Publications by authors named "Yann Le Strat"

128 Publications

National perinatal survey demonstrates a decreasing seroprevalence of infection among pregnant women in France, 1995 to 2016: impact for screening policy.

Euro Surveill 2021 Feb;26(5)

French National Public Health Agency (Santé publique France), Saint-Maurice, France.

BackgroundToxoplasmosis during pregnancy can result in congenital anomalies or fetal death. Universal antenatal screening is recommended in France, a strategy in place since the 1970s.AimWe determined the seroprevalence of toxoplasmosis among pregnant women participating in the 2016 national perinatal survey (ENP), compared results with previous ENPs, and investigated factors associated with infection.MethodsUsing the 2016 ENP data, which contain sociodemographic and clinical information from all women giving birth during a one week period, we calculated adjusted prevalence ratios (aPR) by sociodemographic factors. Using available data from prior ENPs (1995, 2003 and 2010), we calculated age-standardised seroprevalences and aPRs for French women.ResultsIn 2016, seroprevalence was 31.3% overall. Among French women, associations with increasing age (aPR: 1.54; 95% CI: 1.39-1.70), residence in Paris (aPR: 1.19; 95% CI: 1.08-1.31) or south-western regions (aPR: 1.19; 95% CI: 1.08-1.31), and higher professional status (aPR: 1.12; 95%CI 1.04-1.21) were observed. An association with increasing age was also evident among women from North Africa and sub-Saharan Africa. Age-standardised seroprevalence decreased from 55.0% in 1995 to 33.7% in 2016. Among French women, significant associations with age, Paris and south-west regions persisted across all ENPs.ConclusionHigher prevalences in older women may reflect a higher past risk of exposure while persistent geographical differences may reflect dietary or environmental differences. seroprevalence among pregnant women continues to fall and will impact screening effectiveness. This warrants a comprehensive review to determine the appropriate future of prevention in France.
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http://dx.doi.org/10.2807/1560-7917.ES.2021.26.5.1900710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863230PMC
February 2021

A governmental program to encourage medical students to deliver primary prevention: experiment and evaluation in a French faculty of medicine.

BMC Med Educ 2021 Jan 13;21(1):47. Epub 2021 Jan 13.

Université de Paris, ECEVE UMR 1123, Inserm, F-75010, Paris, France.

Background: A public health student service was set up by the French government in 2018 with the aim of increasing awareness of primary health promotion among the 47,000 students of medicine and other health professions. It is an annual program involving community-based actions on nutrition, physical activity, addiction or sexuality. Our objective was to evaluate its implementation at local level and the different experiences of the stakeholders.

Methods: A quasi-experimental study using process evaluation was performed in a Faculty of Medicine in Paris. Quantitative and qualitative data were collected from medical students who carried out preventive health actions, in the institutions in which the actions took place and from a subsample of beneficiaries.

Results: One hundred and eight actions were carried out by 341 students in 23 educational or social institutions, mostly high schools (n = 12, 52%). Two thirds of the students did not feel sufficiently prepared to deliver preventive health interventions (65.7%, 224/341); however the beneficiaries found that the interventions were good (278/280, 99,2%). Nineteen (83%) of the host institutions agreed to welcome health service students again, of which 9 required some modifications. For students, the reporting of a satisfactory health service experience was associated with the reporting of skills or knowledge acquisition (p < 0.01). Delivering actions in high schools and to a medium-sized number of beneficiaries per week was associated with students' satisfaction. No effect of gender or theme of prevention was observed. For 248/341 (72.7%) students, the public health service program prompts them to address prevention issues in the future.

Conclusion: The public health service undertaken by medical students through the program is a feasible and acceptable means of delivering preventive actions. Reinforcement of training and closer interaction with the host institutions would improve results.
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http://dx.doi.org/10.1186/s12909-020-02472-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805043PMC
January 2021

Sustaining the unsustainable: Rapid implementation of a Support Intervention for Bereavement during the COVID-19 pandemic.

Gen Hosp Psychiatry 2021 Jan-Feb;68:102-103. Epub 2020 Dec 10.

AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Université de Paris, Faculté de médecine, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, France.

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http://dx.doi.org/10.1016/j.genhosppsych.2020.11.015DOI Listing
February 2021

Corticotropin releasing hormone receptor CRHR1 gene is associated with tianeptine antidepressant response in a large sample of outpatients from real-life settings.

Transl Psychiatry 2020 11 5;10(1):378. Epub 2020 Nov 5.

Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Vulnerability of Psychiatric and Addictive Disorders, 75014, Paris, France.

Polymorphisms of genes involved in the hypothalamic-pituitary-adrenocortical (HPA) axis have been associated with response to several antidepressant treatments in patients suffering of depression. These pharmacogenetics findings have been reported from independent cohorts of patients mostly treated with selective serotonin reuptake inhibitors, tricyclic antidepressant, and mirtazapine. Tianeptine, an atypical antidepressant, recently identified as a mu opioid receptor agonist, which prevents and reverses the stress induced by glucocorticoids, has been investigated in this present pharmacogenetics study. More than 3200 Caucasian outpatients with a major depressive episode (MDE) from real-life settings were herein analyzed for clinical response to tianeptine, a treatment initiated from 79.5% of the subjects, during 6-8 weeks follow-up, assessing polymorphisms targeting four genes involved in the HPA axis (NR3C1, FKPB5, CRHR1, and AVPR1B). We found a significant association (p < 0.001) between CRHR1 gene variants rs878886 and rs16940665, or haplotype rs878886*C-rs16940665*T, and tianeptine antidepressant response and remission according to the hospital anxiety and depression scale. Analyses, including a structural equation model with simple mediation, suggest a moderate effect of sociodemographic characteristics and depressive disorder features on treatment response in individuals carrying the antidepressant responder allele rs8788861 (allele C). These findings suggest direct pharmacological consequences of CRHR1 polymorphisms in the antidepressant tianeptine response and remission, in MDE patients. This study replicates the association of the CRHR1 gene, involved in the HPA axis, with (1) a specificity attributed to treatment response, (2) a lower risk of chance finding, and in (3) an ecological situation.
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http://dx.doi.org/10.1038/s41398-020-01067-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644692PMC
November 2020

Epidemiological study of opioid use disorder in French emergency departments, 2010-2018 from OSCOUR database.

BMJ Open 2020 10 30;10(10):e037425. Epub 2020 Oct 30.

Data Science Division, Santé publique France, Saint-Maurice, France.

Objectives: Opioid consumption in France has remained stable over the last 15 years, with much lower levels than in the USA. However, few data are available on patients who consume opioids and their use of the health system. Emergency department (ED) data has never been used as a source to investigate opioid use disorder (OUD) in France.

Design/settings/participants: We used the OSCOUR national surveillance network, collecting daily ED data from 93% of French ED, to select and describe visits and hospitalisations after an OUD-related ED visit between 2010 and 2018 using International Classification of Diseases, version 10 (ICD10) codes. We described the population of interest and used binomial negative regressions to identify factors significantly associated with OUD such as gender, age, administrative region, year of admission and ICD10 codes. We also analysed the related diagnoses.

Primary Outcome Measure: Trend in ED visits for an OUD-related ED visit.

Results: We recorded 34 362 OUD-related visits out of 97 892 863 ED visits (36.1/100 000 visits). OUD-related visits decreased from 39.2/100 000 visits in 2010 to 32.9/100 000 visits in 2018, resulting in an average yearly decrease of 2.1% (95% CI 1.5% to 2.7%) after multivariate analysis. We recorded 15 966 OUD-related hospitalisations out of 20 359 574 hospitalisations after ED visits (78.4/100 000 hospitalisations) with an increase from 74.0/100 000 hospitalisations in 2010 to 81.4/100 000 hospitalisations in 2018. The analysis of related diagnoses demonstrated mostly polydrug abuse in this population.

Conclusions: While the proportion of OUD visits decreased in the time frame, the hospitalisation proportion increased. The implementation of a nationwide surveillance system for OUD in France using ED visits would provide prompt detection of changes over time.
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http://dx.doi.org/10.1136/bmjopen-2020-037425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604823PMC
October 2020

Sadness and the continuum from well-being to depressive disorder: Findings from a representative US population sample.

J Psychiatr Res 2021 01 3;132:50-54. Epub 2020 Oct 3.

Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700, Colombes, France; Faculty of Medicine, Université de Paris, 75013, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014, Paris, France.

Objective: Sadness is a common symptom in the general population. We tested the hypothesis that sadness is an intermediate state on a continuum from well-being to major depressive disorder (MDD).

Methods: Using data from The National Epidemiologic Study of Alcohol and Related Conditions III (NESARC-III), a large and representative US population sample, we assessed the prevalence of sadness, its sociodemographic and clinical correlates, using three non-overlapping groups: (i) non-depressed sad participants, (ii) non-sad non-depressed participants and (iii) depressed participants. We estimated sensitivity and specificity of sadness.

Results: Sadness was frequent in the general population 34.3%), and present in almost all participants with MDD (99.6%). Sad (N = 4593) and MDD participants (N = 4593) and 7889 respectively) shared common sociodemographic characteristics. Compared to controls, sad and MDD participants presented more psychiatric disorders, including anxiety, substance use, psychotic, eating and personality disorders. Sadness was an intermediate state, sad individuals reporting more psychiatric disorders than controls, but less than participants with MDD. Sadness demonstrated a very high sensitivity (99.6%), with a good specificity (83.8%) for MDD.

Limitations: The NESARC assessed sadness over lifetime, which may involve memorization bias.

Conclusion: Our study confirms the existence of a depressive continuum. Sadness is frequent in general population, and shares correlates with MDD. We have also shown a continuum where sadness is an intermediate state between well-being and psychiatric disorders. With high sensitivity and specificity, sadness appears as a clear MDD prodrome and at-risk state, and may be a symptom of a transdiagnostic distress process.
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http://dx.doi.org/10.1016/j.jpsychires.2020.10.004DOI Listing
January 2021

Addictions in the COVID-19 era: Current evidence, future perspectives a comprehensive review.

Prog Neuropsychopharmacol Biol Psychiatry 2021 03 12;106:110070. Epub 2020 Aug 12.

AP-HP, Department of Psychiatry, Louis Mourier Hospital, Université de Paris, Faculté de Médecine, Colombes, France; Institute of Psychiatry and Neurosciences of Paris (IPNP, Inserm U1266), 102 rue de la Santé, 75014 Paris, France.

Background: In the context of the COVID-19 worldwide pandemic, an up-to-date review of current challenges in addictions is necessary. While large scale disasters may have an impact on substance use and addictions, the use of some substances is also likely to modify the risk of COVID-19 infection or course. Many countries have imposed lockdowns. Whether this quarantine or the end of lockdown measures will have an impact on substance use is discussed. The aim of this review is to gather knowledge for clinicians and to guide public health policies during/after lockdown.

Methods: PubMed was reviewed in August 6th (2020), to determine the current evidences and observations concerning the addictions and SARS-CoV2. We used all the names of the severe acute respiratory syndrome of coronavirus 2 (SARS-CoV2 previously 2019 nCoV), the name of the coronavirus disease 2019 (COVID-19), and common substances of abuse. For the physiopathological parts, searches were conducted using key words such as "infection" or "pneumonia". For the lockdown effects, key words such as "quarantine", "disaster" or "outbreak" were used.

Results: Overall, pathophysiological data showed an increased risk of infections for individuals with Substance Use Disorders (SUD) and a possible protective role of nicotine. During lockdown, there is a substantial risk of increasing SUDs. Individuals with opioid use disorder are particularly at risk of relapse or of involuntary withdrawal. After lockdown, increase of use may be observed as far as years after. Individuals with addictions are at higher risk of multimorbidity and mortality during COVID outbreak.

Conclusion: This review describes useful strategies in clinical practice, including a systematic assessment of addiction comorbidity during this almost worldwide lockdown/pandemic. This review also highlights important areas for future research.
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http://dx.doi.org/10.1016/j.pnpbp.2020.110070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7420609PMC
March 2021

A traumatic life experience in childhood increases the risk of a psychiatric disorder in the offspring.

Psychiatry Res 2020 08 23;290:113101. Epub 2020 May 23.

AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102-108 rue de la Santé, 75014, Paris, France; Univ Paris Diderot, Sorbonne Paris Cite, Faculty of Medicine, Paris, France.

A traumatic life experience in childhood is a fundamental risk factor of numerous psychiatric disorders. Recently, studies try to evaluate the mental health consequences on victims' offspring, but few psychiatric disorders were examined, and whether these results apply to the general population remains unknown. In this study, we use the National Epidemiologic Survey on Alcohol and Related Conditions, a large representative sample of American population, in order to estimate the impact on the offspring of a traumatic experience in parents. Besides, we use a well-known risk factor for offspring's psychiatric disorder: a familial history of a psychiatric disorder, in order to compare and assess the importance of parental traumatism as a risk factor for the offspring. Our results show that the five psychiatric disorders studied, alcohol use disorder, substance use disorder, mood disorder, antisocial personality disorder and anxiety disorder, are more prevalent in the offspring, when at least one parent report a traumatic life event in his own childhood. Moreover, the magnitude of this risk factor is close to the magnitude of having a parental history of psychiatric disorder.
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http://dx.doi.org/10.1016/j.psychres.2020.113101DOI Listing
August 2020

Self-evaluation of negative symptoms in adolescent and young adult first psychiatric episodes.

Prog Neuropsychopharmacol Biol Psychiatry 2020 12 29;103:109988. Epub 2020 May 29.

AP-HP Greater Paris University Hospital, Psychiatry Department, University Hospital Louis Mourier, France; University of Paris, INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France.

Background: Negative Symptoms (blunted affect, alogia, anhedonia, avolition, and asociality) are usually described in schizophrenia but they are also present in other psychiatric disorders. The diagnosis and prognosis relevance of negative symptoms (NS) self-assessment during a first psychiatric episode is still unknown.

Aims: To determine (i) the rate of self-assessed NS in a first psychiatric episode among adolescents and young adults compared to control subjects; and (ii), whether there is a difference in the prevalence of NS between schizophrenia and major depressive disorder first episodes.

Methods: The population included patients aged 15-25 years, with no psychiatric history and no history of medication. A dimensional evaluation was assessed during hospitalization, including depressive (Hamilton Depression Scale), psychotic symptoms (Prodromal Questionnaire, 16 items) and the self-evaluation of negative symptoms (SNS scale). Prospective categorical diagnoses were updated 6 months after hospitalization. The population included 117 individuals (58 patients and 59 healthy controls).

Results: Among healthy individuals, 47.5% reported at least one NS, the most reported being amotivation. After binary logistic regression, Negative Symptoms (SNS score) were associated with a diagnostic of psychiatric disorder at the 6-months follow-up (OR = 1.163, p = .001), whereas depressive symptoms and psychotic experiences were not. A SNS threshold allowed to screen first episode patients and SZ patients in the general population (assessed with ROC curve). A high prevalence of self-reported NS was observed across diagnostic boundaries in first psychiatric episodes, with a mean SNS score of 19.3 ± 7.1 for schizophrenic disorders and 20.7 ± 8.6 for depressive disorders. The prevalence of NS was not significantly different between depressive disorders and schizophrenic disorders (p > .05).

Conclusion: NS are an important transnosographic dimension during first psychiatric episodes among adolescents and young adults. Negative symptoms self-assessment with the SNS scale is relevant during a first psychiatric episode.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109988DOI Listing
December 2020

Estimating the burden of SARS-CoV-2 in France.

Science 2020 07 13;369(6500):208-211. Epub 2020 May 13.

Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France.

France has been heavily affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and went into lockdown on 17 March 2020. Using models applied to hospital and death data, we estimate the impact of the lockdown and current population immunity. We find that 2.9% of infected individuals are hospitalized and 0.5% of those infected die (95% credible interval: 0.3 to 0.9%), ranging from 0.001% in those under 20 years of age to 8.3% in those 80 years of age or older. Across all ages, men are more likely to be hospitalized, enter intensive care, and die than women. The lockdown reduced the reproductive number from 2.90 to 0.67 (77% reduction). By 11 May 2020, when interventions are scheduled to be eased, we project that 3.5 million people (range: 2.1 million to 6.0 million), or 5.3% of the population (range: 3.3 to 9.3%), will have been infected. Population immunity appears to be insufficient to avoid a second wave if all control measures are released at the end of the lockdown.
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http://dx.doi.org/10.1126/science.abc3517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223792PMC
July 2020

Comorbidities of self-reported fibromyalgia in United States adults: A cross-sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III).

Eur J Pain 2020 09 18;24(8):1471-1483. Epub 2020 May 18.

AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.

Background: Fibromyalgia has been associated with various physical and mental disorders. However, these comorbidities need to be quantified in a population-based study.

Method: We compared participants with and without self-reported fibromyalgia to assess (a) The prevalence of self-reported fibromyalgia and its sociodemographic characteristics in a US representative sample, (b) The associations between self-reported fibromyalgia and lifetime and past 12-month mental and physical disorders and (c) The quality of life associated with self-reported fibromyalgia. This cross-sectional study used a large national sample (n = 36,309) of the US population, the National Epidemiologic Survey on Alcohol and Related Conditions-III. Face to face interviews were conducted, collecting sociodemographic characteristics, diagnostic and statistical manual of mental disorders-5 structured diagnosis and self-reported medical conditions (including fibromyalgia).

Results: The past 12-month prevalence of self-reported fibromyalgia was estimated at 2.05%. Participants with self-reported fibromyalgia were significantly at higher risk to report a lifetime history of mental disorder (adjusted odds ratio [aOR] = 2.32). Self-reported fibromyalgia was also positively associated with 24 of the 27 physical conditions assessed in this study. Participants with self-reported fibromyalgia were more likely to report a past 12-month history of suicide attempts (aOR = 5.81), substance use disorders (aOR = 1.40), mood disorders (aOR = 2.67), anxiety disorders (aOR = 2.75) and eating disorders (aOR = 2.45). Participants with self-reported fibromyalgia had lower levels of both mental and physical quality of life than those without fibromyalgia.

Conclusions: Participants with self-reported fibromyalgia have a higher prevalence of comorbid mental and physical disorders, and lower mean levels of mental and physical quality of life than their counterparts without fibromyalgia.

Significance: We showed here a strong association of self-reported fibromyalgia with both mental and physical comorbidities. We showed that among participants with self-reported fibromyalgia, more than 8 out of 10 had at least three other physical comorbidities, and almost half had at least three mental comorbidities. This is a cross-sectional study using a representative sample of the US population with highly reliable psychiatric diagnosis that makes our results generalizable. Practitioners managing fibromyalgia should search and treat these comorbidities.
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http://dx.doi.org/10.1002/ejp.1585DOI Listing
September 2020

The role of comorbidity in the association of obesity with unemployment and disability.

Ann Epidemiol 2020 05 2;45:61-68. Epub 2020 Apr 2.

Université de Paris, INSERM U1266, Paris, France; Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France.

Purpose: The association of obesity with a large range of physical conditions and numerous psychiatric disorders has been extensively studied. Our study sought the extent to which physical conditions or psychiatric disorders associated with obesity mediate the association of obesity with unemployment or disability.

Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012-2013), we estimated the prevalence of unemployment as a function of obesity taking into account these comorbidities. Data on self-reported height and weight were available for 35,725 respondents. Clinician-diagnosed physical conditions were self-reported and lifetime psychiatric disorders were assessed with a semistructured interview.

Results: The adjusted prevalence of obesity was 30.4%. Participants with obesity were more likely than participants without obesity to report at least one of the 31 assessed physical conditions (64.46% vs. 46.87%; P < .001). Participants with obesity were more likely to report at least one of the 24 assessed psychiatric diagnoses than respondents without obesity (60.57 vs. 56.75%; P < .001). The rates of unemployment were higher in participants with obesity than in those without obesity (15.75% vs. 11.26%; P < .001). Similarly, participants with obesity reported higher rates of disability than those without obesity. Although the number of physical conditions and psychiatric disorders partly explains this association, obesity remained significantly associated with unemployment and greater disability when controlling for the number of physical conditions and psychiatric disorders.

Conclusions: Obesity is associated with high rates of unemployment and with high disability. This is not explained solely by the high rate of physical conditions and psychiatric disorders associated with obesity.
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http://dx.doi.org/10.1016/j.annepidem.2020.03.004DOI Listing
May 2020

Diphtheria-Tetanus-Polio, Measles-Mumps-Rubella, and Hepatitis B Vaccination Coverage and Associated Factors among Homeless Children in the Paris Region in 2013: Results from the ENFAMS Survey.

Int J Environ Res Public Health 2020 04 21;17(8). Epub 2020 Apr 21.

Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France.

: The number of homeless families has increased considerably since the 1990s in France. We aimed to estimate the homeless children vaccination coverage (VC) for diphtheria, tetanus, polio, measles-mumps-rubella and hepatitis B and identify factors associated with insufficient VC according to birthplace. : A cross-sectional survey was conducted among homeless shelter families in the greater Paris area. A nurse conducted face-to-face interviews and collected vaccination records. We analyzed factors associated with insufficient VC, stratified by birthplace and vaccine, using robust Poisson regression. : The study included 214 children born in France and 236 born outside France. VC in French-born homeless children was high (>90% at 24 months for most vaccinations) and similar to levels observed in the general population, whereas VC in those born outside France was low (<50% at 24 months for all vaccines). Factors significantly associated with insufficient VC among children born outside France were age, parents with French-language difficulties, and changing residence at least twice in the previous year. Children in contact with the healthcare system at least once in the previous year had significantly higher VC, irrespective of vaccine and birthplace. : Special attention should be paid to homeless children born outside France, with recent European and French recommendations confirming the need for catch-up vaccination in children with undocumented VC.
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http://dx.doi.org/10.3390/ijerph17082854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216283PMC
April 2020

Changes in alcohol use and heavy episodic drinking in U.S. Women of childbearing-age and peripartum between 2001-2002 and 2012-2013.

Addict Behav 2020 08 9;107:106389. Epub 2020 Mar 9.

APHP, Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; Université de Paris, France; Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris F-75014, France. Electronic address:

Background: Heavy episodic drinking (HED) is a frequent pattern of alcohol use in women of childbearing age with severe consequences for both women and child, making it a major public health issue. Some states in the US have reported laws that target the use of alcohol during pregnancy. Our aim was to examine the evolution of 12-month alcohol use and 12-month HED prevalence in childbearing age, pregnant and postpartum women between 2001 and 2002 and 2012-2013.

Methods: Our data were drawn from the National Epidemiologic Study of Alcohol and Related Conditions (NESARC) conducted in 2001-2002 and NESARC-III conducted in 2012-2013, two independent, representative samples of U.S.

Population: Past-year alcohol use and HED was evaluated according face-to-face interview for all participants.

Results: Our sample consisted of 24,536 women of childbearing age, including 2846 pregnant and postpartum women. Prevalence of 12-month alcohol use increased from 2001 to 2002 to 2012-2013, in both childbearing-aged women (66.14% to 75.48%; aOR = 1.62, 95%CI = 1.46-1.80) and pregnant and postpartum women (57.81% to 66.19%; aOR = 1.56, 95%CI = 1.25-1.94). Prevalence of 12-month HED increased from 2001 to 2002 to 2012-2013, in both childbearing-aged women (22.57% to 36.34%; aOR = 1.97, 95%CI = 1.79-2.16) and pregnant and postpartum women (17.85% to 28.21%; aOR = 1.84, 95%CI = 1.47-2.30).

Conclusions: Alcohol use and HED increased in last 10 years in both childbearing age and pregnant and postpartum US women. That questions the impact of implemented laws, policies and alcohol guidelines in this population within the last 10 years.
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http://dx.doi.org/10.1016/j.addbeh.2020.106389DOI Listing
August 2020

Shorter and longer durations of sleep are associated with an increased twelve-month prevalence of psychiatric and substance use disorders: Findings from a nationally representative survey of US adults (NESARC-III).

J Psychiatr Res 2020 05 21;124:34-41. Epub 2020 Feb 21.

Paris Diderot University - Paris VII, 5 Rue Thomas Mann, 75013, Paris, France; Department of Psychiatry, Assistance Publique-Hôpitaux de Paris (AP-HP), Louis Mourier Hospital, 178 Rue des Renouillers, 92700, Colombes, France.

The lack of comprehensive data on the association between psychiatric and substance use disorders and habitual sleep duration represents a major health information gap. This study examines the 12-month prevalence of mental disorders stratified by duration of sleep. Data were drawn from face-to-face interviews conducted in the National Epidemiologic Survey on Alcohol and Related Conditions III, a nationally representative survey of US adults (N = 36,309). There were 1893 (5.26%) participants who reported <5h of sleep/night; 2434(6.76%) 5 h/night; 7621(21.17%) 6 h/night; 9620(26.72%) 7 h/night; 11,186(31.07%) 8 h/night, and 3245(9.01%) ≥9 h/night. A U-shaped association was observed between sleep duration and all mental disorders. The prevalence of mental disorders was 55% for individuals with <5 h/night and 47.81% for ≥9 h/night, versus 28.24% for the 7 h/night (aOR = 1.90 and 1.39 respectively). The greatest odds ratios were for the <5 h/night group, with an increased risk above 3-fold for panic disorder (PD), post-traumatic stress disorder (PTSD), psychotic disorder, and suicide attempt; between 2 and 3 fold for major depressive disorder (MDD), bipolar disorder (BD), and generalized anxiety disorder (GAD); and between 1 and 2 fold for tobacco and drug use disorders, specific and social phobias. The ≥9 h/night group had an increased risk above 1 to 2-fold regarding tobacco and drug use disorders, MDD, BD, PD, social phobia, GAD, PTSD, psychotic disorder, and suicide attempt. U-shaped associations exist between sleep duration and mental disorders, calling for respect to recommendations for adequate sleep duration in routine clinical care as well as to actions for primary prevention in public health settings.
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http://dx.doi.org/10.1016/j.jpsychires.2020.02.018DOI Listing
May 2020

Polygenic Risk Scores Shed Light on the Relationship between Schizophrenia and Cognitive Functioning: Review and Meta-Analysis.

J Clin Med 2020 Jan 25;9(2). Epub 2020 Jan 25.

Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris F-75014, France.

Schizophrenia is a multifactorial disease associated with widespread cognitive impairment. Although cognitive deficits are one of the factors most strongly associated with functional impairment in schizophrenia (SZ), current treatment strategies hardly tackle these impairments. To develop more efficient treatment strategies in patients, a better understanding of their pathogenesis is needed. Recent progress in genetics, driven by large genome-wide association studies (GWAS) and the use of polygenic risk scores (PRS), has provided new insights about the genetic architecture of complex human traits, including cognition and SZ. Here, we review the recent findings examining the genetic links between SZ and cognitive functions in population-based samples as well as in participants with SZ. The performed meta-analysis showed a negative correlation between the polygenetic risk score of schizophrenia and global cognition ( < 0.001) when the samples rely on general and healthy participants, while no significant correlation was detected when the three studies devoted to schizophrenia patients were meta-analysed ( > 0.05). Our review and meta-analysis therefore argues against universal pleiotropy for schizophrenia alleles and cognition, since cognition in SZ patients would be underpinned by the same genetic factors than in the general population, and substantially independent of common variant liability to the disorder.
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http://dx.doi.org/10.3390/jcm9020341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074036PMC
January 2020

A transnosographic approach of negative symptoms pathophysiology in schizophrenia and depressive disorders.

Prog Neuropsychopharmacol Biol Psychiatry 2020 04 10;99:109862. Epub 2020 Jan 10.

AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France. Electronic address:

Background: Negative Symptoms (blunted affect, alogia, anhedonia, avolition and asociality) are observed in schizophrenia but also in depressive disorders.

Objective: To gather cognitive, neuroanatomical, neurofunctional and neurobiological knowledge of negative symptoms in studies on schizophrenia, depressive disorder, and transnosographic studies.

Results: Blunted affect in schizophrenia is characterized by amygdala hyperactivation and frontal hypoactivation, also found in depressive disorder. Mirror neurons, may be related to blunted affect in schizophrenia. Alogia may be related to cognitive dysfunction and basal ganglia area impairments in schizophrenia. Data surrounding alogia in depressive disorder is scarce; wider speech deficits are often studied instead. Consummatory Anhedonia may be less affected than Anticipatory Anhedonia in schizophrenia. Anhedonia is associated with reward impairments and altered striatal functions in both diagnostics. Amotivation is associated with Corticostriatal Hypoactivation in both disorders. Anhedonia and amotivation are transnosographically associated with dopamine dysregulation. Asociality may be related to oxytocin.

Conclusion: Pathophysiological hypotheses are specific to each dimension of negative symptoms and overlap across diagnostic boundaries, possibly underpinning the observed clinical continuum.
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http://dx.doi.org/10.1016/j.pnpbp.2020.109862DOI Listing
April 2020

Prevalence and correlates of psychotic-like experiences in the general population.

Schizophr Res 2020 01 30;215:371-377. Epub 2019 Aug 30.

Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Faculty of Medicine, Paris Diderot University, 75013 Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France.

Background: To what extent Psychotic Like Experiences (PLEs) are associated with nonpsychotic psychiatric disorders and whether the number of PLEs is associated with higher rates of psychiatric disorders remains unclear.

Methods: The sample was composed of 34,653 civilian participants, aged 18 years and older from wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). This was a representative sample of the non-institutionalized U.S.

Population: Twenty-two PLEs were assessed. Lifetime prevalence of psychiatric disorders (any mood, anxiety, substance use and personality disorders, PTSD, ADHD, and suicide attempts) according to the number of PLEs were calculated.

Results: Almost a third (26.69%) of respondents reported experiencing at least one type of PLEs. There was a gradual association between the number of PLEs and the presence of a nonpsychotic psychiatric disorder (ranging from 5.68%in participants with no PLEs up to 99.53% in those with five or more PLEs). This association with PLE was significant for each of the 25 psychiatric disorders examined regardless of the number of PLEs. Lifetime prevalence of PLEs were significantly higher among the younger respondents, women, non-married, unemployed, high educational level and those with low family income.

Conclusion: There is a gradual increase in the magnitude of the association of the numbers of PLEs for each of the 25 nonpsychotic psychiatric disorders examined. Having at least one PLE is strongly associated with the presence of a psychiatric disorder.
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http://dx.doi.org/10.1016/j.schres.2019.08.024DOI Listing
January 2020

Major Depressive Disorder (MDD) and Schizophrenia- Addressing Unmet Needs With Partial Agonists at the D2 Receptor: A Review.

Int J Neuropsychopharmacol 2019 10;22(10):651-664

INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), France.

Second-generation antipsychotics are common candidates for the adjunctive treatment of major depressive disorder and for the treatment of schizophrenia. However, unmet needs remain in the treatment of both disorders. Considering schizophrenia, antipsychotics are the most common treatment and have demonstrated good efficacy. Still, side effects of these treatments are commonly reported and may impact adherence to the medication and functioning in patients with schizophrenia. Regarding major depressive disorder, despite the availability of several classes of antidepressants, many patients do not achieve remission. Adjunctive treatment with antipsychotics may improve clinical and functional outcomes. Compared with dopamine D2 receptor antagonism that is exhibited by most antipsychotics, partial agonism may result in improved outcomes in major depressive disorder and in schizophrenia. Aripiprazole, cariprazine, and brexpiprazole have partial agonism at the dopamine D2 receptor and could potentially overcome limitations associated with D2 antagonism. The objectives of this review were (1) to discuss the goal of treatment with second-generation antipsychotics in major depressive disorder and schizophrenia, and the clinical factors that should be considered, and (2) to examine the short- and long-term existing data on the efficacy and safety of D2 receptor partial agonists (aripiprazole, cariprazine, and brexpiprazole) in the adjunctive treatment of major depressive disorder and in the treatment of schizophrenia.
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http://dx.doi.org/10.1093/ijnp/pyz043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822140PMC
October 2019

Estimate of male urethritis incidences in France between 2007 and 2017 with a specific focus on Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infections.

BMC Infect Dis 2019 Jun 27;19(1):561. Epub 2019 Jun 27.

Réseau Sentinelles, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), UMR S 1136 Inserm Sorbonne Université, Faculté de médecine Sorbonne Université - site Saint Antoine, 27 rue Chaligny, 75571, cedex 12, Paris, France.

Background: In a context of increasing use of Nucleic Acid Amplification Test, diagnoses of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men increased in Europe and USA since 2007. We aimed to describe trends in the incidence of male urethritis in France between 2007 and 2017.

Methods: We analysed male urethritis clinical cases reported by the French GPs' Sentinelles network.

Results: GPs reported 1944 cases of male urethritis during the study period. The estimated annual incidence rates in men aged 15 years and older remained stable between 226 cases per 100,000 seen in 2007 and 196 in 2017 (P value = 0.9). A third-generation cephalosporin with macrolide or tetracycline was prescribed in 17.5% of cases in 2009 (27/154) and 32.4% in 2017 (47/145) (P value = 0.0327).

Conclusions: The incidence rates for adult male urethritis diagnosed in primary care have remained stable since 2007 in France in contrast with the increasing trend of Neisseria gonorrhoeae and Chlamydia trachomatis infections based on microbiological surveillance. Using stable clinical definition for male urethritis seems essential to follow correctly epidemiological dynamic.
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http://dx.doi.org/10.1186/s12879-019-4202-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598258PMC
June 2019

RE: Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review.

J Natl Cancer Inst 2019 03;111(3):335-336

AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.

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http://dx.doi.org/10.1093/jnci/djz003DOI Listing
March 2019

Corrigendum: Continuous Decline of Seroprevalence in Hospital: A 1997-2014 Longitudinal Study in Paris, France.

Front Microbiol 2018 27;9:2814. Epub 2018 Nov 27.

Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis, Lariboisière, Fernand-Widal, Paris, France.

[This corrects the article DOI: 10.3389/fmicb.2018.02369.].
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http://dx.doi.org/10.3389/fmicb.2018.02814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277832PMC
November 2018

Mental disorders associated with recent cancer diagnosis: Results from a nationally representative survey.

Eur J Cancer 2018 12 30;105:10-18. Epub 2018 Oct 30.

AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; INSERM U894, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Univ Paris Diderot, Sorbonne Paris Cite, Faculty of Medicine, Paris, France.

Background: Receiving a diagnosis of cancer may be associated with increased risk of mental disorders. Yet, in this context, no factor predicts the onset of a mental disorder besides the diagnosis of cancer itself. If patients with a history of mental disorder are at particular risk is unknown.

Methods: Data were derived from a large national sample of the US population. Face-to-face surveys were conducted on 36309 adults during 2012-2013 period. Data were used to examine the associations among the past-year prevalence of mental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders-5), the treatment-seeking rates and a recent cancer diagnosis. Data were analysed according to the antecedents of mental disorder in participants and according the presence of a recent cancer diagnosis.

Results: Participants recently diagnosed with cancer (n = 1300) were significantly at higher risk to present suicide attempt (adjusted odds ratio [AOR] = 3.52; 95% confidence interval [CI] = 1.23-10.04), post-traumatic stress disorder (AOR = 2.25; 95% CI = 1.71-2.96), bipolar disorder (AOR = 2.22; 95% CI = 1.46-3.38) and drug use disorder (AOR = 1.64; 95% CI = 1.13-3.39). The prevalence of most of the mental disorders considered was significantly higher for participants with a history of mental disorder compared with participants without such a history. Conversely, a recent diagnosis of cancer was not associated with significant differences in the incidence of mental disorders in participants with no history of mental disorder.

Conclusions: Patients with a history of mental disorder receiving a cancer diagnosis are at high risk of relapse and should be closely monitored.
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http://dx.doi.org/10.1016/j.ejca.2018.09.038DOI Listing
December 2018

Continuous Decline of Seroprevalence in Hospital: A 1997-2014 Longitudinal Study in Paris, France.

Front Microbiol 2018 5;9:2369. Epub 2018 Oct 5.

Santé Publique France, French National Public Health Agency, Paris, France.

The protozoan presents a risk for reactivation of latent cysts in immunocompromised patients. Anti- antibodies are therefore usually screened before chemotherapy or transplantation to propose prophylactic measures against this parasite. We analyzed the results obtained in our hospital to study the epidemiological trend of infection. We collected all the anti- antibody titers from January 1, 1997 to December 31, 2013 using the Platelia IgG ELISA assay (Bio-Rad). The results were classified as positive when titers reached a concentration of ≥10 UI/ml. Only the first result obtained at entry for each patient was considered. seroprevalence was estimated using a multivariate logistic regression model accounting for age, sex, and year in which the sample was collected. A total of 21,480 patient samples were analyzed. The seroprevalence continuously decreased over time, from 64.5% in 1997 to 54.7% in 2013 (i.e., an average of 1.3% per year, < 0.001). The decrease was 5.0% per year for patients <20 years. After 2013, the model predicts that the seroprevalence would continuously decrease. We also observed a higher proportion of seropositive men than women in the 15- to 45-year-old group (58.5% versus 52.0%, < 10). The overall seroprevalence of toxoplasmosis at our hospital showed an accelerating downward trend over 17 years. The reason for this continuous decline is likely associated with the lower parasite presence within meat. Thus, although young immunocompromised patients are increasingly less at risk of reactivation in the near future, older immunocompromised patients will remain at high risk of reactivation. The reasons of the higher prevalence in men remain to be explored.
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http://dx.doi.org/10.3389/fmicb.2018.02369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182058PMC
October 2018

Tobacco Smoking and Psychotic-Like Experiences in a General Population Sample.

J Clin Psychiatry 2018 10 2;79(6). Epub 2018 Oct 2.

AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.

Objective: Recent findings suggest an association between tobacco and psychosis, but whether this association is mediated by confounding factors is unknown. Psychosis-like experiences (PLEs) are a subclinical expression of psychosis. To disentangle the association of tobacco with PLEs, we examined data from a large US population-based, nationally representative sample.

Methods: Analysis was conducted on Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653 adults, conducted from 2004 to 2005). Participants were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV. Twenty-two PLEs previously described as observed indicators of psychosis were used. Participants were stratified according to their smoking status (never/former/current) for 5 different types of tobacco.

Results: There was a significant association (ie, with 95% CIs for which the lower value was ≥ 1) between smoking status and 14 of the 22 assessed PLEs. These associations remained significant after adjustment for sociodemographic variables (including urbanicity or ethnicity), lifetime drug use disorder, and past-year cannabis use. While 26.33% of nonsmokers reported at least 1 PLE, this prevalence was slightly higher in former smokers (27.48%) and rose as high as 39.09% in current smokers (for current smokers vs lifetime abstainers, adjusted OR = 1.33; 95% CI, 1.23-1.45). All 22 PLEs had higher prevalence in smokers than in former smokers or lifetime abstainers. A total of 8.56% of smokers reported at least 5 PLEs, compared to 3.42% in lifetime abstainers (aOR = 1.56; 95% CI, 1.32-1.84).

Conclusions: In a large population-based, nationally representative sample, smoking status was associated with various PLEs. This association was not explained only by other known risk factors of PLEs or schizophrenia. There is a need to identify the potential neurobiological mechanisms by which smoking and PLEs are associated, for patients and from a public health perspective.
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http://dx.doi.org/10.4088/JCP.17m11994DOI Listing
October 2018

What is the evolution of stroke unit's accessibility in metropolitan France from 2009 to 2014? A trend analysis of over 600 000 patients using national hospital databases.

BMJ Open 2018 09 28;8(9):e023599. Epub 2018 Sep 28.

Univ Rennes, EHESP, Recherche en pharmaco-épidémiologie et recours aux soins, Rennes, France.

Objectives: We aimed to study trends in stroke unit (SU) admission during a period of their deployment in France and to assess whether this led to better and more equitable access to this specialised care.

Design: Analysis of records from the national hospital database.

Setting: All acute care hospitals in metropolitan France for the period 2009-2014.

Participants: Over 600 000 patients admitted in acute care with a main diagnosis of stroke.

Main Outcome Measures: Admission to a SU.

Results: Between 2009 and 2014, the number of stroke admissions rose from 93 728 to 109 456, and the proportion of SU admission from 23% to 44%. Overall, characteristics associated with higher probability of SU admission were: male gender, younger age, ischaemic stroke type, medium level of comorbidity and larger size of town of residence. Although likelihood of SU admission increased in all patients' categories during the study period, we identified steeper positive temporal trends among older patients, those with more comorbidities and those residing in medium or small towns (all p values <0.001), suggesting a 'catching up' phenomena. Temporal trends of men and women did not differ however.

Conclusions: Admission to SU nearly doubled in France between 2009 and 2014. Faster trends observed for patients with lower admission to SU suggest that equity in access has improved over the period.
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http://dx.doi.org/10.1136/bmjopen-2018-023599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169775PMC
September 2018

Assessing the cost-effectiveness of hepatitis C screening strategies in France.

J Hepatol 2018 Oct 1;69(4):785-792. Epub 2018 Jul 1.

IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France.

Background & Aims: In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France.

Methods: A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80 years, undiagnosed for CHC for different strategies: S1 = current strategy targeting the at risk population; S2 = S1 and all men between 18 and 59 years; S3 = S1 and all individuals between 40 and 59 years; S4 = S1 and all individuals between 40 and 80 years; S5 = all individuals between 18 and 80 years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (€32,800).

Results: Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40-80 was the only cost-effective strategy at both thresholds (€26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18-80 is associated with the highest costs, it is more effective than targeting all people aged 40-80, and cost-effective at both thresholds (€31,100/QALY).

Conclusions: In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented.

Lay Summary: In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.
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http://dx.doi.org/10.1016/j.jhep.2018.05.027DOI Listing
October 2018

Mapping influenza activity in emergency departments in France using Bayesian model-based geostatistics.

Influenza Other Respir Viruses 2018 11 21;12(6):772-779. Epub 2018 Aug 21.

Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France.

Background: Maps of influenza activity are important tools to monitor influenza epidemics and inform policymakers. In France, the availability of a high-quality data set from the Oscour surveillance network, covering 92% of hospital emergency department (ED) visits, offers new opportunities for disease mapping. Traditional geostatistical mapping methods such as Kriging ignore underlying population sizes, are not suited to non-Gaussian data and do not account for uncertainty in parameter estimates.

Objective: Our objective was to create reliable weekly interpolated maps of influenza activity in the ED setting, to inform Santé publique France (the French national public health agency) and local healthcare authorities.

Methods: We used Oscour data of ED visits covering the 2016-2017 influenza season. We developed a Bayesian model-based geostatistical approach, a class of generalized linear mixed models, with a multivariate normal random field as a spatially autocorrelated random effect. Using R-INLA, we developed an algorithm to create maps of the proportion of influenza-coded cases among all coded visits. We compared our results with maps obtained by Kriging.

Results: Over the study period, 45 565 (0.82%) visits were coded as influenza cases. Maps resulting from the model are presented for each week, displaying the posterior mean of the influenza proportion and its associated uncertainty. Our model performed better than Kriging.

Conclusions: Our model allows producing smoothed maps where the random noise has been properly removed to reveal the spatial risk surface. The algorithm was incorporated into the national surveillance system to produce maps in real time and could be applied to other diseases.
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http://dx.doi.org/10.1111/irv.12599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185885PMC
November 2018

Waterborne Disease Outbreak Detection: A Simulation-Based Study.

Int J Environ Res Public Health 2018 07 17;15(7). Epub 2018 Jul 17.

Santé Publique France, the French National Public Health Agency, 94 410 Saint-Maurice, France.

Waterborne disease outbreaks (WBDOs) remain a public health issue in developed countries, but to date the surveillance of WBDOs in France, mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities, is characterized by low sensitivity. In this context, a detection algorithm using health insurance data and based on a space⁻time method was developed to improve WBDO detection. The objective of the present simulation-based study was to evaluate the performance of this algorithm for WBDO detection using health insurance data. The daily baseline counts of acute gastrointestinal infections were simulated. Two thousand simulated WBDO signals were then superimposed on the baseline data. Sensitivity (Se) and positive predictive value (PPV) were both used to evaluate the detection algorithm. Multivariate regression was also performed to identify the factors associated with WBDO detection. Almost three-quarters of the simulated WBDOs were detected (Se = 73.0%). More than 9 out of 10 detected signals corresponded to a WBDO (PPV = 90.5%). The probability of detecting a WBDO increased with the outbreak size. These results underline the value of using the detection algorithm for the implementation of a national surveillance system for WBDOs in France.
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http://dx.doi.org/10.3390/ijerph15071505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068474PMC
July 2018

Parity and bipolar disorder: New analyses.

J Affect Disord 2018 10 31;238:489-490. Epub 2018 May 31.

AP-HP, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France; University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 2 ter rue d'Alesia, 75014, Paris, France.

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http://dx.doi.org/10.1016/j.jad.2018.05.039DOI Listing
October 2018