Short-term outcomes of community-based adolescent weight management: The Loozit® Study

<p>Abstract</p> <p>Background</p> <p>The Loozit^®Study is a randomised controlled trial investigating extended support in a 24 month community-based weight management program for overweight to moderately obese, but otherwise healthy, 13 to 16 year olds.</p> <p>Methods</p> <p>This pre-post study examines the two month outcomes of the initial Loozit^®group intervention received by both study arms. Adolescents (n = 151; 48% male) and their parents separately attended seven weekly group sessions focused on lifestyle modification. At baseline and two months, adolescents' anthropometry, blood pressure, and fasted blood sample were assessed. Primary outcomes were two month changes in body mass index (BMI) z-score and waist-to-height-ratio (WHtR). Secondary outcomes included changes in metabolic profile, self-reported dietary intake/patterns, physical and sedentary activities, psychological characteristics and social status. Changes in outcome measures were assessed using paired samples t-tests for continuous variables or McNemar's test for dichotomous categorical variables.</p> <p>Results</p> <p>Of the 151 adolescents who enrolled, 130 (86%) completed the two month program. Among these 130 adolescents (47% male), there was a statistically significant (P < 0.01) reduction in mean [95% CI] BMI (0.27 kg/m²[0.41, 0.13]), BMI z-score (0.05 [0.06, 0.03]), WHtR (0.02 [0.03, 0.01]), total cholesterol (0.14 mmol/L [0.24, 0.05]) and low-density lipoprotein cholesterol (0.12 mmol/L [0.21, 0.04]). There were improvements in all psychological measures, the majority of the dietary intake measures, and some physical activities (P < 0.05). Time spent watching TV and participating in non-screen sedentary activities decreased (P < 0.05).</p> <p>Conclusions</p> <p>The Loozit^®program may be a promising option for stabilizing overweight and improving various metabolic factors, psychological functioning and lifestyle behaviors in overweight adolescents in a community setting.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry</p> <p><a href="http://www.anzctr.org.au/trial_view.aspx?ID=1277">ACTRNO12606000175572</a></p

Epidemiology of community urinary tract infections

Les infections urinaires (IUs) sont un motif très fréquent de consultation et de prescription d’antibiotique en médecine générale. Le choix de l’antibiotique repose sur les caractéristiques du patient, la susceptibilité des germes aux antibiotiques et des analyses de coût. Cette démarche thérapeutique est devenue de plus en plus complexe en raison de l’augmentation des résistantes aux antibiotiques. Dans ce contexte, mon travail de thèse repose sur deux principales études :A partir des données d’IMS-health France, une analyse spectrale des ventes d’antibiotiques urinaires a montré l’existence d’une saisonnalité annuelle entre 2001 et 2012 avec des pics estivaux. A partir des données de recherche de Google en France et dans six autres pays, le même phénomène a été observé. Ceci représente un argument en faveur d’une saisonnalité des cystites aigues simples.Une étude a été mise en place, visant à estimer l’incidence des IUs à germes résistants et à déterminer les facteurs associés à l’acquisition de ces germes. Un taux d'incidence annuel des IUs présumées en médecine générale a été estimé à 3 200 pour 100 000 femmes en France [IC 95%: 2 400-4 000], avec un taux d'incidence annuel des infections urinaires à E. coli résistant au fluoroquinolone en médecine générale à 102 pour 100 000 femmes en France [IC 95%: 30-50]. Les facteurs associés aux IU à entérobactéries résistantes à plus de trois classes d’antibiotique étaient l'utilisation de la pénicilline par la patiente (OR = 3,1 ; [1,2-8,0]), avoir fourni un hébergement à un résident d'un pays à haut risque de résistance aux antibiotiques (OR = 4,0 [1,2-15,1]) et la consommation de viande crue (OR = 0,3 ; [0,1-0,9]).Urinary tract infections (IUs) are a frequent reason for consultation and prescription of antibiotics in general practice. The choice of the antibiotic is based on the patient’s characteristics, the antibiotic susceptibility of bacteria and cost analyzes. This therapeutic approach has become increasingly complex due to the increase in antibiotic resistance. In this context, my thesis is based on two main studies:From the data of IMS health France, a spectral analysis of urinary antibiotic sales was shown the existence of an annual seasonality between 2001 and 2012 with summer peaks. The same phenomenon was been observed from Google search data in France and in six other countries. This is an argument for seasonality in acute cystitis.Another study was set up, to estimate the incidence of resistant germs in IUs and identify factors associated with the acquisition of these germs. An annual incidence rate of IUs in general practice was estimated at 3,200 per 100,000 women in France [95% CI: 2,400-4,000], with an annual incidence rate of IUs due to E. coli resistant to fluoroquinolone in general practice at 102 per 100,000 women in France [95% CI: 30-50]. Factors associated with IU due to Enterobacteriaceae resistant to more than three classes of antibiotic were having used penicillin by the patient (OR = 3.1; [1.2 to 8.0]), having provided accommodation to a resident of a country at high risk for antibiotic resistance (OR = 4.0 [1.2 to 15.1]) and raw meat consumption (OR = 0.3; [0.1-0.9] )

Epidémiologie des infections urinaires communautaires

Urinary tract infections (IUs) are a frequent reason for consultation and prescription of antibiotics in general practice. The choice of the antibiotic is based on the patient’s characteristics, the antibiotic susceptibility of bacteria and cost analyzes. This therapeutic approach has become increasingly complex due to the increase in antibiotic resistance. In this context, my thesis is based on two main studies:From the data of IMS health France, a spectral analysis of urinary antibiotic sales was shown the existence of an annual seasonality between 2001 and 2012 with summer peaks. The same phenomenon was been observed from Google search data in France and in six other countries. This is an argument for seasonality in acute cystitis.Another study was set up, to estimate the incidence of resistant germs in IUs and identify factors associated with the acquisition of these germs. An annual incidence rate of IUs in general practice was estimated at 3,200 per 100,000 women in France [95% CI: 2,400-4,000], with an annual incidence rate of IUs due to E. coli resistant to fluoroquinolone in general practice at 102 per 100,000 women in France [95% CI: 30-50]. Factors associated with IU due to Enterobacteriaceae resistant to more than three classes of antibiotic were having used penicillin by the patient (OR = 3.1; [1.2 to 8.0]), having provided accommodation to a resident of a country at high risk for antibiotic resistance (OR = 4.0 [1.2 to 15.1]) and raw meat consumption (OR = 0.3; [0.1-0.9] ).Les infections urinaires (IUs) sont un motif très fréquent de consultation et de prescription d’antibiotique en médecine générale. Le choix de l’antibiotique repose sur les caractéristiques du patient, la susceptibilité des germes aux antibiotiques et des analyses de coût. Cette démarche thérapeutique est devenue de plus en plus complexe en raison de l’augmentation des résistantes aux antibiotiques. Dans ce contexte, mon travail de thèse repose sur deux principales études :A partir des données d’IMS-health France, une analyse spectrale des ventes d’antibiotiques urinaires a montré l’existence d’une saisonnalité annuelle entre 2001 et 2012 avec des pics estivaux. A partir des données de recherche de Google en France et dans six autres pays, le même phénomène a été observé. Ceci représente un argument en faveur d’une saisonnalité des cystites aigues simples.Une étude a été mise en place, visant à estimer l’incidence des IUs à germes résistants et à déterminer les facteurs associés à l’acquisition de ces germes. Un taux d'incidence annuel des IUs présumées en médecine générale a été estimé à 3 200 pour 100 000 femmes en France [IC 95%: 2 400-4 000], avec un taux d'incidence annuel des infections urinaires à E. coli résistant au fluoroquinolone en médecine générale à 102 pour 100 000 femmes en France [IC 95%: 30-50]. Les facteurs associés aux IU à entérobactéries résistantes à plus de trois classes d’antibiotique étaient l'utilisation de la pénicilline par la patiente (OR = 3,1 ; [1,2-8,0]), avoir fourni un hébergement à un résident d'un pays à haut risque de résistance aux antibiotiques (OR = 4,0 [1,2-15,1]) et la consommation de viande crue (OR = 0,3 ; [0,1-0,9])

Pratiques et déterminants de la vaccination BCG en médecine générale, en France, depuis la suspension de l obligation vaccinale

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Perception des médecins généralistes et des pédiatres en France métropolitaine sur une modification du calendrier vaccinal

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

APEMA (évaluation par des patients d'affiches de prévention réalisées par des externes en stages de médecine ambulatoire de trois facultés parisiennes)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Le dépistage chez les adolescents en médecine générale (élaboration et évaluation d un auto-questionnaire de dépistage chez l adolescent)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

«Digesting Crohn’s Disease»: The Journey of Young Adults since Diagnosis

Crohn’s disease affects 2.5 million people in Europe (more than 100,000 people in France) and often occurs between the ages of 15 and 30, a period marked by self-construction. However, few studies have focused on the experience of the diagnosis during this sensitive developmental stage. This study aimed to qualitatively explore the experience of Crohn’s disease in young adults since their diagnosis. Fifteen young adults (18–35 years) diagnosed with Crohn’s disease participated in a semi-directive interview. Narrative data were subjected to a thematic analysis, and thirty percent of the interviews were double-coded. The results revealed an evolution of four main themes since diagnosis: (1) course of care, (2) illness perceptions, (3) disease management and (4) self-perception. For most participants, the onset of the disease was difficult, marked by severe symptoms requiring hospitalization, numerous medical examinations and sometimes several consultations before diagnosis. This journey was more difficult when it was associated with negative relations with the medical staff, who were sometimes perceived as unsupportive. Thus, some people described this diagnostic period as an “ordeal”, while others experienced it as a “relief” from their suffering. The announcement of the diagnosis was often a “shock”, an “upheaval” or a “downfall”, followed by phases of denial associated with a desire to maintain a “normal life” and not to be defined by the disease. Despite a difficult start, most participants grew from their experience with CD, with a sense of a personal development that was made possible by self-regulation processes that enabled them to draw on their own experience and resources to adjust to their illness. By highlighting positive possibilities for evolution, this study suggests the importance of supporting the psychological resources of young adults by proposing, at an early stage, psychological support or therapies focused on acceptance and engagement

Toward Further Understanding of Crohn’s Disease-Related Fatigue: The Role of Depression and Emotional Processing

International audienceBecause the relationship between Crohn’s Disease (CD) activity and CD-related fatigue remains poorly understood, this study investigated the role of underlying psychological processes (depression, anxiety, and emotional processing). It was expected that the relationship between CD activity and CD-related fatigue would be mediated by depression and anxiety and also by a deficit in emotional processing. This prediction was tested in 110 CD patients who completed self-reported questionnaires assessing fatigue (FSS), clinical activity of Crohn’s Disease (HBAI), psychological suffering (HADS), and emotional processing (EPS-25). A path analysis showed both direct and indirect effects in the relationship between CD activity and CD-related fatigue, accounting for 33% of the variance. One indirect effect on the experience of fatigue was depression, but there was no effect of anxiety. These preliminary results confirmed that disease activity induces an increase in depressive symptoms, which in turn leads to an increase in the level of fatigue. The most novel result of the present study is that emotional processing had an indirect effect on the relationship between CD and CD-related fatigue: when the disease was more active, patients exhibited greater disruption of emotional processing, which in turn led to greater fatigue. These results did not reveal any association between depression and emotional processing. In conclusion, this work highlights the role of emotional processing in CD-related fatigue and the importance of taking this factor into account in order to manage this condition better