Reducing financial barriers through the implementation of voucher incentives to promote children's participation in community sport in Australia.

BACKGROUND: Participation in organised sport and physical activity contributes to health-enhancing levels of leisure time physical activity. In Australia, 58% of children aged 0-14 years participated at least once a week in October 2015 - December 2017. To overcome the frequently cited cost barrier, sports voucher incentives have been widely implemented across Australia. METHOD: The financial value of jurisdictional vouchers and the National median financial value were used to calculate the proportion of total annual expenditure on children's participation in sport supported by sports vouchers. Participation rates using AusPlay data were estimated by age, sex and socio-economic index (SEIFA) at state and national level for children aged 0-14 years. RESULTS: Five States and Territories implemented sports vouchers from 2011 to 2018, with a median value of AU$150. Nationally, median annual expenditure for children's sport participation was AU$447 (IQR $194.2-936), with 27% reported expenditure supported by a sports voucher. The proportion of financial support from sports vouchers increased considerably with social disadvantage, rising to over 60% of total expenditure in the most disadvantaged populations. CONCLUSIONS: Socio-economic status was associated with sports-related expenditure and sports participation amongst children. Sport vouchers should target children in the most disadvantaged areas to promote participation in organised sport and physical activity.

[Which patient for TAVI in 2019?] / À quel patient proposer un TAVI en 2019 ?

The therapeutic management of aortic stenosis has been drastically changed by the advent of percutaneous valve replacement (TAVI). Since the first implantation, the indications have progressively been extended from the inoperable patient to the patient at low surgical risk. The main objective of this review is to describe the currently recommended main indications of TAVI depending on an individualized assessment of each patient's risk, technical characteristics and anatomical valvular criteria.

Assessment of peak skin dose in interventional cardiology: A comparison between Gafchromic film and dosimetric software em.dose.

OBJECTIVE: To compare the use of a dose mapping software to Gafchromic film measurement for a simplified peak skin dose (PSD) estimation in interventional cardiology procedure. METHODS: The study was conducted on a total of 40 cardiac procedures (20 complex coronary angioplasty of chronic total occlusion (CTO) and 20 coronary angiography and coronary angioplasty (CA-PTCA)) conducted between January 2014 to December 2015. PSD measurement (PSDFilm) was obtained by placing XR-RV3 Gafchromic under the patient's back for each procedure. PSD (PSDem.dose) was computed with the software em.dose©. The calculation was performed on the dose metrics collected from the private dose report of each procedure. Two calculation methods (method A: fluoroscopic kerma equally spread on cine acquisition and B: fluoroscopic kerma is added to one air Kerma cine acquisition that contributes to the PSD) were used to calculate the fluoroscopic dose contribution as fluoroscopic data were not recorded in our interventional room. Statistical analyses were carried out to compare PSDFilm and PSDem.dose. RESULTS: The PSDFilm median (1st quartile; 3rd quartile) was 0.251(0.190;0.336)Gy for CA-PTCA and 1.453(0.767;2.011)Gy for CTO. For method-A, the PSDem.dose was 0.248(0.182;0.369)Gy for CA-PTCA and 1.601(0.892;2.178)Gy for CTO, and 0.267(0.223;0.446)Gy and 1.75 (0.912;2.584)Gy for method-B, respectively. For the two methods, the correlation between PSDFilm and PSDem.dose was strong. For all cardiology procedures investigated, the mean deviation between PSDFilm and PSDem.dose was 3.4±21.1% for method-A and 17.3%±23.9% for method-B. CONCLUSION: The dose mapping software is convenient to calculate peak skin dose in interventional cardiology.

Assessment of Patient's Peak Skin Dose Using Gafchromic Films During Interventional Cardiology Procedures: Routine Experience Feedback.

To assess the interest of Gafchromic films in detection of patient's peak skin dose (PSD) in interventional cardiology. A prospective study of 112 patients was conducted (July-December 2015). Three diagnostic and therapeutic procedures were evaluated: coronary angiography (CA), coronary angiography and coronary angioplasty for one or two vessels disease (CA-PTCA) and coronary angioplasty of complex chronic total occlusion (CTO). Dosimetric indicators (DIs) were collected and PSD were measured with Gafchromic films. Dose distribution was evaluated within 10 'Thorax Body-zone' defined by the system. Correlations between PSD and DI or dose distribution were computed. Delivered dose increased in complex procedures. The PSD were 0.121 ± 0.063 Gy for CA, 0.256 ± 0.142 Gy for CA-PTCA and 1.116 ± 0.721 Gy for CTO. High correlations were observed for PSD and DI as well for dose distribution within the 'Thorax Body-zone'. Film dosimetry is suggested for CTO procedures since the threshold of 2 Gy for skin injuries is likely to be exceeded.

[What is the place of bioresorbable vascular scaffolds in setting of ST-segment elevation myocardial infarction?]. / Quelle place pour les stents biorésorbables dans la prise en charge du syndrome coronarien aigu avec sus-décalage du segment ST ?

A 50-year-old woman was admitted for an inferior ST-segment elevation myocardial infarction; immediate coronary angiogram revealed a subocclusive stenosis of the right coronary artery. After optimal antithrombotic treatment, the type of stent could be discussed. The latest generation of drug-eluting stents showed excellent efficacy and safety in the long-term but has limitations such as potential chronic inflammation of the arterial wall and no recovery of vasoactive function. Bioresorbable vascular scaffolds, with complete resorption within several months, may reduce these limitations. Implantation of bioresorbable scaffold in the context of myocardial infarction may be interesting. However, very few studies are currently available in this setting. Preliminary results and perspectives are presented in this review.

[Are there any contraindications to the transradial approach?]. / Existe-t-il des contre-indications à la coronarographie par voie radiale ?

The transradial approach is the most frequent access used in France for coronarography and percutaneous coronary intervention. This access permits a reduction of local complications in comparison with femoral access. There are very few real contraindications of transradial approach. The use of Allen's test before coronarography remains controversial in the transradial catheterization community. It remains a standard practice in some institutions, however many centers have stopped using Allen's test considering that there is no evidence supporting its use.

[Diagnostic and prognostic significance of CK-MB, troponins, CRP, BNP and/or NT-proBNP in coronary angioplasty. Elevation mechanisms and clinical implications]. / Intérêt diagnostique et pronostique des marqueurs biologiques dans l'angioplastie coronaire en cas d'angor stable et de syndrome coronaire aigu ST-. Quelle stratégie biologique en routine?

The recommendations from respected bodies concerning the treatment and follow up of patients undergoing coronary angioplasty for stable angina or acute coronary syndrome (ACS) are essential for reducing the risks related to the procedure, and for preventing the occurrence of long term complications. Measuring the levels of troponin and CK-MB is part of the diagnostic and prognostic strategy during the coronary angioplasty procedure. In this context, the frequent elevation of markers following uncomplicated angioplasty is a sign of minor irreversible myocardial damage, the prognostic significance of which remains under discussion. Recent data suggest that only a basal troponin elevation (more so than CK-MB) prior to angioplasty has a long term prognostic value in ACS ST- patients, and that troponin elevation occurring after the procedure in the presence of normal basal concentrations, is only associated with in-hospital complications. Determining the basal level of troponin would appear to be essential for interpreting any elevation in concentrations following angioplasty. The recommendations should integrate this fundamental point, if it is confirmed. On the other hand, the question has been raised whether other markers (CRP, BNP and/or NT-proBNP) should be systematically measured as a routine prior to angioplasty. An elevation of CRP before and/or after angioplasty is an unfavourable short and long term prognostic factor. Elevation of NT-proBNP before angioplasty is also an unfavourable long term prognostic factor. Recommending a multi-marker strategy might represent a future direction for identifying at risk patients prior to coronary angioplasty, thus enabling specific treatment to be proposed.

[Effects of bradykinin in the cardiovascular effects of angiotensin-converting enzyme inhibitors]. / Effets de la bradykinine dans les effets cardiovasculaires des inhibiteurs de l'enzyme de conversion.

The role of bradykinin in the cardiovascular effects of angiotensin converting enzyme inhibitors remains difficult to establish. On their haemodynamic effects, bradykinin acts during their acute administration, participating in their vasodilatation action, while during their chronic administration they act slightly or not at all. On their trophic effects, the action of the tissue kallikrein-kinin system, suggested by the results of animal experimentation, is yet to be demonstrated in man. For their effects on cardiovascular morbidity and mortality the role of bradykinin remains under discussion. Nevertheless, besides ACE inhibitors, the other therapeutic agents which increase the levels of bradykinin, such as neutral endopeptidase inhibitors, have a significant field of development in the course of cardiovascular pathologies.

[Holter EKG for the hypertensive heart disease]. / Intérêt du holter ECG dans la surveillance de la cardiopathie hypertensive.

During chronic mechanical overload induced by hypertension, left ventricular hypertrophy predisposes to atrial and ventricular arrhythmias. Atrial arrhythmias, mainly atrial fibrillation, decrease cardiac output and increase the risk of embolism whereas ventricular arrhythmias remain the major cause of sudden death. In hypertensive patients, Holter EKG recordings frequently detect atrial or ventricular premature beats and more rarely atrial or ventricular tachycardia. In these patients, the presence of non-sustained ventricular tachycardia is considered as an independent predictor of mortality. Moreover, this non invasive method through the assessment of heart rate variability allows the study of the autonomic control of the heart, known to modulate occurrence of arrhythmias.