Abstract Introduction New digital tools constitute an opportunity in understanding the interactions between sleep health and mental health. Structural equation analysis applied to these e-cohort ...allows to study the bidirectional associations between these dimensions. Thus, we aimed to study the reciprocal interactions between behaviors (duration, temporality, regularity) and sleep health (insomnia and somnolence) and mental health (anxiety and depression). Methods Digital cohort of 3000 participants invited to complete weekly self-questionnaires over 17 days on their sleep health (Epworth and ISI), their mental health (PHQ-9 and PHQ-2) as well as sleep diaries which made it possible to calculate their sleep behaviors (duration, median, and regularity index). The interaction analysis used a longitudinal structure equation model. Results The average age of the participants was 51 years (68% women). The average sleep duration was 7h24, the median sleep time was 3h30 in the morning, the regularity index was 84/100. Among them, 57% reported insomnia (ISI≥15), 41% reported drowsiness (ESS≥11), 19% reported anxiety (PHQ-2≥3) and 18% reported depression (PHQ-9≥15). Sleep behaviors were associated with sleep health and mental health cross-sectionally. Longitudinal structural equation modeling shows bidirectional associations between sleep health behaviors and mental health. Conclusion The demonstration of these reciprocal interactions confirms the importance of the joint assessment and management of sleep and mental health behaviors and health in digital interventions aimed at modifying them. New interventional studies are awaited to confirm these results in the general population but also in subgroups of individuals at risk. Support (if any)
To describe the clinical features and course of liver involvement in a cohort of patients with Niemann-Pick type C disease (NP-C), a severe lysosomal storage disorder.
Patients with genetically ...confirmed NP-C (NPC1, n = 31; NPC2, n = 3) and liver involvement before age 6 months were retrospectively included. Clinical, laboratory test, and imaging data were collected until the last follow-up or death; available liver biopsy specimens were studied using anti-CD68 immunostaining.
At initial evaluation (median age, 17 days of life), all patients had hepatomegaly, 33 had splenomegaly, and 30 had neonatal cholestasis. Portal hypertension and liver failure developed in 9 and 4 patients, respectively. Liver biopsy studies, performed in 16 patients, revealed significant fibrosis in all 16 and CD68+ storage cells in 15. Serum alpha-fetoprotein concentration measured in 21 patients was elevated in 17. Plasma oxysterol concentrations were increased in the 16 patients tested. Four patients died within 6 months of life, including 3 from liver involvement. In patients who survived beyond age 6 months (median follow-up, 6.1 years), cholestasis regressed in all, and portal hypertension regressed in all but 1; 25 patients developed neurologic involvement, which was fatal in 16 patients.
Liver involvement in NP-C consisted of transient neonatal cholestasis with hepatosplenomegaly, was associated with liver fibrosis, and was responsible for death in 9% of patients. The combination of liver anti-CD68 immunostaining, serum alpha-fetoprotein measurement, and studies of plasma biomarkers should facilitate early identification of NP-C.
Urbanization of coastal habitats, of which harbors and marinas are the paragon, has led to various ecological paradigms about their functioning. Harbor infrastructures offer new hard substrata that ...are colonized by a wide variety of organisms (biofouling) including many introduced species. These structures also modify hydrodynamism and contaminant dispersal, leading to strong disturbance gradients within them. Differences in sessile community structure have previously been correlated to these gradients at small spatial scale (<100 m). Local adaptation might be involved to explain such results, but as correlation is not causation, the present study aims to understand the causal link between the environmental gradients and community structure through a reciprocal transplant experiment among three sites of a marina (inner, middle, entrance). Our results highlighted strong small-scale spatial variations of contaminants (trace metals, PCB, pesticides, and PAH) in sediments and animal samples which have been causally linked to changes in community composition after transplant. But historical contingency and colonization succession also play an important role. Our results provided strong evidence for local adaptation since community structure, respiration, and pollutant uptake in Bugula neritina, as well as the metabolomes of B. neritina and Ciona intestinalis were impacted by the transplant with a disadvantage for individuals transplanted from the entrance to the inner location. The here observed results may thus indicate that the disturbance gradient in marinas might constitute a staple for selecting pollutant-resistant species and populations, causing local adaptation. This highlights the importance of conducting further studies into small scale local adaptation.
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•Previous work observed spatial variation (<100 m) of communities within marinas.•This may be due to pollution gradients and local adaptation, but proof is required.•We reveal a pollution gradient, with higher levels at the inner part of the marina.•Community transplants show that this gradient causally impacts community structure.•Potential local adaptation was observed on different levels of biological function.
We study efficient non-linear taxation of labour and capital in a dynamic Mirrleesian model incorporating political economy constraints. Policies are chosen sequentially over time, without ...commitment. Our main result is that the marginal tax on capital income is progressive, in the sense that richer agents face higher marginal tax rates.
•Virtual patients can simulate a realistic psychiatric interview.•Virtual patients are effective to measure students’ psychiatric knowledge and empathic skills.•Medical students are open to virtual ...patients for training and enjoyed the interaction.•Virtual patients could complement existing pedagogic tool in psychiatry.
A psychiatric diagnosis involves the physician's ability to create an empathic interaction with the patient in order to accurately extract semiology (i.e., clinical manifestations). Virtual patients (VPs) can be used to train these skills but need to be evaluated in terms of accuracy, and to be perceived positively by users.
We recruited 35 medical students who interacted in a 35-min psychiatric interview with a VP simulating major depressive disorders. Semiology extraction, verbal and non-verbal empathy were measured objectively during the interaction. The students were then debriefed to collect their experience with the VP.
The VP was able to simulate the conduction of a psychiatric interview realistically, and was effective to discriminate students depending on their psychiatric knowledge. Results suggest that students managed to keep an emotional distance during the interview and show the added value of emotion recognition software to measure empathy in psychiatry training. Students provided positive feedback regarding pedagogic usefulness, realism and enjoyment in the interaction.
Our sample was relatively small. As a first prototype, the measures taken by the VP would need improvement (subtler empathic questions, levels of difficulty). The face-tracking technique might induce errors in detecting non-verbal empathy.
This study is the first to simulate a realistic psychiatric interview and to measure both skills needed by future psychiatrists: semiology extraction and empathic communication. Results provide evidence that VPs are acceptable by medical students, and highlight their relevance to complement existing training and evaluation tools in the field of affective disorders.
Adenosine kinase (ADK) deficiency is characterized by liver disease, dysmorphic features, epilepsy and developmental delay. This defect disrupts the adenosine/AMP futile cycle and interferes with the ...upstream methionine cycle. We report the clinical, histological and biochemical courses of three ADK children carrying two new mutations and presenting with neonatal cholestasis and neurological disorders. One of them died of liver failure whereas the other two recovered from their liver damage. As the phenotype was consistent with a mitochondrial disorder, we studied liver mitochondrial respiratory chain activities in two patients and revealed a combined defect of several complexes. In addition, we retrospectively analyzed methionine plasma concentration, a hallmark of ADK deficiency, in a cohort of children and showed that methionine level in patients with ADK deficiency was strongly increased compared with patients with other liver diseases. ADK deficiency is a cause of neonatal or early infantile liver disease that may mimic primary mitochondrial disorders. In this context, an elevation of methionine plasma levels over twice the upper limit should not be considered as a nonspecific finding. ADK deficiency induced-liver dysfunction is most often transient, but could be life-threatening.
ObjectiveThis study aims to evaluate whether the first wave of the COVID-19 pandemic resulted in a deterioration in the quality of care for socially and/or clinically vulnerable stroke and ST-segment ...elevation myocardial infarction (STEMI) patients.DesignTwo cohorts of STEMI and stroke patients in the Aquitaine neurocardiovascular registry.SettingSix emergency medical services, 30 emergency units, 14 hospitalisation units and 11 catheterisation laboratories in the Aquitaine region in France.ParticipantsThis study involved 9218 patients (6436 stroke and 2782 STEMI patients) in the neurocardiovascular registry from January 2019 to August 2020.Primary outcome measuresCare management times in both cohorts: first medical contact-to-procedure time for the STEMI cohort and emergency unit admission-to-imaging time for the stroke cohort. Associations between social (deprivation index) and clinical (age >65 years, neurocardiovascular history) vulnerabilities and care management times were analysed using multivariate linear mixed models, with an interaction on the time period (pre-wave, per-wave and post-first COVID-19 wave).ResultsThe first medical contact procedure time was longer for elderly (p<0.001) and ‘very socially disadvantaged’ (p=0.003) STEMI patients, with no interaction regarding the COVID-19 period (age, p=0.54; neurocardiovascular history, p=0.70; deprivation, p=0.64). We found no significant association between vulnerabilities and the admission imaging time for stroke patients, and no interaction with respect to the COVID-19 period (age, p=0.81; neurocardiovascular history, p=0.34; deprivation, p=0.95).ConclusionsThis study revealed pre-existing inequalities in care management times for vulnerable STEMI and stroke patients; however, these inequalities were neither accentuated nor reduced during the first COVID-19 wave. Measures implemented during the crisis did not alter the structured emergency pathway for these patients.Trial registration numberNCT04979208
A psychiatric diagnosis involves the physician’s ability to create an empathic interaction with the patient in order to accurately extract symptomatology (i.e., clinical manifestations). Virtual ...patients (VPs) can be used to train these skills but need to propose a structured and multimodal interaction situation, in order to simulate a realistic psychiatric interview. In this study we present a simulated psychiatric interview with a virtual patient suffering from major depressive disorders. We suggested some design guidelines based on psychiatry theories and medicine education standards. We evaluated our VP with user testing with 35 4th year medical students, and probed their opinion during debriefing interviews. All students showed good abilities to communicate empathetically with the VP, and managed to extract symptomatology from VP’s simulation. Students provided positive feedbacks regarding pedagogic usefulness, realism and enjoyment in the interaction, which suggests that our design guidelines are consistent and that such technologies are acceptable to medical students. To conclude this study is the first to simulate a realistic psychiatric interview and to measure both skills needed by future psychiatrists: symptomatology extraction and empathic communication. Results provide evidence for the use of VPs to complement existing tools and to train and evaluate healthcare professionals in the future.
Objective
Considering household disinfectants and cleaning products (HDCP) as mixture of ingredients, rather than each ingredient individually, might help in characterizing their role in asthma. We ...investigated the association between HDCP and asthma, using the recently developed Ménag’Score
®
, a health risk assessment score based on exhaustive ingredient lists of HDCP.
Methods
The study is based on 103 female volunteers of the SEPAGES cohort (2014–2019), with repeated data (up to 3 collection times, 200 observations). HDCP use was assessed from a barcode-based smartphone application linked with an ingredient database. The Ménag’score
®
risks for health and environment were computed for each weekly used HDCP from their exhaustive ingredient data (from
A
: no known risk to
E
: highest risk). The association between the use of HDCP with a poor Ménag’score
®
(
D
or
E
; overall, health, environment scores) and asthma symptoms, was estimated by generalized estimating equations models adjusted for age, BMI and smoking status.
Results
Participants were on average 33 years old, 11% smoked and 20% had at least one asthma symptom. The Ménag’score
®
was computed for 540 HDCP scanned by participants. Weekly use of HDCP with a poor Ménag'score
®
-health (around 60% of the participants) was associated with a higher risk of asthma symptoms (OR 3.13, 95% CI 1.32–7.43). No association was observed for the Ménag'score
®
-environment.
Conclusion
The use of HDCP with a poor Ménag’score
®
-health was associated with asthma symptoms. The results support the use of the Ménag’score
®
-health to further evaluate the health risks of HDCP in observational studies and as a potential public health tool.
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