M S-medecine Sciences最新文献

Gender bias in medicine influences the diagnosis, treatment, and care provided to patients. Rooted in a lack of awareness of sex- and gender-specific needs and in stereotypes, it distorts the interpretation of symptoms and clinical and therapeutic decision-making. While some gender-related differences in patient management may be clinically justified on the basis of health equity, others reflect unjustified inequalities. Using concrete examples, this article examines their effects on the medical practice of care, while highlighting the need for appropriate training for healthcare professionals.

In women, cardiovascular risk is influenced by factors that differ from those in men, including hormonal status, obstetric complications, and specific conditions such as migraine, endometriosis, or chronic inflammatory diseases. These factors affect both arterial and venous risk, which are often not accounted for by standard risk scores. This literature review highlights these women-specific factors, emphasizing the need for appropriate risk stratification tools, personalized prevention strategies, and improved information for women throughout their lives.

The healthcare expenditures incurred by men and women over the course of their lives obviously depend on their health status and their specific healthcare needs. Their economic and social situation, individual preferences, and gender-related social norms also help to explain the differences in their healthcare utilization and expenditure. This article provides an overview of the economic and epidemiological literature on differences between men and women in healthcare expenditure and use at different stages of life. Healthcare expenditures is analyzed in terms of social and economic behaviors, with a particular focus on gender effects beyond the biological and specific healthcare needs of men and women.

Since 1803, midwifery has been recognized as a medical profession, experiencing a golden age in the 19^th century. The professionalization of birth support stemmed from the political desire to establish a lasting gendered competence, closely linking care and therapeutic practices. The specificity of midwives' work (from pregnancy to postpartum care, for both mother and child) shaped the nature of temporality (both occasional and continuous) of care they provided, ranging from moral support to active medical intervention. Their largely independent practice was based on their full availability for care, shaping the contemporary conception of the midwife's role.

The menopausal transition concerns over a quarter of the female population in France, but its clinical and socio-professional trajectories remain poorly explored. CLIMATÈRE is a prospective, fully digital cohort study designed to recruit over 100,000 women, aged 30 and over (whether premenopausal, perimenopausal, or menopausal). Participants register on the CLIMATÈRE website to complete questionnaires covering menopausal symptoms, lifestyle factors, mental health, and occupation. Annual follow-up will be conducted. CLIMATÈRE will provide a national map of women's health at the time of menopause, with the goal of developing personalized prevention tools in the field of women's health.

Lower-limb exoskeletons are promising devices to support walking and transfers in individuals with neuromuscular diseases (NMDs). However, the actual effects of these devices on gait in individuals with these pathologies remain largely unknown because existing devices are based on assistance algorithms whose relevance to the compensatory strategies specific to NMDs has yet to be demonstrated. Within our research program, we conducted a multiparametric analysis during gait combining kinematic, electromyographic, muscle strength and subjective perception data. Our findings indicate on the one hand that, compared to healthy subjects, patients with NMD present a decrease in walking performance which is associated with reduced cadence, longer stance duration, shorter step length and duration, reduced ankles angles at gait cycle initiation, lower muscle strength, and increased variability in hip kinematics. On the other hand, the evaluation of two commercial exoskeletons (Keeogo® and Myosuit) revealed, despite safe use, a global decrease in walking performance compared to that evaluated without these devices, due to complex redistributions of muscular activity. Key determinants of performance remained similar with and without assistance, highlighting the current limitations of these devices. Future directions involve developing individualized musculoskeletal models to optimize assistance towards an optimized personalization.

A significant number of patients with congenital myopathy remain undiagnosed, complicating their clinical management, genetic counseling, and limiting access to therapeutic trials or existing treatments. This study, conducted as part of the MYOCAPTURE research project, aimed to identify novel mutations and genes by analyzing the exome of 310 families affected by genetically undiagnosed congenital myopathies. A genetic diagnosis was established for 123 families (40%). Among the diagnosed cases, only 44 (36%) had mutations in a known gene associated with a classical phenotype. Fifty-five families (44%) had mutations in known genes but associated with atypical phenotypes. And in 20% of the cases, we identified the involvement of 14 novel myopathy genes. This study highlights the relevance of untargeted high-throughput sequencing, such as exome sequencing, for the diagnosis of congenital myopathies and contributes to improving their clinical management.

Pancreatic islet transplantation (PIT) became a clinical reality in France in 2021, providing a groundbreaking alternative for patients with type 1 diabetes (T1D) suffering from lability or severe hypoglycemic unawareness. This cellular therapy involves implanting insulin-producing islets from brain-deceased donors (allograft) or after pancreatectomy (autograft), significantly improving glucose control and reducing diabetes-related complications. However, PIT faces major challenges, including limited donor availability, lifelong immunosuppression, and progressive islet loss. Researchers are now exploring alternative approaches, such as stem cell-derived islets and xenografts, to overcome these obstacles and expand access to this promising therapy. The future of PIT may hinge on the success of hypoimmune stem cell-derived insulin secreting islets or autologous grafts that would avoid rejection and autoimmune recurrence in the absence of immunosuppressive drug treatment, paving the way for a long-term solution for millions of diabetic patients worldwide.