Pierre Chauvin

ABSTRACT Introduction. Social support could constitute a pathway in the association between maltreatment in childhood and the risk of depression in adulthood. Our objective was (1) to investigate the association between child abuse and depression in adulthood, and (2) to test the effect of perceived social support in adulthood as a pathway in this association. Methods. Data. SIRS cohort study, a longitudinal epidemiological survey of 4560 adults of the Paris metropolitan area conducted since 2005. Data collection in 2005 and 2010 (n=1460). Outcome: Cases of depression identified by the Mini-Diag in 2005 and in 2010. Individual variables: maltreatment in childhood (retrospective data on physical or sexual child abuse and exposure to interparental violence), perceived social support in 2005 (defined as the number of sources of emotional, financial and instrumental support). Statistical analysis: structural equation modeling with latent variables. Results. Maltreatemnt in childhood was associated with a higher risk of depression in 2005 and in 2010 (Beta=0.33;t=2.59), but not with a lack of perceived social support in 2005 (Beta=0.01;t=0.17). In the full structural equation model (RMSEA<0.05;NFI>0.96), the higher the number of perceived social support sources in 2005, the lower the risk of depression in 2010 (Beta=-0.16;t=-2.05). Conclusion. In the SIRS cohort study, these results suggest that psychological factors such as violence in childhood and social interactions later in adulthood have an independent effect on the occurence of depression. Both factors have to be included in the psychosocial model of depression.

Fresh frozen sections of mature skeletal muscle fibers from patients with genetically determined "absence" of skeletal muscle phosphorylase (McArdle's disease) have no histochemical phosphorylase activity. That regenerating muscle fibers, in vitro and in vivo, from such patients do have histochemical phosphorylase activity present suggests a loss of enzyme activity with fiber maturity.

From a series of 30 cases of immediate allergy to the latex of Hevea Brasiliensis, the authors recall the principal clinical aspects of these allergies, specially contact urticaria (during the use of surgical or cleaning gloves) and systemic anaphylactic accidents, essentially the anaphylactic shock during surgical procedures. They mention the diagnostic procedures; skin tests and measurement of specific IgE (RAST). They show the interest of biological research, yielding to the identification of the allergens of the latex in order to obtain non allergenic latex. Such a result would be of interest to limit the number of the accidents in a period where the use of rubber protective material is much larger/gloves and condoms).

The prevalence of depression in the general population is 5 to 10% but can exceed 50% in the most socially vulnerable populations. The perceptions of this disease are widely described in the literature, but no research has been carried out in France to explain the reasons for not consulting a general practitioner during a depressive episode, particularly in people in the most precarious situations. The objective of this study was to describe the reasons for not seeking primary care during a depressive episode in a socially vulnerable population. An exploratory sequential design with a preliminary qualitative study using a phenomenological approach. Subsequently, themes that emerged from the qualitative analysis were used in a questionnaire administered in a cross-sectional observational study at a free outpatient clinic in Paris in 2010. Lastly, a logistic regression analysis was performed. The qualitative analysis revealed four aspects that explain the non-consulting of a general p...

D'un point de vue de santé publique, l'internet est rapidement apparu comme un outil potentiellement utile pour l'information des patients et la promotion de la santé. Si les facteurs individuels impliqués dans le recours à l'internet santé sont maintenant bien connus, l'effet du lieu de résidence reste peu étudié. L'objectif de cette étude était d'évaluer l'impact des caractéristiques contextuelles du quartier de résidence sur l'utilisation de l'internet pour s'informer en matière de santé. Des analyses de régression logistique multiniveau ont été réalisées sur les données de la cohorte SIRS, échantillon représentatifde la population de l'agglomération parisienne en 2005. Une variation entre quartiers de résidence a été mise en exergue à la fois dans l'utilisation générale de l'internet et plus spécifiquement pour s'informer en matière de santé. Cette variabilité diminue lors de la prise en compte de facteurs individuels, ...

The tongue-retaining device is a customized monobloc oral appliance used in the treatment of obstructive sleep apnea syndrome (OSAS). This study evaluated tongue-retaining device efficacy and its tolerance by patients with OSAS. The charts of 84 apneic patients were retrospectively analyzed, and patients were contacted by telephone to answer an oral questionnaire. The median follow-up time was 5 years. Based on the apnea-hypopnea index, a complete or partial response was obtained in 71% of the cases. The mean apnea-hypopnea index decreased significantly from 38 to 14 (p < 0.001) with the tongue-retaining device. The subjective intensity of snoring decreased by 68% (p < 0.0001) and the Epworth Sleepiness Scale score decreased from 9 to 6 (p < 0.05). An age of more than 60 years associated with a mandibular protrusion distance inferior or equal to 7 mm was predictive of a nonresponse (odds ratio [OR]: 7.25; 95% confidence interval [CI]: 1.43-36.7; p < 0.02). The compliance...

The Internet is a growing source of information for health in general, with university student being online almost daily. Evaluating their use of the Internet for mental health information and support can help understanding if online tools and websites should be used for mental health promotion and, to some extent, care. A survey was conducted with more than 600 students of Law, Nursing and Computer Science of the University of Cadiz in Spain to determine their general use of the Internet and their perceptions and trust in using this medium for mental health information. Data were collected using a 25-item-questionnaire and findings indicated that students had a strong distrust in online mental health information, notwithstanding their daily use of the Internet. The frequency and methods of their research on the Internet correlated with their health status, their medical consultations and with certain socio-demographic characteristics.

Cet ouvrage propose un état des lieux de la situation de différentes mégapoles du Nord et du Sud, de l'Orient et de l'Occident, confrontées au « défi des nouvelles inégalités ». Les auteurs ont, en effet, voulu sensibiliser un lectorat le plus large possible à plusieurs notions ...

In France, the sentinel general practitioners of the French Communicable Diseases Network (FCDN) monitor the epidemiological surveillance of eight communicable diseases, including measles. For the last 10 years, this surveillance has shown a seasonality of the annual incidence of measles (with peaks in late spring) and a decrease in incidence since the last outbreaks in 1986 and 1987. This decrease, the increasing mean age of the cases and an increase in the percentage of appropriately vaccinated cases are due to the increasing vaccination coverage of children due to the national immunization programme was reinforced in 1989. However, with 75,000 cases in 1993, measles is far from being a rare disease in France; epidemiological surveillance and improved vaccination coverage are still necessary.

The decision on the appropriate surgical technique for treating cholesteatoma in children raises a number of controversial questions, most because of personal convictions rather than because of established data. We attempted to determine which patients are at risk of residual cholesteatoma in order to propose the most rational therapeutic strategy. A retrospective study of 250 children with cholesteatoma or severe retraction underwent surgery between 1986 and 1992. During this period 69 cases of residual cholesteatoma were recorded during a second intervention. After a mean follow-up of 33 months after the final operation, the Kaplan-Meier plot shows a rate of 31% and 34% at 3 and 5 years respectively. The univariate and multivariate (Cox regression) analysis was performed to search for a correlation between residual cholesteatoma development and past history including type of process involved, peroperative findings and surgical technique. Three factors were closely and independently related (p < 0.003) to residual cholesteatoma: invasion of the posterior middle ear, presence of ossicular erosion after excision and presumption of incomplete ablation. Inversely, age, surgical history, extension and nature of the process involved as well as surgical technique had no effect on development of residual cholesteatoma. Only one comparable study has been published where only ossicular erosion was found to be significant on multivariate analysis. The presence of one or more of the three of the factors mentioned above should lead to a second intervention, perhaps after a short delay, whatever the initial technique (open or closed).

Measles vaccine has been available and widely used in the United States for 30 years. During the first 20 years, the incidence of measles dramatically decreased and the Department of Health hoped that the disease would be eradicated from the United States by 1982. Yet, as early as 1970, some American epidemiologists started to doubt whether it would be possible to attain this goal with a single dose schedule. From 1989, many outbreaks have occurred in some inner-cities. This resurgence shows that the existence of small non-immune population groups is sufficient for a persistent and epidemic transmission of the disease. New control measures were proposed, and evaluated, to increase the vaccination coverage of these populations and to prolong the immunity of adolescents vaccinated in their early childhood. With 30 years experience, the description of the modifications of the epidemiological characteristics of measles following mass vaccination is useful for countries which became involved in such programmes more recently.

This study aimed to determine which children are at risk of having residual cholesteatoma develop after initial surgery for either cholesteatoma or severe retraction pocket. This study aimed to identify the characteristics of each patient and assessing whether predictive factors exist to propose a well-guided therapeutic approach. This was a retrospective study. Mean follow-up period (after the last eradication intervention) was 42 months. Two hundred thirty-one children (256 ears) with either cholesteatoma (n = 157) or severe retraction pockets (n = 99), both treated surgically, composed the patient group. univariate analysis of event-free survivals (using log-rank test and Kaplan-Meier estimate) and multivariate analysis (using Cox regression model) of clinical history, surgical observations, residuals occurrence (using Kaplan-Meier's statistical method) were used. Posterior mesotympanum involvement, ossicular chain interruption after disease excision (and moreover combination of both), relative lack of experience of the surgeon, and presumed incomplete removal were identified as independent risk factors highly correlated with residuals' development (relative risks ranging from 2.02-4.84). Disease extension, type of process (cholesteatoma vs. retraction pocket), eventual surgical history, and surgical method initially used (closed or open) showed no such correlation. The identification of any of these factors should instigate a mandatory second-look procedure regardless of other initial surgical findings and of technique used. The authors propose to advance this procedure from 12 to 9 months when all these factors are found in one child.