Genome-wide phylogeography reveals cryptic speciation in the circumglobal planktonic calcifier Limacina bulimoides.

Little is known about when and how planktonic species arise and persist in the open ocean without apparent dispersal barriers. Pteropods are planktonic snails with thin shells susceptible to dissolution that are used as bio-indicators of ocean acidification. However, distinct evolutionary units respond to acidification differently, and defining species boundaries is therefore crucial for predicting the impact of changing ocean conditions. In this global population genomic study of the shelled pteropod Limacina bulimoides, we combined genetic (759,000 single nucleotide polymorphisms) and morphometric data from 161 individuals, revealing three major genetic lineages (FST = 0.29-0.41): an "Atlantic lineage" sampled across the Atlantic, an "Indo-Pacific lineage" sampled in the North Pacific and Indian Ocean, and a "Pacific lineage" sampled in the North and South Pacific. A time-calibrated phylogeny suggests that the lineages diverged about 1 million years ago, with estimated effective population size remaining high (~10 million) throughout Pleistocene glacial cycles. We do not observe any signatures of recent hybridization, even in areas of sympatry in the North Pacific. While the lineages are reproductively isolated, they are morphologically cryptic, with overlapping shell shape and shell colour distributions. Despite showing that the circumglobal L. bulimoides consists of multiple species with smaller ranges than initially thought, we found that these pteropods still possess high levels of genetic variability. Our study adds to the growing evidence that speciation is often overlooked in the open ocean, and suggests the presence of distinct biological species within many other currently defined circumglobal planktonic species.

Comparison of MALDI-ToF MS with the Rapidec Carba NP test for the detection of carbapenemase-producing Enterobacteriaceae.

Although carbapenemase-producing Enterobacteriaceae (CPE) have become a serious public health issue, their detection remains challenging. The aim of this study was to implement a test based on imipenem hydrolysis by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS), using 65 strains producing or not a carbapenemase. Then, we compared its performance to that of the Rapidec Carba NP test using 20 additional strains. The MS-based test effectively discriminated between CPE and other non-carbapenem-susceptible strains compared to the Rapidec Carba NP test (sensitivity 100% and 92%, specificity 94% and 92%, respectively). The MS-based test gave less difficulty in interpretation than the colorimetric Rapidec Carba NP test. MALDI-ToF gave a result in less than one hour and limited the use of expensive molecular assays. In conclusion, the hydrolysis test based on MALDI-ToF MS can detect clinically relevant CPE isolates in routine practice. This technology, also described to screen for carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii complex strains, also seems to be interesting in routine practice for these pathogens.

Multicenter performance evaluation of the Unyvero IAI cartridge for detection of intra-abdominal infections.

Intra-abdominal infections (IAIs) are one of the most common type of infections in patients with sepsis and an important cause of death in intensive care units. Early detection and treatment are necessary to reduce patient complications and improve outcomes. The Unyvero IAI Application (Curetis GmbH) is the first automated assay to rapidly and simultaneously identify a large panel of bacteria, fungi, toxins, and antibiotic resistance markers directly from IAI-related samples. The assay was evaluated in four European clinical laboratories in comparison to routine microbiological practices. A total of 300 clinical samples were tested with an overall sensitivity of 89.3% and specificity of 99.5%, while time to results was reduced by an average of about 17 h compared to identification (ID) results and 41 h compared to full antibiotic susceptibility testing (AST) results. The Unyvero IAI was able to detect additional microorganisms compared with culture, in particular anaerobes, with most detections confirmed by sequencing. The most frequent resistance markers detected were mecA/mecC (n = 25), aacA4 (n = 20), and blaCTX-M (n = 17) and carbapenemase genes were identified in nine specimens. Further studies are now required to determine the clinical impact of this new rapid test which could play a role in the successful treatment of IAI.

Place of diagnostic tools in the identification of Anaerobiospirillum succiniciproducens bacteraemia.

Anaerobiospirillum succiniciproducens is a rare but potentially lethal pathogen. We report a case of A. succiniciproducens bloodstream infection in a 55-year-old man hospitalized for pelvic trauma. The strain was identified by 16sRNA sequencing after several failures of identification by MALDI-TOF MS. The strain was susceptible to beta-lactam antibiotics and ciprofloxacin, but resistant to macrolides and clindamycin. Identification tools must be improved to enhance our knowledge on this rare pathogen and to define optimal therapy.

[Secondary pulmonary alveolar proteinosis in a transplant patient]. / Protéinose pulmonaire secondaire chez un patient greffé.

INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by alveolar accumulation of lipoproteinaceous material, caused by a macrophagic clearance disorder. We present a case of PAP in a patient taking the immunosuppressant drug mycophenolate mofetil (MMF) in the context of invasive pulmonary aspergillosis, of which we discuss the pathophysiology and treatment as reported in the literature. CASE REPORT: A 43-year-old man with cardiomyopathy received a heart transplant and was treated by MMF, tacrolimus and corticosteroids. Three months after the transplant, he presented with acute oxygen-dependent respiratory failure. The diagnosis of PAP seemed likely on the CT scan and was confirmed by bronchoalveolar lavage, as was the diagnostic of invasive pulmonary aspergillosis (IPA). However, GM-CSF autoantibodies were not found. As there existed a suspicion of MMF imputability, the treatment was discontinued and an antifungal treatment was started. The patient was reassessed one month after discontinuation of MMF and found to have clinically and radiologically improved. Four other cases of MMF-induced PAP have been reported in the literature. CONCLUSIONS: MMF and IPA could be predisposing cofactors for the occurrence of secondary PAP.

Social disparities in musculoskeletal disorders and associated mental malaise: findings from a population-based survey in France.

AIMS: Various types of musculoskeletal disorders (MSDs) have comorbid mental disorders, which may in turn have a negative influence on disease course and role impairment, but the contribution of social factors to this type of comorbidity is a much under-researched area. This study investigates whether there is a socially patterned association of MSDs with different dimensions of mental malaise. METHODS: The sample included 3,368 economically active participants aged 18-64 years, randomly selected from the Lorraine region in north-eastern France. Information was provided through a post-mailed questionnaire on fatigue, sadness/depression (Duke questionnaire) and cognitive disability during the last eight days. RESULTS: MSDs were significantly more prevalent in manual workers, clerks and other occupations than in upper and intermediate professionals, and similar occupational disparities were found for cognitive disability, fatigue and sadness/ depression. Stratifying the sample, we found the occupational disparities in cognitive disability to be much stronger among participants suffering from MSDs than among participants not suffering from MSDs, and the occupational disparities in fatigue and sadness/depression to be limited to the subsample of subjects suffering from MSDs. CONCLUSIONS: The findings demonstrate that the association of MSDs with mental malaise is much stronger in the lower occupational groups than in the higher groups. Given that psychological factors are implicated in disease prognosis and in the development of disabilities, awareness of the social dimension of the association and treatment of the comorbid mental disorders could open a promising avenue for reducing social inequalities in disability related to MSDs.

[Relationship between depressive symptoms, hopelessness and suicidal ideation among 1547 high school students]. / Relations entre symptomatologie dépressive, désespoir et idées de suicide chez 1547 lycéens.

OBJECTIVES: The aim of the study was to evaluate the incidence of depressive symptoms and suicidal ideation, and to test the mediating role of hopelessness between depressive symptoms and the wish to kill oneself. METHOD: A random sample of 1547 high school students from the department of Haute-Garonne, France, (854 girls, mean age=16.9+/-1.5; 693 boys, mean age=17.4+/-1.5) completed a questionnaire assessing cannabis use, the Center for Epidemiological Studies-Depression Scale (CES-D) completed by the three items subscale measuring suicidal ideation proposed by Garrison et al. (1991) ("I felt life was not worth living"; "I felt like hurting myself"; "I felt like killing myself"). The measure of hopelessness was based on a single item, "I felt life was not worth living". RESULTS: At least occasional wish to kill oneself were reported by 13% of boys and 14% of girls (NS). The mean CES-D score for girls was significantly higher than for boys (20.3+/-10.7 versus 16.7+/-9.9; p<0.01). According to the cut-off score of 24, 19% of boys and 34% of girls had a moderate to severe depressive symptomatology (p<0.0001). The mean suicidal ideation score was significantly higher in participants scoring 24 or above on the CES-D than participants scoring less than 24 (2.4+/-2.7 versus 0.3+/-0.9; p<0.0001). Among participants with CES-D greater or equal to 24, 34% reported at least occasional wish to kill oneself versus 6% of participants with CES-D less than 24 (p<0.0001). CES-D scores and suicidal ideation scores were moderately correlated in girls (Pearson's r=0.59) and boys (r=0.61) in the total sample. To explore the role of hopelessness as mediator between depressive symptoms and the wish to kill oneself, multiple regression analyses were performed separately by gender. To establish mediation, three regression equations should be estimated and the four following conditions must hold: First, the independent variable (CES-D scores) must affect the mediator in the first equation; second, the independent variable must affect the dependent variable (the wish to kill oneself) in the second equation; third, the mediator must affect the dependent variable in the third equation regressing the dependent variable on both the independent variable and on the mediator; fourth, the effect of the independent variable on the dependent variable must be less in the third equation than in the second. Among girls, in the first equation, CES-D score explained 35% of the variance of hopelessness (beta=0.59, t=21.5, p<0.001). In the second equation, CES-D score explained 16% of the variance in the wish to kill oneself (beta=0.40, t=12.7, p<0.001). In the third equation, CES-D and hopelessness scores explained 32% of the variance in the wish to kill oneself. Hopelessness was the main predictor (beta=0.50, t=14, p<0.001) while the effect of CES-D was markedly reduced (beta=0.10, t=2.9, p<0.01). Among boys, in the first equation, CES-D score explained 38% of the variance of hopelessness (beta=0.62, t=20.7, p<0.001). In the second equation, CES-D score explained 25% of the variance in the wish to kill oneself (beta=0.50, t=15.1, p<0.001). In the third equation, CES-D and hopelessness scores explained 47% of the variance in the wish to kill oneself. Hopelessness was the main predictor (beta=0.60, t=17, p<0.001) while the effect of CES-D was substantially weakened (beta=0.13, t=3.6, p<0.001). DISCUSSION: These results showed a strong association between depressive symptoms and suicidal ideation in this nonclinical sample of adolescents. According to Beck's assumption, hopelessness appeared to be a mediator between depressive symptoms and the wish to kill oneself both in boys and girls. These findings are relevant for prevention and therapy. They suggest that targeting hopelessness may be as important in adolescents as in adults to reduce suicidal ideation and prevent suicidal attempts.

Limited efficacy of nontreponemal test combined with treponemal test in the initial syphilis screening algorithm.

PURPOSE: Various syphilis screening algorithms have been proposed and are now used by many clinical laboratories following the introduction of automated treponemal tests (TTs). In France, the diagnosis of syphilis is based on a TT combined with a nontreponemal test (NTT). The objective of this study was to evaluate the diagnostic impact of NTT on initial syphilis screening at the Amiens University Hospital between January 2013 and December 2016. METHODOLOGY: Serum samples sent for syphilis testing were analysed using a treponemal enzyme immunoassay (Siemens IMMULITE 2000 Syphilis Screen) combined with a nontreponemal test. Enzyme immunoassay (EIA)-reactive and/or nontreponemal-reactive samples were titrated to endpoint using the Treponema pallidum particle agglutination test (TPHA). Complementary tests, such as line immunoassay, and medical charts were reviewed to categorize reactive samples into positive or negative syphilis contacts. RESULTS: Among 15 523 initial screening samples, 148 samples (0.95 %) were reactive with the combined TT and NTT, and 335 (2.16 %) and 66 (0.42 %) were reactive with TT or NTT only. Analysis of the 66 discordant results between TT and NTT showed that only 4 sera were reactive with a second-line TPHA, but these results were not confirmed by line immunoassay and patient characteristics. CONCLUSION: The results of this study show that the combination of NTT and TT for initial screening does not provide any diagnostic gain, but represents additional laboratory work time.

Characterization of a multidrug-resistant Klebsiella pneumoniae ST607-K25 clone responsible for a nosocomial outbreak in a neonatal intensive care unit.

PURPOSE: Multidrug-resistant Klebsiella pneumoniae strains are regularly involved in hospital outbreaks. This study describes an ESBL-producing K. pneumoniae clone (ST607-K25) responsible for a nosocomial outbreak in a neonatal intensive care unit. METHODOLOGY: Fourteen strains isolated from 13 patients were included. Antimicrobial susceptibility testing was performed by the agar diffusion method. A clonal link was first investigated by fingerprinting (ERIC-PCR and REP-PCR) then confirmed by MLST. Characterization was performed by molecular detection and identification of several drug resistance and virulence determinants. RESULTS: All strains expressed the same antibiotype, combining ESBL production, fluoroquinolones and aminoglycoside resistance, except for one which remained susceptible to fluoroquinolones. Fingerprinting methods confirmed the clonal link and MLST identified a ST607 clone. Molecular investigations revealed: (I) genes encoding for two narrow-spectrum beta-lactamases (SHV-1 and TEM-1) and an ESBL (CTX-M-15); (II) absence of any chromosomal mutation in quinolone resistance-determining- regions (QRDR) of gyrA/gyrB and parC/parE genes; (III) genes encoding for three plasmid-mediated quinolone-resistance (PMQR) determinants: oqxAB (14/14), aac(6')-Ib-cr (14/14) and qnrB (13/14); (IV) production of a K25 capsule; and (V) carriage of three genes encoding for virulence factors: mrkD (type 3 fimbriae) (14/14), ybts (yersiniabactin) (12/14) and entB (enterobactin) (14/14). CONCLUSION: We described a multidrug-resistant Kp ST607 clone responsible for a nosocomial outbreak in vulnerable and premature newborns. Molecular investigations allowed us to identify several resistance factors responsible for ESBL production (CTX-M-15) and quinolone resistance (three PMQR determinants). The detection of a gene (ybtS) belonging to the high-pathogenicity island yersiniabactin could partly explain its high colonization and diffusion potential.

Sex and gender differences in tobacco smoking among adolescents in French secondary schools.

AIM: We investigated the relationship between sex (genetic/biological) and gender (environmental/cultural) factors in relation to adolescent tobacco smoking. METHODS: A representative sample of 11,582 students from French secondary public schools participated in the study by completing a self-administered, standardised questionnaire. RESULTS: Using the WHO classification for smoking in the youth, 15.6% of the adolescents were regular smokers, 7.7% occasional smokers, 17.9% experimental smokers and 4.8% ex-smokers, with no statistically significant gender difference. Taking non-smoking as a reference, puberty had a much greater effect on the likelihood of being a regular smoker [OR = 18.0 (95% Confidence Interval: 9.6-32)] than of being an experimental/occasional smoker [OR = 3.7 (2.9-4.6)] among girls. For boys, the effect of puberty was not as great [OR = 4.7 (3.5-6.5)] for regular vs. [OR = 2.1 (1.8-2.5)] for experimental/occasional smokers). Similarly, illicit drug use had a larger effect on the likelihood of being regular smoker vs. non-smoker [OR = 15.0 (12.0-20.0) in boys and 12 (8.8-16.0) in girls] than of being experimental/occasional smoker vs. a non-smoker [OR = 4.8 (3.7-6.1) and 2.9 (2.1-3.9) respectively]. Other factors related to regular smoking were exposure to passive smoking and regular alcohol consumption. Living with both parents was a protective factor for life and regular smoking in both genders. CONCLUSIONS: Our results show that influential factors of sex-related (puberty), gender-specific (environmental tobacco smoking, alcohol consumption, drug abuse) or sex/gender (regular sexual intercourse) are related to the smoking behaviour in French adolescents.

Phenomenology, psychosocial correlates, and treatment seeking in major depression and dysthymia of adolescence.

OBJECTIVE: To compare phenomenology, psychosocial correlates, and treatment seeking in DSM-Itt-R major depression and dysthymia among adolescents diagnosed as cases in a community-based study. METHOD: A self-report questionnaire, including psychosocial data, life events, eating behaviors, depressive symptoms, substance use, pathological behaviors, and family and school functioning was administered to a nonselected sample (N = 3,287, 93.2% of targeted population) of adolescents aged 11 to 20 years from several Haute-Marne communities in France in 1988-1989. Subgroups of subjects (n = 205, 84.7% of eligible subjects) were interviewed with a structured diagnostic schedule, and adolescents with major depression (n = 49), dysthymia (n = 21) and controls (n = 135) were compared. RESULTS: Nearly 30% of controls had at least one current symptom of depression. Patterns of affective symptoms were similar in major depression and dysthymia, but significant differences emerged in comorbid conditions (more anxiety disorders, suicidal behaviors, and alcohol intoxications associated with major depression) and stressor at onset (more severe in major depression). Experiences of loss during the prior 12 months were associated with both forms of affective disorder, while poor family relationships were specific correlates of dysthymia. In contrast, peer relationships and pathological behaviors did not differ between depressed subjects and controls. Although psychosocial functioning was significantly impaired in both groups of depressed adolescents, treatment seeking was limited to 34.7% for major depressive subjects and 23.8% for dysthymic subjects. CONCLUSION: The results provide evidence that major depression and dysthymia in adolescence are equally severe but may have distinct patterns in associated factors. Despite free access to health care, the rate of treatment seeking for mood disorders in France is similar to that reported in U.S. studies.

Prevalence and severity of asthma in adolescents in France. Cross-sectional and retrospective analyses of a large population-based sample.

SETTING: Asthma is the most common chronic respiratory disease among adolescents; however, very little is known about asthma in this age group. OBJECTIVE: To explore asthma in adolescence using cross-sectional and retrospective representative data. DESIGN: A population-based sample of adolescents was selected from 578 classes in 186 schools of eight metropolitan educational districts in France and invited to complete a self-administered questionnaire (National Adolescent Health Survey [NAHS]). RESULTS: Of 14,278 adolescents selected, 12,466 (87%) participated in the survey. Prevalence of 'ever asthma' was higher among boys, among those in the south and west, among those from French overseas departments, in active smokers, and in those with other allergies, including food allergy. It was lower in adolescents whose mother was a housewife. Puberty was not associated with 'ever asthma'; however, asthmatic boys without signs of puberty usually had more attacks than those with. Severe asthma was associated with early onset and female sex. Asthma medications and consultations did not depend on socio-economic status. Asthmatic adolescents were found to need more health care in terms of medication use, consultations and hospitalisations other than for asthma than other adolescents; this relationship was strongest among severe asthmatics.

Regional variations in alcohol use among young people in France. Epidemiological approach to alcohol use and abuse by adolescents and conscripts.

Over the past decade, we have observed a disparity between alcohol consumption and related mortality, especially in its regional distribution. Two epidemiological surveys carried out by CRSSA and INSERM (unit 472) focused on drinking behaviour patterns among young conscripts and secondary school students. Regular drinkers in particular were studied. Geographical distribution of regular alcohol use differs from that of alcohol-related deaths. Alcohol consumption is higher in the south of France than in the north, while mortality from alcohol abuse remains higher in the north.

Self-reported alcohol consumption among high school students in France. Epidemiological approach of the alcoholisation process and its evolution.

Very few data are available concerning alcohol consumption among adolescents in France. Three epidemiological surveys carried out by INSERM (Unit 185), focused on the evolution of drinking behaviour patterns among high school students. Consumption trends from 1971 to 1984 were studied: daily wine consumption fell by one-third between these periods; daily beer consumption remained steady; regular hard liquor use fell by about 50% between 1971 and 1978 but showed a marked increase thereafter. The experience of drunkeness increased very significantly among young people, especially among girls. It seems that alcohol consumption became of a more addictive type recently.

Alcohol prevention among adolescents: a French experiment.

Under the guidance of experts, 120 secondary school students from three wine-producing and three other areas of France discussed their experience with alcohol; assessed the value of materials used in primary prevention programmes; produced themselves such materials and evaluated the impact of the different approaches. From the affective and cognitive interactions resulted a noticeable change of the participants' attitude.

Hospitalization in a pediatric ward of adolescent suicide attempters admitted to general hospitals.

PURPOSE: Considering the growing interest of pediatricians in the adolescent patient, one might hypothesize that adolescent suicide attempters might receive superior treatment in a pediatric unit than in other in-patient settings. METHODS: In order to examine this hypothesis, we compared sociodemographic and psychosocial characteristics of patients admitted to pediatric wards (n = 174) with those admitted to other departments (n = 251), based on data from a survey of 430 adolescents aged 13-19 years hospitalized following a suicide attempt. RESULTS: Patients admitted to pediatric units tended to be younger and were more often described as manifesting depression and sleep disturbances. However, no differences were found between the two groups for the other factors investigated (sex, socio-professional category of parents, academic level, family situation, psychiatric problems, social problems, etc.). We then examined differences between the two groups with respect to hospital care (length of stay, psychiatric consultations) and follow-up course (coordination with the family doctor and/or social services, recommended after-care). Our findings showed that for a similar psychosocial profile, pediatric units contact the family doctors more often and proposed a more extensive follow-up. The role in patient management of depression, family, social and school problems is also discussed. CONCLUSION: Compared with other departments to which adolescent suicide attempters could be admitted, pediatric wards appear to show better performance.

Sexual intercourse, contraception, and risk-taking behavior among unselected French adolescents aged 11-20 years.

An epidemiological study was carried out among 4,255 adolescents, aged 11-19 years, randomly selected from secondary schools in a northern urban area of France. The questionnaire concerned sexual activity, contraception, health status, licit and illicit drug consumption, and other risk-taking behavior. A total of 31% of the adolescents had had sexual relations (43% of the boys, 20% of the girls). Sexual activity increased with age. A large majority (70%) of the sexually active adolescents used some form of contraception. The study confirms the relationship between smoking, drinking, illicit drug consumption, and sexual activity, but shows that contraceptive behavior is not related to problem behavior.

PIP: Questionnaires from 4255 randomly selected adolescents from 42 schools in the northern district of Arras in France in the winter of 1988/89 were obtained in order to examine 1) the relationship between risk-taking behavior and sexual behavior, and 2) the negative relationship between contraception and risk-taking behavior by age and sex. Questions were based on a tool developed by Choquet and Menke and included measures of sociodemographics, academic standing and difficulties, life style, quality of family and peer relationships, self-perception, sexual activity, contraceptive habits, licit and illicit drug use, and recent health visits. Stepwise logistic regression was used in the analysis of the sexually experienced (SI), who were further grouped into contraceptive users (CTC) or not (NCTC). Relative odds ratio (OR) and logistic regression were used to assess the relative effect of risk-taking behavior on contraceptive use or sexual intercourse. Descriptive results showed 52.3% boys and 47.7 girls. 86.8% of fathers and 51.3% of mothers were employed. Fathers were in a variety of professions: executives (13%), shopkeepers (8%), middle managers (13%), office employees (19%), blue-collar workers (32%), and farmers (6%). 81% of parents were married. 43% of boys and 20% of girls were SIs, of whom 50% were active regularly. 71% of boys and 76% of girls used contraception (p.05) and 50% of boys and 69% of girls used it systematically. SIs increased with age. For boys, each risk behavior at any age was related to sexual activity; proportions of sexually active varied with risk behavior. For girls, similar trends were found, i.e., heavy smoking and regular illicit drug use were correlated the most significantly with sexual activity. There were differences also. CTC and NCTC groups had similar risk-taking behavior. Frequency of contraceptive use was 2.5 times greater in the older boys' age group (OR = 2.45). Smoking (the strongest predictor), drinking (more prevalent among boys), and illicit drug use are all related to sexual activity, but not necessarily contraception. The implications are that contraceptive use would have been lower and sexual activity higher if other populations had been included. For health care providers, it is important that treatment of adolescent sexuality involve the whole person and context, and not as an isolated problem. A weakness was in not including confounding factors such as social class and the lack of detailed questions on topics.

Self-reported use of drugs for sleep or distress among French adolescents.

PURPOSE: In the framework of an epidemiological survey on adolescent health, we investigated teenagers' psychotropic drug use to identify risk factors. METHODS: A representative sample of school adolescents aged 12-20 years (N = 3287) was asked to fill out a self-administered questionnaire on their current health status (depressive mood, somatic complaints) and their psychotropic drug use. Parents completed a second questionnaire about the subjects' childhood. RESULTS: About one in five (21.1%) indicated having used psychotropic medications during the previous 12 months, most of which were prescription drugs. Drugs for tension or distress were taken more frequently than ones for sleep disorders. Psychotropic drug use was more widespread among girls (27.5%) than among boys (13.8%), and it increased with age: at 18 years 27.9% of the teenagers (versus 12.7% at age 12-13 years) had used psychotropic medicine. Adolescent psychotropic drug use was related to current depressive mood or somatic complaints, and to consumption of psychotropic drugs during childhood. A logistic regression analysis showed that current depression and past psychotropic use between the ages of 6-12 years were the major associated factors of adolescent consumption. CONCLUSIONS: The hypothesis of psychotropic drug use as an early "learned" response to psychological problems is discussed.

Sexual behavior among adolescents reporting chronic conditions: a French national survey.

PURPOSE: To compare sexual behavior in adolescents with a physical handicap or a chronic illness (HCI, n = 604) to a healthy group (HG, n = 7,332). METHODS: Data drawn from a French national health survey carried out among 7,936 adolescents (mean age = 16.2 years) were used. A self-report questionnaire concerning health behavior, sexual behavior, and chronic illness was used in 136 public secondary schools. HCI and HG groups were compared on reported sexual behavior as well as on information (on sexuality, AIDS, and pregnancy) given by the parents. Logistic regression was performed for boys and girls to explore the relationship of health status (HCI or HG) to sexual intercourse, adjusted for sociodemographic variables. RESULTS: Fifty-two percent of HCI boys and 38% of HCI girls reported sexual intercourse (vs. 42% of HG boys and 28% of HG girls). The HCI girls reported more often than HG girls changing partners, pregnancy, and use of oral contraceptives. The HCI boys reported more often than HG boys receiving information on sexuality from their parents. CONCLUSIONS: French HCI adolescents were found to be at high risk for pregnancy and sexually transmitted diseases (STD).

Predictive factors of chronic Post-Traumatic Stress Disorder in rape victims.

This study aimed to investigate the psychological disorders following rape as well as the course of Post-Traumatic Stress Disorder (PTSD), and to determine clinical factors predictive of chronic PTSD. Seventy-three rape victims were observed in a systematic follow-up study over 1 year following rape using structured interview schedules. The frequency of PTSD was massive. The early disorders predicting PTSD 1 year after rape included somatoform and dissociative disorders, agoraphobia and specific phobias as well as depressive and gender identity disorders and alcohol abuse. Through stepwise logistic regressions, the following were found to be good models of prediction of chronic PTSD 1 year after rape: for the characteristics of the traumas, intrafamily rape, being physically assaulted outside rape, and added physical violence during rape; for the early psychological and behavioural attitudes, low self-esteem, permanent feelings of emptiness and running away; and for early mental disorders, agoraphobia and depressive disorders. Finally, among all these predictive factors, added physical violence during rape, low self-esteem, permanent feelings of emptiness and agoraphobia were shown to constitute a strong model of predictors. People presenting features such as the predictive factors of chronic PTSD found in the study should be asked about a history of rape and symptoms of PTSD.