The i-Share (Internet-based Students HeAlth Research Enterprise) study, the only one of its type in the world, intends to monitor the state of health of 30 000 students over a period of 10 years. It will provide precious information on the state of health of students, to ensure better management of the health system for this population. This cohort study is being carried out by Inserm, the Université de Versailles Saint-Quentin-en-Yvelines and the Université de Bordeaux. In order to recruit the panel of students required for this study, the universities of Bordeaux and Versailles Saint-Quentin-en-Yvelines are running a recruitment campaign using tools with which these young people are already familiar: websites, mobile applications, social network sites, etc. I-Share will also serve as a platform for biomedical research projects and for testing prevention strategies.

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The i-Share study, investing for the future

There are over two million students in France. A population that is exposed to pathologies that could cause serious complications, such as depression and the risk of suicide, or disrupt their daily life and studies, such as migraine. Their behaviour during their student years can have both immediate effects (such as accidents due to binge drinking), and more long-term effects on chronic diseases (cancers, cardiovascular diseases).

The best way to study the health problems of students and find the solutions is to set up and monitor a large-scale cohort study. This is the goal of the i-Share study, which is one of the winning projects in the “Investissements d’avenir” (Investing for the Future) programme. The i-Share study wishes to monitor the state of health of 30 000 young adults over a period of 10 years. Its aim is to explore the risk factors of diseases in this population, for which we currently have very little available information.

The project is targeting four major pathological themes in particular: migraine, mental health, infections, risky behaviour and accidents

By providing accurate data on the frequency and consequences of certain diseases and infections, eating habits, the consumption of medication…

I-Share will help to fill in the missing data on young adults and will provide an overall picture of the state of health and wellbeing of students

The study will also provide the opportunity of testing prevention or medical care strategies to help with public health planning. Finally, this large-scale epidemiological cohort will serve as a platform to study the determinants and the mechanisms of diseases, through collaboration with other fields of biomedical research.

Efficient recruitment needs the use of student-friendly tools

I-share.fr, a website giving information about the study

In order to recruit and keep in contact with the 30 000 students, the i-Share.fr site was launched in mid-February 2013. The questionnaire on the i-Share.fr site concerns health, living habits, social and family environment and is the first step in the cohort enrolment process. I-Share.fr also centralizes all data relating to the cohort: type and progress of studies, goals, research themes, etc. The contents will be enriched by articles, photos and videos.

Development on social network sites

Much importance is given to exchanges, expression of feelings and experiences based on the subject of health. The participants will also be asked to attend various events and in general, to communicate on the cohort Twitter or Facebook sites to participate in the community.

Relay students

The relay students will be equipped with tablets and will go around meeting other students and introducing them to the missions of the i-Share cohort and encourage them to take part in this study.

 Scientific collaboration

i-Share.fr will also be the space dedicated to publishing the results of the study as it progresses. The description of the data and how to access them by external researchers will help collaboration with i-Share, which is an open study.

– on the one hand, so-called inactive ectopic pregnancies for which medical or surgical treatment may be decided

– on the other hand, so-called active ectopic pregnancies for which surgical treatment is necessary which may be conservational or radical.

For the first time in a single therapeutic trial, the Inserm researchers compared the fertility of women two years after the various treatments.

For this purpose, the researchers included women presenting with an ectopic pregnancy that was treated in the 17 French centres that took part in the study between 2005 and 2009. Just over 400 women were divided into two groups depending on the activeness (and seriousness) of the ectopic pregnancy. In each group, one of two possible treatments were selected through drawing lots  and the women were then monitored for two years.

In the first group, the cumulative fertility curves that reflect the number of pregnancies in patients during the two years of follow-up showed no significant difference between medical and preservation surgery. The intra-uterine pregnancy rate two years after the intervention was 67% following medical treatment with methotrexate and 71% after conservation surgery among the female research population.

In the second group, two years after treatment, 70% of the women who wanted to become pregnant again were able to achieve an intra-uterine pregnancy after conservation surgery and 64% after radical surgical treatment.

For the researchers, the results of this trial are an invitation to gynæcologists to reconsider the treatment they offer for ectopic pregnancies, taking account of the various factors governing subsequent fertility, the length of follow-up after treatment and patient preference as well as the risks inherent in each of the treatments.

As far as Perrine Capmas is concerned, “medical treatment should be prioritised in the case of an inactive ectopic pregnancy due on the one hand to patient preference but also to the lesser risk especially thanks to the absence of anæsthesia and surgery. In view, however of the absence of difference regarding subsequent fertility, surgical treatment should be offered initially to women who, it is feared, might not to stick to the treatment (supervision after medical treatment can be extended for several weeks)”.

 “In the case of ectopic pregnancies that require surgical treatment, doctors can reassure women that even radical surgery will not alter their chances of subsequently having a natural pregnancy”.

Constances is a “generalist’ epidemiological cohort constituted from a representative sample of 200,000 adults aged 18 to 69. It has been organised by the Centre de recherche en épidémiologie et santé des populations (CESP – INSERM/Université Paris Sud/Université de Versailles Saint-Quentin-en-Yvelines) in partnership with the CNAMTS* and the CNAV and its purpose is to create a national database open to the public health research community.

Under the scientific and technical leadership of Marie Zins (CESP), Constances (CONSulTANts des Centres d’Examens de Santé), has already recruited 14,000 subjects since it was initiated during the course of 2012. The patients were chosen by drawing lots from the CNAV** database and received a letter asking whether they would participate in the cohort. Upon entry into the cohort, the volunteers benefited from a complete health check at the Social Security Health Examination Centres and this check will be repeated every five years. With the help of a questionnaire to be completed annually, they will be providing health information, their lifestyles (work, food, alcohol or tobacco consumption, etc.), and their environment social. This data will be compared with that of the Caisse nationale d’assurance vieillesse** and in the health insurance fund to find out when they were off work sick, the costs of care submitted for reimbursement and the hospitalisation data as well as their social life and careers. Blood and urine samples will also be preserved for the purpose of creating a “biobank”.

The “Investments in the future” programme has been labelled a national biology and health infrastructure. This research project and the creation of this very significant sample (the largest in France and one of the largest in Europe) monitored over time (cohort) has been designed as an “open epidemiological laboratory” accessible to the French and international research community, also acts as a tool that provides those in charge of public health with diversified sources of information about the population’s health, including risk factors, how the health care and the prevention system are used and the medical, occupational and social history of the subjects involved.

“Constances is a generalist cohort but we have stressed the process of ageing and chronic conditions, occupational hazards, women’s health, socially determining factors and social inequalities”

* Caisse nationale de l’assurance maladie des travailleurs salariés [National Health Insurance Fund for Employees]
** Caisse nationale de l’assurance vieillisse = Old Age Insurance Fund

When blood pressure is normal in the doctor’s surgery, but is high at home! This is an unknown phenomenon known as “masked hypertension”. Christophe Tzourio, Research Director of Inserm unit 708 “Neuroepidemiology” (University of Bordeaux Ségalen) studied the occurrence of masked hypertension in a population of 1500 elderly persons. Not only does it occur frequently and by definition goes undetected by doctors, it incurs a high risk of developing into permanent hypertension over a very short period of time. These results, published in the Journal of Hypertension, outline the importance of blood pressure self-measurement by elderly persons in order to prevent the risks of heart disease and stroke.

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“These results outline the importance for elderly people of measuring their own blood pressure at home, in order to help diagnose masked hypertension that by definition remains undetected by the doctor, and to take measures to lower the blood pressure and thus reduce the risk of heart disease and strokes. Self-measurement of blood pressure also makes the dialogue easier between patient and doctor and helps to find a more suitable treatment “concluded Professor Christophe Tzourio, Research Director of the Inserm unit 708

This study was financed by INPES (the French national institute for prevention and health education).

Françoise Clavel-Chapelon, (Director of Research at INSERM-University of Paris-Sud 11, at the Institut Gustave Roussy), and Guy Fagherazzi were interested in a connection between the consumption of ‘diet’ or ‘light’ soft drinks and the risk of Type II diabetes. The analysis performed on 66,188 women in the E3N cohort confirms a link between sweet soft drinks and type II diabetes and reveals for the first time in France that, contrary to received wisdom, there is a higher risk of diabetes from so-called ‘diet’ or ‘light’ drinks than from ‘normal’ sweetened soft drinks. Additional studies on the effects of ‘light’ sweetened soft drinks are needed to corroborate the result. The article containing details of the results was published in the American Journal of Clinical Nutrition.

Diabetes affects more than three million people inFrance, 90% of whom suffer from Type II diabetes. While it has been established that consumption of sweetened drinks is associated with an increased risk of obesity and of Type II diabetes, the effect of ‘diet’ or ‘light’ sweetened soft drinks on cardio-metabolic diseases is less well-known. INSERM researchers on the E3N team assessed the link between the consumption of sweetened soft drinks and the risk of developing type II diabetes. The study was conducted on 66,118 French women in the E3N cohort who were monitored for 14 years.

The results show that women who drink ‘light’ or ‘diet’ sweetened soft drinks drink more of them than those who drink ‘normal’ sweet soft drinks (2.8 glasses per week as against an average of 1.6 glasses per week respectively).

Yet when an equal quantity is consumed, the risk of contracting diabetes is higher for ‘light’ or ‘diet’ drinks than for ‘non-light’ or ‘non-diet’ drinks.

Is this risk mainly associated with ‘light’ or ‘diet’ soft drinks? In order to find this out, the researchers also investigated the effects on the human organism of 100% natural squeezed fruit juices and their study found no association with a risk of diabetes.

The consumption of sweetened soft drinks increases the risk of being overweight, itself a risk factor in diabetes. In their study, the E3N team researches observed, however, that the effect produced by high consumption of sweet drinks was independent of corpulence in women.

In conclusion, it has been shown for the first time in a French population that high consumption of sweet soft drinks (both normal and ‘light’) is associated with a high increase in the risk of contracting Type II diabetes. This increased risk is all the greater for drinks of the ‘light’ or ‘diet’ type. Additional studies of the effects of ‘light’ or ‘diet’ soft drinks are necessary to confirm this result.

When a household experiences financial difficulties, the portion of the budget allocated to food is often restricted. In some cases, these difficulties may lead to food insecurity, i.e. limited and irregular access to a healthy and balanced diet. Based on a case study of 2,120 children, a team of Inserm researchers coordinated by Maria Mechior (Inserm Unit 1017 “Research Centre into epidemiology and population health”) has shown that children in food-insecure families have a high risk of developing long-term behavioural disorders, such as hyperactivity and attention deficiency.

This research has been published in the Plos One review. 

Food insecurity is defined as restricted, inadequate or uncertain access to healthy and nutritious food. It is mainly caused by financial difficulties and affects up to 10% of the general public. Previous research has shown that children who grow up in food-insecure families have a high level of psychological and behavioural problems; however, studies conducted to date did not distinguish the different types of behavioural difficulties and did not study relationships over the long-term.

This study conducted by Inserm researchers is based on data from a representative birth cohort of the Québec population. 2,120 children born in 1997-1998 were regularly monitored up to the age of eight. The researchers examined the link between food insecurity in children between 18 months and four and a half years and their behaviour between four and a half and eight years (i.e. the frequency of symptoms of depression/stress, aggression or hyperactivity/attention deficiency).

 5.9% of the children monitored experienced food insecurity during their early infancy. Compared to children who were not exposed to food insecurity, this group was three times more likely to develop long-lasting symptoms of hyperactivity and/or attention deficiency during childhood.

This link remains even when account is taken of family income and other characteristics that can be linked to food insecurity and the behaviour of children: single-parent families, parental psychopathology and negative behaviour of parents towards children. The link is therefore independent of these factors.

Food insecurity is a marker for particularly significant social and economic difficulties, of which the impact on the health of adults and children is known.

According to the researchers “Parents who are unable to regularly provide a satisfactory diet to the family may weaken the parent-child bond in early childhood, with effects on the long-term development of these children”.

Finally, food insecurity leads to changes in the diet of these families and generally results in the consumption of less fresh food and more foods that are high in fat and sugar. For some children, nutritional deficiencies (particularly iron), as well as excessive sugar intake, can result in hyperactive and inattentive behaviour.

For the researchers “reducing food insecurity in families could help reduce the frequency of behavioural disorders in young children”.