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International audience; Background: The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and treatment. Most patients newly diagnosed with digestive system cancer are aged 65 and over. Methods: We performed a retrospective, observational, multicentre cohort study based on prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer between January 2018 until August 2020 were enroled. Results: Data on 7882 patients were analysed. The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease. The decrease in newly treated digestive system cancer did not differ as a function of age, sex, comorbidities, primary tumour site, and disease stage. The proportion of patients admitted to an emergency department increased during the lockdown period. We do not observe a higher 3-month mortality rate in 2020, relative to the corresponding calendar periods in 2018 and 2019. Conclusion: To avoid a decrease in newly treated cancers during future lockdown periods, access to healthcare will have to be modified. Although 3-month mortality did not increase in any of the patient subgroups, the 2020 cohort must be followed up for long-term mortality.

Background Prostate cancer (PCa) and obesity are two ever-increasing public health issues that can independently impair the quality of life (QOL) of affected patients. Our objective was to evaluate the impact of overweight and obesity on the QOL of patients with PCa receiving an anticancer treatment. Methods We performed a systematic review of the literature using PubMed, Embase, Cochrane Library and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search equation targeted studies that included PCa patients who had a body mass index (BMI) greater than 25 kg/m2, who were receiving anticancer therapy, and whose QOL was analyzed according to validated or non-validated scores. Results Of 759 identified articles, we selected 20 studies published between 2000 and 2019 of 12,529 patients treated for PCa, including 5549 overweight or obese patients. QOL assessment was performed using nine validated scales and two non-validated questionnaires. Of seven studies on radiotherapy, six found obesity to have a negative impact on patients' QOL (especially urinary, sexual, and bowel-related QOL). Thirteen studies assessed the QOL of patients who underwent radical prostatectomy, with a BMI > 25 kg/m2 having no observed impact. In obese patients under 65 years of age and without comorbidities, nerve-sparing surgery appeared to limit the deterioration of QOL. Four studies on brachytherapy found discordant results. One study showed greater QOL impairment in obese patients receiving first-generation hormone therapy than in those with normal or decreased BMI. No study evaluated the QOL of overweight or obese patients receiving other types of systemic treatment. Conclusion Based on the published data, the level of evidence for an association between QOL and overweight or obesity in patients treated for PCa is not high. Prospective cohort studies including this type of patient population are warranted to answer this topical public health issue.

Background The fear of contracting coronavirus disease 2019 (COVID-19) and the preventive measures taken during the health crisis affected both people’s lifestyles and the health system. This nationwide study aimed to investigate the impact of the first wave of the COVID-19 pandemic on hospitalizations and mortality related to geriatric syndromes (GS) in older adults in France. Methods The French National Health Data System was used to compare hospital admissions (excluding the main diagnosis of COVID-19) and mortality rates (using multiple-cause and initial-cause analyses, and both including or excluding confirmed/probable COVID-19) related to 10 different GS (dementia, other cognitive disorders and symptoms, delirium/disorientation, depression, undernutrition/malnutrition, dehydration, pressure ulcer, incontinence, fall/injury and femoral neck fracture) from January to September 2020 to rates observed in previous years. Analyses were stratified by age, sex, place of residence or place of death, and region. Results Hospitalization rates for all GS decreased during the first lockdown compared to the same periods in 2017-19 (from −59% for incontinence to −13% for femoral neck fractures). A dose–response relationship was observed between reduced hospitalizations and COVID-19-related mortality rates. Conversely, for almost all GS studied, excess mortality without COVID-19 was observed during this lockdown compared to 2015-17 (from +74% for delirium/disorientation to +8% for fall/injury), especially in nursing homes and at home. Conclusions In France, during the first lockdown, a substantial decrease in hospitalizations for GS was accompanied by excess mortality. This decline in the use of services, which persisted beyond lockdown, may have a mid- and long-term impact on older adults’ health.

Background Inter-individual variations of non-glomerular filtration rate (GFR) determinants of serum creatinine, such as muscle mass, account for the imperfect performance of estimated GFR (eGFR) equations. We aimed to develop an equation based on creatinine and total lumbar muscle cross-sectional area measured by unenhanced computed tomography scan at the third lumbar vertebra. Methods The muscle mass–based eGFR (MMB-eGFR) equation was developed in 118 kidney donor candidates (iohexol clearance) using linear regression. Validation cohorts included 114 healthy subjects from another center (51Cr-EDTA clearance, validation population 1), 55 patients with chronic diseases (iohexol, validation population 2), and 60 patients with highly discordant creatinine and cystatin C–based eGFR, thus presumed to have atypical non-GFR determinants of creatinine (51Cr-EDTA, validation population 3). Mean bias was the mean difference between eGFR and measured GFR, precision the standard deviation (SD) of the bias, and accuracy the percentage of eGFR values falling within 20% and 30% of measured GFR. Results In validation population 1, performance of MMB-eGFR was not different from those of CKD-EPICr2009 and CKD-EPICr2021. In validation population 2, MMB-eGFR was unbiased and displayed better precision than CKD-EPICr2009, CKD-EPICr2021 and EKFC (SD of the biases: 13.1 vs 16.5, 16.8 and 15.9 mL/min/1.73 m2). In validation population 3, MMB-eGFR had better precision and accuracy {accuracy within 30%: 75.0% [95% confidence interval (CI) 64.0–86.0] vs 51.5% (95% CI 39.0–64.3) for CKD-EPICr2009, 43.3% (95% CI 31.0–55.9) for CKD-EPICr2021, and 53.3% (95% CI 40.7–66.0) for EKFC}. Difference in bias between Black and white subjects was −2.1 mL/min/1.73 m2 (95% CI −7.2 to 3.0), vs −8.4 mL/min/1.73 m2 (95% CI −13.2 to −3.6) for CKD-EPICr2021. Conclusion MMB-eGFR displayed better performances than equations based on demographics, and could be applied to subjects of various ethnic backgrounds.

Introduction The periods of lockdown during 2020 led to changes in daily occupations. As participation relies on dynamic interactions between the person, his/her occupations and his/her environment, we wondered whether people from different generations shared the same perception of occupational disruptions during the lockdown. Methods We performed an online survey based on the Canadian Occupational Performance Measure (COPM) of adults in 27 European Union countries, the United Kingdom and Switzerland. Three groups were compared: young adults (YAs, aged 18–39), middle-aged adults (MAs, aged 40–59) and older adults (OAs, aged 60 and over). Results 2865 participants (YAs: 47%; MAs: 33%; OAs: 20%) reported a total of 6549 disrupted occupations. The most frequently disrupted domain was leisure (83%), followed by productivity (16%) and self-care (2%); there were no significant intergroup differences ( p = 0.18). In a multivariate analysis, socializing disruptions were more likely to be associated with younger age (adjusted odds ratio (OR) [95% confidence interval (CI)] = 0.62 [0.50–0.76] for YAs versus MAs and 0.46 [0.30–0.71] for YAs versus OAs. Conclusion With the exception of socializing, the main disrupted occupations were similar from one generation to another. Our findings might enable the more accurate assessment of the risk of occupational disruption in a restrictive environment.

The population is ageing, and psychiatric disorders are common in older people. Those are associated with worsened quality of life. Although the positive relationship between dog ownership and physical health has been documented, data on mental health are scarcer, especially in community-dwelling older adults.We sought to establish whether owning a dog was associated with a lower number of symptoms of psychological disorders in community-dwelling older adults.We conducted a systematic review of the literature published between January 2005 and December 2020. We analysed comparative studies of the level of insomnia and symptoms of depression and/or anxiety among community-dwelling dog owners aged 70 and over.The search identified 191 articles, of which 117 full texts were assessed for eligibility. Five cross-sectional studies and one before-after with control group study (assessing a total of 25,138 older adults) were included. The mean (range) NOS score (five studies) was 6.8/9 (5-9) and the EPOC score (one study) was 2/8. The association between the presence of a dog and depressive symptoms did not appear to be significant. Regular contact with a dog was associated with fewer symptoms of anxiety. None of the studies specifically examined sleep disorders.Although the presence of a dog did not appear to be related to the level of depressive symptoms among community-dwelling older adults, there might be a beneficial relationship with anxiety. Further investigation is needed - especially with regard to the type of dog and the type of relationship with the dog.

Background The organization of healthcare systems changed significantly during the COVID-19 pandemic. The impact on the use of primary care during various key periods in 2020 has been little studied. Methods Using individual data from the national health database, we compared the numbers of people with at least one consultation, deaths, the total number of consultations for the population of mainland France (64.3 million) and the mean number of consultations per person (differentiating between teleconsultations and consultations in person) between 2019 and 2020. We performed analyses by week, by lockdown period (March 17 to May 10, and October 30 to December 14 [less strict]), and for the entire year. Analyses were stratified for age, sex, deprivation index, epidemic level, and disease. Results During the first lockdown, 26% of the population consulted a general practitioner (GP) at least once (-34% relative to 2019), 7.4% consulted a nurse (-28%), 1.6% a physiotherapist (-80%), and 5% a dentist (-95%). For specialists, consultations were down 82% for ophthalmologists and 37% for psychiatrists. The deficit was smaller for specialties making significant use of teleconsultations. During the second lockdown, the number of consultations was close to that in 2019, except for GPs (-7%), pediatricians (-8%), and nurses (+ 39%). Nurses had already seen a smaller increase in weekly consultations during the summer, following their authorization to perform COVID-19 screening tests. The decrease in the annual number of consultations was largest for dentists (-17%), physiotherapists (-14%), and many specialists (approximately 10%). The mean number of consultations per person was slightly lower for the various specialties, particularly for nurses (15.1 vs. 18.6). The decrease in the number of consultations was largest for children and adolescents (GPs: -10%, dentists: -13%). A smaller decrease was observed for patients with chronic diseases and with increasing age. There were 9% excess deaths, mostly in individuals over 60 years of age. Conclusions There was a marked decrease in primary care consultations in France, especially during the first lockdown, despite strong teleconsultation activity, with differences according to age and healthcare profession. The impact of this decrease in care on morbidity and mortality merits further investigation.

Background Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. Methods This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between 1 January 2005 and 31 December 2020 in 43 French pediatric (n = 7) or adult (n = 36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as to assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, in critically ill patients with m-TSS. Results In total, 102 patients with m-TSS (median age, 18 years; interquartile range, 16–24 years) were admitted to 1 of the participating ICUs. All blood cultures (n = 102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for superantigenic toxin gene sequences was performed for 76 of the 92 vaginal samples positive for S. aureus (83%), and toxic shock syndrome toxin 1 was isolated from 66 strains (87%). At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS, and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with antitoxin antibiotic therapy, and 8 (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors, and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. Conclusions In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.

Background: It was suggested that Coronavirus disease 2019 (COVID-19) may affect more frequently and with more severe evolution cancer patients. Our objectives were to assess the COVID-19 rate in cancer patients, to characterize their demographic, clinical and biological features and to assess their care trajectories and case-fatality rate. Methods: Based of Electronic Health Records of the Assistance Publique - Hopitaux de Paris, cancer patients were identified according to previous or actual history of cancer, and among them all patients tested for SARS-CoV-2 between March 03, 2020, and May 19, 2020 were included in this retrospective cohort study. We assessed the COVID-19 rate, described the clinical and biological cancer-related and non-cancer characteristics, care trajectories and mortality rate. Main outcome was COVID-19 assessed by positivity of Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS-CoV-2. Findings: Among the 29307 cancer patients, 8104 (28%) underwent a SARS-CoV-2 RT-PCR test. A total of 1672 patients (21% among tested cancer patients, 99% CI: 19 - 22) had COVID-19. Among them, median age was 75 years, 57% were men, 21% had gastro-intestinal tumors, 21% hematological malignancies, 22% were metastatic; 52% had a recent cancer diagnosed in 2019 or early 2020. Regarding the comorbidities, 51% had hypertension, 32% coronary heart diseases or heart failure, 27% diabetes, and 24% cardiac arrhythmia. Overall, 86% were hospitalized, and among them 18% in Intensive Care-Unit. Mortality rate for this population was 26% (99% CI: 24-28). During the same period, among the 309474 non-cancer patients, 98134 were tested for COVID-19 (32%), 24% (99% CI: 24-24) had a confirmed COVID-19 diagnosis. Mortality rate was 8·6%. Interpretation: Our results suggest that in hospital-based setting, cancer patients were not more affected by COVID-19 than non-cancer patients and that the high case fatality-rate may be mainly driven by advanced age and comorbidities. Funding Statement: Supported by Assistance Publique -Hopitaux de Paris Foundation. Declaration of Interests: MAB, JL, DW, EK, GG, MB, NP, TM, AB, CD, JC, FCP and JG do not declare any relevant conflicts of interest in the context of this work. JG reports grants from Eisai, Genomic-Health, Pfizer, Roche-Genentech, personal fees from Daiichi, Eisai, Genomic-Health, Macrogenics, MSD, Novartis, Onxeo, Pfizer, Roche-Genentech and non-financial support from Eisai, Genomic-Health, Novartis, Pfizer, Roche-Genentech, outside the submitted work. Ethics Approval Statement: On April 16, 2020, the Scientific and Ethics Committee of the AP-HP Health Data Warehouse gave a positive opinion to our research project concerning the analysis of data from cancer patients diagnosed COVID-19 at AP-HP. This study was approved by Institutional Review Board (IRB 00011591). The database was authorized by the National Freedom and Informatic Commission (CNIL Number 1980120).

BackgroundQuality of life (QoL) and burden scales have proved to be useful in estimating the impact of diseases and treatments from the patient’s perspective. Yet, no data nor scales are currently available with respect to the burden associated with the low sodium diet usually prescribed in heart failure (HF) patients, despite the lack of evidence of its efficacy and the previously reported evidence for negative effects in restricted diets (e.g. gluten-free).ObjectivesTo develop and validate a low sodium diet burden scale in HF patients.MethodsAfter a literature review and interviews with patients, 14 items were selected (coded 0-4, global score/70, higher scores reflecting higher burden) for the following domains relating to dietary habits: organization, pleasure, leisure, social life, vitality and self-rated health. The validation study was conducted in HF patients (NYHA I-IV) prospectively enrolled between 09/2012-09/2013 (H.Mondor Hospital, Cardiology Dpt, Creteil).Results93 patients completed the burden scale (men 64%; mean age 63.2 [±13.3]), of whom 14% had a highly restricted low sodium diet (

A 45-year-old healthy man wishes to climb Mount Kilimanjaro (5895 m) in a 5-day period, starting at 1800 m. The results of a recent exercise stress test were normal; he runs 10 km 4 or 5 times per week and finished a marathon in less than 4 hours last year. He wants to know how he can prevent becoming ill at high altitude and whether training or sleeping under normobaric hypoxic conditions in the weeks before the ascent would be helpful. What would you advise?

To determine the frequency of and factors associated with early tumor necrosis factor α (TNFα) antagonist therapy in everyday clinical practice in patients with suspected axial spondyloarthropathy (SpA).We used data from the prospective observational study in the French Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR; Outcome of Recent Undifferentiated Spondylarthropathies) cohort of 708 patients with recent-onset (3 years) inflammatory back pain (IBP) suggesting axial SpA. TNFα antagonist use was recorded at months 6 and 12 and factors independently associated with TNFα antagonist therapy were identified by multivariate logistic regression.Among the 708 patients (mean age 33.8 years, 46.2% men), 166 (23.4%) patients received TNFα antagonist therapy by month 12, including 120 (73.6%) patients who fulfilled Assessment of SpondyloArthritis international Society (ASAS) axial criteria and 157 (94.6%) who fulfilled at least 1 SpA criteria set; 109 (65.6%) had no sacroiliitis. Factors independently associated with early TNFα antagonist therapy were high Ankylosing Spondylitis Disease Activity Score using the C-reactive protein level (odds ratio [OR]1-point increase 1.60, 95% confidence interval [95% CI] 1.25-2.03, P0.001), high physician's global disease activity score (OR 1.37, 95% CI 1.21-1.54, P0.001), ASAS nonsteroidal antiinflammatory drug score50 (OR 1.88, 95% CI 1.24-2.87, P = 0.003), current or past disease-modifying antirheumatic drug use (OR 2.09, 95% CI 1.22-3.59, P = 0.008), systemic corticosteroid use (OR 2.48, 95% CI 1.43-4.34, P = 0.002), and mild to severe radiographic hip abnormalities (OR 9.43, 95% CI 2.11-42.09, P = 0.003). After adjustment on these factors, Achilles enthesis hypervascularization by power Doppler and number of work days missed were associated with TNFα antagonist therapy.In the DESIR cohort, approximately one-fourth of patients with recent IBP suggestive of axial SpA were under anti-TNFα therapy after 1 year of followup. All factors associated with this early initiation reflected higher disease activity, refractoriness, or severity, which suggests compliance of French rheumatologists with current treatment guidelines.

G-8 screening tool showed good screening properties for identifying vulnerable elderly patients with cancer who would benefit from a comprehensive geriatric assessment (CGA). We investigated whether tumour site and metastatic status affected its accuracy.Cross-sectional analysis of a prospective cohort study.Geriatric-oncology clinics of two teaching hospitals in the urban area of Paris.Patients aged 70 or over (n = 518) with breast ( n= 113), colorectal (n = 108), urinary-tract (n = 89), upper gastrointestinal/liver (n = 85), prostate (n = 69), or other cancers (n = 54).Reference standard for diagnosing vulnerability was the presence of at least one abnormal test among the Activities of Daily Living (ADLs), Instrumental ADL, Mini-Mental State Examination, Mini Nutritional Assessment, Cumulative Illness Rating Scale-Geriatrics, Timed Get-Up-and-Go, and Mini-Geriatric Depression Scale. Sensitivity, specificity and likelihood ratios of G-8 scores ≤ 14 were compared according to tumour site and patient characteristics.Median age was 80; 48.2% had metastases. Prevalence of vulnerability and abnormal G-8 score was 84.2% (95% confidence interval [95% CI], 81-87.3) and 79.5% (95% CI, 76-83). The G-8 was 86.9% sensitive (95% CI, 83.4-89.9) and 59.8% specific (95% CI, 48.3-70.4). G-8 performance varied significantly (all p values0.001) across tumour sites (sensitivity, 65.2% in prostate cancer to 95.1% in upper gastrointestinal/liver cancer; and specificity, 23.1% in colorectal cancer to 95.7% in prostate cancer) and metastatic status (sensitivity and specificity, 93.8% and 53.3% in patients with metastases vs. 79.5% and 63.3% in those without, respectively). Differences remained significant after adjustment on age and performance status.These G-8 accuracy variations across tumour sites should be considered when using G-8 to identify elderly patients with cancer who could benefit from CGA.

The aim of this study was to assess the risk and prognostic factors of status epilepticus (SE) among elderly inpatients.From May 2003 to April 2005, 63 consecutive patients aged 70 years or older with SE were included. Each patient was matched to three controls without SE seen during the same period. Matching variables were age (±3 years), gender, and comorbidity index (±3). Multivariate logistic regression model were used to compare cases to controls and, among the cases, nonsurvivors to survivors.By multivariate analysis, factors independently associated with SE were acute decompensation (cardiac, respiratory, or hepatic) [adjusted odds ratio (OR(a) ) 2.57, 95% confidence interval (95% CI) 1.05-6.25] history of epilepsy (OR(a) 3.93, 95% CI 1.27-12.14), chronic cerebrovascular disease (OR(a) 7.96, 95% CI 3.31-19.15), nonvascular dementia (OR(a) 4.16, 95% CI 1.86-9.29), and dysnatremia (OR(a) 5.08, 95% CI 2.34-11.04). In-hospital 1-month mortality was 2.3 times higher among cases than controls (14/63, 22.0%; 95% CI 12.7-34.5%; vs. 18/189, 9.5%; 95% CI 5.7-14.7%; p = 0.01). Among the cases, factors independently associated with in-hospital death within 1 month were younger age (OR(a) per 1-year increase 0.87, 95% CI 0.76-0.98), higher comorbidity index (OR(a) per 1-point increase 1.27, 95% CI 1.07-1.55), and de novo SE (OR(a) 14.95, 95% CI 2.24-192.8).Independent predictors of SE in hospitalized patients aged 70 years or older were acute decompensation (cardiac, respiratory, or hepatic), history of epilepsy, chronic cerebrovascular disease, nonvascular dementia, and dysnatremia. Factors that independently predicted death in patients with SE were younger age, higher comorbidity index, and de novo SE.