Clinical features of the prevalent form of childhood deafness, DFNB1, due to a connexin-26 gene defect: implications for genetic counselling

BACKGROUND

DFNB1, the locus of an autosomal recessive form of deafness due to mutations in the connexin-26 gene (CX26 or GJB2) is one of the most frequent hereditary defects in human beings. To date, no clinical characterisation of the DFNB1 inner-ear defects has been reported, which precludes the provision of prognostic information and genetic counselling.

METHODS

We enrolled, in a prospective study, 140 children from 104 families affected by sensorineural deafness with various degrees of hearing loss. The children either belonged to a family affected by autosomal recessive deafness (DFNB family) or represented sporadic cases. We searched for mutations in the 5' non-coding exon and in the coding region of CX26. Audiometric and radiological features were investigated and compared in deaf children with and without CX26 mutations.

FINDINGS

CX26 mutations were present in 43 (49%) of the 88 families with cases of prelingual deafness versus none of the 16 families with postlingual forms of deafness (p<0.01). The inner-ear defects of 54 prelingually deaf children with biallelic CX26 mutations were compared with the defects in 57 prelingually deaf children without CX26 mutations. DFNB1 deafness varied from mild to profound, associated with sloping or flat audiometric curves and a radiologically normal inner ear. Hearing loss was not progressive in 11 of 16 cases tested, and variations in the severity of deafness between siblings were common.

INTERPRETATION

The characteristic audiometric and radiological features of DFNB1 should be the reference used to guide the investigation, by CX26 molecular diagnostic tests, of deaf children with a compatible phenotype. Prognostic information can now be given to families: the hearing loss in DFNB1 deafness is non-progressive in most cases, at least up to young adulthood. An important element for genetic counselling is that the severity of hearing loss due to DFNB1 is extremely variable and cannot be predicted, even within families.

SLC26A4 gene is frequently involved in nonsyndromic hearing impairment with enlarged vestibular aqueduct in Caucasian populations

Sensorineural hearing loss is the most frequent sensory deficit of childhood and is of genetic origin in up to 75% of cases. It has been shown that mutations of the SLC26A4 (PDS) gene were involved in syndromic deafness characterized by congenital sensorineural hearing impairment and goitre (Pendred's syndrome), as well as in congenital isolated deafness (DFNB4). While the prevalence of SLC26A4 mutations in Pendred's syndrome is clearly established, it remains to be studied in large cohorts of patients with nonsyndromic deafness and detailed clinical informations. In this report, 109 patients from 100 unrelated families, aged from 1 to 32 years (median age: 10 years), with nonsyndromic deafness and enlarged vestibular aqueduct, were genotyped for SLC26A4 using DHPLC molecular screening and sequencing. In all, 91 allelic variants were observed in 100 unrelated families, of which 19 have never been reported. The prevalence of SLC26A4 mutations was 40% (40/100), with biallelic mutation in 24% (24/100), while six families were homozygous. All patients included in this series had documented deafness, associated with EVA and without any evidence of syndromic disease. Among patients with SLC26A4 biallelic mutations, deafness was more severe, fluctuated more than in patients with no mutation. In conclusion, the incidence of SLC26A4 mutations is high in patients with isolated deafness and enlarged vestibular aqueduct and could represent up to 4% of nonsyndromic hearing impairment. SLC26A4 could be the second most frequent gene implicated in nonsyndromic deafness after GJB2, in this Caucasian population.

Comparison of a spatial perspective with the multilevel analytical approach in neighborhood studies: the case of mental and behavioral disorders due to psychoactive substance use in Malmo, Sweden, 2001

Most studies of neighborhood effects on health have used the multilevel approach. However, since this methodology does not incorporate any notion of space, it may not provide optimal epidemiologic information when modeling variations or when investigating associations between contextual factors and health. Investigating mental disorders due to psychoactive substance use among all 65,830 individuals aged 40-59 years in 2001 in Malmö, Sweden, geolocated at their place of residence, the authors compared a spatial analytical perspective, which builds notions of space into hypotheses and methods, with the multilevel approach. Geoadditive models provided precise cartographic information on spatial variations in prevalence independent of administrative boundaries. The multilevel model showed significant neighborhood variations in the prevalence of substance-related disorders. However, hierarchical geostatistical models provided information on not only the magnitude but also the scale of neighborhood variations, indicating a significant correlation between neighborhoods in close proximity to each other. The prevalence of disorders increased with neighborhood deprivation. Far stronger associations were observed when using indicators measured in spatially adaptive areas, centered on residences of individuals, smaller in size than administrative neighborhoods. In neighborhood studies, building notions of space into analytical procedures may yield more comprehensive information than heretofore has been gathered on the spatial distribution of outcomes.

Fixed 50% nitrous oxide oxygen mixture for painful procedures: A French survey

OBJECTIVE

Although the equimolecular mixture of oxygen and nitrous oxide (EMONO) seems a good choice to relieve procedure-related pain in children, it has not been accepted everywhere. In France, the rapid spread of its use has elicited suspicion and doubts regarding its safety. To assess the use and the safety of this gas mixture in the pediatric settings in France, we conducted a national survey.

METHODOLOGY

Centers that had accepted a nation- wide invitation to participate in the survey filled out a questionnaire after each EMONO administration during a 2-month study. Procedure and inhalation characteristics, as well as pain evaluations and side effects, were reported.

RESULTS

One thousand nineteen EMONO inhalations from 31 centers that agreed to participate in this 2-month survey were analyzed. Median (range) age was 6.4 (0-18) years. Four percent (46) of children were 12 months old or younger, 29% (295) were 5 years old or younger, 45% (459) were 6 to 10 years old, and 26% (265) were older than 10 years of age. The procedures performed with EMONO inhalation were: lumbar punctures (286), bone marrow aspirations (BMA; 231), laceration repairs (215), minor procedures (75), minor surgery (53), punctures (49), fractures (45), dental care (43), and pulmonary endoscopy (22). Nine percent of procedures were undertaken without the presence of a physician; the child being observed only by the attending nurse. A drug association was noted in 182 (17.9%) of procedures: midazolam (63%), acetaminophen (18%), nalbuphine (8.5%), hydroxyzine (5%), flunitrazepam (2%), chlorazepate (2%), morphine (1%), and lorazepam (.5%). EMLA cream (Astra) was applied in 98.6% of lumbar punctures, 93.7% of BMA, and 54.2% of punctures including lymph nodes, hematoma, or renal biopsies. Lidocaine infiltration was performed in 51% of minor surgery procedures, 40% of laceration repairs, and 28% of BMA. The inhalation system included a whistle, a scented mask, and a nonrebreathing respiratory valve in 48.9%, 71.2%, and 78.3% of the patients, respectively. Initial physical restraint was needed in 18. 2% of all the patients. Inhalation refusal was noted in 129 (12.7%) children; of these, 53 had an alternative method of analgesia (EMLA or lidocaine infiltration), 15 had no other analgesia, and in the remaining 61, EMONO inhalation was maintained against the child's will. Median (interquartile) inhalation length was 4 (3-5) minutes before starting the procedure and 6 (6-15) minutes for the total inhalation. Median (interquartile) procedural pain evaluations were 9 (0-30) for children on a 0 to 100 visual analog scale, 1 (0-3) for both nurses and parents on a 0 to 10 numerical scale. Median (interquartile) procedural pain as evaluated by nurses for the 3 most frequent procedures were 0 (0-2) for lumbar punctures, 2 (0-4) for bone marrow aspiration, and 2 (0-4) for laceration repair. Comparison of pain assessed by nurses in children 3 years old or younger and those older than 3 years of age showed a median (range) score of 2 (0-10) versus 1 (0-10), respectively. Pain self-assessment was completed in 647 children 6 years of age or older. Median (interquartile) children pain assessments were as follows: lumbar puncture (5; 0-20), bone marrow aspiration (12.5; 0-40), laceration repair (12; 0-40), minor procedures (18; 0-32), minor surgery (10; 0-35), punctures (0; 0-18), fracture (15; 0-30), dental care (20; 0-40), and pulmonary endoscopy (15; 0-30). Ninety-three percent of the 647 children who were able to answer the question said they would accept EMONO analgesia if a new procedure were to be performed. Behavioral reactions during procedures varied with age of the child; cry was observed in 44.1%, 24.4%, 12.9%, and 11.2% of children 3 years or younger, 4 to 6 years, 7 to 10 years, and 11 years or older, respectively. Physical restraint was necessary in 34.2%, 22%, 13.5%, and 8.4% of children aged 3 years or younger, 4 to 6 years, 7 to 10 years, and 11 years or old

Risk factors of Pneumocystis pneumonia in solid organ recipients in the era of the common use of posttransplantation prophylaxis

Pneumocystis pneumonia (PCP) in solid organ transplant (SOT) recipients becomes rare in the immediate posttransplantation period thanks to generalized prophylaxis. We aimed to identify the predictive factors for PCP in the era of universal prophylaxis and to propose a strategy for preventing PCP beyond the first year after transplantation. In a retrospective case-control study, 33 SOT cases with PCP diagnosed between 2004 and 2010 were matched with two controls each to identify risk factors for PCP by uni- and multivariate analysis. All the patients benefited from 6 months of posttransplantation trimethoprim-sulfamethoxazole prophylaxis. Most PCP in SOT patients occurred during the second year posttransplantation (33%). By univariate analysis, age, nonuse of tacrolimus, total and CD4 lymphocyte counts, gamma-globulin concentration and cytomegalovirus (CMV) infection appeared to be PCP risk factors. In the final multivariate analysis, age (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI]: 1.3-10.4), CMV infection (OR: 5.2, 95% CI: 1.8-14.7) and total lymphocyte count (OR: 3.9, 95% CI: 1.4-10.7) were found to be independently associated with PCP. The second year posttransplantation appeared to be the new period of highest risk of PCP. Age, CMV viremia and lymphocytes were the most pertinent predictive criteria to evaluate the risk of PCP in clinical practice.

Comparison of a spatial approach with the multilevel approach for investigating place effects on health: the example of healthcare utilisation in France

STUDY OBJECTIVE

Most studies of place effects on health have followed the multilevel analytical approach that investigates geographical variations of health phenomena by fragmenting space into arbitrary areas. This study examined whether analysing geographical variations across continuous space with spatial modelling techniques and contextual indicators that capture space as a continuous dimension surrounding individual residences provided more relevant information on the spatial distribution of outcomes. Healthcare utilisation in France was taken as an illustrative example in comparing the spatial approach with the multilevel approach.

DESIGN

Multilevel and spatial analyses of cross sectional data.

PARTICIPANTS

10,955 beneficiaries of the three principal national health insurance funds, surveyed in 1998 and 2000 on continental France.

MAIN RESULTS

Multilevel models showed significant geographical variations in healthcare utilisation. However, the Moran's I statistic showed spatial autocorrelation unaccounted for by multilevel models. Modelling the correlation between people as a decreasing function of the spatial distance between them, spatial mixed models gave information not only on the magnitude, but also on the scale of spatial variations, and provided more accurate standard errors for risk factors effects. The socioeconomic level of the residential context and the supply of physicians were independently associated with healthcare utilisation. Place indicators better explained spatial variations in healthcare utilisation when measured across continuous space, rather than within administrative areas.

CONCLUSIONS

The kind of conceptualization of space during analysis influences the understanding of place effects on health. In many contextual studies, viewing space as a continuum may yield more relevant information on the spatial distribution of outcomes.

Health information seeking on the Internet: a double divide? Results from a representative survey in the Paris metropolitan area, France, 2005-2006

BACKGROUND

The Internet is a major source of information for professionals and the general public, especially in the field of health. However, despite ever-increasing connection rates, a digital divide persists in the industrialised countries. The objective of this study was to assess the determinants involved in: 1) having or not having Internet access; and 2) using or not using the Internet to obtain health information.

METHODS

A cross-sectional survey of a representative random sample was conducted in the Paris metropolitan area, France, in the fall of 2005 (n = 3023).

RESULTS

Close to 70% of the adult population had Internet access, and 49% of Internet users had previously searched for medical information. Economic and social disparities observed in online health information seeking are reinforced by the economic and social disparities in Internet access, hence a double divide. While individuals who reported having a recent health problem were less likely to have Internet access (odds ratio (OR): 0.72, 95% confidence interval (CI): 0.53-0.98), it is they who, when they have Internet access, are the most likely to search for health information (OR = 1.44, 95% CI = 1.11-1.87).

CONCLUSION

In the French context of universal health insurance, access to the Internet varies according to social and socioeconomic status and health status, and its use for health information seeking varies also with health beliefs, but not to health insurance coverage or health-care utilisation. Certain economic and social inequalities seem to impact cumulatively on Internet access and on the use of the Internet for health information seeking. It is not obvious that the Internet is a special information tool for primary prevention in people who are the furthest removed from health concerns. However, the Internet appears to be a useful complement for secondary prevention, especially for better understanding health problems or enhancing therapeutic compliance.

The role of daily mobility in mental health inequalities: the interactive influence of activity space and neighbourhood of residence on depression

The literature reports an association between neighbourhood deprivation and individual depression after adjustment for individual factors. The present paper investigates whether vulnerability to neighbourhood features is influenced by individual "activity space" (i.e., the space within which people move about or travel in the course of their daily activities). It can be assumed that a deprived residential environment can exert a stronger influence on the mental health of people whose activity space is limited to their neighbourhood of residence, since their exposure to their neighbourhood would be greater. Moreover, we studied the relationship between activity space size and depression. A limited activity space could indeed reflect spatial and social confinement and thus be associated with a higher risk of being depressed, or, conversely, it could be linked to a deep attachment to the neighbourhood of residence and thus be associated with a lower risk of being depressed. Multilevel logistic regression analyses of a representative sample consisting of 3011 inhabitants surveyed in 2005 in the Paris, France metropolitan area and nested within 50 census blocks showed, after adjusting for individual-level variables, that people living in deprived neighbourhoods were significantly more depressed that those living in more advantaged neighbourhoods. We also observed a statistically significant cross-level interaction between activity space and neighbourhood deprivation, as they relate to depression. Living in a deprived neighbourhood had a stronger and statistically significant effect on depression in people whose activity space was limited to their neighbourhood than in those whose daily travels extended beyond it. In addition, a limited activity space appeared to be a protective factor with regard to depression for people living in advantaged neighbourhoods and a risk factor for those living in deprived neighbourhoods. It could therefore be useful to take activity space into consideration more often when studying the social and spatial determinants of depression.

GJB2 and GJB6 mutations: genotypic and phenotypic correlations in a large cohort of hearing-impaired patients

OBJECTIVES

To analyze the clinical features of hearing impairment and to search for correlations with the genotype in patients with DFNB1.

DESIGN

Case series.

SETTING

Collaborative study in referral centers, institutional practice. Patients A total of 256 hearing-impaired patients selected on the basis of the presence of biallelic mutations in GJB2 or the association of 1 GJB2 mutation with the GJB6 deletion (GJB6-D13S1830)del.

MAIN OUTCOME MEASURES

The prevalence of GJB2 mutations and the GJB6 deletion and audiometric phenotypes related to the most frequent genotypes.

RESULTS

Twenty-nine different GJB2 mutations were identified. Allelic frequency of 35delG was 69%, and the other common mutations, 313del14, E47X, Q57X, and L90P, accounted for 2.6% to 2.9% of the variants. Concerning GJB6, (GJB6-D13S1830)del accounted for 5% of all mutated alleles and was observed in 25 of 93 compound heterozygous patients. Three novel GJB2 mutations, 355del9, V95M, and 573delCA, were identified. Hearing impairment was frequently less severe in compound heterozygotes 35delG/L90P and 35delG/N206S than in 35delG homozygotes. Moderate or mild hearing impairment was more frequent in patients with 1 or 2 noninactivating mutations than in patients with 2 inactivating mutations. Of 93 patients, hearing loss was stable in 73, progressive in 21, and fluctuant in 2. Progressive hearing loss was more frequent in patients with 1 or 2 noninactivating mutations than in those with 2 inactivating mutations. In 49 families, hearing loss was compared between siblings with similar genotypes, and variability in terms of severity was found in 18 families (37%).

CONCLUSION

Genotype may affect deafness severity, but environmental and other genetic factors may also modulate the severity and evolution of GJB2-GJB6 deafness.

Clinical long-term in vivo evaluation of poly(L-lactic acid) porous conduits for peripheral nerve regeneration

It was the purpose of this study to evaluate the clinical long-term effects of PLLA degradation in vivo on nerve regeneration in the rat sciatic nerve model. Thirty-one Sprague Dawley rats were utilized. Two groups of animals were selected. The control group of 10 animals received a 12 mm reversed isograft into the right sciatic nerve from 5 donor animals. The experimental group (n = 21) received a 12 mm empty PLLA conduits placed into a 12 mm defect in the right sciatic nerve. The left leg served as an internal control. Walking track analysis was performed monthly through 8 months. At the end of 4 and 8 months, animals in the control isograft and experimental group had the medial and lateral gastrocnemius muscles harvested and weighed for comparison. The midconduit/isograft and the distal nerve in these same animals were harvested and histomorphologically analyzed. Multiple samples were collected and expressed as means +/- standard error. A two-sample t-test and Wilcoxon rank sum test was used to compare the variables. Significance level was set at alpha = 0.05. After Bonferroni correction for multiple testing, a p value of < or = 0.01 was considered statistically significant. Throughout all time periods, the PLLA conduit remained structurally intact and demonstrated tissue incorporation and vascularization. There was no evidence of conduit collapse or breakage with limb ambulation. Moreover, there was no evidence of conduit elongation at 8 months as previously observed with the 75:25 poly(DL-lactic-co-glycolic acid) (PLGA) conduits. The mean absolute value of the sciatic functional index (SFI) demonstrated no group differences from isograft controls measured over the 8 months except at 3 months where the isograft values were higher (p = 0.0379) and at 7 months were the isograft group was significantly lower (p = 0.0115). At 4 and 8 months, the weight of the gastrocnemius muscles of the experimental group was not significantly different from isografts. At 4 months the number of axons/mm2 and nerve fiber density was not significantly different between the isograft control and experimental groups in either the midconduit/isograft or distal nerve. At 8 months the number of axons/mm2 was significantly lower in the isograft compared to the midconduit experimental group (p = 0.006). The number of axons/mm2 in the distal nerve and the nerve fiber density in the midconduit and distal nerve were not significantly different between the two groups. The study confirmed our initial hypothesis that PLLA conduits are a viable scaffold for clinical long-term nerve gap replacement. We are critically aware however that longer evaluation of polymer degradation is warrented. Further studies on these individual nerve components are continuing, with the ultimate goal being the fabrication of a bioactive conduit that meets or exceeds the functional results of isografts.

Effect of bilateral stimulation of the subthalamic nucleus on parkinsonian voice

The purpose of this study was to assess several acoustic features of the voices of 26 parkinsonian patients under two conditions, with and without bilateral chronic stimulation of the subthalamic nucleus (STN) to estimate the effectiveness of this procedure on parkinsonian speech. When compared to unstimulated patients, stimulated patients showed longer duration of sustained vowels, shorter duration of sentences, nonsense words, and pauses, more variable fundamental frequency (f0) in sentences, and more stable f0 during sustained vowels. Relative intensity was unchanged in both conditions. Further acoustic analyses are warranted to clarify the role of STN stimulation on parkinsonian speech.

Otologic features in children with primary ciliary dyskinesia

OBJECTIVES

To analyze otologic features in patients with primary ciliary dyskinesia (PCD) aged 0 to 18 years and to evaluate the correlation between ultrastructural defects and severity of otologic features.

DESIGN

Retrospective study.

SETTING

Pediatric referral center.

PATIENTS

Fifty-eight patients with PCD were evaluated in the following 4 age intervals: group 1, preschool (≤ 5 years [n = 47]); group 2, school (6-11 years [n = 50]); group 3, teenagers (12-17 years [n = 34]); and group 4, young adults (≥ 18 years; 27 years for the oldest [n = 10]). Follow-up was 2 to 6 years in each age group; 26 patients had total follow-up of more than 12 years. Ultrastructural defects occurred in the outer dynein arm (n = 33), the inner dynein arm (n = 13), and the central complex (n = 11). One patient had typical Kartagener syndrome with typical PCD features but normal ciliary ultrastructure.

MAIN OUTCOME MEASURES

Frequency of acute otitis media, otitis media with effusion, otorrhea, chronic otitis media, hearing loss, and middle ear surgery and type of antibiotic regimen according to age and type of defect.

RESULTS

Recurrent acute otitis media decreased from group 1 (32 of 47 [68%]) to group 4 (0 of 10 [0%]) (P < .001). Otitis media with effusion was more severe in groups 1 through 3 than in group 4 (P = .02). Otorrhea decreased in group 4: 30% vs 80% (3 of 10 vs 36 of 41) in the other groups (P < .001). Half of the patients with tympanostomy tubes eventually had tympanic perforation. Hearing loss was moderate in groups 1 through 3 and mild in group 4. Continuous antibiotic therapy could be slightly reduced only in group 4. Central complex defect was a significant marker of severity for all these criteria.

CONCLUSIONS

Despite continuous antibiotic therapy, the middle ear condition in PCD remained severe throughout childhood, with improvement only after age 18 years. Armstrong grommet placement did not improve the middle ear condition. Central complex defect is a marker of severity.

Myringoplasty in children: predictive factors of outcome

OBJECTIVES

To assess the results of myringoplasty in children and to determine which factors independently influence the postoperative results.

STUDY DESIGN

Retrospective study of the anatomic and functional results of 231 consecutive myringoplasties performed in 188 children between 1988 and 1992. Multivariate analysis of poor prognostic factors by cross-sectional comparison 1 year after surgery.

METHODS

Myringoplasties were performed via an endaural approach with a fascia temporalis underlay graft.

RESULTS

In 216 of 231 ears (93.5%) the tympanic membrane was closed. A good anatomic outcome was considered to have been achieved in 188 ears (81.6%), although in 18 ears (7.8%) seromucous otitis media occurred, in 8 ears (3.5%) a progressive retraction pocket was encountered, and in 2 ears significant lateralization was present. One hundred thirty-nine (67.5%) of the 206 ears tested in the postoperative period had a postoperative air-bone gap of 10 dB or less. On average, mean bone conduction remained unaltered. The age of the patient and the size and the location of the perforation did not affect the outcome. Three prognostic factors for an abnormal postoperative tympanic membrane were found, with 95% confidence intervals: inflammatory changes in the middle ear mucosa (P < .05), contralateral tympanic perforation (P < .05), and contralateral cholesteatoma (P < .01).

CONCLUSIONS

Myringoplasty with underlay grafting of the fascia temporalis in children gives good anatomic and functional results. Inflammatory changes within the middle ear mucosa, contralateral tympanic perforation, and contralateral cholesteatoma independently influence the risk of an abnormal postoperative tympanic membrane. The presence of one of these factors preoperatively should lead to the consideration of alternative, more durable graft material, such as autologous cartilage.

Determinants of the frequency of online health information seeking: results of a web-based survey conducted in France in 2007

In the general population, social disparities in Internet practices have been less described than disparities in health information access. Aim is to determine whether there are differences in the frequency of Internet use for health information among health seekers. We conducted an Internet-based survey from November 2006 to March 2007. We considered the 3720 residents of France who had searched for health information during the previous 12 months. This study reveals different uses of the Internet for health information seeking (HIS) between men and women and between the general population and people who work in the health sector. Health status, taking care of somebody who is sick, and active Internet use were associated with higher frequencies of online HIS to varying degrees. The effects of age and level of education were not clear or were not significant. Greater health concerns and some issues in the physician-patient relationship were associated with higher frequencies of Internet use for HIS in the general population. Considering that this increasing use of online tools for HIS is consistent with current public health policies that promote the development of the 'informed patient', one should remain cautious about these social disparities in online HIS practices.

Online mis/disinformation and vaccine hesitancy in the era of COVID-19: Why we need an eHealth literacy revolution

The quality of online health information is cause for concern in general, and the spread of mis/disinformation on the benefits and risks of vaccines has certainly been fueling vaccine hesitancy. In the wake of the COVID-19 pandemic, we have entered an era of unprecedented “infodemic.” There has never been a more urgent time to address the long-standing question of how to overcome the deleterious influence of exposure to online mis/disinformation on vaccine uptake. eHealth literacy, a skill set including media literacy, is key to navigating the web in search for health information and processing the one encountered through social media. Studies assessing the impact of increasing eHealth literacy on behavioral attitudes and health outcomes in the general population are relatively scarce to date. Yet for many reasons, leveraging eHealth literacy skills, and more specifically, media literacy, could be of great value to help mitigate the detrimental effects of erroneous information on vaccination decision-making. In this paper, we make the case that eHealth and media literacies should be viewed as fundamental skills that have the potential to empower citizens to better recognize online mis/disinformation and make informed decisions about vaccination as any other health matters.

Early results of conventional versus two-portal endoscopic carpal tunnel release. A prospective study

The authors compare in a prospective, randomized study the early outcome of carpal tunnel release using either a conventional palmar open release (n = 40) or a two-portal endoscopic release (n = 56). Both groups were similar. No statistically significant differences were found regarding pain, disappearing of paraesthesiae or time to return to work. However, better recovery of grip strength was observed in the endoscopic group at 1 and 3 months. No surgical complications were observed in either group.

Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmö, Sweden, in 2001

STUDY OBJECTIVE

Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform disorders); and (2) investigating the independent impact of contextual deprivation and neighbourhood social disorganisation on mental health, while assessing both the magnitude and the spatial scale of these effects.

DESIGN

Using different spatial techniques, the study investigated mental disorders due to psychoactive substance use, and neurotic disorders.

PARTICIPANTS

All 89,285 persons aged 40-69 years residing in Malmö, Sweden, in 2001, geolocated to their place of residence.

MAIN RESULTS

The spatial scan statistic identified a large cluster of increased prevalence in a similar location for the two mental disorders in the northern part of Malmö. However, hierarchical geostatistical models showed that the two groups of disorders exhibited a different spatial distribution, in terms of both magnitude and spatial scale. Mental disorders due to substance consumption showed larger neighbourhood variations, and varied in space on a larger scale, than neurotic disorders. After adjustment for individual factors, the risk of substance related disorders increased with neighbourhood deprivation and neighbourhood social disorganisation. The risk of neurotic disorders only increased with contextual deprivation. Measuring contextual factors across continuous space, it was found that these associations operated on a local scale.

CONCLUSIONS

Taking space into account in the analyses permitted deeper insight into the contextual determinants of mental disorders.

Herpes zoster: family history and psychological stress-case-control study

BACKGROUND

Several studies have reported risk factors for herpes zoster (HZ), but their results remain controversial and difficult to compare because of their limitations regarding sampling and design.

OBJECTIVES

This study was aimed to determine risk factors in ambulatory patients aged 50 years or more, by consulting general practitioners (GPs) in France.

STUDY DESIGN

A prospective, national, matched case-control study was conducted. It involved 121 GPs who recruited 250 cases of HZ and 500 controls (matched by age and sex), aged 50 years and older, between April 2009 and September 2010. GP and patient questionnaires explored the following risk factors: family history of HZ, comorbidities, depression, anxiety, negative life events, physical trauma, alcohol and tobacco consumption, level of education, and various protective factors (such as exposure to children). Odds ratios were estimated using conditional logistic regression.

RESULTS

In multivariate adjusted analysis, a family history of HZ (OR 3.69, 95% CI 1.81-7.51), a HAD depressive score≥8 (OR 4.15, 95% CI 1.88-9.16), and a recent negative life event (OR 3.40, 95% CI 1.67-6.93) were all significantly associated with HZ.

CONCLUSIONS

This case-control study conducted in ambulatory patients in general practice reinforced the hypothesis that, in addition to the age-related decline in VZV-specific T-cell-mediated immunity, depression negative life event and familiar history of zoster increase the risk of occurrence of herpes zoster. In people with familiar history, this risk could be prevented by vaccination.

Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: a multilevel analysis of individual and area-level determinants

Using a representative sample of the French population, a multilevel analysis allowed us to examine the effect of the level of consumerism, expressed as the gross domestic product (GDP) per capita in the broad area of residence, on the risks of smoking, drinking, sedentary behaviour and overweightness. After adjustment for potential confounders, we found no GDP effect on the odds of being a moderate smoker. Conversely, the risk of being a highly dependent smoker as opposed to a moderate consumer or an abstainer increased with the area-level GDP per capita (OR: 1.13; 95% CI: 1.04-1.23 for an increment of one standard deviation). A similar pattern was found for alcohol consumption: the odds of being a moderate consumer were not related to the GDP per capita, but a positive effect of the GDP on the odds of being an alcohol-dependent drinker as opposed to a moderate consumer or an abstainer was found among women (OR: 1.14; 95% CI: 1.02-1.28). The gap between the sexes with respect to alcohol-dependency therefore appeared to be narrower when the GDP per capita was high. On the other hand, the risk of overweightness was found to increase with the area-level GDP per capita among blue-collar workers only (OR: 1.21; 95% CI: 1.03-1.43). Beyond the well-documented socioeconomic effects operating at both the individual and the local neighbourhood levels, our study suggests that broader areas of residence, through their level of economic development, may also have an independent impact on health-related behaviour.

Incidence of stroke and socioeconomic neighborhood characteristics: an ecological analysis of Dijon stroke registry

BACKGROUND AND PURPOSE

Studies have shown higher stroke incidence in areas with higher levels of deprivation. We aimed to determine the pattern of association between various area socioeconomic status (SES) indicators and stroke incidence in specific sex and age groups.

METHODS

Data are from the Dijon stroke registry for the period 1995 to 2003. The analyses included 1255 cases aged older than 40 (median age, 76.8). Poisson regression was used to model stroke incidence according to the SES level of 61 small areas.

RESULTS

Among women, stroke incidence was higher in neighborhoods with large income inequality (incidence rate ratio, 1.34; P=0.003), higher proportions of unemployed (1.24; P=0.02), of non-French nationals (1.21, P=0.02), and of rented housing (1.31; P=0.03). Areas with a higher proportion of people aged older than 60 were associated with lower stroke incidence (incidence rate ratio, 0.72; P=0.01). Analysis by specific age-groups showed stronger effects among the 60- to 74-year-olds. Among men, no associations between SES and stroke incidence were identified overall but analysis by age groups showed significant effect among the 40- to 59-year-olds. In this age group, incidence rate ratios were 1.47 for unemployment (P=0.01), 1.86 for no car ownership (P=0.02), and 1.56 for income inequality (P=0.01). Among stroke cases, no trend in vascular risk factors prevalence according to area SES was identified.

CONCLUSIONS

Variations of stroke incidence were more marked for the SES indicators of wealth and of income inequality. They were apparent at an earlier age in men and showed a stronger gradient among women.

Exposure to interparental violence and psychosocial maladjustment in the adult life course: advocacy for early prevention

BACKGROUND

Early family-level and social-level stressors are both assumed to be the components of two main path models explaining the association between exposure to interparental violence in childhood and its long-term consequences on mental health explored through life-course epidemiological studies.

AIMS

To investigate the association between exposure to interparental violence in childhood and mental health outcomes in adulthood when taking into account early family and social stressors.

METHODS

A retrospective French cohort study of 3023 adults representative of the general population in the Paris metropolitan area was conducted in 2005 through at-home, face-to-face interviews. The outcomes measures were current depression and lifetime suicide attempt, intimate partner violence, violence against children and alcohol dependence.

RESULTS

The adults exposed to interparental violence during childhood had a higher risk of psychosocial maladjustment. After adjusting for family- and social-level stressors in childhood, this risk was, respectively, 1.44 (95% CI 1.03 to 2.00) for depression, 3.17 (1.75 to 5.73) for conjugal violence, 4.75 (1.60 to 14.14) for child maltreatment and 1.75 (1.19 to 2.57) for alcohol dependence.

CONCLUSIONS

The adult consequences of parental violence in childhood-and this independently of the other forms of domestic violence and the related psychosocial risks-should lead to intensifying the prevention of and screening for this form of maltreatment of children.

Prevalence and socioeconomic and geographical inequalities of household food insecurity in the Paris region, France, 2010

Background

Food insecurity (FI) is the situation where people do not have, at all times, access to sufficient, safe and nutritious food that meets their dietary needs for an active and healthy life. The objectives of this study were to estimate the prevalence of FI in the Paris area by using, for the first time in France, a specific FI questionnaire and to identify the characteristics of food-insecure households, taking into account a potential neighbourhood effect.

Methods

This study is based on data from the third wave of the SIRS cohort study (a representative, population-based socioepidemiological study) that were analysed using a cross-sectional design. In 2010, 3000 individuals in the Paris metropolitan area (PMA) were interviewed. FI was investigated by means of the USDA’s HFSSM. We used stratified multilevel models across three household income categories to identify populations at risk for FI.

Results

In 2010, 6.30% (95% CI = [4.99-7.97]) of the households in the PMA experienced FI (up to 13.59% in the most underprivileged neighbourhoods). About 2.50% of the households experienced severe FI and 2.85% of household living with an income above 1666 € experienced food insecurity, whereas the percentage raises to 23.38% among those living below the poverty threshold (<791 €). Depending on the income level, different household characteristics emerged as being associated with FI. In the poorest households, the presence of a child under 3 years of age was associated with an increased risk of FI (OR = 2.11; p = 0.03). Among higher-income households, the household composition appeared to be strongly associated with FI.

Conclusion

FI exists in several social groups in France. Its prevalence in the most underprivileged households should be considered an indicator of vulnerability, which could permit targeted social assistance policies.

Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015

During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.

Internet uses for health information seeking: A literature review

BACKGROUND

With the widespread dissemination of the Internet throughout the world of health, it would be relevant to report on current knowledge about health information search on the Internet from the consumers' standpoint.

METHODS

We conducted a bibliographical research over the past five years and distinguished between international and French studies.

RESULTS

For a long time, the (mostly US) studies have been merely descriptive. The studies highlight that the factors associated with health searches on the Internet are similar to the factors underlying the digital divide. Consumer searches are deemed efficient although search skills are comparatively below standard. Attempts are underway to set up tools, circulate them widely, and ensure better quality information on the Internet. However, comprehension and literacy are still issues in some social groups. Regarding the impact on consumer health per se, a (positive) effect of the Internet seems to emerge but research should be continued.

CONCLUSION

Many of the behaviors, uses or limits addressed in this paper pertain to any information search on the Internet but other problems or differences also occur in the specific area of health. Longitudinal investigations are needed, specifically to gain deeper insight into the impacts we have addressed, while rolling out a comprehensive approach to the temporal evolution of user practices and experiences. Specifically, the central issue is still to determine how (and for whom) the Internet alters information search behaviors and, in fine, to what extent this affects health behaviors and the recourse to healthcare.