Family presence during CPR was associated with positive results on psychological variables and did not interfere with medical efforts, increase stress in the health care team, or result in medicolegal conflicts. (Funded by Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health; ClinicalTrials.gov number, NCT01009606.).

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BackgroundHypothermia is common in trauma victims and is associated with increased mortality, however its causes are little known. The objective of this study was to identify the risk factors associated with hypothermia in prehospital management of trauma victims.MethodsThis was an ancillary analysis of data recorded in the HypoTraum study, a prospective multicenter study conducted by the emergency medical services (EMS) of 8 hospitals in France. Inclusion criteria were: trauma victim, age over 18 years, and victim receiving prehospital care from an EMS team and transported to hospital by the EMS team in a medically equipped mobile intensive care unit. The following data were recorded: victim demographics, circumstances of the trauma, environmental factors, patient presentation, clinical data and time from accident to EMS arrival. Independent risk factors for hypothermia were analyzed in a multivariate logistic regression model.ResultsA total of 461 trauma patients were included in the study. Road traffic accidents (N = 261; 57%) and falls (N = 65; 14%) were the main causes of trauma. Hypothermia (<35 °C) was present in 136/461 cases (29%). Independent factors significantly associated with the presence of hypothermia were: a low GCS (Odds Ratio (OR) = 0,87 ([0,81-0,92]; p < 0.0001), a low air temperature (OR = 0,93 [0,91-0,96]; p < 0.0001) and a wet patient (OR = 2,08 [1,08-4,00]; p = 0.03).ConclusionThe incidence of hypothermia was high on EMS arrival at the scene. Body temperature measurement and immediate thermal protection should be routine, and special attention should be given to patients who are wet.Level of evidenceProspective, multicenter, open, observational study; Level IV.

Obesity is a worldwide health problem. Fast food is widely considered to be responsible for obesity. McDonald's is a symbol of such fast food [1]. However, the global relation between fast food availability and obesity is unclear [2]. The aim of this study was to determine whether there is a correlation between the number of McDonald's restaurants and the prevalence of obesity worldwide.In total, 44 countries were included in the present study. This group comprised the 20 most populated countries of the world, the five most populated countries of each continent and a few other countries that were included in a recent nutritional study [3]. The number of McDonald's restaurants per million inhabitants was calculated for each of these countries (www.mcdonalds.com). Countries were classified according to quartiles of the number of Mac Donald's â restaurants per million inhabitants. The proportion of overweight persons according to each of these quartiles was calculated using World Health Organization data [4]. The correlation between the proportion of overweight individuals and the number of McDonald's restaurants per million inhabitants was investigated.The study population was approximately 5500 million, corresponding to 75% of the world population. A total of 31 045 McDonald's restaurants were located in these countries corresponding to approximately 95% of the total number of McDonald's restaurants in the world. There were between 0 and 45 (in the USA) McDonald's restaurants per million inhabitants. We found that there was a very strong correlation between the number of McDonald's restaurants and the proportion of overweight individuals in the 44 countries (R 2 = 0.95) (Fig. 1), although we did not establish a causal relationship.Indeed, worldwide Mac Donald's â restaurants implantation probably follows a trend in alimentation behaviour changes. It is an accompaniment of such changes. Consequently, the potential impact of decreasing the number or even a total lack of Mc Donald's â restaurants removal remains unknown. Furthermore, this highly solid robust relationship indicates that the number of Mc Donald's â restaurants implantation is a strong local indicator of obesity risk. Following this indicator could help to evaluate the onset obesity in a given population.Finally, other countries and other fast food restaurants, in addition to McDonald's, should have been included in the present study; however, it is highly unlikely that this would have changed the overall findings. Indeed, including 75% of the world population and 95% of McDonald's restaurants was likely to produce reliable results. Conflict of interest statementNo conflict of interest was declared. Authors' contributionsFL designed the study and analysed the data, SM collected the data, AA wrote the first draft of the manuscript and KT and FA were responsible for overseeing the study. All authors have seen and approved the final version of the manuscript.