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Background The Pap test has been an important part of women's medical care for 40 years. Its utilization over time allows us to study both under- and over-screening. Our objective is to study the trends over time in each woman's screening status while simultaneously examining both its underuse and overuse. Methods Our final sample included 55,141 women. We used sequence analysis methods to characterize trajectories of cervical cancer screening use for each woman. We then obtained 3 clusters of sequences. We performed bivariate analyses by comparing variables of interest according to each woman's cluster membership. Results This study of Pap test reimbursement data shows that 70.7% of our sample was screened more often than necessary according to the guidelines for at least some periods of this study. The cluster analysis highlighted the consistency of the screening status. Once a woman \"adopted\" a screening rhythm, it appeared to continue over time. Most women who overused cervical cancer screening by Pap tests at the beginning of our observation period overused it throughout the follow-up period; the same consistency was found for those up-to-date at the start, and for those underscreened. The women in the overscreened group were in better health, younger, lived with a partner more often, and had the most favorable social characteristics. Conclusion Our results showed an unequal distribution of social, demographic, and health characteristics across screening patterns. The majority of our sample was screened more often than necessary according to the guidelines then in effect. Once a woman \"adopted\" a screening rhythm, it appeared to continue over time.

BackgroundHypoglycemia usually includes various neurological symptoms, which are the consequence of neuroglycopenia. When it is severe, it is associated with altered mental status, even coma.Case presentationWe report the case of a patient with severe hypoglycemia, completely asymptomatic, due to the increase of lactate production in response to tissue hypoperfusion following a hemorrhagic shock. This illustrates that lactate can substitute glucose as an energy substrate for the brain. It is also a reminder that this metabolite, despite its bad reputation maintained by its role as a marker of severity in critical care patients, has a fundamental role in our metabolism.ConclusionsFollowing the example of the “happy hypoxemia” recently reported in the literature describing asymptomatic hypoxemia in COVID-19 patients, we describe a case of “happy hypoglycemia.”

Background Long-term multicentre studies are subject to numerous factors that may affect the integrity of their conclusions. Quality control and standardization of data collection are crucial to minimise the biases induced by these factors. Nevertheless, tools implemented to manage biases are rarely described in publications about population-based cohorts. This report aims to describe the processes implemented to control biases in the Constances cohort taking lung function results as an example. Methods Constances is a general-purpose population-based cohort of 200,000 participants. Volunteers attend physical examinations at baseline and then every 5 years at selected study sites. Medical device specifications and measurement methods have to comply with Standard Operating Procedures developed by experts. Protocol deviations are assessed by on-site inspections and database controls. In February 2016, more than 94,000 participants yielding around 30 million readings from physical exams, had been covered by our quality program. Results Participating centres accepted to revise their practices in accordance with the study research specifications. Distributors of medical devices were asked to comply with international guidelines and Constances requirements. Close monitoring enhanced the quality of measurements and recordings of the physical exams. Regarding lung function testing, spirometry acceptability rates per operator doubled in some sites within a few months and global repeatability reached 96.7 % for 29,772 acceptable maneuvers. Conclusions Despite Constances volunteers being followed in multiple sites with heterogeneous materials, the investment of significant resources to set up and maintain a continuous quality management process has proved effective in preventing drifts and improving accuracy of collected data.

Background Access to emergency care is becoming increasingly challenging due to rising demand and limited resources, such as shortage of general practitioners (GP). In France, emergency medical services (EMS) have experienced a 23% increase in call volume over the past decade. To address this, French dispatch systems are evolving, with Emergency Medical Dispatchers (EMDs) empowered to make certain medical decisions through Autonomous Decision Protocols (ADP). These ADP were designed for most frequent and simple emergency situations such as low back pain, epistaxis, head and limb injury, anxiety, and allowed EMDs to recommend medical advice, send an ambulance or refer the caller to a dispatching doctor. Aim This study aimed to assess callers’ satisfaction with decisions made by EMDs using ADPs compared to decisions made by medical doctors with similar chief complaint. Material & method The study was prospective, involving all ADP calls from September to October 2023. All calls concerning ADPs and dispatched by EMDs were included. Callers were called back within a few days of the call in order to obtain their experience using a questionnaire. Retrospective patient files concerning similar chief complaints handled in the traditional way, over the same period in the previous year, were used for comparison. Results A total of 358 calls were analyzed, with 217 (61%) callers completing a satisfaction survey. The results showed high satisfaction, with an average score of 8.6/10. The most common chief complaints were head and limb injuries, and the vast majority (90%) of callers felt their expectations were met. Only a small percentage (4%) required a second opinion or follow up due to worsening symptoms. Conclusion The findings suggest that ADPs improved efficiency by providing standardized medical advice, reducing unnecessary ambulance dispatches, and saving medical resources. Callers who benefited from ADPs were generally satisfied with the service, with satisfaction rates comparable to those found in international studies. Expanding ADPs to cover additional medical conditions could further enhance emergency dispatch systems, especially in light of increasing demand and reduced medical resources.

BackgroundThe use of personal protective equipment (PPE) by emergency medical services (EMS) providers requires specific attention, as it takes place in out-of-hospital unsecured settings. The aim of this study was to evaluate which PPE gown was less contaminating during doffing procedures in an EMS setting.Six well-trained healthcare worker (HCW) subjects tested 4 different gowns: (1) surgical gowns (SG), (2) full body coveralls (FBC), (3) self-made alternative PPEs (SMP), and (4) non-surgical isolation gowns (NSIG). An invisible tracer was sprayed on the gown after donning each subject. After doffing, each HCW was photographed under UV lights to show areas of fluorescent “contamination” on their clothes. The number, size, and intensity level of contaminated areas were noted, as well as observational deviation from the procedure and doffing time. In addition, the subjects were asked to take a questionnaire about their perception of the level of comfort, ease of doffing, and overall safety for each gown.ResultsDespite a well-trained team of HCW subjects, contamination while doffing was observed with every type of PPE gown, and with each HCW subject. All body areas were contaminated at least once, except the face. Contamination was more frequent while doffing FBCs. On the other hand, the removal of SG was found to be the least contaminating. The mean doffing time was significantly shorter with SG 1:29 and longer with FBC 2:26 (p=0.005).ConclusionResults of this study converge towards the selection of surgical gowns over other types of PPE gowns, which met both contamination criteria as well as staff appreciation in this context. Specific attention should be paid to the legs and abdomino-pelvic areas. Additional protection such as protective trousers or aprons could be added.

Background During the COVID-19 pandemic, as the number of available Intensive Care beds in France did not meet the needs, it appeared necessary to transfer a large number of patients from the most affected areas to the less ones. Mass transportation resources were deemed necessary. To achieve that goal, the concept of a Collective Critical Care Ambulance (CCCA) was proposed in the form of a long-distance bus re-designed and equipped to accommodate up to six intensive care patients and allow Advanced Life Support (ALS) techniques to be performed while en route. Methods The expected benefit of the CCCA, when compared to ALS ambulances accommodating a single patient, was to reduce the resources requirements, in particular by a lower personnel headcount for several patients being transferred to the same destination. A foreseen prospect, comparing to other collective transportation vectors such as airplanes, was the door-to-door capability, minimalizing patients’ handovers for safety concerns and time efficiency. With the project of a short-distance transfer of several Intensive Care Unit (ICU) patients together, the opportunity came to test the CCCA under real-life conditions and evaluate safely its technical feasibility and impact in time and resources saving, before it could be proposed for longer distances. Results Four COVID-19 patients were transported over 37 km. All patients were intubated and under controlled ventilation. One of them was under Norepinephrine support. Mean loading time was 1 min 39 s. Transportation time was 29 min. At destination, the mean unloading time was 1 min 15 s. No serious adverse effect, in particular regarding hemodynamic instability or ventilation disorder, has been observed. No harmful incident has occurred. Conclusions It was a very instructive test. Collective medical evacuation by bus for critically ill patients under controlled ventilation is suitable and easy to implement. Design, ALS equipment, power autonomy, safety and resources saving, open the way for carrying up to 6 ICU-patients over a long distance. The CCCA could bring a real added-value in an epidemic context and could also be helpful in many other events generating multiple victims such as an armed conflict, a terrorist attack or a natural disaster.

Background Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an \"open epidemiologic laboratory\" accessible to the epidemiologic research community. Although designed as a \"general-purpose\" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging. Methods/Design The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death. To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants will be set up and followed through the same national databases as participants. A field-pilot was performed in 2010 in seven HSCs, which included about 3,500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data. Discussion The constitution of the full eligible sample is planned during the last trimester of 2010, and the cohort will be launched at the beginning of 2011.

OBJECTIVES To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires.

[...]victims” were rescued and evacuated by firemen and EMS. [...]29% find this exercise rather or very disruptive in the scared group versus 4% in the non-scared group (p = 0.001). A literature review [7] concerning mass shootings identified mental health outcomes were mainly posttraumatic stress symptoms (PTSS), major depression or other disorders such as generalized anxiety, acute stress, panic or alcohol or drug-related conditions.