As the 2024 Paris Olympic Games approach, it seemed relevant to analyze 25 past years of medical workload at the Stade de France to better predict future needs by identifying the determinants of workload levels.

Site: Stade de France, the largest French stadium, in the Greater Paris area.

Inclusion: Events from 1998 to 2022.

Parameters: Nature of event; level of event; competition finals; number of spectators, weather, and medical workload.

End-points: Number of patient presentations.

459 events were studied: 167 (36%) football matches, 142 (31%) rugby matches, 111 (24%) artistic performances, 26 (6%) athletics competitions, 11 (2%) motor sports competitions, and 2 (0.5%) other types of events. Median attending spectators: 72,057 [56,825-78,500]. Median patient presentations: 29 (15-59) or 5 (2-9) per 10,000 spectators. Median transports to hospital: 2 (1-3) per event, or 0.3 [0.1-0.5] per 10,000 spectators. Median medicalized transports to hospital: 0 [0-0] per event. The nature of the event, rugby (OR = 7.97 [1.65-46.80]), international event (0.18 [0.04-0.76]), and temperature (OR = 0.86 [0.77-0.96]) were associated with a greater frequency of high medical workload in multivariate analysis.

Rugby matches, level of event, and outdoor temperature were independent determinants of medical workload. Number of spectators and duration of the event had no influence.

In the US, cardiovascular diseases (CVD) are the leading cause of death and disability. Cost-related medication non-adherence (CRMN) can have serious consequences and worsen CVD outcomes. We examined the relationship between CVD risk factors and CRMN among US adults.

CDC’s 2019–2021 National Health Interview Survey (NHIS) data were used to examine CRMN among adults, categorized into three groups based on reported risk factors. We used chi-square tests, and logistic regression to determine factors associated with CRMN.

Among 49,464 participants, young, unmarried individuals, females, less educated, and participants from the South had higher CRMN than older, married individuals, males, and those with higher education residing in the other regions. Current smokers and those with more CVD risk factors also reported higher CRMN than former and never-smokers. Conversely, those aged 65 or older, with high-income, and excellent self-rated health had lower CRMN than younger participants, low-income families, and those with poor self-rated health. Public insurance and Medicaid participants had lower CRMN than uninsured (OR 0.13, 95% CI, 0.04–0.45, and OR 0.24, 95% CI, 0.15–0.36). Stratified analysis by diabetes, hypertension, and hyperlipidemia, revealed participants with high-income had lower odds of CRMN (OR 0.38, 95% CI, 0.28–0.50; OR 0.39, 95% CI, 0.28–0.58; OR 0.37, 95% CI, 0.27–0.51 respectively) than those with lower- incomes.

Adults under 65 with more CVD risk factors and lacking insurance coverage are at higher risk of CRMN. Therefore, strengthening prescription drug coverage and targeted interventions are necessary to reduce CRMN among those with cardiovascular risk factors.

To describe the development, delivery, and outcome of an action-oriented intervention comprising an awareness-raising educational video and workshop designed to support general practice teams to identify and plan decarbonization actions, delivered from May-September 2024.

Healthcare services internationally are committing to net zero targets. General practice is recognized as having a pivotal role in achieving these ambitions. However, limited awareness of decarbonization initiatives and insufficient support for implementation highlight the need for an educational resource to facilitate action planning.

Principles of organizational change, video-design, and barriers to decarbonization informed the intervention’s development. The video included modules featuring resource materials and ideas to support the development and implementation of decarbonization actions in general practice. Prompts for a facilitated workshop discussion were developed to support action planning. The intervention was delivered to 64 multidisciplinary staff across 12 general practices in England. A conceptual content analysis was conducted on completed practice green action plans (GAPs) and data from an online participant feedback form were analysed using descriptive statistics to assess perceptions of the intervention. Free-text comments were thematically analysed.

Across the 12 GAPs, each practice planned between three and eight decarbonization actions. ‘Managing waste’ was the most frequently addressed area, appearing in 10 practice GAPs, and most planned actions mapped onto those presented within the video. Thirty (46.9%) participants completed the evaluation survey. The intervention was well received, with 28 (93.3%) survey respondents rating the overall usefulness of the video as 4 or 5 (1 ‘not at all useful’ to 5 ‘very useful’). Free-text comments for suggested improvements related to time for consolidating learning, and concerns about the video’s audio quality and duration.

The educational workshop successfully facilitated the development of structured GAPs with explicit timescales and intended outcomes. This study did not assess the implementation of planned actions.

To examine the prevalence, financial value and marketing leveraging methods of food sponsorship agreements and food service contracts in Canadian recreation and sport facilities (RSF).

Cross-sectional survey using descriptive analysis. RSF managers and directors reported the number, value and types of marketing leveraging methods used in food-related sponsorship agreements and food service contracts.

Publicly funded RSF in nine Canadian provinces that provide indoor sport programming for children and youth.

Eighty-six RSF representatives completed the survey (response rate: 73·9 %). Most facilities were municipally owned and located in urban settings; over 70 % served children under 13 years of age.

Food sponsorship agreements and food service contracts were reported by 36·5 % and 65·5 % of RSF, respectively. Financial donations were included in 88·6 % of sponsorship agreements and 27·4 % of contracts. Sponsors contributed a median of 25·0 % (IQR: 13·9–83·3 %) of total sponsorship income, with a median annual donation per sponsor of $500 (IQR: $288–$1375). Nearly all agreements and contracts included at least one food marketing leveraging method. Branded signage was the most common in sponsorship agreements (64·6 %), while equipment donation was the most common in food service contracts (52·2 %).

Food sponsorship and service agreements are prevalent in Canadian RSF and include financial and in-kind contributions that may benefit facilities. However, the marketing leveraging methods used – such as branded signage and product provision – may also increase children’s exposure to food marketing. Greater monitoring and evaluation of these marketing practices are needed, especially in the context of proposed national marketing restrictions.

Hypoxia is a defining feature of the tumour microenvironment (TME) that drives aggressive tumour behaviour through coordinated adaptive responses. Hypoxia-inducible factors (HIFs), particularly HIF-1α, play a central role in orchestrating metabolic, immune and epigenetic reprogramming within tumours.

This review aims to elucidate the integrated roles of hypoxia in regulating angiogenesis, immune suppression, metabolic adaptation and epigenetic modifications, and to highlight their collective impact on tumour progression and therapeutic resistance.

A comprehensive review of current literature was conducted to examine the molecular and cellular mechanisms mediated by hypoxia and HIF signalling within the TME, with a focus on their interplay across angiogenic, immune, metabolic and epigenetic pathways.

HIF-1α promotes the expression of pro-angiogenic factors, including VEGF, ANGPT2 and CXCL12, leading to abnormal vascularisation and recruitment of immunosuppressive cells such as regulatory T cells and myeloid-derived suppressor cells. This disorganised vasculature exacerbates hypoxia, reinforcing a cycle of immune evasion and metabolic stress. Hypoxia also upregulates immune checkpoint molecules (e.g., PD-L1, PD-1), contributing to T-cell exhaustion and impaired dendritic cell function. Concurrently, metabolic reprogramming—characterised by increased glycolysis, lactate accumulation and extracellular acidification—suppresses cytotoxic T cell and NK cell activity. Epigenetic regulators, including histone demethylases and DNA methyltransferases, sustain these adaptations through persistent transcriptional changes, referred to as hypoxic memory.

Hypoxia acts as a central organising force within the TME, coordinating angiogenic, immune, metabolic and epigenetic processes to promote tumour progression. Targeting HIF-driven pathways represents a promising therapeutic strategy to overcome immune resistance, enhance drug delivery and improve the efficacy of combination treatments, including immunotherapy and metabolic interventions. This review underscores the importance of integrated approaches to disrupt hypoxia-mediated tumour adaptation.