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In France, Mental Disorders (MD) are the second most common medical cause of unfitness-for-work notices. The main objective is to describe the MD causing permanent medically unfitness at the workstation. A cross-sectional multicenter survey was conducted among employees followed by 323 physicians from occupational health services of the South of France in 2017. The MD responsible for unfitness for the job were coded according to the ICD-10 nomenclature and their occupational origin was estimated by each physician. On 359,966 employees screened, 2,788 were unfitted. Among the 2,779 unfitness cases which were analysed, 985 were unfitted for MD. The incidence rate of unfitness for MD was 2.78 unfit per 1,000 employees followed. Representing 36.8% (985 cases) of all grounds for unfitness, MD were estimated to be work-related in 614 (63.6%) of cases. The main MD were 449 (45.6%) cases of major depressive episodes, 227 (23.0%) anxiety disorders and 131 (13.3%) recurrent depressive disorders. Their occupational origin was mentioned in 296 (67.3%), 168 (74.7%), 62 (49.6%) cases and the link with a Burnout (BO) in 166 (38.3%), 61 (27.9%) and 41 (34.2%) cases respectively among 364 all pathologies reported to a BO. Unfitness for MD was more common among women (ORa = 1.79 95% CI [1.50–2.13]), working in trade, transport, accommodation and catering (ORa = 1.47 95% CI [1.04–2.09]) and increase with age (ORa = 4.24 95% CI [2.73–6.60] for over 55). Major depressive episodes represent the MD most frequently responsible for unfitness and the most related to occupational origin. [ABSTRACT FROM AUTHOR]

Cross-linguistic studies describing the syllabic structures of babbling productions agree on the high prevalence of the CV structure, but few have addressed the other types of syllables emerging during this pre-linguistic stage. However, studying the evolution of the distribution of syllabic structures during babbling would make it possible to test both the influence of motor constraints and the influence of the perceptually based patterns from the infant's language environmental input on the production of early syllables. A monthly follow-up of 22 French infants from 8 to 14 months showed that the distribution CV>V> CCV>CVC>VC was shared by the majority of infants in the sample and remained the same throughout the observation period. The comparison of the frequencies of the structures observed with those attested in adult-French and in 4 other languages (Dutch, Korean, Moroccan Arabic and Tunisian Arabic) revealed significant differences between all adult samples and infant productions. The results have implications for understanding the nature of factors impacting syllable production at the babbling stage. We discuss the possibility that the target language does not affect the production of babbled syllables. [ABSTRACT FROM AUTHOR]

Optimal management of patients experiencing persistent low-level viremia (LLV) remains challenging and poorly understood. This study aimed to assess the association between poor antiretroviral treatment (ARV) adherence and persistent LLV. ADHELOW is a sub-study of the ECHEC cohort comprising HIV-infected adults with virological failure (viral load>50 copies/mL). Patients were recruited in 2013–2015 from 4 French university hospitals. Those with LLV (i.e., ≥2 viral load measurements between 50 and 500 copies/mL) were selected and matched on age and sex to 3 controls with virological suppression. The adherence rate was estimated using pharmacy-delivered prescription refills over one year. Overall, 60 patients were included (15 LLV and 45 controls). Mean age was 50.20 years, M/F sex ratio was 14 and mean EPICES (social deprivation) score was 42.90. In univariable analyses, LLV patients had significantly lower adherence (<80%: 53.30% vs. 6.67%, p < 0.01) and were more likely to have an EPICES score >40.2 (60.00% vs. 24.44%, p < 0.01). In multivariable analysis, these two variables remained significantly associated with LLV (OR 31.49, CI 95% [4.54–218.70]) and OR 11.00 (CI 95% [1.87–218.70], respectively). Poor long-term treatment adherence, estimated by prescription refills, was strongly associated with LLV. This reinforces the message that adherence counseling should be the primary intervention to overcome LLV. [ABSTRACT FROM AUTHOR]

The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40–54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%,p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11–6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients’ lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older. [ABSTRACT FROM PUBLISHER]

Background:Infective endocarditis (IE) due to gram-negative bacilli (GNB) is rare. However, several studies described a change in the epidemiological profile of patients within the past few years.Methods:We reviewed all cases diagnosed and followed in the infectious diseases ward of a French teaching hospital in Paris between 2009 and 2014, inclusive.Results:Among the 17 patients with definite GNB-IE (11 male, mean age 54 years), 12 (70%) were due to non-HACEK GNB and 5 (30%) to HACEK group GNB. A prosthetic valve was involved in 10 cases (8 in non-HACEK and 2 in HACEK group).Escherichia coli(4/12 patients) andPseudomonas aeruginosa(3/12 patients) were the most common pathogens in the first group; all the pathogens in the second group wereHaemophilusspp. One-third of the patients with non-HACEK GNB had nosocomial IE, whereas injection drug use-related infections were rare (2/12). All patients with HACEK infection had at least one complication (intracardiac abscess, stroke or other systemic embolization). All patients were treated by antibiotic combination therapy during a median time of 42 days (interquartile range (IQR) = 42–42) and 10 (59%) underwent cardiac surgery. One death at 9 months was observed in the non-HACEK group.Conclusions:Regarding HACEK IE, this report supports the frequent association with vascular complications. Regarding non-HACEK GNB IE, this report supports the increasing proportion of nosocomial infections. We reported a high proportion of surgery in the therapeutic management of both HACEK and non-HACEK groups associated with no in-hospital mortality. [ABSTRACT FROM AUTHOR]

Primary objective: To determine the features of stroke-related HO in a large sample of patients and to assess if HO risk is increased by haemorrhagic stroke. Research design: A case control study (risk factor of a rare event using retrospective analysis). Methods and procedures: Sixty-one patients with stroke-81 troublesome HOs-were included, each was matched with four controls, i.e. 244 patients with no HO after stroke. Matching criteria were age (±3.5 years) and sex. Data recorded were time from stroke to surgery, ischaemic or haemorrhagic stroke and presence of HO risk factors. Main outcomes and results: Mean age at time of stroke = 46.02 ± 11.4 years (15.9-76.3) for the case sub-group. Time from stroke to surgery = 23.4 ± 27.8 months (3.6-150.0). There was a significant relationship between haemorrhagic stroke and HO development (OR = 3.01; 95% CI = 1.14-7.98; p < 0.05), but not for ischaemic stroke. This became non-significant when all matching and risk factors were included in the model (adjusted OR = 1.98; 95% CI = 0.60-6.54; p = 0.26). Conclusion: Haemorrhagic stroke appears to increase the risk of HO development. Further studies are required to determine if this risk factor is independent from other comorbid factors. [ABSTRACT FROM AUTHOR]

Background: Benzodiazepines (BZD) and nonbenzodiazepines hypnotics (z-drugs) are recognized as one of the most widely prescribed medications in the world. Objectives: The purpose of the study was to assess the BZD and z-drugs dependence in young to middle-aged outpatients who were taking BZD/z-drugs on a chronic basis, and to characterize their profile. Methods: This is a forward-looking cross-sectional epidemiological study. Data were collected through a semi-structured interview within a network of partner pharmacies from the Nantes area, in France. All data were obtained exclusively through patients' declarations. 212 patients (19-64 years old) were included: they were considered dependent when they answered positively to at least three items of the DSM IV. A multivariate logistic regression and a principal component analysis (PCA) were carried out to determine their profile. Results: Almost half of the patients met criteria for BZD/z-drugs dependence. The risk to develop BZD/z-drugs dependence is significantly associated with psychiatric history and with the quantity of BZD/z-drugs that is taken. A two factor concept of dependence could be identified according to the PCA: one axis with items of 'tolerance' and 'long term administration or higher doses', and a second axis with 'concerned by treatment' and 'somatic consequences'. Conclusions/Importance: Among this BZD/z-drug dependent population, the two axes identified in the PCA represent two profiles of dependence: being in positive conditioning or suffering from negative consequences. Clinicians need to know them: these two clinical profiles may have an influence in terms of decision-making, especially to manage discontinuation. [ABSTRACT FROM AUTHOR]

Background: In France, the estimated annual incidence of infective endocarditis (IE) is 33.8 cases per million residents. Valvular surgery is frequently undergone. We report an epidemiological and economic study of IE for 2007 - 2009 in a French region, using the hospital discharge database (HDD). Methods: The population studied concerned all the patients living in Centre region, France, hospitalized for IE. We extracted hospital stay data for IE from the regional HDD, with a definition based on IE-related diagnosis codes. The predictive positive value (PPV) and sensitivity (Se) of the definition were 87.4% and 90%, respectively, according to the Duke criteria (definite IE frequency 74.4%). Hospitalization costs were estimated, taking into account the fi xed hospital charges of the diagnosis-related group (DRG) and supplementary charges due to intensive care unit (ICU) stay. Results: The analysis included 578 patients. The annual average incidence was 45.4 cases per million residents. Valvular surgery was performed in 19.4% of cases. The hospital mortality was 17.6%. Multivariate analysis identified as risk factors for mortality an age ≥ 70 years (odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.78 - 5.18), staphylococcal IE (OR = 3.3, 95% CI = 1.9 - 5.7), chronic renal insufficiency (OR = 2.04, 95% CI = 1.00 - 4.15), ischemic stroke (OR = 2.55, 95% CI = 1.19 - 5.47), and hemorrhagic stroke (OR = 5.7, 95% CI = 1.9 - 17.3). The average cost per episode was $20 103 (€ 15 281). Conclusions: We report a higher incidence of IE than described by the French national study of 2008. Valvular surgery was considerably less frequent than in the published data, whereas mortality was similar. IE generates substantial costs. [ABSTRACT FROM AUTHOR]