Depressive symptoms among teenagers in the emergency department: prevalence estimate and concordance with parental perceptions

Purpose

This study aims to estimate the prevalence of depressive symptoms among adolescents seen in hospital emergency departments and to investigate the concordance between self-reported adolescent depression and parental perceptions of their adolescents’ health status.

Method

A multicentre cross-sectional survey in three emergency departments receiving adolescents in Ile-de-France took place in 2010. All adolescents completed a questionnaire including the Adolescent Depression Rating Scale (ADRS) and a series of questions concerning somatisation and risk behaviours. Parents simultaneously completed a questionnaire collecting their perceptions of their adolescent’s health status.

Results

The study included 346 adolescents, and of them, 320 were fully analysed. ADRS scores were in the normal range for 70.6 % of the sample (score of <3) (n?=?226); 19.4 % (n?=?62) showed moderate depressive symptoms (3?≤?score?<?6), and 10.0 %, severe depressive symptoms (score of ≥6) (n?=?32). We observed a wide discrepancy between adolescent depression, determined by a score on a self-administered scale, and parental perceptions of it.

Conclusion

Routine use of a self-administered questionnaire in emergency units could enable identification of adolescents with moderate or severe depressive symptoms. The present study confirms the importance of increasing parental awareness of their adolescent children’s depressive symptoms.     

PLA2G6-associated neurodegeneration: Lessons from neurophysiological findings

Background and aims

Phospholipase A2 associated neurodegeneration (PLAN) is a heterogeneous autosomal recessive disorder caused by mutations in the ubiquitously expressed PLA2G6 gene. It is responsible for delayed brain iron accumulation and induces progressive psychomotor regression. We report the concomitant clinical, radiological and neurophysiological findings in PLAN patients in an attempt to determine the contribution of each test to guide diagnosis.

Learning the relationship between smoking,drinking alcohol and the risk of esophageal cancer

This study examined the effect of outcome feedback on learning the multiplicative relationship between daily intakes of tobacco and alcohol, and the risk of esophageal cancer. In the first of two experiments, 65 French adults judged the risk of esophageal cancer associated with combinations of five levels of intake of tobacco and five of wine. They made these judgments both before and after learning sessions in which they were shown the actual risk for each vignette. In the second experiment, 35 French adults underwent the same testing and learning, and were re-tested twice 1 month later. The study hypotheses were supported. First, prior to the learning sessions, the participants used a subadditive rule to combine the perceived risk of esophageal cancer from smoking and drinking. Second, they learned after only one training session to change to the multiplicative rule that is consistent with epidemiological data. Third, this learning persisted for 1 month. This methodology may prove useful in correcting people's underestimation of their health risks.     

Platelet-activating factor in vasoobliteration of oxygen-induced retinopathy

PURPOSE: To test whether platelet-activating factor (PAF) directly causes retinovascular endothelial cell (EC) death. METHODS: Retinovascular density was calculated in rat pups exposed to 80% O(2) from postnatal days (P)6 to P14 (to produce oxygen-induced retinopathy [OIR]), using the adenosine diphosphatase (ADPase) technique, in animals treated with distinct PAF receptor blockers (PCA-4248, BN52021, or THG315). PAF levels were then measured in the retinas. Viability of ECs from piglets and humans in response to C-PAF (a stable PAF analogue) was determined by the reduction of the tetrazolium salt 3-(4,5-dimethyl thiazol-2yl)-2,5-diphenyl tetrazolium bromide (MTT) by viable cells, incorporation of propidium iodide (PI), TUNEL assay, and release of lactate dehydrogenase. Release of thromboxane (TX) was measured in the cell media. RESULTS: PAF levels in retina were markedly increased by exposure of isolated rat retinas to H(2)O(2) (1 micro M) and of rat pups placed in 80% O(2). Exposure to 80% O(2) induced retinal vasoobliteration, which was equally significantly inhibited ( approximately 60%) by all PAF receptor blockers tested. C-PAF increased incorporation of PI by isolated rat retinal microvasculature. Also, C-PAF caused time- and concentration-dependent death of cultured retinal ECs, which was prevented by the PAF receptor antagonist CV-3988. This effect of C-PAF was selective on retinal and neurovascular ECs, but not on other ECs. DNA fragmentation (TUNEL) was hardly detected, and inhibition of apoptosis-related processes by nicotinamide, cyclosporin A, and Z-DEVD-FMK and Z-VAD-FMK (caspase inhibitors) barely protected against death in EC, whereas C-PAF increased release of lactate dehydrogenase, implying that necrosis is the nature of EC death. Finally, C-PAF-induced cell death was preceded by an increase in TXB(2) levels and was prevented by TXA(2) synthase inhibition (with CGS12970). CONCLUSIONS: The data suggest PAF plays a major role in vasoobliteration in OIR by triggering death of neuroretinal microvascular ECs. The cell death seems to be mediated at least in part by TXA(2). These effects of PAF may participate in ischemic retinopathies such as diabetes and retinopathy of prematurity.     

Second-line drugs used in recent-onset rheumatoid arthritis in Brittany (France)

OBJECTIVE: The management of recent-onset rheumatoid arthritis (RA) is not well standardized. We conducted a survey of drugs prescribed to RA patients in Brittany at presentation and during the first 1 to 3 years of follow-up. METHODS: A cohort of 270 patients with recent-onset inflammatory joint disease was recruited between 1995 and 1997. The evaluation at presentation included a medical history, a thorough physical examination, and a standard battery of investigations. Follow-up at 6-month intervals was offered. At the last visit, between June and December 1999, a panel of five rheumatologists established that 98 patients had RA. RESULTS: At presentation, hydroxychloroquine and injectable gold were the most widely used second-line drugs, and only two patients were offered a combination of second-line drugs. At the last visit, the most commonly used drugs were methotrexate, injectable gold, and hydroxychloroquine (23, 23, and 21 patients, respectively); only three patients were on more than one second-line drug and 38 (38/98, 39%) patients were on glucocorticoid therapy. CONCLUSION: Rheumatologists in Brittany prefer monotherapy with hydroxychloroquine or injectable gold as the initial treatment. Later, they rely mainly on methotrexate, injectable gold, and hydroxychloroquine, often in combination with glucocorticoid therapy.     

Survival after gamma interferon intratumoral injections in a model of hepatocarcinoma

BACKGROUND/AIMS: Short-term efficacy of local gamma interferon delivered via a single injection of an adenovirus-gamma interferon vector has been reported in immunocompetent animals which develop spontaneous liver cancer. However the long-term outcome was not examined. The aim of this randomized trial was to assess in an immunodeficient mouse ectopic model the benefit, if any, of the long-term efficacy of intratumoral injections of gamma interferon itself. METHODOLOGY: 77 mice were randomly assigned to 4 groups. Gamma interferon treated groups received a dose of 5000, 10000 or 20000 IU per animal versus phosphate-buffered saline. The follow-up lasted 46 days. RESULTS: Significant differences were noted in mice receiving 20000 IU compared to controls: increase in survival (p=0.0485), slowing down of tumor growth in large tumors (p=0.009), increase in necrosis (p=0.004). The preferential staining in necrotic areas with anti-Class II antibody and the accumulation of nuclear debris indicated that neutrophils were involved. CONCLUSIONS: Gamma interferon could accentuate the migration of non-specific immune cells to necrotic areas which occur spontaneously in large tumors. These results in animals bearing large tumor suggest that it may be worthwhile to explore local gamma interferon delivery to patients with extensive hepatocarcinoma.     

In vitro activities of telithromycin, linezolid, and quinupristin-dalfopristin against Streptococcus pneumoniae with macrolide resistance due to ribosomal mutations

To date, 86 of 7,746 macrolide-resistant Streptococcus pneumoniae isolates from 1999 to 2002 PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) surveillance studies were negative for methylase and efflux mechanisms. Mutations in 23S rRNA or the genes encoding riboprotein L4 or L22 were found in 77 of 86 isolates. Six isolates were resistant to quinupristin-dalfopristin and two were resistant to linezolid, while telithromycin demonstrated good activities against all isolates.