Université De Picardie Jules Verne

Influenza causes considerable morbidity and mortality in Europe, particularly among older adults due to comorbidities, as well as immunosenescence and inflammaging, which contribute to a diminished immune response. Vaccination remains the most effective way to prevent poor outcomes; however, uptake is suboptimal and many countries recommend standard vaccines despite evidence supporting better protection with enhanced (adjuvanted and high-dose) vaccines.

A multidisciplinary group of experts reviewed the burden of influenza in Europe and evaluated data on enhanced vaccines, providing recommendations for their use in older adults. The group discussed barriers to vaccination and strategies to increase uptake.

Improving protection of older adults against influenza relies upon increasing vaccine uptake and ensuring access to vaccines that overcome age-related immunological decline. Achieving higher uptake requires national policies that facilitate equitable access and clear communication about vaccine eligibility. Based on available evidence, enhanced vaccines offer better protection than standard vaccines against hospitalization and complications in older adults. National recommendations should prioritize the use of enhanced influenza vaccines over standard vaccines in older adults. Limitations to interpretation of evidence include discrepancies in reporting of influenza-related medical encounters and underreporting of influenza-related complications.

The value of a bridge in loop ileostomies is debated. We aimed to evaluate whether using a bridge when creating a loop ileostomy can reduce morbidity following an ileostomy.

Patients who had a loop ileostomy after elective colorectal surgery from January 2016 to July 2022 were randomized in this multicenter phase 2 randomized superiority trial. The primary endpoint was the absence of postoperative stomal complications at 2 months and was assessed in a blinded fashion by a stoma therapist. Secondary endpoints were morbidity at 1 month and the STOMA-QOL score at 2 months.

During the study period, 67 patients were randomized to the bridge group and 63 to the no-bridge group. Epidemiological and perioperative data did not differ between the two groups. The stomal complication-free rate was 76% in the bridge group and 67% in the no-bridge group (p = 0.3). There was no difference in the distribution of complications at 1 month according to the Clavien-Dindo score (p = 0.2) or the STOMA-QOL score at 2 months (p = 0.4) between the two groups.

The bridge does not reduce the rate of stomatal complications, nor does it appear to reduce patients' quality of life.

NCT02756273 (May 10, 2016).

The Adverse Outcome Pathway (AOP) concept leverages existing data to formalize and disseminate knowledge and is a well-accepted concept in chemical risk assessment. However, it does not handle the socio-economic impact that environmentally-induced diseases may generate, which might be highly relevant for risk management and prioritization. Here, we propose to connect the AOP framework by bridging an Adverse Outcome (AO) to Cost Outcomes (CO) creating so-called Cost Outcome Pathways (COPs) for including the socio-economic costs of exposure to chemicals into the AOP framework. Exposures to certain classes of chemicals have been linked to loss of intellectual quotient (IQ) points in children. This may lead to healthcare costs and reduced working productivity and contribute to increasing the substantial socio-economic burden worldwide. As an in silico case study, a new COP related to neurodevelopmental toxicity was designed, with a connection between the AO 'decreased, IQ' and an umbrella CO 'increased, socio-economic burden'. This framework can support policymaking in the public health sector and might also hold great potential for other environmental exposure-related diseases such as cancer, obesity or neurodegeneration, which are diseases known to have detrimental socio-economic impacts.