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.

[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.

Differentiated health problems according to gender among adolescents reporting sexual or physical assault

Background and objectives: Gender studies previously enlightened our research. Gender differences among traumatized adolescents remain understudied. We hypothesized that comparing health problems between adolescents reporting physical assault and adolescents reporting sexual assault could show a gender difference and could help to identify risks.MethodsIn our 1993 cross-sectional epidemiological representative survey of adolescents in France – 14 278 enrolled in the school system, and 3005 who had left school – we selected the 5893 adolescents in the 16–20 age span, and extracted the sub-sample of 1324 who reported sexual or physical assaults (23%). The symptoms noted were not necessarily a consequence of the assault, but they clearly captured health states in these groups.ResultsThe rate of sexual assault reports by adolescents who left the school system (9.4%) was higher than in the other group (4.2%, p < 0.001). The symptoms selected for the comparisons sexual / physical were chosen because they were significantly more frequent (p < 0.001) among adolescents reporting assault compared to non-assaulted adolescents. For each gender and each type of assault, these symptoms were explored using logistic regressions, adjusting age and schooling status (being inside or outside the school system): among boys, health problems seem more salient when the assault report was sexual rather than physical (e.g. suicide attempts: OR = 3.9, 95%CI = [1.9–8.0]); in contrast, among girls, the two groups seem equally affected.ConclusionThis gender study highlights the risk of suicide among assaulted adolescents. Sexually assaulted boys require care, including suicide prevention, even though they seem to cope effectively with physical assault. (AU)

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.

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.

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.

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.

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.

Parental alcohol dependence, socioeconomic disadvantage and alcohol and cannabis dependence among young adults in the community.

We tested the hypothesis that socioeconomic disadvantage exacerbates the intergenerational transmission of substance dependence. Among 3056 community-based young adults (18-22 years, 2007), the prevalence of alcohol dependence (WHO AUDIT, 5.8%) and cannabis dependence (DSM IV criteria, 7.3%) was doubled in the presence of combined parental alcohol dependence and socioeconomic disadvantage.

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.

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.

Determinants of school injury proneness in adolescents: a prospective study.

OBJECTIVE: Injury proneness is common in adolescents, but the role of individual factors has received little attention. This study assessed the relationships of a number of individual characteristics with frequency of school injuries. METHODS: This prospective study was conducted on 2396 students from middle schools and high schools in an urban area in France over one school year. A questionnaire was completed by each student at the beginning of the school year, and an injury questionnaire was completed for all injuries that occurred at school during the year. Data were analysed using the chi2 independence test and logistic models. RESULTS: Over the study year, 10.6% of the students had a single injury. Frequent injuries (two or more) were common (2.3%) and were strongly related to younger age [adjusted odds ratio (aOR) 1.52, 95% confidence interval (95%CI) 1.28-1.79], frequent use of psychotropic drugs (aOR 2.03, 95%CI 1.06-3.86) and a poorer average school mark (<10/20, aOR 2.58, 95%CI 1.30-5.12). The occurrence of a single injury was less strongly related to younger age (aOR 1.20, 95%CI 1.11-1.30) and frequent use of psychotropic drugs (aOR 1.43, 95%CI 1.04-1.96), and was also associated with parental absence (aOR 1.33, 95%CI 1.00-1.77), not being calm (aOR 1.41, 95%CI 1.03-1.89) and not being easily irritated (aOR 1.56, 95%CI 1.14-2.13). CONCLUSIONS: This study identified a number of factors associated with injury frequency. This information could be useful for injury prevention. Physicians could help students, parents, teachers and school staff to be more aware of the risks and to find remedial measures.

Associations of job, living conditions and lifestyle with occupational injury in working population: a population-based study.

OBJECTIVES: To assess the roles of job demands, living conditions and lifestyle in occupational injury. METHODS: The sample included 2,888 workers, aged > or =15 years, randomly selected from the north-eastern France. The subjects completed a mailed questionnaire. Data were analyzed with adjusted odds ratios (ORa) computed with the logistic model. RESULTS: In total, 9.2% of workers had an injury during the previous 2 years. The high job demands: tasks at height, handling objects, pneumatic tools, other vibrating hand tools, work in adverse climate, physical workload, vibrating platform, machine tools, cold, heat, awkward posture, noise, hammer, and pace had crude odds ratios between 1.81 and 5.25 for injury. A strong exposure-response relationship was found between the cumulated job demands (CJD, defined by their number) and injury: OR 1.88 (95% CI 1.23-2.87) for CJD1, 4.39 (2.98-4.46) for CJD2-3, and 9.93 (6.70-14.7) for CJD > or = 4, versus CJD0. These ORs decreased to 1.68, 3.70, and 7.15 respectively, when adjusted for sex, age, and living conditions/lifestyle confounders; and to 1.54, 2.99, and 5.45 respectively when also adjusted for job category. The following factors had significant ORa: age <30 years (1.54, 1.12-2.12), male (1.64, 1.18-2.30), smoking (1.60, 1.22-2.10), musculoskeletal disorders (1.54, 1.17-2.04), and frequent drug use for fatigue (2.03, 1.17-3.53). The workmen, farmers/craftsmen/tradesmen, and foremen had a 5.7-8.7-fold while the clerks and technicians a 2.7-3.6-fold higher risk compared with upper class. The risk associated with CJD was twofold higher among the workers aged > or =40 or with frequent drug use for fatigue compared with the others. Obesity had ORa 2.05 (1.11-3.78) among the subjects aged > or =40, and excess alcohol use had ORa 2.44 (1.26-4.72) among those free of disease. CONCLUSIONS: This study identified a wide range of job demands and living conditions/lifestyle which predicted injury. Preventive measures should be conducted to reduce job demands and to help workers to be aware of the risk and to improve their living conditions/lifestyle.

What are the characteristics of adolescent hospitalized suicide attempters?

AIM: To study the specificity of hospitalized adolescent suicide attempters. METHOD: Among a national sample of students (n = 11,718, mean age = 16.6 years) studied in 1999, 9.2% (n = 1078) made at least one suicide attempt during their life (SA); 21.9% (n = 234) of them were hospitalized (HSA). We identified the risk factors (family, school, behavioral and psychological) of SA and HSA by comparing (by gender) a) suicide attempters to non-suicide attempters and b) hospitalized suicide attempters to non-hospitalized suicide attempters. RESULTS: Both for girls and boys, the risk factors for SA varied. However, certain risk factors, particularly depressive mood, low self-esteem and poor parent-child relationships, were not associated with hospitalization. Hospitalized suicide attempters had more personal and social problems. But there is an important difference according to gender: in boys, hospitalization is related to physical fighting (OR = 2.2) and offences (OR = 3.4), in girls to running away (OR = 1.7), consumption of illegal drugs other than cannabis (OR = 2.0), having a living standard outside average (OR = 2.0) and going to a private school (OR = 1.7). CONCLUSION: Suicide attempters with problem behavior are more at risk of being hospitalized than others. However, the difference between hospitalized and non-hospitalized subjects was smaller than expected.

[Disturbed eating behavior and suicide thoughts among adolescents: results of a national telephone survey ]. / Conduites alimentaires perturbées et pensées suicidaires chez les adolescents: résultats d'une enquête nationale par téléphone.

The objective of this paper is to study the relation between the disturbed eating behaviours and the suicidal thoughts. In the Young People Health Barometer 97/98, 13.3% of the adolescents interviewed stated that they have "quite often" or "very often" overeaten and experienced difficulty in stopping themselves in the last 12 months. 1.0% have voluntarily vomited, 4.8% are afraid of starting to eat for fear of not being able to stop themselves, 5.6% eat in secret. Moreover, 10.3% say that they have had thoughts about suicide in the last 12 months. Percentage of suicidal thoughts increases notably with the number of declared disturbed eating behaviours. The adjusted odd ratio on sex and age for having had thoughts about suicide, comparing those declaring at least one of these eating behaviours to those declaring none of these behaviours, is 2.9.

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.

[Is aggressiveness really inhibited in asthmatic adolescents? An epidemiological approach]. / L'agressivité est-elle réellement inhibée chez l'adolescent asthmatique? Approche épidémiologique.

Clinical data support the hypothesis that aggressivity is inhibited amongst asthmatics. The relationship of violence, as a marker of aggressiveness, to asthma was examined in a population-based sample of 12.466 students of secondary schools in France (Enquête sur la Santé de l'adolescent 1993/1994) using an epidemiological questionnaire on health status, life events, potential risk factors and disease management. Twelve percent of the students reported having had at least one episode of asthma, 4% had asthma attacks, and 1% had severe asthma at the time of the survey. Asthma had been confirmed by a physician in 81% of the cases. Acts of violence [fits of violence (21%), screaming when angry (30%), hitting when angry (45%), 'racketeering' (1%)] or sustained violence [physical aggressions (15%) and rape (4%)] were significantly related to asthma in past year when applying a logistic model including age, sex, ethnic group, socioeconomical status, geographical zone, and type of school as potential confounders (adjusted odds-ratios ranging from 1.26 to 1.87 and from 1.44 to 3.48 respectively). Similarly, violence was related to severe asthma. Results persisted after exclusion of individuals for whom asthma had not been confirmed by a physician. These findings strongly challenge the current hypothesis according to which aggressiveness is inhibited in asthmatic adolescents.

A psychological assessment of adolescent and young adult inpatients after traumatic brain injury.

The purpose of this study was to evaluate the cognitive, behavioural, depressive and self-awareness disorders, and their relationships, after severe traumatic brain injury (TBI) in adolescent and young adult inpatients. Two groups of patients with (n = 83) and without (n = 103) TBI, aged 14-25 years, hospitalized after severe traumatic pathology, were compared using the clinician's report and self-report. A higher frequency of depressive tendencies in TBI patients than in controls was shown in the clinician's therapeutic attitude (i.e. prescription of antidepressant drugs), the clinician's report and the self-report. The same difference between the two groups was observed for behavioural and schooling problems in the clinician's report, but not in the self-report. Discrepancies between self- and clinician's evaluation were in favour of a lack of self-awareness of behavioural and cognitive disorders among TBI patients. Correlations of depressive mood with anxiety and cognitive complaints were stronger in TBI than in non-TBI patients. Depression in TBI patients seems compatible with some degree of lack of self-awareness of cognitive and behavioural difficulties.