Explore the vast range of titles available.

Background Early recognition and treatment of meningococcal disease improves its outcome. Haemorrhagic rash is one of the most specific signs that parents can learn to recognise. Objective To determine the percentage of parents able to recognise a haemorrhagic rash and perform the tumbler test. Methods 123 parents of children consulting for mild injuries were interviewed about the significance and recognition of haemorrhagic rash in febrile children. Results Although 88% of parents undressed their children when they were febrile, it was never to look specifically for a skin rash. Only 7% (95% CI 3% to 12%) were able to recognise a petechial rash and knew the tumbler test. Conclusion Information campaigns about the significance of haemorrhagic rash and about the tumbler test are needed.

The present article looks to pinpoint explanatory factors for the sharing of escorting of children in dual-earner families. It proposes a detailed analysis of inequalities and interactions in dual-earner families when it comes to escorting children by taking into account the characteristics of trips to and from school for children, the characteristics of the parents’ occupations, and the characteristics of the household. Compared with earlier research, the model considers more detailed data about the escorts’ jobs, such as specific working hours, which provide a better understanding of the constraints on parents and insight into the choices made when both parents are in a position to escort their children. The findings depart somewhat from those of earlier work on the question because more specific data are considered. They show a marked gender inequality in escorting because mothers in dual-earner families do more than two-thirds of the escorting. But the factors explaining the sharing of escorting act almost symmetrically for both parents, with the effect of work starting and finishing times being preponderant. These models confirm that the inequality kicks in ahead of this: mothers in dual-earner households are more often than fathers in jobs with short working hours and which are more compatible with escorting.

In travel surveys, immobility is often approached as a technical issue that needs to be dealt with in order to measure mobility more accurately. By covering mobility patterns over a full week, the 2008 French Travel Survey allows immobility to be analysed other than as a marginal and random phenomenon. For working days alone, 28.8% of the adults in the survey had experienced one or more immobility episodes. By considering the intensity of immobility, and by introducing latent variables into Structural Equation Modelling, we have been able to propose a model with reasonable explanatory power. Our findings agree with previous studies and also show that within suburban or rural areas, access to shops or the type of local residential fabric are also factors that influence the number of immobile days. In addition, our findings show that the effects of the determinants differ between categories of individuals, notably between working adults and students on the one hand, and between retired and non-working people on the other.

ObjectivesThe first COVID-19 lockdown led to a significantly reduced access to healthcare, which may have increased decompensations in frail patients with chronic diseases, especially older patients living with a chronic cardiovascular disease (CVD) or a mental health disorder (MHD). The objective of COVIQuest was to evaluate whether a general practitioner (GP)-initiated phone call to patients with CVD and MHD during the COVID-19 lockdown could reduce the number of hospitalisation(s) over a 1-month period.DesignThis is a cluster randomised controlled trial. Clusters were GPs from eight French regions.ParticipantsPatients ≥70 years old with chronic CVD (COVIQuest_CV subtrial) or ≥18 years old with MHD (COVIQuest_MH subtrial).InterventionsA standardised GP-initiated phone call aiming to evaluate patients’ need for urgent healthcare, with a control group benefiting from usual care (ie, the contact with the GP was by the patient’s initiative).Main outcome measuresHospital admission within 1 month after the phone call.ResultsIn the COVIQuest_CV subtrial, 131 GPs and 1834 patients were included in the intervention group and 136 GPs and 1510 patients were allocated to the control group. Overall, 65 (3.54%) patients were hospitalised in the intervention group vs 69 (4.57%) in the control group (OR 0.82, 95% CI 0.56 to 1.20; risk difference −0.77, 95% CI −2.28 to 0.74). In the COVIQuest_MH subtrial, 136 GPs and 832 patients were included in the intervention group and 131 GPs and 548 patients were allocated to the control group. Overall, 27 (3.25%) patients were hospitalised in the intervention group vs 12 (2.19%) in the control group (OR 1.52, 95% CI 0.82 to 2.81; risk difference 1.38, 95% CI 0.06 to 2.70).ConclusionA GP-initiated phone call may have been associated with more hospitalisations within 1 month for patients with MHD, but results lack robustness and significance depending on the statistical approach used.Trial registration numberNCT04359875.

The outer suburbs of Paris are home to a large number of low-income households driven from the centre by the workings of the property market. This shift could give rise to a new form of socio-spatial segregation insofar as the elevated costs of mobility in such highly car-dependent areas restrict and change these households' mobility patterns.These effects were observed in data on three groups of working people from the 2001 global transport survey. However, the socio-spatial impact of this outward movement is significantly reduced by the residential mobility of low-income households, which move from the most car-dependent areas to denser areas with better public transport provision.The presence of social housing in these areas only partially explains these migrations.These results obtained from 1999 census micro-data cast doubt upon the emergence of a new form of segregation in the outer suburbs described by Dodson and Sipe.

I was left flabbergasted by your leader (Fire and ice, 6 January). How can you demand that the tiny 300,000 population of Iceland take responsibility for the debts incurred by their country's bankrupt private banks?

I am a handicapped male who hails from Michigan and have been living in Florida for the past six-odd years.

Intelectins are ancient carbohydrate binding proteins, spanning chordate evolution and implicated in multiple human diseases. Previous GWAS have linked SNPs in ITLN1 (also known as omentin) with susceptibility to Crohn's disease (CD); however, analysis of possible functional significance of SNPs at this locus is lacking. Using the Ensembl database, pairwise linkage disequilibrium (LD) analyses indicated that several disease-associated SNPs at the ITLN1 locus, including SNPs in CD244 and Ly9, were in LD. The alleles comprising the risk haplotype are the major alleles in European (67%), but minor alleles in African superpopulations. Neither ITLN1 mRNA nor protein abundance in intestinal tissue, which we confirm as goblet-cell derived, was altered in the CD samples overall nor when samples were analyzed according to genotype. Moreover, the missense variant V109D does not influence ITLN1 glycan binding to the glycan β-D-galactofuranose or protein–protein oligomerization. Taken together, our data are an important step in defining the role(s) of the CD-risk haplotype by determining that risk is unlikely to be due to changes in ITLN1 carbohydrate recognition, protein oligomerization, or expression levels in intestinal mucosa. Our findings suggest that the relationship between the genomic data and disease arises from changes in CD244 or Ly9 biology, differences in ITLN1 expression in other tissues, or an alteration in ITLN1 interaction with other proteins.

SOLAR-1 and BYLieve trials documented the efficacy of the PI3K-inhibitor alpelisib in pre-treated PIK3CA -mutant, hormone receptor-positive, HER2-negative (HR+/HER2-) advanced breast cancer (ABC) patients. We report here real-life data of patients prospectively registered in the French alpelisib early access program (EAP) opened to PIK3CA -mutant HR+/HER2- ABC patients treated with alpelisib and fulvestrant. Primary endpoint was PFS by local investigators using RECIST1.1. Eleven centers provided individual data on 233 consecutive patients. Patients had received a median number of 4 (range: 1–16) prior systemic treatments for ABC, including CDK4/6 inhibitor, chemotherapy, fulvestrant and everolimus in 227 (97.4%), 180 (77.3%), 175 (75.1%) and 131 (56.2%) patients, respectively. After a median follow-up of 7.1 months and 168 events, median PFS was 5.3 months (95% CI: 4.7–6.0). Among 186 evaluable patients, CBR at 6 months was 45.3% (95% CI: 37.8–52.8). In multivariable analysis, characteristics significantly associated with a shorter PFS were age < 60 years (HR = 1.5, 95% CI = 1.1–2.1), >5 lines of prior treatments (HR = 1.4, 95% CI = 1.0–2.0) and the C420R PI3KCA mutation (HR = 4.1, 95% CI = 1.3–13.6). N  = 91 (39.1%) patients discontinued alpelisib due to adverse events. To our knowledge, this is the largest real-life assessment of alpelisib efficacy. Despite heavy pre-treatments, patients derived a clinically relevant benefit from alpelisib and fulvestrant.