A large survey, coordinated by Inserm Unit 1178, “Mental Health and Public Health,” and the University Division of Fondation Vallée, describes the current situation regarding issues and challenges in adolescence. These data, collected by means of self-administered questionnaires, reflect the perceptions of 15,235 young people attending school, aged 13-18 years, regarding their own adolescence. The study addresses subjects as varied as their physical and mental health, consumption patterns, recreational activities and even sexuality. The results reaffirm the complex nature of these future adults, with marked differences between boys and girls, and an age-related gradient. They should help to improve our knowledge of adolescent behaviours, and help identify new indicators of problems that can be used in the introduction of preventive measures.

Adolescence, the transition between childhood and adulthood, is a period of complex psychological and physiological upheaval that may cause certain problems and lead to risky behaviours. The “Portraits of Adolescents” survey, coordinated by Inserm Unit 1178, “Mental Health and Public Health,” and the University Division of Fondation Vallée, makes it possible to analyse the “profiles” of these 15,235 young school-goers from their third year of secondary school to the end of the senior cycle, using data collected via anonymous self-administered questionnaires.

Adolescents are far from stereotypical
The current generation of adolescents is often portrayed as heedless, disenchanted, lazy and more reliant on things than on relationships. This study shows, however, that nearly half of adolescents (48.4%) are confident about the future (especially boys, 58.6%, compared with 38.9% of girls).

A large majority feel good about their relationships with their parents, and believe that their parents see them in a positive light. Furthermore, most of them judge that adults generally worry too much about adolescents (72.8%).

88% of these young people (90.3% of girls versus 85.5% of boys) believe that their intrinsic value does not depend on the number of things they own. They value themselves in relation to the image they convey to others, their academic results, and their creativity.

With respect to boundaries, today’s adolescents are far from stereotypical: although more than half of them think that adults set too many boundaries, even more recognise that they need them (74.9%). However, over three-quarters of them believe that too many boundaries, on the other hand, encourage risk-taking (77%).

Risk taking is, moreover, generally described as an essential part of adolescence. For over a third of these young people (34.1%), to live a good life, “you have to take risks without counting the cost”. These data reflect the well-known ambivalence of adolescents.

New forms of unhappiness

Adolescents are aware that the period they are going through is not an easy one: they often question themselves (49.3%), especially girls (61.7% vs 35.7% of boys). Half of them question themselves about the people in their entourage, girls (57.8%) more than boys (49.6%). This period of profound evolution of identity, conducive to risky behaviours, accentuates the psychopathological vulnerability of these young people.

Attempted suicide seems to be more frequent than before: 7.8% of young people have already attempted suicide once, and 3.7%, more than once. Depression affects 16.8% of girls and 7% of boys. Furthermore, 38.9% of young people have already thought that “life wasn’t worth living.” Alarming figures, especially since a very large majority of adolescents (74.5% of girls and 57.6% of boys) prefer isolation as a “way of coping” when they are not feeling good. This makes it less likely that others will become aware of their unhappiness, since friends represent only the third resource, after listening to music (mostly girls) or playing video games (mostly boys). We can also be concerned about figures for young “subdepressives” or mild depressives: 33.6% of girls and 21.6% of boys, strongly increased compared with the last available data.

Although the goal of this study was to better understand adolescents’ self-perception, this report contains many results, particularly with regard to:

-Their relationship with social networks:

88% of adolescents are on social networks. For 76.9% of them, this choice is justified by the presence of friends on the same network.

-Their use of psychoactive substances:

Generally, girls use mainly tobacco (9.2% of them claim to be “hooked,” compared with 7.8% of boys), while boys use mainly alcohol, with worrying figures for binge drinking in the month prior to the survey (37.6%). 7.1% of young people are regular users of cannabis.

-Their sexuality:

10.7% of boys versus 4.2% of girls state that they had sexual relations before the age of 13 years, which remains a worrying figure.

-Their education:

The vast majority find school tiring, stressful and irritating, or even painful. Only a third of young people find it enjoyable, although they believe it to be essential.

-Their recreational activities:

Sport, music, friends, the Internet and computer games (especially boys) are the most popular pastimes among adolescents.

The indoor air quality in nursing homes has a serious effect on the lung health of elderly residents, according to the findings of a new study. The study, which is published online today (12 March 2015) in the European Respiratory Journal, is the first to detail the negative effects of poor air quality in nursing homes across several countries.

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Researchers from the EU-funded GERIE research project collected data on five indoor air pollutants: PM₁₀, PM_0.1, formaldehyde, NO₂ and O_3. These pollutants come from a range of sources including heaters, building materials, furniture, cleaning products, disinfectants and cooling systems. They objectively assessed levels of the pollutants in 50 different nursing homes in seven countries (Belgium, Denmark, France, Greece, Italy, Poland and Sweden).

A total of 600 residents aged over 65 years (82 years in mean) were used in the study. Each participant underwent a number of clinical tests including lung function testing and a health questionnaire.

The results showed that exposure to high levels of PM₁₀ and NO₂ was significantly associated with breathlessness and cough. High levels of PM_0.1 were associated with wheeze during the last year and high concentrations of formaldehyde were linked with chronic obstructive pulmonary disease (COPD). The associations were even seen with moderate concentrations of indoor air pollutants that did not exceed the existing international guidelines. The findings were also enhanced in homes with poor ventilation and in residents over the age of 80.

With life expectancy increasing, more people are living in nursing homes. As a person ages their body becomes more susceptible to the risks of air pollution and they are also exposed to higher levels of indoor air pollution due to their reduced activity.

Dr Isabella Annesi-Maesano, lead author of the study, commented: “Our findings have shown an independent effect of several indoor air pollutants on the lung health of the elderly living in nursing homes. This is a worrying problem since the body’s ability to cope with harmful air pollutants decreases as we age. Nursing homes should do more to prevent indoor air pollution by limiting its sources and by improving ventilation in their buildings. The respiratory health of residents should also be checked on a regular basis.”

Dan Smyth, Chair of the European Lung Foundation, said: “The majority of lung diseases are preventable therefore we must focus on strategies that target the risk factors linked to these diseases. These findings add to a body of evidence confirming that indoor air pollution is one of these risk factors. We must raise awareness of this, through campaigns such as Healthy Lungs for Life, to ensure that the public, patients, healthcare professionals and policymakers understand the importance of breathing clean air to help prevent disease.”

The authors believe that further investigations are now needed to assess more nursing homes in different countries and to conduct intervention studies to assess which prevention methods are most successful.

An observational study carried out in France by Jennifer Zeitlin and her team (Inserm Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, EPOPé), on over 14,000 women, shows that only 21% of infants with foetal growth restriction (FGR) had been suspected of having FGR during pregnancy, despite national recommendations that invite women to have an ultrasound scan during the third trimester of pregnancy. The study shows that nearly half of the infants with suspected FGR were of normal weight at birth (false positives). Moreover, suspected FGR during pregnancy was associated with an increased risk of planned pre-labour caesarean delivery or induced labour, independent of the existence or otherwise of low birthweight. The results of this study, published in BJOG: An International Journal of Obstetrics and Gynaecology, emphasise the need to reflect on the reasons for the poor performance of FGR screening, and also raise questions about the potential iatrogenic effects of screening on the false positives.

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Few studies to date had assessed the performance and impact of FGR screening on the general population. The aim of the researchers was to estimate the percentage of infants for whom FGR had been suspected antenatally, and to measure the effect of this suspicion on medical decision-making, by analysing a representative sample of births in France in 2010. To do this, they estimated the number of low birthweight (below the 10th percentile for gestational age) infants born and, of these, the proportion of infants who had been suspected of having FGR antenatally.

The study showed that only 21% of low birthweight infants had been suspected of having FGR during pregnancy. Furthermore, half of the infants suspected of having FGR during pregnancy were of normal birthweight (≥ 10th percentile). Antenatal suspicion of FGR was associated with an increased probability of having a planned pre-labour caesarean delivery or an induced labour, independent of the existence or otherwise of low birthweight. Similar results were obtained for the subgroup of women who showed no complications during pregnancy.

For Jennifer Zeitlin and her team:

“The results of this study emphasise the need for a reflection on the reasons for the poor performance of FGR screening in France. They also raise questions about risks from carrying out unnecessary medical interventions, where suspected FGR during pregnancy has not been confirmed at birth.”

Since 2004, the ‘Tous Chercheurs’ association, presided over by neurobiologist Constance Hammond (Director of Research of Inserm Unit 901 “Mediterranean Institute of Neurobiology (INMED)”), is offering a novel experience to members of patient groups.

This organisation arranges an average of seven practical training courses in biology per year, each one lasting three days, for people affected by chronic diseases (rare genetic diseases, autoimmune diseases, inflammatory diseases, familial cancers, …).  The details of this programme have just been published in the journal PloS Biology dated 10 February.

© Tous Chercheurs/M. Mathieu

The groups are composed of 8 to 12 people, members of the same patient group or of groups affected by similar conditions.

Each session takes place at the Tous Chercheurs laboratory, based at the Mediterranean Institute of Neurobiology (INMED, Inserm), on the Luminy Science Campus (University of the Mediterranean).

Each session runs over three periods:

• The first morning consists of an initial observation period, followed by questioning, which leads to the formulation of a theory of work. This first morning puts the trainee “in the shoes of a researcher” and into an active apprenticeship;
• From the afternoon of the first day to the end of the third morning trainees carry out practical experiments linked to their disease;
• The afternoon of the last day is dedicated to a meeting with a doctor or researcher working on their disease to discuss the latest advances in terms of research or treatment of the disease.

In 10 years, Tous Chercheurs has devised and presented 64 training sessions and as such has trained around 600 members of patient groups.

The prospect for the coming years is to extend this training to other Inserm laboratories. For now, Tous Chercheurs is coordinating training within the French Federation of DNA Schools including four other patient training centres (Angers, Evry-Généthon, Nîmes, Poitiers).

Among the associations welcomed (and associated diseases), we should note AFM (French Muscular Dystrophy Association – neuromuscular diseases), VLM (Cystic Fibrosis), APTEPF (familial polyposis), AFSR (Rett syndrome), AFAF (Friedreich ataxia), ASL (hereditary spastic paraplegia), Wegener (GPA) and other vasculitis updates, AFA (Crohn’s disease and ulcerative colitis), ANDAR (rheumatoid arthritis), AFPCA (relapsing polychondritis), AFDIAG (coeliac disease).

This was made possible thanks to the support of our funding partners, specifically: AFM-Téléthon, Courtin Arthritis Foundation , the PACA (Provence – Alpes – Côte d’Azur) Region , MENESR (French Ministry of National and Higher Education and Research, the town of Marseille, Inserm and Aix-Marseille University.

Since 2011, nearly 7,000 premature infants have been enrolled in the EPIPAGE 2 study. This study is aimed at assessing the survival of infants born between 22 and 34 weeks’ gestation, and their subsequent outcomes. Compared with data from the EPIPAGE 1 cohort in 1997, the proportion of infants born in 2011 from the 25^th week of gestation, who survived without severe neonatal disease, showed a definite increase. However, survival is still rare for infants born before 25 weeks. These results make it possible to establish the prognosis for very premature and extremely premature infants, and review the changes that have occurred in the last 15 years. They provide useful information to medical teams caring for infants and supporting families.

This study, carried out by researchers from the Inserm EPOPé team—“Obstetrical, Perinatal, and Pediatric Epidemiology Team,” at the Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS, Inserm/Paris Descartes University Unit 1153)—is published in the journal JAMA Pediatrics.

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The EPIPAGE 2 study (Epidemiological Study on Low Gestational Age) is a French national study aimed at improving knowledge on the outcomes of premature infants in light of the changes that have occurred in the last 15 years. It is being conducted in 25 regions of France. From 28 March 2011 through 31 December 2011, nearly 7,000 premature infants (stillborn and live births) were enrolled in EPIPAGE 2. Information was collected from maternity and neonatal units by medical and research teams from the 25 participating regions.

The average length of a normal pregnancy is 40 weeks. An infant born before 37 weeks’ gestation (before the beginning of the 9th month of pregnancy) is considered premature, and very premature if born between 22 weeks (5 months) and 31-32 weeks (7 months).

In this study, three groups of premature infants were constituted:

– extremely premature infants (born before the end of the 6^th month of pregnancy, at 22 through 26 completed weeks’ gestation)

– very premature infants (born before the end of the 7^th month of pregnancy, at 27 through 31 completed weeks’ gestation)

– moderately premature infants (born at the beginning of the 8^th month of pregnancy, at 32 through 34 completed weeks’ gestation)

The EPIPAGE 2 results showed that 0.44% of births took place before 27 weeks in France, 0.84% between 27 and 31 weeks, and 1.8% at 32-34 weeks.

On analysis, the 2011 data show that the more premature the infant, the lower the survival rate. Thus survival is 99% at 32-34 weeks, 94% at 27-31 weeks, 60% at 25 weeks, and less than 1% before 24 weeks.

Since premature infants are at high risk of neonatal complications, particularly affecting the brain and respiratory and digestive systems, survival rates without serious neonatal disease are lower. These are 97% at 32-24 weeks, 31% at 27-31 weeks, 30% at 25 weeks, and 12% at 24 weeks.

It is from the 25^th week that the researchers observe a significant improvement in the survival of premature infants in the last 15 years.

“We see a substantial increase in survival rate for infants from the EPIPAGE 2 cohort born in 2011. Compared with 1997 (the first EPIPAGE study), the proportion of infants surviving without severe morbidity has increased by 14% for infants born between the 25th and 29th weeks and by 6% for infants born between 30 and 31 weeks’ gestation,” explains Pierre-Yves Ancel, leader of the Inserm Obstetrical, Perinatal, and Pediatric Epidemiology Team behind the study. These data therefore suggest that the care of premature infants has improved in 15 years.

Results in the most immature infants, however, show little progress. They reflect great uncertainty regarding the outcome for these infants and the care that should be proposed. The results from EPIPAGE 2 could be an opportunity to reflect on the care of the smallest infants. This reappraisal should take “morbidity” and long-term sequelae into account.

“Data collected in the EPIPAGE 2 study are invaluable in defining specific care needs during childhood, and better understanding the consequences of prematurity” the researchers conclude.

© Inserm / Pierre Yves Ancel

Is there a relationship between blood group and the risk of developing type 2 diabetes? This is the question studied by Guy Fagherazzi and his collaborators from Joint Research Unit 1018, “Centre for Research in Epidemiology and Population Health” (Inserm/University Paris-Sud) at Gustave Roussy Institute. The analysis, carried out on 82,104 women from the E3N cohort who were monitored for 18 years, suggests for the first time that the risk of type 2 diabetes may be lower for individuals with blood group O than for those with blood groups A, B or AB.

These results are published in the journal Diabetologia.

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Diabetes affects more than 382 million people worldwide, 90% of whom have type 2 diabetes. Approximately 4.6% of the French population is affected by this disease, and the figure continues to grow. Known risk factors are obesity, lack of physical inactivity, excessive caloric intake, smoking, hypertension and hypercholesterolaemia. The researchers believe that it is now crucial to identify new factors that will make it possible to understand this disease and thereby slow its development.

In this study, 82,104 French women from the E3N cohort were monitored for 18 years, between 1990 and 2008.

“We show, for the first time in such a large population, that women with blood group O—approximately 43% of French people presently have this group—have a lower risk of developing type 2 diabetes,” explains Guy Fagherazzi, an epidemiologist at Inserm.

More specifically, women with other blood groups had an increased risk of developing diabetes, going from 10% for group A, to 17% for group AB, and 21% for group B, compared with group O.

When the individual’s Rhesus factor was taken into account, the researchers noted that women with blood group O- (only 6% of the French population) had a lower risk of diabetes than the others.

How can these results be explained?

At present there are few biological mechanisms that make it possible to link blood group to the risk of type 2 diabetes, but some hypotheses already identified might partly explain the observed association:

• It would seem that some endothelial markers and inflammatory markers are present in greater quantity in people who are not blood group O. And these markers are associated with an increased risk of type 2 diabetes.

• ABO blood group has also been identified as being one of the genetically determined factors modulating the composition of the intestinal microbiota, which in turn plays a role in glucose metabolism, energy balance and chronic inflammation.

“Despite the robustness of our data, it is necessary to replicate this study in other large populations, especially populations with other genetic backgrounds, and in men, even though the mechanisms proposed are not sex-dependent,” says Guy Fagherazzi, first author of the study.

If these observations are confirmed, it might be relevant to collect blood group information in routine practice, in future studies regarding type 2 diabetes, and when monitoring people at risk. The researchers will need to determine why individuals with blood group O are at lower risk of developing type 2 diabetes.

With advancing age, every individual can be affected by sensory, motor, and cognitive defects, as well as by chronic illnesses. Past the age of 85 years, over three out of four French people state that their activities are limited. Falls, which are frequent events for older people, are part of the risk of losing autonomy and being admitted to an institution, and prove very costly in terms of quality of life and care. In an ageing population, prevention of falls and maintaining independence in daily activities are therefore major challenges for public health.

Inserm was asked by the French Ministry of Community, Youth Affairs and Sports to prepare a collective expert report that would provide a review of the scientific knowledge regarding the contribution of physical activity to the prevention of falls in older people.© Fotolia

The authors of the collective expert report thus emphasise the beneficial effect of regular physical activity, centred on balance training, for all older subjects at varying risk of falling. To be tailored to the state of health and lifestyle of older people, physical exercise programmes should be better supervised and involve closer cooperation between players from the medical, non-profit and sports sectors.

Accidental falls in older people: current situation and consequences

The elderly population is a very heterogeneous group from a medical and functional point of view. From the age of 65 years, 15-20% of people living at home would be fragile. Moreover, fragility is associated with an increased risk of mortality and insults such as falls.

In France, according to the permanent survey on everyday accidents, falls represented 90% of everyday accidents recorded among the over 75s by the emergency services in 2009. 20-33% of people aged 65 years or older report having fallen in the previous year. Of those who had fallen, half would have fallen at least twice that year. Moreover, falls are the main cause of physical trauma among the over 70s.

Physical exercise contributes to reducing the frequency and risk of falling

The most effective exercise programmes are those centred on balance training. Generally, those that include balance exercises lead to a significant reduction in risk of falling in the order of 25%. Nonetheless, muscle strength training and endurance improvement contribute to the maintenance of functional abilities, and have effects that complement balance training in preventing falls. For older people living at home, programmes based on several types of physical activity exercises are effective in both reducing the rate of falls, the risk of falling, and the risk of fractures.

Physical activity: a solution for maintaining autonomy in older people

Older people who devote time to a physical activity have a better perception of their general health, vitality, and mental and physical condition.

Public participation in online influenza surveillance

Launched 3 years ago by the Sentinelles Network (Inserm–Pierre and Marie Curie University Joint Research Unit 1136) and the French Institute for Public Health Surveillance (InVS), the GrippeNet.fr website returns for a fourth consecutive year.

GrippeNet.fr complements the traditional surveillance systems for influenza, which are fed information collected in private physician practices and hospitals. These data enable research initiatives (at European as well as national level) aimed at gaining a better understanding of influenza (research on risk factors, the role of age, demand for health care, impact of vaccination, spread of the disease at European level, etc.), and help to monitor changes in the epidemic over time within the population.

The principle of the GrippeNet.fr website is to enable anyone living in metropolitan France, and who wishes to participate in influenza surveillance, whether ill or not, to do so anonymously and voluntarily, regardless of age, nationality or state of health.

Review of the last season

During the 2013-2014 season, GrippeNet.fr enabled the collection of a large amount of data regarding influenza, over a 5-month period (from 13 November 2013 to 13 April 2014). Although the number of participants remained stable, with 6,000 Internet users, weekly participation increased, with an average of 4,000 questionnaires completed each week (compared with 3,700 during the 2012-2013 season). This season showed an increased retention of participants in the GrippeNet.fr study.

During the 2013-2014 season, 24% of participants reported symptoms consistent with an influenza-like illness (compared with 29% during the 2012-2013 season), which may reflect the short duration of the influenza epidemic. The latter only lasted 5 weeks, and is one of the shortest epidemics recorded by the Sentinelles network. Only 42% of participants with an influenza-like illness consulted a health professional. (More information available at review of 2013-2014 season).

The new season, 2014-2015

Spotlight on pregnant women, a population at risk of developing influenza-related complications

Influenza can have serious consequences for the mother and her infant during pregnancy. Since 2012, influenza vaccination has therefore been recommended in France for all pregnant women. In practice, however, it is difficult to assess whether this recommendation is being closely followed.

As well as the usual monitoring of the general population, specific surveillance of pregnant women has been put in place this year. Project G-GrippeNet is aimed at estimating the frequency of influenza in this particular population, and the number of women vaccinated for influenza during their pregnancy in France. This study is the very first use of the GrippeNet.fr tool to monitor one population in particular.

Once she has created her personal account on www.grippenet.fr, the mother-to-be will complete the first enrolment questionnaire, in which she will reply “yes” to the question “Are you pregnant?” Every week, she will then be invited to complete a questionnaire on symptoms (identical to that on GrippeNet.fr). Another will also be made available to her if she wishes to report the occurrence of a particular event during her pregnancy, or report that she has had her baby. Participants will also receive a monthly newsletter dealing with a pregnancy-related health topic.

In order for GrippeNet.fr estimates to be as reliable as possible, large-scale participation by the population is essential. This makes it possible to study changes in the influenza epidemic over time for different population categories, especially men and young participants, who have been under-represented in past seasons, and now pregnant women. Everyone is invited to participate, regardless of his/her state of health (not susceptible to winter infections, or often sick in winter), age, profession, etc.