Introduction Alors que la majorité des traitements antidépresseurs prescrits en France durent moins de 28 jours 1 , moins de 2 % des travaux étudiant le traitement pharmacologique des troubles de ...l’humeur explorent les facteurs métapsychologiques associés à l’adhésion 2 . Quelles sont les attitudes aux antidépresseurs des patients observants et demandeurs de soins ? Objectif L’objectif de cette étude était d’évaluer les attitudes aux antidépresseurs chez : – des patients hospitalisés pour leur dépression ; – ceux se rendant chez leur pharmacien pour chercher leur traitement. Méthode Les attitudes aux antidépresseurs étaient évaluées en utilisant la version courte du Drug Attitude Inventory (DAI-10), chez 98 patients : 40 hospitalisés de leur plein gré en psychiatrie et 58 venant chercher une prescription d’antidépresseur en officine. Résultats L’âge moyen de l’échantillon était de 43 ans, avec 69 % de femmes. Dans l’échantillon hospitalier, la médiane du DAI était de 3,5 (échelle de –10 à +10). Trente pour cent des patients avaient une attitude négative à l’antidépresseur prescrit, dont 10 % de l’échantillon ne connaissait pas le nom. Il s’agissait de la première prescription d’antidépresseur pour 30 % des patients. Dans le volet ambulatoire, la médiane du DAI n’était que faiblement plus positive (4), et 10 % des sujets avaient une attitude négative à l’antidépresseur qu’ils venaient chercher. Vingt pour cent des sujets déclaraient ne pas avoir de suivi de son trouble dépressif. Discussion Cette étude naturalistique met en relief l’ambivalence des patients face aux antidépresseurs. Tandis qu’un comportement montre un engagement fort dans les soins (être hospitalisé en milieu spécialisé, aller chercher une prescription au long cours), les connaissances sur les troubles les justifiant et les croyances envers les thérapeutiques prescrites restent précaires 3. Conclusion Cette ambivalence, reflet des attitudes de la société face à nos médicaments, pourrait être mieux explorée en pratique clinique quotidienne.
Chemsex is defined by the use of psychoactive substances to facilitate or improve sexual relations. Our objectives were to assess the prevalence of the practice of 'chemsex' in a population of French ...university students and to identify socio-demographic and clinical factors associated with this practice.
We have used an anonymous online questionnaire comprising 15 questions on socio-demographic characteristics, chemsex use, sexual satisfaction, the type of substances used in this sexual context and their route of administration.
A total of 680 people were included in our study. Among them, 22.5% reported chemsex behaviour in the past year. Using a multivariate analysis, factors associated with chemsex were dating application use (p = 0.049) and pornography use viewing more than once per month (p = 0.002). Having a sexual partner involved in chemsex (p < 0.0001), celibacy (p = 0.007), sexual orientations other than heterosexual (p = 0.0013) and especially bisexuality (p = 0.0002) were also significantly associated with chemsex.
This is the first study reporting a high prevalence of chemsex in a university student population. Further larger studies should be conducted to confirm these results showing a high prevalence of this at-risk behaviour.
Stigma associated with depression and antidepressants is strong among the general population but also among patients and health professionals.
This cross-sectional study is aimed at: 1) evaluating ...the knowledge and attitude towards antidepressant by nursing student; 2) exploring the association between instruction in psychiatry and representation of depression and antidepressants.
2037 undergraduate students from 10 French nursing schools were invited to participate in 2017, 1475 (73%) completed the questionnaire.
The self-report questionnaire included the Drug Attitude Inventory (DAI) and questions about representation on depression and antidepressant. Four groups of students were built: 1) pre-teaching group (PT) as a reference group, 2) clinical training in psychiatry (CT), 3) receiving mental health theoretical education (TE), 4) receiving both (CT + TE).
The mean (standard deviation) DAI score was negative: -1.9 (±4.4) with only 40% of the nursing students conveying a positive attitude towards antidepressant. A combination of CT and TE was associated with a more positive attitude towards antidepressant in comparison with the PT condition. The CT + TE group was more prone to view antidepressants as effective and safe.
There is strong stigma against depression/antidepressants among nursing student. Education combined with clinical experiences in psychiatry improved these representations.
•60% of the nursing students had a negative attitude to antidepressant.•Students showed a stronger mistrust in antidepressant than general population.•Theoretical education + clinical practicum improved antidepressants representations.
Introduction La non-adhésion diminue largement l’efficacité des antidépresseurs 1,2 , dont la représentation évolue dans un contexte particulièrement défiant et médiatiquement tendu. Objectif ...L’objectif de cette étude est de : – évaluer l’adhésion aux antidépresseurs chez des patients hospitalisés pour épisode dépressif majeur ; – explorer les représentations que les patients ont des antidépresseurs et de la dépression, ainsi que la perception de la stigmatisation aux troubles mentaux ; – analyser la relation entre les attitudes face aux antidépresseurs et des paramètres sociodémographiques et cliniques. Méthode L’adhérence était évaluée chez 40 patients en utilisant la version courte du Drug Attitude Inventory (DAI-10), complétée par un questionnaire mesurant les connaissances, craintes, impact des média et stigmatisation liés aux antidépresseurs. Des entretiens d’investigation étaient ensuite menés à l’aide de celui-ci. Résultats L’âge moyen de l’échantillon est de 43 ans, dont 27 % d’homme. Il s’agit d’un premier épisode pour 40 % des patients. La médiane du DAI est de 3,5 (échelle de −10 à +10), et 30 % des patients ne sont pas adhérents. Les hommes de l’échantillon ont une plus mauvaise représentation des antidépresseurs (−2 VS 4 ; U de Mann-Whitney = 90,50 ; p = 0,0035). Soixante-dix pour cent des patients ont des craintes par rapport à leur antidépresseur (prise de poids et dépendance au premier rang). Vingt pour cent des patients n’ont pas dit à leur entourage qu’ils prenaient des médicaments contre la dépression. Discussion Une intervention à de multiples niveaux pourrait augmenter les connaissances des patients ainsi que de l’opinion publique 3 . Une collaboration spécifique entre journalistes et psychiatres permettrait une meilleure connaissance et une diffusion plus représentative des enjeux de santé mentale dans les média 4 . Des actions de santé publique et initiatives citoyennes pourraient aussi être profitables aux patients. Conclusion L’adhérence aux antidépresseurs peut largement être améliorée, la stigmatisation restant une barrière aux traitements et à la prise en charge.
In this manuscript we deal with regularity issues and the asymptotic behaviour (as
p
→
∞
) of solutions for elliptic free boundary problems of
p
-
Laplacian type (
2
≤
p
<
∞
):
-
Δ
p
u
(
x
)
+
λ
0
(
...x
)
χ
{
u
>
0
}
(
x
)
=
0
in
Ω
⊂
R
N
,
with a prescribed Dirichlet boundary data, where
λ
0
>
0
is a bounded function and
Ω
is a regular domain. First, we prove the convergence as
p
→
∞
of any family of solutions
(
u
p
)
p
≥
2
, as well as we obtain the corresponding limit operator (in non-divergence form) ruling the limit equation,
max
-
Δ
∞
u
∞
,
-
|
∇
u
∞
|
+
χ
{
u
∞
>
0
}
=
0
in
Ω
∩
{
u
∞
≥
0
}
u
∞
=
F
on
∂
Ω
.
Next, we obtain uniqueness for solutions to this limit problem. Finally, we show that any solution to the limit operator is a limit of value functions for a specific Tug-of-War game.
During the summer of 2018, a widespread drought developed over Northern and Central Europe. The increase in temperature and the reduction of soil moisture have influenced carbon dioxide (CO
2
) ...exchange between the atmosphere and terrestrial ecosystems in various ways, such as a reduction of photosynthesis, changes in ecosystem respiration, or allowing more frequent fires. In this study, we characterize the resulting perturbation of the atmospheric CO
2
seasonal cycles. 2018 has a good coverage of European regions affected by drought, allowing the investigation of how ecosystem flux anomalies impacted spatial CO
2
gradients between stations. This density of stations is unprecedented compared to previous drought events in 2003 and 2015, particularly thanks to the deployment of the Integrated Carbon Observation System (ICOS) network of atmospheric greenhouse gas monitoring stations in recent years. Seasonal CO
2
cycles from 48 European stations were available for 2017 and 2018. Earlier data were retrieved for comparison from international databases or national networks. Here, we show that the usual summer minimum in CO
2
due to the surface carbon uptake was reduced by 1.4 ppm in 2018 for the 10 stations located in the area most affected by the temperature anomaly, mostly in Northern Europe. Notwithstanding, the CO
2
transition phases before and after July were slower in 2018 compared to 2017, suggesting an extension of the growing season, with either continued CO
2
uptake by photosynthesis and/or a reduction in respiration driven by the depletion of substrate for respiration inherited from the previous months due to the drought. For stations with sufficiently long time series, the CO
2
anomaly observed in 2018 was compared to previous European droughts in 2003 and 2015. Considering the areas most affected by the temperature anomalies, we found a higher CO
2
anomaly in 2003 (+3 ppm averaged over 4 sites), and a smaller anomaly in 2015 (+1 ppm averaged over 11 sites) compared to 2018.
This article is part of the theme issue ‘Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale'.
In a multicenter cohort of probable dementia with Lewy bodies (DLB), we tested the hypothesis that β-amyloid and tau biomarker positivity increases with age, which is modified by
genotype and sex, ...and that there are isolated and synergistic associations with the clinical phenotype.
We included 417 patients with DLB (age 45-93 years, 31% women). Positivity on β-amyloid (A+) and tau (T+) biomarkers was determined by CSF β-amyloid
and phosphorylated tau in the European cohort and by Pittsburgh compound B and AV-1451 PET in the Mayo Clinic cohort. Patients were stratified into 4 groups: A-T-, A+T-, A-T+, and A+T+.
A-T- was the largest group (39%), followed by A+T- (32%), A+T+ (15%), and A-T+ (13%). The percentage of A-T- decreased with age, and A+ and T+ increased with age in both women and men. A+ increased more in
ε4 carriers with age than in noncarriers. A+ was the main predictor of lower cognitive performance when considered together with T+. T+ was associated with a lower frequency of parkinsonism and probable REM sleep behavior disorder. There were no significant interactions between A+ and T+ in relation to the clinical phenotype.
Alzheimer disease pathologic changes are common in DLB and are associated with the clinical phenotype. β-Amyloid is associated with cognitive impairment, and tau pathology is associated with lower frequency of clinical features of DLB. These findings have important implications for diagnosis, prognosis, and disease monitoring, as well as for clinical trials targeting disease-specific proteins in DLB.
This study provides Class II evidence that in patients with probable DLB, β-amyloid is associated with lower cognitive performance and tau pathology is associated with lower frequency of clinical features of DLB.
During the summer of 2018, a widespread drought developed over Northern and Central Europe. The increase in temperature and the reduction of soil moisture have influenced carbon dioxide (CO
) ...exchange between the atmosphere and terrestrial ecosystems in various ways, such as a reduction of photosynthesis, changes in ecosystem respiration, or allowing more frequent fires. In this study, we characterize the resulting perturbation of the atmospheric CO
seasonal cycles. 2018 has a good coverage of European regions affected by drought, allowing the investigation of how ecosystem flux anomalies impacted spatial CO
gradients between stations. This density of stations is unprecedented compared to previous drought events in 2003 and 2015, particularly thanks to the deployment of the Integrated Carbon Observation System (ICOS) network of atmospheric greenhouse gas monitoring stations in recent years. Seasonal CO
cycles from 48 European stations were available for 2017 and 2018. Earlier data were retrieved for comparison from international databases or national networks. Here, we show that the usual summer minimum in CO
due to the surface carbon uptake was reduced by 1.4 ppm in 2018 for the 10 stations located in the area most affected by the temperature anomaly, mostly in Northern Europe. Notwithstanding, the CO
transition phases before and after July were slower in 2018 compared to 2017, suggesting an extension of the growing season, with either continued CO
uptake by photosynthesis and/or a reduction in respiration driven by the depletion of substrate for respiration inherited from the previous months due to the drought. For stations with sufficiently long time series, the CO
anomaly observed in 2018 was compared to previous European droughts in 2003 and 2015. Considering the areas most affected by the temperature anomalies, we found a higher CO
anomaly in 2003 (+3 ppm averaged over 4 sites), and a smaller anomaly in 2015 (+1 ppm averaged over 11 sites) compared to 2018. This article is part of the theme issue 'Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale'.
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