Guillaume Airagnes

Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care--a systematic review.

BACKGROUND Low back pain (LBP) is a problem that is frequently encountered in primary care, and current guidelines encourage care providers to take into account psychosocial risk factors in order to avoid transition from acute to chronic LBP. OBJECTIVE To review the effectiveness of interventions focusing on psychosocial risk factors for patients with non-chronic LBP in primary care. METHODS A systematic search was undertaken for controlled trials focusing on psychosocial factors in adult patients with non-chronic, non-specific LBP in primary care by exploring Medline, Embase, PsycInfo, Francis, Web of Sciences and The Cochrane Library. The methodological quality of the studies included was assessed before analysing their findings. RESULTS Thirteen studies were selected, seven being considered as having a low risk of bias. Information strategies were assessed by eight trials, with high-quality evidence of no effectiveness for pain, function, work issues and health care use, low-quality evidence of no effectiveness for self-rated overall improvement, satisfaction and pain beliefs and lack of evidence in terms of quality of life. Cognitive behavioural therapy was assessed by three trials, with very low-quality evidence of moderate effectiveness for pain, function, quality of life, work issues and health care use. There was lack of evidence concerning the effectiveness of individual and group education intervention or work coordination. CONCLUSION Among the wide range of psychosocial risk factors, research has focused mainly on pain beliefs and coping skills, with disappointing results. Extended theoretical models integrating several psychosocial factors and multicomponent interventions are probably required to meet the challenge of LBP.

Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management

Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians’ belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.

Abdominal stab wounds: self-inflicted wounds versus assault wounds.

Intentional penetrating wounds, self inflicted or inflicted by others, are increasingly common. As a result, it can be difficult for the forensic examiner to determine whether the cause is self-inflicted or not. This type of trauma has been studied from a psychological perspective and from a surgical perspective but the literature concerning the forensic perspective is poorer. The objective of this study was to compare the epidemiology of abdominal stab wounds so as to distinguish specific features of each type. This could help the forensic scientist to determine the manner of infliction of the wound. We proposed a retrospective monocentric study that included all patients with an abdominal wound who were managed by the visceral surgery department at Angers University Hospital. Demographic criteria, patient history, circumstances and location of the wound were noted and compared. A comparison was drawn between group 1 (self inflicted wound) and group 2 (assault). This study showed that the only significant differences are represented by the patients prior history and the circumstances surrounding the wound, i.e. the scene and time of day. In our study, neither the site, nor the injuries sustained reveal significant clues as to the origin of the wound. According to our findings, in order to determine the cause, the forensic examiner should thus carefully study the circumstances and any associated injuries.

Daily alcohol consumption and sickness absence in the GAZEL cohort

Background : Previous studies that examined the association between daily alcohol consumption and sickness absences (SA) were mostly retrospective and did not take into account the characteristics of SA.  : A total of 9907 daily drinkers (8442 men and 1465 women) of the GAZEL prospective cohort were included. Daily alcohol consumption over the three previous years was self-reported at baseline and categorized as low, moderate, high or very high risk according to the World Health Organization. Duration of SA (short: ≤7 days; moderate: 8-28; long: >28) was collected from administrative records as well as causes for long SA. Negative binomial regression models were used to estimate Risk Ratios of SA according to alcohol consumption with low-risk category as reference.  : Duration of follow-up (in years) for SA was 8.4 ± 3.7 in men and 11.2 ± 5.4 in women. Increasing alcohol consumption predicted increasing risk of SA with a dose-response relationship ( P < 0.01 for men; P = 0.01 for women). In men, strength of this association increased with SA duration [e.g. RRs from 1.41 (95% CI: 1.12-1.79) to 2.12 (95% CI: 1.49-3.00) in the very high-risk category, for short and long SA, respectively]. In men, even a moderate consumption predicted increased risk of SA whatever their duration (RR = 1.15; 95% CI: 1.07-1.23). In women, a moderate consumption predicted only long SA (RR = 1.22; 95% CI: 1.00-1.50). Daily alcohol consumption was associated with almost all causes of long SA in men, and with respiratory diseases, digestive diseases and injury in women.  : We found a dose-response relationship between daily alcohol consumption and the risk of SA. Even moderate consumption could increase this risk, particularly in men.

Hostility predicts alcohol consumption over a 21-year follow-up in the Gazel cohort

BACKGROUND Hostility has been found to be positively associated with alcohol intake in cross-sectional studies. Our aim was to examine prospectively the long-lasting association of hostility with alcohol consumption. METHODS We included 10,612 men and 3834 women from the French Gazel cohort with mean ages in 1993 of 48.6 (SD=2.9) and 45.7(SD=4.2), respectively. Hostility (i.e., total, cognitive and behavioral) was assessed in 1993 with the Buss and Durkee Hostility Inventory. Alcohol consumption was self-reported annually from 1994 to 2014. Hostility scores were introduced successively in general linear mixed models with annual alcohol consumption in drinks per week as dependent variable. Multivariable analyses were adjusted for age, occupational status, marital status, retirement status and depression score. All the analyses were stratified by sex. RESULTS Among men (women), 83.0% (76.2%) completed at least 75% of all annual assessment of alcohol consumption over a 21-year follow-up. In univariate analysis, alcohol consumption was associated with total and behavioral hostility in both sex (all p<0.001). In multivariable analyses, these associations remained significant with a greater size effect for behavioral hostility. Estimated means of alcohol consumptions ranged from 10.50 [95CI%: 10.01-10.92] drinks per week to 13.32 [95%CI: 12.90-13.74] in men and from 4.09 [95%CI: 3.71-4.46] to 5.78 [95%CI: 5.39-6.17] in women, for the first and last quartiles respectively (p trends<0.001 and all pairwise comparisons<0.01). Similar effects were observed among participants with at-risk alcohol consumption at baseline. CONCLUSIONS In both men and women, behavioral hostility predicted alcohol consumption over a 21-year follow-up. Interventions aiming at modulating behavioral hostility may help reducing its long-lasting influence on alcohol consumption.

Electronic cigarette use is associated with depressive symptoms among smokers and former smokers: Cross-sectional and longitudinal findings from the Constances cohort.

AIMS To examine the cross-sectional and longitudinal associations between depressive symptoms and electronic cigarette (e-cig) use in a large population-based sample while taking into account smoking status and sociodemographic confounders. METHODS Participants from the French Constances cohort were included from February 2012 to December 2016. Smoking status, e-cig use (never/ever/current) and nicotine concentration were self-reported. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regressions were used to provide odds ratios (ORs) and 95% confidence intervals (95%CI) of e-cig use according to depressive symptoms, adjusting for age, sex and education. RESULTS In cross-sectional analyses (n = 35,337), depressive symptoms (i.e. a CES-D score ≥ 19) were associated with both ever (OR [95%CI]: 1.67 [1.53-1.82]) and current (1.73 [1.53-1.96]) e-cig use with a dose-dependent relationship (p-trend<0.001). In longitudinal analyses (n = 30,818), depressive symptoms at baseline were associated with current e-cig use at follow-up (2.02 [1.72-2.37]) with a similar dose-dependent relationship. These associations were mainly significant among smokers or former smokers at baseline. Furthermore, among smokers at baseline, depressive symptoms were associated with dual consumption at follow-up (1.58 [1.41-1.77]), whereas among former smokers, they were associated with either smoking only (1.52 [1.34-1.73]) or e-cig use only (2.02 [1.64-2.49]), but not with dual consumption (1.11 [0.73-1.68]) at follow-up. Finally, depressive symptoms were positively associated with nicotine concentration among e-cig users at baseline. CONCLUSIONS Depressive symptoms were positively associated with e-cig use in both cross-sectional and longitudinal analyses with a dose-dependent relationship. In addition, nicotine concentration and depressive symptoms were positively associated.

Les outils du sevrage tabagique en 2018

Smoking cessation treatments have been proved effective to stop smoking. For pharmacological treatments, nicotine replacement therapies (NRT) as well as bupropion allow to increase 6 month-abstinence rates by more than 80% in comparison with placebo while varenicline prescription doubles success rates in the same conditions. These results mean that for 10 smokers who quit with placebo, 18 are expected to quit with NRT or bupropion and 28 are expected to quit with varenicline. Varenicline is 50% more effective than nicotine patch and 70% more effective than nicotine gum. Nevertheless, a combination including NRT patch and oral nicotine forms is as effective as varenicline, thus leading to encourage the prescription of a combination NRT when NRT are chosen. For these three pharmacological treatments, cardiovascular as well as neuropsychiatric tolerance were not found statistically different from placebo in randomized controlled trials. Yet, bupropion prescription leads to an increasing risk of seizure (1/1000 to 1/1500). For behavioral treatment, motivational interviewing as well as cognitive behavior therapies are been proven to be effective to stop smoking but few smokers have access to this treatment. Smoking cessation mobile application and smartphone application seem to be promising in terms of effectiveness and might be useful to reach more smokers.

Job exposure to the public in relation with alcohol, tobacco and cannabis use: Findings from the CONSTANCES cohort study

Objectives To examine the associations between job exposure to the public (e.g., customers, guests, users of a public service, patients) and alcohol, tobacco and cannabis use. Methods From the French population-based CONSTANCES cohort, 16,566 men and 17,426 women currently working were included between 2012 and 2016. They reported their exposure to the public (daily versus no daily), and among the daily exposed participants (10,323 men and 13,318 women), the frequency of stressful exposure (often versus rarely). Dependent variables were: chronic alcohol consumption (<1(1), 1-27(1–13), 28-42(14–28), >42(28) drinks per week in men(women)), heavy episodic drinking (never, at most once a month, more than once a month), alcohol use risk with Alcohol Use Disorders Identification Test (mild, dangerous, problematic or dependence), tobacco use (non-smoker, former smoker, 1–9, 10–19, >19 cigarettes per day) and cannabis use (never, not in past year, less than once a month, once a month or more). Logistic regressions provided odds ratios of substance use, stratifying for gender and adjusting for sociodemographic confounders, depression, effort-reward imbalance and perceived health status. Results Exposed men had higher risks of alcohol (chronic alcohol consumption, heavy episodic drinking and alcohol use risk), tobacco and cannabis use. Exposed women had higher risks of tobacco and cannabis use. In men, stressful exposure was associated with increased risks of heavy episodic drinking, tobacco and cannabis use. In women, stressful exposure was associated with increased risks of chronic alcohol consumption, alcohol use risk, tobacco and cannabis use. All these findings remained significant in multivariable analyses, taking into account sociodemographic variables, depressive symptoms, perceived health status and effort-reward imbalance. Conclusions Interventions to reduce emotional job demand should systematically integrate assessment and prevention measures of addictive behaviors. Vulnerable workers may be offered more specific interventions to reduce the impact of exposure to the public on their substance use.

Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers

Abstract Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis‐specific sickness absence. Design A multi‐cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time‐points, and were linked to records of sickness absence. Diagnosis‐specific sickness absence was followed for 4–7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000–02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985–88 and 1991–94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1–11 and > 11 units per week in women and 0, 1–34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio‐economic status, smoking and body mass index. Findings Women who reported drinking 1–11 units and men who reported drinking 1–34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22–1.88], musculoskeletal disorders (1.22, 95% CI = 1.06–1.41), diseases of the digestive system (1.35, 95% CI = 1.02–1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29–1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13–1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at‐risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.

Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers: consideration of the U-shaped association between alcohol use and sickness absence in four cohort studies: Alcohol and sick leave diagnosis

Abstract Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis‐specific sickness absence. Design A multi‐cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time‐points, and were linked to records of sickness absence. Diagnosis‐specific sickness absence was followed for 4–7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000–02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985–88 and 1991–94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1–11 and > 11 units per week in women and 0, 1–34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio‐economic status, smoking and body mass index. Findings Women who reported drinking 1–11 units and men who reported drinking 1–34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22–1.88], musculoskeletal disorders (1.22, 95% CI = 1.06–1.41), diseases of the digestive system (1.35, 95% CI = 1.02–1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29–1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13–1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at‐risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.