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Whether positively or negatively, an individual's geographical location has an impact on his or her state of health. Often described as a "catchword", the notion of territory is complex to define. To better understand its influence, we'll be looking at the different territorial scales, as well as the responses of populations to these issues. With this in mind, we'll take a look at how healthcare professionals are changing their practices.

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Although France's healthcare system is rich in multi-faceted skills, both in the community and in hospitals, and implemented by a range of medical, paramedical and medico-social professionals, it is no longer able to meet the health needs of all. Today, these social inequalities in health require us to rethink our policies and redesign existing systems, in order to develop new alternatives that will make quality care and health maintenance accessible to all.

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The rapid increase in the number of Parkinson's patients in the population is raising questions about the organization of expert resources. The creation of advanced practice nurses is likely to have an impact on this public health issue, as is the implementation of multi-level care gradation and the prospects for paramedical development.

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The number of people suffering from Parkinson's disease is constantly increasing. Diagnosis is based on the motor and non-motor symptoms present throughout the course of the disease. To preserve patient autonomy, the main therapeutic challenge is to propose a treatment adapted to each profile, in conjunction with the implementation of non-medication strategies, reflection on improved accessibility to existing medication and research into innovative therapies.

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A major advance has been made in the management of rectal cancer, with the emergence in 2021 of total neoadjuvant treatment. The main publications from the RAPIDO and PRODIGE-23 trials reported a significant improvement in progression-free survival and the pathological complete response rate. The aim of this review is to synthesize recent data on neoadjuvant treatment of rectal cancer, to explain the long-term results of the RAPIDO and PRODIGE-23 trials, and to put them into perspective, considering current advances in de-escalation strategies. The update of the 5-year survival data from the RAPIDO trial highlights an increased risk of loco-regional relapse, with 11.7% of relapses in the experimental group and 8.1% in the control group, while the update of the PRODIGE-23 trial confirms the benefits of this treatment regimen, with a significant improvement in overall survival. In addition, the results of the OPRA and PROPSPECT trials confirm the benefit of total neoadjuvant treatment with induction chemotherapy, as well as the possibility of surgical de-escalation in the OPRA trial and radiotherapy in the PROSPECT trial. The challenge for the future is to identify patients who require total neoadjuvant treatment with the aim of curative surgery to obtain a cure without local or distant relapse, and those for whom therapeutic de-escalation can be envisaged.

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The Many Victims plan describes aims to organize evacuations in a coherent manner, to preserve the human and material resources capacity of the fire and rescue service. The aim is to avoid postponing the disaster on the ground to the hospital and to guarantee the continuity of response to the current risk and an over-event. In this device, the firefighter nurse is an asset by his ability to take care of serious victims without the physical presence of a doctor, in a context of crisis.

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Recent international guidelines recommend rapid initiation and titration of basic treatments of heart failure but do not explain how to achieve this goal. Despite these recommendations, implementation of treatment in daily practice is poor. This may be partly explained by the profile of the patients (frailty, comorbidities), safety considerations and tolerability issues related to kydney function, low blood pressure or heart rate and hyperkalaemia. In this special article, we intended to help the physician, through an algorithmic approach, to quickly and safely introduce guideline-directed medical therapy in the field of heart failure with ejection fraction under 50%.

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Self-handicapping strategies consist of creating or declaring obstacles to oneself before a situation of accomplishment that threatens the self, as might be the case during an academic assessment or a sporting competition, in order to protect oneself from a possible failure or to valorise oneself in the event of success. It turns out that beyond the physiological effects sought and the dependence linked to the product, the consumption of psychoactive substances can serve as an excuse for users in the event of failure, thus protecting their sense of competence or enhancing it in the event of success, for having succeeded in spite of their consumption, which is known to have a negative impact on performance.

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Pertussis is a respiratory disease that can be fatal at all ages but especially in infants before their mandatory vaccination. Recent epidemiological data shows a decrease in the number of pertussis cases, but a resurgence cannot be excluded in the coming years due to the cyclic evolution of the disease and the loosening of hygiene measures. Two approaches are used to protect infants before their vaccination: vaccination of the mother during pregnancy and vaccination of all the infant's close relatives (cocooning). The vaccination of the mother during pregnancy is more effective. The uncertain risk of chorioamniotitis associated with vaccination during pregnancy is insufficient to question this strategy.

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In order to tackle climate change and increasing competition in access to resources, the European Union has defined far-reaching transformations in the areas of energy and digitalisation as well as the conversion of the economic system towards an inclusive, circular economy in the so-called Green Deal. From a mining perspective, these transformations mean a continued growing demand for raw materials, which must be met by extracting mineral raw materials from primary deposits. However, increased quantities with "business as usual" would also increase the environmental and social impacts of mining, which is not an option, especially in Europe and Austria.Due to these facts, there is a need for research on new and improved mining methods and planning, as well as on optimised processes and machinery. This article describes how the Chair of Mining Engineering and Mineral Economics at Montanuniversität Leoben intends to use these challenges as an opportunity with its updated strategy, both for research and for teaching. For the research area, sustainability and involvement in the shaping of raw materials policy should form the framework. With a focus on digitisation and underground mining as well as strengthening the areas of open-pit mining, conveying technology and geoinformatics, research is to be future-proofed for these upcoming transformations. Teaching will continue to include a basic engineering education with specialisation in mining, whereby digitalisation will play an increasingly strong role.

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The aim was to evaluate patient-reported outcomes before and after a patient-centered management strategy targeting concurrent proximal musculoskeletal complaints (MSCs) in patients with an isolated hand/forearm complaint. A prospective interventional study included 66 patients. Intervention targeting concurrent MSCs was implemented as a patient-centered add-on to standard treatment for primary hand/forearm complaints. The patient-centered management strategy included patient education, individualized exercises, and manual therapy. Patient-reported outcome measures and pain questionnaires regarding the location, frequency, and intensity of pain in hands, elbows, shoulders, and neck were collected at baseline, after the last session of the patient-centered management strategy, and at 3-month follow-up. There were significant improvements in all patient-reported outcomes between baseline and follow-up. DASH scores improved significantly, by 17-29 points on the 3 subscales. There was a significant improvement of 6 points in PCS, 2 points in HADS, and 0.051 points in EQ-5D index. Median pain intensity on NRS decreased from 6 (4-8) to 5 (2.5-7) in hands, 3 (0-6) to 0 (0-3) in elbows, 5 (2-7) to 2.5 (0-5) in shoulders, and 3 (0-6) to 2 (0-3) in the neck, between baseline and discharge. Patients reporting concurrent MSCs in the elbow, shoulder, and neck after an isolated hand/forearm complaint may benefit from patient-centered management comprising patient education, individualized exercises, and manual therapy targeting pain and functional deficits in the upper-limb and neck. LEVEL OF EVIDENCE: IV.

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BACKGROUND: We aim to determine how knowledge and type 1 diabetes (T1D) management strategies are associated with hypoglycemic risk for physical activity (PA)-induced hypoglycemia among people with T1D (PWT1D). METHODS: One hundred thirty-seven physically active adults with T1D completed diabetes management, PA habits and PA-associated hypoglycemia questionnaire. RESULTS: PA-associated hypoglycemia (during PA, within 1 hour of PA and overnight after PA) was reported by 49% to 61% of respondents, with 18% indicating that they felt inadequately equipped to perform regular PA safely. For during PA, more hypoglycemia was reported by PWT1D with more knowledge of hypoglycemia prevention strategies and those using continuous subcutaneous insulin infusion (CSII) vs multiple injections, those with decreasing basal rate 30 to 60 minutes before PA vs no adjustment before PA, and those taking snacks for unplanned PA vs no snacking. For within 1 hour after PA, more hypoglycemia was reported by PWT1D less knowledgeable about insulin pharmacokinetics and those practicing pre- vs post-dinner PA. For overnight after PA, more hypoglycemia was reported by PWT1D with shorter diabetes duration; CSII users having greater understanding of exercise-induced glucose fluctuations; those reporting reducing nocturnal insulin infusion rates vs no adjustment at night; those engaged in PA for at least 31 minutes; and those engaged in moderate and vigorous PA (vs light PA) as well as regularly performing interval training vs nonregular practice. Glycated hemoglobin and use of continuous glucose monitoring were not associated with any timing of reported PA-associated hypoglycemia. CONCLUSIONS: PA-associated hypoglycemia is common among PWT1D. Greater knowledge of PA and T1D management is not associated with less PA-associated hypoglycemia. Diabetes management confidence could encourage higher tolerance for hypoglycemic risk.

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The field of clear cell renal cell carcinoma (ccRCC) has undergone major changes in the last decade, both in terms of the understanding of the mechanisms of oncogenesis and the role of the tumor microenvironment in anti-tumor immunity, as well as in therapeutic developments. After the era of tyrosine kinase inhibitors (TKIs) targeting VEGFR and then the era of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway, we are now entering the era of combination therapy for first-line metastatic cancer (m-ccRCC), such as combinations including a TKI and a PD-1 inhibitor or combinations of PD-1 and CTLA-4 blockers. In this extremely dynamic environment, new molecules with various mechanisms of action will appear in the very near future: immune response modulators (other ICIs, pro-inflammatory cytokines, gut microbiota modulators), new anti-angiogenic agents (new TKIs, anti-HIF-1α antibodies), agents affecting cell metabolism (glutaminase inhibitors, tryptophan regulators or adenosine A2A receptor antagonists) or epigenetic regulators (HDAC inhibitors). In parallel, new strategies are being evaluated that could rapidly change the standards of management of advanced disease, including therapeutic intensification with triple combinations or, conversely, adaptive and/or alternative de-escalation regimens (SURF trial), and biomarker-driven treatments (BIONIKK trial). The main new molecules and strategies currently being evaluated are reviewed in this article.

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In the midst of Covid-19 pandemic, on the cusp of a fourth wave, second-year nursing students conducted a campaign to promote vaccination. This educational activity is part of the evaluation of teaching unit 4.6 of semester 3 "educational and preventive care". It is conducted in the form of a project and is based on the principle of so-called active teaching methods.

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Many countries with a high perinatal level have started a policy of vaccination of pregnant women against pertussis. To date, France has not chosen this policy. The objective was to review knowledge on pertussis mortality in infants. Compare the strategies available to protect the infant before his first vaccination, scheduled for two months of age. We proceeded to a litterature analysis, from January 1998 to 2021. Search by the following keywords used ; "Whooping cough, vaccination, pregnancy, strategy, cocooning", on the scientific basis of "Pubmed", as well as French and foreign vaccination recommendations. Currently 90% of whooping cough deaths are concerning infants under six months of age and this mortality represents 2% of mortality in the first year of life. Vaccination at birth is not effective. The cocooning strategy, which consists of vaccinating those around the child, is expensive and difficult to implement. A systematic vaccination policy for pregnant women is effective and reasonably expensive when compared to the cocooning strategy. In England, it was recently accompanied by a 78% reduction in confirmed cases of pertussis in infants under six months of age. In conclusion, compared to cocooning strategy, pertussis vaccination of pregnant women appears more effective and cost-effective, and this with each pregnancy.

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As a tool for public health, the vaccination policy is based on the analysis of benefits and risks. Thus, the National Consultative Ethics Committee has been at the heart of the orientations taken in terms of the deployment of the vaccination against severe acute respiratory syndrome coronavirus 2, by contributing its reflections on the associated ethical issues.

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INTRODUCTION: Falcine or tentorial meningioma can be complex to resect. When large meningiomas are located in eloquent areas, a direct ipsilateral surgical approach may cause brain injury and postoperative neurological deficits. In this series, 5 patients were surgically treated using a contralateral transfalcine or transtentorial approach to minimize brain retraction. This strategy was called the Dural Dark-Side Approach (DDSA). The aim was to analyze the quality of tumor resection and postoperative outcome. MATERIAL AND METHODS: In our department, from June 2018 to January 2020, 5 patients underwent microsurgical DDSA for resection of 4 falcine and 1 tentorial meningioma. All tumors were selected on the following two criteria: large>40mm diameter tumor, with surrounding functional cortex. Clinical and radiologic data were retrospectively analyzed. RESULTS AND DISCUSSION: Mean follow-up was 20 months. No patients required use of a rigid retractor during surgery. Gross total resection was performed in 3 patients and near-total resection in 2. All patients had favorable neurologic outcome. Postoperative MRI showed no ipsilateral or contralateral brain lesions. CONCLUSION: This series suggested that meticulous DDSA allows excellent resection in selected large falcine or tentorial meningioma. The approach offered a safe and effective surgical corridor without injuring the surrounding healthy parenchyma.

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The potential usefulness of lopinavir-ritonavir on Covid 19 infection during the first wave of contamination in France had boosted Kaletra® syrup prescription to the point of causing its national shortage. In the intensive care units of Parisian hospitals in charge of patients with life-threatening viral contamination, caregivers had to resort to lopinavir-ritonavir-based tablets, crushing them and then dispersing the powder in milk to facilitate administration by nasogastric tube. The difficulties and poor control of this degraded mode, which does not always ensure control of the amount of the drug in the prepared dose and may induce insufficient antiviral exposure, led us to develop in a very short time, while ensuring quality control proportional to the risk, a liquid form as an alternative to Kaletra® oral solution shortage. For this purpose, we describe this compounding formulation and its preparation process, while justifying the quality control strategy adapted to the risk as well as its chemical and physical stability. Based on the chemical and physical studies, the preparation was showed to be stable during at least 2 months between +2°C and +8°C and 1 week at room temperature. This has resulted in the design of kits that include multi-dose packaging and a measuring device and contain the appropriate quantities of drugs to ensure at least one week's treatment for each patient, during which time the kit in use can be stored at room temperature. The intensive care team used this treatment under conditions that they considered well adapted until the imported specialty became available.

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