Bone, cognitive, and anthropometric profiles and their relation to fracture sites in fallers: a cross-sectional study.

Risk factors involved in the different osteoporotic fracture locations are not well-known. The results of this study suggest that there is not one typical profile characterising a particular fracture site but that the occurrence of a fracture may result from the combination of different bone, cognitive, and anthropometrics characteristics. PURPOSE: Risk factors involved in the different osteoporotic fracture locations are not well-known. The aim of this study was to identify the differences in bone, cognitive, and anthropometric characteristics between different fracture sites, and to determine whether the site of a fall-related fracture is related to a specific profile. METHODS: One hundred six women aged 55 years and older with a recent fall-related fracture of the hip (n = 30), humerus (n = 28), wrist (n = 32), or ankle (n = 16) were included. Bone, cognitive, and anthropometric characteristics were first compared among the four fracture site groups. Then, a principal component analysis (PCA) was performed and a comparison was made between the four profiles identified by the first two PCA components. RESULTS: The four fracture site groups differed significantly in their education level, bone mineral density (BMD), body mass index (BMI), fear of falling, and number of errors in the Trail Making Test B, an executive function test. Each of the four fracture sites was found in each four PCA profiles, albeit with a different distribution. The profiles differed mainly by bone, cognitive, and anthropometric characteristics, but also by fear of falling. CONCLUSIONS: The fall-related fracture sites differ significantly in anthropometric and bone parameters, in fear of falling and in cognitive abilities. There is not one typical bone, cognitive, and anthropometric profile characterising a particular fall-related site, but rather several possible profiles for a given site. This suggests that the fracture site depends on a combination of several characteristics of the patient.

Psychiatric hospitalisations for people who are incarcerated, 2009-2019: An 11-year retrospective longitudinal study in France.

Background: Despite the poor mental health status of people who are incarcerated, few studies have examined the number of psychiatric hospitalisations in this population. Since 2010, France has progressively opened nine full-time inpatient psychiatric wards exclusively for people who are incarcerated, called "specially adapted hospital units" (unités hospitalières spécialement aménagées, UHSAs, 440 beds). This study aimed to present the annual rates of psychiatric hospitalisations and primary psychiatric diagnoses among people who are incarcerated in France from 2009 to 2019. Methods: We used discharge reports from the French national hospital database to describe longitudinal retrospective administrative data of psychiatric hospitalisations for people in jail and prison between 2009 and 2019, the age, sex, and principal diagnoses of these patients, the proportion of voluntary versus involuntary care, and the interactions between UHSAs and other facilities. Findings: Between Jan 1, 2009, and Dec 31, 2019, 32,228 (92.2% men, n = 29,721; 7.8% women, n = 2 507) incarcerated people were hospitalised for psychiatric care (64,481 stays). The main diagnoses were psychotic disorders (27.4%), personality disorders (23.2%), and stress-related disorders (20.2%). The annual number of incarcerated people hospitalised in psychiatric care increased from 3263 in 2009 to 4914 in 2019. The gradual increase in the activity of UHSAs (300 hospitalisations in 2010 versus 3252 in 2019) was not associated with a reduction in the rate of hospitalisation of incarcerated people in local psychiatric hospitals. Interpretation: The creation of psychiatric hospitals specifically dedicated to the prison population has not stopped the hospitalisation of people who are incarcerated at psychiatric hospitals. These findings suggest that access to psychiatric hospitalisation remains problematic for people who are incarcerated in France. Funding: There was no funding source for this study.

Psychiatric Hospitalizations of People Found Not Criminally Responsible on Account of Mental Disorder in France: A Ten-Year Retrospective Study (2011-2020).

Background: Criminal responsibility is a key concept in the criminal sanctioning of people diagnosed with mental health disorders who have committed crimes. In France, based on the recommendations of one or more expert psychiatrists, a judge can declare a person not criminally responsible on account of mental disorder (NCRMD) if, at the time of the offense, the person was presenting a psychiatric disorder that abolished or altered his/her capacity for discernment and/or ability to control his/her actions. In such a case, the judge also generally orders an involuntary psychiatric hospitalization. The objectives of this study were to (1) describe longitudinal retrospective administrative data of psychiatric hospitalizations for people found NCRMD, (2) identify the age, sex, and principal diagnoses of these individuals, and (3) characterize the trajectories of their psychiatric care before and after NCRMD psychiatric hospitalization. Methods: We used discharge reports from the French national hospital database called Programme de médicalisation des systèmes d'information (PMSI) to gather longitudinal data that describe psychiatric hospitalizations for people found NCRMD between 2011 and 2020, the age, sex, and principal diagnoses of these patients, the length of their hospitalization, and the trajectories of their psychiatric care before and after their NCRMD psychiatric hospitalization. Results: We identified 3,020 patients who were hospitalized for psychiatric care after having been found NCRMD between 2011 and 2020. The number of admissions on these grounds has remained stable over this period, ranging from 263 in 2011 to 227 in 2021. They were mostly young men diagnosed with a psychotic disorder (62%). The majority (87%) were hospitalized in general psychiatric hospitals, and only 13% were admitted to maximum-security units (Unités pour malades difficiles, UMD). The median duration of hospitalization for these patients was 13 months. Our results show that 73% of the patients had already been hospitalized prior to their NRCMD hospitalization. The rehospitalization rate within 5 years of discharge from NCRMD psychiatric hospitalization was 62%. Conclusion: We conducted the first study investigating the psychiatric hospital treatment of people declared NCRMD in France. There is an urgent need for further studies to investigate the clinical characteristics of these patients.