultural perspectives’.

Vitiligo is a skin condition that leads to skin depigmentation in irregular patterns with potentially severe esthetic and psychological effects on the affected individual. While its etiology is not well understood, it seems to be a multifactorial condition that may be caused by hereditary factors and autoimmune processes among others. By reviewing various publications found through different databases like PubMed and GoogleScholar, this paper summarizes the different therapeutic options available for vitiligo. This includes JAK inhibitors, both topical and oral, and other types of topical drugs, such as vitamin D, calcineurin inhibitors, and steroids. There are also various phototherapy techniques, which all utilize ultraviolet (UV) light. Phototherapy devices are able to deliver the wavelengths that are most beneficial for the stimulation of repigmentation through special filtering. These different treatments give hope to millions of individuals afflicted by this condition worldwide. The following paper overviews and compares the different JAK inhibitors, other topical drugs, and phototherapy options available to treat vitiligo.

Remote patient monitoring (RPM) for the management of patients with chronic heart failure (CHF) has been widely studied from clinical and health-economic points of view. In contrast, data on the organisational impact of this type of RPM are scarce. The objective of the present study of cardiology departments (CDs) in France was to describe the organisational impact of the Chronic Care ConnectTM (CCCTM) RPM system for CHF. An organisational impact map for health technology assessment was used to identify and define the criteria evaluated in the present survey, including the care process, equipment, infrastructure, training, skill transfers, and the stakeholders’ abilities to implement the care process. In April 2021, an online questionnaire was sent to 31 French CDs that were using CCCTM for CHF management: 29 (94%) completed the questionnaire. The survey results showed that CDs progressively modified their organisational structures upon or shortly after the implementation of the RPM device. Twenty-four departments (83%) had created a dedicated team, sixteen (55%) had provided dedicated outpatient consultations for patients with an emergency alert, and twenty-five (86%) admitted patients directly (i.e., avoiding the need to attend the emergency department). The present survey is the first to have assessed the organisational impact of the implementation of the CCCTM RPM device for CHF management. The results highlighted the variety of organisational structures, which tended to structure with the use of the device.

Little is known about brain aging or dementia in nonindustrialized environments that are similar to how humans lived throughout evolutionary history. This paper examines brain volume (BV) in middle and old age among two indigenous South American populations, the Tsimane and Moseten, whose lifestyles and environments diverge from those in high-income nations. With a sample of 1,165 individuals aged 40 to 94, we analyze population differences in cross-sectional rates of decline in BV with age. We also assess the relationships of BV with energy biomarkers and arterial disease and compare them against findings in industrialized contexts. The analyses test three hypotheses derived from an evolutionary model of brain health, which we call the embarrassment of riches (EOR). The model hypothesizes that food energy was positively associated with late life BV in the physically active, food-limited past, but excess body mass and adiposity are now associated with reduced BV in industrialized societies in middle and older ages. We find that the relationship of BV with both non-HDL cholesterol and body mass index is curvilinear, positive from the lowest values to 1.4 to 1.6 SDs above the mean, and negative from that value to the highest values. The more acculturated Moseten exhibit a steeper decrease in BV with age than Tsimane, but still shallower than US and European populations. Lastly, aortic arteriosclerosis is associated with lower BV. Complemented by findings from the United States and Europe, our results are consistent with the EOR model, with implications for interventions to improve brain health.

While it is commonly thought that patrilocality is associated with worse outcomes for women and their children due to lower social support, few studies have examined whether the structure of female social networks covaries with post-marital residence. Here, we analyse scan sample data collected among Tsimane forager–farmers. We compare the social groups and activity partners of 181 women residing in the same community as their parents, their husband's parents, both or neither. Relative to women living closer to their in-laws, women living closer to their parents are less likely to be alone or solely in the company of their nuclear family (odds ratio (OR): 0.6, 95% CI: 0.3–0.9), and more likely to be observed with others when engaging in food processing and manufacturing of market or household goods, but not other activities. Women are slightly more likely to receive childcare support from outside the nuclear family when they live closer to their parents (OR = 1.8, 95% CI 0.8–3.9). Their social group size and their children's probability of receiving allocare decrease significantly with distance from their parents, but not their in-laws. Our findings highlight the importance of women's proximity to kin, but also indicate that patrilocality per se is not costly to Tsimane women. This article is part of the theme issue ‘Cooperation among women: evolutionary and cross-cultural perspectives’.

BACKGROUND In South Africa, diabetes prevalence is expected to reach 5.4 million by 2030. Moreover, a large proportion of adults remain undiagnosed. In South Africa, diabetes-related complications not only severely impact patient health and quality of life, but also the economy. OBJECTIVE The Diabetes Nurse Educator (DNE) study assessed the benefit of adding the MyDiaCare program to standard of care for managing type 1 and 2 diabetes patients in South Africa. An economic study was also performed to assess the benefit of adding MyDiaCare to standard of care in type 2 diabetes patients, older than 19 years, treated in the South African private healthcare sector. METHODS The real-world DNE study was designed as an observational, retrospective, multicenter, single group study. Eligible patients were older than 18 years and with at least 6 months of participation in the MyDiaCare program. The MyDiaCare program combines patient mobile application and a healthcare professional platform with face-to face visits with a DNE. The benefit of MyDiaCare was assessed by the changes in HbA1c levels, the proportion of patient achieving clinical and biological targets, adherence to care plans, and satisfaction after 6 months of participating in the MyDiaCare program. A budget impact model was performed using data from the DNE study and another South African cohort to estimate the economic benefit of MyDiaCare. RESULTS Between 25 November 2019 and 30 June 2020, 117 patients (8 with type 1 diabetes and 109 with type 2) were enrolled in two centers. After 6 months of MyDiaCare, a clinically relevant decrease in mean glycated hemoglobin (HbA1c) levels by 0.6% from 7.8% to 7.2% was observed. Furthermore, 54% of patients reached or maintained their HbA1c targets at 6 months. Most patients achieved their targets for blood pressure (67% for systolic and 89% for diastolic blood pressure) and lipid parameters (69% for low-density lipoprotein (LDL) cholesterol, 58% for high-density lipoprotein (HDL) cholesterol, and 83% for total cholesterol, but fewer patients for triglycerides (46%), waist circumference (18%), and body weight (17%). The mean overall adherence to the MyDiaCare care plan was 93%. Most patients (74%) were satisfied with the MyDiaCare program. The economic study estimated that after 1 year of using the MyDiaCare program, the cost of type 2 diabetes management in the South African private healthcare sector would be reduced by 26 billion rands: from 117 billion rands with standard of care to 91 billion rands by adding MyDiaCare. CONCLUSIONS The MyDiaCare program, that combines digital tools for patients and healthcare professionals with DNE support, is a practical, clinically effective (lowering HbA1c levels and other cardiovascular risk factors), and cost-saving solution for diabetes management in the South African private healthcare sector. CLINICALTRIAL Not applicable.

Brain atrophy is correlated with risk of cognitive impairment, functional decline, and dementia. Despite a high infectious disease burden, Tsimane forager-horticulturists of Bolivia have the lowest prevalence of coronary atherosclerosis of any studied population and present few cardiovascular disease (CVD) risk factors despite a high burden of infections and therefore inflammation. This study (a) examines the statistical association between brain volume (BV) and age for Tsimane and (b) compares this association to that of 3 industrialized populations in the United States and Europe. This cohort-based panel study enrolled 746 participants aged 40–94 (396 males), from whom computed tomography (CT) head scans were acquired. BV and intracranial volume (ICV) were calculated from automatic head CT segmentations. The linear regression coefficient estimate β^T of the Tsimane (T), describing the relationship between age (predictor) and BV (response, as a percentage of ICV), was calculated for the pooled sample (including both sexes) and for each sex. β^T was compared to the corresponding regression coefficient estimate β^R of samples from the industrialized reference (R) countries. For all comparisons, the null hypothesis β T = β R was rejected both for the combined samples of males and females, as well as separately for each sex. Our results indicate that the Tsimane exhibit a significantly slower decrease in BV with age than populations in the United States and Europe. Such reduced rates of BV decrease, together with a subsistence lifestyle and low CVD risk, may protect brain health despite considerable chronic inflammation related to infectious burden.

To investigate the predictors and burden of hospital readmission with recurrent Clostridioides difficile infection (rCDI) in a large European healthcare system with a low prevalence of hyper-virulent C. difficile clones. We conducted an inception cohort study based on an exhaustive health insurance database and including all survivors of a first hospital stay with CDI over a one-year period (2015) in France. Readmissions with rCDI were defined as a novel hospital stay with CDI within 12 weeks following discharge of the index hospitalization. Risk factors for readmission with rCDI were investigated through multivariate logistic regression analyses. Among the 14,739 survivors of the index hospital stay (females, 57.3%; median age, 74 [58–84] years), 2135 (14.5%) required at least one readmission with rCDI. Independent predictors of readmission were age ≥ 65 years (adjusted odds ratio (aOR), 1.34, 95% confidence interval (CI), 1.21–1.49, P

OBJECTIVE Recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT) with positive cytomegalovirus (CMV) serology are at increased risk of morbidity and mortality. The primary objective of this study was to assess the association between treated CMV infection and overall mortality within 1 year after allo-HCT in adult CMV-seropositive Recipients (R+). Secondary objectives included overall 5-year mortality after allo-HCT, risk factors for treated CMV infection, associations between treated CMV infection and allo-HCT complications and medical costs. METHODS A multicenter retrospective cohort study was conducted in adult CMV-seropositive recipients (R+) who underwent to allo-HCT between 1st January 2010 and 31st December 2014. RESULTS Five hundred seventy two CMV-seropositive patients (mean age, 50.2 years) undergoing allo-HCT between 2010 and 2014 were included; 55.9% of donors were CMV seropositive. CMV infection treated with antiviral therapy was reported in 227 patients (39.7%) after transplantation. One-year overall mortality was significantly increased in patients with treated CMV infections (hazard ratio, 1.86; 95% CI, 1.16-3.00; P = .011). Mean medical costs during the first post-HCT year were higher in patients with CMV infection (€46 853 vs €31 318; P

Body temperature in tropical forager-farmers declined as much in the past two decades as among Americans in the past 150 years., Normal human body temperature (BT) has long been considered to be 37.0°C. Yet, BTs have declined over the past two centuries in the United States, coinciding with reductions in infection and increasing life expectancy. The generality of and reasons behind this phenomenon have not yet been well studied. Here, we show that Bolivian forager-farmers (n = 17,958 observations of 5481 adults age 15+ years) inhabiting a pathogen-rich environment exhibited higher BT when first examined in the early 21st century (~37.0°C). BT subsequently declined by ~0.05°C/year over 16 years of socioeconomic and epidemiological change to ~36.5°C by 2018. As predicted, infections and other lifestyle factors explain variation in BT, but these factors do not account for the temporal declines. Changes in physical activity, body composition, antibiotic usage, and thermal environment are potential causes of the temporal decline.

Summary Indigenous communities worldwide share common features that make them especially vulnerable to the complications of and mortality from COVID-19. They also possess resilient attributes that can be leveraged to promote prevention efforts. How can indigenous communities best mitigate potential devastating effects of COVID-19? In Bolivia, where nearly half of all citizens claim indigenous origins, no specific guidelines have been outlined for indigenous communities inhabiting native communal territories. In this Public Health article, we describe collaborative efforts, as anthropologists, physicians, tribal leaders, and local officials, to develop and implement a multiphase COVID-19 prevention and containment plan focused on voluntary collective isolation and contact-tracing among Tsimane forager-horticulturalists in the Bolivian Amazon. Phase 1 involves education, outreach, and preparation, and phase 2 focuses on containment, patient management, and quarantine. Features of this plan might be exported and adapted to local circumstances elsewhere to prevent widespread mortality in indigenous communities.

High social status is often associated with greater mating opportunities and fertility for men, but do women also obtain fitness benefits of high status? Greater resource access and child survivorship may be principal pathways through which social status increases women's fitness. Here, we examine whether peer-rankings of women's social status (indicated by political influence, project leadership, and respect) positively covaries with child nutritional status and health in a community of Amazonian horticulturalists. We find that maternal political influence is associated with improved child health outcomes in models adjusting for maternal age, parental height and weight, level of schooling, household income, family size, and number of kin in the community. Children of politically influential women have higher weight-for-age ( B = 0.33; 95% CI = 0.12–0.54), height-for-age ( B = 0.32; 95% CI = 0.10–0.54), and weight-for-height ( B = 0.24; 95% CI = 0.04–0.44), and they are less likely to be diagnosed with common illnesses (OR = 0.48; 95% CI = 0.31–0.76). These results are consistent with women leveraging their social status to enhance reproductive success through improvements in child health. We discuss these results in light of parental investment theory and the implications for the evolution of female social status in humans.

Becoming valuable to fellow group members so that one would attract assistance in times of need is a major adaptive problem. To solve it, the individual needs a predictive map of the degree to which others value different acts so that, in choosing how to act, the payoff arising from others’ valuation of a potential action (e.g., showing bandmates that one is a skilled forager by pursuing a hard-to-acquire prey item) can be added to the direct payoff of the action (e.g., gaining the nutrients of the prey captured). The pride system seems to incorporate all of the elements necessary to solve this adaptive problem. Importantly, data from western(-ized), educated, industrialized, rich, and democratic (WEIRD) societies indicate close quantitative correspondences between pride and the valuations of audiences. Do those results generalize beyond industrial mass societies? To find out, we conducted an experiment among 567 participants in 10 small-scale societies scattered across Central and South America, Africa, and Asia: (i) Bosawas Reserve, Nicaragua; (ii) Cotopaxi, Ecuador; (iii) Drâa-Tafilalet, Morocco; (iv) Enugu, Nigeria; (v) Le Morne, Mauritius; (vi) La Gaulette, Mauritius; (vii) Tuva, Russia; (viii) Shaanxi and Henan, China; (ix) farming communities in Japan; and (x) fishing communities in Japan. Despite widely varying languages, cultures, and subsistence modes, pride in each community closely tracked the valuation of audiences locally (mean r = +0.66) and even across communities (mean r = +0.29). This suggests that the pride system not only develops the same functional architecture everywhere but also operates with a substantial degree of universality in its content.

We test the contribution of sex differences in physical formidability, education, and cooperation to the acquisition of political leadership in a small-scale society. Among forager-farmers from the Bolivian Amazon, we find that men are more likely to exercise different forms of political leadership, including verbal influence during community meetings, coordination of community projects, and dispute resolution. We show that these differences in leadership are not due to gender per se but are associated with men's greater number of cooperation partners, greater access to schooling, and greater body size and physical strength. Men's advantage in cooperation partner number is tied to their participation in larger groups and to the opportunity costs of women's intrahousehold labor. We argue these results highlight the mutual influence of sexual selection and the sexual division of labor in shaping how women and men acquire leadership.

Background Clostridium difficile infection (CDI) is associated with a substantial Quality of life impact on patients that has not been so far measured with a generic validated instrument. Methods A prospective study was performed in 7 French acute-care settings in patients presenting with a bacteriologically-confirmed CDI. The EQ-5D-3 L was filled in by patients at 7 ± 2 days after CDI diagnosis to describe their state of health at that date as well as their state of health immediately before the CDI episode (baseline). Individual utility decrement was obtained by subtracting the corresponding utilities. The Quality Adjusted Life Year (QALY) loss was calculated by multiplying the days spent from baseline to the date of the interview, by the decrement of utility. A multivariate analysis of variance of the utility decrement according to CDI and patients characteristics was performed. Results Eighty patients were enrolled (mean age: 69.4 years, 55% females). The utility scores dropped from a mean 0.542 (SD: 0.391) at baseline to 0.050 (SD: 0.404) during the CDI episode with a mean adjusted utility decrement of 0.492 (SD: 0.398) point. This decrement increased significantly with CDI severity (Zar score ≥ 3) (p = 0.001), in patients with a positive baseline utility (p = 0.032), in women as compared to men (p = 0.041) and in patients aged more than 65 years (p = 0.041). No association with the Charlson index was found. The associated QALY loss not integrating the excess mortality was 0.028 (SD: 0.053). Conclusions The impact on quality of life of CDI episodes is major and translates in a substantial QALY loss despite their short duration. Electronic supplementary material The online version of this article (10.1186/s12955-019-1081-5) contains supplementary material, which is available to authorized users.

This set of experiments shows that in 15 traditional small-scale societies there is an extraordinarily close correspondence between (i) the intensity of shame felt if one exhibited specific acts or traits and (ii) the magnitude of devaluation expressed in response to those acts or traits by local audiences, and even foreign audiences. Three important and widely acknowledged sources of cultural variation between communities—}geographic proximity, linguistic similarity, and religious similarity{—}all failed to account for the strength of between-community correlations in the shame{–}devaluation link. This supplies a parallel line of evidence that shame is a universal system, part of our species{’} cooperative biology, rather than a product of cultural evolution.Human foragers are obligately group-living, and their high dependence on mutual aid is believed to have characterized our species{’} social evolution. It was therefore a central adaptive problem for our ancestors to avoid damaging the willingness of other group members to render them assistance. Cognitively, this requires a predictive map of the degree to which others would devalue the individual based on each of various possible acts. With such a map, an individual can avoid socially costly behaviors by anticipating how much audience devaluation a potential action (e.g., stealing) would cause and weigh this against the action{’}s direct payoff (e.g., acquiring). The shame system manifests all of the functional properties required to solve this adaptive problem, with the aversive intensity of shame encoding the social cost. Previous data from three Western(ized) societies indicated that the shame evoked when the individual anticipates committing various acts closely tracks the magnitude of devaluation expressed by audiences in response to those acts. Here we report data supporting the broader claim that shame is a basic part of human biology. We conducted an experiment among 899 participants in 15 small-scale communities scattered around the world. Despite widely varying languages, cultures, and subsistence modes, shame in each community closely tracked the devaluation of local audiences (mean r = +0.84). The fact that the same pattern is encountered in such mutually remote communities suggests that shame{’s match to audience devaluation is a design feature crafted by selection and not a product of cultural contact or convergent cultural evolution.

Indigenous people worldwide suffer from higher rates of morbidity and mortality than neighboring populations. In addition to having limited access to public health infrastructure, indigenous people may also have priorities and health perceptions that deter them from seeking adequate modern healthcare. Here we propose that living in a harsh and unpredictable environment reduces motivation to pursue deliberate, costly action to improve health outcomes. We assess whether variation in Health Locus of Control (HLC), a psychological construct designed to capture self-efficacy with respect to health, explains variation in treatment uptake behavior among Tsimane Amerindians (N = 690; age range: 40–89 years; 55.8% female; data collection: 2008–2012), a high mortality and morbidity indigenous population in the Bolivian Amazon, Beni Department. Comparisons with two industrialized populations in Japan (Miyagi prefecture; e0 = 76.6 years) and the United Kingdom (Caerphilly county borough; e0 = 81.2 years) confirm that Tsimane (e0 = 54.1 years) have a more externalized HLC. Multilevel level models were used to investigate whether HLC predicts treatment uptake, and mediates the relationship between modernization and treatment uptake. External HLC scores were predictive of treatment outcomes: Powerful others scores were positively associated with probability of receiving modern treatment (adjusted odds ratio [OR] = 1.33), while Chance scores were negatively associated with probability of receiving modern treatment (adjusted OR = 0.76). We found no effects, however, of Internal HLC or educational capital on treatment uptake. Overall, our findings indicate that health-related decision-making is influenced more by a psychological orientation affecting self-efficacy, shaped in part by perceptions of environmental unpredictability and harshness, than by limited knowledge, education or other indicators of modernization.

Objectif Evaluer les consequences sur la qualite de vie d’un episode d’infection a Clostridium difficile (ICD) chez des patients hospitalises en court sejour. Materiel et methodes Une etude observationnelle prospective a ete conduite en 2016 dans sept centres hospitaliers francais chez des patients presentant une ICD confirmee microbiologiquement. L’auto-questionnaire EQ-5D-3L a ete complete par les patients pour decrire leur etat de sante percu, a deux reprises : a 7 (± 2) jours apres le diagnostic d’ICD ainsi que de facon retrospective pour decrire leur etat avant l’episode infectieux. Les decrements d’utilite correspondants (avant et pendant l’episode) ont ete calcules en appliquant les valeurs de reference francaises [1] . Le score obtenu variait entre −1 et 1, 1 etant la meilleure qualite de vie possible. Le calcul des QALYs a ete effectue a partir de l’EQ-5D et des durees moyennes observees des episodes dans les etudes publiees. La perte de QALY a ete estimee en multipliant la perte incrementale d’utilite par la duree moyenne d’un episode. Une analyse de la variance des decrements d’utilite en fonction de la severite de l’ICD et des caracteristiques des patients a ete realisee. Resultats Au total, 80 patients ont ete inclus et disposaient de donnees exploitables ; 45 % des patients inclus etaient des hommes et l’âge median a l’inclusion etait de 71 ans (min/max : 30/98). La duree d’hospitalisation moyenne etait de 30 jours (± 29). Le score moyen de Charlson etait de 5,1 (± 2,8). Les scores d’utilite etaient negatifs chez 14 patients (18 %) avant l’episode d’ICD et chez 43 patients (54,4 %) pendant l’episode. Le score moyen EQ-5D est passe de 0,542 (± 0,391) avant l’episode infectieux a 0,050 (±0,404) pendant l’episode, avec une perte d’utilite moyenne ajustee de 0,482 points (±0,4). Le decrement d’utilite etait significativement plus important en fonction de la severite de l’ICD (score Zar ≥ 3) (p = 0,001), pour les patients avec un score d’utilite positif avant l’episode (p = 0,032), pour les femmes (p = 0,041) et pour les patients âges de 65 ans ou plus (p = 0,041). Aucune association avec le score de Charlson n’a ete mise en evidence. La perte de QALY associee en l’absence de deces etait de 10,22 QALD (« Quality-Adjusted Life Days ») (± 19,44) soit 0,028 QALY (± 0,052). Conclusion Les consequences sur la qualite de vie des episodes d’ICD, en dehors des consequences en termes de mortalite plus elevee, sont importantes et se traduisent en une perte significative de QALY malgre leur courte duree.

Objectif Les etudes evaluant la surmortalite liee aux infections a Clostridium difficile (ICD) aboutissant a des resultats contradictoires, l’objectif etait d’estimer, en France, l’impact des ICD en termes de mortalite et de rehospitalisation. Patients et methodes Une cohorte historique a ete constituee a partir de l’echantillon au 1/97 e de la base de remboursement de l’assurance maladie. Afin de ne selectionner que des primo-infections a C. difficile , les patients hospitalises pour la premiere fois avec un diagnostic principal, relie ou associe d’ICD ont ete inclus entre 2007 et 2014 apres exclusion de ceux hospitalises pour cette infection en 2006. La survie et les rehospitalisations de ces patients ont ete comparees a celles d’un groupe temoin de patients ayant ete hospitalises sur la meme periode, sans diagnostic d’ICD et apparie selon un score de propension. Ce score a ete calcule a partir des variables : âge, sexe, score de Charlson, duree d’hospitalisation, annee d’hospitalisation et principales comorbidites. Un modele de Cox a permis d’estimer le hazard ratio de deces dans le groupe infecte par Clostridium difficile comparativement au groupe temoin. Resultats Au total, 482 patients ayant eu une ICD ont ete apparies a 964 temoins. Les deux groupes etaient similaires au regard des caracteristiques ayant contribue au calcul du score de propension. Une augmentation statistiquement significative du risque de deces a ete observee dans le groupe de sujets atteints d’une ICD avec un hazard ratio non ajuste de 1,65 (IC95 % = [1,33 ; 2,04]) et ajuste de 1,58 (IC95 % = [1,27 ; 1,97]). Les risques relatifs ajustes de deces etaient 1,78 (IC95 % = [1,18 ; 2,70]) a 28 jours, 1,52 (IC95 % = [1,17 ; 1,98]) a 3 mois, 1,52 (IC95 % = [1,20 ; 1,93]) a 6 mois et 1,64 (CI95 % = [1,32 ; 2,03]) a 12 mois. Les analyses de sensibilite realisees ont abouti a des resultats similaires et statistiquement significatifs. Les proportions de sujets rehospitalises dans l’annee ayant suivi l’hospitalisation initiale etaient de 52,5 % et 41,2 % ( p p Conclusion Les ICD sont responsables d’une surmortalite et d’une rehospitalisation plus frequente en comparaison a une population similaire en termes d’âge, de sexe, de comorbidites et de duree d’hospitalisation.