Mental health in adolescents with obesity: conflicting views among physicians, a qualitative study

Mental health issues in adolescents with obesity are multifold, with no explicit screening recommendations. The aim of this research is to explore how this screening is performed by physicians and, thus, how it impacts adolescents' care pathways, offering insights into how to improve it through a qualitative study using interpretative phenomenological analysis. Twenty physicians (non-psychiatrist physicians and child and adolescent psychiatrists) involved at various stages in the care pathway were interviewed with semi-structured questionnaires. The findings connect 2 meta-themes. Non-psychiatrist physicians perceive widespread but ill-defined suffering in adolescents with obesity. Non-psychiatrist physicians see screening for mental conditions as mandatory. Unlike child and adolescent psychiatrists, they are not experts in distinguishing psychosocial suffering from psychiatric disorders. Screening is clinical. Adolescents' demand to lose weight in a context of shaming and alexithymia limits their access to psychiatric care. Child and adolescent psychiatrists then redefine the medical response to polymorphous symptoms. Psychiatric diagnoses mainly involve anxiety and depression symptoms, seldom eating disorders.    Conclusion: Physicians have overtly conflicting perspectives over the intensity of mental conditions. Non-psychiatrists, sensitive to perceived distress, seek to have it quickly appraised if they detect a significant suffering. Child and adolescent psychiatrists find appraisal complex to perform in the absence of means, interest, and/or experience. Improving screening requires training health professionals and using multidisciplinary assessment means. What is Known: • Mental health and eating disorders are contributing factors of obesity but their relationship remains complex between cause and consequence. • Mental health conditions and psychosocial suffering are the main complications among adolescents suffering from obesity with guilt, sadness, or stigma. What is New: • Non-psychiatric physicians express their need of a specialized diagnosis to define this suffering, but the lack of availability of psychiatrists and the necessity of time and of a multidisciplinary team lead to a delayed assessment. • For psychiatrists, this suffering is often not a psychiatric condition. Though requiring attention, this can lead to a misunderstanding between professionals.

Description of patients with eating disorders by general practitioners: a cohort study and focus on co-management with depression

BACKGROUND

International guidelines often state that general practitioners (GPs) provide early management for most patients with eating disorders (EDs). GP management of EDs has not been studied in France. Depressive disorders are often a comorbidity of EDs. The aims of this study were to describe in France the characteristics of people with all subcategories of EDs (Anorexia Nervosa, Bulimia Nervosa, ED Not Otherwise Specified) managed by their GPs and to study the management temporality between depression and all subcategories of EDs.

METHODS

Retrospective cohort study of patients with EDs visiting French GPs. Data collected from 1994 through 2009 were extracted from the French society of general electronic health record. A descriptive analysis of the population focused on depression, medication such as antidepressants and anxiolytics, and the management temporality between depression and EDs.

RESULTS

1310 patients aged 8 years or older were seen at least once for an ED by a GP participating in the database out of 355,848 patients, with a prevalence rate of 0.3%. They had a mean age of 35.19 years, 82.67% were women. 41.6% had anorexia nervosa, 26.4% bulimia nervosa, and 32% an ED not otherwise specified. Overall, 32.3% had been managed at least once for depression, and 18.4% had been prescribed an antidepressant of any type at least once. Benzodiazepines had been prescribed at least once for 73.9% of the patients treated for depression. Patients with an ED seen regularly by their GP ("during" profile) received care for depression more frequently than those with other profiles. 60.9% had a single visit with the participating GP for their ED Treatment and management for depression did not precede care for EDs.

CONCLUSIONS

Data extracted from the French society of general practice were the only one available in France in primary care about EDs and our study was the only one on this topic. The frequency of visits for EDs was very low in our general practice-based sample. Depressive disorders were a frequent comorbidity of EDs. GPs could manage common early signs of depression and EDs, especially if they improved their communication skills and developed collaborative professional management.

Constructing childhood depression: a qualitative study with international experts in child psychiatry

After decades of controversy, the concept of childhood depression now seems to be part of standard medical knowledge. Yet the form and content of this nosological entity, like many psychiatric diseases, is continuously shaped by the scientific, clinical, and political communities involved in child psychiatry. In this qualitative study, we explored how the concept of childhood depression is constructed in early twenty-first century child psychiatry. We conducted a series of 18 interviews with practising child psychiatrists, international experts in the field, and interpreted them with thematic analysis informed by discourse analysis. We identified five overarching discourse themes across interviews, relating to the definition of depression, the diagnostic process, the causes of this condition, the therapeutic strategy, and the scientific role of child psychiatry. Most participants agreed that childhood depression was a mental disorder where irritability prevailed, heavily influenced by psychosocial factors, and for which psychotherapy was the ideal treatment. However, subtle points of dissent also surfaced: whether depression is primarily a mood state or psychological suffering, whether categories or dimensions are more suitable to make the diagnosis, and whether there is a genetic predisposition were some of the most controversial topics. Theoretical considerations regarding childhood depression may have significant scientific, moral, and socio-political implications beyond child psychiatry and should be addressed appropriately.

Chronic conditions, subjective wellbeing and risky sexual behaviour among adolescents and young adults

The purpose of this study is to clarify the relationship between having a chronic condition (CC) and several types of risky sexual behaviour (RSB) among adolescents and young adults. We used data from a multicentre cross-sectional study carried out on 14,431 adolescents from 137 French schools. Logistic regression was used to assess the association between several types of RSB and CCs among the 2680 participants aged 17 years or over who reported sexual intercourse. Survival analysis was conducted to assess the association between CCs and age at first sexual intercourse across the whole sample. Analyses were conducted separately by gender with and without adjustment for the parents' education level, early menarche and subjective wellbeing (relationship with mother and father, depression, perceived health status and liking school). Among boys, having a CC was associated with a higher risk of RSB in both univariate (OR: 1.58 [95% CI: 1.10-2.27]) and multivariate analyses (aOR: 1.62 [95% CI: 1.11-2.38]). Among girls, the association between chronic condition and RSB in univariate analysis was non-significant (OR: 1.30 [95% CI: 0.97-1.76]) and disappeared after adjustment on subjective wellbeing (aOR: 1.08 [95% CI: 0.78-1.49]). There was no association between CC and age at first sexual intercourse.    Conclusion: There were major gender differences. Boys with a CC were more prone to engage in RSB independent of their subjective wellbeing, whereas in girls, subjective wellbeing seemed to mediate the relationship between CC and RSB. Clinicians should be aware of those gender differences in order to deliver preventive strategies regarding sexuality that target both genders. What is Known: • Young people with chronic conditions have a higher likelihood of engaging in risky sexual behaviour. • Engaging in such behaviours can be much more costly, as it can weaken their underlying state of health. What is New: • We found major gender differences. Boys were more prone to engage in risky behaviour independent of their subjective wellbeing, whereas in girls, it seemed to play an important role. • By understanding how risky sexual behaviour differs according to gender, clinicians can deliver prevention messages that target both genders.

Adolescent attendance at transcultural psychotherapy: a retrospective cohort study

Migrant adolescents in therapy for psychological problems are at risk of poor attendance or even of dropping out. Transcultural psychotherapy has been developed in France to take cultural diversity into account in psychological treatment and to deal with the specific difficulties encountered in the psychotherapeutic treatment of this population. This study aims to assess adolescents' attendance rates to this form of psychotherapy and to explore the association of these rates with demographic, cultural, and clinical variables. We conducted a retrospective clinical cohort study of 148 adolescents aged from 11 to 20 years treated between 2008 and 2018 at two transcultural psychotherapy centers in Paris. Statistical analyses tested demographic, cultural, and clinical hypotheses. The main result was the high attendance rate at transcultural psychotherapy sessions among adolescents (77.8%). Attendance rates were not associated with age, gender, family size, generation of migration, or cultural area of origin, but were significantly linked to support in therapy, specifically, the presence at the first transcultural psychotherapy session of the first-line therapist, an interpreter, or both. Transcultural psychotherapy appears to be an effective method for addressing the complex symptoms experienced by migrant adolescents. Better attendance at sessions is statistically significantly associated with factors favoring a therapeutic alliance, specifically, the presence of the first-line therapist or an interpreter in TPT sessions and the existence of support from a social worker. The holistic approach of transcultural psychotherapy to adolescent care may explain the high attendance rates observed.

Health Literacy throughout adolescence: Invariance and validity study of three measurement scales in the general population

OBJECTIVE

To simultaneously investigate the psychometric properties of three recently developed health literacy measurement scales throughout adolescence in the general population.

METHODS

French versions of the Health Literacy for School-Aged Children (HLSAC, unidimensional) scale, the Health Literacy Assessment Scale for Adolescents (HAS-A, multidimensional) and the 16-item European Health Literacy Survey questionnaire (HLS-EU-Q16, unidimensional) were completed by 1 444 adolescents in 8th, 9th, 11th grade in general school and 11-12th grade in vocational school. Psychometric properties were studied using confirmatory factor analysis, McDonald's omega coefficient and hypothesis testing.

RESULTS

Structural validity was acceptable (HLS-EU-Q16) to good (HAS-A and HLSAC), no measurement invariance issue was found and internal consistency was acceptable for the three scales (0.68-0.84). Convergent validity was low (Pearson correlation coefficients<0.5) and the only scale for which results were in agreement with a priori hypotheses was the HLSAC.

CONCLUSIONS

Our results were supportive of the use of HLSAC to assess health literacy during adolescence but the HAS-A, with a slightly better structural validity, can also be promoted due to its three measured dimensions.

PRACTICE IMPLICATIONS

The use of these scales in practice will help to focus on health literacy, a critical factor for prevention and health promotion in adolescence.

Epidemiological description of 529 families referred for French transcultural psychotherapy: A decade of experience

BACKGROUND

Transcultural psychotherapy (TPT) is an original therapeutic method developed in various forms in France and several other countries in Europe as well as North America to address issues of migrant mental health care when psychosocial, economic, or cultural barriers hinder its accessibility and effectiveness. This study aims to describe the patients referred for TPT in Paris and its suburbs over the past decade, to examine intercultural differences and associations with social, demographic, and clinical variables, and to assess TPT in terms of patient adherence, attendance, and duration of care.

METHOD

Retrospective study of 529 patients referred for TPT care, classified in three categories-no treatment, initiated treatment, engaged and continuing treatment. Collection and analysis of social, demographic, cultural, and clinical data, as well as of country of origin, duration of treatment, number of sessions attended (adherence), and number of sessions scheduled.

RESULTS

In all, 301 patients from 45 countries participated in an 11-month course of care lasting an average of 8 sessions. Most were children, accompanied by their families. The main psychiatric symptoms at the beginning of treatment were depressive, and the main cultural problem identified was the existence of a traditional theory explaining the illness in the family's culture. Patients kept 80% of their appointments for sessions, and attendance was not associated with socio-cultural or clinical variables.

CONCLUSION

The high level of treatment adherence and attendance over time suggest that TPT is an effective method for addressing complex symptoms experienced by migrant families. Results highlighted the potential richness and originality of studies based on retrospective medical data.

Association between cumulating substances use and cumulating several school, violence and mental health difficulties in early adolescents

Multiple substances (alcohol, tobacco, cannabis and other illicit drugs (OID)) have been frequently used in early adolescents maybe due to school, violence and mental-health difficulties. We investigated the associations between substance-use patterns and related difficulties among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, school, violence and mental-health difficulties (school grade repetition, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms and suicide attempt; cumulated number noted SVMD_score) and the time of their first occurrence during the life course. Data were analyzed using logistic and negative binomial regression models. Alcohol, tobacco, cannabis and OID use affected 35.2, 11.2, 5.6 and 2.8% of the subjects respectively. The risk of using tobacco only, alcohol and tobacco, alcohol plus tobacco and cannabis, or all alcohol, tobacco, cannabis and OID strongly increased with the SVMD_score (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMD_score. Exposure to several SVMDs may be a transmission vector towards the substance use, starting mostly with alcohol/tobacco, and then shifting to cannabis/OID. These findings help to understand substance-use risk patterns and identify at-risk adolescents.

Formulation and Characterization of Conjugate Vaccines to Reduce Opioid Use Disorders Suitable for Pharmaceutical Manufacturing and Clinical Evaluation

This study focused on formulating conjugate vaccines targeting oxycodone and heroin for technology transfer, good manufacturing practice (GMP), and clinical evaluation. Lead vaccines used the highly immunogenic carrier protein keyhole limpet hemocyanin (KLH), which poses formulation problems because of its size. To address this barrier to translation, an oxycodone-based hapten conjugated to GMP-grade subunit KLH (OXY-sKLH) and adsorbed on alum adjuvant was studied with regard to carbodiimide coupling reaction time, buffer composition, purification methods for conjugates, conjugate size, state of aggregation, and protein/alum ratio. Vaccine formulations were screened for post-immunization antibody levels and efficacy in reducing oxycodone distribution to the brain in rats. While larger conjugates were more immunogenic, their size prevented characterization of the haptenation ratio by standard analytical methods and sterilization by filtration. To address this issue, conjugation chemistry and vaccine formulation were optimized for maximal efficacy, and conjugate size was measured by dynamic light scattering prior to adsorption to alum. An analogous heroin vaccine (M-sKLH) was also optimized for conjugation chemistry, formulated in alum, and characterized for potency against heroin in rats. Finally, this study found that the efficacy of OXY-sKLH was preserved when co-administered with M-sKLH, supporting the proof of concept for a bivalent vaccine formulation targeting both heroin and oxycodone. This study suggests methods for addressing the unique formulation and characterization challenges posed by conjugating small molecules to sKLH while preserving vaccine efficacy.

The real-life effectiveness of psychosocial therapies on social autonomy in schizophrenia patients: Results from a nationwide cohort study in France

The objectives of the present study were to describe the prescribing patterns for psychosocial therapies in routine clinical practice and to assess the impact of psychoeducation on symptoms and social autonomy of patients with schizophrenia. We used data from the nationwide French ESPASS observational cohort study including 5967 patients with schizophrenia, which provided data on exposure to psychosocial therapies from 4961 (83%) participants. Patients who initiated psychosocial therapy within the first 3 months of study onset (n=143) were compared to patients not subject to psychosocial therapy throughout follow up (n=4268), using parametric tests. Symptom severity and social autonomy at 6 months from baseline were compared between patients undergoing psychoeducation (n=117) and patients not subject to psychosocial therapy, matched (1:1) on propensity scores. Patients who initiated psychosocial therapy were significantly younger, more severely ill and used less often antipsychotic drugs than patients in the reference group. At 6 months, patients who initiated psychoeducation and their matched referents did not differ significantly in terms of symptom severity, but their level of improvement in social autonomy was significantly greater (p=0.005). In routine clinical practice, psychoeducation in addition to antipsychotic drugs provides some benefit among schizophrenia patients, particularly in terms of social autonomy.

Risk factors for substances use and misuse among young people in France: What can we learn from the Substance Use Risk Profile Scale?

BACKGROUND

The prevention of addictions in young people is a challenge for Mental and Public Health policies, and requires specific risk-screening tools. Specific personality traits, as assessed using the Substance Use Risk Profile Scale (SURPS), could play a key role in the onset and escalation of substance use. This study aimed to examine (1) measurement invariance across age and gender (2) the effects of age and gender on associations between SURPS scores and the most frequently-consumed substances.

METHODS

Analyses were based on the responses from 5069 participants (aged 14-20 years) from the 2011 ESPAD-France dataset. Substance-use outcomes were experimentation and current frequency of alcohol, tobacco and cannabis use, and drunkenness.

RESULTS

Our approach, consisting in analysing measurement and structural invariance and interaction terms, established the stability of (i) SURPS profiles, and (ii) relationships between these scores and substance experimentation and use over a developmental period ranging from mid-adolescence to early adulthood. Measurement invariance across genders was also confirmed despite the absence of scalar invariance for 2 items. Significant interactions between gender and SURPS factors were established, highlighting differential vulnerability, especially concerning Hopelessness and experimentation of alcohol and drunkenness, or Impulsivity and tobacco experimentation. Finally, Anxiety Sensitivity could be protective against substance use, especially for cannabis in girls.

CONCLUSIONS

Our results suggest the relevance of the SURPS to assess vulnerability towards drug use, and underline the need to consider gender differences in addiction risks.

Erratum to: Do girls with depressive symptoms exhibit more physical aggression than boys? A cross sectional study in a national adolescent sample

[This corrects the article DOI: 10.1186/s13034-015-0064-5.].

Do girls with depressive symptoms exhibit more physical aggression than boys? A cross sectional study in a national adolescent sample

BACKGROUND

The relationship between depression and aggressive behaviors in adolescents has previously been reported in clinical and epidemiological studies. However, there is conflicting evidence concerning the effect of gender on this relationship. This study tested whether the link between depressive symptoms and physical aggression differed between boys and girls in a large community-based sample of adolescents.

METHODS

A cross-sectional sample of adolescents aged 15-19 (N = 6,677) was studied within the 2007 ESPAD national survey. Depressive symptoms were assessed using the Adolescent Depression Rating Scale. We distinguished adolescents with subthreshold levels of depressive symptoms and adolescents with clinically significant levels of depressive symptoms. Physical aggressive behaviors in the last year were reported using items from the Antisocial Behavior Scale.

RESULTS

After adjusting for confounding variables, the odds-ratio between depressive symptoms and physical aggressive behaviors was around 1.4. This relationship was stronger for girls than for boys in presence of clinically significant levels of depressive symptoms, but did not differ between the genders in the case of subthreshold levels of depressive symptoms.

CONCLUSIONS

Girls with severe depressive symptoms were more likely to present physical aggressive behaviors than boys. Future studies will be needed to explore the role of irritability in these differences.

When Assessing Intra-Familial Relationships, Are Sociologists, Psychoanalysts and Psychiatrists Really Considering Different Constructs? An Empirical Study

This paper aimed to look for the existence of a common core when envisaging intra-familial interactions as perceived by adolescents, which could be shared by sociology, psychoanalysis and child and adolescent psychiatry. An empirical study based on a mixed-method design collected the responses of 194 adolescents to the instruction “In the next half hour, would you please write as freely as you wish about your relationships in your family, explaining how things are”. All answers were then analyzed and 18 dimensions related to 3 different theoretical frameworks were rated blind using numerical scores by two independent raters from each discipline. Inter-rater reliability was good. A parallel analysis evidenced a strong underlying factor explaining a large amount of variance (>50%). This factor is bipolar, it reflects the level of positivity/negativity in the adolescent’s point of view concerning his/her intra-familial relationships. A second factor can marginally be considered (10% of the variance). The 2-factor analysis found one factor related to positive feelings and the other to negative feelings. This finding of unidimensionality supports family study as an intervention science.

Symptoms of depression and anxiety in anorexia nervosa: links with plasma tryptophan and serotonin metabolism

Depressive, anxiety and obsessive symptoms frequently co-occur with anorexia nervosa (AN). The relationship between these clinical manifestations and the biological changes caused by starvation is not well understood. It has been hypothesised that reduced availability of tryptophan (TRP) could reduce serotonin activity and thus trigger these comorbid symptoms. The aim of this study, during re-feeding in individuals with AN, was to analyse covariations across measures of nutritional status, depressive and anxiety symptoms, and peripheral serotonin markers. Depressive and anxiety symptoms, nutritional status and serotonin markers--whole blood serotonin content, plasma TRP and the ratio between TRP and large neutral amino acids--were assessed for 42 AN participants at admission to inpatient treatment and after re-feeding. Biological measures were compared to those obtained in 42 non-eating disordered subjects. For those with AN, psychological, nutritional and biological parameters improved significantly during hospitalisation. Levels of serotonin markers were significantly lower in the AN group compared to the control group, at admission and at discharge. Increase in the TRP/LNAA ratio was correlated with a decrease in depressive symptoms. In addition, there was a positive correlation between serotonin levels and symptoms of both anxiety and depression at discharge. We speculate that enhanced TRP availability during re-feeding, as a result of the increase in the TRP/LNAA ratio, could restore serotonin neurotransmission and lead to a decrease in depressive symptoms. The association between serotonin and anxiety and depressive symptoms would be consistent with numerous observations indicating abnormal functioning of the serotoninergic system in AN.

Multiple Curve Comparisons with an Application to the Formation of the Dorsal Funiculus of Mutant Mice

Much biological experimental data are represented as curves, including measurements of growth, hormone, or enzyme levels, and physical structures. Here we consider the multiple testing problem of comparing two or more nonlinear curves. We model smooth curves of unknown form nonparametrically using penalized splines. We use random effects to model subject-specific deviations from the group-level curve. We present an approach that allows examination of overall differences between the curves of multiple groups and detection of sections in which the curves differ. Adjusted

Suicidal behaviors in depressed adolescents: role of perceived relationships in the family

CONTEXT

Suicide is the second leading cause of death in adolescents and young adults in Europe. Reducing suicides is therefore a key public health target. Previous studies have shown associations between suicidal behaviors, depression and family factors.

OBJECTIVE

To assess the role of family factors in depression and suicidality in a large community-based sample of adolescents and to explore specific contributions (e.g. mother vs. father; conflict vs. no conflict; separation vs. no separation) taking into account other risk factors.

METHODS

A cross-sectional sample of adolescents aged 17 years was recruited in 2008. 36,757 French adolescents (18,593 girls and 18,164 boys) completed a questionnaire including socio-demographic characteristics, drug use, family variables, suicidal ideations and attempts. Current depression was assessed with the Adolescent Depression Rating Scale (ADRS). Adolescents were divided into 4 groups according to suicide risk severity (grade 1 = depressed without suicidal ideation and without suicide attempts, grade 2 = depressed with suicidal ideations and grade 3 = depressed with suicide attempts; grade 0 = control group). Multivariate regressions were applied to assess the Odds Ratio of potential risk factors comparing grade 1, 2 or 3 risk with grade 0.

RESULTS

7.5% of adolescents (10.4% among girls vs. 4.5% among boys) had ADRS scores compatible with depression; 16.2% reported suicidal ideations in the past 12 months and 8.2% reported lifetime suicide attempts. Repeating a year in school was significantly associated to severity grade of suicide risk (1 and 3), as well as all substance use, tobacco use (severity grades 2 and 3) and marijuana use (severity grade 3), for girls and boys. After adjustment, negative relationships with either or both parents, and parents living together but with a negative relationship were significantly associated with suicide risk and/or depression in both genders (all risk grades), and Odds Ratios increased according to risk severity grade.

CONCLUSION

Family discord and negative relationship with parents were associated with an increased suicide risk in depressed adolescents. So it appears essential to take intrafamilial relationships into account in depressed adolescents to prevent suicidal behaviours.

Association between Body Mass Index and depression: the "fat and jolly" hypothesis for adolescents girls

BACKGROUND

Results concerning the association between Body Mass Index (BMI) and depression in adolescence are conflicting, some describing a linear association (increase in BMI with level of depression), some a U-shaped association (both underweight and obesity are associated with high levels of depression), and they mostly concern small samples. The purpose of this study was to describe the association between BMI and depression in a large representative sample of French adolescents.

METHODS

The association between BMI and depression, measured on the Adolescent Depression Rating Scale (ADRS), was tested in a French national representative sample of 39542 adolescents aged 17. Self-report data is derived from the 2008 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. We used spline function analysis to describe the association between BMI and depression.

RESULTS

The association between BMI and depression is significant (p < 0.001) and non-linear for both genders, with no effect of parental working and marital status. For boys, there is U-shaped association. For girls the shape of the association is complex and shows inverted convexity for high levels of BMI. The spline shows higher scores for depression among overweight girls than among obese girls.

CONCLUSION

There is evidence for a gender difference in the association between BMI and depression in adolescents, supporting the need to study boys and girls separately. Overweight adolescent girls are more likely to be depressed than obese adolescent girls, giving support for "fat and jolly" hypothesis not only among older women but also among adolescent girls.

Parental alcohol dependence, socioeconomic disadvantage and alcohol and cannabis dependence among young adults in the community

We tested the hypothesis that socioeconomic disadvantage exacerbates the intergenerational transmission of substance dependence. Among 3056 community-based young adults (18-22 years, 2007), the prevalence of alcohol dependence (WHO AUDIT, 5.8%) and cannabis dependence (DSM IV criteria, 7.3%) was doubled in the presence of combined parental alcohol dependence and socioeconomic disadvantage.

Mechanical characterization of neural electrodes based on PDMS-parylene C-PDMS sandwiched system

Manufacturing of neural electrodes based on metal foil and silicone rubber using a laser is a simple and promising method. A handicap of such electrode arrays is the mechanical robustness of the thin metal tracks that connect the electrode sites with the interconnection pads. Embedding of structured parylene C foil in silicone rubber turned out to be an interesting method to increase the robustness. Test samples with 12.5 μm thick platinum tracks and a 15 μm thick embedded and RIE-structured parylene C foil showed more than 800 % higher ultimate strength until breakage of the tracks. Different structured parylene C foil showed increasing robustness with increasing hole-spacing.

Cell cycle control of wnt receptor activation

Low-density lipoprotein receptor related proteins 5 and 6 (LRP5/6) are transmembrane receptors that initiate Wnt/beta-catenin signaling. Phosphorylation of PPPSP motifs in the LRP6 cytoplasmic domain is crucial for signal transduction. Using a kinome-wide RNAi screen, we show that PPPSP phosphorylation requires the Drosophila Cyclin-dependent kinase (CDK) L63. L63 and its vertebrate homolog PFTK are regulated by the membrane tethered G2/M Cyclin, Cyclin Y, which mediates binding to and phosphorylation of LRP6. As a consequence, LRP6 phosphorylation and Wnt/beta-catenin signaling are under cell cycle control and peak at G2/M phase; knockdown of the mitotic regulator CDC25/string, which results in G2/M arrest, enhances Wnt signaling in a Cyclin Y-dependent manner. In Xenopus embryos, Cyclin Y is required in vivo for LRP6 phosphorylation, maternal Wnt signaling, and Wnt-dependent anteroposterior embryonic patterning. G2/M priming of LRP6 by a Cyclin/CDK complex introduces an unexpected new layer of regulation of Wnt signaling.

First positive reactions to cannabis constitute a priority risk factor for cannabis dependence

AIM

To assess the association between first reactions to cannabis and the risk of cannabis dependence.

DESIGN

A cross-sectional population-based assessment in 2007.

SETTING

A campus in a French region (Champagne-Ardennes).

PARTICIPANTS

A total of 1472 participants aged 18-21 years who reported at least one life-time cannabis consumption, of 3056 students who were screened initially [the Susceptibility Addiction Gene Environment (SAGE) study].

MEASUREMENTS

Positive and negative effects of first cannabis consumptions, present cannabis dependence and related risk factors were assessed through questionnaires.

FINDINGS

  The effects of first cannabis consumptions were associated dose-dependently with cannabis dependence at age 18-21 years, both according to the transversal approach of the SAGE study and to the prospective cohort of the Christchurch Health and Development Study (CHDS) assessed at the age of 25 years. Participants of the SAGE study who reported five positive effects of their first cannabis consumption had odds of life-time cannabis dependence that were 28.7 (95% confidence interval: 14.6-56.5) higher than those who reported no positive effects. This association remains significant after controlling for potentially confounding factors, including individual and familial variables.

CONCLUSIONS

This study suggests an association between positive reactions to first cannabis uses and risk of life-time cannabis dependence, this variable having a central role among, and through, other risk factors.

Functional analysis of the group A streptococcal luxS/AI-2 system in metabolism, adaptation to stress and interaction with host cells

Background

The luxS/AI-2 signaling pathway has been reported to interfere with important physiological and pathogenic functions in a variety of bacteria. In the present study, we investigated the functional role of the streptococcal luxS/AI-2 system in metabolism and diverse aspects of pathogenicity including the adaptation of the organism to stress conditions using two serotypes of Streptococcus pyogenes, M1 and M19.

Results

Exposing wild-type and isogenic luxS-deficient strains to sulfur-limited media suggested a limited role for luxS in streptococcal activated methyl cycle metabolism. Interestingly, loss of luxS led to an increased acid tolerance in both serotypes. Accordingly, luxS expression and AI-2 production were reduced at lower pH, thus linking the luxS/AI-2 system to stress adaptation in S. pyogenes. luxS expression and AI-2 production also decreased when cells were grown in RPMI medium supplemented with 10% serum, considered to be a host environment-mimicking medium. Furthermore, interaction analysis with epithelial cells and macrophages showed a clear advantage of the luxS-deficient mutants to be internalized and survive intracellularly in the host cells compared to the wild-type parents. In addition, our data revealed that luxS influences the expression of two virulence-associated factors, the fasX regulatory RNA and the virulence gene sibA (psp).

Conclusion

Here, we suggest that the group A streptococcal luxS/AI-2 system is not only involved in the regulation of virulence factor expression but in addition low level of luxS expression seems to provide an advantage for bacterial survival in conditions that can be encountered during infections.

Kremen is required for neural crest induction in Xenopus and promotes LRP6-mediated Wnt signaling

Kremen 1 and 2 (Krm1/2) are transmembrane receptors for Wnt antagonists of the Dickkopf (Dkk) family and function by inhibiting the Wnt co-receptors LRP5/6. Here we show that Krm2 functions independently from Dkks during neural crest (NC) induction in Xenopus. Krm2 is co-expressed with, and regulated by, canonical Wnts. Krm2 is differentially expressed in the NC, and morpholino-mediated Krm2 knockdown inhibits NC induction, which is mimicked by LRP6 depletion. Conversely, krm2 overexpression induces ectopic NC. Kremens bind to LRP6, promote its cell-surface localization and stimulate LRP6 signaling. Furthermore, Krm2 knockdown specifically reduces LRP6 protein levels in NC explants. The results indicate that in the absence of Dkks, Kremens activate Wnt/β-catenin signaling through LRP6.

Perceived parenting styles and tobacco, alcohol and cannabis use among French adolescents: gender and family structure differentials

AIMS

To assess associations between parental control or parental emotional support and current tobacco, alcohol or cannabis use among 12-18-year-old students, according to gender and family structure (intact family, reconstituted family, single-parent family).

METHODS

A cross-sectional survey was conducted in a national representative sample in France (2003) of 6-12th grade students (N = 16,532), as a part of the ESPAD study (European Study Project on Alcohol and Other Drugs). The self-administered questionnaire included questions on last 30 days' consumption of alcohol, tobacco and cannabis as well as on socio-demographic characteristics, school characteristics, and some simple questions on parental control and parental emotional support. Logistic modelling was carried out and (adjusted Odds Ratio) Ora calculated, adjusted for age, parental educational and characteristics of the school.

RESULTS

A negative relationship exists between parental control and substance use, but this relationship is more marked for tobacco (OR a between 1.8 and 5.6 according to level of control, family status and gender) and cannabis (OR between 1.5 and 6.4) than for alcohol (OR a between 1.0 and 2.7). Parental control is more markedly related to substance use in girls than in boys. These tendencies were observed for intact families as well as for single-parent families or reconstituted families. Parental control has a greater impact than emotional support. Among girls, emotional support has a greater impact than among boys.

CONCLUSIONS

There is a gradient relationship between parental control and current consumption, especially among girls. Thus, there may be a need for parental control, whatever the family structure.

The MRH protein Erlectin is a member of the endoplasmic reticulum synexpression group and functions in N-glycan recognition

Kremen1 and 2 (Krm1/2) are coreceptors for Dickkopf1 (Dkk1), an antagonist of Wnt/beta-catenin signaling, and play a role in head induction during early Xenopus development. In a proteomic approach we identified Erlectin, a novel protein that interacts with Krm2. Erlectin (XTP3-B) is member of a protein family containing mannose 6-phosphate receptor homology (MRH-, or PRKCSH-) domains implicated in N-glycan binding. Like other members of the MRH family, Erlectin is a luminal resident protein of the endoplasmic reticulum. It contains two MRH domains, of which one is essential for Krm2 binding, and this interaction is abolished by Krm2 deglycosylation. The overexpression of Erlectin inhibits transport of Krm2 to the cell surface. Analysis of its embryonic expression pattern in Xenopus reveals that Erlectin is member of the endoplasmic reticulum synexpression group. Erlectin morpholino antisense injection leads to head and axial defects during organogenesis stages in Xenopus embryos. The results indicate that Erlectin functions in N-glycan recognition in the endoplasmic reticulum, suggesting that it may regulate glycoprotein traffic.

What are the characteristics of adolescent hospitalized suicide attempters?

AIM

To study the specificity of hospitalized adolescent suicide attempters.

METHOD

Among a national sample of students (n = 11,718, mean age = 16.6 years) studied in 1999, 9.2% (n = 1078) made at least one suicide attempt during their life (SA); 21.9% (n = 234) of them were hospitalized (HSA). We identified the risk factors (family, school, behavioral and psychological) of SA and HSA by comparing (by gender) a) suicide attempters to non-suicide attempters and b) hospitalized suicide attempters to non-hospitalized suicide attempters.

RESULTS

Both for girls and boys, the risk factors for SA varied. However, certain risk factors, particularly depressive mood, low self-esteem and poor parent-child relationships, were not associated with hospitalization. Hospitalized suicide attempters had more personal and social problems. But there is an important difference according to gender: in boys, hospitalization is related to physical fighting (OR = 2.2) and offences (OR = 3.4), in girls to running away (OR = 1.7), consumption of illegal drugs other than cannabis (OR = 2.0), having a living standard outside average (OR = 2.0) and going to a private school (OR = 1.7).

CONCLUSION

Suicide attempters with problem behavior are more at risk of being hospitalized than others. However, the difference between hospitalized and non-hospitalized subjects was smaller than expected.

Is alcohol, tobacco, and cannabis use as well as polydrug use increasing in France?

Two school surveys measured the consumption of alcohol, tobacco and cannabis among French adolescents (7-12th grades), one in 1993 (N=8435, 48.8% males), another in 1999 (N=11,331, 47.9% males). Increase in all substance use and polydrug use was observed (total sample, by gender and by age). The increase was important (1) for lifetime consumption of cannabis, "tobacco+cannabis," "alcohol+tobacco" and "alcohol+tobacco+cannabis" (OR=3.0); (2) for regular consumption of cannabis and "tobacco+cannabis" (OR=3.0); (3) among girls; (4) among youngsters aged 15 and more. In summary, these patterns of increase were quite different from those we expected for France, a wet and masculine culture.

Evidence for use of chemical cues by male horseshoe crabs when locating nesting females (Limulus polyphemus)

Horseshoe crabs come ashore in attached pairs during spring high tides to mate and nest on beaches of the Atlantic and Gulf coasts. Unattached males also come ashore and crowd around the nesting pairs as satellites and engage in sperm competition with the attached male. Females with no satellites and females with large numbers of satellites nest next to one another on the same tide. When females are removed and replaced by a cement model, satellite males continue to be attracted to the same location. Models over sites where females with many satellites had nested are more attractive to males than sites from which a female with no satellites had been removed or a site where no crab had been nesting recently. A second experiment demonstrated that males are responding to chemical cues. A sponge filled with seawater taken from below a female with many satellites and placed under a model female was more attractive to males than a sponge filled with seawater. This is the first demonstration that horseshoe crabs use chemical cues, in addition to visual cues, to locate mates.

Contribution of vasopressin to progression of chronic renal failure: study in Brattleboro rats

We have previously shown that a chronic reduction in plasma vasopressin level slowed the progression of chronic renal failure (CRF) in Sprague Dawley rats. The aim of the present study was to determine the respective contribution of pressor (V1) and antidiuretic (V2) effects of vasopressin on progression. Male homozygous Brattleboro rats with hereditary central diabetes insipidus were submitted to 5/6 nephrectomy. They were divided into three groups, two of which received chronic i.p. infusion of AVP (V1 + V2 effects) or dDAVP (V2 effects). The third group served as control (CONT). The doses of AVP and dDAVP were chosen so as to produce urine osmolality similar to that observed in 5/6 Nx Sprague Dawley rats. All rats ate the same amount of food and drank water ad libitum. Renal function was studied for 13 weeks. All three groups showed a marked hypertension. Rats infused with dDAVP, but not those infused with AVP, had a higher creatininemia, anemia and urinary protein excretion than CONT rats. In the dDAVP but not the AVP group, fractional excretion of urea was markedly decreased and plasma urea concentration rose much more than that of creatinine. These results show that V2 but not V1 effects play a major role in the deleterious influence of vasopressin on progression, at least in Brattleboro rats. The more severe progression seen in dDAVP rats could indirectly result from the V2-mediated effects on the collecting duct resulting in a decreased efficiency of urea excretion, an increased intrarenal urea recycling, and a rise in plasma urea concentration. Both the toxic effects of urea and the recently demonstrated V2-mediated increase in glomerular hemodynamics might be involved in the deleterious influence of V2 agonism.

Self-reported health and behavioral problems among adolescent victims of rape in France: results of a cross-sectional survey

OBJECTIVES

To measure the prevalence rate of rape among French adolescents; to analyze the associated health and behavioral problems; to analyze the use of the health care system by rape victims.

METHOD

A national representative sample of 8,140 students attending public secondary schools in France (grades 8 to 12) filled in a self-administered questionnaire (274 questions) on health and behavior problems (acceptance rate = 87%). Each rape victim in the sample (n = 61) was matched to two nonvictims (n = 122).

RESULTS

The reported prevalence rate of rape was .8% (.9% among girls, .6% among boys). For both boys and girls, there was a relationship between rape and current sleep difficulties, depressive symptoms, somatic complaints, tobacco consumption, and behavior problems (running away, violent behavior, stealing, and school absenteeism). Additional problems were associated for boy rape victims: attempted suicide, regular use of alcohol and of illicit drugs. Rape victims did consult health professionals, but the majority saw neither a mental health specialist nor a social worker.

CONCLUSION

The findings indicate that rape victims, especially boys, have more behavior problems and health problems than nonrape victims. Authors suggest that adolescents who have ran away from home, attempted suicide, or manifested violent behavior should be systematically asked about rape.

Amino acid handling in uremic rats: citrulline, a reliable marker of renal insufficiency and proximal tubular dysfunction

The kidney is involved in amino acid reabsorption and metabolism; consequently, in renal insufficiency, these important functions are disturbed, as has been reported in animals and patients. In a first experimental series, rats were subjected to degrees of nephrectomy (NX) varying between 10% and 90%. Three weeks later, amino acid levels were measured in plasma to correlate the levels with the degree of NX. The results indicate that in the range of 33% to 74% NX, the plasma concentration of only three to four amino acids was modified, whereas in rats with 84% NX, the concentration of 11 amino acids was disturbed, compared with sham-operated rats. Citrullinemia was enhanced in uremic rats and correlated with the degree of NX. More interestingly, citrullinemia was increased in the range of 10% to 33% NX without any changes in uremia and creatininemia, two well-known markers of uremic states. A second experimental series was designed to study the time course of changes in aminoacidemia to find a marker for the onset of renal failure. Rats were subjected to 36% NX for a period of 1 to 21 days. Uremia and creatininemia peaked 24 to 48 hours after NX, and creatinine clearance (Clcreat) concomitantly diminished. Unfortunately, these three markers of uremic states returned to control values during the next few days before increasing during the last 2 weeks. In contrast, citrullinemia increased twofold 48 hours after NX and plateaued over the next 20 days. We conclude that in rats, citrullinemia could be used (1) to detect acute and chronic renal failure, (2) as a specific marker of normal function of the proximal tubule, and (3) to estimate the degree of renal damage. From this study, renal insufficiency might be easily detected by measuring citrullinemia.

Cyclic AMP is a hepatorenal link influencing natriuresis and contributing to glucagon-induced hyperfiltration in rats

The effects of glucagon (G) on proximal tubule reabsorption (PTR) and GFR seem to depend on a prior action of this hormone on the liver resulting in the liberation of a mediator and/or of a compound derived from amino acid metabolism. This study investigates in anesthetized rats the possible contribution of cAMP and urea, alone and in combination with a low dose of G, on phosphate excretion (known to depend mostly on PTR) and GFR. After a 60-min control period, cAMP (5 nmol/min x 100 grams of body weight [BW]) or urea (2.5 micromol/min x 100 grams BW) was infused intravenously for 200 min with or without G (1.2 ng/min x 100 grams BW, a physiological dose which, alone, does not influence PTR or GFR). cAMP increased markedly the excretion of phosphate and sodium (+303 and +221%, respectively, P < 0.01 for each) but did not alter GFR. Coinfusion of cAMP and G induced the same tubular effects but also induced a 20% rise in GFR (P < 0.05). Infusion of urea, with or without G, did not induce significant effects on PTR or GFR. After G infusion at increasing doses, the increase in fractional excretion of phosphate was correlated with a simultaneous rise in plasma cAMP concentration and reached a maximum for doubling of plasma cAMP. These results suggest that cAMP, normally released by the liver into the blood under the action of G, (a) is probably an essential hepatorenal link regulating the intensity of PTR, and (b) contributes, in conjunction with specific effects of G on the nephron, to the regulation of GFR.

Renal synthesis of arginine in chronic renal failure: in vivo and in vitro studies in rats with 5/6 nephrectomy

Synthesis of arginine (Arg) from citrulline (Cit) by the kidney is a major source of Arg for the body. The high level of plasma Cit in chronic renal failure is often thought to result from the impairment of the renal conversion of Cit to Arg. To verify this assumption, we performed two studies in Sprague-Dawley rats with 5/6 nephrectomy (CRF rats) and in sham-operated rats (CONT rats). In study I synthesis of Arg by isolated proximal convoluted tubules (PCT; the nephron segment exhibiting the highest Arg synthesis) was measured in vitro with two concentrations of Cit (200 or 50 microM) corresponding to those observed in plasma of rats with or without renal failure. In study II the net renal uptake of Cit and release of Arg were determined in vivo by measuring PAH clearance and arterial and renal venous Arg, and Cit concentrations in anesthetized rats. The in vitro results showed that Arg synthesis increased only in proportion to the hypertrophy of remnant PCT (+50%), and was highly and similarly dependent on Cit concentration in PCT of remnant and normal kidneys (Arg production with 200 microM Cit was 3 times higher than with 50 microM Cit for both CONT and CRF). The in vivo results showed that renal Cit uptake and Arg release were not altered in CRF: -286 +/- 28 versus -326 +/- 16 nmol Cit.min-1 (NS), and + 390 +/- 47 versus + 399 +/- 22 nmol Arg.min-1 (NS) in CONT and CRF rats, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of two configurations of tricalcium phosphate for treating craniotomies

Biodegradable beta-tricalcium phosphate disks (TCP) of two configurations were inserted into 15-mm-diameter craniotomy wounds and nontreated control sites were evaluated in 60 rabbits. There were no adverse tissue reactions and no apparent difference in the clinical appearance of the 12- and 24-week implanted disks. By 36 weeks and continuing to 48 weeks, the omnidirectional TCP (OTCP) implants were degrading more rapidly than the unidirectional TCP (UTCP) implants, with degradation progressing centripetally and replacement by woven bone and maturing lamellar bone. Host-implant interface of both TCP configurations was a bone bond without interposed soft tissue. TCP disks may be clinically useful for craniotomy repair.

A systems-oriented treatment of an adolescent with factitious lip crusting

The case of an adolescent girl with a factitious lip crusting is presented. The usefulness of treating this disorder in a way similar to the treatment given adolescents with psychosomatic disorders is illustrated.