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 18–69 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%–61.0%) than by women at 36.6% (95%CI: 35.9%–37.4%). 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%–10.6%) 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 méconnaissance des troubles est un symptôme particulièrement fréquent en psychiatrie. Les patients pour lesquels ce défaut d’insight est le plus marqué sont les schizophrènes. Or de nombreux auteurs ont montré que l’absence d’insight avait des conséquences délétères sur l’évolution de la maladie du fait d’une mauvaise observance thérapeutique, d’une augmentation du risque de rechute et d’un amoindrissement de la qualité de vie. Face à ce constat, d’importants travaux ont été menés ces vingt dernières années; tout d’abord concernant les différentes théories physiopathologiques pouvant rendre compte des multiples dimensions de l’insight mais également concernant l’élaboration d’échelles d’évaluation spécifiques dans la schizophrénie ainsi que le développement de thérapies susceptibles d’améliorer l’insight (remédiation cognitive, TCC, programmes psychoéducatifs, etc.). En regard des données actuelles, il semble fondamental d’intégrer dans la prise en charge de tout schizophrène une évaluation du degré d’insight ainsi que la mise en œuvre de stratégies adéquates pour l’améliorer

Occupational life and addictive behaviors (alcohol, tobacco, cannabis, benzodiazepine misuse) in the Constances cohort

L’objectif général était d'étudier les liens entre les conduites addictives et différents aspects de la vie professionnelle dans l’infrastructure de recherche CONSTANCES : (1) Estimer les prévalences d'usage de substances en population générale française en fonction des facteurs sociodémographiques et cliniques, (2) Étudier les associations longitudinales entre stress au travail et usage chronique de benzodiazépines, (3) Étudier les associations transversales entre demande émotionnelle au travail et usages d’alcool, de tabac et de cannabis, (4) Étudier les associations transversales entre demande émotionnelle au travail et usage chronique de benzodiazépines, (5) Étudier les associations longitudinales entre usages d’alcool, de tabac et de cannabis et la perte d’emploi.1. Les prévalences d'usage d'alcool, de tabac et de cannabis en population générale ont été estimées. Concernant l’usage chronique de benzodiazépines, sa prévalence était 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-dépendantes entre l’intensité du stress au travail, mesuré par le déséquilibre effort-récompense, et le risque d’usage chronique de benzodiazépines sur une période de suivi de deux ans (n = 31 077), avec un OR = 2,18 (IC 95 % : 1,50-3,16) pour les sujets les plus stressés comparés aux moins stressés, après ajustement pour les facteurs sociodémographiques, les usages d’alcool et de tabac, la dépression et l’état de santé perçu.3. Il existait des associations significatives entre la demande émotionnelle au travail, mesurée par la fréquence de l’exposition stressante au public, et les usages d’alcool, de tabac et de cannabis, en ajustant pour les facteurs sociodémographiques (n=23 641). Concernant l’usage d’alcool, la demande émotionnelle était associée chez les hommes à une augmentation du risque d’alcoolisations paroxystiques intermittentes plus d’une fois par mois (OR = 1,29 (IC 95 % : 1,10-1,51), et chez les femmes à une augmentation des risques de consommation hebdomadaire élevée ou très élevée (OR = 1,59 (IC 95 % : 1,12-2,25) et de trouble de l’usage d’alcool (OR = 2,30 (IC 95 % : 1,54-3,44).4. Il existait des relations dose-dépendantes entre la demande émotionnelle au travail et l'usage chronique de benzodiazépines, en ajustant pour l’âge, le niveau d’éducation et l’indice de déprivation sociale (n=33 195). Les OR étaient 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 exposés à la plus forte demande émotionnelle comparée à la plus faible. Ces associations persistaient en l’absence d’autres facteurs de vulnérabilité à l’usage des benzodiazépines.5. Les usages d’alcool, de tabac et de cannabis étaient tous associés, de manière indépendante, et suivant des relations dose-dépendantes, au risque de perte d’emploi à un an, en ajustant pour l’âge, le genre, la dépression et l’état de santé perçu(n=18 879). Le risque de perte d’emploi associé à un usage problématique ou de dépendance probable de l’alcool était de 1,92 (IC 95 % : 1,34-2,75) comparé à un usage à faible risque. Il était de 1,78 (IC 95 % : 1,26-2,54) pour les gros fumeurs comparés aux non-fumeurs et de 2,68 (IC 95 % : 2,10-3,42) pour les consommateurs de cannabis au moins une fois par mois comparés aux non-consommateurs.Ces résultats pourraient permettre aux décideurs en santé publique et en santé au travail d'élaborer des stratégies d'information et de prévention destinées à réduire l'usage de substances, notamment en milieu professionnel. En raison de la complexité des interrelations entre conduites addictives et vie professionnelle, ce champ de recherche en épidémiologie devrait poursuivre son développement afin de répondre aux enjeux majeurs de santé publique posés 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-à-vis de l’emploi : analyse transversale de la cohorte CONSTANCES

International audienceEstimer les prévalences d’usage de tabac en 2017 et en 2019 en population française couverte par le Régime Général d’Assurance Maladie en fonction du statut vis-à-vis de l’emploi. À partir d’un échantillon de 18 008 volontaires inclus en 2017 dans CONSTANCES, une cohorte nationale en population générale française ayant recruté de manière aléatoire des volontaires de 18-69 ans affiliés au Régime Général d’Assurance Maladie, les prévalences d’usage du tabac en fonction de du statut vis-à-vis de l’emploi ont été estimées en 2017 et en 2019 après correction pour les biais de sélection à l’inclusion et de non-réponse au suivi. En 2019, la prévalence du tabagisme était plus élevée chez les actifs inoccupés (29,2 % chez les hommes et 20,7 % chez les femmes) par rapport aux actifs occupés (16,5 % chez les hommes et 13,8 % chez les femmes). La prévalence du tabagisme la plus élevée concernait les personnes sans activité professionnelle pour raisons de santé (38,5 % chez les hommes et 35,8 % chez les femmes). Les fumeurs étaient plus à risque d’être actifs inoccupés 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 prévalence d’actifs occupés parmi les petits fumeurs (<10 cigarettes/jour) a baissé entre 2017 (87,1 %) et 2019 (74,8 %). Ces analyses soulignent l’importance d’intensifier les campagnes de prévention sur le tabagisme parmi les actifs inoccupés et les inactifs, en particulier pour raisons de santé

Pertinence du placebo dans les stratégies thérapeutiques des troubles psychiatriques

Depuis les déclarations d’Helsinki de 2002, les lois de bioéthique imposent une information claire et loyale du patient sur le traitement qu’il reçoit. Cette obligation, s’associant à l’essor de la psychopharmacologie, a largement contribué à diminuer l’utilisation du placebo en clinique, cantonnant ainsi son usage aux essais thérapeutiques. Quelles que soient les études, l’efficacité du placebo dans le traitement de la dépression avoisine les 50 %. Elle est de 30 à 40 % dans les tableaux sévères et dépasse 70 % dans les formes plus légères. Le traitement par placebo n’augmente pas le risque suicidaire. Il existerait des caractéristiques de bonne amélioration sous placebo. On note l’importance capitale des attentes positives du patient, de la bonne de l’observance et de la conviction du prescripteur. La qualité de la relation médecin-malade tient également une place essentielle. Il n’existe pas de « personnalité répondeur ». L’effet placebo se maintient après révélation au patient de la nature du traitement prescrit. Son efficacité s’en trouve même renforcée lorsque les explications sont claires et approfondies. Face à ces constations, certains auteurs s’interrogent s’il est éthique de ne pas prescrire de placebo dans les situations où la balance bénéfices/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 84 943 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 1 year, (4) unemployed for 1 to 3 years and (5) unemployed for 3 years 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, ≤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: 1.74–2.50), being continuously at-risk (OR: 1.21–1.83), experiencing an increase in alcohol use (OR: 1.21–1.51) and a decrease in alcohol use (OR: 1.17–1.84). 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