Luc Dauchet

Background: Early exposure to research methodology is essential in medical education, yet many students show limited motivation to engage with nonclinical content. Gamified strategies such as educational escape rooms may help improve engagement, but few studies have explored their feasibility at scale or evaluated their impact beyond student satisfaction. Objective: This study aimed to assess the feasibility, engagement, and perceived educational value of a large-scale escape room specifically designed to introduce third-year medical students to the principles of diagnostic test evaluation. Methods: We developed a low-cost immersive escape room based on a fictional diagnostic accuracy study with 6 puzzles mapped to five predefined learning objectives: (1) identifying key components of a diagnostic study protocol, (2) selecting an appropriate gold standard test, (3) defining a relevant study population, (4) building and interpreting a contingency table, and (5) critically appraising diagnostic metrics in context. The intervention was deployed to an entire class of third-year medical students across 12 sessions between March 2023 and April 2023. Each session included 60 minutes of gameplay and a 45-minute debriefing. Students completed pre- and postintervention questionnaires assessing their knowledge of diagnostic test evaluation and perceptions of research training. Descriptive statistics and 2-tailed paired t tests were used to evaluate score changes; univariate linear regressions assessed associations with demographics. Free-text comments were analyzed using the hierarchical classification by Reinert. Results: Of the 530 participants, 490 (92.5%) completed the full evaluation. Many participants had had limited previous exposure to escape rooms (206/490, 42% had never participated in one), and most (253/490, 51.6%) reported low initial confidence with critical appraisal of scientific articles. Mean overall knowledge scores increased from 62 of 100 (SD 1) before to 82 of 100 (SD 2) after the activity (+32%; P <.001). Gains were observed across all learning objectives and were not influenced by age, sex, or previous experience. Students rated the educational escape room as highly entertaining (mean score 9.1/10, SD 1.1) and educational (mean score 8.2/10, SD 1.5). Following the intervention, 86.9% (393/452) felt more comfortable with critical appraisal of diagnostic test studies, and 79% (357/452) considered the escape room format highly appropriate for an introductory session. Conclusions: This study demonstrates the feasibility and enthusiastic reception of a large-scale, reusable escape room aimed at teaching the fundamental principles of diagnostic test evaluation to undergraduate medical students. This approach may serve as a valuable entry point to engage students with evidence-based reasoning and pave the way for deeper exploration of medical research methodology.

Air pollution is associated with elevated cardiovascular mortality and an increase in cardiovascular risk factors. However, the literature data on associations between air pollution and cardiovascular risk factors are contradictory. To explore the relationship between residential exposure to atmospheric pollutants and cardiovascular risk factors (lipid biomarker and blood pressure levels). We studied a sample of 2339 adult participants in the ELISABET study from the Dunkirk and Lille urban areas of France. The mean annual exposure to atmospheric pollutants (PM₁₀, NO₂ and SO₂) at the home address was estimated via an air dispersion model. The associations were probed in multivariate linear regression models. The mean NO₂ level was 26.05 μg/m³ in Lille and 19.96 µg/m³ in Dunkirk. The mean PM₁₀ level was 27.02 μg/m³ in Lille and 26.53 μg/m³ in Dunkirk. We detected a significant association between exposure to air pollutants and the high-density lipoprotein (HDL) (which is a protective factor against cardiovascular diseases) level: for a 2 µg/m³ increment in PM₁₀, the HDL level decreased by 1.72% (p = 0.0037). None of the associations with other lipid variables or with blood pressure were significant. We didn’t find evidence significant associations for most of the risk factors but, long-term exposure of adults to moderate levels of ambient air pollution was associated with a decrement in HDL.

Background. Carotenoids and docosahexaenoic acid (DHA) were identified as essential components for eye health and are both naturally present in eggs. Objective. We aimed to evaluate the effect of the daily consumption of two eggs enriched with lutein/zeaxanthin and DHA on macular pigment optical density (MPOD) and on circulating xanthophyll and fatty acid concentrations in healthy participants. Methods. Ninety-nine healthy volunteers consumed either two standard eggs or two enriched eggs per day for 4 months. MPOD was measured at baseline (V0) and at follow-up (V4) using a modified confocal scanning laser ophthalmoscope (primary outcome). Blood samples were collected to determine total plasma and lipoprotein fatty acids and lutein/zeaxanthin compositions at V0 and V4 (secondary outcomes). Results. A slight but significant increase in MPOD was observed for all study participants consuming two eggs per day for 4 months at all eccentricities (0.5°, 1°, 2°, and 4°). Plasma and lipoprotein lutein, zeaxanthin, and DHA concentrations significantly increased in both groups but were greater in the enriched group (for the enriched group (V0 vs. V4): lutein, 167 vs. 369 ng/mL; zeaxanthin, 17.7 vs. 29.2 ng/mL; DHA, 1.89 vs. 2.56% of total fatty acids). Interestingly, lutein from high-density lipoprotein (HDL) was strongly correlated with MPOD at 0.5 and 1° eccentricities (rho = 0.385, p = 0.008, and rho = 0.461, p = 0.001, respectively). Conclusions. MPOD was slightly increased in both groups. Lutein, zeaxanthin, and DHA plasma concentrations were strongly enhanced in the enriched group compared with the standard group. A significant correlation was found between MPOD level and lutein concentration in HDL.

Aims: The question of interactions between the renin angiotensin aldosterone system drugs and the incidence and prognosis of COVID-19 infection has been raised by the medical community. We hypothesised that if patients treated with ACE inhibitors (ACEI) or AT1 receptor blockers (ARB) were more prone to SARS-CoV2 infection and had a worse prognosis than untreated patients, the prevalence of consumption of these drugs would be higher in patients with COVID-19 compared to the general population. Methods and results: We used a clinical epidemiology approach based on the estimation of standardised prevalence ratio (SPR) of consumption of ACEI and ARB in four groups of patients (including 187 COVID-19 positive) with increasing severity referred to the University hospital of Lille and in three French reference samples (the exhaustive North population (n=1,569,968), a representative sample of the French population (n=414,046), a random sample of Lille area (n=1,584)). The SPRs of ACEI and ARB did not differ as the severity of the COVID-19 patients increased, being similar to the regular consumption of these drugs in the North of France population with the same non-significant increase for both treatment (1.17 [0.83–1.67]). A statistically significant increase in the SPR of ARB (1.56 [1.02–2.39]) was observed in intensive care unit patients only. After stratification on obesity, this increase was limited to the high risk subgroup of obese patients. Conclusions: Our results strongly support the recommendation that ACEI and ARB should be continued in the population and in COVID-19 positive patients, reinforcing the position of several scientific societies.