Utility of self-reported mental health measures for preventing unintentional injury: results from a cross-sectional study among French schoolchildren

AbstractBackgroundIdentify children at-risk of having mental health problems is of value to prevent injury. But the limited agreement between informants might jeopardize prevention initiatives. The aims of the present study were 1) to test the concordance between parents and children reports, and 2) to investigate their relationships with parental reports of children’ unintentional injuries.MethodsIn a population-based sample of 1258 children aged 6 to 11, the associations between child psychopathology (using the Dominic Interactive and the Strengths and Difficulties Questionnaire) and unintentional injuries in the past 12 months were examined in univariate and multivariate models.ResultsAs compared to children, parents tended to overestimate behavior problems and hyperactivity/inattention, and underestimate emotional symptoms. Unintentional injury in the last 12-month period was reported in 184 out of 1258 children (14.6%) and multivariate analyses showed that the risk of injury was twice as high in children self-reporting hyperactivity/inattention as compared to others. However this association was not retrieved with the parent-reported instrument.ConclusionOur findings support evidence that child-reported measures of psychopathology might provide relevant information for screening and injury prevention purposes, even at a young age. It could be used routinely in combination with others validated tools.</jats:sec

Santé mentale, céphalées et surpoids chez l'enfant âgé entre 6 et 11 ans (Résultats d'une étude transversale en population générale)

Objectifs. Examiner les relations entre les problèmes de sante mentale les plus fréquents chez l enfant (trouble intériorisés et extériorisés) et sa santé physique, céphalées d une part, surpoids et l obésité d autre part. Matériel et méthodes. Enquête transversale menée en 2004-2005 en région Provence-Alpes Côte d Azur auprès de 2341 enfants âgés entre 6 et 11 ans et scolarisés dans des établissements primaires. La santé mentale de l enfant était évaluée du point de vue de l enfant et de son parent à l aide d instruments validés et standardisés : le Dominique Interactif pour l enfant et le Strenghts and Difficulties Questionnaire SDQ pour le parent. Les associations statistiques ont été examinées en analyse bivariée puis multivariée à l aide de modèles de régression logistique prenant en compte les facteurs de confusion potentiels. Résultats. Le taux de réponse des parents était de 57,6% et de 76,5% pour les enfants. Les taux de prévalence des céphalées et du surpoids étaient respectivement de 10,9% (intervalle de confiance IC95%= 9,1-12,7) et 17,3% (IC95%=14,9-19,8). Après ajustement, les facteurs associés de façon indépendante aux céphalées étaient: la présence de comorbidités physiques (odds ratio OR=1,75 ; IC95%=1,13-2,73), les difficultés totales au SDQ (OR=1,76; IC95%=1,03-3,01), en particulier pour la dimension des troubles émotionnels (OR=1,99; IC95%=1,13-3,52) et les attitudes punitives faibles (OR=0,41; IC95%=0,18-0,94). Les facteurs associés de façon indépendante au surpoids étaient : être scolarisé en Zone d Education Prioritaire ZEP (OR=1,88; IC95%=1,03-3,44) et les difficultés relationnelles avec les pairs rapportés par le SDQ parent (OR=2,06 ; IC95%=1,27- 3,35). Conclusion. Ce travail de thèse illustre par deux exemples le lien étroit entre la psychopathologie du jeune enfant et sa santé physique. La prise en compte de l association céphalées troubles émotionnels dans la pratique clinique pourrait permettre d éviter le passage à la chronicité des symptômes et l évolution par exemple vers un processus de somatisation. Des actions de santé publique concernant la nutrition et la prévention de l obésité sont à envisager dans les ZEP où la prévalence du surpoids est plus élevée.Objectives. To examine the associations between mental health and physical health (headaches and overweight) in young children aged 6 to 11 years old. Methods. Survey conducted in Provence-Alpes Côte d'Azur region in 2004-2005 among 2341 children aged 6 to 11 years old attending primary schools. Child mental health was assessed using standardized and validated instruments: the Dominique Interactive for children and the Strengths and Difficulties Questionnaire SDQ for parents. Statistical associations were examined in univariate then multivariate analysis using logistic regression adjusted on potential confounding factors. Results. Response rate was 57.6% for parents and 76.5% for children. Prevalence rates were 10.9% (confidence interval 95 % CI = 9,1-12,7) for headaches and 17.3% for overweight (IC95% = 14,9-19,8). After adjustment, factors associated with headache were: physical comorbidities (odds ratio OR = 1,75; IC95% = 1,13-2,73), SDQ total difficulties (OR = 1,76; IC95% = 1,03-3,01), particularly emotional problems OR = 1,99; IC95% = 1,13-3,52), and low punitive attitudes (OR = 0,41; IC95% = 0,18-0,94). Factors associated with headaches werre: attending school in Disadvantaged School (OR = 1,88; IC95% = 1,03-3,44) and SDQ peer relationship difficulties (OR = 2,06; IC95% = 1,27-3,35). Conclusion. This research work illustrates by two examples the link between child mental health and physical health.PARIS5-BU Saints-Pères (751062109) / SudocSudocFranceF

Présentation des données de tolérance dans les essais controlés randomisés ( revue systématique de la littérature)

Contexte : Les résultats des essais cliniques mettent souvent en valeur les données concernant l'efficacité en particulier lorsque les résultats sont statistiquement significatifs. Dans les essais cliniques, la présentation des données de tolérance est aussi importante que la présentation des résultats concernant l'efficacité. La description insuffisante des données de tolérance peut conduire à des erreurs d'interprétation et à des conclusions fausses sur les interventions évaluées, avec des conséquences possibles pour la population cible. Objectifs : Décrire les principales caractéristiques de la présentation des données de tolérance dans les essais contrôlés randomisés; en particulier présentation des données de sévérité, utilisation des tableaux et figures, restrictions de la présentation à certains évènements indésirables, analyse statistique de la tolérance. Matériel et méthode : Revue systématique de tous les essais contrôlés randomisés à deux bras parallèles et de supériorité publiés en 2006 dans un des 6 journaux généralistes à impact factor élevé : DAMA, NEJM, Lancet, BMJ, Annals of Internal Medicine et Plos Medicine. Les données ont été recueillies à partir d'une grille d'extraction standardisée préalablement testée et validée. Résultats : Au total. 133 essais contrôlés randomisés ont été retenus et inclus dans l'analyse. 96.2% des essais présentaient des données de tolérance quelque elles soient dans la partie résultats. Nous avons retrouvé une importante hétérogénéité et variabilité dans la présentation des données de tolérance. 38 (28.6%) essais restreignaient la description des résultats aux évènements indésirables les plus fréquents ou les plus sévères. 21 (15.8%) essais utilisaient des grades de sévérité pour décrire la sévérité des évènements. Un tiers des essais ne rapportaient ni tableau ni figure pour décrire la tolérance. Conclusion En dépit des recommandations préexistantes (CONSORT Harm et recommandations ICH), nos résultats soulignent la nécessité de poursuivre la standardisation et l'élaboration de recommandations pratiques concernant la présentation des données de tolérance des essais cliniques. L'utilisation de tableaux et/ou figures, des grades de sévérité pourraient à ce titre être développés.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Reporting of safety results in published reports of randomized controlled trials.

International audienceBACKGROUND: Reports of clinical trials usually emphasize efficacy results, especially when results are statistically significant. Poor safety reporting can lead to misinterpretation and inadequate conclusions about the interventions assessed. Our aim was to describe the reporting of harm-related results from randomized controlled trials (RCTs). METHODS: We searched the MEDLINE database for reports of RCTs published from January 1, 2006, through January 1, 2007, in 6 general medical journals with a high impact factor. Data were extracted by use of a standardized form to appraise the presentation of safety results in text and tables. RESULTS: Adverse events were mentioned in 88.7% of the 133 reports. No information on severe adverse events and withdrawal of patients owing to an adverse event was given in 27.1% and 47.4% of articles, respectively. Restrictions in the reporting of harm-related data were noted in 43 articles (32.3%) with a description of the most common adverse events only (n = 17), severe adverse events only (n = 16), statistically significant events only (n = 5), and a combination of restrictions (n = 5). The population considered for safety analysis was clearly reported in 65.6% of articles. CONCLUSION: Our review reveals important heterogeneity and variability in the reporting of harm-related results in publications of RCTs

Determinants of Satisfaction With Health Services by Dimensions of Care: An Age-Stratified Analysis

Abstract Studies that examined satisfaction with care in older adults are scarce. The aim of this research was to analyse satisfaction among older adults considering mental health, socio-clinical and health system factors and by age category. Data come from the Étude sur la Santé des Aînés Services study including 1,624 adults aged ≥65 years recruited between 2011-2013 in primary care in Quebec. Patient satisfaction was assessed during interviews with questions adapted from the Primary Care Assessment Survey. Mental health (anxiety, depression, suicidal ideation, psychological distress, cognition), social support, quality of life, the presence of pain and chronic conditions were self-reported. Health service use was extracted from administrative registries. Logistic regressions stratified by age were used to examine the associations of low satisfaction in three dimensions of care. For continuity of care, the determinants of low satisfaction were pain and attraction index for psychiatric services in adults 65 to 75 years versus anxiety, cognition and hospitalizations in adults 75 years and older. For patient-provider interactions, the determinants were psychological distress, attraction index for psychiatric services in adults 65 to 75 years versus quality of life and cognition in adults 75 years and older. For adequacy of care, anxiety, psychological distress, social support, pain, quality of life and attraction index for psychiatric services were significant in adults 65 to 75 years versus quality of life and cognition in adults 75 years and older. Results highlight different patterns of satisfaction by age category that should be used to improve care delivered in primary care.</jats:p

The VEPRO trial: A cross-over randomised controlled trial comparing 2 progressive lenses for patients with presbyopia

Abstract Background The aim of this trial was to compare the effectiveness of two generations of progressive lenses for presbyopia. Methods A multicenter cross-over randomized controlled trial performed in a primary care setting (5 optical dispensaries) was planned. Two categories of progressive lenses were compared: 1) a new-generation lens (i.e., VARILUX PANAMIC ORMA CRIZAL), which is expensive but a supposed improvement in comfort, and 2) an older-generation lens (i.e., VARILUX CONFORT ORMA CRIZAL), which is less expensive and is considered the reference lens. Patients were randomized to wear one generation of progressive lens for 4 weeks, then cross over to wear the other lens for 4 weeks, without knowing the sequence of lenses. Inclusion criteria were 1) age 43–60 years; 2) outpatients already wearing progressive lenses and referred to an optician ophthalmologist for optical correction prescription within the last 6 months; 3) receiving a correction of ≤3 dioptres in cases of associated myopia, hyperopia or astigmatism; 4) understanding and speaking French and able to answer a questionnaire; and 5) giving written consent to participate in the study. The primary outcome was patient preference for one progressive lens at week 8. Secondary outcomes were subjective measures of bifocal visual performance, including a) near visual acuity, b) visual field, c) kinetic visual skills, d) visual adaptability, e) visual comfort, and f) rapidity of adaptation. Results 127 patients were randomized to one of the lens groups. Two patients withdrew prematurely; 98.4% and 97.6% patients who wore the new versus older lenses, respectively, wore their progressive lenses every day during the 4-week period 1 and period 2. The number of participants in each of 5 centres varied from 16 (12.6%) to 35 (27.6%). 57.9% patients preferred the new-generation lenses, 36.5% the older-generation lenses, and 5.6% had no preference (p = 0.01). The two groups did not differ in any of the measures of bifocal visual performance except near visual acuity. Conclusion Patients with presbyopia had slightly higher preference for the new-generation than older-generation lens, with no difference in lens groups for most of the visual outcomes assessed. Trial Registration ClinicalTrials.gov NCT00635115</p

Combined aging multi-trajectories in older adults

Abstract : Objectives: To identify profiles of aging combining psychological distress, cognition and functional disability and their associated factors. Methods: Data were drawn from the Étude sur la Santé des Aînés-Services longitudinal study and included 1585 older adults ≥ 65 years. Socio-demographic, psychosocial, lifestyle, physical, mental health were informed from structured interviews. Group-based multi-trajectory modelling and multinomial logistic regression were used to identify aging profiles and correlates. Sampling weights were applied to account for the sampling plan. Results: The weighted sample size was of 1591.Three trajectories were identified: a favorable (79.0%), intermediate (14.5%) and severe scenario (6.5%). Factors associated with the severe scenario were older age, male gender, lower education, the presence of anxiety disorders, low physical activity and smoking. Membership in the intermediate scenario was associated with daily hassles, chronic physical disorders, anxio-depressive disorders, antidepressants/psychotherapy use, low physical activity and no alcohol use. High social support was protective against less favorable profiles, as was primary care recruitment site. Conclusions: Symptoms of anxiety and depression and a high burden of chronic physical disorders were associated with less favorable trajectories. Modifiable lifestyle factors have a significant effect on healthy aging. Clinical implications: Assessment and management of anxiety and depressive symptoms are important in older adults. Clinical interventions including access to psychotherapy and promotion of healthier lifestyles should be considered