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Purpose: The COVID-19 pandemic has put hospital workers around the world in an unprecedented and difficult situation, possibly leading to emotional difficulties and mental health problems. We aimed to analyze psychological symptoms of the hospital employees of the Paris Saint-Joseph Hospital Group a few months after the 1st wave of the pandemic., Participants and Methods: From July 15 to October 1, 2020, a cross-sectional survey was conducted among hospital workers in the two locations of our hospital group using the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) to measure anxiety, depression, and PTSD symptoms. Factors independently associated with these symptoms were identified., Results: In total, 780 participants (47% caregivers, 18% health administrative workers, 16% physicians, and 19% other professionals) completed the survey. Significant symptoms of anxiety, depression, and PTSD were reported by 41%, 21%, and 14% of the participants, respectively. Hierarchical regression analysis showed a higher risk of having psychological symptoms among those (1) who were infected by SARS-CoV-2 or had colleagues or relatives infected by the virus, (2) who retrospectively reported to have had an anxious experience during the first wave, and (3) with a previous history of burnout or depression. In contrast, job satisfaction appeared to be a protective factor. Overall, hospital workers showed the statistically same levels of anxiety, depression, and PTSD symptoms, regardless of their profession and whether they had worked in units with COVID-19 patients or not., Conclusions: Our cross-sectional survey of 780 hospital workers shows that after the first wave, hospital employees had a significant burden of mental health symptoms. Specific preventive measures to promote mental well-being among hospital workers exposed to COVID-19 need to be implemented, first among particularly vulnerable staff, and then, for all hospital staff for whom anxiety is detected early, and not only those who were directly exposed to infected patients., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Marguerite d’Ussel reports personal fees and non-financial support from Grunenthal, Ethypharm and IPRAD in the previous three years, outside the submitted work. Xavier Durand reports personal fees and non-financial support from JANSSEN, ASTELLAS, RECORDATI and IPSEN in the previous three years, outside the submitted work. Cédric Lemogne reports personal fees and non-financial support from Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical, and Boehringer Ingelheim in the previous three years, outside the submitted work.

Aims: To examine the association between benzodiazepine receptor agonist (BZRA) use and mortality in patients hospitalised for coronavirus disease 2019 (COVID-19)., Methods: A multicentre observational study was performed at Greater Paris University hospitals. The sample involved 14 381 patients hospitalised for COVID-19. A total of 686 (4.8%) inpatients received a BZRA at hospital admission at a mean daily diazepam-equivalent dose of 19.7 mg (standard deviation (s.d.) = 25.4). The study baseline was the date of admission, and the primary endpoint was death. We compared this endpoint between patients who received BZRAs and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, medical comorbidities and other medications. The primary analysis was a Cox regression model with inverse probability weighting (IPW)., Results: Over a mean follow-up of 14.5 days (s.d. = 18.1), the primary endpoint occurred in 186 patients (27.1%) who received BZRAs and in 1134 patients (8.3%) who did not. There was a significant association between BZRA use and increased mortality both in the crude analysis (hazard ratio (HR) = 3.20; 95% confidence interval (CI) = 2.74-3.74; p < 0.01) and in the IPW analysis (HR = 1.61; 95% CI = 1.31-1.98, p < 0.01), with a significant dose-dependent relationship (HR = 1.55; 95% CI = 1.08-2.22; p = 0.02). This association remained significant in sensitivity analyses. Exploratory analyses indicate that most BZRAs may be associated with an increased mortality among patients hospitalised for COVID-19, except for diazepam, which may be associated with a reduced mortality compared with any other BZRA treatment., Conclusions: BZRA use may be associated with an increased mortality among patients hospitalised for COVID-19, suggesting the potential benefit of decreasing dose or tapering off gradually these medications when possible.

Background: The role of nurses in screening for posttraumatic stress disorder is crucial in trauma units., Objectives: To create and evaluate an easy and brief tool for nurses to predict chronic posttraumatic stress disorder 1 year after a motor vehicle crash., Methods: We performed a 1-year follow-up multicenter study from 2007 to 2015, including 274 patients injured in a motor vehicle crash who were hospitalized in an orthopedic trauma unit. Nurses administered the DEPITAC questionnaire. Posttraumatic stress disorder was measured by the Post-Traumatic Stress Disorder Checklist of symptoms during the first year following the crash. A multivariable logistic regression model was implemented to select items significantly associated with posttraumatic stress disorder to improve the DEPITAC questionnaire. Predictive performance to predict posttraumatic stress disorder 1 year after the motor vehicle crash was examined for these different models., Results: Of 274 patients studied, a total of 75.9% completed the questionnaire at 1 year of follow-up. We found that only two questions and two simple elements of the patient's medical record (other injury or a person dying during the crash, perception of vital threat, number of children, and length of stay in trauma) predicted posttraumatic stress disorder 1 year after a motor vehicle crash., Conclusions: The brevity of this evaluation, simple scoring rules, and screening test performance suggest that this new screening tool can be easily administered in the acute care setting by nurses., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Society of Trauma Nurses.)

Objective: Disentangle the temporal relationships between frequency of cannabis use and alcohol consumption., Methods: A cross-lagged model providing standardised coefficients (SCs)±their standard errors in 13 255 men and 13 696 women enrolled in 2015 or 2016 in the French population-based 'CONSulTANts des Centres d'Examens de Santé' (CONSTANCES) cohort. Cannabis use was categorised as follows: 'No use during the past 12 months', 'Use during the past 12 months but not in the past month' and 'Use in the past month' for cannabis use at baseline, and No use during the past 12 months, 'Use less than once per month' and 'Use once per month or more' for cannabis use at 1 year of follow-up. Alcohol consumption was measured at baseline and at 1 year of follow-up and three categories were determined: low risk (<28 drinks per week in men; <14 drinks per week in women), moderate risk (≥28 and<42 in men; ≥14 and<28 in women) and high risk (≥42 in men; ≥28 in women). Analyses were adjusted for age, sex, education, income, tobacco consumption, self-rated health status and depressive symptoms., Results: Both associations from alcohol to cannabis and from cannabis to alcohol were significant (SC=0.02±0.01 with p=0.003 and SC=0.06±0.01 with p<0.001, respectively). However, the SC of the association from cannabis to alcohol was three times higher than the opposite association (p<0.001). After stratification for sex, SCs of the association from cannabis to alcohol were more than two times higher than for the opposite association in men, and more than four times higher in women (both p<0.001)., Conclusions: The association between frequency of cannabis use and subsequent alcohol consumption was stronger than the opposite association. This finding encourages considering the risk of increased alcohol consumption among cannabis users., Competing Interests: Competing interests: GA has received speakers and/or consulting fees from Pfizer, Lundbeck, Zentiva and Pierre Fabre, outside the submitted work. FL has received speaker and/or consulting fees from Janssen-Cilag, Euthérapie-Servier, and Lundbeck, outside the submitted work. CL has received speakers and/or consulting fees from Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical, and Boehringer Ingelheim, outside the submitted work., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners., Design: Systematic review and meta-analysis., Data Sources: Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction., Review Methods: We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels., Results: A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences., Conclusion: These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions., (© 2021 John Wiley & Sons Ltd.)

We examined the prospective association of physical exertion at work with subsequent tobacco, cannabis, alcohol use, and sugar and fat consumption. Volunteers of the French population-based CONSTANCES cohort currently employed were included from 2012 to 2017 for tobacco and cannabis outcomes (n = 100,612), and from 2012 to 2016 for alcohol and sugar and fat outcomes (n = 75,414). High level of physical exertion at work was defined as a score ≥ 12 at the Rating Perceived Exertion Borg scale. Substance use was self-reported and diet rich in sugar and fat was obtained from principal component analysis and analyzed as quartiles. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline physical exertion at work, while adjusting for sociodemographic factors, depressive symptoms and baseline level of consumption. High physical exertion was associated with tobacco use with dose-dependent relationships. It was also associated with increased odds of cannabis use at least once per month compared to no use in the past and with increased odds of diet rich in sugar and fat. Hence, the role of physical exertion at work on tobacco and cannabis use and diet rich in sugar and fat should be tackled for information and prevention strategies., (© 2022. The Author(s).)

Background: In intensive care units (ICUs), the quality of communication with families is a key point in the caregiver-patient-family relationship. During the COVID-19 pandemic, hospital visits were prohibited, and many ICUs implemented a daily telephone call strategy to ensure continuity of communication with patients' families., Objective: To assess how family members and health care providers perceived this communication strategy., Methods: The study was conducted in a 45-bed ICU during the COVID-19 pandemic. Communication with families consisted of a single daily telephone call from the senior physician in charge of the patient to the patient's surrogate decision maker. Satisfaction was qualitatively assessed via an anonymous online questionnaire with open-ended questions., Results: Participants completed 114 questionnaires. Forty-six percent of surrogate decision makers stated that the key medical messages were understandable, but 57% of other family members expressed that the frequency of information delivery was insufficient. Fifty-six percent of the physicians described the practice as functional for the organization of the unit. Among health care providers other than physicians, 55% felt that not having to interact with families decreased their emotional load and 50% mentioned saving time and the absence of task interruptions as positive aspects., Conclusion: Fixed-time, daily telephone calls in the ICU allowed satisfactory transmission of information between physicians and surrogate decision makers, as perceived by both parties. However, the telephone-based communication strategy could still be improved., (©2022 American Association of Critical-Care Nurses.)

Importance: After an infection by SARS-CoV-2, many patients present with persistent physical symptoms that may impair their quality of life. Beliefs regarding the causes of these symptoms may influence their perception and promote maladaptive health behaviors., Objective: To examine the associations of self-reported COVID-19 infection and SARS-CoV-2 serology test results with persistent physical symptoms (eg, fatigue, breathlessness, or impaired attention) in the general population during the COVID-19 pandemic., Design, Setting, and Participants: Participants in this cross-sectional analysis were 26 823 individuals from the French population-based CONSTANCES cohort, included between 2012 and 2019, who took part in the nested SAPRIS and SAPRIS-SERO surveys. Between May and November 2020, an enzyme-linked immunosorbent assay was used to detect anti-SARS-CoV-2 antibodies. Between December 2020 and January 2021, the participants reported whether they believed they had experienced COVID-19 infection and had physical symptoms during the previous 4 weeks that had persisted for at least 8 weeks. Participants who reported having an initial COVID-19 infection only after completing the serology test were excluded., Main Outcomes and Measures: Logistic regressions for each persistent symptom as the outcome were computed in models including both self-reported COVID-19 infection and serology test results and adjusting for age, sex, income, and educational level., Results: Of 35 852 volunteers invited to participate in the study, 26 823 (74.8%) with complete data were included in the present study (mean [SD] age, 49.4 [12.9] years; 13 731 women [51.2%]). Self-reported infection was positively associated with persistent physical symptoms, with odds ratios ranging from 1.39 (95% CI, 1.03-1.86) to 16.37 (95% CI, 10.21-26.24) except for hearing impairment (odds ratio, 1.45; 95% CI, 0.82-2.55) and sleep problems (odds ratio, 1.14; 95% CI, 0.89-1.46). A serology test result positive for SARS-COV-2 was positively associated only with persistent anosmia (odds ratio, 2.72; 95% CI, 1.66-4.46), even when restricting the analyses to participants who attributed their symptoms to COVID-19 infection. Further adjusting for self-rated health or depressive symptoms yielded similar results. There was no significant interaction between belief and serology test results., Conclusions and Relevance: The findings of this cross-sectional analysis of a large, population-based French cohort suggest that persistent physical symptoms after COVID-19 infection may be associated more with the belief in having been infected with SARS-CoV-2 than with having laboratory-confirmed COVID-19 infection. Further research in this area should consider underlying mechanisms that may not be specific to the SARS-CoV-2 virus. A medical evaluation of these patients may be needed to prevent symptoms due to another disease being erroneously attributed to "long COVID."

(1) Background: Based on its antiviral activity, anti-inflammatory properties, and functional inhibition effects on the acid sphingomyelinase/ceramide system (FIASMA), we sought to examine the potential usefulness of the H1 antihistamine hydroxyzine in patients hospitalized for COVID-19. (2) Methods: In a multicenter observational study, we included 15,103 adults hospitalized for COVID-19, of which 164 (1.1%) received hydroxyzine within the first 48 h of hospitalization, administered orally at a median daily dose of 25.0 mg (SD = 29.5). We compared mortality rates between patients who received hydroxyzine at hospital admission and those who did not, using a multivariable logistic regression model adjusting for patients' characteristics, medical conditions, and use of other medications. (3) Results: This analysis showed a significant association between hydroxyzine use and reduced mortality (AOR, 0.51; 95%CI, 0.29-0.88, p = 0.016). This association was similar in multiple sensitivity analyses. (4) Conclusions: In this retrospective observational multicenter study, the use of the FIASMA hydroxyzine was associated with reduced mortality in patients hospitalized for COVID-19. Double-blind placebo-controlled randomized clinical trials of hydroxyzine for COVID-19 are needed to confirm these results, as are studies to examine the potential usefulness of this medication for outpatients and as post-exposure prophylaxis for individuals at high risk for severe COVID-19.

Introduction: Development of fully internet-based programs could provide a new avenue to improve access to healthcare for problem gamblers. In this project, we aim to assess the efficacy of a web-based cognitive intervention targeting inhibitory control among problem gamblers, using a randomised controlled design. As impaired inhibitory control is involved in self-regulation difficulties in behavioural addictions, it represents a particularly relevant cognitive process to target for an online psychological intervention., Methods and Analysis: This will be a single-blinded, randomised, comparative therapeutic web-based, controlled trial. Up to 200 non-treatment seeking adult problem gamblers with a Problem Gambling Severity Index-recent (PGSI-recent) score ≥5 will be included. The intervention will be a computerised cognitive training program targeting inhibitory skills. The comparator, an active control, will be a computerised neutral sensorial program. Both programs will be carried out under similar conditions: biweekly online training for 6 weeks and optional telephone support will be offered to patients for debriefing. The main objective of the study is to assess the clinical efficacy of the online cognitive training program at 6 weeks, measured with the PGSI-recent. The secondary objectives are to assess the efficacy on the gambling behaviour assessed by the account-based gambling data, on the self-reported gambling practice, and on the inhibition performance at the neuropsychological level at 6, 14 and 52 weeks. We will also assess the acceptability of this program and the preferred level of guidance. Data analysis will be in intention-to-treat., Ethics and Dissemination: This randomized controlled trial will be executed in compliance with the Helsinki Declaration, and was approved by the local ethics boards (Comité de Protection des Personnes) in October 2017. The findings will be published in peer-reviewed journals., Trial Registration Number: NCT03673800., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Persistent physical symptoms are common after a coronavirus disease 2019 (COVID-19) episode, but their pathophysiological mechanisms remain poorly understood. In this study, we aimed to explore the association between anxiety and depression at 1-month after acute infection and the presence of fatigue, dyspnea, and pain complaints at 3-month follow-up. Methods: We conducted a prospective study in patients previously hospitalized for COVID-19 followed up for 3 months. The Hospital Anxiety and Depression Scale (HAD-S) was administered by physicians at 1-month follow-up, and the presence of fatigue, dyspnea, and pain complaints was assessed at both 1 month and 3 months. Multivariable logistic regressions explored the association between anxiety and depression subscores and the persistence of each of the physical symptom at 3 months. Results: A total of 84 patients were included in this study (Median age: 60 years, interquartile range: 50.5-67.5 years, 23 women). We did not find any significant interaction between anxiety and the presence of fatigue, dyspnea, or pain complaints at 1 month in predicting the persistence of these symptoms at 3 months (all p ≥ 0.36). In contrast, depression significantly interacted with the presence of pain at 1 month in predicting the persistence of pain at 3 months (OR: 1.60, 95% CI: 1.02-2.51, p = 0.039), with a similar trend for dyspnea (OR: 1.51, 95% CI: 0.99-2.28, p = 0.052). Discussion and Conclusion: Contrary to anxiety, depression after an acute COVID-19 episode may be associated with and increased risk of some persistent physical symptoms, including pain and dyspnea., Competing Interests: CL reports personal fees and non-financial support from Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical, and Boehringer Ingelheim in the previous 3 years, outside the submitted work. The APHP, which employs J-SH, has received research grants from Bioserenity, Sanofi, Servier, and Novo Nordisk. J-SH has received speaker, advisory board or consultancy fees from Amgen, Astra Zeneca, Bayer, Bristol-Myers Squibb, Novartis, WeHealth. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bottemanne, Gouraud, Hulot, Blanchard, Ranque, Lahlou-Laforêt, Limosin, Günther, Lebeaux and Lemogne.)

Objectives: To determine whether the terrorist attacks occurring in Paris on November 2015 have changed benzodiazepine use in the French population., Design: Interrupted time series analysis., Setting: National population-based cohort., Participants: 90 258 individuals included in the population-based CONSTANCES cohort from 2012 to 2017., Outcome Measures: Benzodiazepine use was evaluated according to two different indicators using objective data from administrative registries: weekly number of individuals with a benzodiazepine delivered prescriptions (BDP) and weekly number of defined daily dose (DDD). Two sets of analyses were performed according to sex and age (≤50 vs >50). Education, income and area of residence were additional stratification variables to search for at-risk subgroups., Results: Among women, those with younger age (incidence rate ratios (IRR)=1.18; 95% CI=1.05 to 1.32 for BDP; IRR=1.14; 95% CI=1.03 to 1.27 for DDD), higher education (IRR=1.23; 95% CI=1.03 to 1.46 for BDP; IRR=1.23; 95% CI=1.01 to 1.51 for DDD) and living in Paris (IRR=1.27; 95% CI=1.05 to 1.54 for BDP) presented increased risks for benzodiazepine use. Among participants under 50, an overall increase in benzodiazepine use was identified (IRR=1.14; 95% CI=1.02 to 1.28 for BDP and IRR=1.12; 95% CI=1.01 to 1.25 for DDD) and in several strata. In addition to women, those with higher education (IRR=1.22; 95% CI=1.02 to 1.47 for BDP), lower income (IRR=1.17; 95% CI=1.02 to 1.35 for BDP) and not Paris residents (IRR=1.13; 95% CI=1.02 to 1.26 for BDP and IRR=1.13; 95% CI=1.03 to 1.26 for DDD) presented increased risks for benzodiazepine use., Conclusion: Terrorist attacks might increase benzodiazepine use at a population level, with at-risk subgroups being particularly concerned. Information and prevention strategies are needed to provide appropriate care after such events., Competing Interests: Competing interests: CG, EC, MG and MZ have no conflict of interest to report. GA has received speakers and/or consulting fees from Pfizer, Lundbeck and Pierre Fabre. CL has received speakers and/or consulting fees from Boehringer Ingelheim, Janssen, Lundbeck and Otsuka Pharmaceutical. FL has received speaker and/or consulting fees from AstraZeneca, Lundbeck, Janssen, Roche, Servier and Otsuka Pharmaceuticals., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for COVID-19 pandemic, caused catastrophic health and social effects, but little is known about its consequences on mental health. Other viral infections have been associated with psychiatric sequelae: infection-triggered disturbing of the immune system and the stressful intensive unit care can cause psychological and psychiatric complications. Moreover, SARS-CoV-2 can potentially induce neuronal injuries, leading to neurocognitive disabilities. Previous studies during the COVID-19 pandemic reported a high occurrence rate of psychopathological and neurocognitive conditions among COVID-19 survivors, highlighting the need for screening for these impairments in order to implement early interventions and secondary prevention. However, many psychiatric disorders can take several years to develop, and it is still difficult to differentiate between factors linked to the infection itself or to the global context of the pandemic. In this review, we describe the effects of SARS-CoV-2 infection on mental health, the mechanisms involved in psychiatric and neurocognitive sequelae, and the strategies of prevention and management. More studies are needed to investigate the effects of a range of factors including clinical, sociodemographic, and inflammatory predictors. These efforts could be useful to identify high-risk individuals and inform targeted preventive actions., Competing Interests: CL reports personal fees and non-financial support from Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical, and Boehringer Ingelheim in the previous 3 years, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bottemanne, Delaigue and Lemogne.)

Background: Cognitive complaints are frequent after COVID-19 but their clinical determinants are poorly understood. This study aimed to explore the associations of objective cognitive performances and psychological distress with cognitive complaints in COVID-19 survivors. Materials and Methods: Patients previously hospitalized for COVID-19 in a university hospital during the first wave of COVID-19 pandemic in France were followed-up at 1 month after their admission. Cognitive complaints were self-reported and standardized instruments were used to assess neuropsychological status (Digit Symbol Substitution Test, Semantic Verbal Fluency Test, Mini Mental Status Examination) and psychological distress (Hospital Anxiety and Depression Scale, HADS). Multivariable analyses were adjusted for age, sex, admission in intensive care unit (ICU) and need for oxygen and C-reactive protein. Results: One hundred patients (34% women, median age: 60 years [interquartile range: 49-72)] completed the neuropsychological assessment at follow-up. In multivariable analyses, cognitive complaints at 1-month were associated with greater HADS score (OR for one interquartile range: OR: 1.96, 95% CI: 1.08-3.57) and older age (OR: 1.05, 95% CI: 1.01-1.09) and, negatively, with admission in ICU (OR: 0.22, 95% CI: 0.05-0.90). In contrast, none of the objective neuropsychological test scores was significantly associated with cognitive complaints. Exploratory analysis showed that cognitive complaints were associated with both anxiety and depressive symptoms. Discussion: These preliminary results suggest that cognitive complaints at 1 month after a hospitalization for COVID-19 are associated with psychological distress, independently of objective neuropsychological status. Anxiety and depression symptoms should be systematically screened in patients presenting with cognitive complaints after a severe COVID-19 episode., Competing Interests: CL reports personal fees and non-financial support from Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical, and Boehringer Ingelheim in the previous three years, outside the submitted work. The APHP, which employs J-SH, has received research grants from Bioserenity, Sanofi, Servier and Novo Nordisk. J-SH has received speaker, advisory board or consultancy fees from Amgen, Astra Zeneca, Bayer, Bristol-Myers Squibb, Novartis, WeHealth. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gouraud, Bottemanne, Lahlou-Laforêt, Blanchard, Günther, Batti, Auclin, Limosin, Hulot, Lebeaux and Lemogne.)

Introduction: An observatory of sexual harassment and psychological abuse was set up at one of France's largest schools of medicine to both quantify and reduce sexual harassment or psychological abuse of medical students., Methods: Over a 2-year period, we described the evolution of sexual harassment and psychological abuse and explored for associated factors. Moreover, a qualitative analysis using an inductive approach was performed from students' verbatim., Results: 2795 responses were collected. Sexual harassment was reported in 7% and psychological abuse in 15%, at baseline, and decreased after the observatory was set up. Women had higher odds of being a victim of sexual harassment. Older students reported less often psychological abuse and being a witness of sexual harassment. Surgery departments were associated with up to 5.7-fold increased odds of sexual harassment. Surgery and pediatrics departments were associated with a 2-fold increased odds of psychological abuse. Qualitative analysis revealed four categories: humiliation, the feeling of inferiority, sexual harassment, and manifestations of violence., Conclusion: During clerkships, factors associated with higher odds of sexual harassment and psychological abuse were female gender, younger age, and departments of surgery. Setting up such an observatory may contribute to reduce this burden and provide a useful tool to raise awareness.

A prior meta-analysis showed that antidepressant use in major depressive disorder was associated with reduced plasma levels of several pro-inflammatory mediators, which have been associated with severe COVID-19. Recent studies also suggest that several antidepressants may inhibit acid sphingomyelinase activity, which may prevent the infection of epithelial cells with SARS-CoV-2, and that the SSRI fluoxetine may exert in-vitro antiviral effects on SARS-CoV-2. We examined the potential usefulness of antidepressant use in patients hospitalized for COVID-19 in an observational multicenter retrospective cohort study conducted at AP-HP Greater Paris University hospitals. Of 7230 adults hospitalized for COVID-19, 345 patients (4.8%) received an antidepressant within 48 h of hospital admission. The primary endpoint was a composite of intubation or death. We compared this endpoint between patients who received antidepressants and those who did not in time-to-event analyses adjusted for patient characteristics, clinical and biological markers of disease severity, and other psychotropic medications. The primary analysis was a multivariable Cox model with inverse probability weighting. This analysis showed a significant association between antidepressant use and reduced risk of intubation or death (HR, 0.56; 95% CI, 0.43-0.73, p < 0.001). This association remained significant in multiple sensitivity analyses. Exploratory analyses suggest that this association was also significant for SSRI and non-SSRI antidepressants, and for fluoxetine, paroxetine, escitalopram, venlafaxine, and mirtazapine (all p < 0.05). These results suggest that antidepressant use could be associated with lower risk of death or intubation in patients hospitalized for COVID-19. Double-blind controlled randomized clinical trials of antidepressant medications for COVID-19 are needed., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.)

Depression is common in older individuals and is associated with high disability and mortality. A major problem is treatment resistance: >50% of older patients do not respond to current antidepressants. Therefore, new effective interventions for prevention and treatment of depression in older individuals need to be developed, which requires a better understanding of the mechanisms underlying depression. The pathophysiology of depression is multifactorial and complex. Microvascular dysfunction may be an early and targetable mechanism in the development of depression, notably depression that initiates in late life (late-onset depression). Late-onset depression commonly co-occurs with other diseases or syndromes that may share a microvascular origin, including apathy, cognitive impairment, dementia, and stroke. Together, these disabilities may all be part of one large phenotype resulting from global cerebral microvascular dysfunction. In this review, we discuss the pathophysiology of microvascular dysfunction-related late-onset depression, summarize recent epidemiological evidence on the association between cerebral microvascular dysfunction and depression, and indicate potential drivers of cerebral microvascular dysfunction. We also propose the hypothesis that depression may be a manifestation of a larger phenotype of cerebral microvascular dysfunction, highlight potential therapeutic targets and interventions, and give directions for future research., (Copyright © 2021 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Introduction: Attendance at face-to-face courses is low in the 2nd and 3rd years of medical school in France, possibly because of a lack of interactivity. We used Moodle (an open-source course management system) to introduce blended learning on Infectious Diseases and Microbiology through interactive quizzes and sessions of online-based continuous assessment. This pre-post observational study assessed changes in students' attendance and student as well as teacher satisfaction., Methods: During the 2017-2018 academic session of Infectious Diseases and Microbiology, we used Moodle to include interactive quizzes during courses and to organize five continuous assessment sessions. Pre-post comparisons (2017-2018 vs. 2016-2017) were performed for the following outcomes: attendance rate, satisfaction questionnaire and exam performance. In addition, the students' and teachers' perception of Moodle-based interactive quizzes and continuous assessment sessions in 2017-2018 was assessed with Likert-like scales, closed and open-ended questions. A thematic analysis of the free comments was performed through inductive coding by two coders., Results: In 2017-2018 vs. 2016-2017, mean (±SD) attendance rate was higher [12.5 (±7.2) % vs. 7.9 (±3.5) % of students, P<0.001] and clinical case-based courses, which encompassed 93% of Moodle-based courses in 2017-18, were more frequently considered to improve teaching and learning (81.9% vs. 73.8%, P=0.01). Students more frequently judged the teaching organization and structure to be adequate (85.5% vs. 80.2%, p=0.03) and more frequently recommended to next-year students that they attend courses (96.1% vs. 42.1%, P<0.001)., Conclusion: Using Moodle for blended learning on Infectious Diseases and Microbiology improved student satisfaction and attendance at face-to-face courses., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Aims: Depression is associated with increased risk of cardiovascular disease (CVD) and the role of poor medical adherence is mostly unknown. We studied the association between depressive symptoms and non-adherence to medications targeting treatable cardiovascular risk factors in the CONSTANCES population-based French cohort., Methods and Results: We used CONSTANCES data linked to the French national healthcare database to study the prospective association between depressive symptoms (assessed at inclusion with the Center for Epidemiological Studies Depression scale) and non-adherence to medications (less than 80% of trimesters with at least one drug dispensed) treating type 2 diabetes, hypertension, and dyslipidaemia over 36 months of follow-up. Binary logistic regression models were adjusted for socio-demographics, body mass index, and personal history of CVD at inclusion. Among 4998 individuals with hypertension, 793 with diabetes, and 3692 with dyslipidaemia at baseline, respectively 13.1% vs. 11.5%, 10.5% vs. 5.8%, and 29.0% vs. 27.1% of those depressed vs. those non-depressed were non-adherent over the first 18 months of follow-up (15.9% vs. 13.6%, 11.1% vs. 7.4%, and 34.8% vs. 36.6% between 19 and 36 months). Adjusting for all covariates, depressive symptoms were neither associated with non-adherence to medications for hypertension, diabetes, and dyslipidaemia over the first 18 months of follow-up, nor afterwards. Depressive symptoms were only associated with non-adherence to anti-diabetic medications between the first 3-6 months of follow-up., Conclusion: Non-adherence to medications targeting treatable cardiovascular risk factors is unlikely to explain much of the association between depressive symptoms and CVD at a population level. Clinicians are urged to search for and treat depression in individuals with diabetes to foster medications adherence., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Background: In older patients with cancer, depression is difficult to assess because of its heterogeneous clinical expression. The 4-item version of the Geriatric Depression Scale (GDS-4) is quick and easy to administer but has not been validated in this population. The present study was designed to test the diagnostic performance of the GDS-4 in a French cohort of older patients with cancer before treatment., Materials and Methods: Our cross-sectional analysis of data from the Elderly Cancer Patient cohort covered all patients with cancer aged ≥70 years and referred for geriatric assessment at two centers in France between 2007 and 2018. The GDS-4's psychometric properties were evaluated against three different measures of depression: the geriatrician's clinical diagnosis (based on a semistructured interview), the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and a cluster analysis. The scale's sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver operating characteristic curve (AUROC) were calculated., Results: In a sample of 2,293 patients (median age, 81 years; women, 46%), the GDS-4's sensitivity and specificity for detecting physician-diagnosed depression were, respectively, 90% and 89%. The positive and negative likelihood ratios were 8.2 and 0.11, and the AUROC was 92%. When considering the subset of patients with data on all measures of depression, the sensitivity and specificity values were, respectively, ≥90% and ≥72%, the positive and negative likelihood ratios were, respectively, ≥3.4 and ≤ 0.11, and the AUROC was ≥91%., Conclusion: The GDS-4 appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer., Implications for Practice: Considering the overlap between symptoms of cancer and symptoms of depression, depression is particularly difficult to assess in older geriatric oncology and is associated with poor outcomes; there is a need for a routine psychological screening. Self-report instruments like the 4-item version of the Geriatric Depression Scale appears to be a clinically relevant, easy-to-use tool for routine depression screening in older patients with cancer. Asking four questions might enable physicians to screen older patients with cancer for depression and then guide them toward further clinical evaluation and appropriate care if required., (© 2021 AlphaMed Press.)

Introduction: We examined whether duration of electronic cigarette (e-cigarette) use could be associated with smoking reduction or cessation attempt., Methods: 5,409 current smokers at baseline enrolled in the French CONSTANCES cohort in 2015 or 2016 were included. Duration of e-cigarette use was categorized as follows: never; former user for more than one year; former user for less than one year; new user for less than one year; return to use for less than one year; regular use for one to two years; regular use for more than two years. Two outcomes were considered at one-year of follow-up: change in the number of cigarettes per day and cessation attempt., Results: Compared to never users, former users had an increase in the number of cigarettes per day at follow-up (B = 0.95[95%CI:0.57-1.33] and B = 1.03[95%CI:0.47-1.59] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had a decrease in the number of cigarettes per day (B = -3.31[95%CI:-4.07;-2.54] and B = -4.18[95%CI:-5.06;-3.29] for new users of less than one year and users of more than two years, respectively). Compared to never users, former users had a decreased likelihood of cessation attempt (OR = 0.80[95%CI:0.67-0.95] and OR = 0.77[95%CI:0.60-0.99] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had an increased likelihood of cessation attempt (OR = 3.12[95%CI:2.32;4.19] and OR = 3.36[95%CI:2.39;4.72] for new users of less than one year and users of more than two years, respectively)., Conclusions: E-cigarette use was associated with smoking reduction and cessation attempt for individuals who have used it for less than one year and additional benefits are expected to occur with a longer duration of use. Former users of e-cigarettes had poorer outcomes than those who have never used them., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined., Methods: The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S., Results: The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group., Conclusion: Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Psychotropic drugs such as anxiolytics, antidepressants and antipsychotics may have anticholinergic properties that could directly affect patients' cognition., Objectives: Our objective was to assess the relationship between exposure to anticholinergic-positive (AC+) psychotropic drugs and cognitive impairment compared with psychotropic drugs without anticholinergic activity (AC-)., Methods: This analysis included participants (aged 45-70 years) enrolled between January 2012 and October 2017 in the CONSTANCES cohort treated with psychotropic drugs (antidepressants n = 2602, anxiolytics n = 1195, antipsychotics n = 197) in the 3 years preceding cognitive assessment. Within each drug class, the Anticholinergic Cognitive Burden scale was used to classify drugs as either AC+ or AC-. Cognitive impairment was defined as a score below - 1 standard deviation from the standardized mean of the neuropsychological score. We used multiple logistic regression models and matching on propensity score to estimate the relationship between anticholinergic activity and cognitive impairment., Results: Our analyses did not show any increased risk of cognitive impairment for AC+ antidepressants and anxiolytics, with the exception of a slight increase for AC+ antidepressants in episodic memory (odds ratio [OR] 1.19; 95% confidence interval [CI] 1.05-1.36). Conversely, we found a more marked increase in risk with AC+ antipsychotics on executive function (Trail Making Test-A [TMT-A], OR 4.49 [95% CI 2.59-7.97] and TMT-B, OR 3.62 [95% CI 2.25-5.89])., Conclusion: Our results suggest there is no clinically relevant association between the anticholinergic activity of antidepressant and anxiolytic drugs and cognitive impairment in middle-aged adults. An association could exist between AC+ antipsychotics and executive function.

Background: Psychiatric comorbidities are frequent in patients admitted in general hospital and are associated with greater lengths of stay (LOS). Early consultation-liaison psychiatry (CLP) interventions may reduce the LOS but previous studies were underpowered to allow subgroup analyses and have generally not considered the severity of the condition for which patients were admitted ('disease severity')., Aims: To investigate the association between the timing of CLP interventions and LOS in a general hospital., Method: We retrospectively included 4500 consecutive patients admitted in non-psychiatric wards of a university hospital between 2008 and 2016 who had a first CLP intervention. We used general linear models to examine the association between the referral time, defined as log(days before the consultation)/log(LOS), and log(LOS), adjusting for age, gender, year of admission, place of residence, main psychiatric diagnosis, admission to the intensive care unit (ICU), main physical condition and disease severity., Results: Referral time was associated with log(LOS) (β = 0.31; P <0.001), notably for older patients (β = 0.43; P <0.001) and those admitted to the ICU (β = 0.50; P <0.001), but not for those with psychotic disorders (β = -0.20; P = 0.10). The association was confirmed when considering the expected LOS for each patient. For instance, for an expected LOS of 10 days, a CLP intervention on day 3 compared with day 6 was associated with a reduction of the actual LOS of 2.4 days., Conclusions: Earlier CLP interventions were associated with a clinically significant shorter LOS in a large population even after adjusting for disease severity. Early CLP interventions may have benefits for both patients and health-related costs.

Introduction: Chlorpromazine has been suggested as being potentially useful in patients with coronavirus disease 2019 (COVID-19) on the grounds of its potential antiviral and anti-inflammatory effects., Objective: The aim of this study was to examine the association between chlorpromazine use and mortality among adult patients hospitalized for COVID-19., Methods: We conducted an observational, multicenter, retrospective study at Assistance Publique-Hôpitaux de Paris (AP-HP) Greater Paris University hospitals. Study baseline was defined as the date of first prescription of chlorpromazine during hospitalization for COVID-19. The primary endpoint was death. Among patients who had not been hospitalized in intensive care units (ICUs), we compared this endpoint between those who received chlorpromazine and those who did not, in time-to-event analyses adjusted for patient characteristics, clinical markers of disease severity, and other psychotropic medications. The primary analysis used a Cox regression model with inverse probability weighting. Multiple sensitivity analyses were performed., Results: Of the 14,340 adult inpatients hospitalized outside ICUs for COVID-19, 55 patients (0.4%) received chlorpromazine. Over a mean follow-up of 14.3 days (standard deviation [SD] 18.2), death occurred in 13 patients (23.6%) who received chlorpromazine and 1289 patients (9.0%) who did not. In the primary analysis, there was no significant association between chlorpromazine use and mortality (hazard ratio [HR] 2.01, 95% confidence interval [CI] 0.75-5.40; p = 0.163). Sensitivity analyses included a Cox regression in a 1:5 ratio matched analytic sample that showed a similar result (HR 1.67, 95% CI 0.91-3.06; p = 0.100) and a multivariable Cox regression that indicated a significant positive association (HR 3.10, 95% CI 1.31-7.34; p = 0.010)., Conclusion: Our results suggest that chlorpromazine prescribed at a mean daily dose of 70.8 mg (SD 65.3) was not associated with reduced mortality.

Background: Haloperidol, a widely used antipsychotic, has been suggested as potentially useful for patients with COVID-19 on the grounds of its in-vitro antiviral effects against SARS-CoV-2, possibly through sigma-1 receptor antagonist effect., Methods: We examined the associations of haloperidol use with intubation or death and time to discharge home among adult patients hospitalized for COVID-19 at Assistance Publique-Hôpitaux de Paris (AP-HP) Greater Paris University hospitals. Study baseline was defined as the date of hospital admission. The primary endpoint was a composite of intubation or death and the secondary endpoint was discharge home among survivors in time-to-event analyses. In the primary analyses, we compared these two outcomes between patients receiving and not receiving haloperidol using univariate Cox regression models in matched analytic samples based on patient characteristics and other psychotropic medications. Sensitivity analyses included propensity score analyses with inverse probability weighting and multivariable Cox regression models., Results: Of 15,121 adult inpatients with a positive COVID-19 PT-PCR test, 39 patients (0.03%) received haloperidol within the first 48 hours of admission. Over a mean follow-up of 13.8 days (SD = 17.9), 2,024 patients (13.4%) had a primary end-point event and 10,179 patients (77.6%) were discharged home at the time of study end on May 1st. The primary endpoint occurred in 9 patients (23.1%) who received haloperidol and 2,015 patients (13.4%) who did not. The secondary endpoint of discharge home occurred in 16 patients (61.5%) who received haloperidol and 9,907 patients (85.8%) who did not. There were no significant associations between haloperidol use and the primary (HR, 0.80; 95% CI, 0.39 to 1.62, p = 0.531) and secondary (HR, 1.30; 95% CI, 0.74 to 2.28, p = 0.355) endpoints. Results were similar in multiple sensitivity analyses., Conclusion: Findings from this multicenter observational study suggest that haloperidol use prescribed at a mean dose of 4.5 mg per day (SD = 5.2) for a mean duration of 8.4 days (SD = 7.2) may not be associated with risk of intubation or death, or with time to discharge home, among adult patients hospitalized for COVID-19., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: NH has received personal fees and non-financial support from Lundbeck, outside the submitted work. FL has received speaker and consulting fees from Janssen-Cilag, Euthérapie-Servier, and Lundbeck, outside the submitted work. CL reports personal fees and non-financial support from Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical, and Boehringer Ingelheim, outside the submitted work. GA reports personal fees from Pfizer, Pierre Fabre and Lundbeck, outside the submitted work. Other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The prevalence of psychological symptoms and the co-occurrence of substance abuse disorders in adult patients with Langerhans cell histiocytosis (LCH) has not been previously explored. We aimed to use validated scales to evaluate depression and anxiety symptoms experienced by adult LCH patients., Methods: In this cross-sectional study, all consecutive adult LCH patients seen at our national reference center between January 2012 and January 2013 were asked to complete the following instruments: the Hospital Anxiety and Depression scale (HADS); Barratt Impulsiveness Scale, Version 10 (BIS-10); and Cannabis Use Disorders Identification Test (CUDIT). Self-reported scores on these scales were used to determine the point prevalence of clinically significant psychological symptoms and substance use disorders in LCH patients. Patient profiles in terms of psychological features were assessed by principal component analysis including the HADS and BIS-10 instruments values, followed by hierarchical clustering. Fisher exact tests and Wilcoxon tests were used to examine the associations between disease-related parameters and high levels of anxiety and impulsivity., Results: Seventy-one adult LCH patients, mainly with pulmonary LCH (PLCH), completed the evaluations. Clinically significant anxiety and depression symptoms were reported by 22 (31%) and 4 (6%) subjects, respectively. Impulsivity was detected in 14% (10/71) of the patients. Seventeen percent (12/71) of the patients used cannabis on a regular basis, with 50% of these individuals (6/12) exhibiting scores consistent with cannabis use disorder. Three derived clusters of patients were identified in the principal component analysis; these patient clusters differed in successful weaning from tobacco at the time of evaluation (p = 0.03). In univariate analyses, isolated PLCH and the use of psychotropic treatments were statistically associated with clinically significant anxiety symptoms., Conclusions: High levels of anxiety and impulsivity are common in adult patients with LCH. The consequences of these symptoms for the management of LCH patients warrant further evaluation., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following updated competing interests: G. Lorillon reports travel accomodation from Chiesi and VitalAire; A Tazi reports personal fees from Chiesi, travel accomodation from VitalAire, Astrazeneca, and Boehringer Ingelheim, outside the submitted work. All other authors have declared that no competing interest exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objectives: To describe the role of the internet and cognitive biases in the controversy surrounding chronic Lyme disease. The attribution of chronic but aspecific symptoms to Lyme borreliosis is a source of worldwide controversy., Patients and Methods: Some patients attribute their aspecific symptoms to Lyme borreliosis even though, in fact, they have a functional somatic syndrome., Results: These patients' diagnostic and therapeutic wandering contributes to the above attribution and to their suffering. The Internet has deregulated the information market. Cognitive confirmation bias contributes to confinement in belief. Negativity bias explains the tendency of the human brain to select the most alarming information available. The narrative force of alarmist videos or personal testimonies acts like a nocebo effect. The social exclusion generated by adherence to this belief is a factor of reinforcement and aggravation., Conclusions: Deconstructing chronic Lyme disease with empathy and conviction is in patients' best interests., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: Inconsistent association between depression and hypertension has been highlighted. The association of depression with blood pressure (BP) might depend upon socioeconomic status (SES), but evidence remains weak., Objectives: This study aimed to examine how the associations between depressive symptoms and BP levels and hypertension and then, according to SES variables (education, income, occupational status)., Methods: Among 66,478 volunteers of the French CONSTANCES cohort (31,093 men; mean age (standard deviation): 47.8 (12.9) years), depressive symptoms were assessed with the Center of Epidemiologic Studies Depression scale (CES-D). Overall associations between depressive symptoms and BP and hypertension were estimated using regressions and by stratifying on SES., Results: SES were associated with BP in both genders. CES-D score was negatively associated with systolic BP (SBP) in women (b=-0.62 95%CI [-1.03; -0.21] and in men (b=-1.03 95%CI [-1.45; -0.61]) but not with diastolic BP (DBP) in both genders. In women, the decrease in SBP and DBP was more pronounced as educational level increases (p for interaction: 0.012 and 0.013, respectively). In men, few interactions were observed between CES-D score and SES factors for BP levels. The association between CES-D score and hypertension was significant for men, OR=0.86, 95%CI [0.80; 0.93] but not for women, OR=1.03, 95%CI [0.96; 1.10]. No interactions were observed between CES-D score and SES for hypertension., Conclusion: Gender differences were observed for considering depressive symptoms according to SES factors for BP variation and hypertension. In women, educational level was the SES factor which has the main modifying effect on this association., (Copyright © 2020. Published by Elsevier B.V.)

Purpose of Review: To review evidence regarding the association between bipolar disorder and schizophrenia, henceforth referred to as severe mental disorders (SMD), and cardiovascular morbidity and mortality, its mechanisms, and the interventions to reduce this burden., Recent Findings: Much of the loss in life expectancy in people with SMD remains driven by cardiovascular mortality. Antipsychotics and mood stabilizers are associated with negative cardio-metabolic outcomes, but large inter-individual differences are observed, and not treating SMD might be associated with even greater cardiovascular mortality. Classical modifiable cardiovascular risk factors remained inadequately screened and, once identified, too seldom treated in people with SMD. After a myocardial infarction, aggressive tertiary prevention may be as effective in people with SMD as in the general population but is less prescribed. Reduced healthcare quality and increased prevalence of cardiovascular risk factors may not fully explain the excess cardiovascular mortality associated with SMDs, which themselves should be considered risk factors in risk calculators. Hazardous health behaviors, the cardio-metabolic adverse effects of medications, and a reduced access to quality healthcare remain priority targets for intervention.

Background : Our aim was to examine whether work conditions could be associated with alcohol use even after taking into account life conditions outside of work. Methods : In 2019, 591 consecutive French workers were screened for alcohol use with the Fast Alcohol Consumption Evaluation (FACE). Ten different work conditions and four life conditions outside of work were assessed with 5-item Likert scales. Sociodemographic factors, smoking status and the Copenhaguen Burn-out Inventory were also collected. The associations between each work condition and FACE total score were examined with generalized linear models. Results : After adjusting for sociodemographic factors, the following work conditions were associated with a decreased FACE total score: "positive and/or grateful feedback on your work" ( B  = -0.22 (95%CI: -0.37; -0.07), p  = 0.004), "time to do your job well" ( B  = -0.19 (95%CI: -0.35; -0.03), p  = 0.019) and "freedom to organize your work" ( B  = -0.25(95%CI: -0.43; -0.08), p  = 0.004). After further adjusting for life conditions outside of work, "positive and/or grateful feedback on your work" ( B  = -0.18 (95%CI: -0.33; -0.03), p  = 0.021) and "freedom to organize your work" ( B  = -0.20(95%CI: -0.38; -0.02), p  = 0.027) remained significantly associated with FACE total score. Additional adjustments for smoking status and burnout did not alter these results. Conclusions : Life conditions outside of work should not interfere with how improvements work conditions can help reduce alcohol use.

Background: Since the first successful facial transplantation in 2005, the benefits of this procedure in terms of aesthetics, functionality, and quality of life have been firmly established. However, despite immunosuppressive treatment, long-term survival of the allograft might be compromised by chronic antibody-mediated rejection (CAMR), leading to irreversible necrosis of the tissue. In the absence of therapeutic options, this complication is inevitably life-threatening., Methods: We report facial retransplantation in a man, 8 years after his first facial transplantation because of extensive disfigurement from type 1 neurofibromatosis and 6 weeks after complete loss of his allograft due to severe CAMR. We describe the chronology of immune-related problems that culminated in allograft necrosis and the eventual loss of the facial transplant, the desensitisation protocol used for this highly immunosensitised recipient, the surgical technicalities of the procedure, the specific psychological management of this patient, and the results from follow-up at 30 months., Findings: Although the patient had a complicated postoperative course with numerous immunological, infectious, cardiorespiratory, and psychological events, he was discharged after a hospital stay of almost 1 year. He has since been able to re-integrate into his community with acceptable restoration of his quality of life., Interpretation: This clinical report of the first documented human facial retransplantation is proof-of-concept that the loss of a facial transplant after CAMR can be mitigated successfully by retransplantation combined with an aggressive desensitisation process., Funding: Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The perceived importance of clinical empathy may decline among students during medical training. Several interventions have been shown to be effective in promoting or preserving medical students' empathic abilities, such as empathy skills training or Balint groups. Although narrative medicine training shares some features with these interventions, no randomized study to date examined the efficacy of narrative medicine training. This study aimed to assess the effects of Balint groups and narrative medicine training on clinical empathy measured by the self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students., Methods: Students who gave their consent to participate were randomly allocated in equal proportion to Balint groups, narrative medicine training or to the control group. Participants in the intervention groups received either seven sessions of 1.5-h Balint groups or a 2-h lecture and five sessions of 1.5-h narrative medicine training from October 2015 to December 2015. The main outcome was the change in JSPE-MS© score from baseline to one week after the last session., Results: Data from 362 out of 392 participants were analyzed: 117 in the control group, 125 in the Balint group and 120 in the narrative medicine group. The change in JSPE-MS© score from baseline to follow-up was significantly higher in the Balint group than in the control group [mean (SD): 0.27 (8.00) vs. -2,36 (11.41), t = 2.086, P = 0.038]. The change in JSPE-MS© score in the narrative medicine group [mean (SD): - 0.57 (8.76)] did not significantly differ from the changes in the control group (t = 1.355, P = 0.18) or the Balint group (t = 0.784, P = 0.43). Adjusting for participants' characteristics at baseline, Balint groups remained associated with better outcomes compared to the control group (β = 2.673, P = 0.030)., Conclusions: Balint groups may promote clinical empathy to some extent among medical students, at least in the short run.

Objective: People with panic disorder are at increased risk of suicide. Multiple factors influence their risk suggesting a need to combine them into an integrative model to develop more effective suicide prevention strategies for this population. In this report, we sought to build a comprehensive model of the 3-year risk of suicide attempt in individuals with panic disorder using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005)., Method: We used structural equation modeling to simultaneously examine effects of six broad groups of clinical factors previously identified as potential predictors of suicide attempt in adults with panic disorder: 1) severity of panic disorder, 2) severity of comorbidity, 3) prior history of suicide attempt, 4) family history of psychiatric disorders, 5) sociodemographic characteristics and 6) treatment-seeking behavior., Results: The 3-year prevalence rate of suicide attempt was 4.6%. A general psychopathology factor, lower physical health-related quality of life, prior suicide attempt and a greater number of stressful life events at baseline significantly and independently predicted suicide attempt between the two waves (p < .05). R-square of the models ranged from 0.47 to 0.50., Conclusion: This model may help inform future research and identify high-risk individuals among adults with panic disorder., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: The COVID-19 pandemic has led to an urgent reorganisation of the healthcare system to prevent hospitals from overflowing and the virus from spreading. Our objective was to evaluate the socioeconomic and psychological impact of the COVID-19 outbreak on radiologists., Material and Methods: French radiologists were invited to answer an online survey during the pandemic through mailing lists. The questionnaire was accessible for nine days. It covered socio-demographic information, exposure to COVID-19 at work and impact on work organisation, and included the Insomnia Severity Index and Hospital Anxiety and Depression Scale. Outcomes were moderate to severe insomnia, definite symptoms of depression or anxiety. Risk and protective factors were identified through multivariate binary logistic regression., Results: 1515 radiologists answered the survey. Overall, 674 (44.5 %) worked in a highCOVID-19 density area, 671 (44.3 %) were women, and 809 (53.4 %) worked in private practice. Among responders, 186 (12.3 %) expressed insomnia, 222 (14.6 %) anxiety, and 189 (12.5 %) depression symptoms. Lack of protective equipment, increased teleradiology activity and negative impact on education were risk factors for insomnia (respectively OR [95 %CI]:1.7[1.1-2.7], 1.5[1.1-2.2], and 2.5[1.8-3.6]). Female gender, respiratory history, working in COVID-19 high density area, increase of COVID-19 related activity, and impacted education were risk factors for anxiety (OR[95 %CI]:1.7[1.2-2.3], 2[1.1-3.4], 1.5[1.1-2], 1.2[1-1.4], and 2.1[1.5-3]). Conversely, working in a public hospital was a protective factor against insomnia, anxiety, and depression (OR[95 %CI]:0.4[0.2-0.7], 0.6[0.4-0.9], and 0.5[0.3-0.8])., Conclusions: During COVID-19 pandemic, many radiologists expressed depression, anxiety and insomnia symptoms. Working in a public hospital was a protective factor against every psychological symptom. Socio-economic impact was also major especially in private practice., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The role of alcohol, tobacco and cannabis use in social differences in terms of depression is poorly understood., Method: We have applied mediation and moderated-mediation models stratified by gender to a population-based sample (N = 37,192) of French men and women from the Constances cohort with baseline and follow-up measures of depressive states. We have examined whether socioeconomic status (SES, measured by education and income) differences in the prevalence of depressive states may be explained by both differences in prevalence of substance use according to SES (mediating effects) and differential effects of substance use on depressive state according to SES (moderating effects)., Results: In the mediation models, substance use only explained 5.3% and 2.4% of the association between low education and depressive state in men and women respectively, and was not a significant mediator for income. Moderated mediation models showed robust moderation effects of education and income in both men and women. The association of tobacco use with depressive symptoms, which was the only substance for which a mediation effect remained and for which the moderation effect of SES was the strongest, was significantly higher in participants with low SES., Limitations: The partially cross-sectional nature of the data restricts the possibility of drawing causality with regards to associations between SES and substance use., Conclusion: Targeting substance use, particularly tobacco, can especially reduce depression risk in individuals of low SES., Competing Interests: Declaration of Competing Interest Dr. Hoertel has received personal fees and non-financial support from Lundbeck, outside the submitted work. Dr. Limosin reports non-financial support from Otsuka Pharmaceutical, outside the submitted work. Cédric Lemogne has received speaker and consulting fees from Boehringer Ingelheim, Janssen-Cilag, Lundbeck and Otsuka, outside the submitted work. The other authors have nothing to declare., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Cross-sectional results have suggested a linear association between the number of dietary exclusions and depressive symptoms. This longitudinal study aimed to examine the direction of this association. Methods : In the population-based Constances cohort, depressive symptoms were defined by a score ≥19 on the Centre of Epidemiologic Studies-Depression (CES-D) scale. Diet was measured with a 24-item qualitative food frequency questionnaire (FFQ). Both variables were available at inclusion (from 2012 to 2014) and on follow-up (2015 for the CES-D and 2017 for diet). Food exclusion was categorized into five different groups: No exclusion, exclusion of one, two, three, or ≥4 food groups according to the self-reported number of food groups rarely or never consumed. Logistic regressions were conducted, either taking depressive symptoms as the outcome on follow-up with dietary exclusions at baseline as predictor or with the opposite, adjusting for age, sex, education, income, alcohol intake, smoking, physical activity, and anemia. The path analysis included outcomes and covariates in one model. Results : The median follow-up was three years. A total of 29,337 participants (53.4% women, 48.15 ± 12.9 y.o.) had complete CES-D data and 25,356 (53.56% women, 49.05 ± 12.8 y.o.) FFQ data. Dietary exclusion at inclusion predicted depressive symptoms at follow-up (odds ratio [95% confidence interval]: 2.35 [1.62-3.40] for ≥4 excluded items compared to no exclusions). Depressive symptoms at inclusion predicted dietary exclusions at follow-up (3.45 [1.93-6.16] for ≥4 excluded items). In the path analysis, the standardized estimate of the association between dietary exclusions at inclusion and depressive symptoms at follow-up was by far higher than the opposite (0.1863 and 0.00189, respectively, both p < 0.05). Conclusions : The association of dietary exclusion with subsequent depression is stronger than the opposite association.

Context: Most medical doctors are likely to work with patients experiencing mental health conditions. However, educational opportunities for medical doctors to achieve professional development in the field of psychiatry are often limited. Simulation training in psychiatry may be a useful tool to foster this development., Objectives: The purpose of this study was to assess the effectiveness of simulation training in psychiatry for medical students, postgraduate trainees and medical doctors., Methods: For this systematic review and meta-analysis, we searched eight electronic databases and trial registries up to 31 August 2018. We manually searched key journals and the reference lists of selected studies. We included randomised and non-randomised controlled studies and single group pre- and post-test studies. Our main outcomes were based on Kirkpatrick levels. We included data only from randomised controlled trials (RCTs) using random-effects models., Results: From 46 571 studies identified, we selected 163 studies and combined 27 RCTs. Interventions included simulation by role-play (n = 69), simulated patients (n = 72), virtual reality (n = 22), manikin (n = 5) and voice simulation (n = 2). Meta-analysis found significant differences at immediate post-tests for simulation compared with active and inactive control groups for attitudes (standardised mean difference [SMD] = 0.52, 95% confidence interval [CI] 0.31-0.73 [I 2  = 0.0%] and SMD = 0.28, 95% CI 0.04-0.53 [I 2  = 52.0%], respectively), skills (SMD = 1.37, 95% CI 0.56-2.18 [I 2  = 93.0%] and SMD = 1.49, 95% CI 0.39-2.58 [I 2  = 93.0%], respectively), knowledge (SMD = 1.22, 95% CI 0.57-1.88 [I 2  = 0.0%] and SMD = 0.72, 95% CI 0.14-1.30 [I 2  = 80.0%], respectively), and behaviours (SMD = 1.07, 95% CI 0.49-1.65 [I 2  = 68.0%] and SMD = 0.45, 95% CI 0.11-0.79 [I 2  = 41.0%], respectively). Significant differences in terms of patient benefit and doctors' behaviours and skills were found at the 3-month follow-up., Conclusions: Despite heterogeneity in methods and simulation interventions, our findings demonstrate the effectiveness of simulation training in psychiatry training., (© 2020 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Anemia is known to be associated with depression both in community and clinical populations. However, it is still unknown if this association depends or not on antidepressant intake. We investigated the respective association of depression and antidepressant intake with low hemoglobin level in a large community-based cohort. In 8640 volunteers aged 50 to 75 recruited between June 2008 and June 2012 in Paris (France), we assessed hemoglobin levels (g/dl), depressive symptoms and antidepressant intake. We examined the association of both depression and antidepressant intake with hemoglobin level, adjusting for numerous socio-demographic and health variables. We also assessed the association with specific antidepressant classes. Depression and antidepressant intake were independently associated with lower hemoglobin level (β = -0.074; p = .05 and β = -0.100; p = .02 respectively in the fully-adjusted model). Regarding antidepressant classes, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) intake were associated with lower hemoglobin level (β = -0.11; p = .01). To conclude, both depression and antidepressant intake were associated with lower hemoglobin level. In particular, as SSRI or SNRIs intake was also related to lower hemoglobin level, these classes should be used with caution in depressed individuals at risk for anemia., Competing Interests: Declaration of competing interest HV reports a research grant from Servier. CL reports consulting or speaker fees from Boehringer-Ingelheim, Janssen, Lundbeck and Otsuka Pharmaceuticals, outside the submitted work. ND has received research grants from Amgen, Astra-Zeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Eli-Lilly, Merck, Pfizer, and Sanofi and fees for lectures or consulting for Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, Eli-Lilly, MSD, Novo-Nordisk, Pfizer, Sanofi, and Servier. FL reports consulting, investigator or speaker fees from AstraZeneca, Janssen, Lundbeck, Roche and Servier, and non-financial support from Lundbeck and Otsuka Pharmaceutical. Other authors have no conflicts of interest to declare., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has caused major sanitary crisis worldwide. Half of the world has been placed in quarantine. In France, this large-scale health crisis urgently triggered the restructuring and reorganization of health service delivery to support emergency services, medical intensive care units and continuing care units. Health professionals mobilized all their resources to provide emergency aid in a general climate of uncertainty. Concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising. The goal of the present article is to provide up-to-date information on potential mental health risks associated with exposure of health professionals to the COVID-19 pandemic., Methods: Authors performed a narrative review identifying relevant results in the scientific and medical literature considering previous epidemics of 2003 (SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 pandemic. We highlighted most relevant data concerning the disease characteristics, the organizational factors and personal factors that may contribute to developing psychological distress and other mental health symptoms., Results: The disease characteristics of the current COVID-19 pandemic provoked a generalized climate of wariness and uncertainty, particularly among health professionals, due to a range of causes such as the rapid spread of COVID-19, the severity of symptoms it can cause in a segment of infected individuals, the lack of knowledge of the disease, and deaths among health professionals. Stress may also be caused by organizational factors, such as depletion of personal protection equipment, concerns about not being able to provide competent care if deployed to new area, concerns about rapidly changing information, lack of access to up-to-date information and communication, lack of specific drugs, the shortage of ventilators and intensive care unit beds necessary to care for the surge of critically ill patients, and significant change in their daily social and family life. Further risk factors have been identified, including feelings of being inadequately supported, concerns about health of self, fear of taking home infection to family members or others, and not having rapid access to testing through occupational health if needed, being isolated, feelings of uncertainty and social stigmatization, overwhelming workload, or insecure attachment. Additionally, we discussed positive social and organizational factors that contribute to enhance resilience in the face of the pandemic. There is a consensus in all the relevant literature that health care professionals are at an increased risk of high levels of stress, anxiety, depression, burnout, addiction and post-traumatic stress disorder, which could have long-term psychological implications., Conclusions: In the long run, this tragic health crisis should significantly enhance our understanding of the mental health risk factors among the health care professionals facing the COVID-19 pandemic. Reporting information such as this is essential to plan future prevention strategies. Protecting health care professionals is indeed an important component of public health measures to address large-scale health crisis. Thus, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented, and to strengthen prevention and response strategies by training health care professionals on mental help and crisis management., (Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Ranking antidepressants according to their acceptability (i.e. a combination of both efficacy and tolerability) in the general population may help choosing the best first-line medication. This study aimed to rank antidepressants according to the proportion of filled prescription sequences consistent with a continuation of the first treatment versus those consistent with a change. A first step was validating this measure as a proxy of acceptability by examining the association of these two kinds of sequences with levels of depressive symptoms. Among 64,467 individuals included in the French population-based Constances cohort, reimbursements of antidepressants from January 2009 to December 2015 were extracted from the French national health insurance system claims database. Depressive symptoms were measured at inclusion with the Center for Epidemiologic Studies-Depression scale (CES-D). Between January 2010 and December 2015, 6675 participants newly initiated an antidepressant (34.5% men, mean (SD) age: 48.3 (12.1) years). Among the subsample of participants included during the six-month period following treatment initiation, individuals with continuation sequences had lower levels of depressive symptoms than those with change sequences (mean (SE) CES-D score: 18.9 (0.8) versus 26.5 (2.1), p < 0.001). According to the continuation/change ratio observed over this six-month period in all participants, escitalopram ranked first, followed by sertraline, venlafaxine, citalopram, fluoxetine and paroxetine. In an independent replication sample representative of the French national population, the same six medications ranked first, with escitalopram remaining in first place. The proportion of filled prescription sequences consistent with a continuation versus a change of the first prescribed treatment may provide a widely available measure of antidepressant acceptability in community practice., Competing Interests: Declaration of competing interest Dr. Hoertel reports personal fees and non-financial support from Lundbeck, non-financial support from Otsuka, outside the submitted work. Dr. Limosin reports personal fees from Lundbeck, personal fees from Servier, personal fees from Janssen-Cilag, outside the submitted work; Dr. Olfson reports personal fees from Lundbeck, outside the submitted work; Carlos Blanco holds stock in Sanofi, Eli Lilly and General Electric, outside the submitted work; Dr. Fossati has received personal fees and non-financial support from Lundbeck and personal fees from Servier. Dr. Haffen reports personal fees and non-financial support from Lundbeck, personal fees and non-financial support from Janssen-Cilag, personal fees and non-financial support from Otsuka, personal fees and non-financial support from Servier, non-financial support frim Livanova, outside the submitted work; Dr. Lemogne reports personal fees and non-financial support from Boehringer Ingelheim, personal fees from Janssen-Cilag, personal fees and non-financial support from Lundbeck, personal fees and non-financial support from Otsuka, outside the submitted work. Mr. Olekhnovitch, Dr. Fagot-Campagna, Dr. Goldberg and Dr. Zins have nothing to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Psychological factors such as hostility and depression have been associated with cardiovascular disease. However, their role in predicting incident cardiac events independently one of another is not clear., Methods: Among 10,304 GAZEL middle-aged workers free of cardiovascular diseases in 1993, 581 incident cardiac events were validated from 1994-2014. Hostile traits (cognitive hostility, behavioral hostility, irritability and negativism) were assessed with the Buss and Durkee Hostility Inventory at baseline. Depressive symptoms were assessed at baseline and every three years with the Center for Epidemiological Studies Depression scale. We used Cox proportional hazards models to calculate hazard ratios (HR) of hostile traits for incident cardiac events adjusting for baseline self-reported socio-demographics and family history of coronary heart diseases (model 1), then additionally for time-dependent depressive symptoms (either as a binary or continuous variable) (model 2) and for yearly self-reported modifiable cardiovascular risk factors (physical activity, smoking, body mass index, diabetes, dyslipidemia and hypertension) (model 3)., Results: In Model 1, the only hostile trait associated with incident cardiac events was irritability (HR for one interquartile range: 1.16, 95% confidence interval: 1.02-1.32). This association was no longer statistically significant when further adjusting for depressive symptoms. Depressive symptoms, in turn, remained significant predictors of cardiac events with HRs ranging from 1.40-1.49 (binary)., Limitations: Hostility traits were measured only once., Conclusions: Depressive symptoms might explain the association between irritability and cardiac events and should therefore be prioritized in interventions aiming to prevent cardiovascular disease. Further research is needed to identify the mechanisms underlying this association., Competing Interests: Declaration of Competing Interest Cédric Lemogne declares grants, personal fees and non-financial support from Lundbeck, personal fees from Boehringer Ingelheim, personal fees from Janssen, non-financial support from Otsuka Pharmaceutical, outside the submitted work. Frédéric Limosin declares personal fees and non-financial support from Lundbeck, and non-financial support from Janssen-Cilag and Otsuka Pharmaceutical, outside the submitted work. For the remaining authors none were declared., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: Self-rated health and depressive symptoms have been shown to improve upon retirement. Participants with obesity might benefit more of retirement because of the extra work-related burden they are carrying. The present study aimed to investigate whether the association between retirement and health changes may depend upon obesity in the large French GAZEL occupational cohort during 21 years of follow-up., Methods: 17,655 men and women were included in the analyses. Self-rated health was measured on a scale from 1 to 8 with 8 being very bad. Depressive symptoms were measured at four time points by the CES-D score. Mixed models examined the association of self-rated health or depressive symptoms with time (i.e. from -10 years before to +10 years after retirement), retirement, body mass index (BMI), and their interactions., Results: Regardless of retirement, BMI was associated with poorer health. Positive BMI by time interactions showed a less favorable time course of both health indicators in the presence versus the absence of obesity (0.024 versus 0.014 and - 0.19 versus -0.07 points per year for self-rated health and depressive symptoms, respectively). However, negative BMI by retirement interactions showed that the improvement of health observed upon retirement was stronger in with the presence versus the absence of obesity (-0.4 versus -0.3 and - 2.42 versus -1.70 points for self-rated health and depressive symptoms, respectively)., Conclusion: Improvement upon retirement was observed in the presence of obesity and was even higher than in the presence of normal weight and overweight., Competing Interests: Declaration of Competing Interest CL reports personal fees and non-financial support from Boehringer Ingelheim, Janssen-Cilag, Lundbeck and Otsuka Pharmaceutical, outside the submitted work. SC reports personal fees from Novo, Lilly, Servier, BMS, outside the submitted work. SC holds share of MyGoodLife.Other authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Aim: Type A personality has been associated with increased survival in people with type 1 diabetes (T1D). Systemic low-grade inflammation may play a critical role, as suggested in recent reports, although the links between the inflammatory circulating transcriptome and Type A remain unknown. This prompted our exploration of the potential associations between Type A personality and c-Fos gene expression, a candidate gene closely linked to inflammatory processes, in T1D., Methods: Type A personality was assessed by Bortner questionnaire in patients with T1D, and two subscales - 'speed' and 'competitiveness' - were used to measure these specific dimensions of Type A. Expression of the c-Fos gene was assessed by a quantitative real-time polymerase chain reaction technique., Results: This pilot study included 20 men with T1D. Multivariable analyses showed an independent inverse association between Type A competitiveness score and c-Fos expression, while a regression model adjusted for age, body mass index and HbA 1c levels revealed a significant inverse relationship between c-Fos transcripts and Type A competitiveness (P = 0.003)., Conclusion: This strong association between Type A competitiveness and reduced c-Fos expression is in line with recent data suggesting a psychobiological influence of the Type A profile in T1D via inflammatory pathways., (Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Objective: The aim was to investigate the potential association between hearing impairment and incident depressive symptoms., Methods: Using a prospective community-based cohort study in France (the Paris Prospective Study III), participants aged 50-75 years were recruited between 2008 and 2012 and thereafter followed up every 2 years up to 2018. Hearing impairment, measured at study recruitment by audiometry testing, was defined as a pure tone average >25 decibels in the better ear. Incident depressive symptoms, measured using the validated 13-item Questionnaire of Depression 2 nd version, was assessed during follow-up. Multivariate generalized estimating equations were used to compute odds ratio (OR) and 95% confidence intervals (CI)., Results: Among 7591 participants free of depressive symptoms at baseline (mean age 59.8 years, 63% of men), 14.3% had hearing impairment. Over 6 years of follow-up, 479 subjects (6.3%) had incident depressive symptoms. The OR for incident depressive symptoms was 1.36 for subjects with baseline hearing impairment (95% CI, 1.06-1.73). A pooled analysis of 4 published prospective studies yielded a multivariable relative risk of baseline hearing impairment for incident depressive symptoms of 1.29 (95% CI, 1.09-1.53)., Conclusions: In this community-based prospective cohort study of participants aged 50 to 75 years, baseline hearing impairment was associated with a 36% increased odds of incident depressive symptoms., (Copyright © 2019 Elsevier Inc. All rights reserved.)