Risk factors for return visits and rehospitalizations to the child emergency psychiatric unit: A retrospective study over 2 years at Saint-Étienne University Hospital.

PURPOSE: This retrospective study aimed to achieve a better understanding of risk factors leading children and adolescents hospitalized in an emergency psychiatric ward to return visits, and to propose preventive devices. METHOD: From January 2, 2010 through February 29, 2012, 180 children and adolescents younger than 17 years were hospitalized in a total of 261 stays in the emergency psychiatric ward of University hospital of Saint-Étienne (France). We assessed clinical and sociodemographic characteristics of these patients and traced any of their return visits to the same unit through December 31, 2012. Risk factors for patients' repeated visits were calculated using multivariate analysis, and the cumulative incidence of returns using the Kaplan-Meier method for censored data. We used confidence interval of relative risk, considering 0.05 to reflect significance. RESULTS: Over the 2 years of the study, 77 (42.8%) of the 180 patients revisited the emergency psychiatric ward; 62 (80.7%) of these required further hospitalizations. Multivariate analysis linked the patients' psychiatric history (RR=2.5) and pursuit of vocational education (RR=4) with the risk of return. Return visits rose from 27.2% at 6 months to 41.2% at 2 years. CONCLUSION: Knowledge of risk factors would allow implementation of secondary or tertiary preventive devices. Students could undergo early screening of psychiatric pathologies using mobile screening teams which would save money, avoid hospitalizations, and when necessary, facilitate both hospitalization and return visits.

[Neuro-anatomic activations of prepotent responses in schizophrenia in Hayling's task]. / Inhibition des réponses automatiques au test du Hayling dans la schizophrénie.

OBJECTIVES: In schizophrenia, alteration in the prefrontal cortex can induce some deficiencies of the executive functions, and among them errors in inhibition of prepotent responses. This type of inhibitory processes was called "restraint function" by Hasher et al. It implies a conscious and voluntary inhibition which demands attentional resources. Among the tasks exploring this function, the Hayling completion sentence task (Burgess and Shallice) appears to be the most specific. Moreover, healthy subjects performing this task in functional magnetic resonance imaging (fMRI) show activation of the prefrontal cortex. In this study, we investigated inhibitory processes in schizophrenic patients using two versions of the Hayling completion sentence task, a behavioural version and an fMRI version in order to assess both performance levels and brain correlates of inhibitory processes. METHODS: Forty-eight schizophrenic participants according to DSM-IV, (mean age: 32.8, S.D. 7.7), stabilized for at least one month, receiving antipsychotic medication and with IQ higher than 70 (mean: 96.86, S.D. 20.67) and education level (mean: 11.15, S.D. 3.26) participated in the behavioural study. They were matched on age (mean: 33.8, S.D. 7.6) and education level (mean: 12.28, S.D. 2.87) with thirty-two healthy controls. Nineteen of schizophrenic participants (mean age: 33, S.D. 6.9 and IQ: 99, S.D. 10.74) were assessed by an fMRI adaptation of the Hayling task, matched with 12 controls (mean: 33.9, S.D. 7.3). All the participants had to perform the Hayling task and a speed accuracy task. The Hayling task consists in sentences for which the last word is missing. In the initiation condition, the participants had to complete the sentence with the appropriate word, whereas in inhibition condition the participants had to complete the sentence with inappropriate and unrelated words. RESULTS: Compared to controls, schizophrenics showed an increased number of errors in the inhibition of prepotent responses associated with increased reaction times, even when considering information processing speed. fMRI results showed fairly similar frontal activations in both groups. Nevertheless, schizophrenic patients presented principally large activations in dorsolateral and ventrolateral frontal cortex, the superior frontal sulcus, the frontal pole and the premotor cortex, and stronger activations (bilateral) in the posterior parietal cortex. Control subjects demonstrated a network of deactivated brain regions whereas the schizophrenics did not. DISCUSSION: Our results are in favour of poorer efficacy of restraint function, sometimes comprising impairment of inhibitory processes inducing errors in schizophrenics. This deficiency might be considered as insufficiency in attentional resources and/or in working memory. Hence patients cannot simultaneously restrain prepotent response and find appropriate controlled strategy for correct completion of the task. Moreover, bilateral patterns of parietal hyperactivation and absence of patterns of deactivation seem also in favour of an attentional hypothesis. The Hayling task might be interesting for assessment of inhibitory processes in schizophrenia.

Quality assessment in surgical care departments: proposal for a scoring system in terms of structure and process.

OBJECTIVE: To build a score able to reflect and rank surgical departments according to a definition of "quality" in terms of structure and process. METHODS: Collaborative design of a quality score in the framework of the French clinical research project NosoQual. Feasibility and observational study in 46 surgical departments visited between November 2002 and March 2003 according to standardised procedures. A bibliographic review followed by expert consultations, a field test, analysis and a final reconsideration leading to the definition of a consensual score. RESULTS: 138 variables comprised the score. They were classified into seven dimensions, each representing a different aspect of quality of care in surgery. According to the threshold and weight attributed to every variable, scores were calculated for each department. The average level of achievement of the scores varied from 42% to 71% of theoretical maxima. The variability of the scores related to the seven dimensions was larger and more significant than the one expressed by the overall score (coefficient of variation=0.1). CONCLUSION: This analytical work contributed to the design of a quality score for surgery. However, the progress of the score should continue to take into account all the obstacles that were observed and to meet the high requirements of the actual patient safety issue.

ViralORFeome: an integrated database to generate a versatile collection of viral ORFs.

Large collections of protein-encoding open reading frames (ORFs) established in a versatile recombination-based cloning system have been instrumental to study protein functions in high-throughput assays. Such 'ORFeome' resources have been developed for several organisms but in virology, plasmid collections covering a significant fraction of the virosphere are still needed. In this perspective, we present ViralORFeome 1.0 (http://www.viralorfeome.com), an open-access database and management system that provides an integrated set of bioinformatic tools to clone viral ORFs in the Gateway(R) system. ViralORFeome provides a convenient interface to navigate through virus genome sequences, to design ORF-specific cloning primers, to validate the sequence of generated constructs and to browse established collections of virus ORFs. Most importantly, ViralORFeome has been designed to manage all possible variants or mutants of a given ORF so that the cloning procedure can be applied to any emerging virus strain. A subset of plasmid constructs generated with ViralORFeome platform has been tested with success for heterologous protein expression in different expression systems at proteome scale. ViralORFeome should provide our community with a framework to establish a large collection of virus ORF clones, an instrumental resource to determine functions, activities and binding partners of viral proteins.

[Preliminary comparative study of the personality disorder evaluation DIP instrument with the semi-structured SCID-II interview]. / Etude préliminaire comparative de l'instrument d'évaluation des troubles de la personnalité DIP avec l'entretien semi-structuré SCID-II.

INTRODUCTION: This work deals with the comparative study of two standardised instruments, which can be used to diagnose personality disorders (PD): the SCID-II and the DIP. Each instrument used as a self-questionnaire followed by a semi-structured interview by the same clinician was applied to 21 patients suffering from PD. The DIP (DSM-IV and ICD-10 Personality), which is a recent instrument, consists of a self-questionnaire (DIP-Q) and a semi-structured interview (DIP-I), created by Bodlund and Ottosson. It makes it possible to evaluate PD from criteria based on the DSM-IV as well as the ICD-10. We translated it into French then evaluated it in comparison with another instrument, the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) whose validity was demonstrated by Bouvard. METHOD: For the self-questionnaire (SCID-auto), we used CUNGI'S computerised version. The present version of the semi-structured interview SCID-E (French translation by Bouvard et al.) evaluates the 10 PD of the DSM-IV, the depressive personality and the passive-aggressive personality, included in the DSM-IV appendix B. The DIP-Q questionnaire is made up of 140 right/wrong items referring to the 10 PD of the DSM-IV and the eight disorders of the ICD-10. The DIP-I is the self-structured interview created by Ottosson et al. and it is built on the same pattern as the SCID-II. It provides diagnoses for all DSM-IV and/or ICD-10 PD as well as the schizotypic disorder. The DIP-I is usually preceded by a general "scan" interview in order to assess an existing personality disorder corresponding to Axis I of the DSM-IV or the ICD-10. In our study, we substituted a Mini International Neuropsychiatric Interview (MINI) questionnaire for this interview. Twenty-four patients suffering from one or several PD were chosen among ambulatory or out-patients by clinicians from the Saint-Etienne Psychiatric University Hospital Center. The diagnosis was not revealed to the examiner during the study. The subjects filled in the DIP-I and the SCID-II self-questionnaires. The answers to each test were first processed through a computer, then the patients were seen over the following weeks for the DIP-I and SCID-II semi-structured interviews. For both questionnaires, we only explored the diagnostic categories reaching pathological level (as was recommended by the authors). Considering the small number of patients involved, we used nonparametric tests: Wilcoxon test, Mac Nemar test and the Kappa. RESULTS: As far as the self-questionnaire results are concerned, we noticed important differences for the schizoid and the schizotypic PD between the DIP-Q (ICD) and the DIP-Q (DSM). The most represented PDs are the paranoiac, borderline, avoiding and obsessional personalities. After the semi-structured interviews, it appears that only 30 to 50% of the diagnoses obtained through self-evaluation were confirmed (with the exception of the schizotypic personality and the antisocial personality for the SCID with perfect agreement between self and clinical evaluation). Globally, the agreement between diagnosis by self-evaluation and diagnosis by semi-structured interview is not very satisfactory. Finally, a cluster analysis of the results of the three semi-structured interviews put together reveals that five patients show at least one PD diagnosed in the three clusters, two have no diagnosis, six patients have one or several PDs in clusters B and C, three patients have some in clusters A and C, and five patients only have some in cluster C. Our results lead to several remarks: the size of our group is small, but it must be pointed out that the investigations for each patient took about three hours, which made it difficult for the patients to agree when the clinicians proposed the study; three patients originally included could not be evaluated because of suicidal behaviour. In their self-administered form, the SCID and the DSM version of the DIP-Q broadly diagnose a little more than three PDs per patient, whereas the ICD version of the DIP-Q diagnoses more than five. The administration of semi-structured interviews leads to an average of 1.3 diagnosis for the DIP-Q DSM-IV and 1.6 for the ICD against 1.9 PD for the SCID interview. These results correspond to the literature data. There are differences between the SCID and the DIP-I, as regards to the way they were used: the SCID-II makes it necessary to repeat the questions positively answered in the self-questionnaire, whereas the DIP-I explores all the criteria of the whole diagnosed PD, which may favour the inclusions. Concerning other instruments compared to the SCID-II in the international literature, our results with the DIP are globally satisfactory. CONCLUSION: The results must be interpreted with some care, considering the small number of patients. Important discrepancies were noticed between the diagnoses obtained through self-evaluation and the semi-structured interview, mainly for the A and C personality clusters of the DSM-IV, showing the tests to be extremely sensitive, but not specific enough for detection. However, the agreement between both instruments referring to the DSM-IV is satisfactory. The main interest of our work was to make the first French translation of the DIP known and to compare it to another instrument, which has often been evaluated previously.

Hepatitis C virus infection protein network.

A proteome-wide mapping of interactions between hepatitis C virus (HCV) and human proteins was performed to provide a comprehensive view of the cellular infection. A total of 314 protein-protein interactions between HCV and human proteins was identified by yeast two-hybrid and 170 by literature mining. Integration of this data set into a reconstructed human interactome showed that cellular proteins interacting with HCV are enriched in highly central and interconnected proteins. A global analysis on the basis of functional annotation highlighted the enrichment of cellular pathways targeted by HCV. A network of proteins associated with frequent clinical disorders of chronically infected patients was constructed by connecting the insulin, Jak/STAT and TGFbeta pathways with cellular proteins targeted by HCV. CORE protein appeared as a major perturbator of this network. Focal adhesion was identified as a new function affected by HCV, mainly by NS3 and NS5A proteins.

[Legal and ethical implications in the protection of data collected from electronic medical records and used for epidemiological statistics and surveillance: a situational analysis]. / Les aspects juridiques et éthiques de la protection des données issues du dossier médical informatisé et utilisées en épidémiologie: un point de la situation.

With the emergence of new information and communication technologies (NICT) in the daily practice of medicine, personal medical data have become exportable. Certainly, they represent an interesting source for epidemiologists who were often lacking complete data sets all the way through to morbidity data; but once these data leave the confines of the structure of a medical office, they must be protected in order to respect the fundamental ethical principles which form the basis of the doctor-patient relationship. Given the fact that medical data are not considered merchandise, there is the need to lead a process of reflection which aims to adapt the existing ethical rules and regulations to norms which conform to this new environment. There is also a need to compile a report on the overall European situation, and more specifically the French case.

[Baker and Itagliata's Quality of Life Scale in a group of 139 schizophrenic patients: factorial analysis and evaluation of global validity]. / L'échelle de qualité de vie de Baker et Intagliata dans un groupe de 139 schizophrènes: analyse factorielle et examen de la pertinence de l'utilisation d'une note globale.

The Satisfaction with Life Domains Scale SLDS published by Baker and Intagliata in 1982 and translated in French by Chambon and al. is one of the most used rating scales in the field of Subjective Quality of Life (SQL) for patients suffering from schizophrenia. It comprises 16 scales in 7 points and Likert format exploring the following fields: home/apartment/place of residence, neighbourhood, food, clothes, health, people they live with, friends, love life, relationships with their family, how they get on with other people, job/work day programming, spare time, what they do in the community for fun, services and facilities in their area, economic situation, general quality of life. In this study we present results on SLDS about 139 schizophrenic patients (108 males, 31 females) recruited in two centers Lyon (n = 41) and Saint-Etienne (n = 98). The SLDS was a part of more comprehensive studies including evaluation of needs for care, social support, delivery and costs of services. Diagnosis were confirmed using either the SCAN and CATEGO program (n = 108) or the list of the ICD-10 criteria (n = 31) applied at time of inclusion or on the basis of a representative episode of the illness. Patients were classified in two groups, the S group (S, n = 53) for those patients presenting clinical features at time of inclusion excepted residual forms (F 20.5) and the non S group (N-S, n = 86) for those patients free of symptoms at the time of assessment. Non parametric statistics (U test and Kendall test) were used for comparisons between groups. The field by field comparison of the scores shows the poorest level of SQL for love life (m = 4.2; sd = 1.8) and economic status (m = 4.4; sd = 1.8). Comparisons between S and non-S groups show an average range systematically higher for the non-S group and significant differences for the following fields: food, friends, how they get on with other people. The same comparisons between males and females show no significant differences excepted for the following fields: love life, economic situation. Principal components analysis with Varimax rotation were performed and a 4 factors solution was considered as the best one. Before rotation the first factor accounts for 31% of the variance and comprises all the items with loading higher than 0.4 allowing us to consider the possibility of a global score. This global score is normally distributed (m = 95.1 sd = 17.3) and shows a significant difference between S and non S-groups (S m = 92.2 sd = 20.1; non S m = 99.6 sd = 15.4 p = .02) but not between centers and between males and females. After rotation the first factor comprises relationships with family, how they get on with other people, job/work/day programming, spare time, what they do for fun and life in general. The hypothesis of unidimensionality of QV has to be tested using the RASCH model.

Factorial structure of the 20-item Toronto Alexithymia Scale: confirmatory factorial analyses in nonclinical and clinical samples.

OBJECTIVE: The 20-item Toronto Alexithymia Scale (TAS-20) measures three intercorrelated dimensions of alexithymia: (1) difficulties identifying feelings (DIF), (2) difficulties describing feelings (DDF), and (3) externally oriented thinking (EOT). The aim of the study was to test the three-factor model of the TAS-20 using confirmatory factorial analyses (CFA). METHOD: 769 healthy subjects and 659 patients meeting the DSM-IV criteria for substance use disorders or eating disorders completed the TAS-20. The correlation matrices for each of the samples were analyzed with LISREL 7.16. RESULTS: In each sample, the three-factor model was found to be replicable. CONCLUSION: The three TAS-20 subcales can be used to explore the distinct facets of the alexithymia construct.

Spatial, temporal and subcellular localization of islet-brain 1 (IB1), a homologue of JIP-1, in mouse brain.

Islet-brain 1 (IB1) was recently identified as a DNA-binding protein of the GLUT2 gene promoter. The mouse IB1 is the rat and human homologue of the Jun-interacting protein 1 (JIP-1) which has been recognized as a key player in the regulation of c-Jun amino-terminal kinase (JNK) mitogen-activated protein kinase (MAPK) pathways. JIP-1 is involved in the control of apoptosis and may play a role in brain development and aging. Here, IB1 was studied in adult and developing mouse brain tissue by in situ hybridization, Northern and Western blot analysis at cellular and subcellular levels, as well as by immunocytochemistry in brain sections and cell cultures. IB1 expression was localized in the synaptic regions of the olfactory bulb, retina, cerebral and cerebellar cortex and hippocampus in the adult mouse brain. IB1 was also detected in a restricted number of axons, as in the mossy fibres from dentate gyrus in the hippocampus, and was found in soma, dendrites and axons of cerebellar Purkinje cells. After birth, IB1 expression peaks at postnatal day 15. IB1 was located in axonal and dendritic growth cones in primary telencephalon cells. By biochemical and subcellular fractionation of neuronal cells, IB1 was detected both in the cytosolic and membrane fractions. Taken together with previous data, the restricted neuronal expression of IB1 in developing and adult brain and its prominent localization in synapses suggest that the protein may be critical for cell signalling in developing and mature nerve terminals.

Are depression and denutrition good predictors of dexamethasone suppression test (DST) in anorexia nervosa?

This study was conducted to investigate the corticotropic axis in anorexia nervosa. In 93 female inpatients who met DSM-III-R criteria for anorexia nervosa, subsample (n = 64) with DSM-III criteria was also considered. Using stepwise regression analysis, this study examined the relationship between independent variables ie, age, body mass index, scores on depression scales and postdexamethasone serum cortisol, considered as a dependent variable. In patients who met DSM-III criteria, 16.7% of the variance of serum cortisol can be explained. The main predictors are depressive retardation, emaciation and age. Using stepwise logistic regression the main categorical predictors of the test suppression vs non suppression are of the same nature. The condition of realisation of DST are discussed.

Effect of amifostine on toxicities associated with sequential chemotherapy and radiation therapy for unresectable non-small-cell lung cancer: results of a phase II trial.

PURPOSE: To determine the effect of amifostine on the safety and efficacy of induction chemotherapy with high-dose cisplatin and vinblastine followed by large-field thoracic irradiation to 60 Gy in patients with stage IIIA or IIIB non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Twenty-six patients with unresectable stage IIIA or IIIB NSCLC were entered onto the study between May 1991 and November 1994. Patients received amifostine (740 or 910 mg/m2) followed by cisplatin (120 mg/m2) on days 1 and 29. Vinblastine (5 mg/m2) was given weekly for 5 weeks with no amifostine pretreatment. Following chemotherapy, patients received amifostine (340 mg/m2 4 days a week for 5 weeks, or 200 mg/m2 5 days a week for 6 weeks) 15 minutes before definitive thoracic radiation therapy to a total dose of 60 Gy in 6 weeks. RESULTS: Twenty-five patients were assessable for response and survival. The objective response rate was 60%. One-, 2-, and 3-year survival rates were 55%, 23%, and 23%. There was no grade 3 or greater renal toxicity during chemotherapy or grade 3 or greater esophagitis during radiation therapy. Neutropenia (secondary to vinblastine use) was the only grade 4 toxicity. There were no treatment-related deaths. CONCLUSION: Amifostine can be administered safely with high-dose cisplatin, vinblastine, and radiation therapy for NSCLC. The response rate and survival data provide no evidence that amifostine impairs response to treatment. Amifostine appears to reduce cisplatin-related nephrotoxicity and radiation-induced esophagitis.

[SCL 90 R in a sample of French-speaking subjects free of psychiatric disorders]. / La SCL 90 R dans un échantillon de sujets francophones libres de troubles psychiatriques.

With a sample of 1,331 subjects we form three groups, considering the subjective somatic and psychic state of mind. The first group with a good state may represent the normal subjects N = 780. We else compare here the different groups.

Study of treatment variation in the radiotherapy of head and neck tumors using a fiber-optic on-line radiotherapy imaging system.

On-line radiotherapy imaging systems allow convenient daily acquisition of portal images for treatment verification. The information can also be used to study treatment variability. Using a prototype fiber-optic imaging system, we have measured the treatment variation of 17 head and neck patients. Daily digital portal images were acquired for the on-cord left and right lateral fields. Treatment variations were quantified using the Cumulative Verification Image Analysis (CVIA) method developed at our institute. In the CVIA method, daily portal images were aligned according to three anatomical points predefined on a digitized simulation, or prescription, image. After each image alignment, the block position was cumulated in a bit-map and superimposed on the prescription image to give a cumulative verification summary image. Iso-frequency distributions, or contours, of the block overlap were calculated and examined with respect to the prescription treatment area. The range of the treatment variation was large for the 17 patients. On average, separation of the 0% to 100% block overlap contours was about 10 mm, and the 20% to 80%, 5 mm. The block overlap contours were also used to calculate the frequency with which the prescription area as defined on the simulation film had been treated. The fraction of the prescription area treated depended on the accuracy of the treatment setup and patient repositioning, as expected. At best, approximately 95% of the prescribed area was irradiated 100% of the time during the entire course of radiotherapy. At worst, approximately 70% of the prescribed area was irradiated 100% of the time. These results demonstrate that despite immobilization, large setup variation can still occur. Presenting treatment variation data as population averages does not reflect on the large variation that may be observed in the individual patient.