Differences between the healthcare systems of Quebec and France for the treatment of pain due to spinal disorders

In Quebec,Canada,the public healthcare system offers free medical services.However,patients with spinal pain often encounter long waiting times for specialist appointments and limited physiotherapy coverage.In contrast,private clinics provide expedited care but are relatively scarce and entail out-of-pocket expenses.Once a patient with pain caused by a spinal disorder meets a pain medicine specialist,spinal intervention is quickly performed when indicated,and patients are provided lifestyle advice.Transforaminal epidural steroid injections are frequently administered to patients with radicular pain,and steroid injections are administered on a facet joint to control low back or neck pain.Additionally,medial branch blocks are performed prior to thermocoagulation.France’s universal healthcare system ensures accessibility at controlled costs.It emphasizes physical activity and provides free physical therapy services.However,certain interventions,such as transforaminal and interlaminar epidural injections,are not routinely used in France owing to limited therapeutic efficacy and safety concerns.This underutilization may be a potential cause of chronic pain for many patients.By examining the differences,strengths,and weaknesses of these two systems,valuable insights can be gained for the enhancement of global spinal pain management strategies,ultimately leading to improved patient outcomes and satisfaction.

Early Quality Life Impairment in Alzheimer Disease’s Patients in Geriatric Department: About 214 Cases in Pitié Salpêtrière Hospital of Paris (France)

Alzheimer’s disease (AD) is the most common neurodegenerative disease causing an alteration of life quality in the terminal stage. The purpose was to report 14 years of experience about the early impact on the quality of life of patients with AD. Methodology: Descriptive retrospective study over 14 years in the geriatric department of Pitié Salpêtrière Hospital, using the activity of daily living, Instrumental activity of daily living, neuropsychological inventory and Hoen Yahr scale evaluated at the time of diagnosis of AD according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer Disease’s and Related Disorders Association diagnostic criteria. Results: A total of 214 exploitable files had been listed. At the moment of diagnosis, the mean age was 82.1 years with extremes 68 to 95 with sex ratio 1.6 in women’s favor. The mean socio-cultural level was 4.9 with extremes about 0 to 7. There was poly pathology with a mean Cumulative Illness Rate Scale = 4.6 with extremes 0 to 16. the mean cognitive status was moderate = 22.5 with extremes 0 to 30. Quality life showed moderate impairment of IADL = 9.2 with extreme 3 to 11 compared to activity of daily living. The activity of daily living was more affected in 68 - 80-year-olds, while poly pathology impacted more on IADL in men. The cognitive impairment was more deficient in IADL when the MMSE test was low. The common disorders at the NPI were psychological, behavioral and psychotic. Conclusion: At the early diagnosis of Alzheimer’s Disease cognitive deficiencies were predominant and influenced on global Instrumental activity and psychological, behavioral disorders.

Farm buildings and agri-food transitions in Southern France:Mapping dynamics using a stakeholder-based diagnosis

This study's goal is to present a dynamic portrait of the farm-buildings environment in Occitania,in Southern France,in order to better identify the transitions underway in agri-food chains.To this end,we undertook a ter-ritorial diagnosis based on actor statements,using 28 semi-structured interviews across Occitania.This diagnosis was enriched by graphic modelling,which enabled the spatialization of the dynamics described.We show that the process of standardisation of farm buildings prevails in the majority of the territories studied.This phenomenon has intensified in recent years with the development of vast photovoltaic-roofed sheds,accentuating the farm-land conversion and soil sealing.At the same time,in areas with strong environmental,landscape and heritage contexts,a'new adventure in farm buildings'(2022 survey)is taking shape.It is primarily driven by local short food chains,which rely on self-construction,repurposing and refurbishment,the sharing of tools and equipment,and which favour the use and reuse of local resources.This study shows that farm-buildings dynamics crystallise many challenges confronting the reterritorialisation of agriculture and food production.

Rôles et vécus des pharmaciens d’officine dans les soins palliatifsàdomicile en France Role and Experience ofCommunity Pharmacists in Home Palliative Care in France

The need for home palliative care is increasing in allWestern countries.Community pharmacists are local professionals whose role in end-of-life care at home remains poorly understood.The aim of this study is to understand how community pharmacists see their role in end-of-life home care in France,and to analyze their experiences of this care.An online questionnaire was distributed to community pharmacists working in France between December 2022 and March 2023.Of the 136 respondents to the questionnaire,87%had accompanied at least one patient at the end of life in the 3 months preceding the survey.Therapeutic education(88%of respondents),psychological support for caregivers(85%of respondents),securing treatment(82%of respondents)and monitoring therapeutic compliance(80%of respondents)are the behaviors validated by the greatest number of participants.The majority of professionals surveyed had a positive overall experience of managing patients at the end of life.These results pave the way for pharmacists to better support end-of-life patients at home.

Gifted Students’Special Educational Programs in France:An Analysis of Students’Needs as Perceived by Headmasters-A Secondary Publication

Some French public middle schools offer gifted students the opportunity to pursue their education in general classes,while benefiting from specific facilities within the framework of a dedicated educational program.In this study,we sought to identify and analyze the needs of these students as perceived by the headmaster of each middle school involved.The results highlight two main student needs,common to all these programs(uneasiness and difficulties in peer relationships)as well as needs specifically mentioned by some headmasters(non-adaptive behavior).

Quality of Life in Living Kidney Donors Grenoble Teaching Hospital (France)

Context: Kidney transplantation is today the standard treatment for patients suffering from chronic end-stage renal failure. Living kidney donation offers many advantages for the recipient, but requires a subject without comorbidities to undergo surgery. The aim of this study was to assess the quality of life and psychosocial experience of living kidney donors after donation. Methods: This was a cross-sectional study with an analytical aim, involving living kidney donors during the period from January 2016 to April 2019 at CHUGA. (University Hospital Center of Grenoble Alpes in France). Results: Our study shows that out of 88 donors, 70 responded to our questionnaires, representing a prevalence of 80.5%. The average age of our donors was 55.6 years with a female predominance. Seven out of eight domains of the SF36 score had a good quality of life after donation and the donation did not alter their psychosocial experience. The majority of our donors expressed their pride and enthusiasm, did not regret having saved a life, and this experience was considered positive. Conclusion: Kidney donation does not have a negative impact on quality of life and psychosocial life. The majority of donors do not regret their donation. The dissemination of such results could make it possible to increase the number of kidney transplants from living donors in France, especially in our African countries where the management of ESRD remains a real public health problem.

The effect of ozone on pine forests in South-Eastern France from 2017 to 2019

In South-Eastern forests of France,risks linked to the effects of tropospheric ozone(O_(3))are real;its annual impact has been observed specifically near the coastline and in high altitude mountains during the period 2017-2019.In this study,the risk assessment of O_(3)pollutant was carried out using two approaches based on forest response indicators such as O_(3)specific foliar visible injury and by stomatal O_(3)flux.Phytotoxic O_(3)dose values(POD_(0))were obtained by the DO_(3)SE model.The model requires hourly O_(3)concentration for POD_(0)calculation.A modified approach that uses measurements from passive samplers(monthly average O_(3)concentration)was tested for the calculation of POD_(0)and test results showed good agreement with the POD_(0)calculated using hourly O_(3)data.In the model input file,the average O_(3)concentration is used for POD_(0),and this could be useful for POD_(0)calculation when the active monitor is limited.In this study,a flux-based assessment provided better correlation with O_(3)specific leaf injury,which is also species-specific.Foliar visible injury in response to O_(3)indicates that Pinus cembra and Pinus halepensis are more affected and therefore more sensitive than Pinus sylvestris.The POD_(0)and stomatal conductance(Gsto)seem to be induced by environmental factors,primarily rainfall and the soil water potential(fSWP).The correlation between the O_(3)flux metric and environmental variables with forest response indicators by Spearman rank test confirms P.cembra as one of the most sensitive species to O_(3).

Towards a Modeling of the Impacts of Road Verge Management on the Pollination Service Using System Dynamics: A Case Study in France

Several research studies have proven that eliciting and predicting the impact of human activity on ecosystem services will be crucial to support stakeholders’ awareness and to decide how to interact with the environment in a more sustainable manner. In this sense, the ecosystems known as road verges are particularly important because of their length and surface at an international scale, and their role in mitigating the damage done by roads. Plant pollination by insects is one of the most important ecosystem services. Because of its nature and the fact that they extend across a variety of landscapes, roadside can contribute to the maintenance of healthy ecosystems, under the condition of adapted management practices. This research is the first attempt to develop a System Dynamics-based aiming to estimate the ecological and economic impact of maintenance on the road verge pollination service in France. Maintenance strategies of road verges are simulated to compare their performance. The results show that there are ways to improve current maintenance strategies in terms of pollination value, but also that the model needs to consider other ecosystem services and synergistic effects that could further affect pollination to obtain more accurate estimations.

Surgical Treatment of Olecranon Fractures Using a Medartis Screw-Locked H-Shaped Plate (Medartis Trilock Olecrane Plate) at the Moulins Yzeure Hospital Center (France)

Introduction: Olecranon fractures represent approximately 10% of upper limb fractures, orthopedic treatment is often doomed to failure and surgical treatment consists of fixing the fracture sites. Patients and Methods: This study retrospectively analyzed 130 patients, 90 men and 40 women, aged on average 48.7 ± 11.9 years (30 to 65) treated between 2018 and 2020 in the Orthopedics and trauma department at the Moulins-Yzeure hospital center, for olecranon fracture using the Medartis H-locked plate. The study aimed to evaluate the results of this surgical method, particularly with regard to postoperative complications. Results: Among the 130 patients, there were 90 men and 40 women, with an average age of 48.7 ± 11.9 years (30 to 65). 50% of all patients were aged over 51 years. The plate used was standard, the same for the 130 patients with the same operating technique. The left side was more affected at 53.8%, the dominant side was less affected at 46%;the majority of patients had been temporarily immobilized with a posterior cast splint before surgery. The average time between trauma and operation was 9 days with a minimum time of 1 day and a maximum of 30 days. At a maximum follow-up of 2 years postoperatively, all patients reported satisfactory results with a return to their previous activities within 60 days after surgery. Conclusion: Medartis H-locked plate osteosynthesis is a reliable solution for the surgical treatment of olecranon fractures.

Meningioma of the Optical Nerves in a Case at the Hospitalier Center of Saint Denis in Ile de France

Summary: Optic nerve tumors are rare tumors, representing 3% - 5% of intracranial tumors developing mainly along the optic nerve and/or the chiasm. Optic nerve meningiomas are histologically benign tumors whose severity is linked to diagnostic and especially therapeutic difficulties. The Optic nerve meningioma is the second leading cause of optic nerve tumor after glioma. Observation: We report the case of a 49-year-old woman from South Asia, who consults an ophthalmology department for progressive visual loss in her right eye for about a year with her glasses and would like to renew her optical correction. Having no particular medical history apart from left unilateral blindness is known for approximately 15 years. Magnetic Resonance Imaging (IRM) cerebral found a tissue mass with a clear outline and polylobules on the left temporo-peduncular. Through this case, we describe the circumstances of discovery of the disease, the clinical characteristics, as well as our diagnostic approach. Conclusion: In the majority of cases, these are benign tumours, the circumstances of which are discovered in multiple ways. A mostly unilateral and non-improvable loss of visual acuity must attract our attention. Renewing glasses may be the reason for discovering the disease. Today Magnetic Resonance Imaging (IRM) remains an important and capital examination for the diagnosis and monitoring of this pathology.

Evaluation of Intraoperative Iatrogenic Lesions and Postoperative Complications in 1140 Patients Treated for Carpal Tunnel Syndrome in the Orthopedic Surgery and Traumatology Department of the Moulins-Yzeure Hospital Center in France

Introduction: Carpal tunnel syndrome is a more common form of upper limb canal syndrome, resulting from compression of the median nerve in the carpal tunnel, but is particularly troublesome. Medical treatment is often unsuccessful, and surgical treatment usually involves transection of the annular ligament. The aim of this study was to assess iatrogenic intraoperative and postoperative complications, as well as patient outcomes following the use of conventional and endoscopic surgery in the surgical management of carpal tunnel syndrome. Hypothesis: Are nerve, vascular and tendon injuries of iatrogenic origin always present in the surgical management of carpal tunnel syndrome, even though this surgery is performed on an outpatient basis? Patients and methods: This retrospective series is composed of 1140 patients, 230 men and 910 women, mean age 58.6 ± 16.4 years, operated on between 2010 and 2020 for carpal tunnel syndrome by conventional surgery and under endoscopy. Medical records, operative reports and consultation letters were consulted. All patients were reviewed regularly at one month post-op until recovery. Results: No nerve, vascular or tendon damage was noted, and at a maximum follow-up of 2 years, 20 patients had recurred, i.e. a 2.51% failure rate. Scar disunion was observed in 0.9%, wound infection in 0.9% and scar fibrosis in 0.9%. 92.98% of patients underwent outpatient surgery, irrespective of the type of anesthesia or surgical technique used. Patients who stayed in hospital for a short time were suffering from carpal tunnel syndrome associated with compression of the ulnar nerve in Guyon’s canal, for which both the median and ulnar nerves were freed during the same operation, under general anaesthetic. All patients were able to return to their previous activity within 30 days of surgery. Conclusion: Intraoperative iatrogenic complications, notably nerve, vascular and tendon lesions, were not identified despite the large sample size. On the other hand, postoperative skin complications related to scarring, such as wound disunion, fibrosis and recurrence, were present despite low rates.

Major Results and Research Challenges in Cotton Molecular Genetics at CIRAD(France)

CIRAD(Montpellier,France) develops research activities centered on tropical and sub-tropical agricultural systems.Among others crops,cotton is the focus of a series of research programs in different disciplines from economics to breeding.Major areas in genetics and breeding relate to(1) genetic diversity,(2) cultivar development through classical and molecular breeding,and(3)

The Séchilienne (France) Landslide:a Non-typical Progressive Failure Implying Major Risks

The National Road RN 91 has been threatened for about twenty-five years by a huge landslide, located 25 km south-east to the town of Grenoble (France). If several million cubic meters of rock fall down, the debris will dam the valley. Then the failure of the dam by overtopping and rapid erosion might result in a catastrophic flood and dramatic consequences for human life, environment and economy throughout the valley. The paper presents the hazard assessment based on geological and hydrological surveys, including small scale hydraulic tests, as well as the risk evaluation that has been performed. The risk management relies first upon a high level monitoring and an emergency plan; various mitigation strategies have been considered.

The Custodians of State Policies Dealing With the Financial Crisis： A Comparison Between France and the US

Following the 2008 global economic crisis and rolling out of austerity measures, elites of the state seem to have become a ＂political species＂ of their own, now under threat of extinction. The study of the health and defense policy reforms in France and the US during the 1990s and 2000s shows that far from disappearing, the influence of state elites is being strategically reconfigured to defend some sector-specific policies. Similarly to those ＂custodians of policy＂ dear to P. Selznick, small groups of elites are gaining expertise within strategic sectors of public policy; they are also making the need to control the cost of public spending their royal battle, in order to safeguard what they see as the crucial role of the public good. In the American cases study, the image of the ＂revolving door＂, which encapsulates the idea of professional mobility back and forth from the private to the public sector, implies a fragmented state, open to external pressures of social groups. We document career and professional trajectories marked by a strong commitment to a given policy area. Circulation, we note, is frequent between these positions in the public sector. While these findings do not in and of themselves allow us to fully assess the influence wielded by these elites, this study identifies the social and political resources and forms of specialization which predispose them to play important roles in shaping public policy. For the past 30 years, the question of varieties of liheralisation has been put forward as an explanatory factor for a wide range of public policies （Schrnidt ＆ Thatcher, 2013; Thelen, 2014）. In this perspective, numerous authors have theorised the dismantling of democratic states and the weakening of public authority that would follow （Suleiman, 2003; Fukuyama, 2004; Bez^s, 2009; Bonneli ＆ Pelletier, 2010; Lodge, 2013）. Research on public policy has focused on the success of neoliberal ideas among European and North American political elites （Pierson, 1994; Prasad, 2006; Fourcade, 2009） on the calling into question of the neo-Keynesian paradigm （Hall, 1986; Crouch, 2011） and on the development of budgetary constraints （Bezbs ＆ Sinr, 2011; Streeck ＆ Schafer, 2013; Blyth, 2013）. Other work emphasises the idea that the effects of economic globalization-reinforced by those of the financial crisis of 2008-have accelerated the weakening of state capacity in western democracies by accelerating the expansion of market relations within national political systems （Streeck ＆ Thelen, 2005; Jabko, 2012）. At the same time, this period has seen renewed interest in national regulation （Lodge, 2011）. Even so, if analysis is limited to the evolution of public policies as a simple functional response to the evolution of the international, financial, or ideological contexts in which they are found, research tends to underestimate the role played by competition among the elite groups involved with their elaboration and their capacity for resilient attachment to the power of public authority. For this reason, the hypothesis of the dismantling of the state, allegedly accelerated by the crisis of 2008, should be revisited.

France’s Strategy on Migration Issues in the Mediterranean

The Mediterranean Sea is recognized by France as the most important adjacent area and also the gate to Africa,France’s vast sphere of influence beyond the Mediterranean.The political turmoil here since the Arab Spring has begun,especially emergence of a flood of refugees coming to the EU,was a serious problem for France.The current situation of EU,which is shaken over the acceptance of immigrants and refugees,is grave for France,having a strategic pillar which is to raise the own presence in global politics by obtaining the leadership in the EU.France sets out to put the migration and refugee issues to rest,to maintain EU’s political power and to seize the initiative in the EU.This article will analyze such a national strategy of France focusing on the process from Chirac’s administration to Macron’s.

Acute Renal Failure during Progressive Systemic Sclerosis in the Regional University Teaching Hospital of Brest-La Cavale Blanche (France)

Systemic scleroderma is a rare disease in which visceral manifestations occur, particularly peripheral vascular, digestive, cardiopulmonary and renal. It is pathology with a predilection for women. The present clinical case is that of a man with the renal complications of scleroderma and the difficulties of the treatment even in the developed countries like France. In the present case, the management of this disease required a high dose of corticosteroid therapy and extra-renal purification. Early detection of complications through a minimal clinical examination supplemented with paraclinic tests has proved necessary.

Aims and First Assessments of the French Hydrogen Pathways Project HyFrance3

The HyFrance Group was originally formed in France to support the European project HyWays, by providing （former projects HyFrancel and HyFrance2） the French data and possible hydrogen pathways according to national specificities. HyFrance3 is a new project that focuses on the economic competitiveness of different steps of the hydrogen chain, from the production to end usage, at the time horizon of 2030 in France. The project is coordinated by CEA with the other partners being： ADEME （co-funding）, AFH2, CNRS, IFP, Air Liquide, EdF, GdF Suez, TOTAL, ALPHEA. The project is divided into 4 sub-projects, that address present and future French hydrogen industrial markets for chemical ＆ refinery uses, the analysis of the interplay between wind energy production and storage of hydrogen for different automotive requirements （refuelling stations, BtL plants, H2/NG mix）, massive hydrogen storage to balance various offer and demand characteristics, and the supply network （pipeline option competitiveness vs. trucked in supply） to distribute hydrogen in a French region for automotive applications. Technical and economical issues, as well as GHG emissions, are addressed.

Decline of semen quality among 10 932 males consulting for couple infertility over a 20-year period in Marseille, France

Semen from 10 932 male partners of infertile couples was analysed and sperm parameter trends were evaluated at the Reproduction Biology Laboratory of the University Hospital of Marseille （France） between 1988 and 2007. After 3-6 days of abstinence, semen samples were collected. Measurements of seminal fluid volume, pH, sperm concentration, total sperm count, motility and detailed morphology of spermatozoa were performed. Sperm parameters were analysed on the entire population and in men with normal total numeration （ 〉~ 40 million per ejaculate）. The whole population demonstrated declining trends in sperm concentration （1.5% per year）, total sperm count （1.6% per year）, total motility （0.4% per year）, rapid motility （5.5% per year） and normal morphology （2.2% per year）. In the group of selected samples with total normal sperm count, the same trends of sperm quality deterioration with time were observed. Our results clearly indicate that the auality of semen decreased in this population over the study period.

Biomass production and carbon balance in two hybrid poplar(Populus euramericana)plantations raised with and without agriculture in southern France

Poplar is useful in different climates for bioenergy production and carbon sequestration when planted as a single species or in agroforestry. Europe has large areas potentially suitable for poplar forestry and a bioenergy policy that would encourage poplar forestry. In this study I estimated biomass production and carbon sequestration in poplar monoculture plantation and poplar-wheat agroforestry, in the Mediterranean region of France. A single-tree harvesting method was used to estimate biomass and an empirical conversion factor was adopted to calculate sequestered carbon. Total biomass was higher in agroforestry trees(1223 kg tree) than in monoculture plantation trees(1102 kg tree).Aboveground and belowground biomass distributions were similar in both cases(89 and 88% aboveground, and 11 and12% belowground, respectively in agroforestry and monoculture). The partitioning of total biomass in an agroforestry tree in leaves, branch, and trunk(aboveground), and fine roots, medium roots, coarse roots and underground stem(belowground) was 1,22,and 77,and 6,9, 44 and 40%,respectively. Except for branch and trunk, all other compartments were similarly distributed in a monoculture tree.Storage of C was higher in agroforestry trees(612 kg tree)than in monoculture trees(512 kg tree). In contrast, C storage on a per hectare basis was lower in agroforestry(85 Mg ha) than in monoculture(105 Mg ha) due to the lower density of trees per hectare in agroforestry(139 trees in agroforestry vs 204 trees in monoculture). On a per hectare basis, soil C stocks pattern were similar to per tree stocking:They were higher in agroforestry at 330 Mg hathan in monoculture 304 Mg ha. Higher C accumulation by agroforestry has a direct management implication in the sense that expanding agroforestry into agriculture production areas with short rotation and fast growing trees like poplar would encourage quicker and greater C sequestration. This could simultaneously fulfil the requirement of bioenergy plantation in Europe.

Ecological Agriculture. Integrating Low Input, High Productive Farming with Wildlife Conservation. Results from the Experimental Farm La Combe, Drome France

Wildlife conservation must be integrated with energy and resource efficient agriculture for the human population to survive. Modern high input energy and resource inefficient agriculture does not address these problems. An efficient food producing system which marries wildlife conservation with resource and energy efficient human food production is needed. This is Ecological Agriculture, modelled on how natural ecosystems work. It is defined as: The establishment and maintenance of a diversified, self-sustaining low input farming system managed to maximize net production without causing large or long term changes to the environment. It must be economically viable, and ethically and aesthetically acceptable [1]. Forty years of research on 4 experimental farms have assessed the practicality of this approach (results previously published). The 5th experimental farm in the mountains of the Pre Alps has completed its 10 years. The results are discussed in relation to the tenets of Ecological Agriculture. The techniques previously developed have allowed the results to fulfil the majority of the demands of efficient ecological agriculture and to produce food for 20 families from the farm’s resources despite the difficult climate, topography and soils. It is shown how energy and resource inefficient the omnivorous animals (poultry and pigs) are, compared to herbivores. The species diversity has increased and the whole farm is a nature reserve. Aesthetic and ethical problems have been addressed with an emphasis on a life of quality for farm animals.