[Revue des effets de l'institutionnalisation sur le développement de la dépression chez les personnes âgées résidant en maison de retraite]. / Institutionalization effects on depression development in nursing home elderly residents: a review.

Depression is a prevalent mental health issue among elderly people residing in nursing homes, with significant implications for quality of life. From an initial pool of 175 articles, seven met the inclusion criteria, including four longitudinal studies, two controlled trials, and one systematic review. The findings indicate mixed outcomes regarding the impact of institutionalization on the trajectory of depression, underlining the complexity of its support. A number of risk factors appear to be associated with depression, such as gerontopsychiatric disorders, functional impairment, chronic illness and gender. Interventions such as increased exposure to natural light and psycho-educational programmes could be relevant therapeutic tools. This review emphasizes the need for more robust longitudinal research, and uniform depression assessment methods to better manage depression at the entrance of the nursing home.

Impact of age on the Quadrella index assessing oncological and functional results after prostate brachytherapy: A 6-year analysis.

Purpose: As the oncological results of prostate brachytherapy (BT) are excellent for low-risk (LR) or favorable intermediate-risk (FIR) prostate cancer (PCa), evaluating the side effects has become a major issue, especially for young men. The objective of the study was to compare the oncologic and functional results of BT using Quadrella index for patients aged 60 or less compared with older patients. Material and methods: From June, 2007 to June, 2017, 222 patients, including 70 ≤ 60 years old and 152 > 60 years old, underwent BT for LR-FIR PCa, with good erectile function at baseline according to International Index of Erectile Function-5 (IIEF-5) > 16. Quadrella index was achieved under the following circumstances: 1) Absence of biological recurrence (Phoenix criteria); 2) Absence of erectile dysfunction (ED) (IIEF-5 > 16); 3) No urinary toxicity (international prostate score symptom) IPSS < 15 or IPSS > 15, and ΔIPSS < 5; 4) No rectal toxicity (RT) (Radiation Therapy Oncology Group, RTOG = 0). Patients were treated on demand with phosphodiesterase inhibitors (PDE5i) post-operatively. Results: The Quadrella index was satisfied for about 40-80% of patients ≤ 60 years vs. 33-46% for older patients during 6-year follow-up (significant difference from the second year). At year 5, 100% of evaluable patients aged ≤ 60 and 91.8% > 60 (p = 0.29) reached Phoenix criteria. The criterion of ED (IIEF-5 < 16) largely explained the validity rate of Quadrella alone. There was no ED for 67.2-81.4% of patients ≤ 60 years compared with 40.0-56.1% for patients > 60 (significant difference since year 4 in favor of young men). After two years of follow-up, more than 90% of patients in both the groups showed neither urinary nor rectal toxicities. Conclusions: For young men displaying LR-FIR PCa, BT appears to be a first-class therapeutic option, as the oncological results were at least equivalent to those of older patients with good long-term tolerance.

Self-efficacy in physical activity. Chronic pathology and caregiving posture in therapeutic education / Auto-efficacité à la pratique d'une activité physique de la personne. Pathologie chronique et posture soignante en éducation thérapeutique

Introduction: The prevalence of chronic diseases is a major public health problem. Therapeutic education, self-efficacy, the caregiving posture, and the strength-based approach to care constitute the theoretical framework of this work. Context: Physical activity is beneficial to the health of people living with chronic conditions, but its implementation and maintenance over time is difficult. Objective: To explore the self-efficacy of physical activity in people who have received therapeutic education and the notion of the caregiving posture in therapeutic education. Method: A mixed descriptive and exploratory research design was used. Questionnaires and interviews were carried out with carers and people who had received therapeutic education. Results: The level of posture of the carers was high and homogeneous. The level of self-efficacy of people who had received therapeutic education was heterogeneous, with a greater disparity in scores. Conclusion: The therapeutic education posture cannot compensate for all the personal and environmental factors influencing the practice of physical activity. Regular support for self-efficacy in physical activity is necessary for its implementation and maintenance over time.

Introduction: La prévalence des pathologies chroniques est un problème majeur de santé publique. L'éducation thérapeutique, l'auto-efficacité, la posture soignante et l'approche des soins fondée sur les forces constituent le cadre de référence théorique de ce travail. Contexte: L'activité physique est bénéfique à la santé des personnes vivant avec des pathologies chroniques, mais sa mise en œuvre et son maintien dans le temps est difficile. Objectif: Explorer l'auto-efficacité à la pratique d'une activité physique des personnes ayant bénéficié d'éducation thérapeutique, ainsi que la notion de posture soignante en éducation thérapeutique. Méthode: Un devis mixte de recherche descriptive et exploratoire a été utilisé. Des questionnaires et des entretiens ont été réalisés auprès de soignants et de personnes ayant bénéficié d'éducation thérapeutique. Résultats: Le niveau de posture des soignants est haut et homogène. Le niveau d'auto-efficacité des personnes ayant bénéficié d'éducation thérapeutique est hétérogène avec une plus grande disparité des scores. Conclusion: La posture soignante d'éducation thérapeutique ne peut compenser tous les facteurs personnels et environnementaux influant sur la pratique d'une activité physique. Un accompagnement régulier de l'auto-efficacité à la pratique d'une activité physique est nécessaire pour sa mise en œuvre et son maintien dans le temps.

Pilot Study to Assess the Feasibility of a Mobile Unit for Remote Cognitive Screening of Isolated Elderly in Rural Areas.

BACKGROUND: Given the current COVID-19 pandemic situation, now more than ever, remote solutions for assessing and monitoring individuals with cognitive impairment are urgently needed. Older adults in particular, living in isolated rural areas or so-called 'medical deserts', are facing major difficulties in getting access to diagnosis and care. Telemedical approaches to assessments are promising and seem well accepted, reducing the burden of bringing patients to specialized clinics. However, many older adults are not yet adequately equipped to allow for proper implementation of this technology. A potential solution could be a mobile unit in the form of a van, equipped with the telemedical system which comes to the patients' home. The aim of this proof-of-concept study is to evaluate the feasibility and reliability of such mobile unit settings for remote cognitive testing. Methods and analysis: eight participants (aged between 69 and 86 years old) from the city of Digne-Les-Bains volunteered for this study. A basic neuropsychological assessment, including a short clinical interview, is administered in two conditions, by telemedicine in a mobile clinic (equipped van) at a participants' home and face to face in a specialized clinic. The administration procedure order is randomized, and the results are compared with each other. Acceptability and user experience are assessed among participants and clinicians in a qualitative and quantitative manner. Measurements of stress indicators were collected for comparison. RESULTS: The analysis revealed no significant differences in test results between the two administration procedures. Participants were, overall, very satisfied with the mobile clinic experience and found the use of the telemedical system relatively easy. CONCLUSION: A mobile unit equipped with a telemedical service could represent a solution for remote cognitive testing overcoming barriers in rural areas to access specialized diagnosis and care.

G-Quadruplex binding optimization by gold(iii) insertion into the center of a porphyrin.

Porphyrins represent a valuable class of ligands for G-quadruplex nucleic acids. Herein, we evaluate the binding of cationic porphyrins metallated with gold(iii) to G-quadruplex DNA and we compare it with other porphyrin derivatives. The G-quadruplex stabilization capacity and the selectivity of the various porphyrins were evaluated by biophysical and biochemical assays. The porphyrins were also tested as inhibitors of telomerase. It clearly appeared that the insertion of gold(iii) ion in the center of the porphyrin increases the binding affinity of the porphyrin for the G-quadruplex target. Together with modelling studies, it is possible to propose that the insertion of the square planar gold(iii) ion adds an extra positive charge on the complex and decreases the electron density in the porphyrin aromatic macrocycle, both properties being in favour of stronger electrostatic and π-staking interactions.

A family of rhodium and iridium complexes with semirigid benzylsilyl phosphines: from bidentate to tetradentate coordination modes.

The synthesis of a new trisbenzylsilanephosphine P{(o-C6H4CH2)SiMe2H}3 (1) is shown to proceed with high yields from P(o-tolyl)3. Compound 1 coordinates to the Rh and Ir dimers [MCl(COD)]2 (M = Rh, Ir) in a tetradentate or tridentate fashion, depending on the strict exclusion of water. The dimeric compounds [ClM(SiMe2CH2-o-C6H4)2P(o-C6H4-CH2SiMe2H)]2, 2Rh and 2Ir, feature a tetradentate coordination of the starting ligand with P and two Si atoms as well as a non-classical agostic Si-H group. The presence of adventitious water in the solvents leads to the formation of two new complexes [(µ2-Cl)2M2(SiMe2CH2-o-C6H4)2P(o-C6H4-CH2SiMe2OSiMe2CH2-o-C6H4-)P(SiMe2CH2-o-C6H4)2], 3Rh and 3Ir, which feature a siloxane bridge through Si-H bond breaking in 2. Reaction of [RhCl(COD)]2 with the bisbenzylsilanephosphine PhP{(o-C6H4CH2)SiMe2H}2 leads to the formation of compound 4Rh which features also a dimeric structure with the SiPSi ligand coordinated through the two silicon atoms, one of which occupies the apical position of a square-pyramidal geometry in the solid state, while the second is disposed equatorially trans to π-donor Cl. Finally, bidentate coordination of a PSi ligand is achieved by reaction of [RhCl(COD)]2 with Ph2P{(o-C6H4CH2)SiMe2H} which leads to the monometallic species [RhCl(SiMe2CH2-o-C6H4-PPh2)2], 5Rh, incorporating two chelating PSi ligands and maintaining a Cl ligand.

Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project).

INTRODUCTION: Peripheral venous catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk factors. METHODS: A prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE. RESULTS: Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors. CONCLUSION: Limitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings.

Unexpected behavioural consequences of preterm newborns' clothing.

Restrictions of preterm newborns' movements could have consequences ranging from stress enhancement to impairment of their motor development. Therefore, ability to freely express motor activities appears crucial for their behavioural and physiological development. Our aim was to evaluate behavioural issues of two types of clothing used in NICU. We observed 18 healthy 34-37 post-conception week-old preterm newborns, during resting periods, when they were undisturbed by any interventions. Newborns wore either light clothing (bodysuit and a light wrapping) or heavy clothing (pyjamas, cardigan and sleep-sack). The percentages of time each subject spent in different postures were compared between clothing situations. Arm and hand postures differed in relation to clothing: babies bent their arms more and held their hands nearer their heads when in bodysuits than when in sleepwear. Consequently, babies in bodysuits spent more time touching their body or their environment whereas the others generally were touching nothing. Self-touch is an important way to comfort one's self. Heavy clothing may impair self-soothing behaviours of preterm newborn babies that already lack other forms of contact. Results suggest that more attention should be paid to apparently routine and marginal decisions such as choice of clothes.

Maternal outcomes after uterine balloon tamponade for postpartum hemorrhage.

OBJECTIVE: To evaluate maternal outcomes following uterine balloon tamponade in the management of postpartum hemorrhage. DESIGN: Retrospective case-series. SETTING: Two French hospitals, a level 3 university referral center and a level 2 private hospital. POPULATION: All women who underwent balloon tamponade treatment for primary postpartum hemorrhage. METHODS: Uterine tamponade was used after standard treatment of postpartum hemorrhage had failed. The study population was divided into two groups, successful cases where the bleeding stopped after the balloon tamponade, and failures requiring subsequent surgery or embolization. MAIN OUTCOME MEASURES: Success rates. RESULTS: Uterine tamponade was used in 49 women: 30 (61%) after vaginal delivery and 19 (39%) after cesarean section. Uterine atony was the main cause of hemorrhage (86%). The overall success rate was 65%. Of 17 failures, surgery was required in 16 cases, including hysterectomy in 11, and uterine artery embolization in one case. Demographic and obstetric characteristics did not differ significantly between the success and failure groups. No complications were directly attributed to the balloon tamponade in the postpartum period. Two women had a subsequent full-term pregnancy without recurrence of postpartum hemorrhage. CONCLUSIONS: Balloon tamponade is an effective, safe and readily available method for treating primary postpartum hemorrhage and could reduce the need for invasive procedures.

Stability, dose uniformity, and palatability of three counterterrorism drugs-human subject and electronic tongue studies.

PURPOSE: These studies evaluated the ability of common household food and drink products to mask the bitter taste of three selected anti-terrorism drugs. METHODS: Three anti-terrorism drugs (doxycycline, ciprofloxacin hydrochloride, and potassium iodide) were mixed with a variety of common household food and drinks, and healthy adult volunteers evaluated the resulting taste and aftertaste. In parallel, the ASTREE Electronic Tongue was used to evaluate taste combinations. Stability of the mixtures over time was monitored, as was the dosage uniformity across preparations. RESULTS: Foods and drinks were identified that satisfactorily masked the bitter flavor of each drug. Dose uniformity and stability were also acceptable over the range studied, although some combinations were significantly less stable than others. The electronic tongue was able to differentiate between tastes, but ranked masking agents in a different order than human volunteers. CONCLUSIONS: Doxycycline, potassium iodide, and ciprofloxacin, which are stockpiled in solid tablet form, can conveniently be prepared into more palatable formulations, using common household foods and drinks. The electronic tongue can be used to perform an initial screening for palatability.