B Acad Nat Med Paris
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B Acad Nat Med Paris · Oct 2012
Review[Physical activities and sport; implications for health and society].
The practice of physical and sporting activities (PSA) throughout life is now known to increase healthy life expectancy, to delay the onset of dependency, and to be an effective complementary treatment for many disorders, particularly obesity and disability. The notion of a "sedentary death syndrome " [SeDS] has been evoked on the other side of the Atlantic. Although the beneficial effects of PSA have long been known, statistical analyses have only recently confirmed at the group level what was often disputed at the individual level. ⋯ PSA is no longer seen simply as a leisure activity but is now considered necessary for a healthy body and mind. PSA also has considerable social, educational and integrative implications. Can any society ignore these evident health benefits with impunity? The aims of this article are 1) to provide a quick overview of the advantages of regular, measured and reasonable PSA, as well as the potential risks of excess; 2) to discuss the quantity of PSA providing the optimal balance between benefits and risks, and the means of achieving this balance; 3) to highlight the lack of enthusiasm for PSA among the French population, and to analyze its causes, and 4) to propose a new organization designed to help more of our fellow citizens to adopt PSA, in the interests of their health and well-being.
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Rheumatoid arthritis (RA) is a chronic disabling disease that induces substantial costs in terms of healthcare resources (direct costs) and lost productivity (indirect costs). The main cost drivers used to be disability and hospitalization. ⋯ These effective treatments have lowered RA-related use of healthcare resources, especially totaljoint replacement, as well as sick leave. In contrast, they have not yet been shown to reduce the number of patients who become disabled, and their cost-effectiveness ratio thus tends to be unfavorable.
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Borderline personality disorders are complex clinical states with highly polymorphic symptoms and signs, leading to delays in their diagnosis and treatment. All international classifications emphasize certain clinical criteria such as unstable identity and interpersonal relationships, feelings of emptiness or boredom, and pathological impulsiveness. The prevalence is about 2%, with a female-male sex ratio of 2 or 3 to 1. ⋯ The psychiatric bio-psycho-social model takes into account multiple pathogenic factors, such as trauma during early development, temperamental instability and other emotional disorders, as well as psychosocial, neurobiological (5HT etc.) and genetic vulnerabilities. Treatment requires optimal integration of psychotherapeutic and pharmacotherapeutic approaches. Emergency intervention must be available in case of delirious or suicidal behavior The clinical course is often lengthy and complex, but outcome may be favorable, provided the principal risk--suicide--is correctly managed,
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Gastrointestinal stromal tumors (GIST) are the most frequent sarcomas but were underdiagnosed until the beginning of this century. GIST derive from interstitial cells of Cajal and may develop all along the digestive tract. GIST are characterized by the expression of KIT (CD117), and also DOG-1, which was recently discovered by transcriptome analysis. ⋯ For example, patients with metastatic GIST and a duplication of KIT exon 9 should receive twice the usual dose of imatinib, while GIST with the PDGFRA p. D842 V mutation are resistant to imatinib. This article presents the main pathologic characteristics of GIST and the important insights that GIST research has provided for oncology in general.
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Percutaneous extracorporeal life support (ECLS) is now widespread for treating acute cardiac failure. ECLS has been used for treating in-hospital and out of hospital cardiac arrests. A systematic review of literature was performed in order to assess the results. ⋯ ECLS was used after out of hospital cardiac arrests in 3 studies published between 2008 and January 31, 2011. They included 110 patients of which only 6 survived (4.4 %) despite strict inclusion criteria. Low flow lasted between 60 and 120 min (mean 98 min.) According to these results the use of ECLS should be encouraged after in-hospital cardiac arrest and training in cardiorespiratory resuscitation should be improved in global population and health professionals.