Explanations of educational differences in major depression and generalised anxiety disorder in the Irish population.

Background: Social inequalities in mental disorders have been described, but studies that explain these inequalities are lacking, especially those using diagnostic interviews. This study investigates the contribution of various explanatory factors to the association between educational level and major depression and generalised anxiety disorder in Irish men and women. Methods: The study population comprised a national random sample of 5771 women and 4207 men aged 18 or more in Ireland (SLAN 2007 survey). Major depression and generalised anxiety disorder were measured using a standardised diagnostic interview (CIDI-SF). Four groups of explanatory factors were explored: material, psychosocial, and behavioural factors, and chronic disease. Results: For both genders, low educational level increased the risk of both mental disorders. Material factors, especially no private health insurance, but also no car, housing tenure, insufficient food budget, and unemployment (for men), made the highest contribution (stronger for men than for women) in explaining the association between education and both mental disorders. Psychosocial (especially formal social participation, social support and marital status) and behavioural factors (smoking and physical activity for both genders, and alcohol and drug use for men) and chronic disease made low independent contributions in explaining the association between education and both mental disorders. Limitations: Given the cross-sectional study design, no causal conclusion could be drawn. Conclusions: Targeting various material, psychosocial, and behavioural factors, as well as chronic diseases may help to reduce educational differences in depression and anxiety in the general population. 2011 Elsevier B.V. All rights reserved

Changes in benzodiazepine use in the French general population after November 2015 terrorist attacks in Paris: an interrupted time series analysis of the national CONSTANCES cohort

International audienceObjectives To determine whether the terrorist attacks occurring in Paris on November 2015 have changed benzodiazepine use in the French population. Design Interrupted time series analysis. Setting National population-based cohort. Participants 90 258 individuals included in the population-based CONSTANCES cohort from 2012 to 2017. Outcome measures Benzodiazepine use was evaluated according to two different indicators using objective data from administrative registries: weekly number of individuals with a benzodiazepine delivered prescriptions (BDP) and weekly number of defined daily dose (DDD). Two sets of analyses were performed according to sex and age (≤50 vs >50). Education, income and area of residence were additional stratification variables to search for at-risk subgroups. Results Among women, those with younger age (incidence rate ratios (IRR)=1.18; 95% CI=1.05 to 1.32 for BDP; IRR=1.14; 95% CI=1.03 to 1.27 for DDD), higher education (IRR=1.23; 95% CI=1.03 to 1.46 for BDP; IRR=1.23; 95% CI=1.01 to 1.51 for DDD) and living in Paris (IRR=1.27; 95% CI=1.05 to 1.54 for BDP) presented increased risks for benzodiazepine use. Among participants under 50, an overall increase in benzodiazepine use was identified (IRR=1.14; 95% CI=1.02 to 1.28 for BDP and IRR=1.12; 95% CI=1.01 to 1.25 for DDD) and in several strata. In addition to women, those with higher education (IRR=1.22; 95% CI=1.02 to 1.47 for BDP), lower income (IRR=1.17; 95% CI=1.02 to 1.35 for BDP) and not Paris residents (IRR=1.13; 95% CI=1.02 to 1.26 for BDP and IRR=1.13; 95% CI=1.03 to 1.26 for DDD) presented increased risks for benzodiazepine use. Conclusion Terrorist attacks might increase benzodiazepine use at a population level, with at-risk subgroups being particularly concerned. Information and prevention strategies are needed to provide appropriate care after such events

Work-Related Stressors and Increased Risk of Benzodiazepine Long-Term Use Findings From the CONSTANCES Population-Based Cohort

International audienceObjectives. To examine whether stressful job exposure to the public could be associated with having long-term benzodiazepine use. Methods. From the participants included between 2012 and 2016 in the French population-based CONSTANCES cohort, 13 934 men and 19 261 women declared a daily job exposure to the public and rated the frequency of stressful exposure. We examined benzodiazepine long-term use by using drug reimbursement administrative registries. Logistic regressions provided odds ratios (ORs) of benzodiazepine long-term use, with stratification for gender and adjustment for age, education, and area deprivation index. Occupational grade, job strain, depression, self-rated health, and alcohol use disorder were additional stratification variables. Results. Benzodiazepine long-term use was positively associated with stressful exposure to the public ("often or always" vs "rarely or never") in men (OR = 2.2; 95% confidence interval [CI] = 1.8, 2.8) and women (OR = 1.6; 95% CI = 1.4, 1.9), with dose-dependent relationships (P trends <.001). Adjustments and analyses in subgroups without other individual or environmental vulnerability factors led to similar results. Conclusions. Stressful job exposure to the public increases the risk of benzodiazepine long-term use. Prevention programs aiming at reducing the burden of benzodiazepine longterm use would benefit in targeting this specific population

Hyperglycaemia is associated with cancer-related but not non-cancer-related deaths: evidence from the IPC cohort.,

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Depressive Symptoms and Vegetarian Diets: Results from the Constances Cohort

The association between depressive symptoms and vegetarian diets is controversial. This study examines the cross-sectional association between depressive symptoms and vegetarian diets while controlling for potential confounders. Among 90,380 subjects from the population-based Constances cohort, depressive symptoms were defined by a score &#8805;19 on the Centre of Epidemiologic Studies-Depression (CES-D) scale and diet types (omnivorous, pesco-vegetarian, lacto-ovo-vegetarian and vegan) were determined with a food frequency questionnaire. Associations between depressive symptoms and diet were estimated through logistic regressions adjusting for socio-demographics, other foods, alcohol and tobacco consumption, physical activity and health-related concerns; specificity analyses considered the exclusion of any other food group. Depressive symptoms were associated with pesco-vegetarian and lacto-ovo-vegetarian diets in multivariable analyses (Odds-Ratio [95% confidence interval]: 1.43 [1.19&#8315;1.72] and 1.36 [1.09&#8315;1.70], respectively), especially in case of low legumes intake (p for interaction &lt; 0.0001), as well as with the exclusion of any food group (e.g., 1.37 [1.24&#8315;1.52], 1.40 [1.31&#8315;1.50], 1.71 [1.49&#8315;1.97] for meat, fish and vegetables exclusion, respectively). Regardless of food type, the Odds-Ratio of depressive symptoms gradually increased with the number of excluded food groups (p for trend &lt; 0.0001). Depressive symptoms are associated with the exclusion of any food group from the diet, including but not restricted to animal products

First human facial retransplantation: 30-month follow-up

International audienceBackgroundSince the first successful facial transplantation in 2005, the benefits of this procedure in terms of aesthetics, functionality, and quality of life have been firmly established. However, despite immunosuppressive treatment, long-term survival of the allograft might be compromised by chronic antibody-mediated rejection (CAMR), leading to irreversible necrosis of the tissue. In the absence of therapeutic options, this complication is inevitably life-threatening.MethodsWe report facial retransplantation in a man, 8 years after his first facial transplantation because of extensive disfigurement from type 1 neurofibromatosis and 6 weeks after complete loss of his allograft due to severe CAMR. We describe the chronology of immune-related problems that culminated in allograft necrosis and the eventual loss of the facial transplant, the desensitisation protocol used for this highly immunosensitised recipient, the surgical technicalities of the procedure, the specific psychological management of this patient, and the results from follow-up at 30 months.FindingsAlthough the patient had a complicated postoperative course with numerous immunological, infectious, cardiorespiratory, and psychological events, he was discharged after a hospital stay of almost 1 year. He has since been able to re-integrate into his community with acceptable restoration of his quality of life.InterpretationThis clinical report of the first documented human facial retransplantation is proof-of-concept that the loss of a facial transplant after CAMR can be mitigated successfully by retransplantation combined with an aggressive desensitisation process

Lyme borreliosis: evidence-based data useful for primary care

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Hyperglycaemia is associated with cancer-related but not non-cancer-related deaths: evidence from the IPC cohort.,

International audienc

Alexithymia was not associated with the risk of incident cardiovascular diseases in the supplementation en vitamines et mineraux antioxydants (su.vi.max) cohort

Background: Alexithymia is a personality construct defined by difficulties in identifying and labelling one’s own emotional state. Although it has been suggested to be associated with cardiovascular diseases and mortality, studies are scarce and a causal relationship is questionable. For instance, no study examined the association of alexithymia with the incidence of cardiovascular diseases among a nonclinical population. The aim of this study was to explore this prospective association in participants without cardiovascular history at baseline. Methods: The 26-item Toronto Alexithymia Scale (TAS-26) was completed by 5,586 participants of the French Supplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) cohort (41.4 % of men, mean age ± SD: 52.2 ± 6.3 years). All participants were free from cardiovascular history at baseline. Covariates measured at baseline were age, occupational status, depressive symptoms, smoking status, body mass index, hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia. The cardiovascular events were recorded using self-reported information or clinical visits, and were validated by an independent expert committee. Associations between alexithymia as well as covariates at baseline and cardiovascular events at follow-upwere estimated with hazard ratios (HR) and 95% confidence intervals (CI) computed in Cox regressions. Results: A total of 173 first cardiovascular events were recorded and validated during an average of 11.4 years of followup. After an initial adjustment for age and occupational status, the association between baseline alexithymia and cardiovascular events at follow-up was not significant among men (HR [95% CI] 1.00 [0.99-1.02]) or among women (HR [95% CI] 1.00 [0.97-1.03]). Similar results were found after further adjustment for all covariates. Likewise, exploratory analyses based on TAS-26 subscores showed no association. Conclusion: In this large prospective study, alexithymia and incident cardiovascular events were not associated among a nonclinical population. Greater CV mortality previously associated with alexithymia might result from poorer outcome in individuals with CV diseases rather than from increased incidence. The association between alexithymia and CV diseases in cross-sectional studies might result from the psychological impact of CV disease

Adherence to dietary guidelines as a protective factor against chronic or recurrent depressive symptoms in the French SU.VI.MAX cohort

Several studies have suggested that a healthier overall diet was associated with a lower risk of depression, which is one of the main causes of disability worldwide. Our objective was to investigate the prospective association of adherence to dietary guidelines at midlife, measured by the French Programme National Nutrition Sante-Guide line Score (PNNS-GS), with chronic or recurrent depressive symptoms. The association between the PNNS-GS and chronic or recurrent depressive symptoms was evaluated among participants of the French Supplementation en Vitamines et Mineraux AntioXydants (SU. VI. MAX) cohort with available data on the PNNS-GS at baseline (1994-1996) and on the Center for Epidemiologic Studies-Depression Scale (CES-D) in 1996-1997 and followup (2007-2009) (n = 3328). Chronic or recurrent depressive symptoms were defined by a CES-D score >= 16 at baseline and follow-up. Odds ratios (OR) and 95%-confidence intervals (95%-CI) were estimated across quartiles (Q) of the PNNS-GS, using logistic regressionmodels. In our study, 10.1% of the participants (n= 335) had chronic or recurrent depressive symptoms. After adjustment for potential confounders, the PNNS-GS was inversely associated with chronic or recurrent depressive symptoms: ORQ4 vs. Q1: 0.42 (95%-CI: 0.29, 0.60). Modelling the PNNS-GS as a continuous variable yielded similar results: OR for a 1-point increment in the PNNS-GS: 0.86 (95%-CI: 0.80, 0.92). In conclusion, higher adherence to French dietary guidelines at midlife was associated with a lower rate of chronic or recurrent depressive symptoms, which suggests that these recommendations may be highly relevant, not only to avoid chronic diseases, but also for the overall well-being