Self-harm, somatic disorders and mortality in the 3 years following a hospitalisation in psychiatry in adolescents and young adults

Background There is limited recent information regarding the risk of self-harm, somatic disorders and premature mortality following discharge from psychiatric hospital in young people. Objective To measure these risks in young people discharged from a psychiatric hospital as compared with both non-affected controls and non-hospitalised affected controls. Methods Data were extracted from the French national health records. Cases were compared with two control groups. Cases: all individuals aged 12–24 years, hospitalised in psychiatry in France in 2013–2014. Non-affected controls: matched for age and sex with cases, not hospitalised in psychiatry and no identification of a mental disorder in 2008–2014. Affected controls: unmatched youths identified with a mental disorder between 2008 and 2014, never hospitalised in psychiatry. Follow-up of 3 years. Logistic regression analyses were conducted with these confounding variables: age, sex, past hospitalisation for self-harm, past somatic disorder diagnosis. Findings The studied population comprised 73 300 hospitalised patients (53.6% males), 219 900 non-affected controls and 9 683 affected controls. All rates and adjusted risks were increased in hospitalised patients versus both non-affected and affected controls regarding a subsequent hospitalisation for self-harm (HR=105.5, 95% CIs (89.5 to 124.4) and HR=1.5, 95% CI (1.4 to 1.6)), a somatic disorder diagnosis (HR=4.1, 95% CI (3.9–4.1) and HR=1.4, 95% CI (1.3–1.5)), all-cause mortality (HR=13.3, 95% CI (10.6–16.7) and HR=2.2, 95% CI (1.5–3.0)) and suicide (HR=9.2, 95% CI (4.3–19.8) and HR=1.7, 95% CI (1.0–2.9)). Conclusions The first 3 years following psychiatric hospital admission of young people is a period of high risk for self-harm, somatic disorders and premature mortality. Clinical implications Attention to these negative outcomes urgently needs to be incorporated in aftercare policies

Early cardiovascular events in women with a history of gestational diabetes mellitus

International audienceBackground: The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.Methods: This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid endarterectomy and fibrinolysis. Hypertensive disease was assessed separately. Determinants studied included age, obesity, subsequent diabetes mellitus and hypertensive diseases during pregnancy. Adjusted odds ratios for outcomes were calculated using multiple logistic regressions.Results: The hospital database recorded 1,518,990 deliveries in 2007 and 2008. Among these, 62,958 women had a history of GDM. After adjusting for age, DM, obesity and hypertensive disorders in pregnancy, GDM was significantly associated with a higher risk of CVD (adjusted Odds Ratio aOR = 1.25 [1.09-1.43]). Considering each variable in a separate model, GDM was associated with angina pectoris (aOR = 1.68 [1.29-2.20]), myocardial infarction (aOR = 1.92 [1.36-2.71]) and hypertension (aOR = 2.72 [2.58-2.88]) but not with stroke.Conclusions: A history of GDM was identified as a risk factor of CVD, especially coronary vascular diseases, within the 7 years postpartum. A lifestyle changes from postpartum onwards can be recommended and supported

How did episiotomy rates change from 2007 to 2014? Population-based study in France

International audienceBACKGROUND: Since the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy.METHODS: This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment.RESULTS: There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]).CONCLUSIONS: The episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant

Intérêt des bases de données médico-administratives dans l'évaluation du dépistage, de la surveillance et des complications du diabète

Diabetes is a priority health target worldwide. Access to conclusive data is equally a priority in order to establish clear objectives and to implement coordinated action. Medico-administrative databases are being used more and more frequently for this purpose. We set out to illustrate and assess the interest of using a French healthcare consumption database to evaluate screening, surveillance and the risk of acute or chronic complications of diabetes in certain at-risk populations. We concluded that early screening for type-2 diabetes in women with a history of gestational diabetes was inadequate. Although a slight improvement occurred following the recommendations published in 2010, one woman in two has no screening test in the first year following the pregnancy.Recommended screening for type-2 diabetes following myocardial infarction in the general population is seriously insufficient. At the time of cardiac rehabilitation, 97% of patients were screening for type-2 diabetes screening and 40% of these are diagnosed with diabetes or prediabetes. After stroke, surveillance of diabetes remains poor. In the least severe cases of stroke, it seems that the control of risk factors for recurrence is an integral part of the management of the cerebrovascular disease. We showed that women with gestational diabetes have a risk of early cardiovascular complications and that young persons with type-1 diabetes and schizophrenia have a risk of rehospitalisation for acute complications. Prevention policies for diabetes could be improved if they were based on opportunities to create strong partnerships involving actors from different sectors. The use of medico-administrative databases and observational studies has extended our knowledge of diabetes. However, before being used, data quality and the pertinence of selection algorithms must be evaluated, and it must be shown that the methods used for the statistical analysis are appropriate.Le diabète constitue une des cibles mondiales prioritaires. Le besoin de définir des priorités, d’élaborer des objectifs clairs et de mener des actions coordonnées rend tout aussi prioritaire l’accès aux données probantes. Les bases de données médico-administratives sont de plus en plus utilisées à ses fins. Nous avons choisi d’illustrer et d’évaluer l’intérêt de la base française de données de consommation de soins dans l’évaluation du dépistage, de la surveillance et des risques de complications aigues ou chroniques du diabète dans certaines populations à risque. Nous avons conclu à l’insuffisance du dépistage précoce du diabète de type 2 chez des femmes ayant un antécédent de diabète gestationnel. Si une légère augmentation s’est produite après les recommandations en 2010, une femme sur deux ne réalise aucun dépistage dans la première année suivant la grossesse. Après un infarctus du myocarde, le dépistage préconisé du diabète de type 2 est très insuffisant en population générale. La prescription du test de dépistage au moment de la réadaptation cardiaque crée une forte implication, avec un taux de dépistage de 97% des patients, pour un diagnostic de diabète ou prédiabète chez 40% d’entre eux. Après un accident vasculaire cérébral, la surveillance du diabète reste faible. Le contrôle du risque de récidive semble s’intégrer pleinement à la prise en charge de la maladie cérébrovasculaire dans les cas les moins lourds. Le risque précoce de complications cardiovasculaires après un diabète gestationnel et de réhospitalisation pour complications aigues chez les personnes jeunes, atteintes de diabète de type 1 et de schizophrénie a pu être démontré. La politique de prévention du diabète s’appuyant sur un plaidoyer offrirait l’opportunité de créer des coalitions fortes entre des partenaires aux intérêts divers. L’usage des bases de données médico-administratives et des études observationnelles a prouvé sa capacité à augmenter nos connaissances sur le diabète. Il implique l’évaluation préalable de la qualité des données et des algorithmes de sélection, la mise en œuvre de méthodes d’analyse statistique appropriées

Use of hospital and amubutory data in assessment of screnning, follow-up and complications of diabetes mellitus

Le diabète constitue une des cibles mondiales prioritaires. Le besoin de définir des priorités, d’élaborer des objectifs clairs et de mener des actions coordonnées rend tout aussi prioritaire l’accès aux données probantes. Les bases de données médico-administratives sont de plus en plus utilisées à ses fins. Nous avons choisi d’illustrer et d’évaluer l’intérêt de la base française de données de consommation de soins dans l’évaluation du dépistage, de la surveillance et des risques de complications aigues ou chroniques du diabète dans certaines populations à risque. Nous avons conclu à l’insuffisance du dépistage précoce du diabète de type 2 chez des femmes ayant un antécédent de diabète gestationnel. Si une légère augmentation s’est produite après les recommandations en 2010, une femme sur deux ne réalise aucun dépistage dans la première année suivant la grossesse. Après un infarctus du myocarde, le dépistage préconisé du diabète de type 2 est très insuffisant en population générale. La prescription du test de dépistage au moment de la réadaptation cardiaque crée une forte implication, avec un taux de dépistage de 97% des patients, pour un diagnostic de diabète ou prédiabète chez 40% d’entre eux. Après un accident vasculaire cérébral, la surveillance du diabète reste faible. Le contrôle du risque de récidive semble s’intégrer pleinement à la prise en charge de la maladie cérébrovasculaire dans les cas les moins lourds. Le risque précoce de complications cardiovasculaires après un diabète gestationnel et de réhospitalisation pour complications aigues chez les personnes jeunes, atteintes de diabète de type 1 et de schizophrénie a pu être démontré. La politique de prévention du diabète s’appuyant sur un plaidoyer offrirait l’opportunité de créer des coalitions fortes entre des partenaires aux intérêts divers. L’usage des bases de données médico-administratives et des études observationnelles a prouvé sa capacité à augmenter nos connaissances sur le diabète. Il implique l’évaluation préalable de la qualité des données et des algorithmes de sélection, la mise en œuvre de méthodes d’analyse statistique appropriées.Diabetes is a priority health target worldwide. Access to conclusive data is equally a priority in order to establish clear objectives and to implement coordinated action. Medico-administrative databases are being used more and more frequently for this purpose. We set out to illustrate and assess the interest of using a French healthcare consumption database to evaluate screening, surveillance and the risk of acute or chronic complications of diabetes in certain at-risk populations. We concluded that early screening for type-2 diabetes in women with a history of gestational diabetes was inadequate. Although a slight improvement occurred following the recommendations published in 2010, one woman in two has no screening test in the first year following the pregnancy.Recommended screening for type-2 diabetes following myocardial infarction in the general population is seriously insufficient. At the time of cardiac rehabilitation, 97% of patients were screening for type-2 diabetes screening and 40% of these are diagnosed with diabetes or prediabetes. After stroke, surveillance of diabetes remains poor. In the least severe cases of stroke, it seems that the control of risk factors for recurrence is an integral part of the management of the cerebrovascular disease. We showed that women with gestational diabetes have a risk of early cardiovascular complications and that young persons with type-1 diabetes and schizophrenia have a risk of rehospitalisation for acute complications. Prevention policies for diabetes could be improved if they were based on opportunities to create strong partnerships involving actors from different sectors. The use of medico-administrative databases and observational studies has extended our knowledge of diabetes. However, before being used, data quality and the pertinence of selection algorithms must be evaluated, and it must be shown that the methods used for the statistical analysis are appropriate

Self-harm hospitalization following bariatric surgery in adolescents and young adults

International audienceBackground: While bariatric surgery has demonstrated physical and psychological benefits, a risk of suicide and non-fatal self-harm has also been shown. The aim of this study was to compared the rate of hospitalization for self-harm during a three-year observational follow-up period between adolescents/young adults who underwent bariatric surgery in France in 2013–2014 and two control groups. Methods: All individuals aged 12–25 years old who underwent bariatric surgery in France between January 1st, 2013, and December 31st, 2014, were identified with a validated algorithm from the French national hospital database, and compared to a healthy sample of the general population matched for age and gender. Information relative to hospitalizations, including for self-harm (ICD-10 codes X60-84), were extracted i) between 2008 and the surgery, and ii) for a three-year follow-up period. A second unmatched control group with obesity but no bariatric surgery was also identified. Survival analyses with adjustments for confounding variables were used. Results: In 2013–2014, 1984 youths had bariatric surgery in France. During follow-up, 1.5% were hospitalized for self-harm vs. 0.3% for controls (p < 0.0001). After adjustment, subsequent hospitalization for self-harm was associated with bariatric surgery (HR 3.64, 95% CI 1.70–7.81), prior psychiatric disorders (HR 7.76, 95% CI 3.76–16.01), and prior self-harm (HR 4.43, 95% CI 1.75–11.24). When compared to non-operated youths with obesity, bariatric surgery was not associated with self-harm while prior mental disorders and self-harm were. Mortality reached 0.3% after surgery. Conclusions: Bariatric surgery is associated with an increased risk of self-harm, mainly in relation to preexisting psychological conditions. Vigilance and appropriate care are thus warranted in vulnerable individuals

Is Gestational Diabetes Mellitus a Risk Factor of Maternal Breast Cancer? A Systematic Review of the Literature

The association between gestational diabetes mellitus (GDM) and breast cancer (BC) risk is complex. We aimed to examine this association in a systematic review of the literature. This review was done using the PubMed/Medline and Web of Science databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Newcastle–Ottawa Scale was used for the assessment of bias and quality of studies. Only English-language articles published before 1 June 2021, were included. Fourteen studies were included in this systematic review. Among them, eight did not find statistically significant results. Three studies showed a statistically significant increased risk of BC after GDM, and they explained this potential increased risk by hyperinsulinemia, hyperglycemia, and low-grade inflammation. However, three studies showed a statistically significant decreased risk of BC after GDM, suggesting a possible protective effect of hormonal changes induced by GDM during pregnancy. These controversial results should be interpreted with caution due to both quantitative and qualitative methodological shortcomings. Further investigations are thus needed in order to gain a better understanding of the associations between GDM and BC, and their underlying mechanisms

Risk of non-fatal self-harm and premature mortality in the three years following hospitalization in adolescents and young adults with an eating disorder: A nationwide population-based study

International audienceIntroduction: Eating disorders (ED) are associated with high rates of suicide attempts and premature mortality. However, data in large samples of adolescents and young adults are limited. This study aims to assess the risk of self-harm and premature mortality in young people hospitalized with an ED. Methods: Individuals aged 12 to 25 years old hospitalized in 2013–2014 in France with anorexia nervosa and/or bulimia nervosa as a primary or associated diagnosis were identified from French national health records. They were compared to two control groups with no mental disorders, and with any other mental disorder than ED. The main outcomes were any hospitalization for deliberate self-harm and mortality in the 3 years following hospitalization. Logistic regression models were used. Results: This study included 5, 452 patients hospitalized with an ED, 14,967 controls with no mental disorder, and 14,242 controls with a mental disorder other than an ED. During the three-year follow-up, 13.0% were hospitalized for deliberate self-harm (vs. 0.2 and 22.0%, respectively) and 0.8% died (vs. 0.03 and 0.4%). After adjustment, hospitalization with an ED was associated with more self-harm hospitalizations (hazard ratio [HR] = 46.0, 95% confidence interval [32.3–65.3]) and higher all-cause mortality (HR = 12.6 [4.3–37.3]) relative to youths without any mental disorder; less self-harm hospitalizations (HR = 0.5 [0.5–0.6]) but higher mortality (HR = 1.6 [1.0–2.4]) when compared to youths with any other mental disorder. Conclusion: Young patients hospitalized with an ED are at high risk of self-harm and premature mortality. It is urgent to evaluate and implement the best strategies for post-discharge care and follow-up. Public significance: We found that the risk of being hospitalized for a suicide attempt is 46 times higher and mortality 13 times higher than the general population in adolescents and young adults during the 3 years following hospitalization with an eating disorder. Eating disorders are also associated with a 1.5 higher risk of premature mortality relative to other mental disorders. This risk is particularly high in the 6 months following hospitalization. It is therefore crucial to implement careful post-discharge follow-up in patients hospitalized for eating disorders

Validation study: Evaluation of the metrological quality of French hospital data for perinatal algorithms

International audienceObjective The aim of our validation study was to assess the metrological quality of hospital data for perinatal algorithms on a national level. Design Validation study. Setting This was a multicentre study of the French medicoadministrative database on perinatal indicators. Participants In each hospital, we selected 150 discharge abstracts for delivery (after 22 weeks of gestation), in 2014, and their corresponding medical records. Overall, 22 hospitals were included. Interventions A single investigator performed blind data collection from medical records in order to compare data from discharge abstracts with data from medical records. Finally, 3246 discharge abstracts were studied. Primary and secondary outcome measures Seventy items, including maternal and delivery characteristics and maternal morbidity, were collected for each delivery stay. Results The concordance rate of maternal age at delivery was 94.8% (95% CI 93.8 to 95.4). Combining the two forms of pre-existing diabetes, the algorithm presented a PPV of 65.9% and a sensitivity of 75.7%. The concordance rate of gestational age at delivery was 91.8% (90.9 to 92.7). Regarding gestational diabetes, the PPV was 80.8% (79.4 to 82.2) and the sensitivity was 79.5% (78.1 to 80.9). Regardless of the algorithm explored, the PPV for vaginal delivery was over 99%. For the diagnosis codes corresponding to immediate postpartum haemorrhage, the PPV was 77.7% (76.3 to 79.1) and the sensitivity was 75.5% (74.0 to 77.0). The algorithm for stillbirth presented a PPV of 89.4% (88.3 to 90.5) and a sensitivity of 95.4% (94.7 to 96.1). Conclusions This first national validation study of many perinatal algorithms suggests that the French national hospital database is an appropriate data source for epidemiological studies, except for some indicators which presented low PPV and/or sensitivity