School, behavior and health-related difficulties in early adolescents with contraceptive consultation: a population-based study in eastern France.

BACKGROUND: Early adolescence (10-16 years) is a crucial period for physical, mental and cognitive development where a wide range of school, behavior and health-related difficulties may occur. These issues may be aggravated in adolescents with early affective/sexual live and contraceptive consultation. This study assessed the risk of school, behavior and health-related problems among younger boys and girls having a contraceptive consultation. Such knowledge would inform care providers about their main role in monitoring and caring adolescent problems. METHODS: This cross-sectional study included 1559 middle-school adolescents from north-eastern France (mean age 13.5±1.3). They completed a questionnaire gathering socioeconomic features, obesity, school difficulties, substances use, physical health, psychological health, social relationship, violence, sexual abuse, and suicide behaviors. Data were analyzed for each gender separately using logistic regression models. RESULTS: The contraceptive consultation concerned 6.7% of girls and 3.2% of boys (P=0.002). Based on Odds Ratio (adjusted for age, school-class level and socioeconomic factors), both boys and girls with contraceptive consultation had 2-to-7-time higher risk of consumption of alcohol, tobacco, cannabis and other drogues, poor physical health, relational problems, and perpetrated violence. Additionally, the girls had a 4-time higher risk of low academic-performance and obesity while the boys had 6-to-37-time higher risk of sexual abuse, school dropout ideation, suicide ideation and suicide attempts. CONCLUSIONS: Although based on self-reported data, we found that primary care providers play a prominent role in detecting and monitoring school, behavior and health-related problems during adolescent contraceptive consultations.

Impact of smoking on cardiovascular risk and premature ageing: Findings from the STANISLAS cohort.

BACKGROUND AND AIMS: Smoking may lead to premature ageing, but the impact on the cardiovascular system and circulating proteins needs further investigation. In the present study, we aim to understand the impact of smoking on heart and vessels and circulating biomarkers of multiple domains including cardiovascular damage, premature ageing and cancer-related pathways. METHODS: The STANISLAS Cohort is a longitudinal familial cohort with detailed cardiovascular examination and biomarker assessment. This study included all the participants enrolled in the fourth visit of the STANISLAS Cohort for whom information on smoking habits was available (n = 1696). We assessed pulse wave velocity, intima-media thickness, echocardiographic parameters and a total of 460 proteins to study the association of circulating plasma proteins with smoking status (never vs. past vs. current smoking) while adjusting for potential confounders. RESULTS: Current smokers were approximately 18 years younger but had higher left ventricular mass index (LVMi) and similar pulse wave velocity (PWV), carotid intima media thickness (cIMT), frequency of hypertension, diabetes and carotid plaques compared to the much older never smokers. After multivariate selection, 25 proteins were independently associated with current or past smoking. Current smoking was strongly associated with higher levels of EDIL-3, CCL11, TNFSF13B, KIT, and lower levels of IL-12B and PLTP (p < 0.0001) while past smoking was associated with FGF-21, CHIT1, and lower levels of CXCL10, IL1RL2 and RAGE (p < 0.01). CONCLUSIONS: Current smoking is associated with signs of early onset of cardiovascular ageing and protein biomarkers that regulate inflammation, endothelial function, metabolism, oncological processes and apoptosis.

Perceptions of Antibiotic Use and Resistance: Are Antibiotics the Dentists' Anxiolytics?

BACKGROUND: Antibiotic resistance is a global health crisis. The aim of this study was to explore dentists' perceptions of antibiotic resistance. METHODS: A qualitative method was used. Seventeen dentists practising in the Nancy (Lorraine, France) region were surveyed. They were general practitioners or specialised in oral surgery, implantology, or periodontology. The practitioners took part in semi-structured interviews between September 2019 and July 2020. All of the interviews were transcribed in full and analysed thematically. RESULTS: Four major themes have been selected: attitudes of the dentists in regard to the guidelines, clinical factors that influence prescriptions, non-clinical factors that influence prescriptions, and the perception of antibiotic resistance. The dentists stated that they were very concerned regarding the public health issue of antibiotic resistance. However, they often prescribe according to their own interests and habits rather than according to the relevant guidelines. CONCLUSIONS: Although dentists are generally well aware of antibiotic resistance, they often do not adequately appreciate the link between their prescribing habits and the phenomenon of antibiotic resistance. Regular updating of practitioners' knowledge in this regard is necessary, but patients and the general public should also be made more aware of the issue.

PCSK9 Protein and rs562556 Polymorphism Are Associated With Arterial Plaques in Healthy Middle-Aged Population: The STANISLAS Cohort.

Background PCSK9 (Proprotein convertase subtilisin/kexin type 9) binds low-density lipoprotein receptor, preventing its recycling. PCSK9 is a risk predictor and a biotarget in atherosclerosis. The PCSK9-rs562556 variant has been reported as a gain-of-function mutation. The aim of this study was to determine whether the PCSK9-low-density lipoprotein receptor-rs562556 axis is associated with carotid artery plaques between 2 visits separated by almost 20 years in a longitudinal population cohort. Methods and Results The STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux) cohort is a longitudinal familial cohort from the Lorraine region of France. Participants attending 2 visits (visit 1 and visit 4) separated by 18.5 years (mean) were included (n=997). Carotid artery plaques were determined with standardized vascular echography. The mean age of the adult population at visit 1 was 42±5 years. At visit 4, 203 (20.4%) participants had arterial plaques. Participants who developed arterial plaques were older (42.7±5.4 versus 41.7±4.7 years), more often male (60% versus 49%), smokers (29% versus 18%), with diabetes mellitus (6% versus 3%), and higher cholesterol levels (low-density lipoprotein cholesterol, 1.6±0.4 versus 1.5±0.3 g/L) (all P<0.05). The independent factors associated with arterial plaques were age, smoking, and low-density lipoprotein cholesterol. Higher PCSK9 levels were associated with arterial plaques on top of the clinical model (odds ratio, 2.14; 95% CI,= 1.28-3.58); the missense mutation coding the single-nucleotide polymorphism rs562556 was associated with both higher PCSK9 concentration and incident carotid arterial plaques. Conclusions Higher PCSK9 concentration was associated with the development of arterial plaques almost 20 years in advance in a healthy middle-aged population. Mutations of the single-nucleotide polymorphism rs562556 associated with both PCSK9 levels and arterial plaques reinforce the potential causality of our findings. PCSK9 inhibitors could be useful for primary cardiovascular prevention.

Spécificités du traitement médicamenteux antihypertenseur chez la femme.

The impact of antihypertensive drugs on blood pressure does not differ according to the sex. There are women-specific conditions or medical conditions encountered more frequently among womens that guide the selection of therapy such as a desire to become pregnant, a pregnancy, a polycystic ovarian syndrome, breast cancer, osteoporosis or migraine.

Health-related determinants of undiagnosed arterial hypertension: a population-based study.

BACKGROUND: Undiagnosed arterial hypertension is frequent. Whether it is associated with gender and the absence of cardiovascular-disease warning signs is unknown. Knowledge of the features of undiagnosed-hypertension subjects may help their identification in primary care. OBJECTIVE: To examine whether gender, alcohol consumption, smoking status, health status, cardiovascular diseases/diabetes, familial hypertension history, anti-cholesterol treatment, GP-consultation frequency, body mass index (BMI), waist circumference and metabolic measurements were associated with having undiagnosed hypertension among hypertensive subjects. METHODS: This population-based study included 281 hypertensive adults (aged 50-76 years): 222 subjects with diagnosed and treated-hypertension and 59 undiagnosed-hypertension subjects (no hypertension history, office and 24-h ambulatory blood pressures ≥140/90 and ≥130/80 mmHg, respectively). Subjects' characteristics, clinical and biological measurements, health problems and blood pressures were collected. Data were analyzed using adjusted odds ratios (OR) computed with multivariable logistic regression models. RESULTS: Undiagnosed-hypertension represented 21% of hypertensive subjects. Multivariable logistic regression modeling showed that five risk factors were associated with undiagnosed-hypertension among hypertensive subjects: male gender (OR = 4.61, P < 0.001), no cardiovascular diseases/diabetes (OR=8.51, P < 0.001), no familial hypertension history (OR = 3.15, P = 0.002), number of GP consultations per year (3+, 1-2, and 0; OR = 3.18 per 1-category increase, P < 0.001), and lower waist circumference (OR = 1.05 per 1-cm decrease, P = 0.002). Living alone, alcohol consumption, health status, anti-cholesterol treatment, BMI, and blood glucose were also significant factors (P < 0.05) in bivariate analysis. CONCLUSION: Undiagnosed-hypertension subjects exhibit specific features associated with their hypertension awareness. These findings help understand undiagnosed-hypertension risk patterns and enable better identification of affected subjects for lifestyle management and care.

Memory Alterations and White Matter Hyperintensities in Elderly Patients With Hypertension: The ADELAHYDE-2 Study.

OBJECTIVES: The longitudinal ADELAHYDE-2 study aims to identify the factors associated with cognitive impairment/decline and white matter hyperintensities burden. METHODS: Longitudinal single-center study comprising two visits separated by approximately 7 years. A total of 131 patients completed the two visits. The primary outcome was global memory composite scale, while the secondary outcome was white matter hyperintensities (WMH/Fazekas scale) load. RESULTS: Global memory at visit 2 (V2) was largely influenced by age, smoking status, glycated hemoglobin, and history of stroke already present at visit 1 (V1). These variables accounted for ∼51% of the memory alterations at V2. WMH at V2 was likely influenced by age, left ventricular hypertrophy, diabetes mellitus, carotid intima-media thickness, and body mass index at V1. These findings accounted for ∼37% of the WMH changes at V2. Increase in pulse wave velocity from V1 to V2 showed a trend for association with memory deterioration (adjusted estimates = 0.06; P = .067), whereas smoking and increase in systolic blood pressure (trend) were associated with an increment in WMH (adjusted estimates = 0.49; P = .047 and adjusted estimates = 0.01; P = .08, respectively). On the other hand, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and statins (trend) were likely to be protective (adjusted estimates for angiotensin-converting enzyme inhibitor/angiotensin receptor blockers = -0.49; P = .049, and adjusted estimates for statins = -0.46; P = .055). CONCLUSIONS: Several readily identifiable factors are associated with memory deterioration and WMH, many of which are potentially modifiable. Interventions aimed to control these risk factors need to be tested prospectively in order to assess their cognitive protective value.

Pragmatic diabetes management in nursing homes: individual care plan.

Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients. Given demands on NH personnel (manager, medical coordinator, nurses, and, at the front line of care provision, the undertrained and overworked carers), coupled with the quasiconstant of high staff turnover, the foundation stone of a patient's diabetes management is an Individual Care Plan (ICP) expressed in layman's language. This document that is opened on the patient's admission aims to make sure that the prescriptions established at admission are followed, notably to ensure correct treatment and adapted, regular monitoring with dates and times when examinations and tests are due. This includes monitoring of the diabetes control (HbA1c and, if necessary, blood and urine glucose) and its complications (cardiovascular disease, hypoglycemia, ocular problems, foot disorders, malnutrition, peripheral neuropathy, kidney failure). A necessary corollary is the training of staff to understand the specificities of caring for a frail patient with diabetes, on what to do in a potential emergency, and how to keep the ICP up to date for consultation by doctors and nurses.

[Official recommendations and guidelines for the management and reimbursement of severe hypertension as a chronic disease]. / Les recommandations et le guide << Affections de longue durée >> dans l'hypertension artérielle sévère.

Severe hypertension is a major cardiovascular and cerebrovascular risk factor and places the patient in the category of high cardiovascular risk, independently of any other cardiovascular risk factors. The economic burden of hypertension is high, with severe hypertension the 4th most costly disease (5.5 billion Euros) on the French list of chronic diseases ("Affections de longue durée" or ALD) for which the national health insurance funds reimburse 100% of expenses. The French High Health Authority recently suggested removing hypertension from the ALD list. This recommendation, however, had no scientific rationale but was motivated instead by economic and political factors and may endanger the quality of management of hypertensive patients. The previous ALD criteria for severe hypertension require revision to bring them into line with the recommendations of professional and learned societies. The ALD list should include severe hypertension as well as complicated and treatment-resistant hypertension, with the diagnosis documented by ambulatory or self blood pressure monitoring.