Nous avons tous, enfants, adolescents, adultes subi cette pandémie qui a profondément bouleversé nos vies pendant de nombreux mois et dont les conséquences sur le long terme restent largement ...hypothétiques. Les mesures de confinement, les menaces pesant sur la santé des proches, les contraintes restreignant les ouvertures sociales n’ont laissé personne indifférent, mais ont particulièrement pu faire obstacle au travail de séparation des adolescents. La plupart ont su déployer leurs capacités d’adaptation, alors que pour d’autres cette situation d’exception a déclenché des réactions propres à mettre à l’épreuve, voire à inquiéter leur entourage. Certains se sont d’emblée montrés débordés par les manifestations directes ou indirectes de leur angoisse ou par leur intolérance aux consignes gouvernementales, d’autres n’ont révélé leurs difficultés qu’au moment de la réouverture des établissements scolaires, voire dans un lointain « après-coup » comme en témoignent quelques études réalisées à distance révélant une nette augmentation des idéations suicidaires. On ne s’étonnera pas des problèmes d’adaptation des plus fragiles, de ceux souffrant de troubles psychopathologiques, mais force est de constater une augmentation de la demande de soins psychiques. Les dispositifs propres à accueillir et traiter la souffrance des adolescents font état de leur perplexité face à l’accroissement des gestes auto-vulnérants, des refus scolaires anxieux, des troubles des conduites alimentaires ou des diverses formes d’addiction aux écrans… Chacun s’accorde cependant à reconnaître le rôle crucial des parents et de l’impact de leurs propres souffrances sur celle de leurs enfants, fussent-ils jeunes adultes. Il importe naturellement que les soignants ne les oublient pas dans le soutien qu’ils cherchent à offrir à leurs jeunes patients.
This pandemic has profoundly changed our lives for many months and its long-term consequences remain largely hypothetical. The containment measures, the threats to the health of relatives, the constraints limiting social openings have left no one indifferent, but may have particularly impeded “adolescent separation work”. Most of adolescents have been able to deploy their adaptation capacities, while for others this exceptional situation has triggered stressful reactions for those around them. Some were immediately overwhelmed by the direct or indirect manifestations of their anxiety or by their intolerance of governmental instructions, others revealed their difficulties only when the schools reopened, or even in the distant “aftermath”, as shown by some studies carried out at a distance revealing a clear increase in suicidal ideation. We will not be surprised by the problems of adaptation of the most fragile, of those suffering from psychopathological disorders, but it is necessary to note an increase in the needs for psychological care. Teams dealing with the suffering of adolescents are puzzled by the increase in self-vulnerable acts, anxious school refusals, eating disorders or various forms of addiction to screens. However, everyone agrees on the key role of parents and the impact of their own suffering on that of their children, even if they are young adults. Of course, it is important that caregivers do not forget the parents in the support they aim to provide to their young patients.
Abstract
Background
The percentage of temporary workers in the workforce has increased in many European countries. The working environments of temporary workers are often characterized by job ...insecurity and exposure to hazardous working conditions. Studies have investigated the health status of this population but few of them have specifically investigated work-related diseases. The aim of this study is to compare the risk of uncompensated work-related diseases (UWRD) in temporary workers with permanent contract workers in France between 2009 and 2014.
Methods
UWRD and suspected associated exposure factors were notified by occupational physicians involved in French UWRD surveillance programme. Sociodemographic and professional characteristics were recorded for all salaried workers consulted by occupational physicians. We analysed musculoskeletal (MSD) disorders (elbow, hand/wrist, shoulder, back) and mental health disorders (MHD) according the type of consultation (periodic check-up, hiring...) using logistic regression. The distributions of notified exposure factors for MSD and MHD were compared between temporary and permanent workers.
Results
Of the 433 148 salaried workers consulted as part of the surveillance programme, 5.3% and 80.2% had temporary and permanent contracts, respectively. Temporary workers were as likely to have work-related shoulder, elbow and hand/wrist MSD as permanent workers. The former had a lower risk of MHD irrespective of the type of consultation (OR = 0.4, 95 % CI 0.3-0.5) and a lower risk of back MSD during on-demand/return-to-work consultations (OR = 0.2, 95% CI 0.1-0.5) and during periodic check-ups (OR = 0.3, 95% CI 0.2-0.7).
Conclusions
Temporary workers were not at a higher risk of UWRD (MSD and MHD) than permanent workers. This suggests that the generally poor health status found in temporary workers in previous studies may be linked more to their general health status and perceived job insecurity than to poorer working conditions.
Key messages
In our study, the risk of work related musculoskeletal disorders and mental health disorders in temporary workers was no greater than that in permanent workers.
Poor general health known in temporary workers, may be linked more to their general health status, job insecurity and decreasing career trajectory than to poorer working conditions.
To explore the clinical characteristics and motor activity profile during sleep periods of children and adolescents presenting with disruptive mood dysregulation disorder (DMDD).
Twenty-one youths ...(mean age±standard deviation, 11.7±3 years) wore a wrist actigraph for 9 consecutive days (including both school days and non-school days), to measure sleep parameters: sleep latency, sleep efficiency and the number and duration of periods of wakefulness after sleep onset (WASO). We divided the night-time actigraphy recording sessions into three sections and compared the first and last thirds of the night.
All the study participants had a psychiatric comorbidity (primarily attention deficit hyperactivity disorder, depressive disorder or anxiety disorder). On non-school days, bedrest onset and activity onset were shifted later by about 1h. There was no significant difference between school days and non-school days with regard to the total sleep time. Sleep efficiency was significantly greater on non-school days. Sleep was fragmented on both school days and non-school days. The mean number of episodes of WASO was 24.9 for school days and 30.9 for non-school days. Relative to the first third of the night, we observed a significantly greater number of episodes of WASO during the last third of the night, a period associated with a larger proportion of rapid eye movement (REM) sleep.
Sleep appeared to be fragmented in the study population of youths with DMDD. The greater frequency of WASO in the last third of the night points to a possible impairment of the motor inhibition normally associated with REM sleep.
Using the same Diagnostic and Statistical Manual of Mental Disorders, fifth version (
) criteria as in adults, borderline personality disorder (BPD) in adolescents is defined as a 1-year pattern of ...immature personality development with disturbances in at least five of the following domains: efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, suicidal and self-mutilating behaviors, affective instability, chronic feelings of emptiness, inappropriate intense anger, and stress-related paranoid ideation. BPD can be reliably diagnosed in adolescents as young as 11 years. The available epidemiological studies suggest that the prevalence of BPD in the general population of adolescents is around 3%. The clinical prevalence of BPD ranges from 11% in adolescents consulting at an outpatient clinic to 78% in suicidal adolescents attending an emergency department. The diagnostic procedure is based on a clinical assessment with respect to developmental milestones and the interpersonal context. The key diagnostic criterion is the 1-year duration of symptoms. Standardized, clinician-rated instruments are available for guiding this assessment (eg, the Diagnostic Interview for Borderlines-Revised and the Childhood Interview for DSM-IV-TR BPD). The assessment should include an evaluation of the suicidal risk. Differential diagnosis is a particular challenge, given the high frequency of mixed presentations and comorbidities. With respect to clinical and epidemiological studies, externalizing disorders in childhood constitute a risk factor for developing BPD in early adolescence, whereas adolescent depressive disorders are predictive of BPD in adulthood. The treatment of adolescents with BPD requires commitment from the parents, a cohesive medical team, and a coherent treatment schedule. With regard to evidence-based medicine, psychopharmacological treatment is not recommended and, if ultimately required, should be limited to second-generation antipsychotics. Supportive psychotherapy is the most commonly available first-line treatment. Randomized controlled trials have provided evidence in favor of the use of specific, manualized psychotherapies (dialectic-behavioral therapy, cognitive analytic therapy, and mentalization-based therapy).
Summary Posterior reversible encephalopathy (PRES) represents an uncommon entity related to multiple pathologies, the most common of which is hypertensive crisis. PRES is classically characterized as ...symmetrical parieto-occipital edema, but may affect other areas of the brain. Diffusion-weighted magnetic resonance imaging (DWI) is important for differentiating between vasogenic and cytotoxic edema. We present here the case of a 43-year-old woman, known to suffer from arterial hypertension and severe renal failure, who developed PRES with restricted apparent diffusion coefficients (ADC) in various cerebral areas, suggesting irreversible tissue damage. Nevertheless, follow-up cranial MRI revealed complete remission, indicating that restricted diffusion does not always lead to cell death in this pathology. The underlying pathophysiological mechanism is not well understood. Such reversibility of diffusion anomalies has already been reported with transient ischemia, vasospasm after subarachnoid hemorrhage and epilepsy but, to our knowledge, never before in PRES.
Weight loss is a common problem in patients with Alzheimer's Disease (AD). It is a predictive factor of mortality and it decreases patients' and caregivers' quality of life.
To determine if a ...nutritional education program can prevent weight loss in AD patients.
151 AD patients and their caregivers were enrolled to follow the intervention and 74 AD patients and their caregivers constituted a control group.
Caregivers in the intervention group followed 9 nutritional sessions of one hour each, over one year. Caregivers in the control group didn't follow any sessions but were offered advice provided in a normal follow-up. Patients weight, nutritional state, cognitive function, autonomy, mood, behaviour disorders at baseline and at 6- and 12-month follow-up. Caregivers burden, nutritional and AD knowledge at the baseline and at the 12-month follow-up.
During the year follow-up, the mean weight increased in the intervention group (0.7+/-3.6 kg) whereas it decreased in the control group (-0.7+/-5.4 kg) (p<0.05). The nutritional status (MNA) was maintained in the intervention group (0.3+/-2.6) whereas it decreased significantly in the control group (-1.0+/-3.4) (p<0.005). After adjustment for baseline differences between the two groups (caregiver age, nutritional state, eating behaviour disorders, depression), the weight change between the two groups was not significant (0.6+/-0.4 kg vs. -0.6+/-0. 6 kg respectively in intervention group and control group). However, the percentage of patients with significant weight loss is decreased. The MMSE change became significant between the two groups: -2.3+/-0.3 vs. -3.4+/-0.4 respectively in intervention group and control group (p<0.05).
These results suggest that a nutritional educational program intended for caregivers of AD patients could have a positive effect on patients weight and cognitive function.
Pulmonary hypertension (PH) is a complex disorder resulting from many etiologies that cause disturbances of normal pulmonary haemodynamics. Recent breakthroughs have led to a better understanding of ...the pathophysiology of the disease. In PH, haemodynamic disturbances are closely linked to structural changes and excessive remodeling of pulmonary vessels, leading to progressive narrowing of the pulmonary vascular lumen. Imbalances between pulmonary vasoconstrictors and vasodilators on the one hand, and factors favoring cell proliferation and apoptosis on the other hand, probably account for most cases of PH. This review aims to update readers with the current knowledge on the molecular physiopathology of PH and how this can progress the therapeutic of this disorder.
Abstract
Background
The purpose of this study was to assess the economic burden of cardiovascular diseases (CVDs) in France by analysing the structure and the growth of expenditure attributed to ...these diseases between 2012 and 2017.
Methods
For each year, 11 CVDs were identified from SNDS data using algorithms based on long-term disease registry and hospitalization diagnoses, applied to the population of national health insurance general scheme beneficiaries. The individuals’ expenditure (26 different items) reimbursed for hospitalisations, ambulatory care and cash payments were included. A top-down method was used to attribute expenditure to each considered groups of diseases based on the average expenditure by disease calculated for individuals with only one disease. To analyse trends, we applied the same methodology from 2012 to 2017.
Results
In 2017, of the €140.1 billion reimbursed, €14.0 billion (10.0%) were attributed to the care of 4.0 million people with a CVD (7.0% of the population). Short-stay hospitalisations accounted for 33% of this total expenditure. This proportion was higher for acute CVD (coronary syndrome: 64%, stroke: 56%, heart failure: 65%, pulmonary embolism: 69%) but also for valvular heart disease (50.0%). Medications represented almost 13% of the expenditure attributed to all CVDs, and up to 25% for chronic coronary heart disease. Disability pension essentially concerned sequelae of stroke (12% of the expenditure attributed to this disease). Between 2012 and 2017, the total expenditure attributed to CVDs increased by 3.3% per year, mainly due to the annual mean increase of the number of patients over the period (+3.1%).
Conclusions
These results demonstrate the high economic burden of CVDs in France with a detailed analysis of expenditures and their main drivers. The developed tool will help decision makers to monitor the burden of these diseases but also to provide stake holders with a better understanding of trends and regulating actions.
Key messages
Economic burden of CVD in France is high: 10% of healthcare expenditure.
Implementation of public health policy to prevent CVD and control risk factors must be a priority.
Abstract
Background
French employees receive compensations for diseases officially recognized as professionnal disease. Reimbursment data are thus used to produce statistics. Such data do not ...integrate uncompensated work-related diseases (UUWRD) defined as likely to be of occupational origin but not recognized as well. In 2003, the National Public Health Agency implemented a surveillance program on UWRD. This program is a complement to the compensation system for occupational diseases.
This communication presents results UWRD program can provide.
Methods
Twice a year, a network of volunteer occupational physicians (OP) reports ill health and associated work exposures of employees. Employee sociodemographics are notified. In 2018, half of French regions are integrated in the program.
Prevalence rates are calculated for UWRD. Chi-squared tests are used to compare prevalence rates between groups. Multivariate logistic regressions are conducted to evaluate:1- risks to report UWRD between groups, 2- prevalence rates trends. Underreporting rates of UWRD are approximated using an indicator capturing differences between figures produced by UWRD program and the compensation system.
Results
Over the 2009-2014 period, women working in mass food retail were observed at higher risk to present musuculoskeletical disorders than women of other sectors (ORa = 2.0). Same results were noted for men (ORa = 1.3). In mass food retail, decreases in musculoskeletal disorder prevalence rates were reported. Estimated average annual change rates were of 7.0 % for women and 11.0% for men. In 2011, UWRD data highlighted that between half and three-quarter of work-related musculoskeletal disorders were unreported by the compensation system.
Conclusions
UWRD data are used to identify vulnerable groups, analyse temporal trends and evaluate underreporting of professionnal disease.
Key messages
URWD program is a complement to the compensation system and let to better monitor health status of communities.
Such informations are of interest to guide prevention policies.
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