Self-harm, somatic disorders and mortality in the 3 years following a hospitalisation in psychiatry in adolescents and young adults

Background There is limited recent information regarding the risk of self-harm, somatic disorders and premature mortality following discharge from psychiatric hospital in young people. Objective To measure these risks in young people discharged from a psychiatric hospital as compared with both non-affected controls and non-hospitalised affected controls. Methods Data were extracted from the French national health records. Cases were compared with two control groups. Cases: all individuals aged 12–24 years, hospitalised in psychiatry in France in 2013–2014. Non-affected controls: matched for age and sex with cases, not hospitalised in psychiatry and no identification of a mental disorder in 2008–2014. Affected controls: unmatched youths identified with a mental disorder between 2008 and 2014, never hospitalised in psychiatry. Follow-up of 3 years. Logistic regression analyses were conducted with these confounding variables: age, sex, past hospitalisation for self-harm, past somatic disorder diagnosis. Findings The studied population comprised 73 300 hospitalised patients (53.6% males), 219 900 non-affected controls and 9 683 affected controls. All rates and adjusted risks were increased in hospitalised patients versus both non-affected and affected controls regarding a subsequent hospitalisation for self-harm (HR=105.5, 95% CIs (89.5 to 124.4) and HR=1.5, 95% CI (1.4 to 1.6)), a somatic disorder diagnosis (HR=4.1, 95% CI (3.9–4.1) and HR=1.4, 95% CI (1.3–1.5)), all-cause mortality (HR=13.3, 95% CI (10.6–16.7) and HR=2.2, 95% CI (1.5–3.0)) and suicide (HR=9.2, 95% CI (4.3–19.8) and HR=1.7, 95% CI (1.0–2.9)). Conclusions The first 3 years following psychiatric hospital admission of young people is a period of high risk for self-harm, somatic disorders and premature mortality. Clinical implications Attention to these negative outcomes urgently needs to be incorporated in aftercare policies

Changes in blood pressure in a large cohort of elderly individuals: Study 3C

SummaryObjectiveAnalysis of changes in blood pressure with a two-year interval, and of factors associated with this change, in a large cohort of elderly individuals.MethodsFollow-up of a cohort of 9294individuals aged 65years and over recruited from the general population for Study 3C. Changes in blood pressure are defined as the difference in its averages between the inclusion visit and the follow-up visit at 2years. The factors associated with changes in systolic blood pressure were identified by univariate and multivariate analyses.ResultsSystolic and diastolic blood pressure decreased on average by 7.60mmHg and 4.45mmHg respectively in 7659individuals included in the study between the initial measurement and the follow-up at 2years. The analyses revealed that the initial high blood pressure level was the main factor for this decrease that would be explained by a phenomenon of regression towards the mean.ConclusionThese results confirm the importance of repeating blood pressure measurements during several examinations for a good estimate of individual blood pressure values in this age range. It is also important to consider this phenomenon in studies including specific blood pressure estimates only

Using Discharge Abstracts to Evaluate a Regional Perinatal Network: Assessment of the Linkage Procedure of Anonymous Data

To assess the Burgundy perinatal network (18 obstetrical units; 18 500 births per year), discharge abstracts and additional data were collected for all mothers and newborns. In accordance with French law, data were rendered anonymous before statistical analysis, and were linked to patients using a specific procedure. This procedure allowed data concerning each mother to be linked to those for her newborn(s). This study showed that all mothers and newborns were included in the regional database; the data for all mothers were linked to those for their infant(s) in all cases. Additional data (gestational age) were obtained for 99.9% of newborns

Hospitalizations for Anorexia Nervosa during the COVID-19 Pandemic in France: A Nationwide Population-Based Study

The COVID-19 pandemic has had a detrimental impact on mental health, including on food-related behaviors. However, little is known about the effect of the pandemic on anorexia nervosa (AN). We sought to assess an association between the COVID-19 pandemic and a potential increase in hospitalizations for AN in France. We compared the number of hospitalizations with a diagnosis of AN during the 21-month period following the onset of the pandemic with the 21-month period before the pandemic using Poisson regression models. We identified a significant increase in hospitalizations for girls aged 10 to 19 years (+45.9%, RR = 1.46[1.43–1.49]; p < 0.0001), and for young women aged 20 to 29 (+7.0%; RR = 1.07[1.04–1.11]; p < 0.0001). Regarding markers of severity, there was an increase in hospitalizations for AN associated with a self-harm diagnosis between the two periods. Multivariate analysis revealed that the risk of being admitted for self-harm with AN increased significantly during the pandemic period among patients aged 20–29 years (aOR = 1.39[1.06–1.81]; p < 0.05 vs. aOR = 1.15[0.87–1.53]; NS), whereas it remained high in patients aged 10 to 19 years (aOR = 2.40[1.89–3.05]; p < 0.0001 vs. aOR = 3.12[2.48–3.98]; p < 0.0001). Furthermore, our results suggest that the pandemic may have had a particular effect on the mental health of young women with AN, with both a sharp increase in hospitalizations and a high risk of self-harming behaviors

Medical record: systematic centralization versus secure on demand aggregation

<p>Abstract</p> <p>Background</p> <p>As patients often see the data of their medical histories scattered among various medical records hosted in several health-care establishments, the purpose of our multidisciplinary study was to define a pragmatic and secure on-demand based system able to gather this information, with no risk of breaching confidentiality, and to relay it to a medical professional who asked for the information via a specific search engine.</p> <p>Methods</p> <p>Scattered data are often heterogeneous, which makes the task of gathering information very hard. Two methods can be compared: trying to solve the problem by standardizing and centralizing all the information about every patient in a single Medical Record system or trying to use the data "as is" and find a way to obtain the most complete and the most accurate information. Given the failure of the first approach, due to the lack of standardization or privacy and security problems, for example, we propose an alternative that relies on the current state of affairs: an on-demand system, using a specific search engine that is able to retrieve information from the different medical records of a single patient.</p> <p>Results</p> <p>We describe the function of Medical Record Search Engines (MRSE), which are able to retrieve all the available information regarding a patient who has been hospitalized in different hospitals and to provide this information to health professionals upon request. MRSEs use pseudonymized patient identities and thus never have access to the patient's identity. However, though the system would be easy to implement as it by-passes many of the difficulties associated with a centralized architecture, the health professional would have to validate the information, i.e. read all of the information and create his own synthesis and possibly reject extra data, which could be a drawback. We thus propose various feasible improvements, based on the implementation of several tools in our on-demand based system.</p> <p>Conclusions</p> <p>A system that gathers all of the currently available information regarding a patient on the request of health-care professionals could be of great interest. This low-cost pragmatic alternative to centralized medical records could be developed quickly and easily. It could also be designed to include extra features and should thus be considered by health authorities.</p

Building Application-Related Patient Identifiers: What Solution for a European Country?

We propose a method utilizing a derived social security number with the same reliability as the social security number. We show the anonymity techniques classically based on unidirectional hash functions (such as the secure hash algorithm (SHA-2) function that can guarantee the security, quality, and reliability of information if these techniques are applied to the Social Security Number). Hashing produces a strictly anonymous code that is always the same for a given individual, and thus enables patient data to be linked. Different solutions are developed and proposed in this article. Hashing the social security number will make it possible to link the information in the personal medical file to other national health information sources with the aim of completing or validating the personal medical record or conducting epidemiological and clinical research. This data linkage would meet the anonymous data requirements of the European directive on data protection

Early cardiovascular events in women with a history of gestational diabetes mellitus

International audienceBackground: The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.Methods: This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid endarterectomy and fibrinolysis. Hypertensive disease was assessed separately. Determinants studied included age, obesity, subsequent diabetes mellitus and hypertensive diseases during pregnancy. Adjusted odds ratios for outcomes were calculated using multiple logistic regressions.Results: The hospital database recorded 1,518,990 deliveries in 2007 and 2008. Among these, 62,958 women had a history of GDM. After adjusting for age, DM, obesity and hypertensive disorders in pregnancy, GDM was significantly associated with a higher risk of CVD (adjusted Odds Ratio aOR = 1.25 [1.09-1.43]). Considering each variable in a separate model, GDM was associated with angina pectoris (aOR = 1.68 [1.29-2.20]), myocardial infarction (aOR = 1.92 [1.36-2.71]) and hypertension (aOR = 2.72 [2.58-2.88]) but not with stroke.Conclusions: A history of GDM was identified as a risk factor of CVD, especially coronary vascular diseases, within the 7 years postpartum. A lifestyle changes from postpartum onwards can be recommended and supported

Facteurs cliniques périnatals et paramètres biologiques prédictifs du pronostic chez l'enfant prématuré

L objectif de ce travail était de décrire les facteurs biologiques précoces influençant le pronostic des enfants grands prématurés. A partir d une population de 1 067 enfants admis en réanimation néonatale au CHU de Dijon de 2001 à 2008 et faisant l objet d un recueil prospectif de données clinico-biologiques périnatales, deux objectifs de recherche ont été identifiés : 1) évaluer l impact des troubles de la chlorémie au cours de l adaptation postnatale sur la morbidité neurologique; 2) caractériser la possible association entre l hypoprotidémie du premier jour de vie(J1) et le pronostic défavorable. Ces objectifs ont été approfondis dans 4 études, réalisées sur la population initiale et sur 3 autres cohortes de grands prématurés. Nous avons observé que l hyperchlorémie entraine une acidose métabolique sévère dans les 7 à 10 premiers jours de vie sans que ceci ne s associe à un pronostic neurologique défavorable (hémorragie intraventriculaire et/ou paralysie cérébrale à 18 mois d âge corrigé). Les résultats ont montré l importance de contrôler les apports de chlore des médicaments et de la nutrition parentérale, afin de prévenir toute acidose métabolique indésirable après la naissance. Les études sur la protidémie ont montré que l hypoprotidémie à J1 est un facteur indépendant associé au décès ou à la survie avec anomalies neurologiques sévères et que son pouvoir prédictif de pronostic défavorable est comparable à celui d autres scores de gravité validés. Ce travail contribue à la compréhension des facteurs périnatals influençant le pronostic du grand prématuré et ouvre de nouvelles perspectives de recherche sur la prise en charge de ces enfants vulnérables.Our aim was to identify early biochemical abnormalities associated with adverse outcome in very preterm infants. Based on an 8-year population-study for assessing the outcome in 1067 very preterm babies admitted to the neonatal intensive care unit of Dijon university hospital, two research axes were explored: 1) the impact of plasma chloride abnormalities on neurological morbidities; 2) the association between hypoproteinemia on the first day of life (D1) and adverse outcome. These issues were assessed by 4 studies, performed on the initial population and on 3 other cohorts.We found that hyperchloremia results in severe metabolic acidosis during the first 7-10 days of life, but this is not associated with adverse neurological outcome (intraventricular haemorrhage and/or cerebral palsy at 18 months of corrected age). The tight control of chloride intake by parenteral nutrition or inadvertent administration represents a good means for lowering the incidence of metabolic acidosis after birth.We also showed that hypoproteinemia (D1) has prognostic value for impaired outcome (death or survival with severe cerebral ultrasound findings) and that total plasma protein has a predictive performance comparable with other validated illness severity scores. These results provide additional insight into factors influencing mortality and morbidity for preterm babies. Our findings raise the interest in addressing the above issues in future investigations on: 1) pathophysiological mechanisms underlying the association between biological abnormalities and impaired outcome, 2) their possible therapeutic implications and 3) the development of new severity scores for very preterm babies.DIJON-BU Doc.électronique (212319901) / SudocSudocFranceF

An approach for mining care trajectories for chronic diseases

International audienceWith the increasing burden of chronic illnesses, administrative health care databases hold valuable information that could be used to monitor and assess the processes shaping the trajectory of care of chronic patients. In this context, temporal data mining methods are promising tools, though lacking flexibility in addressing the complex nature of medical events. Here, we present a new algorithm able to extract patient trajectory patterns with different levels of granularity by relying on external taxonomies. We show the interest of our approach with the analysis of trajectories of care for colorectal cancer using data from the French casemix information system