Évolution de la prévalence et de l'incidence de la dysphorie de genre en France depuis 2013 à partir des bases médico-administratives.

INTRODUCTION: In France, trans people can benefit from the coverage of care related to their trans-identity in Long Term Affection (Affection Longue Durée ALD) under the code F64. PURPOSE OF RESEARCH: The aim of this article is to estimate the prevalence and the incidence of trans people in transition from the medical and administrative reimbursement databases in France. RESULTS: In 2020, 8952 persons were in ALD F64. The prevalence was 1.50/100 000 in 2013 and 14.09/100 000 in 2020 all ages combined. Among 0-17 year olds, the increase of prevalence was the greatest (36.75-fold increase). The 18-35 year olds were the largest numbers (459 in 2013 vs 6148 in 2020) with a 12.69 fold increase in prevalence. The incidence has increased by a factor of 8. The incidence of the 0-17 year olds has increased by a factor of 29.45 in 6 years, those of the 18-35 year olds by a factor of 10.63. Overall, more MtF than FtM are observed except in minors and young adults. CONCLUSIONS: There is an overall increase of people with ALD F64 but more marked in minors and young adults. The MtF/FtM ratio is still higher than 1 but tends to be closer to it. It is reversed in minors and young adults.

A national media mass campaign improves beliefs and behaviours about low back pain in the general population and in general practitioners.

INTRODUCTION: Previous international mass-media campaigns for low back pain (LBP) have had conflicting impacts on the general population. The objective was to evaluate the impact of a national back pain campaign conducted between 2017 and 2019 on beliefs and behaviours of general practitioners and the general population in France. METHODS: Between 2017 and 2019, a mass-media campaign was used to disseminate positive messages about LBP using several media, along with a parallel campaign addressed to general practitioners. An email survey before the campaign and 6 and 18 months after the campaign started evaluated beliefs and behaviours among a representative sample of the 2 target populations (3500 people from the general population and 700 general practitioners before the campaign, and 2000 people and 300 general practitioners 6 and 18 months after). RESULTS: Overall, 56% of the general population respondents before the campaign and 74% and 75% at 6 and 18 months after adhered to the statement "One should maintain physical activity" when dealing with LBP. Conversely, the percentage adhering to the statement "The best treatment is resting" decreased significantly from 68% before the campaign to 45% at 6 and 18 months after. Physicians reported delivering more reassurance and giving more documentation to patients after the campaign. They prescribed less sick leave during the first consultation (65% before the campaign, 46% and 30% at 6 and 18 months after). CONCLUSION: A mass-media campaign aimed at the public and general practitioners in France significantly modified beliefs and behaviours about LBP.

Sepsis-Related Brain MRI Abnormalities Are Associated With Mortality and Poor Neurological Outcome in Pediatric Sepsis.

BACKGROUND: It is not known whether brain magnetic resonance imaging (MRI) abnormalities in pediatric sepsis are associated with clinical outcomes. Study objectives were to (1) determine the prevalence and type of sepsis-related neuroimaging abnormalities evident on clinically indicated brain MRI in children with sepsis and (2) test the association of these abnormalities with mortality, new disability, length of stay (LOS), and MRI indication. METHODS: Retrospective cohort study of 140 pediatric patients with sepsis and a clinically indicated brain MRI obtained within 60 days of sepsis onset at a single, large academic pediatric intensive care unit (PICU). Two radiologists systematically reviewed the first post-sepsis brain MRI and determined which abnormalities were sepsis-related. Outcomes compared in patients with versus without sepsis-related MRI abnormalities. RESULTS: PICU mortality was 7%. Thirty patients had one or more sepsis-related MRI abnormality, yielding a prevalence of 21% (95% confidence interval 15%, 28%). Among those, 53% (16 of 30) had sepsis-related white matter signal abnormalities; 53% (16 of 30) sepsis-related ischemia, infarction, or thrombosis; and 27% (eight of 30) sepsis-related posterior reversible encephalopathy. Patients with one or more sepsis-related MRI abnormality had increased mortality (17% vs 5%; P = 0.04), new neurological disability at PICU discharge (32% vs 11%; P = 0.03), and longer PICU LOS (median 18 vs 11 days; P = 0.04) compared with patients without. CONCLUSIONS: In children with sepsis and a clinically indicated brain MRI, 21% had a sepsis-related MRI abnormality. Sepsis-related MRI abnormalities were associated with increased mortality, new neurological disability, and longer PICU LOS.

The PostStroke-Manager - combining mobile, digital and sensor-based technology with personal assistance: protocol of the feasibility study.

INTRODUCTION: Post stroke management has moved into the focus as it represents the only way to secure acute treatment effects in the long term. Due to individual courses, post stroke management appears rather challenging and is hindered by existing barriers between treatment sectors. As a novel concept, the PostStroke-Manager combines digital and sensor-based technology with personal assistance to enable intersectoral cooperation, best possible reduction of stroke-related disability, optimal secondary prevention, and detection of physical and psychological comorbidities. METHODS: This prospective single-center observational study aims to investigate the feasibility of the PostStroke-Manager concept in an outpatient setting. Ninety patients who have suffered an ischemic or hemorrhagic stroke or transient ischemic attack will be equipped with a tablet and mobile devices recording physical activity, blood pressure, and electrocardiographic signals. Through a server-based platform, patients will be connected with the primary care physician, a stroke pilot and, if necessary, other specialists who will use web-based platforms. Via the tablet, patients will have access to an application with 10 newly designed components including, for instance, a communication tool, medication schedule, medical records platform, and psychometric screenings (e.g., depression, anxiety symptoms, quality of life, adherence, cognitive impairment). During the 1-year follow-up period, clinical visits are scheduled at three-month intervals. In the interim, communication will be secured by an appropriate tool that includes text messenger, audio, and video telephony. As the primary endpoint, feasibility will be measured by a 14-item questionnaire that addresses digital components, technical support, and personal assistance. The PostStroke-Manager will be judged feasible if at least 50% of these aspects are rated positively by at least 75% of patients. Secondary endpoints include feedback from professionals and longitudinal analyses on clinical and psychometric parameters. PERSPECTIVE: This study will answer the question of whether combined digital and personal support is a feasible approach to post stroke management. Furthermore, the patient perspective gained regarding digital support may help to specify future applications. This study will also provide information regarding the potential use of remote therapies and mobile devices in situations with limited face-to-face contacts. TRIAL REGISTRATION: German Register for Clinical Trials ( DRKS00023213 .), registered 27 April 2021.

Microalgae and cyanobacteria modeling in water resource recovery facilities: A critical review.

Microalgal and cyanobacterial resource recovery systems could significantly advance nutrient recovery from wastewater by achieving effluent nitrogen (N) and phosphorus (P) levels below the current limit of technology. The successful implementation of phytoplankton, however, requires the formulation of process models that balance fidelity and simplicity to accurately simulate dynamic performance in response to environmental conditions. This work synthesizes the range of model structures that have been leveraged for algae and cyanobacteria modeling and core model features that are required to enable reliable process modeling in the context of water resource recovery facilities. Results from an extensive literature review of over 300 published phytoplankton models are presented, with particular attention to similarities with and differences from existing strategies to model chemotrophic wastewater treatment processes (e.g., via the Activated Sludge Models, ASMs). Building on published process models, the core requirements of a model structure for algal and cyanobacterial processes are presented, including detailed recommendations for the prediction of growth (under phototrophic, heterotrophic, and mixotrophic conditions), nutrient uptake, carbon uptake and storage, and respiration.

The facilitating effect of clinical hypnosis on motor imagery: an fMRI study.

Hypnosis is increasingly being employed in therapy of neurologically impaired patients. In fact, reports from neuropsychological practice point out that neurological patients with a loss of motor abilities achieve successful rehabilitation by means of motor imagery during hypnosis. This approach was shown to be effective even if the patients' ability to imagine movements was impaired or lost. The underlying mechanisms of "how" and "where" hypnosis affects the brain, however, are largely unknown. To identify the brain areas involved in motor imagery under hypnosis, we conducted an fMRI study in which we required healthy human subjects either to imagine or to execute repetitive finger movements during a hypnotic trance. We observed fMRI-signal increases exclusively related to hypnosis in the left superior frontal cortex, the left anterior cingulate gyrus and left thalamus. While the superior frontal cortex and the anterior cingulate were active related more to movement performance than to imagery, the thalamus was activated only during motor imagery. These areas represent central nodes of the salience network linking primary and higher motor areas. Therefore, our data substantiate the notion that hypnosis enhances motor imagery.