[Association between screen time and sleep habits in 11-to-12-year-old French middle school students]. / Associations entre les temps d'écran et les habitudes de sommeil chez des jeunes collégiens.

BACKGROUND: Screen media usage has become increasingly commonplace in daily life with children initiating themselves to screen media at an early age. Given the high prevalence of screen viewing among children worldwide, its impact on children's health has become a cause for concern. Unfortunately, little information on the independent association between sleep habits and screen time in French children is currently available. The main aim of this study was to assess possible relationships between screen time and sleep habits (quality, duration, etc.) among young middle school students in France. METHODS: A total of 448 (55 % girls) 11-to-12-year-olds from 5 schools were included. Body weight and height were measured according to standard procedures and BMI percentiles were determined based on international reference values. Sleep parameters were obtained by sleep diaries and visual estimations. A sleep diary was maintained for one week to record sleeping and waking times and related information. Information on lifestyle habits (sedentary behaviours, physical activity, and dietary intake) was obtained via standardised questionnaires. RESULTS: Participants were 11.5 (±0.4) years of age. From total sample, 25.5 % reported screen time ≥2hours/d during school days and 62.7 % during school-free days. High screen time was associated with significantly poorer sleep habits and these results remained valid after adjustment for several confounding factors (body mass index, sex, center and parental level of educational attainment) (P<0.05). CONCLUSION: This study highlights an association between longer screen time and shorter sleep duration in French middle school students aged 11 to 12 years. Preventive measures on use of and exposure to screens are called for. Further studies are necessary to confirm our findings.

Underestimation and undertreatment of pain in HIV disease: multicentre study.

OBJECTIVE: To measure the prevalence, severity, and impact of pain on quality of life for HIV patients; to identify factors associated with undertreatment of pain. DESIGN: Multicentre cross sectional survey. SETTINGS: 34 HIV treatment facilities, including inpatient hospital wards, day hospitals, and ambulatory care clinics, in 13 cities throughout France. SUBJECTS: 315 HIV patients at different stages of the disease. PATIENTS: recorded presence and severity of pain and rated quality of life. Doctors: reported disease status, estimate of pain severity, and analgesic treatment ordered. RESULTS: From 30% (17/56) of outpatients to 62% (73/118) of inpatients reported pain due to HIV disease. Pain severity significantly decreased patients' quality of life. Doctors underestimated pain severity in 52% (70/135) of HIV patients reporting pain. Underestimation of pain severity was more likely for patients who reported moderate (odds ratio 24) or severe pain (165) and less likely for patients whose pain source was identified or who were perceived as more depressed. Of the patients reporting moderate or severe pain, 57% (61/107) did not receive any analgesic treatment; only 22% (23/107) received at least weak opioids. Likelihood of analgesic prescription increased when doctors estimated pain to be more severe and regarded patients as sicker. CONCLUSIONS: Pain is a common and debilitating symptom of HIV disease which is gravely underestimated and undertreated.

Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in France.

BACKGROUND: Two representative samples of primary care physicians (N = 600) and medical oncologists (N = 300) in France were surveyed about their attitudes toward and knowledge about cancer pain management. METHODS: The survey was conducted by telephone with a questionnaire based on a model developed by the University of Wisconsin-Madison Pain Research Group. It was designed to assess physicians' estimates of the prevalence of pain among patients with cancer, their practice in prescribing analgesics, their training in cancer pain management, and the quality of care received by cancer patients in their own practice and in France. RESULTS: Barriers to adequate cancer pain management are prevalent and consistently more common among primary care physicians than among medical oncologists. Although 85% of primary care physicians and 93% of medical oncologists express satisfaction with their own ability to manage cancer pain, 76% of primary care physicians and 50% of medical oncologists report being reluctant to prescribe morphine for cancer pain. Both groups cite fear of side effects as their main reason to hesitate to prescribe morphine. Concerns about the risk of tolerance (odds ratio [OR], 1.15-2.52), perceptions that other effective drugs are available (OR, 1.11-2.41), perceptions that morphine has a poor image in public opinion (OR, 0.96-2.07), and the constraints of prescription forms (OR, 1.12-2.26) contribute significantly to physicians' infrequent prescription of morphine, as are being female (OR, 1.01-2.03) and being an older oncologist (OR, 1.09-2.51). CONCLUSIONS: This study (1) confirms the existence among French physicians of attitudinal barriers and knowledge deficits previously reported in other countries that can impede cancer pain management, (2) identifies new barriers to the proper prescription of morphine for cancer pain control, and (3) reveals discrepancies in physicians' attitudes and knowledge about pain control which suggest a need for the systematic evaluation of cancer patients' care.

Multicentre study of cancer pain and its treatment in France.

OBJECTIVE: To describe the treatment of cancer pain in France and to evaluate the predictive factors for inadequate management. DESIGN: Multicentre, representative cross sectional survey. SETTING: 20 treatment centres, including cancer centres, university hospitals, state hospitals, private clinics, and one homecare setting (in which patients are supported at home). SUBJECTS: 605 patients with cancer. MAIN MEASURES: Patients rated prevalence and severity of pain and functional impairment related to pain. Doctors reported patients' cancer characteristic, performance status, pain severity, and analgesic drugs ordered. RESULTS: 57% (340/601) of patients with cancer reported pain due to their disease, and, of those with pain, 69% (224/325) rated their worst pain at a level that impaired their ability to function. 30% (84/279) were reported as receiving no drugs for their pain. Of the 270 patients in pain for whom information on treatment was available 51% (137/270) were not receiving adequate pain relief, according to an index based on the World Health Organisation's guidelines. French doctors were found to underestimate the severity of their patients' pain. Younger patients, patients without metastatic disease, patients with a better performance status, and patients who rated their pain as more severe than their doctors did were at greater risk for undertreatment of their pain. CONCLUSIONS: In the light of the high prevalence and the severity of pain among patients with cancer, the assessment and treatment of cancer pain in France remain inadequate, emphasising the need for changes in patient care.