The CONSTANCES cohort: an open epidemiological laboratory.

BACKGROUND: Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an "open epidemiologic laboratory" accessible to the epidemiologic research community. Although designed as a "general-purpose" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging. METHODS: The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death. To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants will be set up and followed through the same national databases as participants. A field-pilot was performed in 2010 in seven HSCs, which included about 3,500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data. DISCUSSION: The constitution of the full eligible sample is planned during the last trimester of 2010, and the cohort will be launched at the beginning of 2011.

Patterns and frequency of atypical antipsychotic prescribing in psychiatric medical centers: a cross-sectional national survey.

Studies describing atypical antipsychotics when compared with conventional antipsychotic drugs are few in France. This study aimed to describe the frequency and characteristics of atypical antipsychotic prescribing. A cross-sectional national survey was conducted from February to June 2003 in a random sample of 100 volunteer French psychiatrists practicing in public psychiatric medical centers. Each psychiatrist was asked to complete a questionnaire for patients to whom at least one antipsychotic was prescribed during the period of the survey. The characteristics of the patients treated with atypical antipsychotics were identified with a logistic regression model. A total of 1733 patients were included in the study. The main diagnoses were schizophrenia (46.1%) and other psychoses (40.8%), followed by mood disorders (10%) and other psychiatric disorders (2.5%). Among these patients, 56% had at least one prescription of an atypical antipsychotic, 42.1% at least one conventional antipsychotic with immediate action and 29.9% at least one conventional antipsychotic with delayed action. Seventy percent of patients were treated with single-drug atypical antipsychotics. Compared with conventional antipsychotics with immediate action, atypical antipsychotics were less likely to be prescribed to patients over 35 years of age [odds ratio (OR) 0.4; 95% confidence interval (CI) 0.3-0.6], with duration of illness >10 years (OR 0.5; 95% CI 0.3-0.7), and were less likely to be used with concomitant corrector agents for neurological side effects (OR 0.4; 95% CI 0.3-0.6). This study shows the important use of atypical antipsychotic drugs especially in schizophrenic patients and younger patients.

When Blue-Collars Feel Blue: Depression and Low Occupational Grade as Synergistic Predictors of Incident Cardiac Events in Middle-Aged Working Individuals.

BACKGROUND: The association of psychological variables with cardiovascular health might depend on socioeconomic status. We examined the moderating effect of occupational grade on the association between depression and incident cardiac events among middle-aged workers from the GAZEL cohort. METHODS AND RESULTS: A total of 10 541 participants (7855 men, mean age: 47.8±3.5 years) free of cardiovascular diseases completed the Center of Epidemiologic Studies Depression scale in 1993. Age, sex, and occupational grade (low, medium, and high) were obtained from company records. Classical cardiovascular risk factors were self-reported. All participants were followed-up for medically certified cardiac events from January 1994 to December 2014. Associations between baseline variables and incident cardiac events were estimated with hazard ratios and 95% confidence intervals computed in Cox regressions. After a median follow-up of 21 years, 592 (5.6%) participants had a cardiac event. There was a significant interaction between depression and occupational grade in both age- and sex-adjusted (P=0.008) and multiadjusted (P=0.009) models. This interaction was mainly explained by an association between depression and incident cardiac events that prevailed among participants of low occupational grade (3.71 versus 1.96 events per 1000 person-years among those depressed versus nondepressed, multiadjusted hazard ratios [95% confidence intervals], 1.99 [1.12-3.48]). CONCLUSIONS: From a research perspective, these results may account for previous conflicting results and constitute an impetus for reanalyzing previous data sets, taking into account the moderating role of socioeconomic status. From a clinical perspective, they urge clinicians and policy makers to consider depressive symptoms and low socioeconomic status as synergistic cardiovascular risk factors.