91 research outputs found
Proportion of At-Risk Alcohol Consumers According to the New French Guidelines: Cross-Sectional Weighted Analyses From the CONSTANCES Cohort
Objective: To estimate the proportion of the participants of the French national population-based CONSTANCES cohort exceeding the new low-risk drinking guidelines according to sociodemographic and clinical factors.Methods: From 34,470 participants with follow-up data in 2019, among volunteers aged 18â69Â years and invited to enroll in the CONSTANCES cohort in 2016 and 2017, weighted prevalence and odds ratios with 95% confidence intervals (CI) exceeding the guidelines using logistic regressions were presented stratified for age, gender, education, occupational grade, employment, income, marital status, pregnancy, work stress, depression, alcohol dependence, binge drinking, cannabis use, smoking status, e-cigarette use, cardiovascular diseases, and cancer.Results: The guidelines were exceeded more by men at 60.2% (95%CI: 59.3%â61.0%) than by women at 36.6% (95%CI: 35.9%â37.4%). Exceeding the guidelines increased with age, socioeconomic status, smoking, vaping, using cannabis, binge drinking, and alcohol dependence. Being depressed was associated with exceeding the guidelines in women. Even though pregnant women were less likely to exceed the guidelines, 7.6% (95%CI: 5.4%â10.6%) were at-risk drinkers.Conclusion: These findings highlight the need to implement effective prevention measures for at-risk alcohol use among the French population
Sociodemographic Differences Between Alcohol Use and Sickness Absence : Pooled Analysis of Four Cohort Studies
Aims: We examined differences in sickness absence in relation to at-risk drinking and abstinence, taking into account potential changes in consumption. Methods: We used individual-participant data (n = 46,514) from four prospective cohort studies from Finland, France and the UK. Participants responded to a survey on alcohol use at two time points 4-6 years apart, and were linked to records of sickness absence for an similar to 6-year follow-up after the latter survey. Abstainers were those reporting no alcohol use in either survey. At-risk drinkers at T1 were labelled as 'former', at-risk drinkers at T2 as 'current' and at-risk drinkers at both times as 'consistent' at-risk drinkers. The reference group was low-risk drinkers at both times. Study-specific analyses were stratified by sex and socioeconomic status (SES) and the estimates were pooled using meta-analysis. Results: Among men (n = 17,285), abstainers (6%), former (5%), current (5%) and consistent (7%) at-risk drinkers had an increased risk of sickness absence compared with consistent low-risk drinkers (77%). Among women (n = 29,229), only abstainers (12%) had a higher risk of sickness absence compared to consistent low-risk drinkers (74%). After adjustment for lifestyle and health, abstaining from alcohol was associated with sickness absence among people with intermediate and high SES, but not among people with low SES. Conclusions: The U-shaped alcohol use-sickness absence association is more consistent in men than women. Abstinence is a risk factor for sickness absence among people with higher rather than lower SES. Healthy worker effect and health selection may partly explain the observed differences. Short summary: In a pooled analysis from four cohort studies from three European countries, we demonstrated a U-shaped association between alcohol use and sickness absence, particularly among men. Abstinence from alcohol was associated with increased sickness absenteeism among both sexes and across socioeconomic strata, except those with low SES.Peer reviewe
Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers : consideration of the U-shaped association between alcohol use and sickness absence in four cohort studies
Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis-specific sickness absence. Design A multi-cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time-points, and were linked to records of sickness absence. Diagnosis-specific sickness absence was followed for 4-7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000-02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985-88 and 1991-94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1-11 and > 11 units per week in women and 0, 1-34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio-economic status, smoking and body mass index. Findings Women who reported drinking 1-11 units and men who reported drinking 1-34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22-1.88], musculoskeletal disorders (1.22, 95% CI = 1.06-1.41), diseases of the digestive system (1.35, 95% CI = 1.02-1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29-1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13-1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at-risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.Peer reviewe
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La mĂ©connaissance des troubles est un symptĂŽme particuliĂšrement frĂ©quent en psychiatrie. Les patients pour lesquels ce dĂ©faut dâinsight est le plus marquĂ© sont les schizophrĂšnes. Or de nombreux auteurs ont montrĂ© que lâabsence dâinsight avait des consĂ©quences dĂ©lĂ©tĂšres sur lâĂ©volution de la maladie du fait dâune mauvaise observance thĂ©rapeutique, dâune augmentation du risque de rechute et dâun amoindrissement de la qualitĂ© de vie. Face Ă ce constat, dâimportants travaux ont Ă©tĂ© menĂ©s ces vingt derniĂšres annĂ©es; tout dâabord concernant les diffĂ©rentes thĂ©ories physiopathologiques pouvant rendre compte des multiples dimensions de lâinsight mais Ă©galement concernant lâĂ©laboration dâĂ©chelles dâĂ©valuation spĂ©cifiques dans la schizophrĂ©nie ainsi que le dĂ©veloppement de thĂ©rapies susceptibles dâamĂ©liorer lâinsight (remĂ©diation cognitive, TCC, programmes psychoĂ©ducatifs, etc.). En regard des donnĂ©es actuelles, il semble fondamental dâintĂ©grer dans la prise en charge de tout schizophrĂšne une Ă©valuation du degrĂ© dâinsight ainsi que la mise en Ćuvre de stratĂ©gies adĂ©quates pour lâamĂ©liorer
Occupational life and addictive behaviors (alcohol, tobacco, cannabis, benzodiazepine misuse) in the Constances cohort
Lâobjectif gĂ©nĂ©ral Ă©tait d'Ă©tudier les liens entre les conduites addictives et diffĂ©rents aspects de la vie professionnelle dans lâinfrastructure de recherche CONSTANCES : (1) Estimer les prĂ©valences d'usage de substances en population gĂ©nĂ©rale française en fonction des facteurs sociodĂ©mographiques et cliniques, (2) Ătudier les associations longitudinales entre stress au travail et usage chronique de benzodiazĂ©pines, (3) Ătudier les associations transversales entre demande Ă©motionnelle au travail et usages dâalcool, de tabac et de cannabis, (4) Ătudier les associations transversales entre demande Ă©motionnelle au travail et usage chronique de benzodiazĂ©pines, (5) Ătudier les associations longitudinales entre usages dâalcool, de tabac et de cannabis et la perte dâemploi.1. Les prĂ©valences d'usage d'alcool, de tabac et de cannabis en population gĂ©nĂ©rale ont Ă©tĂ© estimĂ©es. Concernant lâusage chronique de benzodiazĂ©pines, sa prĂ©valence Ă©tait en 2015 de 2,8 % (IC 95% : 2,3-3,4) chez les hommes et de 3,8% (IC 95 % : 3,3-4,5) chez les femmes(n = 9 535).2. Il existait des relations dose-dĂ©pendantes entre lâintensitĂ© du stress au travail, mesurĂ© par le dĂ©sĂ©quilibre effort-rĂ©compense, et le risque dâusage chronique de benzodiazĂ©pines sur une pĂ©riode de suivi de deux ans (n = 31 077), avec un OR = 2,18 (IC 95 % : 1,50-3,16) pour les sujets les plus stressĂ©s comparĂ©s aux moins stressĂ©s, aprĂšs ajustement pour les facteurs sociodĂ©mographiques, les usages dâalcool et de tabac, la dĂ©pression et lâĂ©tat de santĂ© perçu.3. Il existait des associations significatives entre la demande Ă©motionnelle au travail, mesurĂ©e par la frĂ©quence de lâexposition stressante au public, et les usages dâalcool, de tabac et de cannabis, en ajustant pour les facteurs sociodĂ©mographiques (n=23 641). Concernant lâusage dâalcool, la demande Ă©motionnelle Ă©tait associĂ©e chez les hommes Ă une augmentation du risque dâalcoolisations paroxystiques intermittentes plus dâune fois par mois (OR = 1,29 (IC 95 % : 1,10-1,51), et chez les femmes Ă une augmentation des risques de consommation hebdomadaire Ă©levĂ©e ou trĂšs Ă©levĂ©e (OR = 1,59 (IC 95 % : 1,12-2,25) et de trouble de lâusage dâalcool (OR = 2,30 (IC 95 % : 1,54-3,44).4. Il existait des relations dose-dĂ©pendantes entre la demande Ă©motionnelle au travail et l'usage chronique de benzodiazĂ©pines, en ajustant pour lâĂąge, le niveau dâĂ©ducation et lâindice de dĂ©privation sociale (n=33 195). Les OR Ă©taient de 2,3 (IC 95 % : 1,5-3,6) chez les hommes et de 2,5 (IC 95 % : 1,8-3,4) chez les femmes pour les individus exposĂ©s Ă la plus forte demande Ă©motionnelle comparĂ©e Ă la plus faible. Ces associations persistaient en lâabsence dâautres facteurs de vulnĂ©rabilitĂ© Ă lâusage des benzodiazĂ©pines.5. Les usages dâalcool, de tabac et de cannabis Ă©taient tous associĂ©s, de maniĂšre indĂ©pendante, et suivant des relations dose-dĂ©pendantes, au risque de perte dâemploi Ă un an, en ajustant pour lâĂąge, le genre, la dĂ©pression et lâĂ©tat de santĂ© perçu(n=18 879). Le risque de perte dâemploi associĂ© Ă un usage problĂ©matique ou de dĂ©pendance probable de lâalcool Ă©tait de 1,92 (IC 95 % : 1,34-2,75) comparĂ© Ă un usage Ă faible risque. Il Ă©tait de 1,78 (IC 95 % : 1,26-2,54) pour les gros fumeurs comparĂ©s aux non-fumeurs et de 2,68 (IC 95 % : 2,10-3,42) pour les consommateurs de cannabis au moins une fois par mois comparĂ©s aux non-consommateurs.Ces rĂ©sultats pourraient permettre aux dĂ©cideurs en santĂ© publique et en santĂ© au travail d'Ă©laborer des stratĂ©gies d'information et de prĂ©vention destinĂ©es Ă rĂ©duire l'usage de substances, notamment en milieu professionnel. En raison de la complexitĂ© des interrelations entre conduites addictives et vie professionnelle, ce champ de recherche en Ă©pidĂ©miologie devrait poursuivre son dĂ©veloppement afin de rĂ©pondre aux enjeux majeurs de santĂ© publique posĂ©s tant par les conduites addictives que par l'exposition aux risques professionnels.The overall objective was to explore the links between addictive behaviours (alcohol, tobacco, cannabis, benzodiazepines) and different aspects of occupational life (i.e. job stress, emotional demand, job loss) using data from the CONSTANCES research infrastructure.This general objective has been operationalized into five distinct objectives:(1) Estimate the prevalence of substance use in the general population according to socio-demographic and clinical factors,(2) Examine the longitudinal associations between job stress and benzodiazepine long-term use,(3) Examine the cross-sectional associations between emotional job demand and alcohol, tobacco and cannabis use,(4) Examine the cross-sectional associations between emotional job demand and benzodiazepine long-term use,(5) Examine the longitudinal associations between alcohol, tobacco and cannabis use and job loss.1. The prevalence of alcohol, tobacco and cannabis use in the general population have been estimated. The prevalence of benzodiazepine long-term use in 2015 was of 2.8 % (CI 95 % : 2.3-3.4) in men and 3.8 % (CI 95 % : 3.3-4.5) in women (n=9 535).2. There were dose-dependent relationships between job stress, as measured by the effort-reward imbalance, and the risk of benzodiazepine long-term use over a two-year follow-up (n=31 077), with an OR = 2.18 (CI 95 % : 1.50-3.16) for the most stressed compared to the least stressed subjects, after adjusting for socio-demographic factors, alcohol and tobacco smoking use, depression and self-rated health status.3. There were significant associations between emotional job demand, measured by the stressful exposure to the public in the workplace, and alcohol, tobacco and cannabis use, after adjusting for socio-demographic factors (n=23 641). Regarding alcohol use, emotional job demand was associated in men with an increased risk of heavy episodic drinking more than once a month(OR = 1.29 (CI 95 % : 1.10-1.51), and in women with an increased risk of high or very high weekly consumption (OR = 1.59 (CI 95 % : 1.12-2.25) as well as with alcohol use disorder(OR = 2.30 (CI 95 % : 1.54-3.44).4. There were dose-dependent relationships between emotional job demand and benzodiazepine long-term use, adjusting for age, education level and social deprivation index (n=33 195). ORs were 2.3 (CI 95 % : 1.5-3.6) in men and 2.5 (CI 95 % : 1.8-3.4) in women for individuals exposed to the highest emotional demand compared to the lowest. These associations remained significant even without other factors of vulnerability to benzodiazepine use.5. Alcohol, tobacco and cannabis use were independently and dose-dependently associated with the risk of job loss at one-year, adjusting for age, gender, depression and self-rated health status (n=18 879). The risk of job loss associated with problematic use or alcohol dependence was 1.92 (CI 95 % : 1.34-2.75) compared to low-risk use. This risk was 1.78 (95% CI : 1.26-2.54) for heavy smokers compared to non-smokers and 2.68 (CI 95 % : 2.10-3.42) for cannabis users at least once a month compared to non-users.These findings could help public health and occupational health decision-makers to develop information and prevention strategies aiming at reducing the burden of substance use, particularly in the workplace. Because of the complexity of the interrelationships between addictive behaviours and occupational life, this field of the epidemiologic research should continue to be developed in order to meet the major public health challenges posed by both addictive behaviours and exposure to occupational risks
Stress au travail et usage chronique de benzodiazépines: Résultats prospectifs issus de la cohorte CONSTANCES
International audienceNo abstract availabl
The role of being a former smoker in the association between electronic cigarette and alcohol use
International audienc
Liens entre le statut tabagique et la situation vis-Ă -vis de lâemploi : analyse transversale de la cohorte CONSTANCES
International audienceEstimer les prĂ©valences dâusage de tabac en 2017 et en 2019 en population française couverte par le RĂ©gime GĂ©nĂ©ral dâAssurance Maladie en fonction du statut vis-Ă -vis de lâemploi. Ă partir dâun Ă©chantillon de 18 008 volontaires inclus en 2017 dans CONSTANCES, une cohorte nationale en population gĂ©nĂ©rale française ayant recrutĂ© de maniĂšre alĂ©atoire des volontaires de 18-69 ans affiliĂ©s au RĂ©gime GĂ©nĂ©ral dâAssurance Maladie, les prĂ©valences dâusage du tabac en fonction de du statut vis-Ă -vis de lâemploi ont Ă©tĂ© estimĂ©es en 2017 et en 2019 aprĂšs correction pour les biais de sĂ©lection Ă lâinclusion et de non-rĂ©ponse au suivi. En 2019, la prĂ©valence du tabagisme Ă©tait plus Ă©levĂ©e chez les actifs inoccupĂ©s (29,2 % chez les hommes et 20,7 % chez les femmes) par rapport aux actifs occupĂ©s (16,5 % chez les hommes et 13,8 % chez les femmes). La prĂ©valence du tabagisme la plus Ă©levĂ©e concernait les personnes sans activitĂ© professionnelle pour raisons de santĂ© (38,5 % chez les hommes et 35,8 % chez les femmes). Les fumeurs Ă©taient plus Ă risque dâĂȘtre actifs inoccupĂ©s comparativement aux non-fumeurs (OR 2,63 [95 % Intervalle de confiance [IC] : 1,79 ; 3,85] chez les hommes et OR 1,55 [95 % IC : 1,08 ; 2,22] chez les femmes). Chez les hommes, la prĂ©valence dâactifs occupĂ©s parmi les petits fumeurs (<10 cigarettes/jour) a baissĂ© entre 2017 (87,1 %) et 2019 (74,8 %). Ces analyses soulignent lâimportance dâintensifier les campagnes de prĂ©vention sur le tabagisme parmi les actifs inoccupĂ©s et les inactifs, en particulier pour raisons de santĂ©
Pertinence du placebo dans les stratégies thérapeutiques des troubles psychiatriques
Depuis les dĂ©clarations dâHelsinki de 2002, les lois de bioĂ©thique imposent une information claire et loyale du patient sur le traitement quâil reçoit. Cette obligation, sâassociant Ă lâessor de la psychopharmacologie, a largement contribuĂ© Ă diminuer lâutilisation du placebo en clinique, cantonnant ainsi son usage aux essais thĂ©rapeutiques. Quelles que soient les Ă©tudes, lâefficacitĂ© du placebo dans le traitement de la dĂ©pression avoisine les 50 %. Elle est de 30 Ă 40 % dans les tableaux sĂ©vĂšres et dĂ©passe 70 % dans les formes plus lĂ©gĂšres. Le traitement par placebo nâaugmente pas le risque suicidaire. Il existerait des caractĂ©ristiques de bonne amĂ©lioration sous placebo. On note lâimportance capitale des attentes positives du patient, de la bonne de lâobservance et de la conviction du prescripteur. La qualitĂ© de la relation mĂ©decin-malade tient Ă©galement une place essentielle. Il nâexiste pas de « personnalitĂ© rĂ©pondeur ». Lâeffet placebo se maintient aprĂšs rĂ©vĂ©lation au patient de la nature du traitement prescrit. Son efficacitĂ© sâen trouve mĂȘme renforcĂ©e lorsque les explications sont claires et approfondies. Face Ă ces constations, certains auteurs sâinterrogent sâil est Ă©thique de ne pas prescrire de placebo dans les situations oĂč la balance bĂ©nĂ©fices/risques est en faveur de ce traitement
Changes in alcohol consumption according to the duration of unemployment: prospective findings from the French CONSTANCES cohort
International audienceObjectives To prospectively examine the association between the duration of unemployment among job seekers and changes in alcohol use in a year. Design A prospective study. Setting French population-based CONSTANCES cohort. Participants We selected 84â943 participants from the CONSTANCES cohort included between 2012 and 2019 who, at baseline and 1-year follow-up, were either employed or job-seeking. Outcome measures Multinomial logistic regression models computed the odds of reporting continuous no alcohol use, at-risk alcohol use, increased or decreased alcohol use compared with being continuously at low risk and according to employment status. The duration of unemployment was self-reported at baseline; thus, the employment status at 1-year follow-up was categorised as follows: (1) employed, (2) return to employment since less than a year, (3) unemployed for less than 1âyear, (4) unemployed for 1 to 3âyears and (5) unemployed for 3âyears or more. Analyses were adjusted for age, gender, education, household monthly income, marital status, self-rated health, smoking status and depressive state. Results Compared with being continuously at low risk (ie, â€10 drinks per week), the unemployment categories were associated in a dose-dependent manner with an increased likelihood of reporting continuous no alcohol use (OR: 1.74â2.50), being continuously at-risk (OR: 1.21â1.83), experiencing an increase in alcohol use (OR: 1.21â1.51) and a decrease in alcohol use (OR: 1.17â1.84). Conclusion Although our results suggested an association between the duration of unemployment and a decrease in alcohol use, they also revealed associations between at-risk and increased alcohol use. Thus, screening for alcohol use among unemployed job seekers must be reinforced, especially among those with long-term unemployment
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