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The French Headache Society proposes updated French guidelines for the management of migraine. The first part of these recommendations is focused on the diagnosis and assessment of migraine. First, migraine needs to be precisely diagnosed according to the currently validated criteria of the International Classification of Headache Disorders , 3d version (ICHD-3). Migraine-related disability has to be assessed and we suggest to use the 6 questions of the headache impact test (HIT-6). Then, it is important to check for risk factors and comorbidities increasing the risk to develop chronic migraine , especially frequency of headaches, acute medication overuse and presence of depression. We suggest to use a migraine calendar and the Hospital Anxiety and Depression scale (HAD). It is also necessary to evaluate the efficacy and tolerability of current migraine treatments and we suggest to systematically use the self-administered Migraine Treatment Optimization Questionnaire (M-TOQ) for acute migraine treatment. Finally, a treatment strategy and a follow-up plan have to be proposed. Guidelines for pharmacological and non-pharmacological treatments are presented in the second and third part of the recommendations.

International audience; Aims: We explored lifetime comorbidities in clinical subsamples with a diagnosis of Psychosis (N = 143), bipolar (BD = 511), and unipolar disorders (UP = 861).Methods: We analyzed trajectories and patterns of comorbidities using novel metrics, namely bubble plots and density of antecedent events per year of illness exposure per individual.Results: Age at onset (AAO) of most comorbidities was similar to epidemiological studies, but cumulative rates were higher in clinical cases. There were some between group differences in patterns or burden of comorbidities, for example, Psychosis showed the earliest AAO of any mental disorder; UP showed the latest AAO of the index diagnosis. The relative risk of multimorbidity was lower in UP compared with other diagnoses, however, the goodness of fit for the illness trajectory path was lowest for BD.Conclusions: Bubble plots offer a useful representation of timing, sequence, cumulative probability and of comorbidities, the added value of reporting density measures was less obvious.

Introduction The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV. Methods A survey using respondent-driven sampling (RDS) was conducted among YPUD aged 16–24. Participants were eligible if they reported drug use, confirmed by a urine test. After obtaining informed consent, they were screened for HIV/HCV and assessed using face-to-face questionnaires and self-report. A cluster analysis was conducted, taking into account risk behaviors and confirmed HIV-positive status. Results Seven hundred and three YPUD aged 16–24 were recruited between October 2016 and February 2017, 584 of whom were included in the final analysis. Median age was 21 (17.7, 23.0); 79% were male, 18% female, and 2% transgender. Methamphetamines use was reported by 77%, followed by cannabis (51%) and heroin (17%); polydrug use was common; 15% had “ever” injected drugs. HIV prevalence was 7%. Among all participants, 48% reported non-consistent condom use and 1% reported needle/syringe sharing during the previous month. Four distinct profiles of HIV risk behaviors were identified: The high multiple-risk group mixed unsafe drug use with unsafe sexual practices and had higher prevalence of HIV; the second group practiced high-risk sex with non-consistent condom combined with methamphetamine use; the third group was a moderate-risk group with limited unsafe sexual practices; and the fourth was considered at “low-risk” as reportedly, most never had sex and never injected. The highest risk group included more female YPUD, living in HCMC, who used heroin and had unsafe sex with their regular partners. The second high-risk group included most of the MSM and all transgender people and frequently reported mental health disorders. Conclusions The profiles of YPUD who are at risk of HIV vary according to age, location, and population group. Injecting YPUD are the most exposed to risk and need immediate attention. Sexual exposure to HIV is very common. Mental health is a major concern. Interventions need to be integrated in a differentiated but holistic approach.

Funding Information: The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the United States National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork and consultation on data analysis. None of the funders had any role in the design, analysis, interpretation of results or preparation of this paper. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of the World Health Organization, other sponsoring organisations, agencies or governments. The 2007 Australian National Survey of Mental Health and Wellbeing is funded by the Australian Government Department of Health and Ageing. The Argentina survey – Estudio Argentino de Epidemiología en Salud Mental (EASM) – was supported by a grant from the Argentinian Ministry of Health (Ministerio de Salud de la Nación) – (Grant Number 2002–17270/13−5). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders, EPIBUL, is supported by the Ministry of Health and the National Center for Public Health Protection. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín – Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Generalitat de Catalunya (2017 SGR 452; 2014 SGR 748), Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi MOH and MOP with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund (UNDG ITF). The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013, H25-SEISHIN-IPPAN-006) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the Pan American Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria) and the Federal Ministry of Health, Abuja, Nigeria. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Polish project Epidemiology of Mental Health and Access to Care –EZOP Project (PL 0256) was carried out by the Institute of Psychiatry and Neurology in Warsaw in consortium with the Department of Psychiatry – Medical University in Wroclaw and National Institute of Public Health-National Institute of Hygiene in Warsaw and in partnership with Psykiatrist Institut Vinderen–Universitet, Oslo. The project was funded by the European Economic Area Financial Mechanism and the Norwegian Financial Mechanism. EZOP project was co-financed by the Polish Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with the collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health. The Romania WMH study projects ‘Policies in Mental Health Area’ and ‘National Study regarding Mental Health and Services Use’ were carried out by the National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC Cheyenne Services SRL, Statistics Netherlands and were funded by the Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and the National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Psychiatric Enquiry to General Population in Southeast Spain – Murcia (PEGASUS-Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. Dr Dan J. Stein is supported by the Medical Research Council of South Africa (MRC). A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/ . Publisher Copyright: Copyright © The Author(s), 2021. Published by Cambridge University Press. Abstract Aims Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes. Methods Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressive distress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning. Results Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4-1.6) and suicidality (OR = 1.5-2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD. Conclusions These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD. publishersversion published

International audience; Obesity develops in a substantial number of people initiating and maintaining modern antiretroviral therapy. The comorbidities associated with obesity make significant weight gain and metabolic changes a major consideration in clinical trials studying different regimens' potency and safety. It is as yet unclear what role individual antiretrovirals or classes play in weight gain but the issue is a complex one for clinical trial design, especially when deciding when "too much" weight has been gained, in a context where we do not yet know if switching to alternative regimens will slow, halt or reverse weight gain or metabolic changes. In addition, clinician and trial participant opinion on acceptable weight gain may differ. We offer preliminary guidance for discussion for future antiretroviral clinical trial design.

BackgroundCOVID-19 is a multi-system disease and patients who survive may experience in-hospital complications. These complications are likely to have important short and long-term consequences for patients, healthcare utilisation, healthcare system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and impact of COVID-19 complications, particularly in those who survive using the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK).MethodsA multicentre, prospective cohort study in 302 UK healthcare facilities of adults hospitalised with COVID-19 between 17th January and 4th August 2020. Complications were defined as organ specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. Outcomes included death, critical care use, and ability to self-care at hospital discharge. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities.ResultsOf patients admitted to hospital for management of COVID-19, 49.7% (36 367/73 197) experienced at least one complication. The mean age of our cohort was 71.1 years old (SD 18.7), included more males (56.0%, 41 025/73 ) with 81.0% (59 289/73 197) of patients having at least one comorbidity. Males over 60 were most likely to experience a complication (60 y and over, 54.5% [16 579/30 416] in males and 48.2% [11 707/24 288] in females; Under 60 y, 48.8% [5179/10 609] in males, 36.6% [2814/7689] in females). Renal (24.3%, 17 752/73 197), complex respiratory 18.4% (13 486/73 197), and systemic (16.3%, 11 895/73 197) complications were most frequent. Cardiovascular (12.3%, 8973/73 197), neurological (4.3%, 3115/73 197), and gastrointestinal/liver (0.8%, 7901/73 197) complications were also reported. The presence of any complication was associated with significantly worse survival (adjusted HR 1.74, 95% CI 1.64 to 1.84) and increased admission to critical care (adjusted OR 7.25, 95% CI 6.83 to 7.69). Reduced ability to self-care at discharge was significantly greater in patients who experienced a complication (adjusted OR 2.42, 95% CI 2.31 to 2.54) and was greatest in those who experienced neurological complications (adjusted OR 4.39, 95% CI 3.95 to 4.89). ConclusionsComplications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause significant strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19.

International audience; Background: Allergic diseases appear to be associated with mood disorders. However, particularly regarding allergic rhinitis (AR), such association has not been adequately systematically reviewed. Therefore, we conducted a systematic review and meta-analysis to quantify the association between AR and depression and anxiety. Methodology: We performed an electronic search of PubMed, Web of Science and Scopus for observational studies assessing the association between AR and depression and anxiety. Such association was quantified by means of random-effects meta-analysis, with estimation of pooled odds ratio (OR). Sources of heterogeneity were explored by subgroup analysis. Results: We included a total of 24 primary studies, of which 23 assessed depression and 11 assessed anxiety. Of these, 12 studies presented OR from multivariable regression models and were included in our meta-analysis. AR was associated with higher odds of depression and anxiety. Conclusions: AR appears to be associated with high risk of depression and anxiety. While our results point to the importance of mental comorbidities among patients with AR, longitudinal studies are needed adopting uniform definitions and presenting results stratified by AR severity.

Highlights • Coronavirus disease-2019 (Covid-19) is an ongoing global pandemic of major concern; available data on clinical presentation and prognosis in liver transplant (LT) recipients remains limited. • Disease presentation, immunosuppression management, clinical outcomes, and prognostic factors in 104 French LT recipients (91 adults) with Covid-19 are reported. • The composite endpoint of severe Covid-19 within 30 days after diagnosis was reached by 33.0% of the adult patients. • The 30-day mortality rate of all adult patients was 20.0%, and 28.1% for hospitalized patients., Background Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in organ transplant recipients remains limited. The aim of this registry-based observational study was to report the characteristics and clinical outcomes of liver transplant (LT) recipients included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Methods COVID-19 was diagnosed in patients who had a positive PCR assay for SARS-CoV-2 or in presence of typical lung lesions on imaging or specific SARS-CoV-2 antibodies. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. Results Of the 104 patients, 67 were admitted to hospital and 37 were managed at home (including all 13 children). Hospitalized patients had a median age of 65.2 years (IQR: 58.1 − 73.2 years) and two thirds were men. Most common comorbidities included overweight (67.3%), hypertension (61.2%), diabetes (50.7%), cardiovascular disease (20.9%) and respiratory disease (16.4%). SARS-CoV-2 infection was identified after a median of 92.8 months (IQR: 40.1 − 194.7 months) from LT. During hospitalization, antimetabolites, mTOR inhibitor, and CNIs were withdrawn in 41.9%, 30.0% and 12.5% of patients, respectively. The composite endpoint of severe Covid-19 within 30 days after diagnosis was reached by 33.0% of the adult patients. The 30-day mortality rate was 20.0%, and 28.1% for hospitalized patients. Multivariate analysis identified that age was independently associated with mortality. Conclusion In our large nationwide study, Covid-19 in LT recipients was associated with a high mortality rate.

International audience; Bradykinin mediated angioedema (BK-AE) can be associated either with C1Inhibitor deficiency (hereditary and acquired forms), either with normal C1Inh (hereditary form and drug induced AE as angiotensin converting enzyme inhibitors…). In case of high clinical suspicion of BK-AE, C1Inh exploration must be done at first: C1Inh function and antigenemy as well as C4 concentration. C1Inh deficiency is significant if the tests are below 50 % of the normal values and controlled a second time. In case of C1Inh deficiency, you have to identify hereditary from acquired forms. C1q and anti-C1Inh antibody tests are useful for acquired BK-AE. SERPING1 gene screening must be done if a hereditary angioedema is suspected, even if there is no family context (de novo mutation 15 %). If a hereditary BK-AE with normal C1Inh is suspected, F12 and PLG gene screening is suitable.

Severe asthma (SA) affects less than 5% of the pediatric asthma population but is considered to account for approximately half of total pediatric asthma healthcare costs. Allergic comorbidities, including food allergies (FA) and allergic rhinitis (AR), are frequent in children with SA (1). The presence of FA and AR increases asthma severity (1-6) and medication use (4-6).

Background The impact of prior exposure to systemic corticosteroids on COVID-19 severity in patients hospitalized for a SARS-CoV-2 pneumonia is not known. The present study was designed to answer to this question. Methods The population study was the Covid-Clinic-Toul cohort which records data about all hospitalized patients with a positive reverse transcriptase polymerase chain reaction for a SARS-CoV-2 infection at Toulouse University hospital, France. Exposure to systemic corticosteroids was assessed at hospital admission. A propensity score (PS) according to corticosteroid exposure was calculated including comorbidities, clinical, radiological and biological variables that impact COVID-19 severity. The primary outcome was composite, including admission to intensive care unit, need of mechanical ventilation and death occurring during the 14 days after hospital admission. Logistic regression models adjusted for the PS (overlap weighting) provided odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results Overall, 253 patients were included in the study. Median age was 64 years, 140 patients (59.6%) were men and 218 (86.2%) had at least one comorbidity. Seventeen patients (6.7%) were exposed to corticosteroids before hospital admission. Chronic inflammatory disease (n = 8) was the most frequent indication. One hundred and twenty patients (47.4%) met the composite outcome. In the crude model, the OR of previous exposure to systemic corticosteroids was 1.64; 95% CI: 0.60–4.44. In the adjusted model, it was 1.09 (95% CI: 0.65–1.83). Conclusion Overall, this study provide some evidences for an absence of an increased risk of unfavorable outcome with previous exposure to corticosteroids in the general setting of patients hospitalized for COVID-19.

International audience; There are no studies which have compared the risk of severe Covid-19 and related mortality between transplant recipients and non-transplant patients. We enrolled two groups of patients hospitalized for Covid-19, i.e., kidney transplant recipients from the French Registry of Solid Organ Transplant (n=306) and a single-center cohort of non-transplant patients (n=795). An analysis was performed among subgroups matched for age and risk factors for severe Covid-19 or mortality. Severe Covid-19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death.Transplant recipients were younger and had more comorbidities compared to non-transplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30-day cumulative incidence of severe Covid-19 did not differ between KTR and non-transplant patients; however, 30-day Covid-19-related mortality was significantly higher in KTR (17.9% versus 11.4%, respectively, p=0.038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C-reactive protein (CRP) were associated with severe Covid-19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR=1.55), and creatinine level >115 µmol/L (HR=2.32) were associated with Covid-19-related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. Kidney transplant recipients had a higher Covid-19-related mortality compared to non-transplant hospitalized patients.

Background Our main objectives were to estimate the incidence of illnesses presumably caused by SARS-CoV-2 infection during the lockdown period and to identify the associated risk factors. Methods Participants from 3 adult cohorts in the general population in France were invited to participate in a survey on COVID-19. The main outcome was COVID-19-Like Symptoms (CLS), defined as a sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days and occurred during the 17 days before the survey. We used delayed-entry Cox models to identify associated factors. Results Between April 2, 2020 and May 12, 2020, 279,478 participants were invited, 116,903 validated the questionnaire and 106,848 were included in the analysis. Three thousand thirty-five cases of CLS were reported during 62,099 person-months of follow-up. The cumulative incidences of CLS were 6.2% (95% Confidence Interval (95%CI): 5.7%; 6.6%) on day 15 and 8.8% (95%CI 8.3%; 9.2%) on day 45 of lockdown. The risk of CLS was lower in older age groups and higher in French regions with a high prevalence of SARS-CoV-2 infection, in participants living in cities > 100,000 inhabitants (vs rural areas), when at least one child or adolescent was living in the same household, in overweight or obese people, and in people with chronic respiratory diseases, anxiety or depression or chronic diseases other than diabetes, cancer, hypertension or cardiovascular diseases. Conclusion The incidence of CLS in the general population remained high during the first 2 weeks of lockdown, and decreased significantly thereafter. Modifiable and non-modifiable risk factors were identified.

Cystic fibrosis is the most common and lethal autosomal recessive genetic disease in the Caucasian population. Resulting in numerous clinical and metabolic manifestations, this pathology is however very often unrecognized by dentists. The aim of this thesis is to provide additional information about this pathology: whether at the epidemiological, diagnostic, pathophysiological but also clinical levels. In a part more focused on bacteriology, it will also deal with the pathogenesis of infectious agents and the potential role of the dental surgeon in this contamination within the dental office. Based on a narrative review of the literature, exploring the oral consequences of this pathology, the impact of the dentist in the prognosis of the disease will be studied. The main objective of this work is to develop a guide for the management of patients with cystic fibrosis intended for general dentists and to raise awareness among medical teams of the importance of dental follow-up.; La mucoviscidose est la maladie autosomique récessive d’origine génétique la plus fréquente et létale au sein de la population caucasienne. Se traduisant par de très nombreuses manifestations cliniques et métaboliques, cette pathologie est pourtant bien souvent méconnue des chirurgiens-dentistes. Le but de cette thèse est d’apporter un complément d’information quant à cette pathologie : que ce soit aux niveaux épidémiologique, diagnostique, physiopathologique mais aussi clinique. Elle traitera également dans une partie plus axée sur la bactériologie, de la pathogenèse des agents infectieux et du rôle potentiel du chirurgien-dentiste dans cette contamination au sein du cabinet dentaire. En s’appuyant sur une revue narrative de la littérature, explorant les conséquences bucco-dentaires de cette pathologie, l’impact du chirurgien-dentiste dans le pronostic de la maladie sera étudié. L’objectif principal de ce travail est de développer un guide de prise en charge du patient atteint de mucoviscidose à destination du chirurgien-dentiste omnipraticien et de sensibiliser les équipes médicales à l’importance du suivi dentaire.

International audience; Objective: To estimate the residual mortality rate among people who inject drugs (PWID) in a Low-Middle Income Countries context where the HIV epidemic has been controlled and methadone coverage is high.Study design and setting: PWID from Haiphong, Vietnam, were recruited through three annual respondent-driven sampling surveys that fueled two cohorts of PWID with HIV (n = 761) and without HIV (n = 897), with bi-annual follow-up. Presumed causes of death were ascertained from medical records and/or interviews of participants family.Results: Among the 1658 participants with a median follow-up of 2 years, 67 and 36 died in the HIV-positive and HIV-negative cohort, respectively, yielding crude mortality rates of 4.3 (95% Confidence interval (CI): 3.3-5.4) per 100 person-years of follow-up (PYFU) and 1.9 (CI: 1.4-2.6) per 100 PYFU. In the HIV-positive cohort, in which 81% of participants had undetectable viral load, the two main causes of death were tuberculosis and HIV-related diseases. In the HIV-negative cohort, the two main causes of death were liver-related diseases and overdose. In a time-dependent multivariable model, "unsuppressed viral load" was associated with increased risk of mortality, whereas "being on methadone" or "being employed" was associated with a lower risk.Conclusion: Despite a very successful HIV and methadone program, the mortality remains high among PWID in Vietnam, largely due to curable infectious diseases such as tuberculosis and viral hepatitis.

Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown.Aim: To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019.Methods: In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction.Results: A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock.Conclusions: During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms., Contexte. Les systèmes de santé à travers le monde ont été fortement mis à l’épreuve afin de contrôler la progression de l’épidémie de la COVID-19. L’éventualité que la réorganisation des soins ait pu influencer les délais de reperfusion ou le devenir des patients présentant des syndromes coronaires aigus avec sus-décalage du segment ST (SCA ST +) n’a pas été explorée en France.Objectif. Comparer le taux d’admissions pour SCA ST+, les délais de traitement et enfin le devenir de ces patients entre la première vague épidémique de la COVID-19 et pendant la période similaire en 2019.Méthodes. Dans ce registre national multicentrique, les patients avec SCA ST+ provenant de 65 centres français admis en urgence pour revascularisation entre le 1e mars et le 31 mai 2020 et entre le 1e mars et le 31 mai 2019 ont été analysés. Le critère de jugement principal était un critère composite regroupant la mortalité intrahospitalière toute cause confondue et les complications mécaniques en lien avec l’infarctus.Résultats. Un total de 6 306 patients ont été inclus. Pendant le pic de la pandémie une réduction de 13,9 ± 6,6 % (P = 0,003) des admissions pour SCA ST+ a été observée par semaine. Les délais entre l’apparition des symptômes et l’angioplastie percutanée était significativement augmentés 270 (150−705) versus 245 (140−646) minutes (P = 0,013). Cette augmentation était exclusivement liée à une augmentation du temps entre l’apparition des symptômes et le premier contact médical 121 (60−360) en 2019 versus 150 (62−420) minutes en 2020 (P = 0,002). Durant cette période a été constaté un plus grand nombre de complications mécaniques (0,9 % vs 1,7 % (P = 0,029) conduisant à une augmentation significative de notre critère de jugement principal 112 patients (5,6) en 2019 vs 129 (7,6 %) en 2020 (P = 0,018).Conclusions. Pendant le premier pic de la pandémie il a été constaté : une diminution du taux de SCA ST + associé à un temps d’ischémie prolongé, poussé par l’augmentation du temps entre l’apparition des symptômes et le premier contact médical et enfin un plus grand nombre de complications mécaniques. Ces observations suggèrent la nécessité d’encourager la population à consulter au moindre symptôme inquiétant.

Introduction - The Gender Dysphoria (GD) is a term used to point a distress coming from the incongruence between the gender assigned at birth and the gender felt. It can be alleviated by aligning gender assigned at birth with gender identity, through social, hormonal, and/or surgical transitioning. GD often is accompanied by somatic and psychiatric comorbidities that are rarely or not at all treated medically. The purpose of this literature review was, at first, todescribe the health condition of transgender people. Then to propose various hypotheses that could explain increased morbidity and mortality within this population, including lack of access to medical care. Method - A systematic overview of the literature was made with PubMed and the following keywords: gender dysphoria, gender identity disorder, transgender, gender incongruence, transsexualism, comorbidity, health care, health service, mental health. The taken on articles have been those concerning psychiatric and somatic pathologies regarding transgender adults. We also included studies on risk factors that expose this population to greater risk of certain comorbidities. Results - The literature seems to display an over-representation of psychiatric comorbidities. The transgender population may be twice more impacted by psychiatric disorders than general population. (28.4% to 13.6%). Like this, we seem to have an over-representation of depression-anxiety syndrome, suicide attempts, personality disorders and drugs disorders. Also, several recent studies point a combined occurrence of trans-identity and autistic traits. HIV is the somatic comorbidity most often studied among trans people. It seems to impact 13.7% of the trans population against a 0.6% prevalence in the general population. Other physical comorbidities may be also found more often: certain cardiovascular diseases orcertain cancers linked to viral infection, tobacco use, or hormone therapy. Mortality among trans people appears greater than in the population at large (1.5 to 2.8 times greater depending on the study). Suicide is the principal cause, followed by HIV, cardiovascular disease, and substance abuse. Studies of transidentity have advanced hypotheses on the causes of greater morbidity and mortality among trans people. Among the causes advanced are the consequences of stigmatization, such as violence, harassment, and discrimination. Trans people find themselves marginalized socio-economically, legally, and also in the field of health care, which impacts their ability to access care. In addition, the literature tends to show a significant association between these factors and increased psychological morbidity. Lack of training or awareness of caregivers has been noted. Caregivers often are in difficulty when fielding requests for care where they are unfamiliar with the specifics or specialists to whom patients can be guided. Access to a caregiver trained in transidentity is the most frequently reported obstacle to care before access to a transition specialist. Besides, if legal documents of the person have been changed to reflect gender identity, the trans person will be exposed to the risk of not being sought out or covered for screening tests. Finally, it seems that avoidance of care frequently occurs in the transgender population. 43.8 % of trans people do not seek care despite acute needs, 28% for curative care, and 33% for preventive care. The reasons for this avoidance are fear of discrimination and prior negative medical experiences. Uro-genital care is especially avoided, as it reminds the trans person of the existence of organs that no longer form part of their identity. We note that the majority of data results from studies with low statistical power, no control group, limits on time, or selection bias. Conclusion - The literature feedbacks a higher mobi-mortality in the transgender adult population, promoted by the stigmatization, the lack of health care access and specialized or sensitized medical doctor over transidentity. The prospects of enhancement of the health state for transgender people would be: to make the surroundings compatible with all kinds of gender identity, trained the general population to transidentity, train the nurses to the specific care of this population and to put in place a legal protection against the trans discriminations.; Introduction : la dysphorie de genre (DG) est un terme utilisé pour désigner la souffrance résultant de l’incongruence entre le genre assigné à la naissance et le genre ressenti. Elle peut être soulagée par la mise en adéquation de l’expression de genre avec l’identité de genre, en passant par une transition sociale, hormonale et/ou chirurgicale. La DG s’accompagne fréquemment de comorbidités psychiatriques et somatiques, peu ou pas prises en charge médicalement. L’objectif de cette revue de la littérature était de décrire l’état de santé des personnes transgenres dans un premier temps. Puis de proposer différentes hypothèses, pouvant expliquer la morbi-mortalité accrue dans cette population, comme le manque d’accès à des soins médicaux. Méthode : une revue systématique de la littérature a été réalisé à partir de PubMed avec les mots clefs suivants : gender dysphoria, gender identity disorder, transgender, gender incongruence, transsexualism, comorbidity, health care, health service, mental health. Les articles retenus étaient ceux concernant les pathologies psychiatriques et somatiques touchant les adultes transgenres. Nous avons également inclus les études sur les facteurs de risque qui exposeraient cette population à un risque accru de certaines comorbidités. Résultats : la littérature semble montrer une surreprésentation des comorbidités psychiatriques. La population trans serait 2 fois plus touchée par des troubles psychiatriques que la population générale (28,4% pour 13,6%). Ainsi, on retrouverait une surreprésentation de troubles anxiodépressifs, de tentatives de suicide, de troubles de la personnalité et de troubles de l’usage de substances. Aussi, plusieurs études récentes relèvent une cooccurrence de la transidentité avec des traits autistiques. Le VIH est la comorbidité somatique la plus étudiée chez les trans. Elle toucherait 13,7% des personnes trans contre une prévalence de 0,6% dans la population générale. D’autres comorbidités physiques seraient également retrouvées plus fréquemment : certains cancers liés aux infections virales, au tabac ou à l’hormonothérapie et certaines maladies cardio-vasculaires. La mortalité des personnes trans semble plus élevée que dans la population générale (1,5 à 2,8 fois plus élevée en fonction des études). Le suicide en serait la cause principale suivi par le VIH, les maladies cardiovasculaires et la toxicomanie. Des études sur la transidentité ont mis en avant des hypothèses sur les causes de la morbimortalité accrue des trans. Parmi celles-ci on retrouve les conséquences de la stigmatisation, telles que la violence, le harcèlement et la discrimination. Les trans se retrouveraient marginalisés sur le plan socio-économique, légal mais aussi dans le domaine de la santé, ce qui impacte leur possibilité d’accès aux soins. De plus, la littérature tend à montrer une association significative entre ces facteurs et une morbidité psychique accrue. Un manque de formation et de sensibilisation des soignants a été relevé. Ces derniers seraient alors en difficulté face à des demandes de prise en charge dont ils ne connaissent ni les spécificités, ni les spécialistes vers qui orienter les patients. L'accès à un prestataire formé sur la transidentité serait l'obstacle le plus signalé aux soins devant l’accès à un spécialiste de la transition. De plus, si l’état civil de la personne a été modifié, elle sera exposée au risque de ne plus être sollicitée ni remboursée pour les actes de dépistage. Enfin, il semblerait que l’évitement des soins soit très fréquent dans la population transgenre. 43,8 % des personnes trans n’iraient pas consulter malgré des besoins de soins aigus, 28% pour des soins curatifs et 33% pour des soins préventifs. Les motifs de cet évitement seraient la crainte de la discrimination et les antécédents d’expériences médicales négatives. Les soins urogénitaux sont particulièrement évités. Ils rappelleraient à la personne trans l’existence d’organes ne faisant plus partie de son identité. On notera que la majorité des données sont issues d’études avec une faible puissance, non contrôlées, limitées dans le temps ou encore faisant l’objet de biais de sélection. Conclusion : la littérature rapporterait donc une morbi-mortalité accrue chez les adultes transgenres, favorisée par la stigmatisation, le manque d’accès aux soins et à des médecins spécialistes ou sensibilisés à la transidentité. Des perspectives d’amélioration de l’état de santé des personnes transgenres seraient : de rendre l’environnement compatible avec toutes les identités de genre, d’éduquer la population générale à la transidentité, de former le personnel soignant aux soins spécifiques de cette population et de mettre en place une protection légale à l’encontre des discriminations envers les trans.

International audience; Substance use disorder (SUD) is commonly thought to be less frequent among the elderly than among younger adults. However, this disorder could be insufficiently screened in this population. And the diagnosis could be difficult to make especially because of specificities of this population. The diagnosis is based on the criteria of the DSM-5. Nevertheless, DSM-5 criteria were elaborated for younger adults and some of them could be inappropriate for older adults.Methods: We studied the frequency of the DSM-5 criteria in a population of 59 patients aged around of 80 years, non-dependent and exposed to alcohol or benzodiazepines. We collected data relative to age, gender, type of residence (self-home or retirement house), medical past history, current treatment. Patient were also asked about their alcohol consumption, time of exposition, quantity of alcohol ingested or dose of benzodiazepines ingested and frequency of consumption. Alcohol consumption was reported as alcohol unit per day (one unit containing 10-gram alcohol). Frequency consisted in number of days with consumption in a week. Concerning benzodiazepine with evaluated the quantity by converting dose in equivalent diazepam per day. We determine the frequency of each criterion and the association with SUD diagnosis.Results: We found that 45% of patients presented a diagnosis of SUD. DSM criteria 1, 2, 4, 9, 10 and 11 were found significantly more frequently in patients with addiction than in those without addiction. On the regression analysis criteria 1, 4, 6, 9, 10 and 11 as well as the number of units of alcohol consumed per day were associated with the diagnosis of addiction. The other socio-demographic factors were not associated with the diagnosis.Conclusion: This pilot study highlights that certain DSM-5 addiction criteria seem to be more relevant to seek in the elderly.; Les données actuelles montrent que les troubles liés à l’usage de substance sont moins fréquents chez le sujet âgé. Toutefois ces données peuvent être liées au fait que cette moindre fréquence est liée aux spécificités de cette population et notamment à l’inadéquation de certains critères du DSM-5 avec le mode de vie des sujets âgés. Toutefois il n’existe pas de donnée concernant la répartition des critères du DSM-5 d’addiction chez des sujets âgés. Notre étude avait pour objectif de décrire la répartition des critères DSM-5 du Trouble lié à l’usage de l’alcool et de benzodiazépine dans une population de 59 patients âgés de 80 ans, de décrire les différences entre les groupes de patients souffrant d’une addiction et ceux indemnes d’addiction et de déterminer les facteurs sociaux démographiques associés avec le diagnostic dans notre population. Nous avons observé que 45 % des sujets régulièrement exposés à de l’alcool ou des benzodiazépines avaient un diagnostic de Trouble lié à l’usage de substance. Les critères 1, 2, 4, 9, 10 et 11 du DSM-5 étaient retrouvés significativement plus fréquemment chez les patients présentant une addiction que chez ceux ne présentant pas d’addiction. Sur l’analyse en régression les critères 1, 4, 6, 9, 10 et 11 ainsi que le nombre d’unités d’alcool consommées par jour étaient associés au diagnostic d’addiction. Les autres facteurs sociodémographiques n’étaient pas associés au diagnostic. Cette étude pilote met en évidence que certains critères d’addiction du DSM-5 semblent être plus pertinents à rechercher chez les sujets âgés.

Background A particular ability of the Staphylococcus aureus clonal complex 398 (CC398) to cause bone and joint infections (BJI) remains questionable, since some studies have described high prevalence of MSSA CC398 in prosthetic joint infection (PJI) and diabetic foot ostemolyelitis (DFO). Here, we described the long-term epidemiology of CC398 among S. aureus isolated from BJI and identified risk factors associated with CC398. Methods We included all bone and joint samples with S. aureus-positive culture in our university hospital between January 2010 and December 2017. Logistic regression was used for univariate and multivariate analysis. Results We identified 124 CC398 isolates among the 958 BJI-associated S. aureus. The proportion of CC398 among S. aureus increased steadily from 4% in 2010 to 26% in 2017. Only 4 isolates of CC398 were resistant to methicillin. The distribution of BJI types due to CC398 and non CC398 isolates was similar. In multivariate analysis, age (p = 0.034, OR = 3.9), McCabe score (p = 0.005, OR = 5) and inoculation mechanism (p = 0.020, OR = 3.7) were associated with PJI-related CC398. The year of infection (p p = 0.001, OR = 1.5) and grade 4 (severe) of the International Working Group of the Diabetic Foot classification (p Conclusion We highlighted here the emergence and spread of CC398-MSSA in BJI. Patients with comorbidities are at high risk of CC398 MSSA PJI and DFO. The spread of CC398 in the community and hospital settings remains unclear and further epidemiological studies are needed to identify the determinants of its success.

Resume Introduction L’evolution de l’usage d’e-cigarette chez les usagers de cannabis et les polyconsommateurs d’alcool, tabac ou cannabis est peu decrite dans la litterature. Objectif principal Decrire l’evolution sur 12 mois de l’usage d’e-cigarette chez les usagers de cannabis et les polyconsommateurs. Methodes Etude observationnelle prospective de cohorte en medecine generale entre 2015 et 2016. Resultats Un total de 4,8 % des usagers de cannabis a l’inclusion sont restes ou devenus usagers actuels d’e-cigarette a la fin du suivi contre 4,5 % chez les non-usagers de cannabis, sans difference statistiquement significative. Un total de 5,1 % des polyconsommateurs a l’inclusion sont restes ou devenus usagers actuels d’e-cigarette a la fin du suivi contre 2,4 % chez les non-polyconsommateurs, sans difference statistiquement significative. Les usagers de cannabis et les polyconsommateurs declaraient plus d’experimentation d’e-cigarette par curiosite et sur proposition de quelqu’un, comparativement aux non-usagers de cannabis ou aux non-polyconsommateurs. Aucune association statistiquement significative n’a ete trouvee entre rester ou devenir usager actuel d’e-cigarette sur 12 mois et l’usage de cannabis ou la polyconsommation. Conclusion Les usagers de cannabis et les polyconsommateurs auraient tendance a experimenter davantage la cigarette electronique que les autres patients, sans pour autant se maintenir durablement dans son usage.

IF 7.702; International audience; The survival of patients with diffuse large B-cell lymphoma has increased during the last decade as a result of addition of anti-CD20 to anthracycline-based chemotherapy. Although the trend is encouraging, there are persistent differences in survival within and between the USA and European countries suggesting that non-biological factors play a role. Our aim was to investigate the influence of such factors on relative survival of patients with diffuse large B-cell lymphoma. We conducted a retrospective, multicenter, registry-based study in France on 1165 incident cases of diffuse large B-cell lymphoma between 2002 and 2008. Relative survival analyses were performed and missing data were controlled with the multiple imputation method. In a multivariate analysis, adjusted for age, sex and International Prognostic Index, we confirmed that time period was associated with a better 5-year relative survival. The registry area, the medical specialty of the care department (onco-hematology versus other), the time to travel to the nearest teaching hospital, the place of treatment (teaching versus not-teaching hospital -borderline significance), a comorbidity burden and marital status were independently associated with the 5-year relative survival. Adjusted for first-course treatment, inclusion in a clinical trial and treatment discussion in a multidisciplinary meeting were strongly associated with a better survival outcome. In contrast, socio-economic status (determined using the European Deprivation Index) was not associated with outcome. Despite therapeutic advances, various non-biological factors affected the relative survival of patients with diffuse large B-cell lymphoma. The notion of lymphoma-specific expertise seems to be essential to achieve optimal care management and reopens the debate regarding centralization of these patients' care in hematology/oncology departments.

BackgroundMany studies have shown associations between a history of childhood trauma and more severe or complex clinical features of bipolar disorders (BD), including suicide attempts and earlier illness onset. However, the psychopathological mechanisms underlying these associations are still unknown. Here, we investigated whether affective lability mediates the relationship between childhood trauma and the severe clinical features of BD.MethodA total of 342 participants with BD were recruited from France and Norway. Diagnosis and clinical characteristics were assessed using the Diagnostic Interview for Genetic Studies (DIGS) or the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Affective lability was measured using the short form of the Affective Lability Scale (ALS-SF). A history of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Mediation analyses were performed using the SPSSprocessmacro.ResultsUsing the mediation model and covariation for the lifetime number of major mood episodes, affective lability was found to statistically mediate the relationship between childhood trauma experiences and several clinical variables, including suicide attempts, mixed episodes and anxiety disorders. No significant mediation effects were found for rapid cycling or age at onset.ConclusionsOur data suggest that affective lability may represent a psychological dimension that mediates the association between childhood traumatic experiences and the risk of a more severe or complex clinical expression of BD.

National audience; Introduction - There is no evidence in the literature relating to the evolution of e-cigarette use among cannabis users and multi-users (of alcohol, tobacco or cannabis). Objective - To describe the evolution over 12 months of e-cigarette use in cannabis users and multi-users. Methods - A prospective observational cohort study in general practice, between 2015 and 2016. Results - A total of 4.8% of monitored cannabis users remained or became current users of e-cigarettes by the end of the monitoring period versus 4.5% among non-users of cannabis, with no statistically significant difference. A total of 5.1% of monitored multi-users remained or became current users of e-cigarettes by the end of the monitoring period versus 2.4% among the non-multi-users, with no statistically significant difference. Cannabis users and multi-users reported more e-cigarette experimentation through curiosity and following someone's suggestion, compared to non-cannabis users or non multi-users. No statistically significant association was found between cannabis or multi-drug use and staying or becoming a current e-cigarette user over 12 months. Conclusion - Cannabis users and multi-users would tend to experiment with e-cigarettes more than other patients but this use would not be sustained.

Background With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54–105 (mean = 72.7) years and without dementia at baseline. Studies had 2–15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = −0.1, SE = 0.01), APOE*4 carriage (B = −0.31, SE = 0.11), depression (B = −0.11, SE = 0.06), diabetes (B = −0.23, SE = 0.10), current smoking (B = −0.20, SE = 0.08), and history of stroke (B = −0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = −0.07, SE = 0.01), APOE*4 carriage (B = −0.41, SE = 0.18), and diabetes (B = −0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = −0.24, SE = 0.12), and between diabetes and cognitive decline (B = −0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. Conclusions These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences., Darren Lipnicki and the Sydney COSMIC team analysed cognitive performance and risk factor data from older people from 15 countries to assess associations between risk factors and late-life cognition, Author summary Why was this study done? There is a growing global burden associated with cognitive decline and dementia. Evidence for modifiable risk factors that could be targeted to reduce this burden needs to be improved. Risk factors for cognitive decline and dementia might differ between ethno-regional groups. What did the researchers do and find? We analyzed cognitive performance and risk factor data from 48,522 older individuals, provided by 20 studies of aging representing 15 countries (Australia, Brazil, Cuba, France, Germany, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, The Netherlands, the United Kingdom, and the United States). Cognitive performance was measured as Mini-Mental State Examination (MMSE) and global cognition scores. When controlling for confounding risk factors, the apolipoprotein E ε4 allele (APOE*4), depression, diabetes, current smoking, and history of stroke were associated with poorer cognitive performance, and higher levels of education and vigorous physical activity were associated with better performance. Age, APOE*4, and diabetes were associated with faster cognitive decline. Compared to white people, Asian people showed stronger associations between having ever smoked and cognitive performance, and between diabetes and cognitive decline. What do these findings mean? Modifiable risk factors associated with cognitive decline include education, smoking, physical activity, diabetes, and stroke. If these associations are determined to be causal, interventions targeting these factors may help reduce the global burden of cognitive decline and dementia. Interventions may require tailoring to particular ethno-regional groups.

Since its emergence in 2012, 2,260 cases and 803 deaths due to Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization. Most cases were due to transmission in healthcare settings, sometimes causing large outbreaks. We analyzed epidemiologic and clinical data of laboratory-confirmed MERS-CoV cases from eleven healthcare-associated outbreaks in the Kingdom of Saudi Arabia and the Republic of Korea between 2015–2017. We quantified key epidemiological differences between outbreaks. Twenty-five percent (n = 105/422) of MERS cases who acquired infection in a hospital setting were healthcare personnel. In multivariate analyses, age ≥65 (OR 4.8, 95%CI: 2.6–8.7) and the presence of underlying comorbidities (OR: 2.7, 95% CI: 1.3–5.7) were associated with increased mortality whereas working as healthcare personnel was protective (OR 0.07, 95% CI: 0.01–0.34). At the start of these outbreaks, the reproduction number ranged from 1.0 to 5.7; it dropped below 1 within 2 to 6 weeks. This study provides a comprehensive characterization of MERS HCA-outbreaks. Our results highlight heterogeneities in the epidemiological profile of healthcare-associated outbreaks. The limitations of our study stress the urgent need for standardized data collection for high-threat respiratory pathogens, such as MERS-CoV.

Background and aimsThis study evaluated the clinical and non-clinical determinants of health-related quality of life (HRQoL) associated with untreated chronic hepatitis C (CHC) in France.MethodsFrom 01/2014 to 01/2015, untreated CHC patients were invited to complete a questionnaire including EQ-5D utility instrument and two visual analogue scales (VAS) measuring overall health and fatigue in three French centers (Paris, Lille and Montpellier). Answers were analyzed in mixed models (taking into account the clustering effects of centers and physicians).ResultsFive hundreds and five patients were enrolled: 52% males; the mean age was 54; 41% had BMI>25; 64% had genotype 1; 36% were at the stage of severe fibrosis (F3-F4); 38% had severe comorbidities other than liver-related. In the univariate analysis, EQ-5D utility was associated with socio-demographic variables as age, place of birth, education, and employment; CHC-related variables as conditions of HCV screening and severity of fibrosis; CHC-unrelated variables as comorbidities other than CHC, being overweight, and psychiatric disorders; feelings about CHC disease as perception of progression, lack of information on CHC and its treatments, and entourage's feeling. In multivariate analysis, EQ-5D utility was affected by not being in employment (0.72 vs. 0.80), having severe comorbidities other than CHC (0.72 vs. 0.79), being overweight (0.73 vs. 0.78), and feeling worried about CHC progression (0.66 vs. 0.72-0.84). Similar results were found for the VAS.ConclusionsThe presence of severe comorbidities and worrying about CHC progression, but not stage of fibrosis, seem to alter significantly EQ-5D health utility in CHC French patients.

Introduction : les patients psychiatriques sont à risque de nombreuses comorbidités somatiques. La plupart de ces comorbidités sont liées à des facteurs de risque modifiables. Il existe des recommandations récentes sur le sujet. L’objectif de cette étude est d’évaluer le suivi somatique réalisé, pour ces patients, par les médecins généralistes des 7ème, 8ème et 17ème arrondissements de Paris. Méthode : il s’agit d’une étude épidémiologique transversale déclarative. La liste et l’adresse des médecins sélectionnés ont été élaborées à partir des pages jaunes numériques. Le questionnaire a évalué les différents éléments nécessaires d’un suivi de qualité selon les recommandations en vigueur, et comprends deux questions ouvertes sur les défis et pistes d’amélioration pour la prise en charge de ces patients. Résultats : le taux de réponse au questionnaire est de 18%. Les patients psychiatriques sont fréquemment vus, les différents paramètres de santé clinique sont régulièrement relevés hormis le poids et l’IMC, un bilan biologique est régulièrement prescrit, un ECG est rarement pratiqué pour ces patients, l’orientation vers les spécialistes somatiques n’est pas systématique, la correspondance avec les psychiatres est plutôt pauvre. Concernant les défis et les pistes d’amélioration, apparaît en prédominance la nécessité de mieux correspondre avec les psychiatres. Conclusion : nombre de pratiques sont en accord avec les recommandations. Cependant une sensibilisation sur la nécessité d’une surveillance pondérale et ECG plus fréquente, le recours plus systématique aux spécialistes somatiques, et une meilleure correspondance avec les psychiatres est souhaitable.

International audience; OBJECTIVE:We aimed to assess medical practices of French infectious disease specialists or any other relevant physicians related to the management of non-necrotizing cellulitis (NNC).METHODS:We sent an online questionnaire to members of the French Infectious Diseases Society (SPILF) mailing list in September 2015.RESULTS:A total of 108 specialists took part in the survey and 10% (11/107) declared to always admit NNC patients to hospital. As for the others, 18% declared to admit patients in more than 80% of cases, 49% in 50-80% of cases, 26% in 20-50% of cases, and 7% in less than 20% of cases. The most frequent criteria for hospital admission were severe sepsis/septic shock (99%), poor social conditions (99%), rapid extension of skin lesions (93%), high level of pain (86%), and failure of first-line antibiotic therapy (84%). Participants mentioned similar criteria for reasons to initiate the intravenous (IV) antibiotic therapy. Fifty-three percent of respondents declared initiating antibiotic therapy using the IV route in more than 80% of cases. Physicians declared that the usual antibiotic therapy duration were 15 days (3%).CONCLUSION:Criteria for hospital admission and use of the IV route for antibiotic therapy as well as optimal treatment duration in patients presenting with NNC need to be detailed in guidelines and evaluated in prospective studies.

International audience; The current cross-sectional study investigates the prevalence of the food addiction (FA) phenotype and its association with psychiatric disorders in bariatric surgery candidates. It also investigates the eating behavior characteristics associated with FA and the association between FA and loss of control over specific foods high in sugar, salt and/or fat. We included 128 bariatric surgery candidates and we assessed FA (YFAS 2.0), mood and anxiety disorders, suicidality, eating disorders (current bulimia nervosa and current anorexia nervosa), alcohol and tobacco use disorders (MINI 5.0.0, beck depression inventory, AUDIT, Fagerström Test for Nicotine Dependence) and eating behavior (DEBQ). Prevalence of FA in our sample was 25%. FA was significantly associated with higher prevalence of current mood and anxiety disorders and past mood disorders, higher current suicidality but not with eating disorders and alcohol use disorder. FA was significantly associated with higher emotional eating, and with loss of control over consumption of foods high in fat, sugar and/or salt, but not of fruits, vegetables or grain products. Our results provide arguments for considering psychiatric disorders and suicidality in FA and for considering FA as an addictive disorder in obese patients, with many risk factors in common with other addictions.

La dépendance à l’exercice physique (EP) fait partie des addictions comportementales tout comme le jeu pathologique, qui a récemment intégré le cadre diagnostic dans le DSM-5 des « troubles de l’usage », mais son cadre reste mal défini. Cette étude épidémiologique, observationnelle et transversale réalisée sur 3 mois (2016-2017) évalue la prévalence de la dépendance à l’EP avec l’Exercice Addiction Inventory ainsi que ses liens avec certaines comorbidités psychiatriques (anxiété, dépression, alcool, cannabis, TCA), la gestion de la douleur et l’interdiction de pratique du sport. Les athlètes interrogés sont des adultes recrutés via des clubs (triathlon, trail) ou réseaux sociaux, ils ont répondu à un auto-questionnaire par internet. Selon l’EAI 12,7% des sportifs étaient «à risque de dépendance» et se caractérisaient par le fait d’être plus jeunes (p=0,04), plus à risque de TCA (p=0,02) et de mésusage de l’alcool (p=0,02). Plus le score de l’EAI était élevé, moins les sportifs pratiquaient (r=0,01) mais plus ils avaient de risque d’avoir des troubles anxieux (p

International audience; To identify main prognostic factors for 5-year mortality among age-related comorbidities (ARCs) in older people living with HIV (PLHIV).; A prospective, multicentre cohort study with a 5-year follow-up period in the late HAART era (from January 2008 to December 2012).; The Dat'AIDS cohort involving 12 French hospitals.; All actively followed HIV-1 infected patients aged 60 or older.; The study endpoint was all-cause five-year mortality. The following ARCs were considered: chronic renal disease, cardiovascular diseases, cancer, chronic pulmonary disease, cirrhosis, diabetes and nutritional status. Hepatitis C (HCV), hepatitis B (HBV) co-infection and sociodemographic characteristics were also evaluated. Cox's Proportional Hazards model was used for multivariate analysis.; Among 1415 PLHIV aged 60 or more patients included, mean age was 66±5.5 years; 154 died (mortality rate 2.47/100 patient-years). The most prevalent ARCs were chronic renal disease (20.1%), diabetes (14.2%) and cardiovascular diseases (12.2%). By multivariate analysis, chronic renal disease (adjusted hazard ratio (aHR)=2.25; 95% confidence interval (CI) [1.58-2.21]; p

International audience; ESSENCE refers to early symptomatic syndromes eliciting neurodevelopmental clinical examinations. It includes a broad range of early onset neurodevelopmental disorders affecting more than 10% of children before 5 years of age. ESSENCE includes among others attention deficit hyperactivity disorder (ADHD), intellectual disability (ID) and autism spectrum disorders (ASD). Some degree of disability is the rule rather than the exception. The causes are heterogeneous ranging from extreme social deprivation, pre- and perinatal risk factors, genetic and metabolic diseases, immune and infectious disorders, nutritional factors, physical trauma, and postnatal toxic and environmental factors (and combinations/interactions of some or several of these). Treatments often involve a combination of psychoeducational interventions, home- and school-based programmes, and medication. Here, I will first briefly review our main knowledge on the biological pathways associated with early onset neurodevelopmental disorders and will provide useful links to be informed of the progress in the field. Five main pathways are associated with ASD and ID: chromatin remodelling, cytoskeleton dynamics, mRNA translation, metabolism and synapse formation/function. I will then detail three propositions coming from institutions, researchers and/or communities of patients and families to foster research: 1) to use more dimensional and quantitative data than diagnostic categories; 2) to increase data sharing and research on genetic and brain diversity in human populations; 3) to involve patients and relatives as participants for research. Finally, I will provide examples of very stimulating initiatives towards a more inclusive world for individuals with ESSENCE.

International audience; Parent and child perceived neighborhood safety predicts child health outcomes such as sleep quality, asthma, physical activity, and psychological distress. Although previous studies identify environmental predictors of parent perceived safety, little is known about predictors of child perceived safety. This study aims to identify the social and physical environmental neighborhood features that predict child and parent perceived neighborhood safety and, simultaneously, to assess the association between child and parent perceptions. Data were from the QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort, an ongoing study of Caucasian children (aged 8-10 years) with a parental history of obesity, and their biological parents from Québec, Canada. Measures of social and physical neighborhood features were collected using a spatial data infrastructure and in-person audits. Structural equation modeling was used to test direct and indirect associations between neighborhood features, child and parent perceived safety. Results suggest that among children (N = 494), trees and lighting were positively associated with perceived neighborhood safety, whereas a high proportion of visible minorities was associated with poorer perceived safety. Parents' perceptions of safety were more strongly tied to indicators of disorder and a lack of community involvement, and to traffic. Child perceived safety was partly explained by parent perceived safety, suggesting moderate concordance between perceptions. Although associated with each other, parent and child perceived safety seemed to be determined by distinct environmental features. Though this study focused on determinants of child and parent perceived safety, future research investigating the impact of neighborhood safety on child health should consider both child and parent perspectives.

Objectives To examine (i) the frequency of different sleep complaints (early wake-up, trouble falling asleep, hypersomnia) and their co-occurrence and (ii) the sociodemographic characteristics and psychiatric comorbidity associated with each type of sleep profiles. Methods Data were drawn from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US adult population (wave 1, 2001–2002; wave 2, 2004–2005). The primary analyses were limited to 3573 participants who had a DSM-IV-TR diagnosis of major depressive episode (MDE) between the two waves. We used a multiple regression model to estimate the strength of independent associations between self-reported sleep complaints, sociodemographic characteristics and lifetime psychiatric comorbidity. Results Most of participants with MDE (92%) reported significant sleep complaints, from whom 85.2% had insomnia and 47.5% hypersomnia symptoms. The prevalence rates were for insomnia “only” of 48.5%, hypersomnia “only” of 13.7%, and their co-occurrence of 30.2%. We found that several sociodemographic characteristics (gender, age, education, individual and familial income, marital status) and psychiatric disorders (bipolar disorders, post-traumatic disorders and panic disorder) were significantly and independently associated with different sleep profiles. The co-occurrence of insomnia (especially early wake-up) and hypersomnia presented with a two-/three- fold increase risk of bipolar disorders. Limitations Definitions of sleep complaints were qualitative and subjective. Conclusion Sleep complaints are prevalent and heterogeneous in expression during MDE. Sleep disturbance profiles are associated with specific patterns of comorbidity. Our findings highlight the importance of continued research on sleep complaints during MDE while taking into account psychiatric comorbidity.

Background It is increasingly recognised that reliable and valid assessments of lithium response are needed in order to target more efficiently the use of this medication in bipolar disorders (BD) and to identify genotypes, endophenotypes and biomarkers of response. Methods In a large, multi-centre, clinically representative sample of 300 cases of BD, we assess external clinical validators of lithium response phenotypes as defined using three different recommended approaches to scoring the Alda lithium response scale. The scale comprises an A scale (rating lithium response) and a B scale (assessing confounders). Results Analysis of the two continuous scoring methods (A scale score minus the B scale score, or A scale score in those with a low B scale score) demonstrated that 21–23% of the explained variance in lithium response was accounted for by a positive family history of BD I and the early introduction of lithium. Categorical definitions of response suggest poor response is also associated with a positive history of alcohol and/or substance use comorbidities. High B scale scores were significantly associated with longer duration of illness prior to receiving lithium and the presence of psychotic symptoms. Limitations The original sample was not recruited specifically to study lithium response. The Alda scale is designed to assess response retrospectively. Conclusions This cross-validation study identifies different clinical phenotypes of lithium response when defined by continuous or categorical measures. Future clinical, genetic and biomarker studies should report both the findings and the method employed to assess lithium response according to the Alda scale.

IF 2.558; International audience; Stroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. Though the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity could play an important role in the occurrence of stroke during AMI. We aimed to investigate the relationship between both mean platelet volume (MPV), a parameter of platelet function, and C-reactive protein (CRP) and the occurrence of in-hospital ischemic stroke (IHS) after AMI. Data were obtained from a French regional survey for AMI that included 5976 patients admitted to an intensive care unit (ICU) between 2001 and 2010. Patients were divided into two groups according to the occurrence of IHS. MPV, platelet count (PC), and CRP were routinely measured at admission to the ICU; 99 (1.6%) IHSs were recorded during hospitalization after admission for AMI. In multivariate analysis, IHS was independently associated with a history of stroke (OR: 1.99%, CI: 1.1-3.49, p = 0.01), impaired left ventricular ejection fraction 10 mg/l (OR: 2.19, 95% CI: 1.44-3.33, p < 0.001), and MPV/PC ratio (OR: 1.04, 95% CI: 1.01-1.08, p = 0.023). Compared with the first to fourth quintiles, the last quintile of the MPV/PC ratio was associated with higher rates of IHS on survival curve analysis (p = 0.014). At hospital admission, a high MPV/PC ratio and a high level of CRP might help to identify patients at increased risk of IHS. Moreover, these results provide new insights into the potential role played by increased inflammation and platelet reactivity in the occurrence of stroke after AMI.

Aims EPHESUS was a multicentre, double-blind clinical trial in which 6632 patients with acute myocardial infarction (AMI) complicated by LV systolic dysfunction (LVSD) were randomized to receive eplerenone (n = 3319) or placebo (n = 3313). A total of 1580 EPHESUS patients were treated with PCI, which is now the standard treatment for AMI. This EPHESUS substudy examined the effects of eplerenone upon cardiovascular outcomes in PCI-treated patients. Methods and results EPHESUS patients were divided into PCI-treated and non-PCI-treated cohorts, and the effect of eplerenone upon mortality and other major adverse cardiovascular outcomes was assessed in each cohort. The PCI-treated patients (n = 1580) were younger, and had better renal function and fewer co-morbidities than non-PCI-treated patients (n = 5052). Cardiovascular mortality was significantly lower in PCI-treated patients as compared with non-PCI-treated patients (7% vs. 16%, P < 0.0001). However, the incidence of non-fatal events was similar in PCI-treated and non-PCI-treated cohorts. There was no statistical difference between the PCI-treated and non-PCI-treated cohorts in the primary or secondary outcomes of the trial. Eplerenone administration, compared with placebo, in the PCI-treated cohort did not affect PCI-related clinical outcomes, including recurrence of angina, the occurrence of acute coronary syndromes, or the need for further revascularization. Conclusions The beneficial effects of eplerenone in the EPHESUS trial exist for both PCI- and non-PCI-treated AMI patients with LVSD. Eplerenone has minimal, if any, effect upon reducing PCI-related adverse events in the PCI-treated cohort.

International audience; BACKGROUND:Differential outcomes in patients with acute systolic heart failure (HF) complicating acute myocardial infarction (AMI) and the efficacy of mineralocorticoid receptor antagonists according to non-ST-segment and ST-segment elevation myocardial infarction (NSTEMI, STEMI) status has not been specifically investigated.METHODS:In the EPHESUS study, 6632 patients with acute HF and left ventricular ejection fraction

International audience; By 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately. Extrapulmonary comorbidities are common in COPD and influence prognosis; we propose an exhaustive comorbidities review

International audience; We studied 7,897 women with postmenopausal osteoporosis to assess factors that influence health-related quality of life (HRQoL). An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL. Understanding the factors that affect HRQoL may improve management of these patients.INTRODUCTION:HRQoL is impaired in women treated for postmenopausal osteoporosis (PMO). The objective of this study was to examine the relationship between clinical characteristics, comorbidities, medical history, patient demographics, and HRQoL in women with PMO.METHODS:Baseline data were obtained and combined from two large and similar multinational observational studies: Prospective Observational Scientific Study Investigating Bone Loss Experience in Europe (POSSIBLE EU®) and in the US (POSSIBLE US™) including postmenopausal women in primary care settings initiating or switching bone loss treatment, or who had been on bone loss treatment for some time. HRQoL measured by health utility scores (EQ-5D™) were available for 7,897 women (94 % of study participants). The relationship between HRQoL and baseline clinical characteristics, medical history and patient demographics was assessed using parsimonious, multivariable, mixed-model analyses.RESULTS:Median health utility score was 0.80 (interquartile range 0.69-1.00). In multivariable analyses, young age, low body mass index, previous vertebral fracture, increased number of comorbidities, high fear of falling, and depression were associated with reduced HRQoL. Regression-based model estimates showed that previous vertebral fracture was associated with lower health utility scores by 0.08 (10.3 %) and demonstrated the impact of multiple comorbidities and of fear of falling on HRQoL.CONCLUSIONS:In this large observational study of women with PMO, there was substantial interindividual variability in HRQoL. An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL.

La bronchopneumopathie chronique obstructive (BPCO) est un problème majeur de santé publique en termes de morbimortalité. Longtemps considérée comme une pathologie respiratoire isolée, il est aujourd’hui admis qu’elle coexiste souvent avec d’autres pathologies (maladies cardiovasculaires, anxiété, dépression, ostéoporose, cancers liés au tabac). L’objectif principal de notre étude était de quantifier la prévalence des patients BPCO multimorbides en soins primaires. 138 médecins généralistes Parisiens et Strasbourgeois ont été contactés, 19 (13,8%) ont accepté de participer à l’étude avec pour objectif de remplir un questionnaire pour chaque patient BPCO de plus de 40 ans passant à leur cabinet durant 3 mois consécutifs à Paris de mi-novembre 2015 à février 2016 et à Strasbourg de février à avril 2016. 42 patients BPCO ont été inclus. L’âge moyen était de 67 ans. 95% des patients étaient multimorbides. Les 3 pathologies les plus fréquentes étaient les maladies et facteurs de risque cardiovasculaire avec respectivement 40% et 64% des cas. L’anxiété et la dépression représentaient 64% des cas. 62% des patients présentaient 3 ou plus de 3 pathologies chroniques associées à la BPCO. Les données de notre thèse appuyées par celles de la littérature démontrent que les recommandations de bonne pratique clinique sont caduques et doivent être modifiées afin de refléter au mieux les conditions réelles d’exercice. Le but étant d’aider le médecin généraliste, acteur principal de la prise en charge globale des patients multimorbides, à cibler les patients à fort risque de BPCO nécessitant un dépistage précoce afin de diminuer leur risque de morbimortalité.

International audience; BACKGROUND:Negative effects of obesity on health-related quality of life (HRQoL) have been reported, especially in women, but the relative contribution of cardiometabolic and other obesity-related comorbidities to such effects remains unclear. Our objective was to model the association by sex between body mass index and HRQoL and to precisely quantify the indirect effects mediated by obesity-related comorbidities.METHODS AND RESULTS:Data were drawn from the latest French Decennial Health Survey, a nationwide cross-sectional study conducted in 2003 (21 239 adults aged 25-64 years analyzed). HRQoL was measured by the 36-item short-form health survey questionnaire. A mediation analysis based on the counterfactual framework was performed to quantify the proportion of obesity effects on HRQoL mediated by related comorbidities, including cardiometabolic risk factors (diabetes mellitus, hypertension, dyslipidemia) and diseases (ischemic heart disease, cerebrovascular, and peripheral vascular disease), musculoskeletal disorders, and asthma. After multiple linear regression, inverse associations were found between increasing body mass index category and physically oriented and most mentally oriented 36-item short-form health survey dimensions, with evidence of greater effects in women. Mediation analysis revealed that obesity effects were significantly mediated by several comorbidities, more apparently in men (eg, proportion of obesity class II total effect mediated via cardiometabolic factors: general health 27.0% [men] versus 13.6% [women]; proportion of obesity class II total effect mediated via total count of comorbidities: physical functioning 17.8% [men] versus 7.7% [women] and general health 37.1% [men] versus 20.3% [women]).CONCLUSIONS:Women have a greater overall impact of obesity on HRQoL, but with proportionally lower effects mediated by cardiometabolic and other obesity-related conditions, suggesting the possible role of other specific psychosocial processes.

Background: Clinical features of attention deficit hyperactivity disorder can be frequently observed in cases with bipolar disorders and associated with greater severity of bipolar disorders. Although designed as a screening tool for attention deficit hyperactivity disorder, the Wender Utah Rating Scale could, given its factorial structure, be useful in investigating the early history of impulsive, inattentive or mood-related symptoms among patients with bipolar disorders. Methods: We rated the Wender Utah Rating Scale in 276 adult bipolar disorder cases and 228 healthy controls and tested its factorial structure and any associations with bipolar disorder phenomenology. Results: We confirmed a three-factor structure for the Wender Utah Rating Scale (‘ impulsivity/temper’, ‘ inattentiveness’ and ‘ mood/self-esteem’). Cases and controls differed significantly on Wender Utah Rating Scale total score and sub-scale scores ( p-values −5). About 23% of bipolar disorder cases versus 5% of controls were classified as ‘ WURS positive’ (odds ratio = 5.21 [2.73–9.95]). In bipolar disorders, higher Wender Utah Rating Scale score was associated with earlier age at onset, severity of suicidal behaviors and polysubstance misuse; multivariate analyses, controlling for age and gender, confirmed the associations with age at onset ( p = 0.001) and alcohol and substance misuse ( p = 0.001). Conclusion: Adults with bipolar disorders who reported higher levels of childhood symptoms on the Wender Utah Rating Scale presented a more severe expression of bipolar disorders in terms of age at onset and comorbidity. The Wender Utah Rating Scale could be employed to screen for attention deficit hyperactivity disorder but also for ‘ at-risk behaviors’ in adult bipolar disorder cases and possibly for prodromal signs of early onset in high-risk subjects.

International audience; Hyperkalemia is a common clinical problem, especially in patients with chronic kidney disease, diabetes mellitus, or heart failure. Treatment with renin angiotensin aldosterone system inhibitors exacerbates the risk of hyperkalemia in these patients. Concern about hyperkalemia can result in the failure to initiate, suboptimal dosing, or discontinuation of renin angiotensin aldosterone system inhibitor therapy in patients; effective treatments for hyperkalemia might mitigate such undertreatment. New treatments for hyperkalemia in development may offer better efficacy, tolerability and safety profiles than do existing approved treatments. These compounds might enable more eligible patients to receive renin angiotensin aldosterone system inhibitor therapy or to receive renin angiotensin aldosterone system inhibitors at target doses. The evidence needed to support a treatment claim (reduction in serum potassium) differs from that needed to support a prevention claim (preventing hyperkalemia to allow renin angiotensin aldosterone system inhibitor treatment). Thus, several issues related to clinical trial design and drug development need to be considered. This paper summarizes and expands upon a discussion at the Global Cardiovascular Clinical Trialists 2014 Forum and examines methodologic considerations for trials of new potassium binders for the prevention and management of hyperkalemia in patients with renin angiotensin aldosterone system inhibitor indications.

International audience; BACKGROUND:The most used score to measure comorbidity is the Charlson index. Its application to a health care administrative database including International Classification of Diseases, 10th edition (ICD-10) codes, medical procedures, and medication required studying its properties on survival. Our objectives were to adapt the Charlson comorbidity index to the French National Health Insurance database to predict 1-year mortality of discharged patients and to compare discrimination and calibration of different versions of the Charlson index.METHODS:Our cohort included all adults discharged from a hospital stay in France in 2010 registered in the French National Health Insurance general scheme. The pathologies of the Charlson index were identified through ICD-10 codes of discharge diagnoses and long-term disease, specific medical procedures, and reimbursement of specific medications in the past 12 months before inclusion.RESULTS:We included 6,602,641 subjects at the date of their first discharge from medical, surgical, or obstetrical department in 2010. One-year survival was 94.88%, decreasing from 98.41% for Charlson index of 0-71.64% for Charlson index of ≥5. With a discrimination of 0.91 and an appropriate calibration curve, we retained the crude Cox model including the age-adjusted Charlson index as a 4-level score.CONCLUSIONS:Our study is the first to adapt the Charlson index to a large health care database including >6 million of inpatients. When mortality is the outcome, we recommended using the age-adjusted Charlson index as 4-level score to take into account comorbidities.

Gaëtan Deslee,1 Pierre-Régis Burgel,2 Roger Escamilla,3 Pascal Chanez,4 Isabelle Court-Fortune,5 Pascale Nesme-Meyer,6 Graziella Brinchault-Rabin,7 Thierry Perez,8 Gilles Jebrak,9 Denis Caillaud,10 Jean-Louis Paillasseur,11 Nicolas Roche2On behalf of the Initiatives BPCO Scientific Committee 1Department of Respiratory Diseases, INSERM UMR 903, Maison Blanche Hospital, University Hospital of Reims, Reims, 2Department of Respiratory Diseases, Cochin Hospital, AP-HP and University Paris Descartes, Sorbonne Paris Cité, Paris, 3Department of Respiratory Diseases, Larrey Hospital, Toulouse, 4Department of Respiratory Diseases, APHM, INSERM U1077, CNRS UMR 7733 Aix Marseille Université, Marseille, 5Department of Respiratory Diseases, University Hospital of St Etienne, 6Department of Respiratory Diseases, La Croix Rousse Hospital, Lyon, 7Department of Respiratory Diseases, Pontchaillou Hospital, University Hospital of Rennes, Rennes, 8Department of Respiratory Diseases, Calmette Hospital, University Hospital of Lille, Lille, 9Department of Respiratory Diseases, Bichat Hospital, AP-HP, Paris, 10Department of Respiratory Diseases, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, 11EFFI-STAT, Paris,FranceBackground: Cough and sputum production are frequent in chronic obstructive pulmonary disease (COPD). The objective of this study was to examine the relationship between cough and sputum production and health-related quality of life in COPD.Methods: A cross-sectional study was conducted in the French Initiatives COPD cohort and assessed cough and sputum production within the past 7 days using the cough and sputum assessment questionnaire (CASA-Q), health-related quality of life, spirometry, smoking status, dyspnea, exacerbations, anxiety and depression, and comorbidities.Results: One hundred and seventy-eight stable COPD patients were included (age, 62 [56–69]years, 128 male, forced expiratory volume in 1 second [FEV1]: 57 [37–72] % predicted) (median [Q1–Q3]). In univariate analyses, health-related quality of life (Saint George’s respiratory questionnaire total score) was associated with each CASA-Q domain and with chronic bronchitis, exacerbations, dyspnea, FEV1, depression, and anxiety. All four domains introduced separately were independently associated with health-related quality of life. When introduced together in multivariate analyses, only the cough impact domain remained independently associated with health-related quality of life (R2=0.60). With chronic bronchitis (standard definition) instead of the CASA-Q, the R2 was lower (R2=0.54).Conclusion: This study provides evidence that current cough in the previous 7 days is an important determinant of health-related quality of life impairment in stable COPD patients.Keywords: signs and symptoms, respiratory, sputum, questionnaires, dyspnea, multivariate analysis

International audience; Co-morbidities can influence generic measurement of health indirect utility. We investigated their impact to assess indirect utility with the Medical Outcomes Study Short Form 6D (SF-6D) in patients with osteoarthritis (OA). In patients with hip and knee OA from the Knee and Hip Osteo-Arthritis Long-term Assessment (KHOALA) study, co-morbidities were assessed by the Functional Co-morbidity Index. Multivariate linear regressions were used to determine predictors of utility score.For the 878 patients included, the mean (standard deviation (SD)) utility score for 808 patients was 0.66 (11; range 0.32-1.00) and mean number of co-morbidities 2.05 (1.58). Number of co-morbidities (beta = -0.30; p = 0.002), psychiatric disease (beta = -0.043; p < 0.0001) and degenerative disc disease (beta = -0.014; p = 0.018) were predictors of low utility score. The WOMAC functional score had a higher significant effect (beta = -0.003; p < 0.0001) and explained a higher percentage of the model variance.; For the 878 patients included, the mean (standard deviation (SD)) utility score for 808 patients was 0.66 (11; range 0.32-1.00) and mean number of co-morbidities 2.05 (1.58). Number of co-morbidities (beta = -0.30; p = 0.002), psychiatric disease (beta = -0.043; p < 0.0001) and degenerative disc disease (beta = -0.014; p = 0.018) were predictors of low utility score. The WOMAC functional score had a higher significant effect (beta = -0.003; p < 0.0001) and explained a higher percentage of the model variance.

Background According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult’s risk of falling and if it does, will the relationship hold as the count of risk factors increases? Methods Using a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment. Results For the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls. Conclusions The resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.

The relationship between vitamin D and rheumatoid arthritis (RA) activity remains controversial. RA is a cardiovascular risk factor. A low level of vitamin D may increase blood pressure (BP) and decrease HDL-cholesterol. We aimed to determine the prevalence of vitamin D deficiency in RA patients compared to controls, and also to investigate the relationship between vitamin D and RA activity, and between vitamin D and cardiovascular risk factors.Patients in the COMEDRA study with established inactive RA (1987 ACR criteria) were matched with subjects from the NUTRINET-SANTE cohort (age, gender, latitude, sampling season). Vitamin D deficiency was defined as10 ng/mL, and insufficiency as 10 to 29.9 ng/mL.Eight hundred and ninety-four RA patients were analysed, of which 861 were matched with controls. The prevalence of vitamin D insufficiency and deficiency was lower in RA patients than in controls: 480 (55.8%) vs. 508 (59%) and 31 (3.6%) vs. 45 (5.23%), respectively; p=0.04. There was an inverse correlation between vitamin D levels and RA activity assessed by DAS28-CRP (p=0.01), SDAI (p0.001) and CDAI (p=0.001), but not DAS28-ESR after adjustment for age, gender, inclusion season, body mass index (BMI), vitamin D supplementation, disease duration, RF or anti-CCP status and RA treatments. Vitamin D levels were inversely correlated with BMI (p0.001), but not with BP, total cholesterol, LDL-cholesterol, HDL-cholesterol or blood glucose.This study demonstrates that vitamin D is inversely correlated with RA activity and BMI, but not with other cardiovascular risk factors.

Objectives The French Society of Rheumatology has initiated a large national multicenter, longitudinal, prospective follow-up of patients presenting with early inflammatory back pain in order to set up a database to facilitate several investigations on diagnosis, prognosis, epidemiology, pathogenesis and medico-economics in the field of early inflammatory back pain and spondyloarthritis. Methods Patients were recruited if they had inflammatory back pain of more than 3 months and less than 3 years. Patients will be followed every 6 months during the first 2 years then every year during at least 5 years. Apart from information collected on a Case Report Form (demographics, disease activity, severity, co-morbidities, socio-economics, treatments, radiological and MRI evaluation of the spine and the pelvis according to the local investigators, and for some centers bone densitometry and ultrasonography of entheses), the digital X-rays and MRI of the spine and pelvis are stored using a specific software (Carestream) and the biological samples (DNA, RNA, sera, urines) are centralized at the Biological Resources Center (Bichat Hospital). Results The recruitment period of the 708 patients (mean age: 34 ± 9 years, female 54%, HLA-B27 positive: 57%) in the 25 centers was 26 months (from December 2007 to April 2010). The modified New York criteria, Amor criteria, ESSG criteria and axial ASAS criteria were fulfilled by 26%, 77%, 76% and 67% of the patients at entry, respectively. A history or current symptoms suggestive of peripheral arthritis, acute anterior uveitis and inflammatory bowel disease were observed in 21%, 9% and 4% of the patients, respectively. The disease was active (BASDAI: 45 ± 20) despite an NSAID intake in 66% of the patients. Conclusion This large cohort should facilitate the conduct of researches in different areas (clinical, medico-economics, translational) in order to improve our knowledge on the pathogenesis and natural history of axial spondyloarthritis.