This review is the synthesis of a working group on mild asthma. Mild asthma includes intermittent and persistent mild asthma according to the Global Initiative for Asthma (GINA) classification, and ...affects between 50% and 75% of asthmatic patients. Mild asthma is more frequent, more symptomatic, and less well controlled in children than in adults. Cohort studies from childhood to adulthood show that asthma severity usually remains stable over time. Nevertheless, mild asthma can lead to severe exacerbations, with a frequency ranging from 0.12 to 0.77 per patient-year. Severe exacerbations in mild asthma represent 30-40% of asthma exacerbations requiring emergency consultation. In mild asthma, inflammation and structural remodelling are constant, of varying intensity, but nonspecific. Therapy with inhaled corticosteroids (ICS) decreases bronchial inflammation, but has only a slight effect on structural remodelling, and, when stopped, inflammation immediately recurs. Permanent low-dose ICS therapy is the reference treatment for persistent mild asthma. Effectiveness is to be reassessed at 3 months, and if it is insufficient the patient is no longer considered mildly asthmatic, and treatment has to be stepped up. As mild asthma is the most frequent form of the disease, diagnosis and management require physicians' particular attention.
Although little evidence existed to support that view, European countries and in particular France, have regarded echinoderms, including sea urchins, as low risk in terms of feacal contamination. It ...is hypothesized that the sea urchins mode of feeding, which is based on grazing and differs from bivalve molluscs, would prevent it from concentrating high levels of Escherichia coli. Here, we monitored E. coli levels in sea urchins (Paracentrotus lividus) and in filter‐feeder mussels (Mytillus galloprovincialis), collected concurrently from the same natural area over a 1‐year period to verify this assumption. Sea urchins were collected on the seafloor, whereas mussels were collected from the water column at a depth of 4 m. Our results showed heavy bacterial loading of sea urchins in a natural growing environment. Moreover, we highlighted that E. coli contamination of sea urchins could, in certain conditions, be higher than those detected in filter‐feeding mussels collected at the same location. Finally, the results showed a significant correlation between rainfall and E. coli concentrations in sea urchins, suggesting that the bacterial safety of sea urchin could be linked to the quality of the surrounding water. SIGNIFICANCE AND IMPACT OF THE STUDY: The European regulation requires competent authorities to monitor the sanitary status of shellfish, including live echinoderms, through faecal indicator organisms. In the French Mediterranean, sea urchin production is significant. Until now, as no data showed significant E. coli contamination levels, no monitoring programs focused on this species. This study demonstrates that sea urchins are more vulnerable to faecal contamination than previously hypothesized, especially during heavy rainfall. In consequence, the European authority general approach to microbiological management of shellfish should be applied to sea urchins.
The COVID-19 pandemic has swept through our hospitals which have had to adapt as a matter of urgency. We are aware that a health crisis of this magnitude is likely to generate mental disorders ...particularly affecting exposed healthcare workers. Being so brutal and global, this one-of the kind pandemic has been impacting the staff in their professional sphere but also within their private circle. The COV IMPACT study is an early assessment survey conducted for 2 weeks in May 2020, of the perception by all hospital workers of the changes induced in their professional activity by the pandemic. The study was carried out by a survey sent to the hospital staff of Béziers and Montfermeil. The readjusted working conditions were source of increased physical fatigue for 62 % of the respondents. Moral exhaustion was reported by 36 %. It was related to the stress of contracting the infection (72 %) but above all of transmitting it to relatives (89 %) with a broad perception of a vital risk (41 %). This stress affected all socio-professional categories (CSP) and was independent of exposure to COVID. Change in organisation, lack of information and protective gear and equipment were major factors of insecurity at the start of the epidemic. Work on supportive measures is necessary. It should focus on the spread of information, particularly towards the youngest, as well as bringing more psychological support and a larger amount of medical equipment, beyond healthcare workers and the COVID sectors.
Cats (
Felis silvestris catus
) are one of the most pernicious invasive species on islands, being responsible for the decline and extinction of many vertebrate taxa. Eradications programs are a ...powerful tool to fight against cat impacts on islands, but their implementation requires planning and design to prevent failure. In that sense, gathering data on cat habitat use, abundance and trophic interactions provides key information to effectively design management actions. The present contribution presents a simple resource-efficient methodology using cat feces to assess cat distribution, density and trophic ecology on an inhabited islet. This information is essential in order to effectively organize trapping efforts and minimize subsequent impacts of other species if a control or eradication campaign is undertaken. Additionally, our research effort evaluated the potential influence of coastal and anthropic resources on cat diet, which can also provide useful information for planning aside management actions. Cat distribution on our model islet, La Graciosa, was ‘clumped’, presenting higher densities in anthropic areas (villages and farms). The invasive house mouse and the European rabbit were the main prey items, although native invertebrates, reptiles and birds were also consumed. Cats on La Graciosa ingested a large quantity of garbage, which was negatively correlated with distance from human settlements. Considering the low time and resource requirements of this methodology, and the useful basic ecological information it provides, it can be employed to make optimal management planning decisions for small inhabited islands where cat control or eradication programs are being considered.
La pandémie COVID-19 a déferlé sur les hôpitaux et ceux-ci ont dû s’adapter dans l’urgence. On sait qu’une crise sanitaire de cette ampleur peut générer des troubles psychiques touchant ...particulièrement les soignants exposés. Cette pandémie est particulière par son caractère brutal et global, impactant les personnels dans leur sphère professionnelle mais aussi familiale et sociale. L’étude COV IMPACT est une évaluation précoce réalisée sur deux semaines en mai 2020, de la perception par les agents hospitaliers des bouleversements induits dans leur activité professionnelle par l’épidémie. L’enquête a été réalisée par auto-questionnaire proposé à l’ensemble des personnels des hôpitaux de Béziers et Montfermeil. Les conditions de travail réadaptées ont généré un surcroît de fatigue physique pour 62 % des agents. L’épuisement moral a été rapporté par 36 % des sondés. Celui-ci était sous-tendu par le stress de contracter l’infection (72 %) mais surtout de la transmettre à ses proches (89 %) avec une perception large d’un risque vital (41 % des sondés). Ce stress touchait toutes les catégories socio-professionnelles (CSP) indépendamment de l’exposition au COVID. Les changements d’organisation, le déficit d’information ainsi que le manque d’équipements de protection ont été des facteurs d’insécurité majeurs au début de l’épidémie. Un travail sur les mesures d’accompagnement est nécessaire. Il devrait cibler la diffusion de l’information, notamment vers les plus jeunes, ainsi que l’apport d’un soutien psychologique ou matériel plus large, au-delà du personnel soignant et des secteurs COVID.
The COVID-19 pandemic has swept through our hospitals which have had to adapt as a matter of urgency. We are aware that a health crisis of this magnitude is likely to generate mental disorders particularly affecting exposed healthcare workers. Being so brutal and global, this one-of the kind pandemic has been impacting the staff in their professional sphere but also within their private circle. The COV IMPACT study is an early assessment survey conducted for 2 weeks in May 2020, of the perception by all hospital workers of the changes induced in their professional activity by the pandemic. The study was carried out by a survey sent to the hospital staff of Béziers and Montfermeil. The readjusted working conditions were source of increased physical fatigue for 62 % of the respondents. Moral exhaustion was reported by 36 %. It was related to the stress of contracting the infection (72 %) but above all of transmitting it to relatives (89 %) with a broad perception of a vital risk (41 %). This stress affected all socio-professional categories (CSP) and was independent of exposure to COVID. Change in organisation, lack of information and protective gear and equipment were major factors of insecurity at the start of the epidemic. Work on supportive measures is necessary. It should focus on the spread of information, particularly towards the youngest, as well as bringing more psychological support and a larger amount of medical equipment, beyond healthcare workers and the COVID sectors.
Reduction in mediastinal adhesions is an issue in cardiac surgery. To evaluate a porcine-bioengineered collagen membrane (Cova™ CARD) intended to promote tissue regeneration, 18 sheep underwent a ...sternotomy and a 30 min period of cardiopulmonary bypass. They were divided into three equal groups: pericardium left open, placement of an e-polytetrafluoroethylene membrane (Preclude(®)) taken as a non-absorbable substitute comparator and placement of the absorbable Cova™ CARD membrane. Four months thereafter, the study animals underwent repeat sternotomy and were macroscopically assessed for the degree of material resorption and the intensity of adhesions. Explanted hearts were evaluated blindly for the magnitude of the inflammatory response, fibrosis and epicardial re-mesothelialization. The bioengineered membrane was absorbed by 4 months and replaced by a loosely adherent tissue leading to the best adhesion score. There was no inflammatory reaction (except for a minimal one in an animal). Fibrosis was minimal (P = 0.041 vs Preclude(®)). The highest degree of epicardial re-mesothelialization, albeit limited, was achieved by the bioengineered group in which five of six sheep demonstrated a new lining of mesothelial cells in contrast to two animals in each of the other groups. This collagen membrane might thus represent an attractive pericardial substitute for preventing post-operative adhesions.
The correct use of medication and the ability to assess the severity of the disease and to react appropriately in the case of exacerbation are essential objectives in the management of asthma ...patients. This study, conducted in a school of asthma in Seine-Saint-Denis, aims to measure the influence of socio-demographic and clinical factors, before any educational process, on these four security skills.
A prospective observational study concerning 280 consecutive patients managed between 2008 and 2011 (70 % women, mean age: 44 years 14-85 years; deprivation: 48 %; born abroad: 39 %, low level of education: 23 %). The initial educational diagnosis was compared with the clinical and socio-demographic characteristics.
In relation to asthma control, social characteristics (unemployment, deprivation), geographic or ethnic origin and educational level significantly influence the command of all or some of the security skills. In medical terms, a period of evolution of the disease of less than 10 years, outpatient follow-up without specialized monitoring and the absence of recent exacerbations also appear as predictors of inappropriate conduct in the management of the disease.
This study suggests new priority targets for therapeutic education in asthma.
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