[Supporting sex workers in dealing with risks and exposure to violence]. / Accompagner les travailleurs du sexe face aux risques et à l'exposition à la violence.

Médecins du Monde France is involved in supporting sex workers in reducing health risks, and has highlighted the fragility of this population with regard to current legislative measures concerning sex work. These multiple constraints have negative repercussions in terms of access to health rights, but also in terms of their work.

Impact of Sex and Gender on Metabolic Syndrome in Adults: A Retrospective Cohort Study From the Canadian Primary Care Sentinel Surveillance Network.

OBJECTIVE: Metabolic syndrome (MetS), a cluster of 5 interconnected factors, is the main contributor to cardiovascular disease. Although sex- and gender-related elements have been linked to MetS and its components, this association has not been explored among Canadians with or without MetS. In this study, we aimed to identify sex and gender differences in characteristics of MetS in the Canadian population. METHODS: This retrospective cohort study used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database. The CPCSSN contains de-identified electronic health records of >1.5 million Canadians (2010-2019). Individuals 35 to 75 years of age who had a primary care encounter formed the study sample (N=37,813). Multiple logistic regression models were used to estimate adjusted odds ratios for sex and gender differences among Canadians with and without MetS, which was the primary outcome variable. RESULTS: The estimated prevalence of MetS was 41.9%. The risk of developing MetS was significantly lower among females compared with males (odds ratio 0.73, 95% confidence interval 0.70 to 0.76). However, the risk was higher in females who used antidepressants (odds ratio 1.53, 95% confidence interval 1.42 to 1.65). An equal distribution of deprivation indexes was observed between males and females with MetS, with risk slightly higher for those with material deprivation. Females were found to be the most socially deprived. CONCLUSIONS: This study provides important sex- and gender-specific differences in MetS among Canadians. Targeting sex- and gender-specific risk factors could assist in reversing the trend of adverse cardiovascular outcomes associated with MetS.

[Trans-identity in the light of law and ethics]. / La transidentité au prisme de la loi et de l'éthique.

Gender identity is a concept that is both widespread and relatively abstract for most citizens. It seems important to define this notion in its dynamic perspective, by concretely exploring the administrative, legal, therapeutic, surgical and social components of a person's transition journey in France in 2023. The major role played by militant lesbian, gay, bisexual and transgender associations and the ethical issues raised by this change of identity must be highlighted.

Exploring the Lived Experience of Self-management Practices of Indigenous Men, Women and Two-spirited Individuals Living With Type 2 Diabetes in Canada, the United States, Australia, and New Zealand: A Scoping Review.

OBJECTIVES: Indigenous men, women and two-spirted individuals have been significantly impacted by type 2 diabetes mellitus (T2DM) and its complications. It is believed that T2DM in Indigenous peoples is a direct result of colonization and the introduction of changes to traditional Indigenous ways of knowing, being, and living. The broader question will guide the aim of this scoping review: What is currently known about the lived experience of self-managing diabetes in Indigenous men, women, and two-spirited individuals living with T2DM in Canada, the United States, Australia and New Zealand? Specific objectives of this scoping review include 1) exploring the lived experience of self-management practices of Indigenous men, women, and two-spirited individuals living with T2DM; and 2) describing how self-management experiences differ from physical, emotional, mental, and spiritual perspectives. METHODS: A total of 6 databases were searched, including Ovid MEDLINE, Embase, PsychINFO, CINAHL, Cochrane, and the Native Health Database. An example of keywords searched included "self-management," "Indigenous," and "type 2 diabetes mellitus." A total of 37 articles were included in the synthesis of results, and the 4 quadrants of the Medicine Wheel were used to organize and interpret data. RESULTS: The use of culture within self-management practices was important for Indigenous peoples. Demographic data were collected for many of the studies, including sex and gender characteristics, but only a small number of studies addressed the influence of sex and gender on outcomes. CONCLUSION: Our findings inform future Indigenous diabetes education and health-care service delivery and future research.

Changes in Daily Occupations Patterns, Optimism, and Positive Affect During COVID-19 Lockdown.

Background. The COVID-19 outbreak caused an initial 2-week lockdown throughout Israel. Purpose. To identify (1) changes in time-usage patterns of daily occupations during the first COVID-19 lockdown, by gender and employment status, and (2) correlations among optimism, positive affect, and daily occupations during the lockdown. Method. In a voluntary, anonymous, retrospective, online cross-sectional survey, 481 participants completed the Life Orientation Test, Positive Affect Questionnaire, and Occupational Questionnaire. Findings. During lockdown, participants spent more time in recreation, rest, and sleep regardless of their employment status, and more women than men lost their employment. Both before and during lockdown, women spent significantly higher percentage of time performing everyday tasks but reported less rest and sleep than men. Recreation was associated with positive affect. Conclusion. The COVID-19 pandemic created a temporary occupational disruption. Although people devoted their time differently, the lockdown forced people to find ways to continue engaging in their occupations.

Seduction, deception and technology.

This paper proposes that exploring the use of internet pornography creates a potentially beneficial, albeit defensive liminal space that can be used therapeutically. The content of compelling sexual scenes can be viewed as the psyche's way of mastering internal trauma and masking an inner emptiness. However, from a Jungian perspective, the use of internet pornography can also be seen as a patient's distorted way of trying to make dissociated affects more bearable by triumphing over them. The sexual use of technology can express intrapsychic conflict encapsulated in what Stoller called 'microdots'. Stoller's microdots are unique scripts - a kind of emotional code that gives clinicians an opportunity to reveal unconscious processes and transcend them through meaning making. Wood's work at the Portman Clinic on the chosen 'compelling scenarios' of pornography-addicted patients is also examined with this Jungian lens. Jung's idea of the transcendent function is used to show the value of holding the tension of fantasy and frustration provoked by intimacy. The paper illustrates how they come together within the therapeutic relationship to stimulate something new.

Cet article suggère qu'étudier l'utilisation de la pornographie sur internet crée un espace potentiellement bénéfique, même s'il est défensif, et qui peut être utilisé de manière thérapeutique. Le contenu de scènes sexuelles impressionnantes peut être compris comme la manière dont la psyché maitrise le traumatisme interne et masque le vide intérieur. Mais d'un point de vue Jungien, l'utilisation de la pornographie sur internet peut également être pensée comme la manière, certes perturbée, du patient pour tenter de rendre plus supportables des affects dissociés en prenant le dessus sur ces fameux affects. L'utilisation sexuelle de la technologie peut exprimer le conflit intrapsychique encapsulé dans ce que Stoller a appelé les 'micropoints'. Les micropoints de Stoller sont des scénarios uniques - une sorte de code émotionnel qui donne aux cliniciens l'occasion de révéler les processus inconscients et de les transcender en y donnant du sens. Le travail de Wood à la Portman Clinic - sur les 'scénarios fascinants' des patients dépendants à la pornographie - est également étudié à travers la perspective Jungienne. L'idée Jungienne de la fonction transcendante est utilisée pour montrer qu'il est précieux de tenir la tension entre fantasme et frustration, tension qui provient de l'intimité. Cet article illustre comment ils se rejoignent dans la relation thérapeutique pour stimuler quelque chose de nouveau.

El presente trabajo propone que la exploración del uso de pornografía por internet crea un beneficio potencial, aún siendo un espacio liminal defensivo, que puede ser usado terapéuticamente. El contenido de atractivas escenas sexuales puede percibirse como el modo de la psique de dominar el trauma interno y de enmascarar el vacío interior. Sin embargo, desde una perspectiva Junguiana, el uso de pornografía por internet puede considerarse como un modo distorsionado del paciente de tratar de hacer más tolerables emociones disociadas triunfando sobre las mismas. El uso sexual de tecnología puede expresar conflicto intrapsíquico encapsulado en lo que Stoller llamó `micropuntos`. Los `micropuntos`de Stoller son guiones únicos - una especie de código emocional que le da al clínico una oportunidad para revelar procesos inconscientes y trascenderlos a través de darles sentido. También se examina con este lente Junguiano el trabajo de Wood en la Clínica Portman sobre los elegidos `escenarios cautivantes` de pacientes con adicción a la pornografía. La idea de Jung sobre la Función Trascendente es utilizada para mostrar el valor de sostener la tensión entre fantasía y frustración provocada por la intimidad. El trabajo ilustra cómo ambas coinciden en la relación terapéutica para estimular algo nuevo.

[Sex differences in stroke mortality in Thailand : A National cohort study]. / Différences sexuelles dans la mortalité par accident vasculaire cérébral en Thaïlande : une étude de cohorte nationale.

BACKGROUND: Over half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients. METHOD: All stroke admissions between 2004-2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders. RESULTS: 608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17-1.23; 1 month: HR: 1.17; 95% CI: 1.15-1.20; 1 year: HR: 1.10; 95% CI: 1.09-1.12 and 5 years: HR: 1.02; 95% CI: 1.01-1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00-1.04; 1 month: HR: 1.08; 95% CI: 1.06-1.10; 1 year: HR: 1.04; 95% CI: 1.03-1.06 and 5 years: HR: 1.09; 95% CI: 1.08-1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03-1.06; 1 month: HR: 1.20; 95% CI: 1.14-1.27; 1 year: HR: 1.14; 95% CI: 1.09-1.18 and 5 years: HR: 1.06; 95% CI: 1.03-1.10). CONCLUSIONS: Compared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.

[The female urologist in 2022, where are we?] / La femme urologue en 2022 : où en est-on ?

There are still significant disparities between the sexes even if we are now witnessing a feminization of the urological profession. Women's roles in historically male-dominated services still vary widely based on inherent gender biases. Interventions to minimize the gender gap in urology should not constitute a form of positive discrimination in favor of minorities but on the contrary a form of positive action to eliminate the obstacles present that block the acceptance of women or their promotion. Recognizing the factors responsible for gender disparities remains a key step towards improving equity in still male-dominated fields such as urology.

Predictors of Tri-council Funding Among Nutrition Researchers in Canada.

Purpose: Barriers in research for women and dietitians have been documented. We sought to describe tri-council funding awarded within the nutrition discipline according to institution type, academic rank, gender, dietitian status, and primary research methods used.Methods: Using an online search methodology, faculty members with research appointments were identified from nutrition departments offering accredited dietetic programs and/or at Canada's collective of research-intensive universities known as U15. All data regarding faculty members, their institutions, and funding were collected through publicly available websites and Scopus. Tri-council funding associated with the nominated principal investigator, from a 5-year period, 2013-2014 to 2017-2018, was extracted. Binary logistic regression was used to test for predictors of receiving any tri-council operating funds within the 5-year period.Results: Faculty members (n = 237) from 21 institutions were identified for inclusion. Those from U15 institutions, at the full professor rank, nondietitians, men, and those who engaged in primarily quantitative research methods (vs. qualitative or mixed-methods) were significantly more likely to hold any tri-council funding during the eligible period. Dietitians (n = 76) were significantly less likely to hold tri-council funding, independent of institution, rank, gender, and primary research methods utilized.Conclusions: The apparent under-funding of academic dietitians from federal tri-council sources requires exploration.

[Why (and how) to think of care beyond the sexuation of bodies]. / Pourquoi (et comment) penser le soin au-delà de la sexuation des corps.

More and more young people identify as transgender or non-binary today. This can be attributed to the increased availability of vocabulary regarding gender as well as the diverse representations of trans and non-binary people in media and on social networking sites. However, medical or educational institutions are slow to change and many trans individuals still feel uncomfortable in the presence of health care providers, regardless of their specialty.

PGC-1α overexpression is not sufficient to mitigate cancer cachexia in either male or female mice.

Cancer cachexia (CC) accounts for 20%-40% of cancer-related deaths. Mitochondrial aberrations have been shown to precede muscle atrophy in different atrophy models, including cancer. Therefore, this study investigated potential protection from the cachectic phenotype through overexpression of peroxisome proliferator-activated receptor γ coactivator-1 α (PGC-1α). First, to establish potential of mitochondria-based approaches we showed that the mitochondrial antioxidant MitoTEMPO (MitoT) attenuates myotube atrophy induced by Lewis lung carcinoma (LLC) cell conditioned media. Next, cachexia was induced in muscle-specific PGC-1α overexpressing (MCK-PCG1α) or wildtype (WT) littermate mice by LLC implantation. MCK-PCG1α did not protect LLC-induced muscle mass loss. In plantaris, Atrogin mRNA content was 6.2-fold and ∼11-fold greater in WT-LLC vs WT-phosphate-buffered saline (PBS) for males and females, respectively (p < 0.05). MitoTimer red:green ratio for male PGC was ∼65% higher than WT groups (p < 0.05), with ∼3-fold more red puncta in LLC than PBS (p < 0.05). Red:green ratio was ∼56% lower in females WT-LLC vs PGC-LLC (p < 0.05). In females, no change in red puncta was noted across conditions. Lc3 mRNA content was ∼73% and 2-fold higher in male and female LLC mice, respectively, vs PBS (p < 0.05). While MitoT could mitigate cancer-induced atrophy in vitro, PGC-1α overexpression was insufficient to protect muscle mass and mitochondrial health in vivo despite mitigation of cachexia-associated signaling pathways.

Endothelin system expression in the kidney following cisplatin-induced acute kidney injury in male and female mice.

The chemotherapeutic agent cisplatin accumulates in the kidney and induces acute kidney injury (AKI). Preclinical and clinical studies suggest that young female mice and women show greater recovery from cisplatin-AKI compared to young male mice and men. The endothelin (ET) and ET receptors are enriched in the kidney and may be dysfunctional in cisplatin-AKI; however, there is a gap in our knowledge about the putative effects of sex and cisplatin on the renal ET system. We hypothesized that cisplatin-AKI male and female mice will have increased expression of the renal ET system. As expected, all cisplatin-AKI mice had kidney damage and body weight loss greater than control mice. Cisplatin-AKI mice had greater cortical Edn1, Edn3, Ednra, and Ednrb, while outer medullary Ednra was significantly suppressed in both sexes. Of the ∼25 000 genes sequenced from the inner medulla, only 91 genes (comparing saline mice) and 134 genes (comparing cisplatin-AKI mice) were differentially expressed and they were unrelated to the ET system. However, Edn1 was significantly greater in the inner medulla of male and female cisplatin-AKI mice. Thus, RNA profiles of the ET system were significantly affected by cisplatin-AKI throughout the kidney regardless of sex and this may help determine the therapeutic potential of targeting the ET receptors in cisplatin-AKI.

Sex Differences in Predictors of Completion of a 6-Month Adapted Cardiac Rehabilitation Program for People With Type 2 Diabetes and No Known Cardiac Disease.

BACKGROUND: Our aim in this study was to determine sex differences and predictors of noncompletion of a comprehensive adapted cardiac rehabilitation program (CRP) for people with type 2 diabetes (no known cardiac disease). METHODS: Reasons for noncompletion of a 6-month adapted diabetes exercise-based CRP were ascertained by interview between 2006 and 2017. Regression analyses were conducted to determine demographic, cardiopulmonary, medical and psychosocial predictors of noncompletion in all participants and in females and males separately. RESULTS: Among all participants (460 females and 375 males), predictors of dropout included higher depression score, being unemployed, higher glycated hemoglobin (A1C), younger age and fewer comorbidities. There was no difference in completion rate between females and males in bivariate (28% vs 28.3%, p=0.9) or multivariate (odds ratio=1.089, 95% confidence interval 0.79 to 1.5, p=0.6) analyses, but predictors of dropout varied. In females, these predictors included being married/partnered, living with obesity and having a higher depression score, A1C and triglycerides level, independent of age. For males, only higher depression score and younger age predicted dropout. There was no difference in medical dropouts between females and males (37.2% vs 34% of all dropouts, p=0.6) or in reasons for dropout (p>0.05 for all) or attendance to prescheduled sessions in completers (69.2±16.8% vs 70.4±18.8%, p=0.5) or dropouts (24.7±15.7% vs 25.2±16.1%, p=0.8), respectively. CONCLUSIONS: There was no sex difference in noncompletion, attendance or reasons for dropout from a diabetes CRP. However, being married/partnered, living with obesity and having higher A1C and triglycerides were unique predictors of dropout for females and younger age for males. Being unemployed, glycemic control and depressive symptoms are targets for promoting completion in all participants that can be addressed by multidisciplinary CRP teams.

Heat tolerance and the validity of occupational heat exposure limits in women during moderate-intensity work.

To mitigate excessive rises in core temperature (>1 °C) in non-heat acclimatized workers, the American Conference of Governmental Industrial Hygienists (ACGIH) provides heat stress limits (Action Limit Values; ALV), defined by the wet-bulb globe temperature (WBGT) and a worker's metabolic rate. However, since these limits are based on data from men, their suitability for women remains unclear. We therefore assessed core temperature and heart rate in men (n = 19; body surface area-to-mass ratio: 250 (SD 17) cm2/kg) and women (n = 15; body surface area-to-mass ratio: 268 (SD 24) cm2/kg) aged 18-45 years during 180 min of walking at a moderate metabolic rate (200 W/m2) in WBGTs below (16 and 24 °C) and above (28 and 32 °C) ACGIH ALV. Sex did not significantly influence (i) rises in core temperature, irrespective of WBGT, (ii) the proportion of participants with rises in core temperature >1 °C in environments below ACGIH limits, and (iii) work duration before rises in core temperature exceeded 1 °C or volitional termination in environments above ACGIH limits. Although further studies are needed, these findings indicate that for the purpose of mitigating rises in core temperature exceeding recommended limits (>1 °C), ACGIH guidelines have comparable effectiveness in non-heat acclimatized men and women during moderate-intensity work. Novelty: Sex did not appreciably influence thermal strain nor the proportion of participants with core temperatures exceeding recommended limits. Sex did not significantly influence tolerance to uncompensable heat stress. Despite originating from data obtained in only men, current occupational heat stress guidance offered comparable effectiveness in men and women.

Morphological variation of Rattus rattus Linnaeus, 1758 (Rodentia: Muridae) in forest and anthropogenic habitats of a watershed in northeastern Madagascar.

De par sa haute capacité d'adaptation et la plasticité de son alimentation, reflétée par une variation morphologique des individus, Rattus rattus s'est dispersé et a occupé un large éventail d'habitats à Madagascar après son introduction qui date du Xe siècle environ. Cette étude s'intéresse à la variation morphologique de cette espèce superposée à différents modes d'utilisation du paysage. Nous avons analysé des données morphométriques crânio-dentaires recueillies à partir de 333 spécimens capturés dans le bassin-versant de la rivière Manantenina sur la partie orientale du Massif de Marojejy. Les résultats des tests MANOVA comparant la morphologie crânio-dentaire et la taille des individus par sexe, classe d'âge et type d'habitat ont montré qu'il existe des différences significatives entre la forme du crâne et la taille des individus parmi les types d'habitat et la classe d'âge. Aucun dimorphisme sexuel n'a été trouvé sur la morphologie du crâne, par contre la taille des mâles est significativement plus grande par rapport à celle des femelles. Les individus vivant en dehors de l'habitat forestier ont des crânes nettement plus gros (Tukey HSD, p = 0,004). Comme anticipé, les jeunes individus ont un crâne plus petit que les adultes et les adultes plus âgés, mais la largeur de leur première molaire, la longueur de la rangée de dents de la mandibule et la longueur de la couronne de la rangée de molaire maxillaire sont plus grandes. Due to their high adaptability and dietary plasticity, reflected by individual morphological variation, Rattus rattus has dispersed to and occupies a broad range of habitats on Madagascar after its introduction to the island, which dates towards the 10th century. This study focuses on morphological variation of this species overlaid on different human land use patterns.We analyzed cranio-dental morphometric data collected from 333 specimens captured in the Manantenina River valley on the eastern side of the Marojejy Massif.The results of the MANOVA tests comparing cranio-dental morphology and size of individuals by sex, age class, and habitat type showed that there are significant differences between skull shape and size of individuals among the habitat types and age classes. No sexual dimorphism based on cranio-dental morphology was found but we noted a significant difference between male and female body size between different habitats. Individuals living outside of native forest have distinctly larger skulls (Tukey HSD, p = 0,004). As anticipated, young individuals have a smaller skull than adults and old adults, however the breadth of their first molar, length of mandible toothrow, and crown length of maxillary molar row are proportionally larger.

Age and Sex-Specific Associations in Health Risk Factors for Chronic Disease: Evidence from the Atlantic Partnership for Tomorrow's Health (PATH) Cohort.

The objective of this study was to discern health risk factors for chronic disease by age and sex in a Canadian cohort. Participants of the Atlantic Partnership for Tomorrow's Health (PATH) cohort with health risk factor data (physical activity, smoking, alcohol consumption, diet, body mass index [BMI]) were included (n = 16,165). Multivariable logistic regression models were used to evaluate the relationship among health risk factors, age, and sex. Regression analysis revealed that the odds of engaging in high levels of physical activity and having a BMI ≥ 25 was lower for females than males across all age groups, whereas the odds of abdominal obesity was substantially higher for females of all ages than for males. The odds of habitually consuming alcohol was lower for females of all ages than for males, and the odds of being a former/current smoker was lower for older (57-74 years of age) females than for males. The odds of consuming five or more servings of fruit and vegetables per day was higher for females of all ages than for males. There are evident differences in health risk factors for males and for females, as well as across age groups, and public health efforts need to account for the role played by sex and age in addressing chronic disease burden in Canadian adults.

[Anxiety in subjects with bronchial asthma]. / L'anxiete chez les sujets atteints d'asthme bronchique.

INTRODUCTION: Asthma, a frequent chronic respiratory disease, poses a public health problem due to its frequency, its impact on patients' lives and its significant direct and indirect costs. Despite all the published recommendations and the availability of increasingly effective therapies, many asthmatics remain poorly monitored, treated and controlled. This is due to several factors, including the association with comorbidities. The aim of this study was to determine the relationship between anxiety, asthma and its control. PATIENTS AND METHODS: A descriptive cross-sectional study with an analytical aim spread over one year (July 2016-July 2017). Were included in the study all asthmatics whose age was higher than 16 years randomly recruited at the consultation of the pneumophthisiology service of the CHU of Tizi-Ouzou (Algeria). RESULTS: According to the ACT criteria on 300 asthma patients, only 6.3% were controlled, 51.3% had partial control and 42.3% were uncontrolled. The factors negatively influencing asthma control were female gender (p=0.01) and anxiety (p= 0.0004). Factors associated with anxiety were female gender (p=0.001) and heart disease (p=0.00004). CONCLUSION: Our study highlighted the relationship between asthma and anxiety, which has a negative impact on asthma control.

INTRODUCTION: L'asthme, pathologie respiratoire chronique fréquente, pose un problème de santé publique, par sa fréquence, son retentissement sur le vécu des patients ainsi que par son important coût direct et indirect. Malgré toutes les recommandations publiées et la disponibilité des thérapeutiques, de plus en plus performantes, beaucoup d'asthmatiques restent mal suivis, mal traités et mal contrôlés. Ceci est dû à plusieurs facteurs, dont l'association à certaines comorbidités. PATIENTS ET MÉTHODES: Le but de cette étude est de déterminer la relation entre l'anxiété, l'asthme et son contrôle. Étude transversale descriptive prospective à visée analytique étalée sur une année (juillet 2016-juillet 2017). Ont étés inclus dans l'étude tous les asthmatiques dont l'âge était supérieur à 16 ans recrutés de façon aléatoire à la consultation du service de pneumo-phtisiologie du CHU de Tizi Ouzou (Algérie). RÉSULTATS: Selon les critères de l'ACT sur 300 patients asthmatiques, seuls 6,3% étaient contrôlés, 51,3% avaient un contrôle partiel et 42,3% étaient non contrôlés. Les facteurs influençant négativement le contrôle de l'asthme retrouvé étaient le sexe féminin (p=0,01) et l'anxiété (p= 0.0004). Les facteurs associés à l'anxiété étaient le sexe féminin, (p = 0.001) et les cardiopathies (p = 0.00004). CONCLUSION: Notre étude a mis en évidence la relation entre asthme et anxiété qui a un impact négatif sur le contrôle de l'asthme.

[Socio-anthropological and ethical issues of the augmented operating theatre]. / Enjeux socio-anthropologiques et éthiques du bloc opératoire augmenté.

The arrival of new technologies in the operating theatre raises questions about surgical practice, in a context of societal changes and hospital reorganisation. These innovations will bring changes to the ethos of the profession and ethical issues will be raised by the increase of the surgeon.

Blood withdrawal acutely impairs cardiac filling, output and aerobic capacity in proportion to induced hypovolemia in middle-aged and older women.

Blood donation entails acute reductions of cardiorespiratory fitness in healthy men. Whether these effects can be extrapolated to blood donor populations comprising women remains uncertain. The purpose of this study was to comprehensively assess the acute impact of blood withdrawal on cardiac function, central hemodynamics and aerobic capacity in women throughout the mature adult lifespan. Transthoracic echocardiography and O2 uptake were assessed at rest and throughout incremental exercise (cycle ergometry) in healthy women (n = 30, age: 47-77 yr). Left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (Q̇) and peak O2 uptake (V̇O2peak), and blood volume (BV) were determined with established methods. Measurements were repeated following a 10% reduction of BV within a week period. Individuals were non-smokers, non-obese and moderately fit (V̇O2peak = 31.4 ± 7.3 mL·min-1·kg-1). Hematocrit and BV ranged from 38.0 to 44.8% and from 3.8 to 6.6 L, respectively. The standard 10% reduction in BV resulted in 0.5 ± 0.1 L withdrawal of blood, which did not alter hematocrit (P = 0.953). Blood withdrawal substantially reduced cardiac LVEDV and SV at rest as well as during incremental exercise (≥10% decrements, P ≤ 0.009). Peak Q̇ was proportionally decreased after blood withdrawal (P < 0.001). Blood withdrawal induced a 10% decrement in V̇O2peak (P < 0.001). In conclusion, blood withdrawal impairs cardiac filling, Q̇ and aerobic capacity in proportion to the magnitude of hypovolemia in healthy mature women. Novelty: The filling of the heart and therefore cardiac output are impaired by blood withdrawal in women. Oxygen delivery and aerobic capacity are reduced in proportion to blood withdrawal.

Sex differences in physical and mental health following high-intensity interval training in adults with cardiovascular disease who completed cardiac rehabilitation.

This pre-post study examined sex-differences in peak aerobic power (V̇O2peak) and physical- and mental-health outcomes in adults with cardiovascular disease who completed high-intensity interval training (HIIT)-based cardiac rehabilitation. HIIT consisted of 25 minutes of alternating higher- (4×4 minutes 85-95% heart rate peak (HRpeak)) and lower- (3×3 minutes 60-70% HRpeak) intensity intervals twice weekly for 10 weeks. V̇O2peak estimated from a graded exercise test using the American College of Sports Medicine equation, body mass index (BMI), waist circumference, blood pressure, blood biomarkers and anxiety and depression were assessed at baseline and follow-up. Linear mixed-effects models for repeated measures were performed to examine differences over time between sexes. Of 140 participants (mean ± standard deviation: 58 ± 9 years), 40 were female. Improvements in V̇O2peak did not differ between sexes (interaction: p = 0.273, females: 28.4 ± 6.4 to 30.9 ± 7.6; males: 34.3 ± 6.3 to 37.4 ± 6.0 mL/kg/min). None of the time by sex interactions were significant. Significant main effects of time showed reductions in waist circumference, triglycerides, low-density lipoprotein (LDL), total cholesterol (TC)/high-density lipoprotein (HDL) and anxiety, and increases in V̇O2peak and HDL from baseline to follow-up. Significant main effects of sex revealed smaller V̇O2peak, BMI and waist circumference, and higher LDL, TC and HDL in females than males. HIIT led to similar improvements in estimated V̇O2peak (females: 8.8%, males: 9.0%) and additional health outcomes between sexes. Novelty: HIIT-based cardiac rehabilitation led to similar improvements in estimated V̇O2peak and other physical and mental health outcomes between sexes. The number of sessions attended was high (>70%) and did not differ by sex. Both sexes showed good compliance with the exercise protocol (HR target).