Holistic psychosocial determinants of adherence to medication in people with type 2 diabetes.

BACKGROUND: The aim of this study was to determine whether adherent and non-adherent patients with type 2 diabetes can be differentiated according to psychosocial characteristics. METHODS: A total of 1214 patients were included in the analysis. Data were derived from a cross-sectional observational study of adults with diabetes of the Access Santé (Access Health) panel of Kantar Health France. Patients completed a questionnaire on adherence to medication, psychological determinants (trust in physicians, constancy of habits, patience, temporal horizon, health locus of control, obedience, psychological reactivity, prevention vs promotion, optimism vs pessimism) and social deprivation. RESULTS: Of these 1214 subjects, 46.2% were considered strictly adherent to antidiabetic medication, as reflected by negative answers to all six questions suggesting a non-adherent behaviours, whereas 48.9% provided 1-2 positive answers and 4.9% provided 3-6 positive answers, and were considered non-adherent. In addition to the effect of younger age (P=0.03), multivariate logistic regression analysis demonstrated the following psychosocial determinants of non-adherence: chance locus of control (P=0.02); lack of trust in physicians (P=0.010); and pessimism (P=0.021). Multiple factor analysis identified adherence and social deprivation as dimensions separating three distinct patient populations: (i) non-adherent; (ii) adherent and socially deprived; and (iii) adherent and non-socially deprived. It also revealed that patience, obedience, cautious behaviour, optimism, trust in physicians and constancy of habits were associated with adherence. CONCLUSION: Of the multiple determinants of adherence, trust in physicians and constancy of habits represent modifiable factors, and constitute targets to prevent non-adherence because they can be reinforced through patient education and improved physician - patient relationship. Also, psychosocial determinants of adherence differ widely between socially deprived and non-deprived patients.

Prevalence of sunbed use, and characteristics and knowledge of sunbed users: results from the French population-based Edifice Melanoma survey.

BACKGROUND: In addition to natural sunlight, indoor tanning has emerged as a common source of ultraviolet (UV) radiation associated with an increased risk of melanoma. It is classified as a class I human carcinogen by the World Health Organization. OBJECTIVES: This analysis presents data on the prevalence of sunbed use in France, on factors associated with sunbed use, and on risk factors, attitude and awareness of risk among sunbed users and non-users. METHODS: Edifice Melanoma, a nationwide observational survey, was conducted in France via telephone interviews among a representative sample of 1502 subjects aged ≥18 years, using the quota method. Sunbed users were defined as individuals who reported having used a sunbed at least once in their lifetime. Logistical regressions were conducted in order to identify which factors differentiate the population of sunbed users from that of non-users. RESULTS: One in ten respondents was a sunbed user and three out of four declared having used tanning facilities for over one year. In multivariate analysis, factors significantly associated with the sunbed-user group were female gender (OR = 3.897 [2.573-5.903], P < 0.001), a higher socio-professional category (OR = 2.227 [1.542-3.217]; P < 0.001), fair hair (OR = 1.583 [1.025-2.447], P = 0.039), fair skin (OR = 1.879 [1.086-3.253]; P = 0.024), freckles (OR = 1.570 [1.071-2.302]; P = 0.021) and a history of smoking (OR = 2.383 [1.633-3.476]; P < 0.001). In a second multivariate model, the fact of having a large number of melanoma risk factors was strongly associated with sunbed use (P = 0.001). Sunbed users were more likely to be informed of the role of sun exposure in reducing the skin's regenerative capacity (OR = 2.181 [1.319-3.607]; P = 0.002) but were nevertheless more likely to consider that a tan makes a person look more attractive (OR = 2.309 [1.312-4.064]; P = 0.004) and protects the skin (OR = 2.490 [1.532-4.046]; P < 0.001); they were also more frequently exposed to natural sunlight (OR = 2.214 [1.196-4.102]; P = 0.011). CONCLUSIONS: Compared to non-users, sunbed users cumulate risk factors for melanoma. Knowledge, attitudes and intentions of individuals are critical targets for public education programmes. However, awareness campaigns focusing on sunbed use, and more generally on skin cancer, should also take social and cultural norms into account.

Type 2 diabetes mellitus in France in 2012: results from the ObEpi survey.

AIM: This analysis estimates the prevalence of type 2 diabetes mellitus (T2DM) in French adults participating in the ObEpi (obesity epidemiology) 2012 survey and also proposes a description of that population, according to comorbidities, treatments and sociodemographic factors related to the disease. METHODS: A self-administered questionnaire was posted to 20,000 households from the Kantar Health panel. In total, 25,714 adults aged≥18 years and representative of the French population completed the survey between January and March 2012. RESULTS: The prevalence of T2DM was 5.5±0.3% (95% CI) in this representative sample of the adult French population. Average age of patients was 65.9 years; 55% were men. Mean body mass index was 29.9kg/m(2) (men: 29.4kg/m(2), women: 30.6 kg/m(2); P<0.01); the prevalence of obesity was 43.1% (men: 39.9%, women: 47.1%; P<0.01). Patient-reported treatments for comorbidities were frequent: high blood pressure, 59.1%; dyslipidaemia, 59.9%; myocardial infarction/angina pectoris, 9.7%; revascularization, 7.8%; heart failure, 7.4%; sleep apnoea, 8.3%; and osteoarthritis, 10.7%. With regards to known treatments, 81.4% of patients were taking oral antidiabetic drugs (OADs), and 15.3% were using insulin therapy. Also, 18.8% of diabetic respondents reported financial hardship. CONCLUSION: T2DM remains a disease of major concern: compared with the non-diabetic population, all parameters surveyed showed unfavourable ratings, particularly for women.

Cardiovascular structural changes induced by isolation-stress hypertension in the rat.

The cardiovascular structural remodelling associated with psychogenic hypertension was investigated in genetically normotensive rats subjected to isolation stress. Male Wistar rats were stressed by intermittent social isolation and compared to control rats living in groups. The stressed rats had higher systolic blood pressures than the control rats throughout the study. After 1 week of isolation, ornithine decarboxylase activity, a marker for hypertrophy, was increased in the right ventricle of the stressed rats. After 6 weeks of intermittent isolation, the myocardium of the stressed rats was hypertrophied, involving both right and left ventricles. The aorta was also hypertrophied, whereas the tail artery remained unaffected. Later, after 12 weeks of isolation, the left ventricular hypertrophy persisted whereas the right ventricle and aorta returned to normal. It seems, therefore, that social stress hypertension is accompanied by very early structural changes, which affect at least the heart and the aorta, and cannot be directly linked to the severity or duration of hypertension.

Electric footshocks differentially affect plasma and spinal cord vasopressin and oxytocin levels.

Rats exposed for three minutes to repeated electric footshocks showed an approximate 10-fold increase of basal plasma vasopressin (AVP) and oxytocin (OXT) levels. In contrast, spinal AVP and OXT contents measured in the same rats remained unchanged when compared to undisturbed controls. This observation suggests that spinal AVP and OXT do not play a major role in the short-term adaptation of the organism to stress.

Vasopressin effects on food-rewarded learning tasks might be due to its action on carbohydrate/lipid metabolism, not memory.

Vasopressin (VP) has been implicated in memory processes on the basis of effects observed in aversively motivated learning situations. Therefore researchers have tried to confirm this role by using food-motivated learning tasks. However, the well-established physiological influences of VP on carbohydrate and lipid metabolism were not taken into consideration. At various times following administration, VP might act as a feeding stimulant or as a satiating agent. Experimental designs should allow for these effects when food-rewarded learning paradigms are used to determine whether VP acts on memory.

Vasopressin as a putative mediator in SHR hypoalgesia.

The purpose of this note is to show that vasopressin might be involved in the hypoalgesia of the spontaneously hypertensive rat. This proposal rests upon published data.

Dose-related influence of arginine-vasopressin on a passive avoidance behavior: effect of rearing conditions.

The present experiment was conducted in order to determine what effects administration of arginine-vasopressine (AVP) would have on post weaned male rats, reared for 44 days either in relative social isolation or in group and tested in a cross-through passive avoidance task. AVP (0.0; 0.1 and 1.0 micrograms/rat) was injected subcutaneously immediately after the application of the electric footshock (0.3 mA for 2 sec). The individual post-weaning housing significantly impaired the passive avoidance performance in rats treated with saline (0.0 micrograms) and in rats treated with 1.0 micrograms AVP. No difference, however, was observed between isolated and group-reared rats injected with 0.1 micrograms AVP. It was concluded that AVP acts upon the passive avoidance performance by changing the animal's state of arousal in a non-monotonic dose-dependent manner.

Effect of daily pretrial injection of oxytocin on rat behavior in the open-field situation.

This experiment was conducted to investigate the effects of daily pretrial intraperitoneal injection of oxytocin on behaviors of rats in an open-field situation. The group treated with 0.055 micrograms of oxytocin did not show any behavioral changes except the defecation score which was significantly more elevated than in controls. The group treated with 0.11 micrograms showed a general locomotor activity and a number of rearing behavior significantly more elevated than in all three other groups. The defecation and the grooming scores were however not different from controls. Finally, the group treated with 0.22 micrograms did not present any behavioral difference when compared with controls. Only the defecation score was significantly lower than in all the other groups. It is suggested that daily injection of oxytocin affects the arousal rather than the emotionality level.

Changes in total serum immunoreactive neurophysins and corticosterone levels after restraint stress in rats.

This study indicates that total immunoreactive circulating neurophysins (IRN) increased in male rats submitted to acute restraint stress. Total immunoreactive serum corticosterone levels also were elevated, confirming the stressful character of the restraint situation. It is speculatively suggested that IRN elevations due to stress are the reflection of a corticotropin releasing factor (CRF)-IRN product.

Daily behavioral manipulation increases the total immunoreactive serum neurophysin concentrations irrespective of the duration of water deprivation in rats.

The daily training of rats in a two-compartment test box is sufficient to involve an increase in the total immunoreactive serum neurophysin concentrations when compared to totally undisturbed controls. Furthermore, this training is capable of masking the differences in neurophysin concentrations usually seen in unmanipulated rats after different durations of water deprivation. To interpret these high neurophysin levels, we speculatively suggest the existence of hypothalamic compensatory biosynthetic mechanisms which would induce the formation and/or the release of neurophysin pools under stress. Additionally, we propose that some subnuclei of the paraventricular nuclei are the neuroanatomical substratum of these mechanisms.

Peripheral neurophysins changes under mild stress conditions.

Total immunoreactive neurophysins levels increased significantly in rats after they had been trained in a situation based on the innate light-dark avoidance principle. These levels varied according to the amount of 'familiarisation cues' which characterised the situation. The results are discussed in terms of arousal/stress-neurophysins relationships.

Effect of a high dose of vasopressin on an inhibition avoidance response.

1. This experiment was performed to assess the action of a posttrial high dose of lysine-vasopressin (20.0 I.U./kg) on the maintenance of an inhibitory avoidance response measured in a modified step-through test. 2. In the 24 hr, 48 hr, 72 hr, and 192 hr testings, there was a progressive increase in latencies for control and vasopressin-treated groups. However, in the 384 hr testing, the latency score shown by the experimental group dropped as compared with saline-treated group. 3. These preliminary data suggested there was a non-monotonic time-dependent dose/response curve for behavioral effects of vasopressin.

[Modulation of the hypothalamo-neurohypophyseal system following environmental changes in rats]. / Modulation du système hypothalamo-neurohypophysaire à la suite de modifications environmentales chez le rat.

The innate light-dark avoidance (step-through apparatus) was observed daily on 5 successive days in dehydrated and normal rats, the dehydration starting 24 hr before the first observation. We noted that latency scores from dehydrated groups and from the hydrated group tested together with a dehydrated group increased progressively. These significantly increased latencies did not appear when normally hydrated rats were tested alone. These changes in the temporal development of latencies seemed to be due to the fact that dehydrated rats were able to produce "fear odors" which increased the emotional reactivity of normal rats as well as theirs. The hypothalamo-neurohypophyseal function, characterized by the peripheral total neurophysins levels, also seemed to be modulated by these psychosocial and physical stresses. The neurophysins values from the hydrated group tested together with a dehydrated group were not statistically different from those of the latter group whereas they were higher than those of the hydrated group tested alone (Mann-Whithney; U = 28; n1 = n2 = 10; approach the significance). Further investigations are needed before establishing a definite relationship between the changes in latency scores on the one hand and the changes in neurophysins levels on the other hand. Nevertheless, one may well suppose that peripheral neurophysins levels play their own role in the adaptation of the organism to the environmental variations rather than only reflect the activity of the hypothalamo-neurohypophyseal axis.