Effect of individual- and group-level antibiotic exposure on MRSA isolation: a multilevel analysis

Objectives: To observe the relative role of individual and group-level antimicrobial selective pressure on subsequent methicillin-resistant Staphylococcus aureus (MRSA) isolation in a university hospital. Methods: For this purpose, 18 596 patients were included in a retrospective statistical analysis, applying multilevel modelling with discrete time intervals at the lowest level. Individual-level and hospital group variables on antimicrobial exposure and MRSA colonization pressure were collected from computerized databases. Results: The simultaneous hospital group- and individual-level analysis showed individual exposure to fluoroquinolones and collective exposure to penicillins to be associated with MRSA isolation after adjustment for colonization pressure and other potential confounders. Conclusions: These results support efforts to reduce prescriptions of selected antimicrobial drug classes such as fluoroquinolones and show the added value of multilevel analysis for research on the adverse outcomes of antibiotic prescribin

Noise in urban areas: How does the definition of "neighborhood" impact exposure assessment?

International audienceEnvironmental epidemiological studies commonly quantify subjects' noise exposure level in their neighborhood. How this neighborhood is defined can vary across studies, leading to different approaches whose impacts on exposure levels remain unclear. This article examines the impact of the neighborhood's definition on environmental noise exposure estimates. L Aeq,24h exposures in the vicinity of 10,825 residential buildings were estimated using a high-definition noise map, built on a middle-sized French city. Various definitions of neighborhood (address point, façade, buffers, and official zoning) were used to produce different exposure estimates. Influence of urban environmental factors was analyzed using multilevel modeling. The results showed a significant increase of the exposure estimates (+3.9 dB) and a significant decrease of the variability, when the sample size of the considered neighborhood increased (P<0.01). The difference between the estimates from the 50-m-radius buffers and the 400-m-radius buffers ranged across buildings between –9.4 and +22.3 dB. This variation was influenced by urban environmental characteristics (P<0.01). Furthermore, the same approach was conducted individually considering assessments of exposure to road traffic noise railway noise and two atmospheric pollutants (NO2 and PM 10). The results highlight the need in further exposure and/or epidemiological studies to carefully consider neighborhood definition and environmental composition

Massively multiplayer online role-playing games: comparing characteristics of addict vs non-addict online recruited gamers in a French adult population

<p>Abstract</p> <p>Background</p> <p>Massively Multiplayer Online Role-Playing Games (MMORPGs) are a very popular and enjoyable leisure activity, and there is a lack of international validated instruments to assess excessive gaming. With the growing number of gamers worldwide, adverse effects (isolation, hospitalizations, excessive use, etc.) are observed in a minority of gamers, which is a concern for society and for the scientific community. In the present study, we focused on screening gamers at potential risk of MMORPG addiction.</p> <p>Methods</p> <p>In this exploratory study, we focused on characteristics, online habits and problematic overuse in adult MMORPG gamers. In addition to socio-demographical data and gamer behavioral patterns, 3 different instruments for screening addiction were used in French MMORPG gamers recruited online over 10 consecutive months: the substance dependence criteria for the Diagnostic and Statistical Manual of Mental Disorder, fourth revised edition (DSM-IV-TR) that has been adapted for MMORPG (DAS), the qualitative Goldberg Internet Addiction Disorder scale (GIAD) and the quantitative Orman Internet Stress Scale (ISS). For all scales, a score above a specific threshold defined positivity.</p> <p>Results</p> <p>The 448 participating adult gamers were mainly young adult university graduates living alone in urban areas. Participants showed high rates of both Internet addiction (44.2% for GIAD, 32.6% for ISS) and DAS positivity (27.5%). Compared to the DAS negative group, DAS positive gamers reported significantly higher rates of tolerance phenomenon (increased amount of time in online gaming to obtain the desired effect) and declared significantly more social, financial (OR: 4.85), marital (OR: 4.61), family (OR: 4.69) and/or professional difficulties (OR: 4.42) since they started online gaming. Furthermore, these gamers self-reported significantly higher rates (3 times more) of irritability, daytime sleepiness, sleep deprivation due to play, low mood and emotional changes since online gaming onset.</p> <p>Conclusions</p> <p>The DAS appeared to be a good first-line instrument to screen MMORPG addiction in online gamers. This study found high MMORPG addiction rates, and self-reported adverse symptoms in important aspects of life, including mood and sleep. This confirms the need to set up relevant prevention programs against online game overuse.</p

Negligible Risk for Epidemics after Geophysical Disasters

Short-term risk for epidemics after geophysical disasters is very low

Association between Ambient Noise Exposure and School Performance of Children Living in An Urban Area: A Cross-Sectional Population-Based Study

16 pages Article disponible à l'adresse suivante : http://link.springer.com/article/10.1007%2Fs11524-013-9843-6International audienceMost of the studies investigating the effects of the external noise on children's school performance have concerned pupils in schools exposed to high levels due to aircraft or freeway traffic noise. However, little is known about the consequences of the chronic ambient noise exposure at a level commonly encountered in residential urban areas. This study aimed to assess the relationship between the school performance of 8- to 9-year-old-children living in an urban environment and their chronic ambient noise exposure at home and at school. The children's school performances on the national standardized assessment test in French and mathematics were compared with the environmental noise levels. Children's exposure to ambient noise was calculated in front of their bedrooms (Lden) and schools (LAeq,day) using noise prediction modeling. Questionnaires were distributed to the families to collect potential confounding factors. Among the 746 respondent children, 586 were included in multilevel analyses. On average, the LAeq,day at school was 51.5 dB (SD= 4.5 dB; range = 38-58 dB) and the outdoor Lden at home was 56.4 dB (SD= 4.4 dB; range = 44-69 dB). LAeq,day at school was associated with impaired mathematics score (p = 0.02) or impaired French score (p = 0.01). For a + 10 dB gap, the French and mathematics scores were on average lower by about 5.5 points. Lden at home was significantly associated with impaired French performance when considered alone (p < 10(-3)) and was borderline significant when the combined home-school exposure was considered (p = 0.06). The magnitude of the observed effect on school performance may appear modest, but should be considered in light of the number of people who are potentially chronically exposed to similar environmental noise levels