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La comorbidité d’un trouble anxieux (TA) chez les enfants ayant un trouble du déficit de l’attention avec hyperactivité (TDAH) est fréquente, avec une prévalence variant entre 25 % des jeunes de la population générale et 40 % des jeunes de la population clinique. À ce jour, la thérapie cognitive et comportementale (TCC) est le traitement recommandé pour traiter les TA chez ces enfants. Toutefois, il semble que la présence d’un TDAH pourrait nuire à l’efficacité de la TCC communément prescrite, mais la littérature offre des données divergentes à ce jour. Cette recension systématique des écrits scientifiques vise à décrire l’efficacité de la TCC pour les troubles anxieux chez les jeunes âgés de 4 à 18 ans souffrant de TA et du TDAH en comorbidité comparativement aux jeunes qui présentent uniquement des troubles anxieux. Pour ce faire, la recension systématique se base sur les lignes directrices du Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Moher et al., 2009). Les données recensées montrent une réduction significative des symptômes anxieux chez les enfants qui présentent un TA et un TDAH en comorbidité, qui serait comparable à l’efficacité de la TCC auprès des enfants atteints de TA seulement. La participation parentale ainsi que les adaptations de la TCC pour pallier les difficultés associées au TDAH pourraient contribuer à expliquer ces résultats.

Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trials.

Cette étude qualitative s’intéresse à l’effet de la pratique du Jiujitsu brésilien (JJB) sur la santé mentale et ses mécanismes sous-jacents. Les écrits scientifiques sur les arts martiaux indiquent que ceux-ci pourraient favoriser une meilleure santé mentale en diminuant les symptômes anxieux et dépressifs. L’entrevue semi-dirigée dans le cadre de cette étude permet aux participants de discuter les effets de leur pratique du JJB sur leur santé mentale et les mécanismes sous-jacents. Les dix participants sont des adultes âgés d’au moins 18 ans qui ont complété le General Anxiety Disorder (GAD-7), le Patient Health Questionnaire (PHQ-9) ainsi que le World Health Organization Quality of Life abrégé (WHOQOL-BREF). Les participants rapportent que la pratique du JJB améliorerait leur santé mentale de par ses effets sur leur réseau social, leur sentiment d’auto-efficacité et la gestion de leurs émotions négatives. Lorsque les participants mentionnent des éléments négatifs associés au JJB, ils sont principalement attribués à l’arrêt de la pratique du sport. Les résultats de cette étude pourront guider la réalisation d’une étude quantitative plus large sur ce sujet et servir de base pour développer des stratégies afin d’optimiser l’effet de la pratique du JJB sur la santé mentale.

Distress tolerance (DT) has been conceptualized as a vulnerability factor for several psychopathologies. A five factor model of DT has been suggested, but its associations with anxiety and anxiety sensitivity have yet to be explored.This study aimed to further validate the five-factor model of DT, identify the associations between its factors and elevated anxiety, and assess if anxiety sensitivity mediates the association between DT and anxiety.This observational study included 330 students and university workers (women = 82.7%; mean age = 27.7 years, SD = 9.4). They completed online questionnaires assessing DT, anxiety sensitivity and anxiety levels.The five-factor model was a good fit to the data (RMSEA = .04). Two factors, and the sex of the participants, contributed to the variance in anxiety (r2 = .418, p.001). Tolerance of negative emotion was directly (β = -1.98, 95% CI = [-2.53, -1.42]) and indirectly (β = -1.10, 95% CI = [-1.55, -.78]) associated with lower anxiety through anxiety sensitivity. Tolerance of uncertainty was also directly (β = -.08, 95% CI = [-.10, -.06]) and indirectly (β = -.04, 95% CI = [-.05, -.02]) associated with lower anxiety through anxiety sensitivity.Tolerance of negative emotion and uncertainty were associated with anxiety independently of the other factors of DT. These associations seem partially explained by the effect of anxiety sensitivity.

L’intervention coronarienne percutanée (ICP) et le pontage aortocoronarien (PAC) sont deux procédures de revascularisation visant à traiter la maladie coronarienne athérosclérotique. La perception du patient face à celles-ci influencerait l’anxiété et la dépression au stade postopératoire. Toutefois, peu d’études ont documenté l’impact de ces procédures sur l’anxiété cardiaque et à l’aide d’un suivi de trois mois. Cette étude compare l’évolution de l’anxiété, de l’anxiété cardiaque et de la dépression entre l’ICP et le PAC jusqu’à trois mois postopératoires. 206 participants ayant subi une revascularisation ont été recrutés dans deux centres hospitaliers. Les symptômes d’anxiété, de dépression et d’anxiété cardiaque ont été mesurés avec l’Échellehospitalière d’anxiété et de dépression et le Questionnaire d’anxiété cardiaque. L’interaction entre la procédure et le temps est non significative pour l’anxiété F(1, 160,231) = 0,686, p = 0,409, l’anxiété cardiaque F(1, 161,312) = 1,247, p = 0,266 et la dépression F(1, 159,656) = 2,600, p = 0,109. Le temps influence l’anxiété F(1, 170,157) = 13,112, p < 0,001 et la procédure influence l’anxiété cardiaque F(1, 161,312) = 25,752, p < 0,001, qui toutes deux diminuent. La trajectoire de la détresse psychologique liée aux procédures suggère la mise en place de suivis cliniques plus spécialisés.

BackgroundAnxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress.Design/MethodThis is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files.DiscussionThis study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions.

Background: Atrial fibrillation (AF) and heart failure (HF) frequently coexist and can be challenging to treat. Pharmacologically based rhythm control of AF has not proven to be superior to rate control. Ablation-based rhythm control was compared with rate control to evaluate if clinical outcomes in patients with HF and AF could be improved. Methods: This was a multicenter, open-label trial with blinded outcome evaluation using a central adjudication committee. Patients with high-burden paroxysmal (>4 episodes in 6 months) or persistent (duration Results: From December 1, 2011, to January 20, 2018, 411 patients were randomly assigned to ablation-based rhythm control (n=214) or rate control (n=197). The primary outcome occurred in 50 (23.4%) patients in the ablation-based rhythm-control group and 64 (32.5%) patients in the rate-control group (hazard ratio, 0.71 [95% CI, 0.49–1.03]; P =0.066). Left ventricular ejection fraction increased in the ablation-based group (10.1±1.2% versus 3.8±1.2%, P =0.017), 6-minute walk distance improved (44.9±9.1 m versus 27.5±9.7 m, P =0.025), and NT-proBNP demonstrated a decrease (mean change –77.1% versus –39.2%, P P =0.0036), as did the AF Effect on Quality of Life score (least-squares mean difference of 6.2 [95% CI, 1.7–10.7]; P =0.0005). Serious adverse events were observed in 50% of patients in both treatment groups. Conclusions: In patients with high-burden AF and HF, there was no statistical difference in all-cause mortality or HF events with ablation-based rhythm control versus rate control; however, there was a nonsignificant trend for improved outcomes with ablation-based rhythm control over rate control. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01420393.

Perturbations of cholesterol metabolism have been linked to neurodegenerative diseases. Glia–neuron crosstalk is essential to achieve a tight regulation of brain cholesterol trafficking. Adequate cholesterol supply from glia via apolipoprotein E-containing lipoproteins ensures neuronal development and function. The lipolysis-stimulated lipoprotein receptor (LSR), plays an important role in brain cholesterol homeostasis. Aged heterozygote Lsr+/− mice show altered brain cholesterol distribution and increased susceptibility to amyloid stress. Since LSR expression is higher in astroglia as compared to neurons, we sought to determine if astroglial LSR deficiency could lead to cognitive defects similar to those of Alzheimer’s disease (AD). Cre recombinase was activated in adult Glast-CreERT/lsrfl/fl mice by tamoxifen to induce astroglial Lsr deletion. Behavioral phenotyping of young and old astroglial Lsr KO animals revealed hyperactivity during the nocturnal period, deficits in olfactory function affecting social memory and causing possible apathy, as well as visual memory and short-term working memory problems, and deficits similar to those reported in neurodegenerative diseases, such as AD. Furthermore, GFAP staining revealed astroglial activation in the olfactory bulb. Therefore, astroglial LSR is important for working, spatial, and social memory related to sensory input, and represents a novel pathway for the study of brain aging and neurodegeneration.

Panic disorder (PD) is common in emergency department (ED) patients with noncardiac chest pain (NCCP). The literature suggests that initially PD-free patients may be at increased risk of developing PD in the months or years following an ED visit.This study aims to determine the incidence of PD in the 2 years following an ED visit with NCCP and to identify predictors of incident PD.This study was conducted using a longitudinal, observational design. Five hundred eighty-five patients with NCCP (without PD) were recruited in two EDs. They underwent an interview and completed a series of questionnaires assessing anxiety disorders, perceived social support, psychological distress, anxiety sensitivity, comorbidities, and stressful life events. PD was assessed 6 months, 1 year, and 2 years after the initial interview.PD incidence was 11.1% (95% confidence interval: 8.7-13.9) in the two years following the baseline assessment. Anxiety sensitivity (odds ratio = 1.08; 95% confidence interval: 1.04-1.11; P.001) and stress related to life events (odds ratio = 1.14; 95% confidence interval: 1.06-1.24; P = .001) significantly predicted incident PD.Patients with NCCP are at high risk for developing PD in the 2 years following an ED visit with NCCP. Anxiety sensitivity and stress related to life events may be promising clinical targets for preventive interventions.

International audience; Background A low-protein diet can induce compensatory intake of excess energy. This must be better evaluated to anticipate the obesogenic risk that may result from the dietary recommendations for reducing animal protein consumption. Objectives We aimed to further characterize the behavioral and physiological responses to a reduction in dietary protein and to identify the determinants of protein appetite. Methods Thirty-two male Wistar rats [4 wk old, (mean ± SEM) 135 ± 32 g body weight] were fed a low-protein (LP; 6% energy value) or normal-protein (NP; 20%) diet for 8 wk. Food intake and body mass were measured during the entire intervention. During self-selection sessions after 4 wk of experimental diets, we evaluated rat food preference between LP, NP, or high-protein (HP; 55%) pellets. At the end of the experiment, we assessed their hedonic response [ultrasonic vocalizations (USVs)] and c-Fos neuronal activation in the olfactory tubercle and nucleus accumbens (NAcc) associated with an LP or HP meal. Results Rats fed an LP diet had greater food intake (24%), body weight (5%), and visceral adiposity (30%) than NP rats. All LP rats and half of the NP rats showed a nearly exclusive preference for HP pellets during self-selection sessions, whereas the other half of the NP rats showed no preference. This suggests that the appetite for proteins is driven not only by a low protein status but also by individual traits in NP rats. LP or HP meal induced similar USV emission and similar neuronal activation in the NAcc in feed-deprived LP and NP rats, showing no specific response linked to protein appetite. Conclusions Protein appetite in rats is driven by low protein status or individual preferences in rats receiving adequate protein amounts. This must be considered and further analyzed, in the context of current recommendations for protein intake reduction.

Background Noncardiac chest pain (NCCP) is one of the leading reasons for emergency department visits and significantly limits patients’ daily functioning. The protective effect of physical activity has been established in a number of pain problems, but its role in the course of NCCP is unknown. This study aimed to document the level of physical activity in patients with NCCP and its association with NCCP-related disability in the 6 months following an emergency department visit. Methods In this prospective, longitudinal, cohort study, participants with NCCP were recruited in two emergency departments. They were contacted by telephone for the purpose of conducting a medical and sociodemographic interview, after which a set of questionnaires was sent to them. Participants were contacted again 6 months later for an interview aimed to assess their NCCP-related disability. Results The final sample consisted of 279 participants (57.0% females), whose mean age was 54.6 (standard deviation = 15.3) years. Overall, the proportion of participants who were physically active in their leisure time, based on the Actimètre questionnaire criteria, was 22.0%. Being physically active at the first measurement time point was associated with a 38% reduction in the risk of reporting NCCP-related disability in the following 6 months (ρ = .047). This association remained significant after controlling for confounding variables. Conclusions Being physically active seems to have a protective effect on the occurrence of NCCP-related disability in the 6 months following an emergency department visit with NCCP. These results point to the importance of further exploring the benefits of physical activity in this population.

This study documented the 6-month incidence of panic disorder and its predictors in emergency department patients with panic attacks and non-cardiac chest pain. The assessment included a validated structured interview to identify panic attacks and questionnaires measuring the potential predictors of panic disorder. Presence of panic disorder was assessed 6 months later. The incidence of panic disorder was 10.1 percent ( n = 14/138). Anxiety sensitivity was the only significant predictor of the incidence of panic disorder (odds ratio = 1.06; 95% confidence interval = 1.01–1.12). Patients with panic attacks and non-cardiac chest pain are at an elevated risk for panic disorder. This vulnerability appears to increase with anxiety sensitivity.

This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%–37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%–80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.

OBJECTIVES We sought to reduce the 90% rate of missed diagnoses of panic-like anxiety (panic attacks with or without panic disorder) among emergency department patients with low risk noncardiac chest pain by validating and improving the Panic Screening Score (PSS). METHOD A total of 1,102 patients with low risk noncardiac chest pain were prospectively and consecutively recruited in two emergency departments. Each patient completed a telephone interview that included the PSS, a brief 4-item screening instrument, new candidate predictors of panic-like anxiety, and the Anxiety Disorder Interview for the Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition to identify panic-like anxiety. RESULTS The original 4-item PSS demonstrated a sensitivity of 51.8% (95% CI [48.4, 57.0]) and a specificity of 74.8% (95% CI [71.3, 78.1]) for panic-like anxiety. Analyses prompted the development of the Revised-PSS; this 6-item instrument was 19.1% (95% CI [12.7, 25.5]) more sensitive than the original PSS in identifying panic-like anxiety in this sample (χ2(1, N = 351) = 23.89 p < .001) while maintaining a similar specificity (χ2(1, N = 659) = 0.754, p = .385; 0.4%, 95% CI [-3.6, 4.5]). The discriminant validity of the Revised-PSS proved stable over the course of a 10-fold cross-validation. CONCLUSIONS The Revised-PSS has significant potential for improving identification of panic-like anxiety in emergency department patients with low risk noncardiac chest pain and promoting early access to treatment. External validation and impact analysis of the Revised-PSS are warranted prior to clinical implementation. (PsycINFO Database Record

OBJECTIVE To assess work absenteeism and presenteeism, and to identify biopsychosocial predictors of these outcomes in workers with non-cardiac chest pain (NCCP). METHODS This retrospective cohort study included 375 active workers consulting in an emergency room for NCCP. RESULTS About 66% (247/375) of participants reported work absenteeism in the 3 months preceding the consultation, while 36% (134/375) reported presenteeism during the same period. A family income >$29,999, and reporting at least a mild impact of chest pain on family functioning, social functioning, or physical activities, were associated with work absenteeism. Presenteeism was associated with younger age, symptoms of depression, and heart-focused anxiety. CONCLUSIONS Work absenteeism and presenteeism are highly prevalent among patients with NCCP. Family income and impacts of NCCP on functioning, are associated with increased occupational burden in these patients.

The many functions of astrocytes, such as glutamate recycling and morphological plasticity, enable them to stabilize synapses environment and protect neurons. Little is known about how they adapt to glucocorticoid-induced stress, and even less about the influence of dietary factors. We previously showed that omega-3 polyunsaturated fatty acids (ω3PUFA), dietary fats which alleviate stress responses, influence the way astroglia regulate glutamatergic synapses. We have explored the role of docosahexaenoic acid (DHA), the main ω3PUFA, in the astroglial responses to corticosterone, the main stress hormone in rodents to determine whether ω3PUFA help astrocytes resist stress. Cultured rat astrocytes were enriched in DHA or arachidonic acid (AA, the main ω6PUFA) and given 100 nM corticosterone for several days. Corticosterone stimulated astrocyte glutamate recycling by increasing glutamate uptake and glutamine synthetase (GS), and altered the astrocyte cytoskeleton. DHA-enriched astrocytes no longer responded to the action of corticosterone on glutamate uptake, had decreased GS, and the cytoskeletal effect of corticosterone was delayed, while AA-enriched cells were unaffected. The DHA-dependent anti-corticosterone effect was related to fewer glucocorticoid receptors, while corticosterone increased DHA incorporation into astrocyte membranes. Thus, DHA helps astrocytes resist the influence of corticosterone, so perhaps promoting a sustainable response by the stressed brain. We show that corticosterone increases the glutamate recycling capacity of rat cortical astrocytes in culture, and alters their morphology, which may be detrimental in the long term. Increasing the membrane incorporation of docosahexaenoic acid (DHA), the main omega-3 in brain, reduces the amount of glucocorticoid receptors (GR) and prevents the effects of corticosterone. This may help the astrocytes maintain a functional phenotype in chronic stress situations.

Objective To compare equivalent doses of a nonparticulate (dexamethasone) with a particulate (betamethasone) corticosteroid in lumbar transforaminal epidural steroid injections (TFESIs) in terms of pain, function, and complications. Design Fifty-six patients presenting with debilitating radicular pain were randomized in a double-blind controlled trial to receive a lumbar transforaminal injection of either dexamethasone 7.5 mg (n = 29) or betamethasone 6.0 mg (n = 27). Setting A pain clinic and physical medicine and rehabilitation department in two academic hospital centres. Outcome Measures Data were collected at 1-, 3-, and 6-month follow-ups. The primary outcome was pain reduction on a visual analog scale (VAS) at 3 months. Secondary outcomes were functional improvement, as measured by the Oswestry Disability Index (ODI), and number and type of complications. Results No differences on the VAS, analyzed either as a continuous ( P = 0.209) or categorical variable (≥50% ( P = 0.058) or ≥75% ( P = 0.865) improvement) and ODI ( P = 0.181) were found between the two groups at 3 months. At 6 months, improvement of ODI score was at the limit of statistical significance in favor of dexamethasone ( P = 0.050). Multivariate regression analysis, adjusting for potential confounding variables, showed that differences on the ODI became statistically significant at the 6 month follow-up, also in favor of dexamethasone (adjusted P = 0.003). No serious complications were observed in either group. Conclusion According to this study, pain relief and functional improvement are similar for both dexamethasone and betamethasone at 3 months. Considering its safety profile, dexamethasone could be considered as first choice for TFESI. However, given that the study was underpowered, more research is needed to support a recommendation of systematically using dexamethasone in TFESI.

Twenty-five percent of children with ADHD also have an anxiety disorder (AD). As per Quay and in light of Barkley's model, anxiety may have a protective effect on cognitive deficits and behaviors associated with ADHD. This study aimed to evaluate the effect of treating AD on cognitive deficits and behaviors associated with ADHD in children with both disorders. Twenty-four children with ADHD and AD were divided into two groups: treatment for AD, and wait list. Participants were assessed at pre-treatment, post-treatment, and 6-month follow-up with the ADIS-C, the CBCL, and neuropsychological measures. The results revealed a significant improvement in automatic response inhibition and flexibility, and a decrease in inattention/hyperactivity behaviors following the treatment for AD. No significant differences were observed in motor response inhibition, working memory, or attention deficits. The results do not seem to support Quay's hypothesis: treating AD did not exacerbate cognitive deficits and behaviors associated with ADHD in our sample.

International audience; The detection of food odors by the olfactory system, which plays a key role in regulating food intake and elaborating the hedonic value of food, is reciprocally influenced by the metabolic state. Fasting increases olfactory performance, notably by increasing the activity of olfactory bulb (OB) neurons. The glutamatergic synapses between olfactory sensory neurons and mitral cells in the OB glomeruli are regulated by astrocytes, periglomerular neurons, and centrifugal afferents. We compared the expansion of astroglial processes by quantifying GFAP-labeled areas in fed and fasted rats to see whether OB glomerular astrocytes are involved in the metabolic sensing and adaptation of the olfactory system. Glomerular astroglial spreading was much greater in all OB regions of rats fasted for 17 hr than in controls. Intra-peritoneal administration of the anorexigenic peptide PYY3-36 or glucose in 17 hr-fasted rats respectively decreased their food intake or restored their glycemia, and reversed the fasting-induced astroglial spreading. Direct application of the orexigenic peptides ghrelin or NPY to OB slices increased astroglial spreading, whereas PYY3-36 resulted in astroglial retraction, in agreement with the in vivo effects of fasting and satiety on glomerular astrocytes. Thus the morphological plasticity of OB glomerular astrocytes depends on the metabolic state of the rats and is influenced by peptides that regulate food intake. This plasticity may be part of the mechanism by which the olfactory system adapts to food intake.

Objectives This study aimed to estimate the incidence of medical consultations six months after an emergency department (ED) consultation for non-cardiac chest pain (NCCP). It also investigated the role of heart-focused anxiety (HFA) and other factors in predicting an increased healthcare utilization in these patients. Method This was a prospective study of 428 patients who came to an ED with NCCP. Patients completed an interview and questionnaires assessing HFA, psychological distress, the characteristics of NCCP, and comorbidities. Their medical consultations were assessed by telephone interview six months later. The contribution of each factor was assessed using a binomial negative regression. Results Eighty-three percent of patients reported at least one medical consultation (mean = 3.1, standard deviation = 3.9). HFA (incident rate ratio 1.01; 95% CI, 1.00–1.02), the presence of a medical condition (2.14; 1.51–3.03), NCCP frequency (1.49; 1.16–1.91) and NCCP-related interference (1.08; 1.04–1.13) were predictive of further medical consultations. Conclusions A significant proportion of patients with NCCP are at risk of multiple medical consultations following discharge from the ED. HFA appears as a determinant of medical consultations after controlling for multiple confounding factors.

International audience; We assessed whether the ratio of dietary n-6/n-3 polyunsaturated fatty acids (PUFA) during egg formation engenders transgenerational maternal effects in domestic chicks. We analyzed yolk lipid and hormone concentrations, and HPA-axis activity in hens fed a control diet (high n-6/n-3 ratio) or a diet enriched in n-3 PUFAs (low n-6/n-3 ratio) for 6 consecutive weeks. Their chicks were tested for neophobia during the first week of life. We found higher corticosterone metabolites in droppings of hens fed the diet enriched in n-3 and significantly higher concentrations of yolk progesterone, androstenedione, and estradiol in their eggs compared to controls. Chicks of hens fed the n-3 enriched diet showed a lower body mass at hatch than controls and expressed higher neophobia when exposed to a novel object. These results add support to the hypothesis that the nutritional state of female birds produces variation in yolk hormone levels and engender maternal effects.

Resume Ces dix dernieres annees, la France a connu deux reformes majeures de son systeme de sante. La reforme constitutive a la loi du 4 mars 2002 a bouleverse les rapports entre les professionnels de sante et les malades en introduisant dans le Code de Sante Publique (CSP) un ensemble de dispositions sur le droit des malades et des usagers du systeme sante (premiere partie legislative et reglementaire du CSP). La reforme du 22 juillet 2009 a quant a elle modifie les rapports entre les differents professionnels de sante en les incitant a collaborer davantage par de multiples moyens (reunion de concertation pluridisciplinaire, education therapeutique personnalisee…). De plus, cette reforme a mis fin au cloisonnement entre le milieu hospitalier, celui de « ville » et le milieu medicosocial. En consequence, la reglementation pharmaceutique a ete en tres grande partie modifiee par le role pivot du pharmacien entre les professionnels de sante. Neanmoins, la parution des Bonnes Pratiques de Dispensation (BPD) annoncee dans le CSP ne sont toujours pas parues. Ainsi, dans l’attente de la parution de ces BPD, il nous a semble pertinent de realiser une synthese aussi complete que possible sur la reglementation liee a la dispensation pharmaceutique.

Resume Le pharmacien, qu’il exerce a l’officine, en pharmacies a usage interieur (PUI) ou dans une autre structure de dispensation, s’expose a plusieurs types d’actions juridiques en cas de faute et/ou de dommage. Comme toutes autres personnes, le pharmacien est soumis aux regles du droit commun permettant ainsi de rechercher sa responsabilite civile ou penale. En outre, en tant que membre d’une profession organisee en ordre professionnel, le pharmacien est aussi soumis a une deontologie permettant de rechercher sa responsabilite morale devant ses pairs pharmaciens. Depuis une decennie, le pharmacien a acquis par son role de pivot entre les differents professionnels de sante, de nouvelles possibilites d’actions (education therapeutique, statut de pharmacien correspondant, statut de pharmacien referent d’etablissements d’hebergement pour personnes âgees dependantes…). Ceci induit de plus en plus la recherche de la responsabilite de ce praticien lors d’actions en justice. De par le grand nombre et l’eparpillement des textes qui reglementent l’acte de dispensation pharmaceutique, le pharmacien a souvent du mal a apprehender l’ampleur et les limites de ses responsabilites lors d’une dispensation. Il nous a donc paru pertinent de realiser une synthese aussi complete que possible sur les responsabilites civiles, penales et disciplinaires du pharmacien liee a la dispensation pharmaceutique.

Study design Cross-cultural translation and psychometric testing. Objective To translate, culturally adapt, and validate the Oswestry Disability Index (ODI) version 2.0 for the French-Canadian population. Summary of background data Many authors have recommended the administration of standardized instruments, rather than the creation of new scales, and advocate the adaptation of validated questionnaires in other languages. The application of these scales in different countries and by cultural groups necessitates cross-cultural adaptation. Many scales evaluate the functional incapacity resulting from low back pain. The ODI is among the most commonly used for this purpose. Methods The French-Canadian ODI (ODI-FC) was developed by cross-cultural adaptation following internationally recommended methodology: forward translation, back translation, expert committee revision, and clinical evaluation of the prefinal version. Psychometric testing was performed on 72 patients with chronic low back pain. The subjects were recruited from a physiatry department in a university hospital and from a private practice physiatry clinic. They came from the Montreal area. The psychometric testing included internal consistency (Cronbach α), test-retest reliability (intraclass correlation coefficient) with a time interval set at 48 hours, and construct validity, comparing the ODI-FC with the Roland-Morris Disability Questionnaire and the Quebec Back Pain Disability Scale (Pearson correlation coefficient). Results In 44.4% of the subjects, the average duration of low-back pain varied between 1 and 5 years. Average score for the ODI-FC was 29.2. Good internal consistency was found (Cronbach α = 0.88). Reliability was excellent, with intraclass correlation coefficient = 0.92 (95% confidence interval, 0.87-0.95). Construct validity results revealed excellent correlations between the ODI and the Quebec Back Pain Disability Scale (r = 0.90) and between the ODI and the Roland-Morris Disability Questionnaire (r = 0.84). Conclusion Cross-cultural translation and adaptation of the ODI-FC were successful. Psychometric testing determined that the instrument was homogeneous, reliable, and valid. It could be employed in future clinical trials in Canada and possibly in other French-speaking countries.

Purpose This study aimed at (1) establishing the prevalence of paniclike anxiety in emergency department (ED) patients with unexplained chest pain (UCP); (2) describing and comparing the sociodemographic, medical, and psychiatric characteristics of UCP patients with and without paniclike anxiety; and (3) measuring the rate of identification of panic in this population. Basic Procedure A structured interview, the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , was administered to identify paniclike anxiety and evaluate patients' psychiatric status. Anxious and depressive symptoms were evaluated with self-report questionnaires. Medical information was extracted from patients' medical records. Main Findings The prevalence of paniclike anxiety was 44% (95% CI, 40%-48%) in the sample (n = 771). Psychiatric disorders were more common in panic patients (63.4% vs 20.1%), as were suicidal thoughts (21.3% vs 11.3%). Emergency physician diagnosed only 7.4% of panic cases. Principal Conclusions Paniclike anxiety is common in ED patients with UCP, and this condition is rarely diagnosed in this population.

ACADEMIC EMERGENCY MEDICINE 2011; 18:322–325 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain. Methods: This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions. Results: The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%). Conclusions: The PSS may be useful to identify patients with unexplained chest pain who could benefit from referral to mental health professionals or their primary care providers for evaluation of panic attack and panic disorder. Prospective studies to improve and validate the PSS, followed by impact analysis, are mandatory before clinical implementation. ACADEMIC EMERGENCY MEDICINE 2011; 18:1–4 © 2011 by the Society for Academic Emergency Medicine

National audience; Nutritional investigations indicate that the n-3 polyunsaturated fatty acid (PUFA) content of western diets is too low to provide the brain with an optimal supply of DHA, the main n-3 PUFA in cell membranes. Insufficient brain DHA has been associated with memory impairment, emotional disturbances and altered brain processes in experimental studies. Epidemiological studies have revealed that a low n-3 PUFA is correlated with cognitive or behavioral defects during early development, adulthood and aging. Most of the DHA accumulates in the brain during the perinatal period, but its turnover in brain membranes remains elevated throughout life. Although the mechanism of action of n-3 PUFA in brain processes is not fully understood, an increasing bulk of data show the impact of DHA on brain cell activities. By influencing membrane biophysical properties, participating to lipid signaling pathways, and activating transcriptional factors, DHA is involved in the regulation of neurotransmission, neurogenesis, brain energy supply, and neuroprotection.; Le cerveau est l’un des organes les plus riches en acide docosahexaénoïque ou DHA, le principal AGPI n-3 présent dans les membranes cellulaires. Le déséquilibre des apports en acides gras polyinsaturés, AGPI n-6 et n-3, dans les populations occidentales peut compromettre l’approvisionnement du cerveau en DHA et ainsi altérer la physiologie cérébrale. Les études épidémiologiques et expérimentales ont montré qu’un défaut d’apport en AGPI n-3 est associée à des troubles cognitifs et comportementaux à la fois chez l’enfant, l’adulte et le sujet âgé. La période périnatale est déterminante pour l’incorporation du DHA dans les structures cérébrales mais le renouvellement du DHA a lieu tout au long de la vie. L’influence du DHA dans la physiologie cérébrale est multiple. En influençant les propriétés physico-chimiques des membranes, la production de médiateurs lipidiques dans les cascades de signalisation, l’activation de facteurs de transcription, le DHA intervient dans la régulation de la neurotransmission, la neurogénèse, l’énergétique cérébrale et la neuroprotection.

Isabelle DENIS, Nathalie REZZI : République et élites locales à Mayotte : 1880-1947. II s'agit d'étudier les hauts fonctionnaires qui se sont succédés à Mayotte et dont les titres ont varié (gouverneurs, administrateurs et hauts commissaires) au cours de la période 1880-1947 : après une définition de leurs pouvoirs et de leur mission, l'étude portera sur leurs origines géographiques, familiales, sociales et professionnelles ainsi que sur leur formation (études et diplômes) afin de voir si ces différents éléments les préparaient à cohabiter et à partager le pouvoir avec des élites locales souvent jalouses de leurs connaissances et de leurs privilèges. La réaction et les relations de ces deux entités (administration coloniale et élites locales) peuvent être appréhendées à partir des archives géographiques (même lacunaires) amis aussi à partir des dossiers personnels (contenant souvent des documents descriptifs de la situation locale). Bien sûr l'étude de la réaction des élites locales (ces élites seront définies et présentées au cours de l'étude) sera tributaire de la subjectivité des fonctionnaires qui l'évoquent. Notre étude se propose donc de se consacrer aux 40 hauts fonctionnaires pour lesquels on peut consulter les dossiers (soumis à dérogation) et de pouvoir réfléchir sur l'installation de la République. Sur « un confetti » et surtout comment elle réagit face à des populations qui ont eu souvent le sentiment d'être « abandonnées »., Denis Isabelle, Rezzi Nathalie. République et élites locales : Mayotte (1880-1947). In: Outre-mers, tome 98, n°370-371, 1er semestre 2011. Le contact colonial dans l'empire français : XIXe-XXe siècles, sous la direction de Maria Romo-Navarrete et Sarah Mohamed-Gaillard . pp. 125-134.

This study aims to determine whether the regulation of extracellular glutamate is altered during aging and its possible consequences on synaptic transmission and plasticity. A decrease in the expression of the glial glutamate transporters GLAST and GLT-1 and reduced glutamate uptake occur in the aged (24-27 months) Sprague-Dawley rat hippocampus. Glutamatergic excitatory postsynaptic potentials recorded extracellularly in ex vivo hippocampal slices from adult (3-5 months) and aged rats are depressed by DL-TBOA, an inhibitor of glutamate transporter activity, in an N-Methyl-d-Aspartate (NMDA)-receptor-dependent manner. In aged but not in young rats, part of the depressing effect of DL-TBOA also involves metabotropic glutamate receptor (mGluRs) activation as it is significantly reduced by the specific mGluR antagonist d-methyl-4-carboxy-phenylglycine (MCPG). The paired-pulse facilitation ratio, a functional index of glutamate release, is reduced by MCPG in aged slices to a level comparable to that in young rats both under control conditions and after being enhanced by DL-TBOA. These results suggest that the age-associated glutamate uptake deficiency favors presynaptic mGluR activation that lowers glutamate release. In parallel, 2 Hz-induced long-term depression is significantly decreased in aged animals and is fully restored by MCPG. All these data indicate a facilitated activation of extrasynaptic NMDAR and mGluRs in aged rats, possibly because of an altered distribution of glutamate in the extrasynaptic space. This in turn affects synaptic transmission and plasticity within the aged hippocampal CA1 network.

Several studies suggest that (n-3) PUFA may play a role in the regulation of cognitive functions, locomotor and exploratory activity, and affective disorders. Additionally, (n-3) PUFA affect pineal function, which is implicated in the sleep-wake rhythm. However, no studies to our knowledge have explored the role of PUFA on the circadian system. We investigated the effect of an (n-3) PUFA-deficient diet on locomotor and pineal melatonin rhythms in Syrian hamsters used as model species in circadian rhythm research. To assess the possible relationship between voluntary wheel running activity and dopaminergic neurotransmission, we also measured endogenous monoamine concentrations in the striatum. Two-month-old male hamsters, fed either an (n-3) PUFA-deficient or an (n-3) PUFA-adequate diet, were housed individually in cages equipped with run wheels. At 3 mo, cerebral structures were extracted for biochemical and cellular analysis. In (n-3) PUFA-deficient hamsters, the induced changes in the pineal PUFA membrane phospholipid composition were associated with a reduction in the nocturnal peak level of melatonin that was 52% lower than in control hamsters (P < 0.001). The (n-3) PUFA-deficient hamsters also had higher diurnal (P < 0.01) and nocturnal (P = 0.001) locomotor activity than the control hamsters, in parallel with activation of striatal dopaminergic function (P < 0.05). The (n-3) PUFA-deficient hamsters exhibited several symptoms: chronic locomotor hyperactivity, disturbance in melatonin rhythm, and striatal hyperdopaminergia. We suggest that an (n-3) PUFA-deficient diet lessens the melatonin rhythm, weakens endogenous functioning of the circadian clock, and plays a role in nocturnal sleep disturbances as described in attention deficit/hyperactivity disorder.

Resume Les acides gras polyinsatures (AGPI) de la serie n-3, et notamment l'acide docosahexaenoique (22:6n-3, DHA), sont des nutriments indispensables pour assurer un developpement optimal du systeme nerveux central. En effet, de par sa concentration exceptionnellement elevee dans les membranes excitables du cerveau et de la retine, le DHA exerce un role fondamental dans la physiologie de ces tissus (proprietes structurale, de precurseur de derives endoperoxydes, et regulatrice de l'activite synaptique et de l'expression de genes cibles). Chez le rongeur et le singe, la chute de la teneur membranaire en DHA, suite a une carence alimentaire en AGPI n-3, s'accompagne de la reduction des capacites d'apprentissage et de discrimination visuelle (memoire, attention, motivation). Quelques cas de carence alimentaire ont ete rapportes chez l'Homme, notamment chez des enfants nouveau-nes qui presentaient un retard dans le developpement de leur acuite visuelle. Dans l'apparition de troubles neuropsychiatriques lies a la pathologie (hyperactivite chez l'enfant, schizophrenie, depression, ...), un lien avec l'apport alimentaire en AGPI n-3 pourrait etre implique et concernerait un second acide gras de cette famille, l'acide eicosapentaenoique (20:5n-3, EPA). Enfin, la consommation de ces acides gras pourrait egalement etre benefique vis-a-vis de l'incidence des neuropathologies associees au vieillissement comme le suggerent des etudes epidemiologiques et prospectives recentes (maladie d'Alzheimer, demence senile).