March is the month of the national screening for colorectal cancer, a campaign that speaks to all people between 50 and 74 years. Why? What are the issues? How not to confuse detection and prevention, screening and diagnosis of cancer?
Information on colon cancer screening
Screening is to detect cancer at its earliest possible stage. In the case of colorectal cancer, it is also the detection of pre-cancerous tumor that represents a colon polyp in the process of malignant transformation. Benign polyps (adenomas) colon cancer but not in cancerous potential in 60-85% of cases. It is therefore preferred to withdraw whenever it finds.
Implemented since 2009 throughout the country, screening for colorectal cancer is open to all men and women aged 50 to 74, every two years. It is widespread and systematic, as opposed to individual screening practiced by physicians in their patient base. Nearly 17 million people are involved in this program under the responsibility of the Ministry of Health and managed by the Directorate General of Health (DGS).
It is a measure of the Cancer Plan 14 government (2009-2013), all the more crucial that the turnout is low spontaneously: the cancer is far! Better not think about it ... Only 5 million people (about 17 million invitations) did the test in 2009-2010, 34%. Or desirable to reduce significantly (15-20%) deaths rate is higher than 50%. Ideally, it should reach 65% of 50-74 years.
Risks and consequences of colon cancer
Colorectal cancer is the third most common cancer with 40,000 new cases estimated in 2010 after breast cancer (71,500 new cases) and prostate cancer (52,500 cases). It causes 17,400 deaths annually (estimated number in 2010), is the second leading cause of cancer death, after lung cancer.
His prognosis is good, however when taken in time; "cure" is the rule in the majority of cases (90% of patients alive at 5 years). A fortiori if one removes a polyp or a pre-cancerous stage; recovery is 100% true then.
However, taken at a late stage of invasion of viscera (liver damage and pancreas) and / or distant metastases, it is difficult to control and requires mutilating surgical cuts. This may result in a definitive stoma.
Through screening undertaken since 2003, more than 13,500 cancers were detected, and more than 54,000 adenomas (polyps) in which 31,000 degeneration.
People affected by colorectal cancer screening
The screening is for people 50 to 74 years of both sexes, provided they have no specific risk factors to cancer. That is to say they have no evidence suggestive and do not have a history. They are called medium risk as the only factor used is age: the cancer is (essentially) a disease of aging cells.
If they are part of a family colonic polyps and / or colorectal cancer frequent if they have already had one or more polyps or colon cancer, so they follow a monitoring program apart. As well as people with diseases that may irritate (inflammation) lasting the gut, thus promoting cell carcinogenesis.
Screening for colorectal cancer: what are the principles?
Colonic cancers bleed, but often capriciously. Thus research of blood in the stool, knowing that many other causes can bleed the digestive tract. But we will move to a different diagnosis after checking that there is no colo - rectal cancer.
Having visible blood in the stool should lead quickly to the consultation of the attending physician, who will decide on the way forward. This is not the most common and generally corresponds with advanced cancers. Most often the bleeding is occult in early cancer development.
The test used by the health management is the Hemoccult II®, said "guaiac test", it detects the presence of blood invisible to the naked eye in the stool. It is currently under discussion because of the analytical techniques progress. However, no change is likely before two or three years because of administrative procedures, in particular the assessment of the cost of a more expensive immunological procedure.
How are screened?
Every two years, the county association in charge of screening for people involved an invitation to remove the test from their physician.
The next step is to make yourself at home spreading a little stool on a stamp pad with three stools away. Then everything is mailed to the processing laboratory. In case of constipation, performing the test is longer because the seats are spaced. In case of diarrhea, it is the opposite. As you need your test handy during this time, it is advisable to do so for a holiday.
The test is free but not consulting the doctor. The mailing is free. His analysis is free.
If the test is negative (97% of cases), the person will be requested again two years later.
In case of a positive test, the person is invited to consult your doctor to prescribe that a screening colonoscopy (gold standard), also free.
While colonoscopy is positive (presence of polyps and / or cancer), the patient enters a custom protocol followed.
If colonoscopy is negative, the test is no longer required before five years (mean time to development of polyps) provided that doctors (and treating gastroenterologist) agree.
Taken together, these measures represent a total cost of 70 million euros in 2010 supported 100% by the Ministry of Health and health insurance.
What are the differences between screening, diagnosis and prevention?
Screening research disease or pre-disease. It identifies presence or suspects sign, but he did not assert. It can be individual case by case, to be organized systematically in the whole population so widespread.
The diagnosis is the certainty of a perfectly identified disease. It is rare that a screening procedure also gives the definite diagnosis. But it is the case during a colonoscopy because the doctor can see the tumor and formally recognized. In the wake of it the fee in whole or in part when it is too big (biopsy). The sample is then examined by a histologist (or pathologist) confirms the visual diagnosis and gives a name to the tumor. Sometimes it is necessary to make additional laboratory tests on the tumor to refine its identity, and thus prognosis. For the development and severity of cancers depend on their cellular nature.
Prevention involves behaviors that limit cancer cell transformation. For example, do not smoke and do not live in a free environment is the best way to reduce the risk of lung cancer. However, few cancers caused by a single factor heavily. Most often it is a combination of small factors that accelerates carcinogenesis, as in rectal cancer co-lo is known that residues of the digestion of meat, especially overcooked or charred (BBQ) increase the risk.; it is also the case with chronic bowel disease by persistent inflammation they cause.
March is the month of the national screening for colorectal cancer, a campaign that speaks to all people between 50 and 74 years. Why? What are the issues? How not to confuse detection and prevention, screening and diagnosis of cancer?
Definition of mold
Mildew usually means all fungi in the environment. These microorganisms can enter directly into homes, or get inside in the form of spores in the air; Then they play a vital role in the development of certain diseases or allergies. Allergy defined by an immune response of the body, inappropriate and exaggerated, then touches their eyes, skin, and respiratory system as the nose or bronchi.
Alternatively, other molds enter the body and multiply in the form of filaments causing tissue destruction or inflammation.
Risks and consequences of mold growth
The number of allergies is increasing in industrialized countries. Respiratory allergies are the most common, as it is estimated that about one in four has clinical symptoms of respiratory allergy, and mold are responsible for many of them.
The growth of fungi and mold requires a moist environment: basements, kitchens and bathrooms are ideal area to development. Other factors are also found as a flood, leaks from the roof or plumbing, or poor ventilation.
Origins of mold growth
A number of factors, nutritional and environmental factors must be present for mold to develop. The main molds found in homes are Stachybotrys, Aspergillus sp., Penicillium sp., Fusarium sp., And other Trichoderma sp.
Then pathogenicity mold is twofold:
- First, they can cause allergies with a necessary first step referred awareness is the first meeting of the body or with the mold. Subsequent contacts result in an allergic reaction, which occurs by releasing a substance, histamine, causing the symptoms. The action of histamine can be blocked by specific drugs called "antihistamines."
- Second, molds can cause infections, athlete's foot easy to very serious lung infections in immunocompromised individuals, such as aspergillosis.
Mold - Prevention
How it does it manifest?
The allergy is usually manifested by mild symptoms such as rhinitis (runny nose, sneezing) or conjunctivitis (red eyes, watery) or respiratory symptoms like asthma. These symptoms occur readily in places rich in mold, and in any case, even in a single place (the symptoms resolve when the patient goes on holiday, for example).
Other fungal infections such as result in skin damage, inflammatory or squamous between toes or on the skin.
With what should we be confused?
It should not be confused with mold bacteria or viruses. Molds, and fungi are "micro-organisms" (such as bacteria, viruses, parasites) and most are harmless. Some are used in foods (originally cheeses like Roquefort) or to produce medicines such as antibiotics. Mold does not mean mandatory diseases.
Will it possible prevention?
Humidity promotes the development and growth of mold. Reducing the moisture content must be a priority, with an optimum relative humidity between 30% and 50%. We must therefore ventilate showers and other water facilities outwards use dehumidifiers and exhaust fans, insulate cold surfaces to prevent condensation on pipes and windows.
If flood or leak, clean quickly (within 48 hours). Do not use water or limit its use for cleaning carpets and rugs.
Finally, in case of allergy, avoid contact, particularly when cleaning poorly ventilated rooms.
Molds - Consultation
When to consult?
While most allergies are not emergencies, especially for mold allergies, allergic or anaphylactic shock or asthma attack are true emergency. Symptoms are noisy with difficulty breathing, generalized edema and a drop in blood pressure. The appeal to the SAMU-Centre 15 is essential for medical management.
Similarly, some molds can trigger pneumonia with fever, cough and chest pain. This is aspergillosis requiring emergency treatment, sometimes administered resuscitation.
What is the doctor?
The doctor guides the diagnosis and suspected link with mold. In case of allergy, it may possibly lead to an allergist to identify the allergen or allergens cause, and implement treatment. The allergy consultation through careful questioning and physical examination; depending on the suspected allergens, tests called prick tests or skin tests may be offered.
At the same medical diagnosis, environmental diagnosis of the house is often necessary to search for common signs of damage caused by water and the presence of mold. Visual inspection is simple and reliable: discolorations, dark circles, darker areas or stains on surfaces.
The treatments include the allergen avoidance. So-called antihistamines fight against allergy symptoms. Desensitization (or specific immunotherapy) is difficult in the case of the proposed bit and mold.
The treatment and prevention of mold in the home is also a priority, wearing a mask and rubber gloves during cleaning, and call a specialist if the amount of mold is important (surfaces to be treated).
How to prepare for my next visit?
To facilitate the allergy survey, it is useful to identify and record the symptoms and triggering circumstances. This will find the allergen and avoid it, and thus guide the doctor.
Reimbursement of care: what is it?
The patient should set itself the amount of its care from health professionals that he uses. This is the principle of the advance fee. It is up to him to be then reimbursed by the Social Security Agency and its mutual.
However, in case of hospitalization, occupational disease or accident, the patient can be taught to do this upfront fee. This is what we call the third-party payer. In this case, the patient pays only the co-payment, that is to say, the amount remaining in office, the refundable portion of care is paid directly to the provider and the health insurance agency.
What are the economic and human issues?
One of the few developed to promote direct payment for health care professionals and health reimbursement on insured countries. Numerous studies have shown that not having to do the upfront fee facilitates access to care, particularly for the most disadvantaged.
However, with the widespread use of third-party payment and use of increasingly common Vitale card, the actual cost of care is becoming increasingly difficult to design for people who benefit from it, even though each insured person's finances collectively their Social Security taxes.
In 2007, total health expenditure French amounted to $226.5 billion, which represents nearly 11% of the national wealth and that puts our country in third expenditure in terms of health among developed after the United States (15.3%) and Switzerland (11.3%). country
These expenses increased by 4.7% compared to 2006.
What does it take to be reimbursed?
In general, to be repaid, care or health products including drugs must be on the list of acts or products reimbursed by social security, be prescribed by a doctor (or a dentist or a midwife), and dispensed by a health care professional to do so.
To be reimbursed, it is sufficient if the rights to health insurance to the insured are open to apply by filling out the sheet of care delivered by the health professional, attesting fees received and the payment the amount of benefits. On the address with the order and supporting documents may be required, at the center of Social Security.
With the Carte Vitale, all of these procedures are done automatically. Just present it to health professionals.
In which case a prior agreement is needed?
Some treatments require to be repaid, an agreement of insurance before being made disease. This is what is called the prior agreement.
It is indispensable for acts of Dentofacial Orthopedics, for certain laboratory or medical equipment for ambulance transport serial or over long distances, and from 30 sessions massokinésithérapie.
The request for prior agreement is filled with the health professional and addressed by the insured to the health maintenance organization, which has a period of fifteen days to respond. Failure to respond within this period amounts to an agreement.
When can we benefit from the third-party payment?
Legal paying client is mainly reserved for patients who have suffered an accident at work or an occupational disease, those who benefit from the complementary Universal Health Coverage (CMUc) and beneficiaries of the State Medical Aid ( AME).
It is also applied to in-patients.
It is increasingly common in pharmacies and medical laboratories. But in this case it depends on agreements between health professionals and health insurance providers. Its management is also often offered by mutuals.
Assigns of Health Insurance: What is it?
Under certain conditions, people who are dependents of an insured person (spouse, partner or children) may benefit if they are not insured social, benefits in kind of health insurance, including reimbursement care: they are called beneficiaries.
What are the economic and human consequences of the beneficiaries?
The Code of Social Security provides benefits in kind of health insurance (in particular the management of care) family size. The right of an insured person can be extended to his family in accordance with Article 1 of the Constitution of 1946 (mentioned in the preamble of the 1956): The Nation guarantees everyone "including the child, the mother and elderly workers' protection of health.
The evolution of the health insurance today seems in line with that of the company, since these rights are granted to domestic partners and "civil unions" partners. Even children over 16 years can be recognized as dependents "autonomous" and receive reimbursement for their care on their own.
Which may be entitled to an insured person?
The quality of entitlement covers a wide variety of situations, with two common criteria:
1) it does not take itself, raise a compulsory social security;
2) there must be a dependent of an insured person.
The quality of entitlement can be recognized:
- The spouse, partner or partner related to the insured person by a civil solidarity pact (PACS), provided that either the total, effective and permanent charge of the insured person;
- Children up to 16 years (18 years in case of apprenticeship, 20 years in case of studies) that are the responsibility of the insured, regardless of their status;
- To parents, children, allies and collateral (third degree), provided that they live under the roof of the insured and participate in housework and child rearing;
- The (x) cohabiting (ren) living under the roof of the insured person and his full, effective and permanent load for at least 12 months.
Demand for quality of successor should be made to the illness depends the insured insurance agency.
The dependents are entitled to reimbursement of their care. They are also entitled to prevention in the same conditions as the insured (health exams, screening, prevention), but they are not entitled to daily allowances.
Which can be autonomous beneficiary?
The quality of autonomous beneficiary can receive refunds benefits of health insurance on their own bank or postal account. It is automatically recognized spouse, partner or partner related to the insured person by a civil union.
The quality of autonomous beneficiary is systematically offered to students 16 to 20 years, with a membership in the system of student social security, without consideration of assessment. If they are not students, this quality may finally be granted to children of the insured (or his spouse, partner, partner "PACS") from 16 years at their request.
At any time, interested parties may waive such.
What's happening in case of change of situation?
The quality of entitlement is linked to a specific situation. If this situation is changing (the insured's death, divorce, breach of PACS ...), this quality is lost. However, the right to reimbursement for care is generally maintained for a year.
Maintaining the Rights of benefits in kind of health insurance is maintained indefinitely to beneficiaries who have raised three children.
Care for the elderly
Support services for the elderly: in what circumstances?
When an elderly person can no longer perform only simple actions of everyday life (get up, get dressed, prepare meals ...), it can use a suitable home care for elderly frail people.
Care must be preceded by a needs assessment with the person and if necessary with his entourage.
Assistance to people - that can make a home assistant for the elderly?
It is important to note that support for older people, as part of the home support, should not include acts of care under the control of medical procedures.
Assistance for people specifically dedicated to the following:
- Support and assist the elderly in the essential activities of daily life: mobility aids and travel, help the elderly person at her toilet, her dressing, eating, disposal functions, ensure the role of nurse. ...
-Ensure Vigilance from the person through physical visits usability to detect unusual signs or behaviors. - Support and assist the elderly in their activities that are social and relational life assistance to people in domestic activities and administrative procedures, in his spare time in maintaining social relationships, etc., either home or from home. - Support intellectual, sensory and motor activities of the person: activities including interventions at the home of seniors losing their autonomy, to assist them and help them adapt their actions and lifestyles to their capabilities autonomy in their environment. This support allows at the same time to optimize the support of those around helping himself.
In addition, older persons, whether or not loss of independence, may have different support services to individuals who do not specialize, for example, grocery shopping, light gardening, walking animals company etc.
The conditions of the elderly care
Organizations offering assistance to elderly persons must meet quality requirements strengthened.
The law therefore requires its agencies a quality certification.
Assistance, Disability Supports
The support services for disabled people: ad hoc or permanent Many trades and services support within the disability assistance.
Depending on your disability, you may request the assistance of a daily carer or specific help for more targeted actions:
A carer will accompany you to perform all the essential activities of daily life:
• personal hygiene, dressing, undressing, equipment
• food, sunrise and sunset, travel in housing
• support for the practice of a profession, activity training or paperwork, etc.
The aid disability services also allow you to use an interpreter in sign language, a technician or a written cued speech coder.
Accompanying children and adults with disabilities in their movements outside their home (walks, transport, activities of daily living), is also part of the services of supports to people.
You can, if you have a personal vehicle to drive you in your car.
Finally you can also use different forms of support services to people who are not specialists, such as deliveries of groceries, small DIY services, IT support etc.
The conditions to offer aid services to people
The activities of supports to people with disabilities must meet the requirements of enhanced quality. The law therefore requires organizations a quality approval.
The financial benefits for people who use the services to aid people
Some financial assistance (compensation benefit - PCH or the education allowance for disabled children) to remunerate domestic help can be packaged by your level of disability, age, and by assessing what will your doctor as for your self.
Learn about your rights by contacting the departmental homes of people with disabilities, social services in your area or visit the sites listed below:
Social benefits for disabled Departmental Houses Disability (MDPH)
The quality approval is required to intervene with the elderly or disabled
Accreditation Quality is more demanding than simple approval, mandatory for companies or associations that cater to vulnerable population groups, that is to say, the home services for the elderly, disabled or children under 3 years.
Accreditation Quality should be asked for the following services:
• - child care home under 3 years
• - to assist the elderly or others who need personal assistance at home, with the exception of acts of care under medical procedures
• - disability assistance including as an interpreter in sign language technicians written and cued speech coder,
• - patient care to the exclusion of care
• - mobility aid and transport people with mobility problems when this activity is included in a range of services, home assistance,
• - delivery driving personal vehicle for dependents, from home to work on the holiday destination, for administrative procedures *
• - support for children under 3 years in their travels, the elderly and disabled out of their homes (walks, transport, activities of daily living) *
• - aesthetic home care for dependent persons.
In addition to this procedure, it is possible to intervene of nursing home care
* Provided that this provision is included in a set of activities performed at home
Home service - sick Guard
Family employment, why?
Called family employment tasks performed with a particular employer. The family-employment refers particularly home care, the use of a housekeeper, child care ... home.
Family employment, for whom?
Possible interventions depend on the level of approval. They are of two types:
Easy approval - Family Employment can not intervene:
• children under three years
• People over 70 years
• people with disabilities.
Quality Accreditation - Family Employment can intervene with everyone.
Jobs family, how?
If family employment is governed by a representative structure, it places the employee in an individual who becomes the employer. She also helps them with paperwork.
If family employment is governed by a service structure, it is the employer of the person. It provides a service by providing one of its employees that it will charge for any.
It is also possible to use the service voucher that cuts red tape.
Home service - sick Guard
A very human service
The nurse has a presence to the sick people who stay at home. He oversees the physical comfort of the patient, but also to the moral well-being. He knows how to respond to simple requests, and provides a link with the outside deeply reassuring for the patient, as well as families.
The service at home can be done on the day but also at night, always at home. The speaker is in the immediate vicinity of the patient, and must be available to him at any time.
Ensure not care
The nurse does not provide medical care: it only supports the attentions would have a close to the patient. Nevertheless, it may help in decision-prescription drugs, provided it does not provide for the intervention of a medical assistant.
The conditions to use this kind of service at home
If you use an agency, it must receive "quality approval."
The carer guides people in their daily
What are the main activities of the carer?
They are involved, inter alia, with the elderly.
Carers accompany people in their daily life (housing maintenance, kitchen, dining) stimulate their intellectual or physical activities (outings, leisure) and contribute to the development of their social life and relationships.
What skills and qualities necessary for the carer?
To listen and be able to adapt its response to the situation of each person and their expectations; be discreet and respect their privacy; have a basic knowledge of health and hygiene, namely to prepare balanced meals and adapted.
Have a good physical condition, able to ensure the movement of persons deprived of their mobility and how to perform domestic tasks and to perform simple administrative tasks on behalf of the care recipient.
Who is eligible for a carer to his home?
Once a loss of autonomy is diagnosed by a physician, resulting in the need of help at home to stay at home or because of an age with a decrease in autonomy.
What is the formation of carer?
The Assistant State Diploma of Social Life (DEAVS) is issued at the completion of training: it includes 500 hours of theory and 560 hours of practical training. It is open to persons 18 years of age, irrespective of degree.
The role of a maid:
A housekeeper is a person whose job is to clean the homes of private individuals or companies.
The role of a maid does not necessarily stop cleaning. Various functions can be assigned as their ironing, window cleaning, sewing, washing, cooking etc ...
The conditions of employment of a maid:
The maid can be used directly by an individual with the opportunity to be paid to the universal service employment check (CESU), or be an employee of a company (service provider) or through an organization (agent) responsible for its investment homes.
The housekeeper can provide effective help for couples both working and no longer have time to take in order their homes. The aging population also increases the demand for domestic help, maid, "men all hands" etc ...
This job often little esteemed in society is essential and helps to maintain the personal.
Also called a maintenance worker, local cleaner, cleaner of surfaces, surface technician, housekeeper
What differences between undertakings or associations providers or agents?
The aging of the population, the professional activity of two members of the couple, single parent families and broken lead to the development of friendly society human services for individuals.
The government facilitates access to these services by the introduction of tax breaks. Only these services make it possible to benefit from the 5.5% VAT, the tax reduction of 50%, the use of CESU and exemption from payroll taxes for individuals who use home care services. These services are called personal services.
Definition of personal services:
Occupations personal services cover a broad spectrum of activities and trades:
- The personal services for the family child care home, school support, promotion of all forms of assistance to remain at home for dependents;
- Services related to the quality of daily life at home: support, computer repair, meals on wheels, minor repairs, hairdressing, home maintenance (cleaning, housekeeping, maid);
- Services related to housing: security service, home gardening, timely advice in planning;
- Intermediation services: timely legal advice, assistance with administrative procedures.
Other personal services:
• Beauty: barber, beautician home
• Sport: athletic trainer at home
• Second homes: monitoring during your absence or stewardship;
• Concierge service: laundry, laundry, alterations, shoe repair ... recovered and delivered to your home or your work;
• Garage at home: minor repairs, drain;
• Kitchen: Race to the cooking, a chef takes care of everything;
• beauty care at home;
• Sivraison of home shopping (food or not), frozen food or bulky products;
• Cleaning the home of his car or his boat before the season;
• Pets: animal care at home, walk, talk;
Another name: Home Care
What differences between undertakings or associations providers or agents?
Business or service organization
The company or service organization and provides bulk billing a benefit to the individual service recipient (the salary of the person involved, payroll taxes, management fees and VAT).
The speaker is an employee of the service structure. The company or organization is completely responsible for the service provided to the individual who made the request.
Company or agent combination
The company or agent association is responsible (it is mandated) by the individual claiming the benefits of the service, to recruit the employee involved and to make the administration of the case.
The particular recipient, is the employer. So he will be responsible for payment of wages for the service rendered and the corresponding payroll taxes.
Personal services: Advice and approaches
What differences between undertakings or associations providers or agents?
What are the differences between simple approval and accreditation quality?
Simple approval is not required. It is proof of seriousness for the service rendered. Simple approval may be required for the following services:
• maintenance of the home and housework, gardening work,
• benefits small DIY called "men all hands"
• tutoring or home tutoring,
• Computer and Internet support at home,
• preparing meals at home, including time spent in committees,
• Meals on Wheels delivery *
• collection and home delivery ironed *
• grocery delivery at home *
• Care and walking pets for dependents,
• maintenance, care and vigilance temporary home of the main and secondary residence
• accompanying children over three years in their travels *
• administrative assistance to home
• activities directly and exclusively to coordinate and deliver services to the person.
Accreditation Quality is more demanding mandatory for companies or associations that cater to vulnerable population groups, that is to say, the home services for the elderly, disabled or children under 3 year old.
The quality approval must be sought for the following services:
• Child aged under 3 years,
• assisting the elderly or others who need personal assistance at home, except for acts of care under medical procedures
• Assistance for the Disabled including as an interpreter in sign language technicians written and cued speech coder,
• patient care to the exclusion of care
• mobility aid and transport people with mobility problems when this activity is included in a range of services, home assistance,
• providing staff conduct vehicle for dependents, from home to work on the holiday destination, for administrative procedures *
• support for children under 3 years in their travels, the elderly and disabled out of their homes (walks, transport, activities of daily living) *
• beauty care home for dependent people.
* Provided that this provision is included in a set of activities carried out at home.
Wine and Health
In recent years, work in epidemiology has shown that wine is not bad for your health to the extent that we consume in moderation.
It would lend itself particularly beneficial properties in the prevention of cardiovascular disease.
Professors Andre Vacheron, Pr Ludovic Drouet and Professor David Khayat we are part of the latest studies and observations on moderate wine consumption and health.
Wine and Cardiovascular Disease
Prof. Andre Vacheron: Member of the Academy of Moral and Political Sciences and former president of the Academy of Medicine
Wine is a wonderful drink since we find mention 4000 years before Christ, in the tombs of pharaohs. Hippocrates was the first to boast its medicinal virtues four centuries before Christ, and said that "like love, wine excess could have effects quite deleterious to health." In Ecclesiastes, chapter 40, it says: "Vinum Bonum lactificat cor hominis. "However, it was not until the twentieth century to have work on the beneficial effects of wine, despite the media hype that has befallen the sugar, fat, salt, overweight, wine does not escape.
In recent years, work in epidemiology has shown that wine is not bad for your health to the extent that we consume in moderation. In 1979, St. Leger, in The Lancet, reported an inverse relationship between wine and cardiovascular mortality in 18 countries taking up the death certificates and the concepts of wine consumption. The study is supported by the American Keys in 1980, which shows that wine consumption reduces cardiovascular mortality compared to people who do not consume.
But it's Serge Renaud, a scientist at INSERM in Lyon, which really showed in his study Lyons in The Lancet in 1994, and in Circulation in 1999, the wine was interesting in arterial disease. He studied in 605 coronary mean age of 53 years and having had a myocardial infarction, the effects of a Mediterranean diet based on fruits and vegetables and rich in alpha-linolenic acid margarine, supplemented with a few glasses of wine. He observed the prevention of reinfarction in these survivors by comparing the half who received coronary Mediterranean diet with a little wine and margarine to 300 others who were fed normally.
It was found that, regardless of margarine and other components of the diet, there was a wine and by preventing a reduction in mortality from 73% to 72% and 27 months to 46 months. The study was stopped at 46 months for ethical reasons. However it was the basis of the French paradox. In 1991, Serge Renaud was invited to the United States on CBS and was questioned about his Lyon study. Americans have concluded that the French, despite their diet rich enough in calories and saturated fat, were the people with the lowest blood mortality rate after Japan, thanks in part to the wine consumed.
A large epidemiological study led by the World Health Organization (WHO), the MONICA study, was the subject of several reports between 1994 and 1999, but showed a decrease in cardiovascular mortality among moderate drinkers of wine - one to three drinks per day. Denmark, Copenhagen, Morten Gronbaek conducted a prospective study of 13,285 men between 30 and 70 years followed for 10 to 12 years. For wine drinkers, the risk of dying from a heart attack was significantly lower than among those who never drank wine, but also lower than among drinkers of beer and spirits drinkers. This latest study therefore showed a relative risk of cardiovascular mortality and a decreased risk of overall mortality decreased by 50% among wine drinkers, but increased among drinkers of beer and spirits.
Another epidemiological study was conducted by Serge Renaud in Lorraine. He studied about 34,000 men the effect of moderate wine consumption on cancer mortality by general cause and cardiovascular disease. With moderate consumption of wine, 2 to 4 glasses per day, cardiovascular mortality proves weaker than among abstainers. The beneficial effect also operates in mortality from cancers.
To return to the MONICA study, it also showed a decrease in the prevalence of coronary disease from north to southern Europe with a gradient true north / south. Coronary heart disease are much less common among wine consumers, at the same time that there is a decrease in consumption of distilled liquor, drank more in the countries of northern Europe. Therefore, rather than "French paradox", it would be better to speak of Mediterranean paradox, because the wine is certainly not the only nutrient that is involved in the improvement of cardiovascular risk. The presence of fruit and vegetables participates greatly and we find this Mediterranean paradox in France, Italy, Spain, Greece and Crete.
The wine is superior to beer and other alcohols in cardiovascular protection. Indeed, it is more rich in polyphenols, including resveratrol and quercetin. The latter appears to be the most beneficial polyphenol, red wine containing 5 mg / liter. Resveratrol is an antioxidant LDL, that is to say of low density lipoproteins. There are indeed good and bad cholesterol and it will be deposited in the arterial wall. If the individual does not have enough HDL, that is to say, high-density, bad cholesterol will penetrate tissues and constitute a molehill of fat that will protect in a fibrous shell. Resveratrol is going to prevent these bad proteins go create molehills cholesterol. But resveratrol is also vasorelaxant, that is to say, it relaxes the arterial wall, antiplatelet, anti-inflammatory and anti-atherogenic.
The anti-atherogenic action of resveratrol has been verified in a study of a Chinese working in the United States, Dr. Wang Z. He made hypercholesterolemic rabbits by giving them a diet rich in saturated fatty acids and butter. He then fed red wine without alcohol, but with resveratrol. He observed that there was no development of molehills in these rabbits receiving resveratrol after eating too much butter.
Outside of this action on the arterial wall and the coronary, wine slows and increases durability aging. One study named PAQUID, implementation and Dartiques Orgozozo, focused on 4,000 people over 65, followed between 1988 and 1997, they found that in these moderate wine drinkers and older, the disease of Alzheimer occur so much less common.
Mechanisms of non-wine aging are discussed. Some molecules, sirtuins are activated by the polyphenol. These are from a family of molecules which one of them, the SIRT 1, the active energy producers in cells. In cells that are aging, the SIRT 1 reactive energy battery. Other mechanisms have been invoked as the inhibition of endothelin; activation of the estrogen receptor by a delphinidin which stimulate vasodilation.
In this beneficial effect of wine, the two main mechanisms are decreased atherogenesis, decreased molehills and prevention of thrombosis. These qualities are mostly found in red wine fermentation with several weeks in oak barrels. This will reap rich tannins polyphenols. The wine should be consumed in moderation because a glass provides 100 kcal and 10 g of alcohol on average.
A diet high in wine with chronic excess promotes hypertension. John Steinbeck said thus: "Good wine is like love, too much of one or the other can make a sick man. "
The fatty streaks are deposits of LDL cholesterol which have no deleterious effect on blood flow. But molehills, because of the bad cholesterol, can occur in the arteries open. LDL cholesterol that builds up in the past will grow and thicken and obstruct the flow of blood from upstream to downstream. When the dam is large enough, angina appears. It is due to poor oxygenation of the heart muscle.
Myocardial infarction occurs when a molehill plate forms a blood clot. The crack of the molehill will cause platelet aggregation, which will complete clog the coronary artery. When it is blocked, which was irrigated cardiac muscle necrosis.
These two diseases are the consequences of atherothrombosis and thrombosis. This is why we believe that cardiac drink a little wine may be beneficial in reducing these risks.
Wine and atherothrombosis
Professor Ludovic Drouet: Head of angio-hematology department at the hospital Lariboisière
I take after André Vacheron for you to understand how we can carry out research on this subject. First, we need funding. There are about ten years, the Ministry of Agriculture launched an action named ONIVINS, which was based on a state funding to question the beneficial effects of wine on health, and more particularly cardiovascular disease. Work has been carried out with several French groups from Dijon, Bordeaux, INRA and CNRS in Strasbourg.
In the early 2000s, when the results were regarded, from an epidemiological point of view, studies on the link between wine consumption and cardiovascular disease, all the data proved very consistent: around February-March glasses of wine per day, the risk reduction was 30 to 40%.
An Italian group has recently published an update of these results and showed that when we consume wine, we see a reduction in cardiovascular mortality. However, the curve rises as consumption becomes too strong. The group has also shown a benefit, though smaller and sustainable consumption of beer, reflecting the influence of alcohol in general.
When an artery is cut through, one can observe atherosclerotic plaques - or molehill - that fill the wall and make a lesion ruptures. The latter is breaking, causes coagulation reaction called atherothrombosis mixture of thrombosis and atherosclerosis. Overall, epidemiological studies show a reduction of atherothrombotic events associated with moderate consumption of wine. However, it remains unclear whether this consumption has beneficial effects on the game "thrombosis" or the "athero" section.
Among the animals that we have available to us in our work, the mouse is the most manipulated. By studying the behavior of naturally hypercholesterolemic mice and giving them a wine-enriched diet, the researchers found that there was no effect on atherosclerosis. However, it has effects on the so-called thrombotic component. We have the impression that the wine has an antithrombotic effect and antiathérosclérose.
Other mice with a mutation in the LDL were used and we found that there was no effect on athéroclérose short term, but again an effect on thrombosis. But in the long term, the effect on thrombosis tended to disappear.
We also conducted other experiments with pigs - because the pig is the animal with the most similarities with humans and naturally develops atherosclerotic lesions - and we watched the action on the wine last. But the wine is alcohol and polyphenols and we asked which item was beneficial to health.
We have started our study by looking at the short and long term action in which wine would have removed alcohol. However, we found that there was no effect on atherothrombosis. Yet if we look at the benefits of wine on health, we conclude that a large part comes from polyphenols. After several years of experience, we have found on atherosclerosis that there was no effect on lesion size, but their severity, with a decrease in calcification.
In pursuing the study, we tried to make the much more heterogeneous animals by giving them different diets. But in these conditions, we found that the action of wine phenols was inoperative.
We continued our work truly giving alcohol to our animals. A new study has been conducted using animals for 2 years. We spotted a small effect on atherosclerosis in periphery. We also found a reduction in thrombotic response. The regime in blood sugar and wine limit does not increase the risk of diabetes. We also identified a small antithrombotic effect on a type of platelet aggregation.
As I said, the wine is alcohol and polyphenols. Alcohol has effects on lipoproteins and vascular wall. The wine phenols cause stimulation of the production of nitrogen monoxide. So we watched the vascular reactivity of our animals: wine produces vasodilation of peripheral arteries. Student individually in our animals, we realized that the older animals that have not had the chance to drink wine have arteries dilate hurt as aging. But among those who have had the chance to consume wine in their entire life, vasodilation appears much stronger.
Currently, researchers are trying to understand what happens in the cells to allow protection of the vascular walls. The system of sirtuins will play a role in the maintenance and survival of these cells. A recent study on hypercholesterolemic pigs showed that only wine consumption compared to consumption of vodka or abstinence, resulted in vasodilatation.
I hope I could show you how to search, with its current resources, moves forward in understanding the effects of wine. The most important consequence is the antithrombotic action. Under these conditions, with moderate wine consumption, we find a benefit the cardiovascular system.
I now give the floor to David Khayat, who will speak to us about the relationship between wine and cancer.
Wine and Cancer: Myths and Realities
Professor David Khayat: Chief of Medical Oncology at the Hospital Pitié-Salpêtrière
After cardiovascular diseases, we thought it was good to deal with the other major cause of death in developed and developing countries, namely cancer. It currently affects one in two men and one in three women. In 2012, there were 8,000,000 deaths related to cancer in the world. In 2020, the World Health Organization (WHO) expects 10 million, after the declaration of 20 million new cases this year. The incidence rate of doubling every twenty years cancer in the world, even if it heals better and if the mortality rate remains stable. It represents 150,000 deaths each year, while we record 350,000 new cases in the same time.
Wine is another important issue, it made sense to treat the link between these two items. I will address this topic in a simple way through three channels. The first will deal with the increased risk of cancer among heavy drinkers compared to moderate drinkers. Moderate consumption is estimated at about two to three glasses of wine on average for men, and one to two drinks for women.
For most of the studies that have been done on this subject, more specifically to cancers of the mouth, esophagus, colon, liver, lung or breast, the problem is that 90% of them do not address the link between excessive consumption or moderate wine and increased risk of cancer, but between excessive consumption of alcohol or moderate. But we must understand that they have cases of people that have been followed for decades, and 70% of them were made in the United States, that is to say in a country where alcohol is distilled greatly consumes. These studies are not transferable to countries with strong wine tradition. Indeed, all alcoholic beverages are not good for health, while I think the wine consumed in moderation, has been rather beneficial.
I will not discuss all of the cancer, but I will take emblematic cases such as cancer of the mouth. For this type of cancer, we have studies that examined the relationship between wine and pathology. When I started my classes, I learned that cancer is caused by alcohol and tobacco. There is thus 22 studies published worldwide on the potential increased risk of cancer among heavy users ENT wine and moderate drinkers. However, everyone, including top international experts, consensus that only 14 studies are valid. Some are simply too small or were interrupted hurriedly. Of these 14 studies, nine conclude that excessive consumption of wine increases the risk of head and neck cancer.
However, 5 say, instead, that excessive consumption of wine reduces the risk of cancer compared with moderate consumption. Scientists do in these circumstances? They include the data to create what is called a meta-analysis. The world body, the World Cancer Research Fund, and its experts came to the conclusion that, in heavy wine drinkers compared with moderate drinkers, the increased risk was multiplied by 1.02, which means that increased risk was 2%. But in science, we know that there is a degree of uncertainty in this kind of work, which is called "confidence interval", and in which lies the scientific truth. That is why the 1.02 is between 1 and 1.03, and the increased risk is 1%.
To understand this, we need to revisit the methodology of epidemiological studies. For a study, we follow a procedure called "case-control". We take cases - 1,000 patients who contracted cancer of the mouth, for example - we will compare to controls. The general rule is 1 in 5 for witnesses, that is to say five men to one man, one woman for 5 women, 1 for 5 young young to balance according to the same social, economic criteria, etc. All individuals participating in the work will be asked about the factors related to the study, over a long period.
Indeed, for a cancer spreads in an organization, it takes about 25 to 30 years, because for a cancer cell to become a tumor of one centimeter in diameter comprising 1 billion of these cells, it is necessary that it is divided 33 times, whereby the fact of dividing it takes about 3 to 6 months. To understand the origin of cancer patients, we must ask what they drank there 30 years - 33 times 3 to about 6 months - resulting in inevitable imprecision, because no one is able to remember what he was drinking there so long. Therefore, the finding of the study reveals lapses.
The other problem of this work is that they were all made before 2006, however, this year, a study, since confirmed by others, showed that 70% of oral cancers were caused by papillomavirus ( or HPV), which also give the cervical cancer in women, cancer of the penis in men and cancer of the anus in both. The virus grows in the first oropharyngeal contact. On cancers of the head and neck, excessive or moderate consumption of wine does not increase the risk of disease.
Moreover, doctors agree that there is no increased risk to the consumer or to moderate liver cancer, or cancer of the colon, as it does not exceed 30 40 grams of ethanol per day, that is to say glasses 3-4.
I now turn to my second part: there are two or three years, a study has claimed that alcohol is carcinogenic in the first glass, which strikes the right direction. Another study showed that people drinking 4-5 glasses of alcohol per day had 60% increased risk of skin cancer. However, the researchers did not test the degree of sun exposure of these individuals. This work will therefore reveal little valid.
The question of carcinogenicity of first drink consumed is the work of a great American scholar, Arthur Klatsky, which followed 129,987 volunteers in California between 1978 and 1985 to 2008 and grouped them among abstainers moderate drinkers and heavy drinkers, and sought to understand whether the act of drinking a glass or more resulted in an increased risk of developing a "big cancer" - breast, colon, lung, etc. - About the fact not to drink at all. After publishing his results, all doctors had to recognize that alcohol consumption seemed dangerous from the first drink. But in October 2012, the same researcher found that the study was flawed.
Indeed, an article published in the American Journal of Epidemiology showed that over 50% of returns on wine consumption volunteers for the studies were under-reported. Arthur Klatsky has taken over the files of the 129,987 volunteers and found that among the abstainers over a third had been arrested for driving while intoxicated, assault under the influence of alcohol, ethyl comas, etc. So he rebuilt his study by classifying people between suspects and non-suspects. He then came to apologize to the Congress of Vienna Cancer and explained that removing the suspects, there was no increased risk from the first drink. However, this information was relatively relayed to the public.
Finally, we not only heal more cancer, but, as regards breast cancer, two beautiful studies have established the beneficial link between moderate wine consumption and disease. The first is on 25,000 women with breast cancer followed for 11 years, the second on 13,525 women with breast cancer and followed for 15 years. When doctors looked when, after cancer, is drinking wine increases the risk of relapse and mortality, two studies have shown that drinking 1-2 glasses reduced the risk of dying from 15-16%.
Therefore, drinking wine in moderation or not at all increase the risk of cancer or the risk, when it had a to die faster.
Recent news has unfortunately still remembered. The PACA region recorded 15 cases of meningococcal disease including 4 deaths since the beginning of the year. A 12 year old has been touched on March 11 in Nice. A new deaths has recently been observed in Seine-Saint-Denis. So many tragedies for families that could be avoided. !
More and more people are questioning?
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Definition of hamstrings
The hamstring muscles are located in the back of the thigh (upper leg) and consist of three muscles: biceps femoris, semitendinosus and semimembranosus. This muscle group is involved in flexing the leg at the knee, and the extension of the leg at the hip.
Definition of pulled muscle
Muscular elongation hamstring muscle is torn regards only few fibers; tearing (or breakdown) as it relates to a larger number of fibers. There are three levels of torn hamstrings, until complete rupture.
Risks and origins tears or pulled hamstring muscle
The elongation, or even torn hamstring muscle, usually occur during knee extension with a sudden contraction of the muscle. This injury is common in the context of a sports exercise and inadequate heating can promote it, 90% of muscle accidents involve the lower limbs, especially the elongation or tearing of the hamstring muscle.
Causes tears or pulled thigh
The hamstring muscles allow to walk, run or jump. That these actions are carried out correctly, there must be coordination and regional regulation of all the muscles, tendons and joint leading the movement.
Muscle injuries can occur in the event of default in this regulation. The elongation of the hamstrings occurs for example when the knee extends and the muscle is suddenly contracted. Powerful muscular contraction, with simultaneous stretching and high speed generates two opposing forces responsible for elongation or a tear. The elongation corresponds to muscle micro tears overflow elasticity fibers.
A direct impact on the muscle can also cause damage to the muscle.
Elongation - Prevention
How it does it manifest?
Elongation takes place during the year and is characterized by moderate pain behind the thigh. It is a feeling of stretching the muscle but the pain does not preclude further effort.
Tear Level 1 causes a severe pain in the muscle located in the back of the thigh muscle is sore to the touch, but not bruised.
Tear Level 2 also causes pain to exercise, with a contusion (bruise visible after several hours) where the muscle fibers are torn.
Finally, a tear Level 3 corresponds to a breakdown of muscle fibers. The pain is associated with a snap in the thigh causing them to stop the effort.
With what should we be confused?
Do not stretch the hamstrings to be confused with a simple curvature. Pain related to an elongation occurs during exercise, unlike the stiffness that occurs after exercise. Pain elongation disappears after exercise and reappears in subsequent years.
Will it possible prevention?
Prevention of muscle injury based on a healthy lifestyle with a balanced diet and fight against overweight, to avoid stress on the muscles.
Sports training should be progressive and depending on your physical condition. The equipment must be adapted to correct eg support possible defects with good shoes. Especially, the gradual heating of the muscles and tendons (10 minutes) is essential before and after physical activity: a stretching session, alternating tension and relaxation maintained, allow a better recovery.
Ideally, the advice of a professional trainer help perfect the technique, and to hunt movements or dangerous behavior.
Elongation - Consultation
When you consult?
At the onset of pain during physical exercise, it is imperative to stop the current activity not aggravate injuries. Must be cooled and compressed muscle.
The rest should be continued sporting several days, a medical consultation is needed to determine the extent of damage and consider physiotherapy.
In cases of severe elongation and complete tear of the muscle, immediate care, emergency, is required.
What is the doctor?
The doctor confirms the diagnosis stretching or tearing of the hamstring clinically (palpation, visual inspection). Clinical examination also eliminates another cause (tendon rupture, or avulsion fracture).
Ultrasound is complementary examination to specify the exact location and nature of the muscle injury.
Treatment depends on the severity of the infringement. The acute phase has a glaze (to relieve pain and reduce inflammation), rest, and compression of the muscle. Some analgesic or anti-inflammatory drugs are sometimes prescribed in this phase.
The rehabilitation period (a few days) includes physiotherapy / physical therapy.
Surgery as it relates to the complete muscle ruptures.
How to prepare my next visit?
Sporting activity and muscle load must be taken only when all pain has disappeared, and the strength and mobility have returned to normal. Premature resumption causes a significant risk of relapse. Similarly, do not rub or apply heat to the affected muscle. This can aggravate the pain, injuries and cause bleeding.