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Aim: The aim of this study was to determine the prevalence of adolescents engaged in cyber-bullying and then to identify whether students involved in cyber- and school bullying present the same characteristics of internalizing problems (insomnia, perceived social disintegration, psychological distress) and externalizing problems (general aggressiveness, antisocial behavior)., Method: Semi-structured interviews were conducted with 738 adolescents from a high-school and a middle-school (mean age=14.8 ± 2.7). The Electronic Bullying Questionnaire and the Olweus Bully/Victim Questionnaire were used to identify profiles of cyber-bullying (cyber-victim, cyber-bully, cyber-bully/victim and cyber-neutral) and school bullying (victim, bully, bully/victim and neutral). Internalizing problems were investigated using the Athens Insomnia Scale, a Perceived Social Disintegration Scale and a Psychological Distress Scale. Externalizing problems were assessed using a General Aggressiveness Scale and an Antisocial Behavior Scale., Results: Almost one student in four was involved in cyber-bullying (16.4% as cyber-victim, 4.9% as cyber-bully and 5.6% as cyber-bully/victim); 14% of our sample was engaged in school bullying as a victim, 7.2% as a bully and 2.8% as a bully/victim. The majority of adolescents involved in cyber-bullying were not involved in school bullying. With regard to the problems associated with school bullying, internalizing problems were more prevalent in victims and bully/victims, whereas externalizing problems were more common in bullies and bully/victims. A similar pattern was found in cyber-bullying where internalizing problems were characteristic of cyber-victims and cyber-bully/victims. Insomnia was elevated in the cyber-bully group which is specific to cyberbullying. General aggressiveness and antisocial behavior were more prevalent in cyber-bullies and cyber-bully/victims. Looking at the differences between types of bullying, victims of "school only" and "school and cyber" bullying had higher scores for insomnia and perceived social disintegration than victims of "cyber only" bullying or students "non-involved". Higher general aggressiveness scores were observed for "school only" bullies and "school and cyber" bullies than for bullies in "cyber only" bullying or students "non-involved". Regarding antisocial behavior, "school only" bullies, "cyber only" bullies, "school and cyber" bullies had higher scores than students "non-involved"., Discussion: This study highlights the importance of investigating both school and cyber-bullying as many psychosocial problems are linked to these two specific and highly prevalent forms of bullying., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: Streptococcus pneumoniae is a significant cause of morbidity-mortality: leading agent of community-acquired pneumonia and the first cause of death due to infectious diseases in France. Vaccines are available for children and adults, avoiding serious complications. We studied hospitalizations for pneumococcal pneumonia in Centre region in 2004-2008, using the 2004-2008 national hospital discharges database and assessed vaccine coverage of a sample population., Methods: Hospital discharges with diagnosis of pneumococcal pneumonia were selected, using the corresponding code (J13) in the French Diagnosis-Related Group coding system. We analysed hospitalization and patient data using linkage of the inpatient stays with their anonymous identification number. We analysed hospitalization and patient data: number and length of stay/patient, co-morbid factors and pneumococcal immunisation status., Results: One thousand five hundred and forty-one hospitalisations were found for pneumococcal pneumonia in Centre Region, in 2004-2008. The time pattern showed an annual increase in hospital stays: winter hospitalisations were most frequent. The median age was 58 years, range: 2 months-106 years. The sex ratio M/F of the 1417 distinct inpatients was 1.43. The hospital impact was substantial, with prolonged length of stay (mean=9.9 days), frequent stays in intensive care unit (20%) and high death rate (6%). The vaccine coverage of the population with pneumococcal pneumonia was only 23%., Conclusion: Using the national hospital discharges database, this study presents a snapshot of pneumococcal pneumonia in one French region and demonstrates the local major clinical impact, as found in France. It shows that the hospital discharge database is a potential tool for epidemiology despite its possible bias. This type of study could be useful for organizing a regional vaccination campaing due to the better knowledge of the disease., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: To describe the clinical forms and epidemiology of Lyme borreliosis, in French adult patients hospitalized in Indre-et-Loire (Centre region)., Methods: Patients were recruited from standardized discharge summaries collected in the hospital database. All adult patients, hospitalized in public hospitals of the Indre-et-Loire administrative district, over a period of 8 years (1999-2006), who satisfied the European diagnostic criteria of Lyme borreliosis, were included., Results: Encoding of Lyme borreliosis had a poor positive predictive value (65%). Forty-seven adult patients presented with the 50 following clinical forms: erythema migrans (n=5), neuroborreliosis (n=32), knee single-joint arthritis (n=4), acrodermatitis chronica atrophicans (n=3), carditis (n=2), ocular borreliosis (n=2), miscellaneous (n=2). Three patients had a combination of two different clinical forms. Meningoradiculitis was the most frequent neurologic manifestation. When a cranial nerve was involved, it was constantly the facial nerve, and mainly bilaterally. Few patients in our study had erythema migrans: these patients are usually treated in a general medicine setting. Although the incidence in the Centre region was lower than in some other regions of France and Europe, the clinical spectrum of the disseminated forms was similar., Conclusion: This cohort illustrates the diversity of clinical manifestations of Lyme borreliosis in hospitalized patients, particularly at disseminated and late stages as well as the complexity of its diagnosis and its epidemiological surveillance., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

Urinary albumin excretion (UAE) may be assayed on a morning urinary sample or a 24 h-urine sample. Values defining microalbuminuria are: 1) 24-h urine sample: 30-300 mg/24 h; 2) morning urine sample: 20-200 mg/ml or 30-300 mg/g creatinine or 2.5-25 mg/mmol creatinine (men) or 3.5-35 mg/mmol (women); 3) timed urine sample: 20-200 mug/min. The optimal use of semi-quantitative urine test-strip is not clearly defined. It is generally believed that microalbuminuria reflects a generalized impairment of the endothelium; however, no definite proof has been obtained in humans., In Diabetic Subjects: Microalbuminuria is a marker of increased risk of cardiovascular (CV) and renal morbidity and mortality in type 1 and type 2 diabetic subjects. The increase in UAE during follow-up is associated with greater CV and renal risks in type 1 and type 2 diabetic subjects; its decrease during follow-up is associated with lower risks. IN NON-DIABETIC SUBJECTS: Microalbuminuria is a marker of increased risk for diabetes mellitus, deterioration of renal function, CV morbidity and all-cause mortality. It is a marker of increased risk for the development of hypertension in normotensive subjects, and is associated with unfavorable outcome in patients with cancer and lymphoma. Persistence of elevated UAE during follow-up is associated with poor outcome in some hypertensive subjects. Measurement of UAE may be recommended in hypertensive medium-risk subjects with 1 or 2 CV risk factors in whom CV risk remains difficult to assess, and in those with refractory hypertension: microalbuminuria indicates a high CV risk and must lead to strict control of arterial pressure. Studies focused on microalbuminuria in non-diabetic non-hypertensive subjects are limited; most of them suggest that microalbuminuria predicts CV complications and deleterious outcome. Subjects with a history of CV or cerebrovascular disease have an even greater CV risk if microalbuminuria is present than if it is not; however, in all cases, therapeutic intervention must be aggressive regardless of whether microalbuminuria is present or not. It is not recommended to measure UAE in non-diabetic non-hypertensive subjects in the absence of history of renal disease. Monitoring of renal function (UAE, serum creatinine and estimation of GFR) is recommended annually in all subjects with microalbuminuria., Management: In patients with microalbuminuria, weight reduction, sodium restriction (<6 g per day), smoking cessation, strict glucose control in diabetic subjects, strict arterial pressure control are necessary; in diabetic subjects: use of maximal doses of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are recommended; ACEI/ARB and thiazides have synergistic actions on arterial pressure and reduction of UAE; in non-diabetic subjects, any of the five classes of anti-hypertensive medications (ACEI, ARB, thiazides, calcium channel blockers or beta-blockers) can be used.