Predictors of concurrent heroin use among patients on opioid maintenance treatment in France: a multilevel study over 11 years.

BACKGROUND: Consistent reports from health professionals suggest that heroin is commonly used by patients undergoing opioid maintenance treatment (OMT) in France, potentially jeopardizing their recovery process. However, there has been no formal epidemiological assessment on the matter. METHODS: We use a yearly updated compendium retrieving information on patients admitted in treatment centres in France between 2010 and 2020. Given the hierarchical nature of the data collection, we conduct 2-level modified Poisson regressions to estimate the risks of past month heroin use among patients on OMT. RESULTS: Despite an overall decreasing trend over time, heroin use among patients on OMT is indeed common, with half of patients declaring concurrent use. Our study unveils differentiated risks of heroin use vary according to the type of OMT, with patients on methadone more likely to use heroin compared to those on buprenorphine. The use of multilevel-related measures also uncovers high heterogeneity among patients' profiles, reflecting different stages in the treatment process, as well as differentiated practices across treatment centres. CONCLUSION: Opioid maintenance treatment is associated with heroin use, in particular when methadone is involved. The heterogeneity among patients on OMT should be given particular attention, as it underscores the need for tailored interventions.

Tobacco use and employment status: A cross-sectional analysis of the CONSTANCES cohort / Liens entre le statut tabagique et la situation vis-à-vis de l'emploi : analyse transversale de la cohorte CONSTANCES

This study aims to estimate the prevalence of tobacco use in 2017 and 2019 in the French population covered by the Régime Général d'Assurance Maladie according to employment status. From the French national CONSTANCES cohort, 18,008 randomly recruited volunteers aged between 18 and 69 years, affiliated to the Régime Général d'Assurance Maladie and enrolled in 2017, were included in the analysis. The prevalence of tobacco use according to employment status was estimated. Estimates of these prevalence data were calculated in 2017 and 2019 after correction for selection bias at inclusion and non-response at follow-up. In 2019, smoking prevalence was higher among unemployed people (29.2% among men and 20.7% among women) than among employed people (16.5% among men and 13.8% among women). Smoking prevalence was highest among those not in work for health reasons (38.5% among men and 35.8% among women). Smokers were more likely to be unemployed than non-smokers (OR 2.63 [95% confidence interval (CI): 1.79; 3.85] in men and OR 1.55 [95% CI: 1.08; 2.22] in women). Among men, the prevalence of employed people among light smokers (<10 cigarettes/day) significantly decreased between 2017 (87.1%) and 2019 (74.8%). These results underline the importance of reinforcing smoking prevention campaigns among the unemployed, particularly for health reasons.

Estimer les prévalences d'usage de tabac en 2017 et en 2019 en population française couverte par le Régime Général d'Assurance Maladie en fonction du statut vis-à-vis de l'emploi. À partir d'un échantillon de 18 008 volontaires inclus en 2017 dans CONSTANCES, une cohorte nationale en population générale française ayant recruté de manière aléatoire des volontaires de 18-69 ans affiliés au Régime Général d'Assurance Maladie, les prévalences d'usage du tabac en fonction de du statut vis-à-vis de l'emploi ont été estimées en 2017 et en 2019 après correction pour les biais de sélection à l'inclusion et de non-réponse au suivi. En 2019, la prévalence du tabagisme était plus élevée chez les actifs inoccupés (29,2 % chez les hommes et 20,7 % chez les femmes) par rapport aux actifs occupés (16,5 % chez les hommes et 13,8 % chez les femmes). La prévalence du tabagisme la plus élevée concernait les personnes sans activité professionnelle pour raisons de santé (38,5 % chez les hommes et 35,8 % chez les femmes). Les fumeurs étaient plus à risque d'être actifs inoccupés comparativement aux non-fumeurs (OR 2,63 [95 % Intervalle de confiance [IC] : 1,79 ; 3,85] chez les hommes et OR 1,55 [95 % IC : 1,08 ; 2,22] chez les femmes). Chez les hommes, la prévalence d'actifs occupés parmi les petits fumeurs (<10 cigarettes/jour) a baissé entre 2017 (87,1 %) et 2019 (74,8 %). Ces analyses soulignent l'importance d'intensifier les campagnes de prévention sur le tabagisme parmi les actifs inoccupés et les inactifs, en particulier pour raisons de santé.

Magnesium in the treatment of alcohol withdrawal syndrome: a multicenter randomized controlled trial.

OBJECTIVE: Alcohol withdrawal syndrome (AWS) is a frequent and potentially life-threatening condition experienced in alcohol use disorder. Since hypomagnesemia is involved in AWS's severity, we conducted a multicenter double-blind randomized placebo-controlled trial to examine the efficacy of oral magnesium supplementation as an adjuvant therapy of AWS. MATERIAL AND METHODS: Inpatients were recruited in six different centers if they had a baseline score higher than eight on the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). The experimental treatment was magnesium lactate dehydrate, administrated three times per day providing a total of 426.6 mg per day and up to 15 days. The primary endpoint was the significant between-group difference of the CIWA-Ar total score change from baseline to 3 days later. The treatment group and baseline score were introduced as covariables in an analysis of covariance. RESULTS: A total of 98 inpatients were included {71.4% of men; mean age of 49.1 years [standard deviation (SD): 10.3]}. In the intention-to-treat population, the mean reduction of the CIWA-Ar score in the experimental group between baseline and 3 days later was 10.1 (SD: 5.2), whereas it was 9.2 (SD: 3.9) in the control group. The absolute difference of the adjusted mean in the experimental group compared with the control group was -0.69 (SD: 0.72), which did not correspond to a significant between-group difference (P = 0.34). Per-protocol analysis and sensitivity analyses also supported this result. Supplementary analyses found no significant difference regarding benzodiazepine consumption, magnesium blood concentration, and satisfaction to care. CONCLUSIONS: The present study does not support the rationale of systematic oral magnesium supplementation in patients with AWS.

The association between substance use and subsequent employment among students: prospective findings from the CONSTANCES cohort.

PURPOSE: To examine prospectively associations between substance use and subsequent employment among young students. METHODS: From the French population-based CONSTANCES cohort, 1427 students who never worked were included between 2012 and 2018 and followed up for 2.1 years on average. Generalized estimating equations computed the odds of being unemployed versus employed according to substance use at baseline controlling for sociodemographic factors and depressive state. Tobacco use (smoking status and number of cigarettes), cannabis use frequency, and at-risk alcohol use according to the Alcohol Use Disorder Identification Test (total score > 7) were introduced separately in the models. RESULTS: Tobacco use was not significantly associated with employment. Cannabis use at least weekly was associated with increased odds of being unemployed OR 1.73 (1.16-2.57). At-risk alcohol use was no longer significantly associated with employment after adjustment for depressive state, while analyses on sub-scores of alcohol use suggested that alcohol dependence was associated with increased odds of being unemployed OR 1.65 (1.16-2.34). CONCLUSION: Public health campaigns targeting youth should include lower chances of getting employed among the detrimental roles of regular cannabis use and at-risk alcohol use.

Liens entre le statut tabagique et la situation vis-à-vis de l'emploi : analyse transversale de la cohorte CONSTANCES.

This study aims to estimate the prevalence of tobacco use in 2017 and 2019 in the French population covered by the Régime Général d'Assurance Maladie according to employment status. From the French national CONSTANCES cohort, 18,008 randomly recruited volunteers aged between 18 and 69 years, affiliated to the Régime Général d'Assurance Maladie and enrolled in 2017, were included in the analysis. The prevalence of tobacco use according to employment status was estimated. Estimates of these prevalence data were calculated in 2017 and 2019 after correction for selection bias at inclusion and non-response at follow-up. In 2019, smoking prevalence was higher among unemployed people (29.2% among men and 20.7% among women) than among employed people (16.5% among men and 13.8% among women). Smoking prevalence was highest among those not in work for health reasons (38.5% among men and 35.8% among women). Smokers were more likely to be unemployed than non-smokers (OR 2.63 [95% confidence interval (CI): 1.79; 3.85] in men and OR 1.55 [95% CI: 1.08; 2.22] in women). Among men, the prevalence of employed people among light smokers (<10 cigarettes/day) significantly decreased between 2017 (87.1%) and 2019 (74.8%). These results underline the importance of reinforcing smoking prevention campaigns among the unemployed, particularly for health reasons.

Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study.

A prior meta-analysis showed that antidepressant use in major depressive disorder was associated with reduced plasma levels of several pro-inflammatory mediators, which have been associated with severe COVID-19. Recent studies also suggest that several antidepressants may inhibit acid sphingomyelinase activity, which may prevent the infection of epithelial cells with SARS-CoV-2, and that the SSRI fluoxetine may exert in-vitro antiviral effects on SARS-CoV-2. We examined the potential usefulness of antidepressant use in patients hospitalized for COVID-19 in an observational multicenter retrospective cohort study conducted at AP-HP Greater Paris University hospitals. Of 7230 adults hospitalized for COVID-19, 345 patients (4.8%) received an antidepressant within 48 h of hospital admission. The primary endpoint was a composite of intubation or death. We compared this endpoint between patients who received antidepressants and those who did not in time-to-event analyses adjusted for patient characteristics, clinical and biological markers of disease severity, and other psychotropic medications. The primary analysis was a multivariable Cox model with inverse probability weighting. This analysis showed a significant association between antidepressant use and reduced risk of intubation or death (HR, 0.56; 95% CI, 0.43-0.73, p < 0.001). This association remained significant in multiple sensitivity analyses. Exploratory analyses suggest that this association was also significant for SSRI and non-SSRI antidepressants, and for fluoxetine, paroxetine, escitalopram, venlafaxine, and mirtazapine (all p < 0.05). These results suggest that antidepressant use could be associated with lower risk of death or intubation in patients hospitalized for COVID-19. Double-blind controlled randomized clinical trials of antidepressant medications for COVID-19 are needed.

The association of substance use with attaining employment among unemployed job seeking adults: Prospective findings from the French CONSTANCES cohort.

This study aimed to examine the prospective association between tobacco, alcohol and cannabis use with attaining employment among unemployed job seekers. Data from the French population-based CONSTANCES cohort on 5114 unemployed job seeking adults enrolled from 2012 to 2018 were analyzed. Binary logistic regressions were computed. Odds ratio (OR) and 95%CI of remaining unemployed at one-year of follow-up (versus attaining employment) according to substance use at baseline were obtained. The following independent variables were introduced into separate models: tobacco use (non-smoker, former smoker, light (<10cig/day), moderate (10-19cig/day) and heavy smoker (>19cig/day)), alcohol use according to the Alcohol Use Disorder Identification Test (non-users (0), low (<7), moderate (7-15) and high or very high-risk (>15)) and cannabis use (never used, no use in the previous 12 months, less than once a month, at least once a month but less than once per week, once per week or more). Analyses were adjusted for age, gender and education. At follow-up, 2490 participants (49.7%) were still unemployed. Compared to non-smokers, moderate and heavy smokers were more likely to remain unemployed, with ORs (95%CI) of 1.33 (1.08-1.64) and 1.42 (1.04-1.93), respectively. Compared to low-risk alcohol users, no alcohol users and high or very high-risk alcohol users were more likely to remain unemployed, with ORs (95% CI) of 1.40 (1.03-1.83) and 2.10 (1.53-2.87), respectively. Compared to participants who never used cannabis, participants who use cannabis once a week or more were more likely to remain unemployed, OR (95%CI) of 1.63 (1.33-2.01). Substance use may play an important role in difficulty attaining employment.

Atypical working hours are associated with tobacco, cannabis and alcohol use: longitudinal analyses from the CONSTANCES cohort.

BACKGROUND: This study examined prospective associations between atypical working hours with subsequent tobacco, cannabis and alcohol use as well as sugar and fat consumption. METHODS: In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use. Among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use when appropriate. RESULTS: Working at night was associated with decreased smoking cessation and increased relapse in women [odds ratios (ORs) of 0.81 and 1.25], increased cannabis use in men [ORs from 1.46 to 1.54] and increased alcohol use [ORs from 1.12 to 1.14] in both men and women. Weekend work was associated with decreased smoking cessation in women [ORs from 0.89 to 0.90] and increased alcohol use in both men and women [ORs from 1.09 to 1.14]. Non-fixed hours were associated with decreased smoking cessation in women and increased relapse in men [ORs of 0.89 and 1.13] and increased alcohol use in both men and women [ORs from 1.12 to 1.19]. Overall, atypical working hours were associated with decreased sugar and fat consumption. CONCLUSIONS: The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.

Management of Cardiovascular Health in People with Severe Mental Disorders.

PURPOSE OF REVIEW: To review evidence regarding the association between bipolar disorder and schizophrenia, henceforth referred to as severe mental disorders (SMD), and cardiovascular morbidity and mortality, its mechanisms, and the interventions to reduce this burden. RECENT FINDINGS: Much of the loss in life expectancy in people with SMD remains driven by cardiovascular mortality. Antipsychotics and mood stabilizers are associated with negative cardio-metabolic outcomes, but large inter-individual differences are observed, and not treating SMD might be associated with even greater cardiovascular mortality. Classical modifiable cardiovascular risk factors remained inadequately screened and, once identified, too seldom treated in people with SMD. After a myocardial infarction, aggressive tertiary prevention may be as effective in people with SMD as in the general population but is less prescribed. Reduced healthcare quality and increased prevalence of cardiovascular risk factors may not fully explain the excess cardiovascular mortality associated with SMDs, which themselves should be considered risk factors in risk calculators. Hazardous health behaviors, the cardio-metabolic adverse effects of medications, and a reduced access to quality healthcare remain priority targets for intervention.

Work Conditions are Associated with Alcohol Use after Taking into Account Life Conditions Outside of Work: Findings from a French Occupational Health Service.

Background: Our aim was to examine whether work conditions could be associated with alcohol use even after taking into account life conditions outside of work. Methods: In 2019, 591 consecutive French workers were screened for alcohol use with the Fast Alcohol Consumption Evaluation (FACE). Ten different work conditions and four life conditions outside of work were assessed with 5-item Likert scales. Sociodemographic factors, smoking status and the Copenhaguen Burn-out Inventory were also collected. The associations between each work condition and FACE total score were examined with generalized linear models. Results: After adjusting for sociodemographic factors, the following work conditions were associated with a decreased FACE total score: "positive and/or grateful feedback on your work" (B = -0.22 (95%CI: -0.37; -0.07), p = 0.004), "time to do your job well" (B = -0.19 (95%CI: -0.35; -0.03), p = 0.019) and "freedom to organize your work" (B = -0.25(95%CI: -0.43; -0.08), p = 0.004). After further adjusting for life conditions outside of work, "positive and/or grateful feedback on your work" (B = -0.18 (95%CI: -0.33; -0.03), p = 0.021) and "freedom to organize your work" (B = -0.20(95%CI: -0.38; -0.02), p = 0.027) remained significantly associated with FACE total score. Additional adjustments for smoking status and burnout did not alter these results. Conclusions: Life conditions outside of work should not interfere with how improvements work conditions can help reduce alcohol use.

Sociodemographic and Clinical Characteristics of Vapers Using E-Cigarettes Exclusively: The French Vapoquid Study.

BACKGROUND: Electronic cigarettes are increasingly being used as smoking cessation aids. Most studies assess the dual use of e-cigarettes and traditional cigarettes, but there remains a paucity of literature concerning individuals who use e-cigarettes exclusively. Objective: The aim of this study is to examine the sociodemographic and clinical characteristics of exclusive e-cigarette users, and consider their willingness to quit e-cigarette use. Methods: A French online survey was conducted from March to December 2017. We assessed the following factors: sociodemographic factors; the clinical characteristics of e-cigarette use and its social acceptability; and the self-perceived effectiveness of nicotine replacement therapy (NRT). Associations between the listed factors and a willingness to quit e-cigarette use were examined. Results: A total of 386 exclusive e-cigarette users (70% men) participated in the study and were included in the analysis. Most respondents were not planning to quit e-cigarette use (75%). Compared to those who did not want to quit, a desire to quit was associated with using smoking cessation services (OR [95%CI]: 3.45 [1.82-6.56]), e-cigarette craving (OR [95%CI]: 2.63 [1.44-4.80]) and NRT past-use (1.78 [1.12-2.87]). Users who planned to quit expressed more concerns about smoking initiation among youths using e-cigarettes (OR [95%CI]: 3.62 [1.90-6.93]). In multivariate analysis, these associations remained significant for the use of smoking cessation services, e-cigarette cravings, and concerns about youth tobacco initiation. Conclusion: Most exclusive e-cigarette users were not likely to quit. Planned cessation was associated with using smoking cessation services, experiencing e-cigarette dependence symptoms, and being concerned about smoking initiation among teenager e-cigarette users.

Predictors of Smoking Cessation Attempt and Continued Abstinence among Low-Income Disabled Smokers: Evidence from the French National Smoking Cessation Cohort CDT-Net.

Background: In France, daily smoking has been highly prevalent among low-income smokers.Objectives: Our aim was to search for factors associated with both continued abstinence and attempting to quit among low-income disabled smokers. Methods: From the French national smoking cessation cohort CDT-net, we included 1624 adults living with disability pension or disabled adult allowance. Our dependent variables (abstainers, attempting to quit among non-abstainers) were used in logistic regressions. Continued abstinence was defined as self-reports of no smoking for more than 28 days and attempting to quit was defined as self-reports of no smoking for less than 28 days; both validated with carbon monoxide < 10 ppm. Results: The average age was 48.5 years, with a predominance of men (55.5%). Achieved continued abstinence was 29.9% and was positively associated with age ≥ 55, history of previous attempts, low-dependence, and number of consultations during follow-up (all p < .05). Depression history, anxiety symptoms and cannabis use were negatively associated with continued abstinence (p < .05). Quit attempts were associated with lower dependence and number of consultations during follow-up. Pharmacological treatments prescribed at inception did not contribute to improve continued abstinence rates but varenicline was found to increase quit attempts unless the number of prescriptions was scarce. Conclusion: Even among low-income disabled smokers, achieving continued abstinence and attempting to quit could be promoted with similar predictors than among affluent smokers. Treatment of anxiety symptoms and specific support for smokers with a depression history could be included in the follow-up of quit attempts.

Interventions brèves aux services d'accueil des urgences pour le trouble de l'usage de l'alcool.

INTRODUCTION: Given the high prevalence of alcohol use disorder (AUD) amongst patients in Emergency Rooms (ER), it is recommended to carry out a systematized screening of at-risk drinkers, followed if necessary by a brief intervention (BI) to prevent AUD-related damages. This intervention has been the subject of numerous efficacy and feasibility studies. The purpose of this review of the literature is to identify optimal strategies for systematic screening and BI that can be deployed in the ER. METHODS: We selected randomized controlled trials, meta-analysis and reviews of the literature published between July 2014 and March 2019 evaluating the effectiveness of BI in the ER on reducing alcohol consumption. RESULTS: Thirteen articles were included. There is a significant heterogeneity of the methodologies used and the interventions carried out. The majority of studies conclude in the effectiveness of BI on reducing alcohol consumption, with however differences between the studies in effect size, and an effectiveness that seems to decrease over time. CONCLUSION: The BI in the ER appears to be effective on reducing alcohol consumption but with a modest effect size and heterogeneity of the interventions tested, so that the optimal modalities of its implementation remain to be defined. Further studies to compare different interventions and identify at-risk subgroups would be needed to optimize the use of BI in the ER.

Work-Related Stressors and Increased Risk of Benzodiazepine Long-Term Use: Findings From the CONSTANCES Population-Based Cohort.

Objectives. To examine whether stressful job exposure to the public could be associated with having long-term benzodiazepine use.Methods. From the participants included between 2012 and 2016 in the French population-based CONSTANCES cohort, 13 934 men and 19 261 women declared a daily job exposure to the public and rated the frequency of stressful exposure. We examined benzodiazepine long-term use by using drug reimbursement administrative registries. Logistic regressions provided odds ratios (ORs) of benzodiazepine long-term use, with stratification for gender and adjustment for age, education, and area deprivation index. Occupational grade, job strain, depression, self-rated health, and alcohol use disorder were additional stratification variables.Results. Benzodiazepine long-term use was positively associated with stressful exposure to the public ("often or always" vs "rarely or never") in men (OR = 2.2; 95% confidence interval [CI] = 1.8, 2.8) and women (OR = 1.6; 95% CI = 1.4, 1.9), with dose-dependent relationships (P trends < .001). Adjustments and analyses in subgroups without other individual or environmental vulnerability factors led to similar results.Conclusions. Stressful job exposure to the public increases the risk of benzodiazepine long-term use. Prevention programs aiming at reducing the burden of benzodiazepine long-term use would benefit in targeting this specific population.

Prevalence of prescribed benzodiazepine long-term use in the French general population according to sociodemographic and clinical factors: findings from the CONSTANCES cohort.

BACKGROUND: Data are lacking regarding the prevalence of benzodiazepine long-term use in the general population. Our aim was to examine the prevalence of prescribed benzodiazepine long-term use (BLTU) according to sociodemographic and clinical factors in the French general population. METHODS: Data came from 4686 men and 4849 women included in 2015 in the French population-based CONSTANCES cohort. BLTU was examined using drug reimbursement administrative registries from 2009 to 2015. Analyses were weighted to provide results representative of the French general population covered by the general health insurance scheme. Weighted prevalence of BTLU and weighted Odds Ratios (OR) of having BTLU were computed with their 95% Confidence Interval (95% CI) according to age, education level, occupational status, occupational grade, household income, marital status, alcohol use disorder risk and depressive symptoms. All the analyses were stratified for gender. RESULTS: Weighted prevalence of BLTU were 2.8%(95% CI:2.3-3.4) and 3.8%(95% CI: 3.3-4.5) in men and women, respectively. Compared to men, women had an increased risk of having benzodiazepine long-term use with OR = 1.34(95% CI = 1.02-1.76). Aging, low education, not being at-work, low occupational grade, low income, being alone and depressive state were associated with increased risks of having BTLU. CONCLUSIONS: BLTU is widespread in the French general population, however this issue may particularly concern vulnerable subgroups. These findings may help in raising attention on this public health burden as well as targeting specific at-risk subgroups in preventive intervention.

Poor Perceived Health is Associated with Current use of Electronic Cigarette among Current and Former Smokers: Findings from the CONSTANCES Cohort.

BACKGROUND: Electronic cigarettes (e-cigarettes) have become increasingly popular, yet beyond social or technical features, the specific health-related reasons adults use e-cigarettes remain poorly understood. OBJECTIVE: To explore the cross-sectional associations between perceived health and current e-cigarette use in a large population-based cohort. METHODS: From the participants included in the French CONSTANCES cohort (a large general-purpose national population-based cohort) from 2015 to 2017, we included 18,300 ever tobacco smokers with data on their e-cigarette use. We used logistic regressions to estimate the associations between e-cigarette use and perceived health (global and respiratory), stratifying on participants' smoking status and adjusting for sociodemographic characteristics. To examine the role of objective health features (reported diagnoses and measured parameters during a health examination), we adjusted for prior history of respiratory and cardiovascular diseases, diabetes, cancer, spirometry, and blood pressure. Finally, we examined the effect of additionally adjusting for several health-related behaviors. RESULTS: Participants with poor perceived health (global and respiratory) were at greater risk of e-cigarette use. These associations remained unchanged after adjustment for objective health features and health-related behaviors (e.g., in current smokers, for global perceived health, an odds ratio of 1.10 [95% CI 1.03-1.16] per increase on an 8-point scale from very good to very poor). CONCLUSIONS: Our findings suggest that the more current and former smokers felt unhealthy, the more they tended to currently use e-cigarettes. People who regularly use e-cigarettes should obtain medical supervision that takes into account not only objective diagnoses and measurements but also perceived health. Counseling practices could include assessing perceived health status to reinforce motivation to quit smoking.

The contribution of Micro-CT to the evaluation of trabecular bone at the posterior part of the auricular surface in men.

AIM: Using multi-slice computed tomography (MSCT), Barrier et al. described the disappearance at the posterior auricular surface of a "central line" (CL) and "juxtalinear cells" (JLCs) belonging to a trabecular bundle, and a trabecular density gradient around the CL that decreased with age. The aim of our study was to use micro-CT to test these findings, referring to the concept of Ascadi and Nemeskeri. METHODOLOGY: The coxal bones of fifteen males were used; age was known. CLs were identified on MSCT-sections using Barrier's method (64 detectors, 0.6 mm slice thickness, 0.1 mm overlap) with two different software programs (Synapse®, Amira®). Then, CLs were researched on microCT slices (pixel size: 36 µm). Three volumes of interest were defined (around, above, and below CL), and 3D morphometric parameters of the trabecular microarchitecture (particularly BV/TV and DA) were calculated. Two-tailed statistical analyses were performed attempting to correlate these parameters with age at death. RESULTS: CLs and JLCs were observed on micro-CT slices, but with moderate agreement between both imaging techniques. Their presence was not correlated with the age of the subjects. Around the CL, BV/TV decreased significantly with age; DA was negatively correlated with BV/TV and had a tendency to increase with age. Between areas above and below the CL, there was a BV/TV gradient and both BV/TVs decreased in parallel with age. CONCLUSION: Our findings regarding the contribution of micro-CT to the evaluation of trabecular bone could be a promising research approach for application in a larger study population.

Sociodemographic Differences Between Alcohol Use and Sickness Absence: Pooled Analysis of Four Cohort Studies.

AIMS: We examined differences in sickness absence in relation to at-risk drinking and abstinence, taking into account potential changes in consumption. METHODS: We used individual-participant data (n = 46,514) from four prospective cohort studies from Finland, France and the UK. Participants responded to a survey on alcohol use at two time points 4-6 years apart, and were linked to records of sickness absence for an ~6-year follow-up after the latter survey. Abstainers were those reporting no alcohol use in either survey. At-risk drinkers at T1 were labelled as 'former', at-risk drinkers at T2 as 'current' and at-risk drinkers at both times as 'consistent' at-risk drinkers. The reference group was low-risk drinkers at both times. Study-specific analyses were stratified by sex and socioeconomic status (SES) and the estimates were pooled using meta-analysis. RESULTS: Among men (n = 17,285), abstainers (6%), former (5%), current (5%) and consistent (7%) at-risk drinkers had an increased risk of sickness absence compared with consistent low-risk drinkers (77%). Among women (n = 29,229), only abstainers (12%) had a higher risk of sickness absence compared to consistent low-risk drinkers (74%). After adjustment for lifestyle and health, abstaining from alcohol was associated with sickness absence among people with intermediate and high SES, but not among people with low SES. CONCLUSIONS: The U-shaped alcohol use-sickness absence association is more consistent in men than women. Abstinence is a risk factor for sickness absence among people with higher rather than lower SES. Healthy worker effect and health selection may partly explain the observed differences. SHORT SUMMARY: In a pooled analysis from four cohort studies from three European countries, we demonstrated a U-shaped association between alcohol use and sickness absence, particularly among men. Abstinence from alcohol was associated with increased sickness absenteeism among both sexes and across socioeconomic strata, except those with low SES.

Daily alcohol consumption and sickness absence in the GAZEL cohort.

Background: : Previous studies that examined the association between daily alcohol consumption and sickness absences (SA) were mostly retrospective and did not take into account the characteristics of SA. : A total of 9907 daily drinkers (8442 men and 1465 women) of the GAZEL prospective cohort were included. Daily alcohol consumption over the three previous years was self-reported at baseline and categorized as low, moderate, high or very high risk according to the World Health Organization. Duration of SA (short: ≤7 days; moderate: 8-28; long: >28) was collected from administrative records as well as causes for long SA. Negative binomial regression models were used to estimate Risk Ratios of SA according to alcohol consumption with low-risk category as reference. : Duration of follow-up (in years) for SA was 8.4 ± 3.7 in men and 11.2 ± 5.4 in women. Increasing alcohol consumption predicted increasing risk of SA with a dose-response relationship ( P < 0.01 for men; P = 0.01 for women). In men, strength of this association increased with SA duration [e.g. RRs from 1.41 (95% CI: 1.12-1.79) to 2.12 (95% CI: 1.49-3.00) in the very high-risk category, for short and long SA, respectively]. In men, even a moderate consumption predicted increased risk of SA whatever their duration (RR = 1.15; 95% CI: 1.07-1.23). In women, a moderate consumption predicted only long SA (RR = 1.22; 95% CI: 1.00-1.50). Daily alcohol consumption was associated with almost all causes of long SA in men, and with respiratory diseases, digestive diseases and injury in women. : We found a dose-response relationship between daily alcohol consumption and the risk of SA. Even moderate consumption could increase this risk, particularly in men.