Predictors of elevated capillary blood glucose in overweight railway French employees: a cross-sectional analysis.

BACKGROUND: Hyperglycaemia is a risk factor of cardiovascular disease and a high risk state for progression to type 2 diabetes. Moreover, overweight, defined as a body mass index (BMI) between 25 and 29.9 kg/m2, increases the risk of diabetes. Information about the feasibility of measuring, during routine occupational health examinations, predictors of elevated capillary blood glucose in overweight individuals is scarce. This study aims to identify factors that are associated with elevated capillary blood glucose and can be routinely measured in French overweight employees to develop targeted preventive strategies in the workplace. METHODS: Cross-sectional study based on data collected during a workplace health promotion programme of the French National Railways Company (SNCF) from January 2011 to March 2015. A self-administered questionnaire was completed by overweight volunteers during the routine occupational health examination. Data collected included health, anthropometric, sociodemographic, occupational, and lifestyle characteristics. Elevated capillary blood glucose was defined as capillary blood glucose equal to or higher than 7 mmol/L. Multivariate logistic regression analysis was used to examine factors associated with elevated capillary blood glucose and results were described with odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The analysis concerned 2248 overweight employees (mean age: 43 years) with complete data (total population: 7724). The prevalence of elevated capillary blood glucose was 20.0%. In the multivariate analysis, significant predictors of elevated capillary blood glucose were: male sex (OR 1.66, 95% CI 1.21-2.28), age ≥ 50 years (OR 1.61, 95% CI 1.01-2.55), high blood pressure (OR 1.35, 95% CI 1.07-1.69), and daily intake of sugary food (OR 1.53, 95% CI 1.17-2.00). No association with occupational characteristics (work schedule, job seniority, professional grade, and job sector) was found possibly due to lack of statistical power. CONCLUSIONS: Our findings provide information for setting up specific diabetes prevention strategies in the workplace. Overweight men, aged 50 and older, with high blood pressure and daily sugary food intake should be considered for capillary blood glucose measurements during their occupational medical surveillance. Hypertension screening and management as well as health policy measures to target sugary food consumption could be included in workplace prevention strategies.

The importance of both workplace and private life factors in psychological distress: a large cross-sectional survey of French railway company employees.

PURPOSE: The psychological well-being of employees is a priority in occupational health. This study aimed to estimate the prevalence of psychological distress among employees of a large French company, to calculate the associations between distress and stressors in the workplace and private life domains, and to explore confounding across stressor domains. METHODS: 8,058 employees of the French national railways company completed a nation-wide survey in 2006 (94.3 % participation). Psychological distress was measured by the 12-item General Health Questionnaire and 21 potential stressors and socio-demographic factors by a self-administered questionnaire. Stressors were summarized in scores for work pressure, workplace conflict, and personal life domains. Risk ratios (RRs) between psychological distress and stressors were calculated using robust-variance Poisson regression. RESULTS: The prevalence of psychological distress was 32.8 % (95 % CI 31.8-33.9 %), higher among women (48.9 %, 95 % CI 46.5-51.7 %) than men (30.1 %, 95 % CI 29.0-31.2 %). Each stressor domain was associated with distress in the final model containing likely confounders and all three domains (RR highest vs. lowest level-work pressure: men 1.55, 95 % CI 1.42-1.70, women 1.42, 95 % CI 1.23-1.63; work conflict: men 2.63, 95 % CI 2.38-2.91, women 1.98, 95 % CI 1.70-2.30; life concerns: men 2.04, 95 % CI 1.86-2.23, women 1.53, 95 % CI 1.32-1.78). The mutually adjusted RRs for the stressor domains were smaller than the unadjusted RRs. CONCLUSIONS: Almost one-third of all employees and one-half of female employees experienced psychological distress. All three stressor domains were associated with psychological distress and adjustment reduced the association size, suggesting possible over-estimation if one or more domains are omitted from the survey.

Iron-deficiency anemia in Castleman disease: implication of the interleukin 6/hepcidin pathway.

In addition to occasional autoimmune hemolytic anemia, unexplained iron-deficiency anemia has been reported in childhood Castleman disease (CD). The recent discovery of hepcidin has regenerated the research on iron metabolism. This hormone is a key regulator of iron homeostasis, mainly by inhibiting intestinal iron absorption. Liver expression of hepcidin increases in response to interleukin 6 (IL-6). With chronic overproduction of IL-6 as a hallmark, CD could be an interesting human model for studying the contribution of the IL-6/hepcidin pathway in the pathogenesis of anemia of chronic disease. We report here the case of a 16-year-old boy with chronic iron-deficiency anemia (plasma ferritin: 19 µg/L; plasma iron: 2.2 µmol/L; negative bone marrow Perls' Prussian blue stain), inflammatory syndrome (C-reactive protein: 108 mg/L), and growth retardation for the previous 2 years. Diagnostic workup revealed a large mesenteric mass corresponding to localized CD of mixed histologic type. Resection of the tumor resulted in complete resolution of iron-deficiency anemia and inflammatory syndrome. Parallel variations of plasma IL-6, C-reactive protein, and hepcidin concentrations, together with tumor immunohistochemistry, strongly suggested that IL-6 synthesized by the tumor caused both the inflammation and iron deficiency through enhancement of hepcidin production by the liver. The results of this unique case study (1) explain the mechanism of iron deficiency observed in some children with CD, (2) confirm in vivo the regulatory effect of IL-6 in human hepcidin production, and (3) suggest that iron deficiency is a causal link between IL-6 and anemia of chronic disease.

Agreement between erythrocyte sedimentation rate and C-reactive protein in hospital practice.

BACKGROUND: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are frequently prescribed jointly. The usefulness of this practice is uncertain. METHODS: All patients with ESR and CRP measured at the same time in an academic tertiary hospital during a 1-year period were included. Concomitant measures of serum creatinine, hematocrit, and anti-Xa activity were recorded to study noninflammatory cause of increased ESR. Level of agreement between ESR and CRP was assessed with kappa coefficient, and their accuracy was determined in a medical chart review of 99 randomly selected patients with disagreement between both markers. RESULTS: Among 5777 patients, 35% and 58% had an elevated CRP and ESR, respectively. ESR and CRP were in agreement in 67% of patients (both elevated in 30%, both normal in 37%). A disagreement was observed in 33% (elevated ESR/normal CRP in 28%, normal ESR/elevated CRP in 5%). The kappa coefficient showed poor agreement (k=0.38) between both markers. Review of medical chart showed that 25 patients with elevated CRP and normal ESR had an active inflammatory disease (false-negative ESR). Conversely, 74 patients had elevated ESR and normal CRP-32% had resolving inflammatory disorders, 28% disclosed a variable interfering with the ESR measure (false-positive ESR), 32% had unexplained discrepancies, and 8% had an active inflammatory disease (false-negative CRP). CONCLUSION: In hospital practice, joint measurement of ESR and CRP is unwarranted. Because of slow variation and frequent confounding, ESR is frequently misleading in unselected patients. When an inflammatory disorder is suspected, priority should be given to CRP.

Endothelial dysfunction in systemic lupus patients with low disease activity: evaluation by quantification and characterization of circulating endothelial microparticles, role of anti-endothelial cell antibodies.

OBJECTIVE: We attempted to evaluate endothelial dysfunction and the role of AECAs in systemic lupus (SL) with low disease activity. We quantified endothelial microparticles (EMps) and attempted to find the best flow cytometry method for that purpose. METHODS: CD105, CD144 and CD146 were tested, individually or in combination, on EMp-enriched plasma. Twenty-three healthy blood donors and 27 SL patients were evaluated. SL patients with a SLEDAI <10 (median 2.6) were evaluated in our outpatient clinic. For each patient, EMps (CD105-CD146(+), CD45(-)) and AECAs were quantified and characterized. RESULTS: The monochrome composite marker CD105-CD146 appeared to be the most efficient in detecting EMps. SL patients had more circulating EMps than healthy donors: respective median values were 2575 and 130 EMps/microl (P < 0.001). SL patients had more CD54(+) and CD54(-) EMps than healthy donors (496 vs 34 EMps CD54(+)/microl, P < 0.0001; 1875 vs 89 EMps CD54(-)/microl, P < 0.0001). The ratio CD54(+) EMps/total EMps was lower for lupus patients than for healthy individuals (20.3 vs 33.7%, P = 0.03). Twenty-four patients (89%) were positive for AECAs. EMp counts were not significantly higher for patients with AECAs. CONCLUSION: Monochrome composite marker is efficient in detecting the whole population of EMps using flow cytometry. SL patients with low disease activity have a marked endothelial dysfunction. EMps released from the endothelium originate from activated and non-activated cells. AECAs do not seem to be the main cause of endothelial dysfunction in this population.

Recurrent Escherichia coli meningitis associated with aspergillar sphenoidal sinusitis.

Recurrent meningitis due to Escherichia coli is an extremely rare infection in adult patients. Most cases have been complications of neurosurgery. We report on the case of a 43-y-old man with 4 recurrent spontaneous episodes of E. coli meningitis related to aspergillar sphenoidal sinusitis. Surgical treatment of sinusitis cured the patient.

[Infectious features of atherosclerosis]. / Aspects infectieux de l'athérosclérose.

As an inflammatory focus, the atherosclerotic plaque is viewed as a response to aggressions. Suppressing these causal injuries appears as the best means for preventing the disease. Infection is among the clues for answering the etiological challenge of atherosclerosis. Through direct or indirect, and specific or non specific pathways, some candidate viruses or bacteria are suspected to induce or stimulate plaque formation or complications. Yet, none of these working hypotheses has reached the level of proof required for establishing a valid concept. Although submitted to intensive investigations, anti-infectious drugs and antimicrobial vaccinations are still far-sighted expectations in the treatment and prevention of coronary artery disease.

[Recurrent enterococcal bacteremia associated with a transjugular intrahepatic protosystemic shunt]. / Bactériémie récidivante à entérocoque rapportée à l'infection d'un shunt porto-systémique intra-hépatique par voie transjugulaire.

Transjugular intrahepatic portosystemic shunts (TIPS) are an accepted technique for controlling the complications of portal hypertension. Although the incidence of TIPS-associated bacteremia appears to be low (2%), this complication has a high mortality. We report one case of recurrent enterococcal bacteremia associated with TIPS and regression of TIPS thrombus after antibiotherapy. The antibiotic regimen is similar to that given in bacterial endocardites.