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International audience ; Chronic diseases are diseases of long duration and slow progression. Major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, rheumatologic diseases and mental health) represent the predominant health problem of the Century. The prevention and control of NCDs are the priority of the World Health Organization 2008 Action Plan, the United Nations 2010 Resolution and the European Union 2010 Council. The novel trend for the management of NCDs is evolving towards integrative, holistic approaches. NCDs are intertwined with ageing. The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has prioritised NCDs. To tackle them in their totality in order to reduce their burden and societal impact, it is proposed that NCDs should be considered as a single expression of disease with different risk factors and entities. An innovative integrated health system built around systems medicine and strategic partnerships is proposed to combat NCDs. It includes (i) understanding the social, economic, environmental, genetic determinants, as well as the molecular and cellular mechanisms underlying NCDs; (ii) primary care and practice-based interprofessional collaboration; (iii) carefully phenotyped patients; (iv) development of unbiased and accurate biomarkers for comorbidities, severity and follow up of patients; (v) socio-economic science; (vi) development of guidelines; (vii) training; and (viii) policy decisions. The results could be applicable to all countries and adapted to local needs, economy and health systems. This paper reviews the complexity of NCDs intertwined with ageing. It gives an overview of the problem and proposes two practical examples of systems medicine (MeDALL) applied to allergy and to NCD co-morbidities (MACVIA-LR).

PMC8492020 ; BACKGROUND: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. METHODS: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. FINDINGS: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained ...

Psychotic patients hospitalized in psychiatry are subjected to a lot of constraints whenever tide to the psychiatric disorders themselves, the treatment or the legislation. The therapeutic setting, that is considered here as a multidisciplinary one, establishes some rules, limits, constraints but by doing so doesn't it help the patients to develop their autonomy and their freedom? When exploring the roles of the therapeutic setting, it appears that by containing, enveloping, offering some points of reference, it makes the therapeutic process possible and gives a secure base to the patient, which is absolutely necessary to gain freedom. The therapeutic alliance where patient and therapist engage with each other is key to deal with and accept the different constraints rather than being subjected to them and then to be free. The therapeutic setting, both resistant and flexible, gradually guides the patient in conquering his new areas of freedom. ; Les contraintes subies par les patients psychotiques hospitalisés en psychiatrie sont nombreuses, qu'elles soient liées à la pathologie elle-même, aux modalités de soin, à la législation. Le cadre thérapeutique, envisagé ici dans une perspective pluridisciplinaire, vient certes poser des règles, des limites, des contraintes, mais ce faisant, ne contribue-t-il pas aussi à l'autonomisation du patient et à sa liberté ? En explorant le rôle du cadre thérapeutique, il apparait qu'en venant contenir, envelopper, donner des repères, il rend possible le processus de soin et offre une base de sécurité au patient, prérequis indispensables pour retrouver de la liberté. L'alliance thérapeutique, véritable collaboration entre patient et thérapeute, est clé pour intégrer les contraintes du cadre, du soin et de la pathologie plutôt que de les subir, et exercer ainsi sa liberté. Le cadre thérapeutique, à la fois solide et élastique, accompagne progressivement le patient dans la conquête de ses nouveaux espaces de liberté.

Psychotic patients hospitalized in psychiatry are subjected to a lot of constraints whenever tide to the psychiatric disorders themselves, the treatment or the legislation. The therapeutic setting, that is considered here as a multidisciplinary one, establishes some rules, limits, constraints but by doing so doesn't it help the patients to develop their autonomy and their freedom? When exploring the roles of the therapeutic setting, it appears that by containing, enveloping, offering some points of reference, it makes the therapeutic process possible and gives a secure base to the patient, which is absolutely necessary to gain freedom. The therapeutic alliance where patient and therapist engage with each other is key to deal with and accept the different constraints rather than being subjected to them and then to be free. The therapeutic setting, both resistant and flexible, gradually guides the patient in conquering his new areas of freedom. ; Les contraintes subies par les patients psychotiques hospitalisés en psychiatrie sont nombreuses, qu'elles soient liées à la pathologie elle-même, aux modalités de soin, à la législation. Le cadre thérapeutique, envisagé ici dans une perspective pluridisciplinaire, vient certes poser des règles, des limites, des contraintes, mais ce faisant, ne contribue-t-il pas aussi à l'autonomisation du patient et à sa liberté ? En explorant le rôle du cadre thérapeutique, il apparait qu'en venant contenir, envelopper, donner des repères, il rend possible le processus de soin et offre une base de sécurité au patient, prérequis indispensables pour retrouver de la liberté. L'alliance thérapeutique, véritable collaboration entre patient et thérapeute, est clé pour intégrer les contraintes du cadre, du soin et de la pathologie plutôt que de les subir, et exercer ainsi sa liberté. Le cadre thérapeutique, à la fois solide et élastique, accompagne progressivement le patient dans la conquête de ses nouveaux espaces de liberté.

International audience ; Reviewers' comments: Reviewer #1: Comments to Editor The manuscript "Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war" by Rousseau et al deals with very actual topic: the disclosure of the neurobiology of psychotherapies. Furthermore, approaching such matter by PET activation studies, after about 30 years since the first 15O-H2O ones, using FDG might start a new season for this fascinating research field The manuscript is concise, well written and pretty clear in the aims, methods, results and discussion and in my opinion misses only a few information that will would improve its quality. I have a general comment and some minor specific remarks General comments The authors have recently published on the EJNMMI an editorial promoting functional 18F-FDG PET brain activation imaging. A similar study to the present one was published on the same Journal in 2015 (Eur J Nucl Med Mol Imaging (2015) 42:733-740) in which the very same protocol and methodology were used with the only difference that the stressing stimulus was olfactory and not visual. Since the readers of the present paper will be (firstly) nuclear medicine physicians it is opinion of this reviewer that the above paper should be quoted and the methodology implemented in both of them better "promoted" in the introduction and discussion to stimulate the colleagues to perform similar studies. It is also the opinion of this reviewer that it is a pity that the authors decided to submit such interesting and groundbreaking paper as short communication instead of full paper. Reply: Thanks to the Reviewer for his/her highly positive comments. As mentioned, we are limited by the constraints of a short communication that we indeed chose considering this work as a pilot study with the inclusion of only fifteen subjects. At the discretion of the Editor, the paper could possibly be considered for an Editorial to ...

International audience ; Reviewers' comments: Reviewer #1: Comments to Editor The manuscript "Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war" by Rousseau et al deals with very actual topic: the disclosure of the neurobiology of psychotherapies. Furthermore, approaching such matter by PET activation studies, after about 30 years since the first 15O-H2O ones, using FDG might start a new season for this fascinating research field The manuscript is concise, well written and pretty clear in the aims, methods, results and discussion and in my opinion misses only a few information that will would improve its quality. I have a general comment and some minor specific remarks General comments The authors have recently published on the EJNMMI an editorial promoting functional 18F-FDG PET brain activation imaging. A similar study to the present one was published on the same Journal in 2015 (Eur J Nucl Med Mol Imaging (2015) 42:733-740) in which the very same protocol and methodology were used with the only difference that the stressing stimulus was olfactory and not visual. Since the readers of the present paper will be (firstly) nuclear medicine physicians it is opinion of this reviewer that the above paper should be quoted and the methodology implemented in both of them better "promoted" in the introduction and discussion to stimulate the colleagues to perform similar studies. It is also the opinion of this reviewer that it is a pity that the authors decided to submit such interesting and groundbreaking paper as short communication instead of full paper. Reply: Thanks to the Reviewer for his/her highly positive comments. As mentioned, we are limited by the constraints of a short communication that we indeed chose considering this work as a pilot study with the inclusion of only fifteen subjects. At the discretion of the Editor, the paper could possibly be considered for an Editorial to ...

International audience ; Reviewers' comments: Reviewer #1: Comments to Editor The manuscript "Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war" by Rousseau et al deals with very actual topic: the disclosure of the neurobiology of psychotherapies. Furthermore, approaching such matter by PET activation studies, after about 30 years since the first 15O-H2O ones, using FDG might start a new season for this fascinating research field The manuscript is concise, well written and pretty clear in the aims, methods, results and discussion and in my opinion misses only a few information that will would improve its quality. I have a general comment and some minor specific remarks General comments The authors have recently published on the EJNMMI an editorial promoting functional 18F-FDG PET brain activation imaging. A similar study to the present one was published on the same Journal in 2015 (Eur J Nucl Med Mol Imaging (2015) 42:733-740) in which the very same protocol and methodology were used with the only difference that the stressing stimulus was olfactory and not visual. Since the readers of the present paper will be (firstly) nuclear medicine physicians it is opinion of this reviewer that the above paper should be quoted and the methodology implemented in both of them better "promoted" in the introduction and discussion to stimulate the colleagues to perform similar studies. It is also the opinion of this reviewer that it is a pity that the authors decided to submit such interesting and groundbreaking paper as short communication instead of full paper. Reply: Thanks to the Reviewer for his/her highly positive comments. As mentioned, we are limited by the constraints of a short communication that we indeed chose considering this work as a pilot study with the inclusion of only fifteen subjects. At the discretion of the Editor, the paper could possibly be considered for an Editorial to ...

International audience ; IntroductionAsthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation.Materials and MethodsA cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0–12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS.ResultsThe prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.ConclusionALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.

International audience ; IntroductionAsthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation.Materials and MethodsA cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0–12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS.ResultsThe prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.ConclusionALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.

International audience ; IntroductionAsthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation.Materials and MethodsA cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0–12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS.ResultsThe prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.ConclusionALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.

International audience ; IntroductionAsthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation.Materials and MethodsA cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0–12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS.ResultsThe prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.ConclusionALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.

International audience ; BACKGROUND:The first estimates of Healthy Life Years at age 50 (HLY50) across the EU25 countries in 2005 showed substantial variation in healthy ageing. We investigate whether factors contributing to HLY50 inequalities have changed between 2005 and 2010.METHODS:HLY50 for each country and year were calculated using Sullivan's method, applying the age-specific prevalence of activity limitation from the European Union Statistics on Income and Living Conditions (EU-SILC) survey to life tables. Inequalities in life expectancy at age 50 (LE50) and HLY50 between countries were defined as the difference between the maximum and minimum LE50 or HLY50. Relationships between HLY50 and macro-level socio-economic indicators were investigated using meta-regression. Men and women were analysed separately.RESULTS:Between 2005 and 2010 HLY50 inequalities for both men and women in Europe increased. In 2005 and 2010 HLY50 inequalities exceeded LE50 inequalities, particularly in the established EU15 countries in 2010 where HLY50 inequalities (men: 10.7 years; women: 12.5 years) were four times greater for men and three times for women than LE50 inequalities (men: 2.4 years; women: 4.1 years). Only material deprivation significantly explained variation in EU25 HLY50 in both years with, additionally, long-term unemployment in 2010.CONCLUSIONS:Our results suggest that inequalities in HLY50 across Europe are large, increasing and partly explained by levels of material deprivation. Moreover long-term unemployment has become more influential in explaining variation in HLY50 between 2005 and 2010.

International audience ; BackgroundDrowsiness compromises driving ability by reducing alertness and attentiveness, and delayed reaction times. Sleep-related car crashes account for a considerable proportion of accident at the wheel. Narcolepsy type 1 (NT1), narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) are rare central disorders of hypersomnolence, the most severe causes of sleepiness thus being potential dangerous conditions for both personal and public safety with increasing scientific, social, and political attention. Our main objective was to assess the frequency of recent car crashes in a large cohort of patients affected with well-defined central disorders of hypersomnolence versus subjects from the general population.MethodsWe performed a cross-sectional study in French reference centres for rare hypersomnia diseases and included 527 patients and 781 healthy subjects. All participants included needed to have a driving license, information available on potential accident events during the last 5 years, and on potential confounders; thus analyses were performed on 282 cases (71 IH, 82 NT2, 129 NT1) and 470 healthy subjects.ResultsPatients reported more frequently than healthy subjects the occurrence of recent car crashes (in the previous five years), a risk that was confirmed in both treated and untreated subjects at study inclusion (Untreated, OR = 2.21 95%CI = [1.30–3.76], Treated OR = 2.04 95%CI = [1.26–3.30]), as well as in all disease categories, and was modulated by subjective sleepiness level (Epworth scale and naps). Conversely, the risk of car accidents of patients treated for at least 5 years was not different to healthy subjects (OR = 1.23 95%CI = [0.56–2.69]). Main risk factors were analogous in patients and healthy subjects.ConclusionPatients affected with central disorders of hypersomnolence had increased risk of recent car crashes compared to subjects from the general population, a finding potentially reversed by long-term treatment.

International audience ; BACKGROUND:The first estimates of Healthy Life Years at age 50 (HLY50) across the EU25 countries in 2005 showed substantial variation in healthy ageing. We investigate whether factors contributing to HLY50 inequalities have changed between 2005 and 2010.METHODS:HLY50 for each country and year were calculated using Sullivan's method, applying the age-specific prevalence of activity limitation from the European Union Statistics on Income and Living Conditions (EU-SILC) survey to life tables. Inequalities in life expectancy at age 50 (LE50) and HLY50 between countries were defined as the difference between the maximum and minimum LE50 or HLY50. Relationships between HLY50 and macro-level socio-economic indicators were investigated using meta-regression. Men and women were analysed separately.RESULTS:Between 2005 and 2010 HLY50 inequalities for both men and women in Europe increased. In 2005 and 2010 HLY50 inequalities exceeded LE50 inequalities, particularly in the established EU15 countries in 2010 where HLY50 inequalities (men: 10.7 years; women: 12.5 years) were four times greater for men and three times for women than LE50 inequalities (men: 2.4 years; women: 4.1 years). Only material deprivation significantly explained variation in EU25 HLY50 in both years with, additionally, long-term unemployment in 2010.CONCLUSIONS:Our results suggest that inequalities in HLY50 across Europe are large, increasing and partly explained by levels of material deprivation. Moreover long-term unemployment has become more influential in explaining variation in HLY50 between 2005 and 2010.

International audience ; BACKGROUND:The first estimates of Healthy Life Years at age 50 (HLY50) across the EU25 countries in 2005 showed substantial variation in healthy ageing. We investigate whether factors contributing to HLY50 inequalities have changed between 2005 and 2010.METHODS:HLY50 for each country and year were calculated using Sullivan's method, applying the age-specific prevalence of activity limitation from the European Union Statistics on Income and Living Conditions (EU-SILC) survey to life tables. Inequalities in life expectancy at age 50 (LE50) and HLY50 between countries were defined as the difference between the maximum and minimum LE50 or HLY50. Relationships between HLY50 and macro-level socio-economic indicators were investigated using meta-regression. Men and women were analysed separately.RESULTS:Between 2005 and 2010 HLY50 inequalities for both men and women in Europe increased. In 2005 and 2010 HLY50 inequalities exceeded LE50 inequalities, particularly in the established EU15 countries in 2010 where HLY50 inequalities (men: 10.7 years; women: 12.5 years) were four times greater for men and three times for women than LE50 inequalities (men: 2.4 years; women: 4.1 years). Only material deprivation significantly explained variation in EU25 HLY50 in both years with, additionally, long-term unemployment in 2010.CONCLUSIONS:Our results suggest that inequalities in HLY50 across Europe are large, increasing and partly explained by levels of material deprivation. Moreover long-term unemployment has become more influential in explaining variation in HLY50 between 2005 and 2010.