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International audience; Objective: To simultaneously investigate the psychometric properties of three recently developed health literacy measurement scales throughout adolescence in the general population. Methods: French versions of the Health Literacy for School-Aged Children (HLSAC, unidimensional) scale, the Health Literacy Assessment Scale for Adolescents (HAS-A, multidimensional) and the 16-item European Health Literacy Survey questionnaire (HLS-EU-Q16, unidimensional) were completed by 1 444 adolescents in 8th, 9th, 11th grade in general school and 11-12th grade in vocational school. Psychometric properties were studied using confirmatory factor analysis, McDonald's omega coefficient and hypothesis testing. Results: Structural validity was acceptable (HLS-EU-Q16) to good (HAS-A and HLSAC), no measurement invariance issue was found and internal consistency was acceptable for the three scales (0.68-0.84). Convergent validity was low (Pearson correlation coefficients < 0.5) and the only scale for which results were in agreement with a priori hypotheses was the HLSAC. Conclusions: Our results were supportive of the use of HLSAC to assess health literacy during adolescence but the HAS-A, with a slightly better structural validity, can also be promoted due to its three measured dimensions. Practice implications: The use of these scales in practice will help to focus on health literacy, a critical factor for prevention and health promotion in adolescence.

The purpose of this study is to clarify the relationship between having a chronic condition (CC) and several types of risky sexual behaviour (RSB) among adolescents and young adults. We used data from a multicentre cross-sectional study carried out on 14,431 adolescents from 137 French schools. Logistic regression was used to assess the association between several types of RSB and CCs among the 2680 participants aged 17 years or over who reported sexual intercourse. Survival analysis was conducted to assess the association between CCs and age at first sexual intercourse across the whole sample. Analyses were conducted separately by gender with and without adjustment for the parents' education level, early menarche and subjective wellbeing (relationship with mother and father, depression, perceived health status and liking school). Among boys, having a CC was associated with a higher risk of RSB in both univariate (OR: 1.58 [95% CI: 1.10-2.27]) and multivariate analyses (aOR: 1.62 [95% CI: 1.11-2.38]). Among girls, the association between chronic condition and RSB in univariate analysis was non-significant (OR: 1.30 [95% CI: 0.97-1.76]) and disappeared after adjustment on subjective wellbeing (aOR: 1.08 [95% CI: 0.78-1.49]). There was no association between CC and age at first sexual intercourse. Conclusion: There were major gender differences. Boys with a CC were more prone to engage in RSB independent of their subjective wellbeing, whereas in girls, subjective wellbeing seemed to mediate the relationship between CC and RSB. Clinicians should be aware of those gender differences in order to deliver preventive strategies regarding sexuality that target both genders. What is Known: • Young people with chronic conditions have a higher likelihood of engaging in risky sexual behaviour. • Engaging in such behaviours can be much more costly, as it can weaken their underlying state of health. What is New: • We found major gender differences. Boys were more prone to engage in risky behaviour independent of their subjective wellbeing, whereas in girls, it seemed to play an important role. • By understanding how risky sexual behaviour differs according to gender, clinicians can deliver prevention messages that target both genders.

Migrant adolescents in therapy for psychological problems are at risk of poor attendance or even of dropping out. Transcultural psychotherapy has been developed in France to take cultural diversity into account in psychological treatment and to deal with the specific difficulties encountered in the psychotherapeutic treatment of this population. This study aims to assess adolescents’ attendance rates to this form of psychotherapy and to explore the association of these rates with demographic, cultural, and clinical variables. We conducted a retrospective clinical cohort study of 148 adolescents aged from 11 to 20 years treated between 2008 and 2018 at two transcultural psychotherapy centers in Paris. Statistical analyses tested demographic, cultural, and clinical hypotheses. The main result was the high attendance rate at transcultural psychotherapy sessions among adolescents (77.8%). Attendance rates were not associated with age, gender, family size, generation of migration, or cultural area of origin, but were significantly linked to support in therapy, specifically, the presence at the first transcultural psychotherapy session of the first-line therapist, an interpreter, or both. Transcultural psychotherapy appears to be an effective method for addressing the complex symptoms experienced by migrant adolescents. Better attendance at sessions is statistically significantly associated with factors favoring a therapeutic alliance, specifically, the presence of the first-line therapist or an interpreter in TPT sessions and the existence of support from a social worker. The holistic approach of transcultural psychotherapy to adolescent care may explain the high attendance rates observed.

BackgroundTranscultural psychotherapy (TPT) is an original therapeutic method developed in various forms in France and several other countries in Europe as well as North America to address issues of migrant mental health care when psychosocial, economic, or cultural barriers hinder its accessibility and effectiveness. This study aims to describe the patients referred for TPT in Paris and its suburbs over the past decade, to examine intercultural differences and associations with social, demographic, and clinical variables, and to assess TPT in terms of patient adherence, attendance, and duration of care.MethodRetrospective study of 529 patients referred for TPT care, classified in three categories-no treatment, initiated treatment, engaged and continuing treatment. Collection and analysis of social, demographic, cultural, and clinical data, as well as of country of origin, duration of treatment, number of sessions attended (adherence), and number of sessions scheduled.ResultsIn all, 301 patients from 45 countries participated in an 11-month course of care lasting an average of 8 sessions. Most were children, accompanied by their families. The main psychiatric symptoms at the beginning of treatment were depressive, and the main cultural problem identified was the existence of a traditional theory explaining the illness in the family's culture. Patients kept 80% of their appointments for sessions, and attendance was not associated with socio-cultural or clinical variables.ConclusionThe high level of treatment adherence and attendance over time suggest that TPT is an effective method for addressing complex symptoms experienced by migrant families. Results highlighted the potential richness and originality of studies based on retrospective medical data.

To determine the influence of patient depression (and anxiety) on postoperative outcome and surgeons' consideration of it.Patients' mental state influences the course of nonpsychiatric diseases. Evidence in the surgical setting comes mainly from cardiac-surgery patients and no predictive-model of postoperative outcome considers this dimension.This prospective multicenter study included patients undergoing liver resections, a model of major abdominal surgery, between September 2013 and September 2014 in 8 centers. The primary outcome was postoperative morbidity or mortality (assessed by the Clavien-Dindo grade and the Comprehensive Complication Index) and the postoperative length of stay (LOS). Depression and anxiety were assessed preoperatively with the Hospital Anxiety and Depression Scale and a validated cutoff. Surgeons were preoperatively asked to predict outcome. Multivariable mixed-effects Cox models were fitted to evaluate the influence of depression on actual and surgeon-anticipated outcome and on the difference between actual and surgeon-anticipated LOS.Hospital Anxiety and Depression Scale identified 142 of 591 patients (24.0%) as depressed and 40.3% as anxious. Neither condition was independently correlated with morbidity or mortality, but depression was an independent risk factor for prolonged LOS (adjusted hazard ratio 0.65, 95% confidence interval 0.50-0.83, P = 0.001). Depression was not correlated with anticipated LOS. Three variables explained the gap between anticipated and actual LOS: depression (P = 0.003), associated surgical procedures in addition to liver resection (P = 0.007), and postoperative morbidity (P 0.001).Nearly 1 quarter of patients undergoing major abdominal surgery are depressed preoperatively. This depression is a strong independent predictor of prolonged LOS and partly explains surgeons' failure to predict outcome accurately.

Depressive, anxiety and obsessive symptoms frequently co-occur with anorexia nervosa (AN). The relationship between these clinical manifestations and the biological changes caused by starvation is not well understood. It has been hypothesised that reduced availability of tryptophan (TRP) could reduce serotonin activity and thus trigger these comorbid symptoms. The aim of this study, during re-feeding in individuals with AN, was to analyse covariations across measures of nutritional status, depressive and anxiety symptoms, and peripheral serotonin markers. Depressive and anxiety symptoms, nutritional status and serotonin markers--whole blood serotonin content, plasma TRP and the ratio between TRP and large neutral amino acids--were assessed for 42 AN participants at admission to inpatient treatment and after re-feeding. Biological measures were compared to those obtained in 42 non-eating disordered subjects. For those with AN, psychological, nutritional and biological parameters improved significantly during hospitalisation. Levels of serotonin markers were significantly lower in the AN group compared to the control group, at admission and at discharge. Increase in the TRP/LNAA ratio was correlated with a decrease in depressive symptoms. In addition, there was a positive correlation between serotonin levels and symptoms of both anxiety and depression at discharge. We speculate that enhanced TRP availability during re-feeding, as a result of the increase in the TRP/LNAA ratio, could restore serotonin neurotransmission and lead to a decrease in depressive symptoms. The association between serotonin and anxiety and depressive symptoms would be consistent with numerous observations indicating abnormal functioning of the serotoninergic system in AN.

The objectives of the present study were to describe the prescribing patterns for psychosocial therapies in routine clinical practice and to assess the impact of psychoeducation on symptoms and social autonomy of patients with schizophrenia. We used data from the nationwide French ESPASS observational cohort study including 5967 patients with schizophrenia, which provided data on exposure to psychosocial therapies from 4961 (83%) participants. Patients who initiated psychosocial therapy within the first 3 months of study onset (n=143) were compared to patients not subject to psychosocial therapy throughout follow up (n=4268), using parametric tests. Symptom severity and social autonomy at 6 months from baseline were compared between patients undergoing psychoeducation (n=117) and patients not subject to psychosocial therapy, matched (1:1) on propensity scores. Patients who initiated psychosocial therapy were significantly younger, more severely ill and used less often antipsychotic drugs than patients in the reference group. At 6 months, patients who initiated psychoeducation and their matched referents did not differ significantly in terms of symptom severity, but their level of improvement in social autonomy was significantly greater (p=0.005). In routine clinical practice, psychoeducation in addition to antipsychotic drugs provides some benefit among schizophrenia patients, particularly in terms of social autonomy.

Aim To assess the association between first reactions to cannabis and the risk of cannabis dependence. Design A cross-sectional population-based assessment in 2007. Setting A campus in a French region (Champagne-Ardennes). Participants A total of 1472 participants aged 18–21 years who reported at least one life-time cannabis consumption, of 3056 students who were screened initially [the Susceptibility Addiction Gene Environment (SAGE) study]. Measurements Positive and negative effects of first cannabis consumptions, present cannabis dependence and related risk factors were assessed through questionnaires. Findings The effects of first cannabis consumptions were associated dose-dependently with cannabis dependence at age 18–21 years, both according to the transversal approach of the SAGE study and to the prospective cohort of the Christchurch Health and Development Study (CHDS) assessed at the age of 25 years. Participants of the SAGE study who reported five positive effects of their first cannabis consumption had odds of life-time cannabis dependence that were 28.7 (95% confidence interval: 14.6–56.5) higher than those who reported no positive effects. This association remains significant after controlling for potentially confounding factors, including individual and familial variables. Conclusions This study suggests an association between positive reactions to first cannabis uses and risk of life-time cannabis dependence, this variable having a central role among, and through, other risk factors.

The association between cannabis use and health or behaviour problems is quite well established. Little is known about the risk markers related to occasional or former use. This work aims to explore associations between well-being in life and different levels of cannabis use.A total of 16 934 French adolescents completed self-administered multi-choice questionnaires (from the European Study ESPAD 2003) on substance consumption, psychopathology, socio-demographics and schooling. Four groups were defined according to cannabis use: Never-Users (no lifetime consumption and no consumption during the last month), Former Users (at least one lifetime consumption but none in the last month), Current Occasional Users (5 times during the previous month) and Current Heavy Users (or =5 times during the previous month). Analyses were performed with SAS 8.2 software and adjusted for gender and age.A total of 68.2% of students aged 12-19 years were Never-Users, 15.5% Former Users, 8.3% Current Occasional Users and 8.0% Current Heavy Users. When Former Users were compared with Never-Users, significant differences were found with regard to suicide attempt, odds ratio (OR) = 2.9 (2.4-3.4); multiple acts of violence, OR = 6.4 (5.4-7.7) and running away from home, OR = 3.1 (2.5-3.8). These differences were greater when Current Occasional Users were compared with Never-Users: suicide attempt, OR = 4.2 (3.5-5.0); multiple acts of violence, OR = 12.6 (10.2-15.5) and running away from home OR = 4.2 (3.4-5.4). Differences remain even after adjustment for alcohol and tobacco consumption.These results showed that occasional and even former marijuana use is associated with risky behaviour among adolescents.

Kremen 1 and 2 (Krm1/2) are transmembrane receptors for Wnt antagonists of the Dickkopf (Dkk) family and function by inhibiting the Wnt co-receptors LRP5/6. Here we show that Krm2 functions independently from Dkks during neural crest (NC) induction in Xenopus. Krm2 is co-expressed with, and regulated by, canonical Wnts. Krm2 is differentially expressed in the NC, and morpholino-mediated Krm2 knockdown inhibits NC induction, which is mimicked by LRP6 depletion. Conversely, krm2 overexpression induces ectopic NC. Kremens bind to LRP6, promote its cell-surface localization and stimulate LRP6 signaling. Furthermore, Krm2 knockdown specifically reduces LRP6 protein levels in NC explants. The results indicate that in the absence of Dkks, Kremens activate Wnt/β-catenin signaling through LRP6.

This paper aimed to look for the existence of a common core when envisaging intra-familial interactions as perceived by adolescents, which could be shared by sociology, psychoanalysis and child and adolescent psychiatry. An empirical study based on a mixed-method design collected the responses of 194 adolescents to the instruction "In the next half hour, would you please write as freely as you wish about your relationships in your family, explaining how things are". All answers were then analyzed and 18 dimensions related to 3 different theoretical frameworks were rated blind using numerical scores by two independent raters from each discipline. Inter-rater reliability was good. A parallel analysis evidenced a strong underlying factor explaining a large amount of variance (>50%). This factor is bipolar, it reflects the level of positivity/negativity in the adolescent's point of view concerning his/her intra-familial relationships. A second factor can marginally be considered (10% of the variance). The 2-factor analysis found one factor related to positive feelings and the other to negative feelings. This finding of unidimensionality supports family study as an intervention science.

International audience; AbstractBackgroundThe relationship between depression and aggressive behaviors in adolescents has previously been reported in clinical and epidemiological studies. However, there is conflicting evidence concerning the effect of gender on this relationship. This study tested whether the link between depressive symptoms and physical aggression differed between boys and girls in a large community-based sample of adolescents.MethodsA cross-sectional sample of adolescents aged 15–19 (N = 6,677) was studied within the 2007 ESPAD national survey. Depressive symptoms were assessed using the Adolescent Depression Rating Scale. We distinguished adolescents with subthreshold levels of depressive symptoms and adolescents with clinically significant levels of depressive symptoms. Physical aggressive behaviors in the last year were reported using items from the Antisocial Behavior Scale.ResultsAfter adjusting for confounding variables, the odds-ratio between depressive symptoms and physical aggressive behaviors was around 1.4. This relationship was stronger for girls than for boys in presence of clinically significant levels of depressive symptoms, but did not differ between the genders in the case of subthreshold levels of depressive symptoms.ConclusionsGirls with severe depressive symptoms were more likely to present physical aggressive behaviors than boys. Future studies will be needed to explore the role of irritability in these differences.

Kremen1 and 2 (Krm1/2) are coreceptors for Dickkopf1 (Dkk1), an antagonist of Wnt/beta-catenin signaling, and play a role in head induction during early Xenopus development. In a proteomic approach we identified Erlectin, a novel protein that interacts with Krm2. Erlectin (XTP3-B) is member of a protein family containing mannose 6-phosphate receptor homology (MRH-, or PRKCSH-) domains implicated in N-glycan binding. Like other members of the MRH family, Erlectin is a luminal resident protein of the endoplasmic reticulum. It contains two MRH domains, of which one is essential for Krm2 binding, and this interaction is abolished by Krm2 deglycosylation. The overexpression of Erlectin inhibits transport of Krm2 to the cell surface. Analysis of its embryonic expression pattern in Xenopus reveals that Erlectin is member of the endoplasmic reticulum synexpression group. Erlectin morpholino antisense injection leads to head and axial defects during organogenesis stages in Xenopus embryos. The results indicate that Erlectin functions in N-glycan recognition in the endoplasmic reticulum, suggesting that it may regulate glycoprotein traffic.

The kidney is involved in amino acid reabsorption and metabolism; consequently, in renal insufficiency, these important functions are disturbed, as has been reported in animals and patients. In a first experimental series, rats were subjected to degrees of nephrectomy (NX) varying between 10% and 90%. Three weeks later, amino acid levels were measured in plasma to correlate the levels with the degree of NX. The results indicate that in the range of 33% to 74% NX, the plasma concentration of only three to four amino acids was modified, whereas in rats with 84% NX, the concentration of 11 amino acids was disturbed, compared with sham-operated rats. Citrullinemia was enhanced in uremic rats and correlated with the degree of NX. More interestingly, citrullinemia was increased in the range of 10% to 33% NX without any changes in uremia and creatininemia, two well-known markers of uremic states. A second experimental series was designed to study the time course of changes in aminoacidemia to find a marker for the onset of renal failure. Rats were subjected to 36% NX for a period of 1 to 21 days. Uremia and creatininemia peaked 24 to 48 hours after NX, and creatinine clearance (Clcreat) concomitantly diminished. Unfortunately, these three markers of uremic states returned to control values during the next few days before increasing during the last 2 weeks. In contrast, citrullinemia increased twofold 48 hours after NX and plateaued over the next 20 days. We conclude that in rats, citrullinemia could be used (1) to detect acute and chronic renal failure, (2) as a specific marker of normal function of the proximal tubule, and (3) to estimate the degree of renal damage. From this study, renal insufficiency might be easily detected by measuring citrullinemia.

Context Suicide is the second leading cause of death in adolescents and young adults in Europe. Reducing suicides is therefore a key public health target. Previous studies have shown associations between suicidal behaviors, depression and family factors. Objective To assess the role of family factors in depression and suicidality in a large community-based sample of adolescents and to explore specific contributions (e.g. mother vs. father; conflict vs. no conflict; separation vs. no separation) taking into account other risk factors. Methods A cross-sectional sample of adolescents aged 17 years was recruited in 2008. 36,757 French adolescents (18,593 girls and 18,164 boys) completed a questionnaire including socio-demographic characteristics, drug use, family variables, suicidal ideations and attempts. Current depression was assessed with the Adolescent Depression Rating Scale (ADRS). Adolescents were divided into 4 groups according to suicide risk severity (grade 1 = depressed without suicidal ideation and without suicide attempts, grade 2 = depressed with suicidal ideations and grade 3 = depressed with suicide attempts; grade 0 = control group). Multivariate regressions were applied to assess the Odds Ratio of potential risk factors comparing grade 1, 2 or 3 risk with grade 0. Results 7.5% of adolescents (10.4% among girls vs. 4.5% among boys) had ADRS scores compatible with depression; 16.2% reported suicidal ideations in the past 12 months and 8.2% reported lifetime suicide attempts. Repeating a year in school was significantly associated to severity grade of suicide risk (1 and 3), as well as all substance use, tobacco use (severity grades 2 and 3) and marijuana use (severity grade 3), for girls and boys. After adjustment, negative relationships with either or both parents, and parents living together but with a negative relationship were significantly associated with suicide risk and/or depression in both genders (all risk grades), and Odds Ratios increased according to risk severity grade. Conclusion Family discord and negative relationship with parents were associated with an increased suicide risk in depressed adolescents. So it appears essential to take intrafamilial relationships into account in depressed adolescents to prevent suicidal behaviours.

The effects of glucagon (G) on proximal tubule reabsorption (PTR) and GFR seem to depend on a prior action of this hormone on the liver resulting in the liberation of a mediator and/or of a compound derived from amino acid metabolism. This study investigates in anesthetized rats the possible contribution of cAMP and urea, alone and in combination with a low dose of G, on phosphate excretion (known to depend mostly on PTR) and GFR. After a 60-min control period, cAMP (5 nmol/min x 100 grams of body weight [BW]) or urea (2.5 micromol/min x 100 grams BW) was infused intravenously for 200 min with or without G (1.2 ng/min x 100 grams BW, a physiological dose which, alone, does not influence PTR or GFR). cAMP increased markedly the excretion of phosphate and sodium (+303 and +221%, respectively, P < 0.01 for each) but did not alter GFR. Coinfusion of cAMP and G induced the same tubular effects but also induced a 20% rise in GFR (P < 0.05). Infusion of urea, with or without G, did not induce significant effects on PTR or GFR. After G infusion at increasing doses, the increase in fractional excretion of phosphate was correlated with a simultaneous rise in plasma cAMP concentration and reached a maximum for doubling of plasma cAMP. These results suggest that cAMP, normally released by the liver into the blood under the action of G, (a) is probably an essential hepatorenal link regulating the intensity of PTR, and (b) contributes, in conjunction with specific effects of G on the nephron, to the regulation of GFR.

Background Results concerning the association between Body Mass Index (BMI) and depression in adolescence are conflicting, some describing a linear association (increase in BMI with level of depression), some a U-shaped association (both underweight and obesity are associated with high levels of depression), and they mostly concern small samples. The purpose of this study was to describe the association between BMI and depression in a large representative sample of French adolescents. Methods The association between BMI and depression, measured on the Adolescent Depression Rating Scale (ADRS), was tested in a French national representative sample of 39542 adolescents aged 17. Self-report data is derived from the 2008 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. We used spline function analysis to describe the association between BMI and depression. Results The association between BMI and depression is significant (p < 0.001) and non-linear for both genders, with no effect of parental working and marital status. For boys, there is U-shaped association. For girls the shape of the association is complex and shows inverted convexity for high levels of BMI. The spline shows higher scores for depression among overweight girls than among obese girls. Conclusion There is evidence for a gender difference in the association between BMI and depression in adolescents, supporting the need to study boys and girls separately. Overweight adolescent girls are more likely to be depressed than obese adolescent girls, giving support for "fat and jolly" hypothesis not only among older women but also among adolescent girls.

We tested the hypothesis that socioeconomic disadvantage exacerbates the intergenerational transmission of substance dependence. Among 3056 community-based young adults (18–22 years, 2007), the prevalence of alcohol dependence (WHO AUDIT, 5.8%) and cannabis dependence (DSM IV criteria, 7.3%) was doubled in the presence of combined parental alcohol dependence and socioeconomic disadvantage.

In response to recent research documenting a link between early substance use and suicidal behaviors among youth, the current study sought to examine the associations between ages of substance use initiation and suicidal behavior among students in France and the USA.Cross-sectional logistic regression analyses based on the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) survey (France; n = 13,187) and the 2003 Youth Risk Behavior Survey (YRBS) (United States; n = 15,136) assessed associations between early substance use initiation (i.e., alcohol, cigarette and cannabis/marijuana) and suicide ideation and attempts while controlling for potential confounders.Early alcohol use initiation (OR(adj) = 1.52; 95% CI 1.17-1.97) and early cannabis/marijuana use initiation (OR(adj) = 2.90; 95% CI 2.20-3.83) were associated with suicide attempt in France. Early smoking was associated with suicide attempt in both France (OR(adj) = 1.92; 95% CI 1.55-2.37) and the USA (OR(adj) = 1.53; 95% CI 1.02-2.28). Sex differences were also noted.The associations between substance use initiation and suicidal behaviors differed in the United States and France. These findings, placed into context, can assist the development and implementation of prevention strategies that seek to reduce the harmful consequences of early substance use among youth.

SummaryLow-density lipoprotein receptor related proteins 5 and 6 (LRP5/6) are transmembrane receptors that initiate Wnt/β-catenin signaling. Phosphorylation of PPPSP motifs in the LRP6 cytoplasmic domain is crucial for signal transduction. Using a kinome-wide RNAi screen, we show that PPPSP phosphorylation requires the Drosophila Cyclin-dependent kinase (CDK) L63. L63 and its vertebrate homolog PFTK are regulated by the membrane tethered G2/M Cyclin, Cyclin Y, which mediates binding to and phosphorylation of LRP6. As a consequence, LRP6 phosphorylation and Wnt/β-catenin signaling are under cell cycle control and peak at G2/M phase; knockdown of the mitotic regulator CDC25/string, which results in G2/M arrest, enhances Wnt signaling in a Cyclin Y-dependent manner. In Xenopus embryos, Cyclin Y is required in vivo for LRP6 phosphorylation, maternal Wnt signaling, and Wnt-dependent anteroposterior embryonic patterning. G2/M priming of LRP6 by a Cyclin/CDK complex introduces an unexpected new layer of regulation of Wnt signaling.

Background The luxS/AI-2 signaling pathway has been reported to interfere with important physiological and pathogenic functions in a variety of bacteria. In the present study, we investigated the functional role of the streptococcal luxS/AI-2 system in metabolism and diverse aspects of pathogenicity including the adaptation of the organism to stress conditions using two serotypes of Streptococcus pyogenes, M1 and M19. Results Exposing wild-type and isogenic luxS-deficient strains to sulfur-limited media suggested a limited role for luxS in streptococcal activated methyl cycle metabolism. Interestingly, loss of luxS led to an increased acid tolerance in both serotypes. Accordingly, luxS expression and AI-2 production were reduced at lower pH, thus linking the luxS/AI-2 system to stress adaptation in S. pyogenes. luxS expression and AI-2 production also decreased when cells were grown in RPMI medium supplemented with 10% serum, considered to be a host environment-mimicking medium. Furthermore, interaction analysis with epithelial cells and macrophages showed a clear advantage of the luxS-deficient mutants to be internalized and survive intracellularly in the host cells compared to the wild-type parents. In addition, our data revealed that luxS influences the expression of two virulence-associated factors, the fasX regulatory RNA and the virulence gene sibA (psp). Conclusion Here, we suggest that the group A streptococcal luxS/AI-2 system is not only involved in the regulation of virulence factor expression but in addition low level of luxS expression seems to provide an advantage for bacterial survival in conditions that can be encountered during infections.

Aims: To assess associations between parental control or parental emotional support and current tobacco, alcohol or cannabis use among 12-18-year-old students, according to gender and family structure (intact family, reconstituted family, single-parent family). Methods: A cross-sectional survey was conducted in a national representative sample in France (2003) of 6-12th grade students (N = 16 532), as a part of the ESPAD study (European Study Project on Alcohol and Other Drugs). The self-administered questionnaire included questions on last 30 days' consumption of alcohol, tobacco and cannabis as well as on socio-demographic characteristics, school characteristics, and some simple questions on parental control and parental emotional support. Logistic modelling was carried out and (adjusted Odds Ratio) Ora calculated, adjusted for age, parental educational and characteristics of the school. Results: A negative relationship exists between parental control and substance use, but this relationship is more marked for tobacco (OR a between 1.8 and 5.6 according to level of control, family status and gender) and cannabis (OR between 1.5 and 6.4) than for alcohol (OR a between 1.0 and 2.7). Parental control is more markedly related to substance use in girls than in boys. These tendencies were observed for intact families as well as for single-parent families or reconstituted families. Parental control has a greater impact than emotional support. Among girls, emotional support has a greater impact than among boys. Conclusions: There is a gradient relationship between parental control and current consumption, especially among girls. Thus, there may be a need for parental control, whatever the family structure.

Introduction Depression is one of the main causes of disability in the Western countries. This evidence presents new challenges for somatic medicine, such as surgery. Objectives To determine the influence of patients’ depression on (i) length of hospital stay (LOS, which is a proxy of recovery) after major surgery, and (ii) LOS anticipated by surgeon preoperatively. Aims To explore the influence of depression on recovery after major surgery, and whether and how surgeons take into account patients’ emotional and psychological status in the care of their patients. Methods Prospective multicentre observational study. Depression was assessed with HADS (HADS > 8 showing the presence of significant depression). Two cox PH models were fitted to evaluate the influence of depression on patients’ LOS (first model) and anticipated LOS (second model). Adjustment variables were (i) preoperative (age, sex, anxiety, diagnosis, BMI, biology), (ii) intraoperative (blood transfusion, length of intervention), (iii) postoperative (morbidity). Results Of 372 recruited patients (which had undergone major liver surgery), 69 (18,5%) had HADS>8. After adjustment, depression was a risk factor for a prolonged LOS (HR 1.96, 95%CI 1.44–2.63). However, depression was unrelated to the anticipated LOS (HR 1.26, 95%CI 0.90–1.66). Conclusions 1 in 5 patients presented a significant level of depression. Depression was independently associated to longer LOS (ie. longer recovery time after surgery). However this data was not taken into account by surgeons, which failed to integrate that in their previsions. A psychiatric culture and education need to be developed in surgery, as well as more collaboration.

To study the specificity of hospitalized adolescent suicide attempters. Among a national sample of students (n = 11,718, mean age = 16.6 years) studied in 1999, 9.2% (n = 1078) made at least one suicide attempt during their life (SA); 21.9% (n = 234) of them were hospitalized (HSA). We identified the risk factors (family, school, behavioral and psychological) of SA and HSA by comparing (by gender) a) suicide attempters to non-suicide attempters and b) hospitalized suicide attempters to non-hospitalized suicide attempters. Both for girls and boys, the risk factors for SA varied. However, certain risk factors, particularly depressive mood, low self-esteem and poor parent-child relationships, were not associated with hospitalization. Hospitalized suicide attempters had more personal and social problems. But there is an important difference according to gender: in boys, hospitalization is related to physical fighting (OR = 2.2) and offences (OR = 3.4), in girls to running away (OR = 1.7), consumption of illegal drugs other than cannabis (OR = 2.0), having a living standard outside average (OR = 2.0) and going to a private school (OR = 1.7). Suicide attempters with problem behavior are more at risk of being hospitalized than others. However, the difference between hospitalized and non-hospitalized subjects was smaller than expected.

We have previously shown that a chronic reduction in plasma vasopressin level slowed the progression of chronic renal failure (CRF) in Sprague Dawley rats. The aim of the present study was to determine the respective contribution of pressor (V1) and antidiuretic (V2) effects of vasopressin on progression. Male homozygous Brattleboro rats with hereditary central diabetes insipidus were submitted to 5/6 nephrectomy. They were divided into three groups, two of which received chronic i.p. infusion of AVP (V1 + V2 effects) or dDAVP (V2 effects). The third group served as control (CONT). The doses of AVP and dDAVP were chosen so as to produce urine osmolality similar to that observed in 5/6 Nx Sprague Dawley rats. All rats ate the same amount of food and drank water ad libitum. Renal function was studied for 13 weeks. All three groups showed a marked hypertension. Rats infused with dDAVP, but not those infused with AVP, had a higher creatininemia, anemia and urinary protein excretion than CONT rats. In the dDAVP but not the AVP group, fractional excretion of urea was markedly decreased and plasma urea concentration rose much more than that of creatinine. These results show that V2 but not V1 effects play a major role in the deleterious influence of vasopressin on progression, at least in Brattleboro rats. The more severe progression seen in dDAVP rats could indirectly result from the V2-mediated effects on the collecting duct resulting in a decreased efficiency of urea excretion, an increased intrarenal urea recycling, and a rise in plasma urea concentration. Both the toxic effects of urea and the recently demonstrated V2-mediated increase in glomerular hemodynamics might be involved in the deleterious influence of V2 agonism.

Objectives : To measure the prevalence rate of rape among French adolescents; to analyze the associated health and behavioral problems; to analyze the use of the health care system by rape victims. Method : A national representative sample of 8,140 students attending public secondary schools in France (grades 8 to 12) filled in a self-administered questionnaire (274 questions) on health and behavior problems (acceptance rate = 87%). Each rape victim in the sample ( n = 61) was matched to two nonvictims ( n = 122). Results : The reported prevalence rate of rape was .8% (.9% among girls, .6% among boys). For both boys and girls. there was a relationship between rape and current sleep difficulties, depressive symptoms, somatic complaints, tobacco consumption, and behavior problems (running away, violent behavior, stealing, and school absenteeism). Additional problems were associated for boy rape victims: attempted suicide, regular use of alcohol and of illicit drugs. Rape victims did consult health professionals, but the majority saw neither a mental health specialist nor a social worker. Conclusion : The findings indicate that rape victims, especially boys, have more behavior problems and health problems than nonrape victims. Authors suggest that adolescents who have ran away from home, attempted suicide, or manifested violent behavior should be systematically asked about rape.

Objetivo: Establecer un repertorio de los estudios longitudinales sobre el consumo de sustancias psicoactivas entre los adolescentes y realizar una sintesis de los metodos utilizados y de los resultados obtenidos. Metodos: Se siguieron dos estrategias de investigacion documental: investigacion bibliografica retrospectiva y vigilancia bibliografica mediante la interrogacion de bases de datos a traves de palabras clave, titulos, nombres de autor. Resultados: Se llegaron a identificar 69 estudios, la mayoria de ellos realizados entre la poblacion escolar. Los porcentajes de atricion, instrumentos y factores de riesgo analizados varian enormemente de un estudio a otro. Los resultados confirman la naturaleza predictiva de factores como la calidad de las relaciones interpersonales, la personalidad, los antecedentes de problemas psicopatologicos, el consumo de padres y de companeros, en la utilizacion de las sustancias psicoactivas. Sin embargo, los modelos multifactoriales utilizados muestran que el impacto de esos factores varia ligeramente, dependiendo de las sustancias tomadas en consideracion y del momento exacto del proceso (iniciacion, consumo habitual, abuso). Conclusion: Ciertas lineas de investigacion requieren seguir profundizando en su estudio: los factores especificos de un consumo precoz, los factores de proteccion y la evolucion del consumo en la edad adulta.

Renal synthesis of arginine in chronic renal failure: In vivo and in vitro studies in rats with 5/6 nephrectomy. Synthesis of arginine (Arg) from citrulline (Cit) by the kidney is a major source of Arg for the body. The high level of plasma Cit in chronic renal failure is often thought to result from the impairment of the renal conversion of Cit to Arg. To verify this assumption, we performed two studies in Sprague-Dawley rats with 5/6 nephrectomy (CRF rats) and in sham-operated rats (CONT rats). In study I synthesis of Arg by isolated proximal convoluted tubules (PCT; the nephron segment exhibiting the highest Arg synthesis) was measured in vitro with two concentrations of Cit (200 or 50 µM) corresponding to those observed in plasma of rats with or without renal failure. In study II the net renal uptake of Cit and release of Arg were determined in vivo by measuring PAH clearance and arterial and renal venous Arg, and Cit concentrations in anesthetized rats. The in vitro results showed that Arg synthesis increased only in proportion to the hypertrophy of remnant PCT (+50%), and was highly and similarly dependent on Cit concentration in PCT of remnant and normal kidneys (Arg production with 200 µM Cit was 3 times higher than with 50 µM Cit for both CONT and CRF). The in vivo results showed that renal Cit uptake and Arg release were not altered in CRF: -286 ± 28 versus -326 ± 16 nmol Cit · min -1 (NS), and + 390 ± 47 versus + 399 ± 22 nmol Arg · min -1 (NS) in CONT and CRF rats, respectively. This maintenance of a normal Arg synthesis in CRF in the face of a significant reduction in renal plasma flow (-30%) and glomerular filtration rate (-60%), probably results from the cumulative effects of hypertrophy of remnant PCTs, hyperfiltration in remnant nephrons and high plasma Cit concentration increasing the amount of Cit filtered. Thus, the high plasma level of Cit in CRF, being a consequence of the progressive decline in functioning nephrons able to synthetize Arg, also represents a peripheral adaptatation that enables a reduced mass of functional tissue to maintain a constant renal Arg synthesis.