A novel cgMLST for genomic surveillance of Yersinia enterocolitica infections in France allowed the detection and investigation of outbreaks in 2017-2021.

Enteric yersiniosis, the third most common food-borne zoonosis in Europe, is mainly caused by the pathogen Yersinia enterocolitica. In France, the yersiniosis microbiological surveillance is conducted at the Yersinia National Reference Laboratory (YNRL). Since 2017, isolates have been characterized by whole genome sequencing (WGS) followed by a 500-gene Yersinia-cgMLST. We report here the data of the WGS-based surveillance on Y. enterocolitica isolates for the 2017-2021 period. The YNRL characterized 7,642 Y. enterocolitica strains distributed in 2,497 non-pathogenic isolates from lineages 1Aa and 1Ab, and 5,145 specimens belonging to 8 pathogenic lineages. Among pathogenic isolates, lineage 4 was the most common (87.2%) followed by lineages 2/3-9b (10.6%), 2/3-5a (1.2%), 2/3-9a (0.6%), 3-3b, 3-3c, 1B, and 3-3d (0.1% per each). Importantly, we developed a routine surveillance system based on a new typing method consisting of a 1,727-genes core genome Multilocus Sequence Typing (cgMLST) specific to the species Y. enterocolitica followed by isolate clustering. Thresholds of allelic distances (AD) were determined and fixed for the clustering of isolates: AD ≤ 5 for lineages 4, 2/3-5a, and 2/3-9a, and AD ≤ 3 for lineage 2/3-9b. Clustering programs were implemented in 2019 in routine surveillance to detect genomic clusters of pathogenic isolates. In total, 419 clusters with at least 2 isolates were identified, representing 2,504 of the 3,503 isolates characterized between 2019 and 2021. Most clusters (n = 325) comprised 2 to 5 isolates. The new typing method proved to be useful for the molecular investigation of unusual grouping of cases as well as for the detection of genomic clusters in routine surveillance. IMPORTANCE: We describe here the new typing method used for molecular surveillance of Yersinia enterocolitica infections in France based on a novel core genome Multilocus Sequence Typing (cgMLST) specific to Y. enterocolitica species. This method can reliably identify the pathogenic Y. enterocolitica subspecies and compare the isolates with a high discriminatory power. Between 2017 and 2021, 5,145 pathogenic isolates belonging to 8 lineages were characterized and lineage 4 was by far the most common followed by lineage 2/3-9b. A clustering program was implemented, and detection thresholds were cross-validated by the molecular and epidemiological investigation of three unusual groups of Y. enterocolitica infections. The routine molecular surveillance system has been able to detect genomic clusters, leading to epidemiological investigations.

Nirsevimab Effectiveness Against Cases of Respiratory Syncytial Virus Bronchiolitis Hospitalised in Paediatric Intensive Care Units in France, September 2023-January 2024.

In September 2023, France was one of the first countries that started a national immunisation campaign with nirsevimab, a new monoclonal antibody against respiratory syncytial virus (RSV). Using data from a network of paediatric intensive care units (PICUs), we aimed to estimate nirsevimab effectiveness against severe cases of RSV bronchiolitis in France. We conducted a case-control study based on the test-negative design and included 288 infants reported by 20 PICUs. We estimated nirsevimab effectiveness at 75.9% (48.5-88.7) in the main analysis and 80.6% (61.6-90.3) and 80.4% (61.7-89.9) in two sensitivity analyses. These real-world estimates confirmed the efficacy observed in clinical studies.

Effect of gender on the association between weight status and health-related quality of life in adolescents.

BACKGROUND: Some studies have investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among adolescents, but their results have been discrepant and few paid attention to the role of gender. The present investigation aimed to assess the relationship between weight status and HRQoL in adolescents and to verify whether it was similar in boys and girls. METHODS: Five thousand two hundred and twenty six adolescents aged 14 to 18 years were included in the PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) trial, a 2x2x2 factorial cluster randomized trial performed in 24 high schools in France. Sociodemographic, anthropometric and HRQoL data were collected. BMI was categorized in four classes (thin, normal-weight, overweight, obese). Linear regression models were used to estimate the association between weight status and HRQoL, adjusting for confounders. RESULTS: The mean age of adolescents was 15.7±0.6 years and their mean BMI was 21.6 ±3.5 kg/m2; 55% were girls. Boys were more often overweight and obese than were girls (overweight: 15.6% vs 14.2%, obese: 4.8% vs 3.3%), and girls were more likely to be thin (5.5% vs 4.5%, p=0.0042). All HRQoL scores were higher for boys (p=<0.0001). Weight status was not associated with physical and social scores neither in boys nor in girls. Conversely, it was associated with mental score, but differently in girls than boys. As compared with normal-weight girls, thin girls had better mental HRQoL (ß=+6.17, p=0.0010), and overweight and obese girls had lower mental HRQoL (ß=-3.89 and ß=-5.90, respectively, p<0.001). Mental HRQoL was lower for thin, overweight and obese boys than for normal-weight boys (ß= -4.97, ß= -1.68 and ß= -3.17, respectively, p<0.0001). CONCLUSIONS: Gender can modify the association between weight status and HRQoL in adolescents. Body image could be an important target of public health programs to improve subjective health during adolescence.

Association of perceived environment with meeting public health recommendations for physical activity in seven European countries.

BACKGROUND: This study investigates the association of perceived environment and meeting the current public health recommendations (PHRs) for physical activity (PA) and examines the role of body mass index (BMI) in this relation. METHODS: A total of 4231 subjects (>or=18 years), from seven European countries, were involved in a cross-sectional survey. PA was measured by the International PA Questionnaire, and specific questions about perceived environment for PA were added. RESULTS: Adults with high personal motivation were more likely to meet PHRs for PA than those without motivation (odds ratio [OR] 1.79; 95% confidence interval [CI] 1.50-2.14). Participants perceiving high social support from work or school were more likely to meet PHRs for PA than those without this support (OR 1.60; 95% CI 1.30-2.00). Likewise, those with perceived opportunities for PA were more likely to meet PHRs than those without this perception (OR 1.23; 95% CI 1.02-1.50). BMI had no effect on meeting PHRs for PA. CONCLUSION: The study shows a relation between personal motivation and some aspects of social and physical environment in meeting current PHRs for PA. Future research involving an objective environment to meet PHRs for PA should be undertaken to validate these findings.

Process evaluation of a school-based overweight and obesity screening strategy in adolescents.

The PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) trial highlights the effectiveness of implementing a screening strategy in high schools to prevent overweight/obesity among adolescents. The strategy comprises three steps: i) body measurements to detect overweight/obese adolescents, ii) a medical interview with each adolescent identified to discuss the findings, and iii) an adapted care management consisting of seven group educational sessions. A process evaluation was conducted in the PRALIMAP trial to assess the effective implementation of the screening strategy activities, and the participation of adolescents and school professionals in them, from a qualitative and a quantitative point of view. The present paper describes the process and the implementation of the screening strategy as performed in the PRALIMAP trial, and discusses the feasibility of such an intervention in high school settings. The ability of nurses to explain the screening results improved with the addition of specialist support. The ability of adolescents to take part in the screening strategy improved when the adapted care management was conducted inside schools and could be increased even further if the waiting time between the three steps could be minimised.

Overweight and obesity prevention for adolescents: a cluster randomized controlled trial in a school setting.

BACKGROUND: Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority. PURPOSE: To evaluate the 2-year effectiveness of three strategies aimed at preventing overweight and obesity among adolescents in a high school setting. DESIGN: PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006-2009 and analyzed in 2009-2011. SETTING/PARTICIPANTS: A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial. INTERVENTIONS: The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of "healthy" dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management). MAIN OUTCOMES MEASURES: The main outcome of interest was BMI; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes. RESULTS: Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI (p=0.0303); a 0.04 greater decrease in BMI z-score (p=0.0173); and a 1.71% greater decrease in overweight/obesity prevalence (p=0.0386). Education and environment strategies were not more effective than no strategy intervention. CONCLUSIONS: Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT00814554.

PRALIMAP: study protocol for a high school-based, factorial cluster randomised interventional trial of three overweight and obesity prevention strategies.

BACKGROUND: Given the increase in overweight and obesity prevalence in adolescents in the last decade, effective prevention strategies for these conditions in adolescents are urgently needed. The PRALIMAP (Promotion de l'ALImentation et de l'Activité Physique) trial aims to evaluate the effectiveness for these conditions of 3 health promotion strategies--educational, screening and environmental--applied singly or in combination in high schools over a 2-year intervention period. METHODS: PRALIMAP is a stratified 2 × 2 × 2 factorial cluster randomised controlled trial including 24 state high schools in Lorraine, northeastern France, in 2 waves: 8 schools in 2006 (wave 1) and 16 in 2007 (wave 2). Students entering the selected high schools in the 4 academic years from 2006 to 2009 are eligible for data collection. Interventional strategies are organized over 2 academic years. The follow-up consists of 3 visits: at the entry of grade 10 (T0), grade 11 (T1) and grade 12 (T2). At T0, 5,458 (85.7%) adolescents participated. The educational strategy consists of nutritional lessons, working groups and a final party. The screening strategy consists in detecting overweight/obesity and eating disorders in adolescents and proposing, if necessary, an adapted care management program of 7 group educational sessions. The environmental strategy consists in improving dietary and physical activity offerings in high schools and facilities, especially catering. The main outcomes are body size evolution over time, nutritional behaviour and knowledge, health and quality of life. An evaluation process documents how each intervention strategy is implemented in the schools and estimates the dose of the intervention, allowing for a per protocol analysis after the main intention-to-treat analysis. DISCUSSION: PRALIMAP aims at improving the prevention and management of overweight and obesity in adolescents by translating current evidence into public health practice. Particular attention is paid to clustering, multiple factorials and long-term duration to address common pitfalls in health promotion trials. The results should inform how best to implement, in a school environment, effective nutrition prevention programs targeting adolescents who are at a point their lives when they develop responsibilities and empowerment for health attitude behaviours. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov under NCT00814554.

Association between leisure-time physical activity and health-related quality of life changes over time.

OBJECTIVE: This study aimed to assess whether changes in leisure-time physical activity over 3 years are associated with changes in health-related quality of life. METHOD: Among the adults enrolled in the Supplementation en Vitamines et Minéraux Antioxidants study in France, 3891 completed the Modifiable Activity Questionnaire to assess leisure-time physical activity and the Medical Outcomes Study 36-item Short-Form to assess health-related quality of life in 1998 and 2001. Multivariate analyses involving logistic and linear regressions determined the association between changes in leisure-time physical activity and changes in health-related quality of life. RESULTS: Over 3 years, increased leisure-time physical activity was associated with high scores in health-related quality of life dimensions: physical functioning, mental health, vitality for both sexes as well as social functioning for women only. An increase of 1 h per week of leisure-time physical activity was associated with a 0.17- and 0.39-point increase in the vitality dimension in men and women, respectively. The mental component score was also increased in women increasing their leisure-time physical activity. CONCLUSION: The long-term association between leisure-time physical activity and health-related quality of life changes is limited and has little clinical significance, especially for men and for the physical health-related quality of life dimensions. The long-term association needs to be further explored before formulating public health recommendations.

Leisure time physical activity and health-related quality of life.

BACKGROUND: There are few data on the relationship between health-related quality of life (HRQoL) and leisure time physical activity (LTPA) in the general population. We investigated the relationships of meeting public health recommendations (PHR) for moderate and vigorous physical activity with HRQoL in French adult subjects. METHODS: LTPA and HRQoL were assessed in 1998 in 2333 men and 3321 women from the SU.VI.MAX. cohort using the French versions of the Modifiable Activity Questionnaire (MAQ) and the SF-36 questionnaire, respectively. Relationship between LTPA and HRQoL was assessed using analysis of variance. RESULTS: Results from multivariate analysis showed that meeting physical activity recommended levels was associated with higher HRQoL scores (except in Bodily pain dimension for women): differences in mean HRQoL scores between subjects meeting or not PHR ranged from 2.4 (Mental health) to 4.5 (Vitality) and from 2.2 (Bodily pain) to 5.7 (Vitality) for women and men, respectively. CONCLUSIONS: Subjects meeting PHR for physical activity had better HRQoL than those who did not. Our data suggest that 30' of moderate LTPA per day on a regular basis may be beneficial on HRQoL. Higher intensity LTPA is associated with greater HRQoL. This emphasizes the importance to promote at least moderate physical activity.

Prediction of liver fibrosis in patients with features of the metabolic syndrome regardless of alcohol consumption.

The aim of this study was to determine noninvasive predictive factors of significant liver fibrosis in patients with increased serum aminotransferases associated with features of metabolic syndrome (abdominal obesity, systemic hypertension, fasting hyperglycemia, and dyslipidemia). One hundred seventy-three patients were prospectively examined, regardless of alcohol consumption. Biometric, metabolic, and hepatic biochemical variables were tested for association with fibrosis assessed on liver biopsy according to the Metavir score system. Significant fibrosis, defined as Metavir scores F2, F3, or F4, was observed in 42 of 173 patients (24%). A logistic regression model and receiver operating characteristic curve were used to construct a simple index predictive of significant fibrosis. None of the patients with serum hyaluronate levels of 35 microg/L or less had significant fibrosis. In patients with serum hyaluronate levels >35 microg/L, no case of fibrosis stage F3 or F4 was found when serum carbohydrate-deficient transferrin/transferrin ratio was less than 0.9. In conclusion, in patients with increased serum aminotransferases associated with features of metabolic syndrome, a simple algorithm, including serum hyaluronate and serum carbohydrate-deficient transferrin/transferrin ratio, allows the exclusion of clinically relevant hepatic fibrosis, regardless of current or past alcohol consumption.