Mental health care utilization by first responders after Paris attacks.

BACKGROUND: First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC). AIMS: This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris. METHODS: A web-based study was conducted 8-12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC. RESULTS: Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression. CONCLUSIONS: Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.

Who self-medicates? Results from structural equation modeling in the Greater Paris area, France.

OBJECTIVES: Our study aimed to describe the prevalence of self-medication among the Paris adult population and to identify the factors associated with self-medication. MATERIALS AND METHODS: This cross-sectional study was based on data collected from the SIRS cohort (a French acronym for "Health, inequalities and social ruptures") in 2005 in the Paris metropolitan area using a face-to-face administration questionnaire among a representative sample of 3,023 French-speaking adults. Structural equation models were used to investigate the factors associated with self-medication in the overall population and according to income. RESULTS: The prevalence of self-medication in the past four weeks was 53.5% in the Paris metropolitan area. Seven factors were directly associated with self-medication in the structural equation model. Self-medication was found more common among women, young people, in active employment or student, with a high income, but also among people with a health information seeking behavior, with a high daily mobility, and/or with a history of unmet healthcare needs due to economic reasons. When looking at these coefficients according to income, the association between self-medication and daily mobility appeared stronger in the bottom quartile of income whereas it was no longer significant in the rest of the survey population. CONCLUSION: Self-medication is a frequent practice in the Paris metropolitan area. This study confirms the role of some factors found to be associated with self-medication in the literature such as age or gender and draws attention to other factors rarely explored such as daily mobility, especially among people with a low income, or health information seeking behavior.

Emotional and behavioral difficulties in children growing up homeless in Paris. Results of the ENFAMS survey.

PURPOSE: Children growing up in homeless families are disproportionately more likely to experience health and psychological problems. Our objective was to describe social, environmental, individual and family characteristics associated with emotional and behavioral difficulties among homeless children living in the Paris region. METHODS: Face-to-face interviews with a representative sample of homeless families were conducted by bilingual psychologists and interviewers between January and May 2013 (n=343 children ages 4-13 years). Mothers reported children's emotional and behavioral difficulties (Strength and Difficulties Questionnaire [SDQ]), family socio-demographic characteristics, residential mobility, and parents' and children's physical and mental health. Children were interviewed regarding their perception of their living arrangements, friendships and school experiences. We studied children's SDQ total score in a linear regression framework. RESULTS: Homeless children had higher SDQ total scores than children in the general population of France, (mean total score=11.3 vs 8.9, P<0,001). In multivariate analyses, children's difficulties were associated with parents' region of birth (beta=1.74 for Sub-Saharan Africa, beta=0.60 for Eastern Europe, beta=3.22 for other countries, P=0.020), residential mobility (beta=0.22, P=0.012), children's health (beta=3.49, P<0.001) and overweight (beta=2.14, P=0.007), the child's sleeping habits (beta=2.82, P=0.002), the mother's suicide risk (beta=4.13, P<0.001), the child's dislike of the family's accommodation (beta=3.59, P<0.001) and the child's experience of bullying (beta=3.21, P=0.002). CONCLUSIONS: Children growing up homeless experience high levels of psychological difficulties which can put them at risk for poor mental health and educational outcomes long-term. Access to appropriate screening and medical care for this vulnerable yet underserved group are greatly needed.

ERE environment- and cell type-specific transcriptional effects of estrogen in normal endometrial cells.

Our previous results have suggested a repression of E2 (17beta-estradiol) effect on the c-fos gene of cultured guinea-pig endometrial cells. To investigate this repression, the expression of three human c-fos gene recombinants, pFC1-BL (-2250/+41), pFC2-BL (-1400/+41) and pFC2E (-1300/-1050 and -230/+41), known to be E2-responsive in Hela cells, was studied in stromal (SC) and glandular epithelial cells (GEC). In both cellular types, pFC1-BL was not induced by E2, even in the presence of growth factors or co-transfected estrogen receptor. The pattern of pFC2-BL and pFC2E expression was strikingly different and depended on the cellular type: pFC2-BL and pFC2E induction was restricted to the glandular epithelial cells and did not occur in the SCs. We argue for a repression of E2 action which is dependent on the estrogen-responsive cis-acting element (ERE) environment and also cell type-specific involving DNA/protein and/or protein/protein interactions with cellular type-specific factors.

Gene transfer into subcultured endometrial cells using lipofection.

Lipofection using the Lipofectin reagent was optimized to transiently transfect subcultured guinea pig endometrial stromal cells with a beta-galactosidase gene driven by a simian virus 40 promoter. Efficient transfection was obtained in the following conditions: a value of six for the ratio of lipofectin to DNA, a low cellular density (10(5) cells per 35-mm well) at the time of subculture (48 h before lipofection) and a lipofection duration of 12 hours. Lipofection was compared to calcium phosphate precipitation previously optimized in the same culture model. At a low cellular density, the lipofection method was found to be more efficient than the calcium phosphate precipitation. This result gives a great relevance to lipofection since the cultured cells available in an experiment are often limited. Then, using cells at low density and a plasmid containing the chloramphenicol acetyltransferase (cat) gene linked to an estrogen response element, it was shown that the lipofection procedure is a suitable tool for the evaluation of gene regulation by estrogen.

[Regeneration of transplanted human liver: gene expression at the time of graft implantation]. / Régénération du foie humain transplanté: expression génique au moment de l'implantation du greffon.

The liver tissue mRNA expression of protooncogenes c-fos, c-myc, c-Ha-ras, c-met and c-erb B1, and TGF alpha and TGF beta genes is sequentially and temporarily increased in the early stages after partial hepatectomy, ischaemia or other mitogenic stimuli. These gene expressions were studied in 38 samples of liver tissue from 24 patients who underwent orthotopic liver transplantation, at different evolution stages. Eleven samples were obtained from surgical liver biopsies before graft implantation at day 0 (Group A), 14 samples from percutaneous liver biopsies during the post-operative period from day 9 to day 48 (Group B) and 13 samples in the long-term follow-up period from day 102 to day 1,382 (Group C). Gene expression was studied using 32P-labeled cDNA and oligonucleotidic probe hybridization in slot blots. A GAPD gene was used as a control gene. All expression values of protooncogenes were related to those of the GAPD gene. After cold ischaema, the relative gene expression (quantity of specific mRNA/quantity of GAPD mRNA ratio) tended to diminish in most cases. The relative expressions of c-fos, c-myc, c-Ha-ras, c-met and TGF alpha gene were correlated at day 0. During and after the liver transplantation, an overexpression of c-fos, c-myc, c-Ha-ras, c-met and TGF alpha was observed in different pathological conditions such as cold ischaemia and conservation injury, acute rejection, and cytomegalovirus infection. In three cases the relative expression values of c-fos, c-myc and c-Ha-ras increased over long-term follow-up without any associated acute pathology. These results suggest the necessity of an intercellular mediation--by means of graft reperfusion--in induction of hepatocyte proliferation and regeneration of the transplanted liver.

Epidermal growth factor and insulin induce the proliferation of guinea pig endometrial stromal cells in serum-free culture, whereas estradiol and progesterone do not.

Guinea pig endometrial stromal cells were cultured in serum-free medium to assess the effects of growth factors and ovarian steroids on cell proliferation. When the cells were made quiescent by serum depletion, [3H]thymidine incorporation was increased by the addition of insulin plus epidermal growth factor (EGF), reaching a peak after 24 h of stimulation. This effect was dose-dependent. Both factors acted synergistically. Estradiol-17 beta (E2), either alone or with various concentrations of growth factors, had no mitogenic effect. Thus, cell proliferation appeared to be estrogen-insensitive, despite a high level of estrogen receptors (19,000 sites per cell). The integrity of these receptors was checked by transfecting cells with a plasmid containing an estrogen-responsive element linked to a CAT gene: E2-induced CAT activity was reduced by the antiestrogen ICI 164,384. Despite the presence of progesterone receptors, the cells, either primed with E2 or not, were not growth-stimulated by progesterone. E2 had no effect on cells cultured in the presence of dextran-coated charcoal-stripped serum. Thus, whatever the culture conditions, stromal cells with functional estrogen receptors were insensitive to the putative mitogenic effects of E2 and progesterone. However, they were highly responsive to the mitogenic effects of insulin and EGF.

Identification and characterization of an early estrogen-regulated RNA in cultured guinea-pig endometrial cells.

A cDNA library was prepared from quiescent guinea-pig endometrial glandular epithelial cells stimulated for 2 h with estradiol-17 beta (E2) in the presence of cycloheximide. It was screened by differential hybridization for estrogen-regulated sequences. Six recombinants containing E2-regulated sequences were identified. One of them, called gec1 was then characterized by Northern blot hybridization. The gec1 mRNA was 1,800 bases in size. A 2-fold increase in the gec1 mRNA level was achieved at 120 min after E2 treatment. The E2 action on gec1 gene required the presence of cycloheximide. The cloned gec1 cDNA was 1 kb in size. The sequence so far determined did not show similarity with well characterized genes. This is the first report on a cloned cDNA probe of early estrogen-induced mRNA in a primary culture of endometrial epithelial cells.

Transfected endometrial cultured cells: a system to study gene-regulation by estrogens.

Glandular epithelial (GE) and stromal cells were isolated from guinea-pig endometrium, cultured and subcultured separately. At the end of subculture, the purity of each cell population was higher than 95% and cells displayed a high level of estrogen receptors. Calcium phosphate transfection conditions were defined using a control plasmid containing the bacterial CAT gene driven by viral promoter and enhancer sequences. Transfection experiments were performed with other plasmids in which CAT gene was linked to different estrogen response elements (EREs) derived from those of vitellogenin genes. CAT activity was significantly increased by estradiol-17 beta treatment only when GE or stromal cells were transfected with plasmids containing EREs previously reported as functional EREs in other cell types. This induction was abolished by ICI 164,384 diethylstilbestrol was as effective as estradiol-17 beta for CAT induction and estradiol-17 alpha was ineffective. Transiently transfected endometrial cells in subculture are a suitable system to study the estrogen effect on gene regulatory elements.

Superinduction of c-fos gene expression by estrogen in cultured guinea-pig endometrial cells requires priming by a cycloheximide-dependent mechanism.

The c-fos gene expression is rapidly induced by various mitogenic agents and protein synthesis inhibitors in many cell types. Estradiol-17 beta can induce c-fos gene expression in breast cancer cell lines and in the uterus in vivo, but not in cultured guinea-pig endometrial cells. Using this model, we investigated whether a protein synthesis inhibitor, cycloheximide, could induce the c-fos gene and permit a superinduction by estrogens. In the presence of cycloheximide (10 micrograms/ml), protein synthesis was inhibited at 95% within the first hour. From 190 min after the addition of estradiol-17 beta or diethylstilbestrol (10(-8) M) and cycloheximide (10 micrograms/ml), there was a significant increase (ranging from 3- to 5-fold) of the c-fos messenger RNA level (2.2 kilobase in size), compared with the level in cells treated with cycloheximide alone. Nonestrogenic steroid hormones and estradiol-17 alpha were unable to induce c-fos gene expression in the presence of cycloheximide. The effect of estradiol-17 beta observed in the presence of cycloheximide was completely abolished by 4-hydroxy-tamoxifen or by Ly 156758 or by ICI 164384 (10(-6) M). The c-fos mRNAs were rather stable in cells treated with cycloheximide for 2 h (half-life = 51 +/- 6 min) and there was no further increase in the c-fos messenger RNA stability after the addition of cycloheximide plus estradiol-17 beta (half-life = 40 +/- 3 min). The overall results suggest a response at the transcriptional level. In conclusion, cycloheximide transmits activating signals to the c-fos gene which act as priming elements to allow the estrogen action in cultured guinea-pig endometrial cells.

[Action of estradiol-17 beta on the expression of c-Fos gene in endometrial cells in cultured]. / Action de l'estradiol-17 beta sur l'expression de c-fos dans les cellules d'endomètre en culture.

The c-fos expression was investigated in primary culture of guinea-pig endometrial cells. Cells were made quiescent by serum depletion. Stimulation of these cells by estradiol (E2, 10(-8)M) alone or in combination with epidermal growth factor (EGF, 100 ng/ml) or insulin (10 micrograms/ml) failed to induce c-fos gene. The c-fos expression was early and transiently increased by fetal calf serum (15%) or estradiol plus EGF plus insulin. Protein synthesis inhibitors (cycloheximide or anisomycin) in association with E2 induced a superinduction of c-fos gene. In the same conditions puromycin had no effect. It appears that E2 acts in a multiple step process including an initial c-fos gene derepression by either EGF plus insulin or some protein synthesis inhibitors.