Variance due to the examination conditions and factors associated with success in objective structured clinical examinations (OSCEs): first experiences at Paris-Saclay medical school.

BACKGROUND: We aimed to measure the variance due to examination conditions during the first sessions of objective structured clinical examinations (OSCEs) performed at a French medical school and identify factors associated with student success. METHODS: We conducted a retrospective, observational study using data from the first three OSCEs sessions performed at Paris-Saclay medical school in 2021 and 2022. For all sessions (each organized in 5 parallel circuits), we tested a circuit effect using a linear mixed-effects model adjusted for sex and the average academic level of students (according to written tests). Then, we studied the factors associated with student success at one station using a multivariate linear mixed-effects model, including the characteristics of students, assessors, and standardized patients. RESULTS: The study included three OSCEs sessions, with 122, 175, and 197 students and a mean (± SD) session score of 13.7(± 1.5)/20, 12.7(± 1.7)/20 and 12.7(± 1.9)/20, respectively. The percentage of variance due to the circuit was 6.5%, 18.2% (statistically significant), and 3.8%, respectively. For all sessions, the student's average level and station scenario were significantly associated with the score obtained in a station. Still, specific characteristics of assessors or standardized patients were only associated with the student's score in April 2021 (first session). CONCLUSION: The percentage of the variance of students' performance due to the examination conditions was significant in one out of three of the first OSCE sessions performed at Paris-Saclay medical school. This result seems more related to individual behaviors rather than specific characteristics of assessors or standardized patients, highlighting the need to continue training teaching teams. NATIONAL CLINICAL TRIAL NUMBER: Not applicable.

Pathogen prioritisation for wastewater surveillance ahead of the Paris 2024 Olympic and Paralympic Games, France.

BackgroundWastewater surveillance is an effective approach to monitor population health, as exemplified by its role throughout the COVID-19 pandemic.AimThis study explores the possibility of extending wastewater surveillance to the Paris 2024 Olympic and Paralympic Games, focusing on identifying priority pathogen targets that are relevant and feasible to monitor in wastewater for these events.MethodsA list of 60 pathogens of interest for general public health surveillance for the Games was compiled. Each pathogen was evaluated against three inclusion criteria: (A) analytical feasibility; (B) relevance, i.e. with regards to the specificities of the event and the characteristics of the pathogen; and (C) added value to inform public health decision-making. Analytical feasibility was assessed through evidence from peer-reviewed publications demonstrating the detectability of pathogens in sewage, refining the initial list to 25 pathogens. Criteria B and C were evaluated via expert opinion using the Delphi method. The panel consisting of some 30 experts proposed five additional pathogens meeting criterion A, totalling 30 pathogens assessed throughout the three-round iterative questionnaire. Pathogens failing to reach 70% group consensus threshold underwent further deliberation by a subgroup of experts.ResultsSix priority targets suitable for wastewater surveillance during the Games were successfully identified: poliovirus, influenza A virus, influenza B virus, mpox virus, SARS-CoV-2 and measles virus.ConclusionThis study introduced a model framework for identifying context-specific wastewater surveillance targets for a mass gathering. Successful implementation of a wastewater surveillance plan for Paris 2024 could incentivise similar monitoring efforts for other mass gatherings globally.

[For an institutional outreach approach in emergency medical services]. / Développer une culture institutionnelle de l'« aller vers ¼ dans les Samu.

FOR AN INSTITUTIONAL OUTREACH APPROACH IN EMERGENCY MEDICAL SERVICES. The "outreach" approach has become the new paradigm of social action. With the creation of regional health agencies, the decompartmentalization between curative medicine, preventive medicine and medico-social care is accelerating. The political will to transpose social tools to the medical field requires removing the confusion between the logic of "outreach" (of Samusocial) and "outside the walls" (of Samu). Especially since Samu, as interface organizations, are privileged hospital actors for this decompartmentalization. The approach initiated by the pediatric Samu of Paris shows that this transposition is possible, both at the individual and institutional levels.

DÉVELOPPER UNE CULTURE INSTITUTIONNELLE DE L'« ALLER VERS ¼ DANS LES SAMU. La démarche de l'« aller vers ¼ est devenue le nouveau paradigme de l'action sociale. Avec la création des agences régionales de santé, le décloisonnement entre médecine curative, médecine préventive et prise en charge médico-sociale s'accélère. La volonté politique de transposer les outils du social au champ médical nécessite de lever la confusion entre les logiques de l'« aller vers ¼ (du Samu social) et du « hors les murs ¼ (du Samu). D'autant que les Samu, en tant qu'organisations d'interface, sont des acteurs hospitaliers privilégiés pour ce décloisonnement. La démarche initiée par le Samu pédiatrique de Paris montre que cette transposition est possible, aussi bien au niveau individuel qu'au niveau institutionnel.

The impact of air pollution on the facial skin of Caucasian women using real-life pollutant exposure measurements.

BACKGROUND: To date, studies examining the effect of air pollution on skin characteristics have relied on regional pollution estimates obtained from fixed monitoring sites. Hence, there remains a need to characterize the impact of air pollution in vivo in real-time conditions. We conducted an initial investigation under real-life conditions, with the purpose of characterizing the in vivo impact of various pollutants on the facial skin condition of women living in Paris over a 6-month period. MATERIALS AND METHODS: A smartphone application linked to the Breezometer platform was used to collect participants' individual exposures to pollutants through the recovery of global positioning system (GPS) data over a 6-month period. Daily exposure to fine particulate matter (PM 2.5 µm and PM 10 µm), pollen, and air quality was measured. Facial skin color, roughness, pore, hydration, elasticity, and wrinkle measurements were taken at the end of the 6-month period. Participants' cumulated pollutant exposure over 6 months was calculated. Data were stratified into two groups (lower vs. higher pollutant exposure) for each pollutant. RESULTS: 156 women (20-60 years-old) were recruited, with 124 women completing the study. Higher PM 2.5 µm exposure was associated with altered skin color and increased roughness under the eye. Higher PM 10 µm exposure with increased wrinkles and roughness under the eye, increased pore appearance, and decreased skin hydration. Exposure to poorer air quality was linked with increased forehead wrinkles and decreased skin elasticity, while higher pollen exposure increased skin roughness and crow's feet. CONCLUSION: This study suggests a potential correlation between air pollution and facial skin in real-life conditions. Prolonged exposure to PM, gases, and pollen may be linked to clinical signs of skin ageing. This study highlights the importance of longer monitoring over time in real conditions to characterize the effect of pollution on the skin.

HPV-driven oropharyngeal cancer burden in Paris and its region (ILE DE FRANCE) from 1981 TO 2021.

BACKGROUND: France has the sixth highest incidence of oropharyngeal cancer (OPC) in Europe, but the epidemiological impact of high-risk HPV (HR-HPV) remains poorly documented. The objective of our study was to assess the proportion of OPCs caused by HR-HPV in Paris, and its suburbs, over the four past decades. This area accounts for almost one-fifth of the total population of France. METHODS: OPCs diagnosed in 1981, 1986, 1991, 1996, 2001, 2006, 2011, 2016 and 2020/2021 in two of the main referral cancer centers for HNCs in Paris and its suburbs were retrieved from the tumor biobanks. HPV status was determined by p16-staining and HPV-DNA detection. Samples were considered HPV-driven if both assays were positive. Results were compared to the French cancer registry data. RESULTS: Samples from 697 OPC patients were assessed (including 82 % of all samples diagnosed in 2001, 2006, 2011, 2016, 2021). The proportion of HPV-driven cases rose from 2.7 % to 53 % between 1981 and 2021. HPV16 was the dominant genotype during the study period. Of patients with HPV-driven OPC, 81 % were male and 42 % were smokers versus 80 % and 92 % in their HPV-negative counterparts. The age of OPC patients increased significantly, during the study period, independent of their HPV status CONCLUSION: The proportion of HPV-driven OPCs has significantly increased in Paris and its suburbs, during the last four decades. OPCs has become the 2nd predominant type of head and neck cancer, in France. This may be linked to the rise in HPV-driven cases and the decrease of tobacco and alcohol consumption in men.

[Time and space in the care pathways of women suffering from breast cancer]. / Temps et espaces dans les parcours de soins de femmes souffrant d'un cancer du sein.

Facing breast cancer, women in precarious situations are more likely to be diagnosed at an advanced stage, and when detected at the same stage, they are more to die as well as faster. In this paper, we analyze a corpus of 40 semi-structured interviews conducted in six cancer services in hospitals of the Paris area on the care pathways of women with breast cancer. The analysis focuses on the beginning of the pathways (until the first treatments) and concentrates on their spatial and temporal dimension in the light of precariousness. Depending on the women's situations with regard to precariousness, the spatial and temporal organization of the pathways differs. There are socially differentiated latency periods that delay diagnosis (prior to meeting a medical professional) or the beginning of treatment (in relation to rights, the responsiveness of the health care system, and the interactions between women and the system). Spatially, the geometry of the pathways is variable and reflects different expectations of health institutions and medical staff according to the social profiles of the women. However, a detailed analysis of the pathways allows us to nuance these differences in terms of precariousness. The women's capacity to be autonomous, their network of contacts, the accessibility and responsiveness of the health care system, as well as the sensitive and emotional dimension of this stressful event affect the pathways both in terms of time and space.

Assessing the extinction risk of the spontaneous flora in urban tree bases.

As the spatial arrangement of trees planted along streets in cities makes their bases potential ecological corridors for the flora, urban tree bases may be a key contributor to the overall connectivity of the urban ecosystem. However, these tree bases are also a highly fragmented environment in which extinctions are frequent. The goal of this study was to assess the plant species' ability to survive and spread through urban tree bases. To do so, we developed a Bayesian framework to assess the extinction risk of a plant metapopulation using presence/absence data, assuming that the occupancy dynamics was described by a Hidden Markov Model. The novelty of our approach is to take into account the combined effect of low-distance dispersal and the potential presence of a seed bank on the extinction risk. We introduced a metric of the extinction risk and examined its performance over a wide range of metapopulation parameters. We applied our framework to yearly floristic inventories carried out in 1324 tree bases in Paris, France. While local extinction risks were generally high, extinction risks at the street scale varied greatly from one species to another. We identified 10 plant species that could survive and spread through urban tree bases, and three plant traits correlated with the extinction risk at the metapopulation scale: the maximal height, and the beginning and end of the flowering period. Our results suggest that some plant species can use urban tree bases as ecological corridors despite high local extinction risks by forming a seed bank. We also identified other plant traits correlated with the ability to survive in tree bases, related to the action of gardeners. Moreover, our findings demonstrate that our Bayesian estimation framework based on percolation theory has the potential to be extended to more general metapopulations.

[Emergencies and exceptional health situations: The Paris fire department at the heart of the action]. / Urgences et situations sanitaires exceptionnelles : la brigade des sapeurs-pompiers de Paris au cœur de l'action.

The Paris fire department is at the heart of the management of exceptional health situations and large-scale emergencies. Their operational strategies are benchmarks, both in France and internationally. Their expertise in the context of the Olympic Games makes them a major player.

Dreams: Charcot's Last Words on Hysteria.

Jean-Martin Charcot (1825-1893), the leading neurologist of his time, is best remembered for his studies on hysteria presented in clinical lectures at the Paris Salpêtrière hospital. Developing the concept of traumatic male hysteria after accidents in which patients suffered slight physical damage led him to advance a psychological explanation for hysteria. Traumatic hysteria is the context for a close reading of Charcot's "last words" based upon a final unpublished lesson in 1893. This case history concerns a seventeen-year-old Parisian artisan whose various signs of hysteria developed following a dream in which he imagined himself the victim of a violent assault. Charcot identifies the dream/nightmare as the "original" feature determining traumatic hysteria. The dream sets in motion an overwhelming consciousness followed by a susceptibility to "autosuggestion" producing somatic signs of hysteria. Charcot's final lesson on dreams thus culminates his study of the psychological basis of traumatic hysteria.

COVID-19 profiles in general practice: a latent class analysis.

BACKGROUND: General practitioners (GPs) were on the front line of the COVID-19 outbreak. Identifying clinical profiles in COVID-19 might improve patient care and enable closer monitoring of at-risk profiles. OBJECTIVES: To identify COVID-19 profiles in a population of adult primary care patients, and to determine whether the profiles were associated with negative outcomes and persistent symptoms. DESIGN, SETTING AND PARTICIPANTS: In a prospective multicentre study, 44 GPs from multiprofessional primary care practices in the Paris area of France recruited 340 consecutive adult patients (median age: 47 years) with a confirmed diagnosis of COVID-19 during the first two waves of the epidemic. METHOD AND OUTCOME: A latent class (LC) analysis with 11 indicators (clinical signs and symptoms) was performed. The resulting profiles were characterised by a 3-month composite outcome (COVID-19-related hospital admission and/or death) and persistent symptoms three and 6 months after inclusion. RESULTS: We identified six profiles: 'paucisymptomatic' (LC1, 9%), 'anosmia and/or ageusia' (LC2, 12.9%), 'influenza-like syndrome with anosmia and ageusia' (LC3, 15.5%), 'influenza-like syndrome without anosmia or ageusia' (LC4, 24.5%), 'influenza-like syndrome with respiratory impairment' (LC5) and a 'complete form' (LC6, 17.7%). At 3 months, 7.4% of the patients were hospitalised (with higher rates in LC5), and 18% had persistent symptoms (with higher rates in LC5 and LC6). At 6 months, 6.4% of the patients had persistent symptoms, with no differences between LCs. CONCLUSION: Our findings might help GPs to identify patients at risk of persistent COVID-19 symptoms and hospital admission and then set up procedures for closer monitoring.

Staphylococcus aureus: No ticket for the Paris 2024 Olympic Games!

Athletes are vulnerable to Staphylococcus aureus infections due to skin-to-skin contact and skin abrasions during training and competitions involving sharied sport equipment or toiletries, which promote the spread of the bacteria between athletes and within sport teams. This results not only in higher prevalence of S.aureus carriage among athletes compared to the general population, but also in outbreaks of infections, particularly skin infections, within sports teams. To limit the spread of S. aureus among athletes, a decolonization protocol can be applied when clustered cases of S. aureus infections occur, especially if Panton-Valentine leukocidin-producing strains are implicated. Finally, to avoid exposing athletes to S.aureus transmission/colonization, it is recommended to establish strict and clearly formulated individual and collective hygiene rules and to regularly disinfect shared sports equipment.

The prevention school diary: Evaluability assessment of a widely adopted intervention in Ile-de-France.

OBJECTIVES: The prevention school diary is distributed each year to children aged between 10 and 11 years old by La Ligue contre le cancer, a French association promoting prevention and research against cancer. While they write their homework in the diary, children can learn about a range of health determinants. This diary promotes health in a fun and educational way, as it integrates drawings made by children about the different themes covered by the diary. This paper aims to present the evaluability assessment of this intervention in Ile-de-France (Paris area), where it is already widely deployed. MATERIAL AND METHODS: We have traced the history of the prevention school diary and assessed how it is currently used in Ile-de-France by leading interviews with county committees of La Ligue contre le cancer. Successive versions of the diary and results of teacher satisfaction surveys were examined. All information collected was integrated into a logic model, which characterizes the main components, actors, and effects of the intervention. RESULTS: The prevention school diary was created in the West of France in the late 90s. It was then implemented in Paris and extended to other counties of Ile-de-France. Currently, six counties collaborate on the production of a common diary. Whereas it only dealt with tobacco consumption at the beginning, the prevention school diary now covers nutrition, physical activity, sun exposure, sleep and screen use, addiction, as well as safety in some counties. Three levels of intervention have been identified, depending on whether or not the distribution of the diary is followed by the production of drawings for the next edition or health education sessions. The expected effects of the prevention school diary have been integrated into a logic model emphasizing children, school, and family level. Outcomes include Capabilities (knowledge and skills), Opportunities, and Motivation to adopt healthy Behaviours, according to the theoretical model of behaviour change COM-B. CONCLUSION: The evaluability assessment phase enabled us to gain a better understanding of the conditions under which the intervention is deployed, and thus to identify the factors to be considered for a broad assessment of its effectiveness. It is especially important since the intervention is already well established in Ile-de-France.

Associations between heat wave during pregnancy and term birth weight outcomes: The PARIS birth cohort.

BACKGROUND: Climate change will make extreme weather events more frequent in the 21st century. Extreme ambient temperatures during the prenatal period have been associated with adverse pregnancy outcomes such as preterm birth. It is unclear, however, whether heat waves during pregnancy impact fetal growth in apparently healthy term newborns. OBJECTIVES: We aimed to investigate associations between heat wave during pregnancy and birth weight outcomes in term newborns from the PARIS birth cohort, and to explore meteorological conditions and air pollution as possible intermediate factors. METHODS: We examined data on 3,359 newborns born between 37 and 42 weeks in Paris, France, between 2003 and 2006. Associations of maternal exposure to heat wave (during whole pregnancy and each trimester) with birth weight and small for gestational age (SGA) at term were studied using linear and logistic regression models adjusted for potential confounders. Maternal characteristics were investigated as possible modifiers. We explored the mediating role of ambient temperature, relative humidity, and air pollution levels in the relationship between heat wave during the first trimester and term SGA. RESULTS: Mothers who were pregnant during the 2003 French heat wave (n = 506, 15 %) were more likely to have a term SGA baby (aOR = 2.70; 95 %CI: 1.38, 5.28) compared to mothers who did not experience heat wave during pregnancy. The association was stronger when heat wave occurred during the first trimester (aOR = 4.18; 95 %CI: 1.69, 10.35). Primiparous women were identified as more vulnerable than multiparous women. Average ambient temperature and air quality index explained about 36 % and 56 % of the association between heat wave during the first trimester and term SGA, respectively. CONCLUSIONS: This study suggests prenatal exposure to heat wave, especially during the first trimester, may adversely affect fetal growth of term newborns, which could be explained by both increasing ambient temperatures and worsening air quality.

Insufficient vaccine coverage and vaccine hesitancy in people living with HIV: A prospective study in outpatient clinics in the Paris region.

Vaccine prevention strategies play a crucial role in the management of people living with HIV (PLWH). The aim of this study was to assess vaccination coverage and identify barriers to vaccine uptake in PLWH in the Paris region. A cross-sectional survey was conducted in PLWH in 16 hospitals in the Paris region. The vaccination status, characteristics, opinions, and behaviors of participants were collected using a face-to-face questionnaire and from medical records. A total of 338 PLWH were included (response rate 99.7 %). The median age of participants was 51 years (IQR: 41-58). Vaccination coverage was 77.3 % for hepatitis B (95 % CI: 72.3-81.8 %), 62.7 % for hepatitis A (57.3-67.9 %), 61.2 % for pneumococcal vaccines (55.8-66.5 %), 56.5 % for diphtheria/tetanus/poliomyelitis (DTP) (51.0-61.9 %), 44.7 % for seasonal influenza (39.3-50.1 %), 31.4 % for measles/mumps/rubella (26.4-36.6 %) and 38.5 % for meningococcal vaccine (13.9-68.4 %). The main reason for vaccine reluctance was related to the lack of vaccination proposals/reminders. The overall willingness to get vaccinated was 71.0 % (65.9-75.8 %). In the multivariable analysis, several factors were associated with a higher vaccine uptake; for DTP vaccine: higher education level, having vaccination records, being registered with a general practitioner; for seasonal influenza vaccine: age > 60 years, higher education level, being employed. The overall vaccination coverage was suboptimal. Development of strategies reducing missed opportunity to offer vaccines is needed.

Prescriptions of generic antiretroviral drugs in three healthcare centers in the Paris area, France.

In a retrospective study conducted in three hospitals in Paris, generic antiretroviral accounted for 30.2% of all prescriptions. Tenofovir disoproxil/emtricitabine (TDF/FTC) was the most prescribed generic ART (82.3% of generic prescriptions). Generic ART (gART) was more likely to be prescribed to women, to patients less than 50 years, and with recent HIV diagnosis less than 3 years. Physicians prescribed more gART if they were men, older than 55 years or worked at a university teaching hospital.

GHG mitigation strategies on China's diverse dish consumption are key to meet the Paris Agreement targets.

Combatting climate change depends on demand-side mitigation strategies related to food, which is in turn contingent on explicit estimation and management of dish-level emissions. Here, on the basis of a bottom-up integrated emissions framework, we first estimate the greenhouse gas emissions of 540 dishes from 36 cuisines using data from over 800,488 restaurants in China's provincial capital cities. By mining residents' dietary preferences, we then design various dietary change strategies to explicitly link food emissions to the Paris Agreement pledges. The results show that China's food system greenhouse gas emissions were approximately 4.64 GtCO2eq in 2020, accounting for 37% of total emissions, with average per-dish emissions of 8.44 kgCO2eq. Current emission patterns of food consumption in China may not be consistent with the attainment of the 1.5 °C and 2 °C climate targets, but transitioning towards low-emission cuisines and dishes could change that by reducing emissions by 38-69%.