The Development of a Chatbot Technology to Disseminate Post-COVID-19 Information: Descriptive Implementation Study.

BACKGROUND: Post-COVID-19, or long COVID, has now affected millions of individuals, resulting in fatigue, neurocognitive symptoms, and an impact on daily life. The uncertainty of knowledge around this condition, including its overall prevalence, pathophysiology, and management, along with the growing numbers of affected individuals, has created an essential need for information and disease management. This has become even more critical in a time of abundant online misinformation and potential misleading of patients and health care professionals. OBJECTIVE: The RAFAEL platform is an ecosystem created to address the information about and management of post-COVID-19, integrating online information, webinars, and chatbot technology to answer a large number of individuals in a time- and resource-limited setting. This paper describes the development and deployment of the RAFAEL platform and chatbot in addressing post-COVID-19 in children and adults. METHODS: The RAFAEL study took place in Geneva, Switzerland. The RAFAEL platform and chatbot were made available online, and all users were considered participants of this study. The development phase started in December 2020 and included developing the concept, the backend, and the frontend, as well as beta testing. The specific strategy behind the RAFAEL chatbot balanced an accessible interactive approach with medical safety, aiming to relay correct and verified information for the management of post-COVID-19. Development was followed by deployment with the establishment of partnerships and communication strategies in the French-speaking world. The use of the chatbot and the answers provided were continuously monitored by community moderators and health care professionals, creating a safe fallback for users. RESULTS: To date, the RAFAEL chatbot has had 30,488 interactions, with an 79.6% (6417/8061) matching rate and a 73.2% (n=1795) positive feedback rate out of the 2451 users who provided feedback. Overall, 5807 unique users interacted with the chatbot, with 5.1 interactions per user, on average, and 8061 stories triggered. The use of the RAFAEL chatbot and platform was additionally driven by the monthly thematic webinars as well as communication campaigns, with an average of 250 participants at each webinar. User queries included questions about post-COVID-19 symptoms (n=5612, 69.2%), of which fatigue was the most predominant query (n=1255, 22.4%) in symptoms-related stories. Additional queries included questions about consultations (n=598, 7.4%), treatment (n=527, 6.5%), and general information (n=510, 6.3%). CONCLUSIONS: The RAFAEL chatbot is, to the best of our knowledge, the first chatbot developed to address post-COVID-19 in children and adults. Its innovation lies in the use of a scalable tool to disseminate verified information in a time- and resource-limited environment. Additionally, the use of machine learning could help professionals gain knowledge about a new condition, while concomitantly addressing patients' concerns. Lessons learned from the RAFAEL chatbot will further encourage a participative approach to learning and could potentially be applied to other chronic conditions.

Persistent symptoms after SARS-CoV-2 infection in children: a cross-sectional population-based serological study.

OBJECTIVES: To estimate the prevalence of children and adolescents reporting persistent symptoms after SARS-CoV-2 infection. DESIGN: A random sample of children and adolescents participated with their family members to a serological survey including a blood drawing for detecting antibodies targeting the SARS-CoV-2 nucleocapsid (N) protein and a questionnaire on COVID-19-related symptoms experienced since the beginning of the pandemic. SETTING: The study took place in the canton of Geneva, Switzerland, between June and July 2021. PARTICIPANT: 660 children aged between 2 and 17 years old. PRIMARY AND SECONDARY OUTCOME: The primary outcome was the persistence of symptoms beyond 4 weeks comparing seropositive and seronegative participants. The type of declared symptoms were also studied as well as associated risk factors. RESULTS: Among seropositive children, the sex-adjusted and age-adjusted prevalence of symptoms lasting longer than 2 weeks was 18.3%, compared with 11.1% among seronegatives (adjusted prevalence difference (ΔaPrev)=7.2%, 95% CI: 1.5% to 13.0%). Among adolescents aged 12-17 years, we estimated the prevalence of experiencing symptoms lasting over 4 weeks to be 4.4% (ΔaPrev,95% CI: -3.8% to 13.6%), whereas no seropositive child aged 2-11 reported symptoms of this duration. The most frequently declared symptoms were fatigue, headache and loss of smell. CONCLUSIONS: We estimated the prevalence of experiencing persistent symptoms lasting over 4 weeks to be around 4% among adolescents, which represents a large absolute number, and should raise awareness and concern. We did not observe meaningful differences of persistent symptoms between seropositive and seronegative younger children, suggesting that they may be less affected than their older counterparts.

A population-based serological study of post-COVID syndrome prevalence and risk factors in children and adolescents.

Post-COVID syndrome remains poorly studied in children and adolescents. Here, we aimed to investigate the prevalence and risk factors of pediatric post-COVID in a population-based sample, stratifying by serological status. Children from the SEROCoV-KIDS cohort study (State of Geneva, Switzerland), aged 6 months to 17 years, were tested for anti-SARS-CoV-2 N antibodies (December 2021-February 2022) and parents filled in a questionnaire on persistent symptoms in their children (lasting over 12 weeks) compatible with post-COVID. Of 1034 children tested, 570 (55.1%) were seropositive. The sex- and age-adjusted prevalence of persistent symptoms among seropositive children was 9.1% (95%CI: 6.7;11.8) and 5.0% (95%CI: 3.0;7.1) among seronegatives, with an adjusted prevalence difference (ΔaPrev) of 4.1% (95%CI: 1.1;7.3). Stratifying per age group, only adolescents displayed a substantial risk of having post-COVID symptoms (ΔaPrev = 8.3%, 95%CI: 3.5;13.5). Identified risk factors for post-COVID syndrome were older age, having a lower socioeconomic status and suffering from chronic health conditions, especially asthma. Our findings show that a significant proportion of seropositive children, particularly adolescents, experienced persistent COVID symptoms. While there is a need for further investigations, growing evidence of pediatric post-COVID urges early screening and primary care management.

[A new challenge: post-COVID syndrome in teenagers]. / Nouveau défi : syndrome post-Covid à l'adolescence.

Post-COVID syndrome (or long COVID) is a set of persistent symptoms occurring after a documented SARS-CoV-2 infection. Children and adolescents are also affected, with similar symptoms than adults. To date there is no clinical or biological parameter allowing to confirm the diagnosis, which relies on the presence of typical symptoms associated with a suggestive temporality, in the absence of any other explanation. These persistent symptoms can have a strong impact on the quality of life and schooling. In our specialized consultation for pediatric post-COVID syndrome, we offer a global and multidisciplinary follow-up to patients and their families, supporting them progressively resuming physical and mental activity, and pursuing school attendance to avoid dropout.

Le syndrome post-Covid est un ensemble de symptômes persistants après une infection à SARS-CoV-2 documentée. Cette affection touche aussi les enfants et les adolescents, avec des symptômes similaires à ceux des adultes. Il n'existe à ce jour aucun paramètre clinique ou biologique pour confirmer le diagnostic qui repose sur la présence de symptômes typiques et d'une temporalité suggestive, en l'absence d'autre explication. Ces symptômes persistants peuvent avoir un fort retentissement sur la qualité de vie et la scolarité. Au sein de notre consultation multidisciplinaire dédiée au syndrome post-Covid pédiatrique, nous proposons un suivi global aux patients et à leurs familles, en les accompagnant dans la reprise progressive d'une activité physique et mentale, et en soutenant la poursuite de la scolarité pour éviter la rupture scolaire.

Immunological Assessment of Pediatric Multisystem Inflammatory Syndrome Related to Coronavirus Disease 2019.

BACKGROUND: Recently, cases of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) have been reported worldwide. Negative polymerase chain reaction (RT-PCR) testing associated with positive serology in most of the cases suggests a postinfectious syndrome. Because the pathophysiology of this syndrome is still poorly understood, extensive virological and immunological investigations are needed. METHODS: We report a series of 4 pediatric patients admitted to Geneva University Hospitals with persistent fever and laboratory evidence of inflammation meeting the published definition of MIS-C related to COVID-19, to whom an extensive virological and immunological workup was performed. RESULTS: RT-PCRs on multiple anatomical compartments were negative, whereas anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin A (IgA) and immunoglobulin G (IgG) were strongly positive by enzyme-linked immunosorbent assay and immunofluorescence. Both pseudoneutralization and full virus neutralization assays showed the presence of neutralizing antibodies in all children, confirming a recent infection with SARS-CoV-2. The analyses of cytokine profiles revealed an elevation in all cytokines, as reported in adults with severe COVID-19. Although differing in clinical presentation, some features of MIS-C show phenotypic overlap with hemophagocytic lymphohistiocytosis (HLH). In contrast to patients with primary HLH, our patients showed normal perforin expression and natural killer (NK) cell degranulation. The levels of soluble interleukin (IL)-2 receptor (sIL-2R) correlated with the severity of disease, reflecting recent T-cell activation. CONCLUSION: Our findings suggest that MIS-C related to COVID-19 is caused by a postinfectious inflammatory syndrome associated with an elevation in all cytokines, and markers of recent T-cell activation (sIL-2R) occurring despite a strong and specific humoral response to SARS-CoV-2. Further functional and genetic analyses are essential to better understand the mechanisms of host-pathogen interactions.

Surgical Repair of Mitral Valve Disease in Children: Perioperative Changes in Respiratory Function.

OBJECTIVE: To assess the profile of changes in airway and respiratory tissue mechanics within a follow-up study performed in children with mitral valve disease, before and after surgical valve repair. DESIGN: Perioperative measurements in a prospective, consecutive cross-sectional study. SETTING: University hospital, tertiary care teaching hospital PARTICIPANTS: The study comprised 24 children with congenital or post-rheumatic mitral valve insufficiency. INTERVENTIONS: Input impedance of the respiratory system during spontaneous breathing was measured before and 5 days and 3 weeks after mitral valve surgery. In addition, airway and respiratory tissue mechanics and pulmonary arterial pressure were assessed with the patient under general anesthesia preoperatively and immediately postoperatively. Respiratory tissue elastance and changes in airway measurements were estimated from forced oscillatory impedance data by fitting an appropriate model. MEASUREMENT AND MAIN RESULTS: Relating airway and respiratory tissue mechanics to previously established reference values obtained in age-matched healthy control patients revealed abnormal respiratory function (135±6.2% and 148±13% in respiratory elastance and resistance, respectively; p<0.001). Improvement in the airway properties was observed immediately after surgery (-15.2±3.4%; p<0.005) and lasted for the study period (-19±4.1%; p<0.001). Respiratory tissue elastance, which correlated preoperatively to the diastolic pulmonary arterial pressure, decreased only 5 days postoperatively (-20.6±4.1%; p<0.005). However, there was no evidence of a clear, immediate effect of surgery on the tissue mechanical parameters measured intraoperatively despite a decrease in diastolic pulmonary pressure. CONCLUSIONS: Mitral valve disease in children leads to abnormal airway and respiratory tissue mechanics. Even though surgical repair of mitral insufficiency alleviates abnormal airway function, residual lung tissue stiffening may persist even weeks after the surgery, contributing to a sustained impairment in lung function.

[Pregnancy and motherhood in adolescence]. / Grossesse et maternité à l'adolescence.

Adolescence and pregnancy are two periods which involve major psychological and identity changes. Teenage pregnancies are often considered to be a result of a confusion between these periods. The circumstances of teenage pregnancies and early motherhood are diverse and sit within the wider context of the psychopathology of adolescence, the heterogeneity of family configurations and evolutions in society.

First epidemiological study on occupational radar exposure in the French Navy: a 26-year cohort study.

This retrospective cohort study deals with the causes of death among 57,000 military personnel who served in the French Navy surface vessels and were observed over the period 1975-2000. We successively compared the mortality rate and the specific causes of death between two groups differing in their potential exposure levels to radar. Occupational exposure was defined according to the on-board workplace (radar and control groups). The age-adjusted death ratios of the navy personnel were compared. For all causes of death, the results showed that 885 deaths in the radar group and 299 in the control group occurred (RR = 1.00 (95% CI: 0.88-1.14)). RRs were 0.92 (95% CI: 0.69-1.24) for neoplasms. For the duration of follow-up, the results did not show an increased health risk for military personnel exposed to higher levels of radio frequencies in the radar group, but the number of deaths was very small for some cancer sites.

From forest to cropland and pasture systems: a critical review of soil organic carbon stocks changes in Amazonia.

The impact of deforestation on soil organic carbon (SOC) stocks is important in the context of climate change and agricultural soil use. Trends of SOC stock changes after agroecosystem establishment vary according to the spatial scale considered, and factors explaining these trends may differ sometimes according to meta-analyses. We have reviewed the knowledge about changes in SOC stocks in Amazonia after the establishment of pasture or cropland, sought relationships between observed changes and soil, climatic variables and management practices, and synthesized the δ13 C measured in pastures. Our dataset consisted of 21 studies mostly synchronic, across 52 sites (Brazil, Colombia, French Guiana, Suriname), totalling 70 forest-agroecosystem comparisons. We found that pastures (n = 52, mean age = 17.6 years) had slightly higher SOC stocks than forest (+6.8 ± 3.1 %), whereas croplands (n = 18, mean age = 8.7 years) had lower SOC stocks than forest (-8.5 ± 2.9 %). Annual precipitation and SOC stocks under forest had no effect on the SOC changes in the agroecosystems. For croplands, we found a lower SOC loss than other meta-analyses, but the short time period after deforestation here could have reduced this loss. There was no clear effect of tillage on the SOC response. Management of pastures, whether they were degraded/nominal/improved, had no significant effect on SOC response. δ13 C measurements on 16 pasture chronosequences showed that decay of forest-derived SOC was variable, whereas pasture-derived SOC was less so and was characterized by an accumulation plateau of 20 Mg SOC ha-1 after 20 years. The large uncertainties in SOC response observed could be derived from the chronosequence approach, sensitive to natural soil variability and to human management practices. This study emphasizes the need for diachronic and long-term studies, associated with better knowledge of agroecosystem management.

Implementing a pressure ulcer prevention bundle into practice.

The implementation of a care bundle approach to delivering fundamental care in practice is now a recognised and effective way of translating research into practice, offering consistent care with resulting positive outcomes for the patient. A care bundle consists ofa relatively small number of interventions for every patient to whom the bundle is applied. However, there must be evidence behind each individual intervention to indicate, if delivered, how it will reduce the risk to the patient. This paper reports on a strategy for developing and implementing a pressure ulcer (PU) combined prevention care bundle/ care plan into practice. The effectiveness of the care bundle can be measured when it is in use in the practice setting with an audit tool.

[French general practitioners and electromagnetic fields]. / Les médecins généralistes français face aux champs électromagnétiques.

OBJECTIVE: To assess the perception of risk of general practitioners (GPs) about electromagnetic fields (EMF), their sources of information, as well as their patients' level of concern. METHODS: Six hundred French GPs were selected according to the quotas method. They were asked to answer 24 items via an electronic questionnaire using the Computer-Assisted Web Interviewing (CAWI) method. RESULTS: The GPs know the main EMF sources: cell phone towers, cell phones, power-lines, microwave ovens and WiFi networks. Patients mostly complain or worry about the first three sources and ask their GP for information about these. GPs themselves search for information in the mainstream media rather than in the usual scientific and medical press. As a consequence, their knowledge about potential risks of EMF is deemed rather crude. DISCUSSION AND CONCLUSION: The GPs are sensitive to environmental concerns, particularly regarding EMF exposure. However, according to the results analysis, they do not have the same approach because of an obvious lack of mastery in a complex and poorly informed situation. A serious educational effort is essential and would be welcomed by practitioners, who are aware of their responsibilities in terms of counseling, diagnosis and care.

Considering the role of pyruvate in tumor cells during hypoxia.

Impairment of oxygen supply occurs in many pathological situations. In the case of cancer, both chronic and acute hypoxic areas are found in the tumor. Tumor hypoxia is associated with poor clinical prognoses and is correlated with tumor growth and metastasis development. Pyruvate is a common metabolite, as it is an end-product of glycolysis and an energy substrate for the mitochondrial Krebs cycle. It is also well known for its protective properties against stressful conditions, particularly hypoxia. Its presence determines cellular fate when there is a lack of oxygen. Interestingly, pyruvate metabolism is altered during cancer development. For years, this was assumed to be a consequence of malignant transformation. However, it now is becoming clear that pyruvate could contribute to cancer progression. The role of pyruvate during hypoxia has been widely studied in non-tumor tissues and cells; it is less documented whether or not the protective effect of pyruvate could also take place in cancer cells. If so, pyruvate might be deleterious for cancer patients. The present paper reviews data that highlight the role of pyruvate in cancer cells and tumors during hypoxic stress.

Pyruvate reduces DNA damage during hypoxia and after reoxygenation in hepatocellular carcinoma cells.

Pyruvate is located at a crucial crossroad of cellular metabolism between the aerobic and anaerobic pathways. Modulation of the fate of pyruvate, in one direction or another, can be important for adaptative response to hypoxia followed by reoxygenation. This could alter functioning of the antioxidant system and have protective effects against DNA damage induced by such stress. Transient hypoxia and alterations of pyruvate metabolism are observed in tumors. This could be advantageous for cancer cells in such stressful conditions. However, the effect of pyruvate in tumor cells is poorly documented during hypoxia/reoxygenation. In this study, we showed that cells had a greater need for pyruvate during hypoxia. Pyruvate decreased the number of DNA breaks, and might favor DNA repair. We demonstrated that pyruvate was a precursor for the biosynthesis of glutathione through oxidative metabolism in HepG2 cells. Therefore, glutathione decreased during hypoxia, but was restored after reoxygenation. Pyruvate had beneficial effects on glutathione depletion and DNA breaks induced after reoxygenation. Our results provide more evidence that the alpha-keto acid promotes the adaptive response to hypoxia followed by reoxygenation. Pyruvate might thus help to protect cancer cells under such stressful conditions, which might be harmful for patients with tumors.

Physical activity-related energy expenditure with the RT3 and TriTrac accelerometers in overweight adults.

OBJECTIVE: The objective was to evaluate two accelerometers, the RT3 and the TriTrac-R3D for their ability to produce estimates of physical activity-related energy expenditure (PAEE) in overweight/obese adults. RESEARCH METHODS AND PROCEDURES: PAEE estimates from both accelerometers were obtained in two experiments. In Experiment 1, 13 overweight/obese subjects (BMI 34.2+/-6.4 kg/m2) were monitored over 2 weeks in everyday life, PAEE being simultaneously measured by the doubly labeled water method (DLW). In Experiment 2, 8 overweight/obese subjects (BMI 34.3+/-5.0 kg/m2) and 10 normal-weight subjects (BMI 20.8+/-2.1 kg/m2) were monitored during a treadmill walking protocol, PAEE being simultaneously measured by indirect calorimetry. RESULTS: In Experiment 1, there was no significant difference between methods in mean PAEE (DLW: 704+/-223 kcal/d, RT3: 656+/-140 kcal/d, TriTrac-R3D 624+/-419 kcal/d). The relative difference between methods (accelerometer vs. DLW) was -17.1%+/-16.7% for the RT3 and -20.0+/-44.6% for the TriTrac-R3D. Correlation for PAEE between RT3 and DLW was higher than between TriTrac-R3D and DLW (r=0.67, p<0.05 and r=0.36, p=0.25, respectively). The 95% confidence interval (CI) (kcal/d) of the mean difference between methods was large, amounting to -385 to 145 for the RT3 and -887 to 590 for the TriTrac-R3D. In Experiment 2, both accelerometers were sensitive to the changes in treadmill speed, with no significant difference in mean PAEE between methods in overweight/obese subjects. CONCLUSIONS: Although both accelerometers did not provide accurate estimates of PAEE at individual levels, the data suggest that RT3 has the potential to assess PAEE at group levels in overweight/obese subjects.

A randomized trial of catheter change and short course of antibiotics for asymptomatic bacteriuria in catheterized ICU patients.

OBJECTIVE: To determine the effect on the occurrence of urosepsis of a treatment with a short course of antibiotics and indwelling urethral catheter replacement in clinically asymptomatic intensive care unit (ICU) patients with a positive urine culture occurring at least 48 h after catheterization. METHODS: A prospective randomized clinical trial was conducted in the medico-surgical ICU of a tertiary care centre. Sixty patients hospitalized in the ICU with an indwelling urethral catheter for longer than 48 h developing an asymptomatic positive urine culture were randomized to receive either a 3-day course of antibiotics associated with the replacement of the indwelling urethral catheter 4 h after first antibiotic administration or no antibiotics, no catheter replacement (standard of care). RESULTS: Three patients in each group developed urosepsis (P=0.1). There were no significant differences in duration of mechanical ventilation between the study group and the standard of care group (9 [4-20] days vs 5 [2-15] days, P=0.2), in duration of urinary catheterization (22 [11-40] days vs 18 [14-33] days, P=0.8), or in length of ICU stay (28 [13-46] vs 19 [15-34], P=0.6). The recurrence of positive urine culture at days 7 and 15 was not affected by the randomization (P=0.1). The profile of bacterial resistance was similar in the two groups. CONCLUSIONS: Treating a positive urine culture in an asymptomatic patient with an indwelling urethral catheter does not reduce the occurrence of urosepsis in the medico-surgical ICU.

Diet and physical activity profiles in French preadolescents.

Dietary patterns have been identified in adults, but less is known about children and adolescents. For the first time, we have investigated lifestyle patterns combining diet and physical activity in 12-year-old French preadolescents and examined their association with sociodemographic factors. Physical activity, sedentary activities and dietary habits were assessed by questionnaires given to 2724 students in 2001. Family income tax and parents' educational level, as indicators of socio-economic status, and the size of the residence commune were obtained from parents. After adjusting for socio-economic status, physical activity was positively associated with a consumption of fruit/vegetables/fruit juice on more than four occasions in the previous 24 h (P<0.001). Sedentary activities were positively associated with the consumption of French fries or potato chips (P<0.001), with sweetened drink as the most usual drink (P<0.001) and with nibbling while watching television (P<0.001), and inversely associated with a high consumption of fruit/vegetables/fruit juice (P=0.04). Multiple correspondence analysis identified two independent axes and specific combinations of behaviour: one axis characterised by sedentary activity, sweetened drink as the most usual drink, the consumption of French fries or potato chips and nibbling while watching television; a second one associating physical activity and the consumption of fruit/vegetables/fruit juice. Both socio-economic proxies were associated with the former axis (P<0.001). The size of the residence commune was associated with the latter (P<0.1). Combinations of diet and physical activity habits were identified in adolescents, indicating that prevention programmes targeting both behaviours may have an enhanced outcome.

[Public access to information about the services and quality of care in public hospitals: the need for methodologic clarity. A survey of 44 university hospital directors and administrators]. / Accès du public aux informations sur les prestations et la qualité des soins dans les établissements publics de santé. Enquête auprès de 44 décideurs de CHU.

INTRODUCTION: For the past eight years, the Ministry of Health has released information about the services and quality of care in public hospitals, in response to the increasing concern about hospital performance expressed by patient associations. The press publishes hospital ratings based on this information. This survey asked hospital administrators about their views of communication on this topic. METHODS: This survey, conducted from 7 October through 20 November 2004, sent a two-page open questionnaire to a variety of hospital executive personnel - medical directors, chief administrators, medical school deans, and public information officers - to determine their views on this subject. RESULTS: The response rate was 34%. Without contesting either the legitimacy of the expectation for information or the transparency owed to patients, health professionals expressed the need to know in advance the "rules of the game" and the methodology of the rating techniques to be used. Most reported few changes in their professional behavior due to these publications, the methodology and criteria of which they contested. They suggested changes including different criteria and indicators for the rating, the ability to contest the conclusions drawn from the PMSI data, and the need for preliminary work to define criteria by working groups composed of physicians, other professionals, and even those outside the health field. On the other hand, only half were willing to participate in such a working group. CONCLUSION: These hospital managers see a need for specialists in the analysis of hospital data, who can clarify the meaning of the statistics and improve the public's understanding of them, now shaped by the mass media's failure to provide meaningful analysis.

Interactions between traditional regional determinants and socio-economic status on dietary patterns in a sample of French men.

The aim of the present study was to assess the respective contributions of regional and socio-economic factors to dietary pattern. We used the data from the final MONICA (MONItoring of trends and determinants in Cardiovascular disease) population survey conducted in the three French centres in 1995-7 among a representative sample of 976 men aged 45-64 years. Dietary intake was assessed using a 3-d record method. Dietary patterns were identified by a factor analysis, based on fifteen food items. An analysis of variance was then used to study their relationship with regional and socio-economic determinants. Two major dietary patterns were identified: a 'Western diet', characterized by high intakes of sugar and sweets, grains, butter, added fats, eggs, potatoes and cheese; a 'prudent diet', mainly distinguished by high intakes of fruit, vegetables, olive oil and fish and low intakes of alcohol, high-fat meat and potatoes. Strong associations were mostly observed with the 'prudent diet' pattern, with a significant relationship with region, educational and income-tax levels, leisure-time physical activity and smoking status. There was also a statistically significant interaction between region and educational level (P=0.05), and between region and income-tax level (P=0.03), indicating that the influence of socio-economic factors is different among regions. In conclusion, these results indicate large regional and socio-economic differences in the dietary patterns of this French male population. When considering the 'prudent diet' pattern, they also suggest that traditional regional influences may now be overcome by socio-economic determinants.

Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.

CONTEXT: Dietary patterns and lifestyle factors are associated with mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer, but few studies have investigated these factors in combination. OBJECTIVE: To investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and nonsmoking on all-cause and cause-specific mortality in European elderly individuals. DESIGN, SETTING, AND PARTICIPANTS: The Healthy Ageing: a Longitudinal study in Europe (HALE) population, comprising individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women, aged 70 to 90 years in 11 European countries. This cohort study was conducted between 1988 and 2000. MAIN OUTCOME MEASURES: Ten-year mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer. RESULTS: During follow-up, 935 participants died: 371 from cardiovascular diseases, 233 from cancer, and 145 from other causes; for 186, the cause of death was unknown. Adhering to a Mediterranean diet (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.68-0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67-0.91), physical activity (HR, 0.63; 95% CI, 0.55-0.72), and nonsmoking (HR, 0.65; 95% CI, 0.57-0.75) were associated with a lower risk of all-cause mortality (HRs controlled for age, sex, years of education, body mass index, study, and other factors). Similar results were observed for mortality from coronary heart disease, cardiovascular diseases, and cancer. The combination of 4 low risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44). In total, lack of adherence to this low-risk pattern was associated with a population attributable risk of 60% of all deaths, 64% of deaths from coronary heart disease, 61% from cardiovascular diseases, and 60% from cancer. CONCLUSION: Among individuals aged 70 to 90 years, adherence to a Mediterranean diet and healthful lifestyle is associated with a more than 50% lower rate of all-causes and cause-specific mortality.

Vitamin B12 (cobalamin) deficiency in elderly patients.

Vitamin B12 or cobalamin deficiency occurs frequently (> 20%) among elderly people, but it is often unrecognized because the clinical manifestations are subtle; they are also potentially serious, particularly from a neuropsychiatric and hematological perspective. Causes of the deficiency include, most frequently, food-cobalamin malabsorption syndrome (> 60% of all cases), pernicious anemia (15%-20% of all cases), insufficient dietary intake and malabsorption. Food-cobalamin malabsorption, which has only recently been identified as a significant cause of cobalamin deficiency among elderly people, is characterized by the inability to release cobalamin from food or a deficiency of intestinal cobalamin transport proteins or both. We review the epidemiology and causes of cobalamin deficiency in elderly people, with an emphasis on food-cobalamin malabsorption syndrome. We also review diagnostic and management strategies for cobalamin deficiency.