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De nombreux effets bénéfiques de l’activité physique (AP) sont identifiés pour les patients atteints de cancer. La prescription d’AP adaptée pour les patients atteints d’une affection de longue durée est inscrite dans la loi depuis 2016, et les premières études montrent qu’elle serait efficace pour augmenter le niveau d’AP dans d’autres pays. L’OMS caractérise la prescription de manière générale à travers six étapes. L’objectif de cette étude est d’observer et comparer à travers les critères définis par l’OMS comment, au sein du CHRU Nancy Brabois et l’Institut de Cancérologie de Lorraine (ICL), l’activité physique adaptée est prescrite aux patients atteints de cancer et quel est le parcours des patients suite à cette prescription. Huit professionnels de santé ont été interrogés. Une approche déductive a été mobilisée pour coder les unités de sens au sein des différentes étapes de la prescription. Les résultats montrent que les étapes 1, 2, 6 sont effectués lors des consultations par les professionnels. Néanmoins, le décret de loi n°2016-1990 n’a pas modifié les habitudes d’information et de prescription des professionnels de santé, et sans la légitimité de la prescription, l’AP reste un supplément au parcours de soins plutôt que l’une de ses composantes.

International audience; This study aimed to describe the discrepancy between body satisfaction change and weight change among adolescents following a 2-year school-based intervention, to identify associated sociodemographic factors, and to explore possible associations with perceived health indicators. We used data from a northeastern France representative adolescents sample (14-18 years old) who participated in the PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) study (2006-2009). Weight change was measured by the change in body mass index z-score from the start to the end of the study. Body satisfaction and self-perceived health (anxiety, depression, eating disorder and quality of life) changes were assessed using self-administered questionnaires. Discrepancy between body satisfaction change and weight change was described with cross-tabulations, and subdivided into optimism/pessimism (i.e. positive/negative body satisfaction change compared to weight change). Sociodemographic factors associated with discrepancy were determined by multivariate logistic regression models. Adjusted linear regression models described 2-year change in weight and self-perceived health according to discrepancy. Among the 3279 adolescents included (aged 15.1 ± 0.6 years), the proportion of discrepancy was 74.8% (pessimism = 41.6%; optimism = 33.2%). Discrepancy, especially pessimism, was higher in boys than in girls (OR = 1.44 [1.19; 1.74], p = .0002), and in socially advantaged adolescents (OR = 1.82 [1.20; 2.74], p = .004) than in disadvantage ones. Body satisfaction change was rather in line with anxiety, depression and quality of life changes than weight change. Body satisfaction change should be considered in overweight and obesity prevention interventions alongside body weight change, and could be used as indicator of long-term behavior maintenance. Clinical trials registry and number: ClinicalTrials.gov (NCT01688453).

Introduction L’efficacite a long terme des interventions de prevention du surpoids et de l’obesite chez les adolescents pourrait etre limitee par des divergences entre l’evolution de la satisfaction corporelle et l’evolution reelle de la corpulence. La description de ces divergences, de meme que l’identification des facteurs qui y sont associes restent encore peu etudiees. L’objectif de cette etude etait de decrire les divergences entre l’evolution de la satisfaction corporelle et l’evolution reelle de la corpulence chez des adolescents qui ont participe a une intervention de deux ans, et d’identifier les facteurs sociodemographiques associes. Methodes Les donnees d’adolescents ayant participe a l’essai de prevention PRALIMAP (PRomotion de l’ALIMentation et de l’Activite Physique), realise en milieu scolaire dans le Nord-Est de la France entre 2006 et 2009, ont ete utilisees. L’evolution reelle de la corpulence etait calculee par la difference du z-score de l’indice de masse corporelle (IMC) entre le debut (T0) et la fin de l’intervention (T2), et l’evolution de la satisfaction corporelle etait recueillie par auto-questionnaire a T2. Des donnees sur la sante percue (qualite de vie, anxiete, depression et troubles du comportement alimentaire) etaient recueillies par auto-questionnaire a T0 et T2. Des tests t de Student apparies ont ete utilises pour decrire l’evolution reelle de la corpulence en fonction de l’evolution de la satisfaction corporelle. Des tableaux de contingences ont ete realises pour decrire les divergences entre l’evolution de la satisfaction corporelle et l’evolution reelle de la corpulence. Des modeles de regression logistique multivariee ont permis d’identifier les caracteristiques sociodemographiques associees aux divergences. L’evolution (T2-T0) de la sante percue en fonction des divergences identifiees a ete decrite a l’aide de tests t de Student apparies. Resultats Parmi les 3279 adolescents inclus (âge moyen ± ecart type : 15,1 ± 0,6 ans), le z-score de l’IMC diminuait significativement chez ceux qui se sentaient mieux (moyenne= −0,23 ; p Conclusion La frequence de la divergence entre l’evolution de la satisfaction corporelle et l’evolution reelle de la corpulence est elevee chez les adolescents scolarises, et survient avec une probabilite plus elevee chez les garcons et les adolescents issus de milieux sociaux favorises. L’evolution de la satisfaction corporelle pourrait etre prise en compte, au meme titre que l’evolution reelle de la corpulence, dans les interventions de prevention du surpoids et de l’obesite a l’adolescence afin d’optimiser leur efficacite a long-terme.

The interdependence among eating behaviour (EB), physical activity (PA) and sedentary time (ST) suggests simultaneously identifying homogeneous profiles and describing their changes. This study aimed to (1) identify cross-sectional lifestyle behaviour profiles and their 2-year changes among French school-age adolescents and (2) identify factors associated with these profiles and changes. Longitudinal data from adolescents who participated in the PRomotion de l’ALIMentation et de l’Activité Physique trial were used. PA and ST were assessed with the International Physical Activity Questionnaire and EB with a FFQ. Profiles at baseline and their changes were identified by latent transition analysis. Multinomial logistic regression models were used to identify factors associated with profiles and their changes. Among 2390 adolescents included (14–18 years), five baseline profiles that differed mainly in EB were identified: ‘healthy diet and high PA (7·9 %)’, ‘big eater and moderate to high PA (23·8 %)’, ‘healthy diet and low PA (31·2 %)’, ‘restrictive diet and moderate PA (20·6 %)’ and ‘sugar products, nibbling and moderate PA (16·5 %)’. Young adolescents, those who were overweight or obese and socially advantaged, were more in the ‘healthy diet and low PA’ than others. Boys, older and socially less advantaged adolescents exhibited more ‘unfavourable’ than ‘mixed’ changes, while adolescents with overweight or obesity had less ‘unfavourable’ than ‘mixed’ changes. In conclusion, adolescents were twice the number in the least than the most favourable profile. Findings highlighted the importance of EB among adolescents and suggest taking adolescents’ sociodemographic and weight characteristics into account in interventions aimed at acting on adolescents’ behaviours.

Treatments may become redundant in older patients with multiple sclerosis (MS). Our aim was to explore whether stopping treatments might be possible in patients aged over 50 with disease inactivity. Patients over 50 were included from the population-based MS Lorraine registry if they had a relapsing–remitting course at onset and had experienced no relapse for ≥ 3 years. Patients who stopped treatments were defined as “stoppers”, and the others as “stayers”. The outcomes were the time to first relapse, to first disability progression, and to the occurrence of EDSS score of 6, assessed by multivariate analysis using a propensity score. 132 stoppers and 366 stayers had a median follow-up of 7 years. There was no difference in Log-rank tests for the times to first relapse (p = 0.61) and to first disability progression (p = 0.22). In Cox models, stopping treatments was not associated with an increased risk of relapse (adjusted Hazard ratio (aHR) = 0.92 [0.72–1.16; p = 0.47]) or of an increase in EDSS score (aHR = 0.89 [0.71–1.13; p = 0.34]). However, stopping was associated with a higher risk of occurrence of EDSS score of 6 (aHR = 3.29 [2.22–4.86; p

Objective: The aim of this study is to determine the effectiveness of an extended cognitive rehabilitation program in group’s sessions in multiple sclerosis. Design: Double-blind multicenter randomized trial. Participants: People with multiple sclerosis of 18 to 60 years, Expanded Disability Status Scale ⩽6.0, mild to moderate cognitive impairment. Interventions: They were randomized into cognitive rehabilitation program (ProCog-SEP) or in a placebo program. ProCog-SEP comprises 13 group’s sessions over 6 months and includes psychoeducational advices and cognitive exercises. Placebo program included non-cognitive exercises. No strategy and no cognitive advice were provided. Main measures: The primary endpoint was the percentage of verbal memory learning measured by the Selective Reminding Test. A comprehensive neuropsychological assessment is carried out before and after interventions by a neuropsychologist blinded to intervention. Effectiveness of the ProCog-SEP versus Placebo has been verified using linear regression models. Results: In total, 128 participants were randomized and 110 were included in the study after planning session in groups; 101 completed this trial (77.2% females); mean age: 46.1 years (±9.6); disease duration: 11.8 years (±7.5). ProCog-SEP was more effective in increasing in learning index (9.21 (95% confidence interval (CI): 1.43, 16.99); p = 0.02) and in working memory on manipulation (0.63 (95% CI: 0.17, 1.09); p = 0.01), and updating capacities (–1.1 (95% CI: –2.13, –0.06); p = 0.04). No difference was observed for other neuropsychological outcomes. Regarding quality of life outcomes, no change was observed between the two groups. Conclusion: These findings suggest that ProCog-SEP could improve verbal learning abilities and working memory in people with multiple sclerosis. These improvements were observed with 13 group sessions over 6 months.

ObjectiveThe present study aimed to identify trajectories of physical activity (PA) components (frequency, duration, intensity, and type) and screen-based sedentary behavior (SB) as well as baseline predictors of each trajectory in patients with hip and/or knee osteoarthritis (OA).MethodsWe included 878 patients with a 5-year follow-up from the KHOALA cohort. PA and SB were measured by the Modifiable Activity Questionnaire. We used group-based trajectory analysis to identify the trajectories of PA components and screen-based SB, and multivariable logistic regression to determine predictors of the identified trajectories.ResultsTwo groups of trajectories were identified for each PA component and 3 for SB. High and decreasing PA duration was associated with female sex (OR 0.3, 95% CI 0.1–0.5) as was low and stable, more so than high and decreasing prevalence of weight-bearing activities (OR 0.6, 95% CI 0.4–0.9). Patients with impaired patient-reported outcome measures and obese patients often featured low versus high and decreasing prevalence of weight-bearing activities. Predictors of moderate and high versus low and slightly increasing screen-based SB trajectories were male sex, age < 60 years, single status (OR 1.5, 95% CI 1.1–2.1), obesity (OR 2.1, 95% CI 1.4–3.1), smoking (OR 2.0, 95% CI 1.1–3.7), and less physical jobs. Predictors of moderate and high versus low screen-based SB trajectories were all sociodemographic: male sex, age < 60 years, single status, obesity, smoking, and less physical jobs.ConclusionSociodemographic and clinical predictors of trajectories vary between PA components; they are associated mainly with PA frequency and type. No clinical characteristics were associated with screen-based SB.

International audience; Social differences in prevalence of overweight and obesity among adolescents, known as the weight social gradient, could be explained by differences in behaviours between social classes. This study examined the respective association of physical activity (PA), sedentary behaviour (SB) and weight status with adolescents' socioeconomic status. We used cross-sectional data for 1935 adolescents (13-18 years old) with overweight or obesity who participated in the PRALIMAP-INÉS (PRomotion de l'ALImentation et de l'Activité Physique - INÉgalités de Santé) trial conducted in northeastern France between 2012 and 2015. Adolescents completed the International Physical Activity Questionnaire for PA and SB and the Family Affluence Scale for socioeconomic status. Weight status was assessed by the body mass index (BMI) and BMI z-score. Social gradient of weight status, PA and SB were described according to the Family Affluence Scale (slopes) and evidenced by the linear trend test (p). Adolescents' socioeconomic status was positively associated with PA practice (frequency, vigorous PA and leisure-time PA), but there was no association with their SB. The results confirmed a significant weight social gradient: BMI (β = 0.37, p

International audience; BACKGROUND: A high prevalence of overweight/obesity among low socioeconomic status adolescents contributes to health inequalities. However, evidence-based interventions for reducing social inequalities in adolescent weight are lacking. We aimed to investigate whether strengthened care management for adolescents with low socioeconomic status has an equivalent effect in reducing overweight as standard care management in adolescents with high status.METHODS: PRALIMAP-INÈS was a multicentre trial including 35 state-run high and middle schools in the north-eastern France. A population-based sample of 1639 adolescents aged 13-18 years with screened and clinically confirmed overweight/obesity were proposed for inclusion and divided into two groups by the Family Affluence Scale score: advantaged (score > 5), receiving standard care management (A.S) and less-advantaged randomly assigned to two groups (1:2 ratio): standard care management (LA.S) and standard and strengthened care management (LA.S.S). Interventions were based on the proportionate universalism principle: universal standard care for all groups and proportionate care for the LA.S.S group. Main outcome was body mass index z-score (BMIz) assessed before and 1 year after inclusion.RESULTS: A total of 1419 adolescents were included and 1143 followed up at 1 year: 649 in A.S, 158 in LA.S and 336 in LA.S.S groups. BMIz decreased significantly for boys (-0.11 [95% CI, -0.13 to -0.08]; p

Background Targeted interventions among vulnerable youth populations represent an important approach to the reduction of health inequalities. We must, however, ensure that impacts are not unequally distributed according to the range of resources available to them. We explore these concerns among youth in vocational training to be enrolled in a smoking cessation intervention by describing (1) their socio-economic profile and (2) the association between their socioeconomic characteristics, their smoking practices, and key factors that could be targeted in interventions. Methods A total of 234 young people aged 15–20 years were recruited in three centers in the Lorraine region in France in 2016–2017 as part of the Social Network and Tobacco Cessation (Reseau social et sevrage tabagique [RESIST]) study. We measured participants’ socio-economic characteristics using their parents’ education and occupational grade. We examined the associations of these characteristics with participants’ smoking habits, intention to quit, nicotine dependence, presence of smokers in their network, and representation of a young smoker. We examined the associations between variables with bivariate tests depending on the nature of the variables. Results Participants were more likely to be from a socio-professional background more modest than the national average (56% versus 33%), but still exhibited considerable socioeconomic variability. Smoking status did not vary significantly according to the educational level of the participants’ parents (from 52% to 57%, P = 0.78) or occupational grade (from 52% to 58%, P = 0.35). Compared to participants whose parents had completed a professional or pre-university degree, participants with parents in the lowest education category were less likely to report not intending to quit (P = 0.01) and more likely to report seriously considering to quit in the next six months (P = 0.03) and to have already tried to quit but failed (P = 0.01). Conclusion It is tempting to define youth in vocational training as a homogeneous group, especially when they share the same school environment, employment status, and income. Our results, however, highlight substantial variability in their socioeconomic profiles and smoking characteristics. Researchers are encouraged to further consider these equity issues to contribute to the reduction of health inequalities.

Background Although physical activity (PA) can alleviate fatigue and improve quality of life (QoL) in patients with breast cancer (BC), not all domains of PA may have equal impact. The objective of the current study was to examine the longitudinal impact of PA components on the evolution of fatigue and QoL during and after adjuvant treatment for BC. Methods The women included in the study were participants in the 2-year longitudinal FATSEIN ("Fatigue dans le cancer du Sein") study. Fatigue and QoL were measured using the Multidimensional Fatigue Inventory and the European Organization for Research and Treatment of Cancer 30-item QoL questionnaire, respectively. Group-based trajectory analysis was used to determine patterns of PA evolution (frequency, duration, and intensity). Cross-sectional and longitudinal associations between PA patterns and fatigue and QoL were analyzed by using multivariable linear regression and a mixed model. Results Among the 424 women who were included (mean ± standard deviation age, 57.1 ± 10.4 years), 2 trajectories were identified for each of the 3 PA components: low and insufficient frequency (51.2%) or regular and moderate frequency (48.8%), low and insufficient duration (47.6%) or regular and moderate duration (52.4%), and low intensity (47.2%) or low to moderate intensity (52.8%). Overall, during treatment, fatigue was increased and QoL was decreased, and the reverse was observed after treatment. During treatment, increased fatigue and decreased QoL were limited by regular PA frequency (β = -8.71 for total fatigue; β = 14.59 for emotional function), but the results were less significant after treatment. Conclusions PA, especially its frequency, is an important determinant of fatigue and QoL during adjuvant treatment for BC. The promotion of regular PA among women who are receiving treatment for BC may be an effective way to reduce fatigue and improve QoL. Cancer 2018;124:797-806. © 2017 American Cancer Society.

International audience; PURPOSE: To examine the respective and combined impact of "hypothetical" functional impairment (FI) and burden of comorbidities accrual on a 5-year risk of health utility (HU) loss in osteoarthritis (OA).METHODS: Participants of the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) study with a 5-year follow-up were included. FI, number of comorbidities and HU were measured annually by the WOMAC, Functional Comorbidity Index and Short-Form 6D, respectively. We estimated the population risk of HU loss (PRD: population risk difference, PRR: population risk ratio) under hypothetical FI and comorbidities using the parametric G-formula. Then, mediation analysis investigated the causal mechanism of comorbidities on HU through FI by estimating total, direct and indirect effects.RESULTS: We examined data from 767 patients (68.8% women; 61.6 years). The estimated 5-year risk of HU loss was 47.5% [41.9; 52.2] under natural course and 24.9% [15.5; 34.2] when imposing "Patient acceptable function and No comorbidity" corresponding to a PRD = - 22.6 [- 26.5; - 21.2] and a PRR = 0.5 [0.4; 0.6]. The estimated total risk of HU loss comparing "Two comorbidities" versus "No comorbidity" was significant without mediation effect of FI: Total = 10.1% [6.8; 12.9]; direct = 8.0% [2.7; 13.1]; indirect = 2.1% [- 2.0; 5.2].CONCLUSIONS: FI and comorbidities are important and independent determinants of HU loss in patient with OA. Half of cases (50%) of HU loss during 5 years could be avoided by preventing comorbidities (30%) and limiting FI under patient acceptable function (20%). Caregivers should additionally pay close attention to the prevention and the treatment of comorbidities in routine management of OA.

Background: Long-term structural outcomes of corticosteroids (CS) or hyaluronic acid (HA) intra-articular injections in knee osteoarthritis (KOA) are unclear. Whether HA injections delay the need for total knee replacement (TKR) remains controversial, and an increased risk of cartilage damage has been reported with repeated CS injections. Objectives: We conducted this study to compare, in real-life setting, the risk of TKR in patients receiving CS or HA vs. in those who did not receive intra-articular injections. Methods: Khoala cohort is a French nationwide population-based cohort of 878 patients with symptomatic hip or knee OA (ACR criteria), aged 40-75 years. This study included patients with baseline KOA only. Patients were followed annually by self-reported questionnaires and by clinical examination and radiography at baseline (year 0), years 3 and 5. The risk of incident TKR was compared between patients who had never received intra-articular injections vs. patients who received at least 1 CS or HA injection during follow-up. We used a marginal structural model with inverse probability of treatment weighting to determine the causal relationship between treatment and the risk of incident TKR in the treated knee during the 5-year follow-up. This model allows the adjustment for time-varying confounding factors (i.e. pain, function and mental health scores) in addition to constant confounders (i.e. baseline age, sex, BMI, Kellgren-Lawrence grade). Results: This study involved 656 patients (mean age 62.2 ± 8.5 years; 70.3% females) of which 91 (13.9%) underwent TKR during follow-up. CS or HA injections were performed in 143 (21.8%) and 191 (29.1%) patients, respectively, and 92 (14.0%) received both treatments. The 5-year relative risk of incident TKR in treated vs. untreated knee was 0.96 (95%CI 0.35 to 2.66; p=0.94) CS-treated knees and 0.38 (95%CI 0.15 to 1.03; p=0.06) in HA-treated knees. Conclusion: In this study, CS injections for symptomatic KOA did not increase the 5-year risk of incident TKR. There was a non-significant trend for a reduced risk of TKR in HA-treated knees. Acknowledgement: This work was supported by the French Society of Rheumatology and ART-Viggo Association. Disclosure of Interests: Augustin Latourte: None declared, Anne-Christine Rat: None declared, Willy Ngueyon Sime: None declared, Abdou Omorou: None declared, Florent Eymard: None declared, Jeremie Sellam: None declared, Christian Roux: None declared, Francis Guillemin Grant/research support from: Expanscience, Pascal Richette Consultant for: Grunenthal, Horizon, Speakers bureau: AstraZeneca, Grunenthal

Screening for osteoporosis is crucial in rheumatoid arthritis (RA) patients. The aim of this study was to assess the value of thoraco-abdomino-pelvic CT-derived bone mineral density (BMD) results in L1, compared to dual energy X-ray absorptiometry (DXA) results for osteoporosis screening in rheumatoid arthritis patients. Consecutive RA patients who underwent a CT-scan and DXA within a 2-year period were retrospectively included. The CT sagittal images were then evaluated for vertebral fractures from T4 to L5 using the Genant classification. The CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 were measured on axial images and compared to the DXA results. This study included 105 patients (mean age 61.1 years (± 9.5), 78.1% women). There were 28 patients (26.7%) with DXA-defined osteoporosis and 32 (30%) with osteoporotic fractures (vertebral and/or non-vertebral). The CT assessment indicated that the mean (SD) vertebral L1 attenuation was 142.2 HU (± 18.5). The diagnostic performance for the vertebral CT-attenuation measurement was acceptable: the AUC was 0.67 for predicting osteoporotic fractures and of 0.69 for predicting vertebral fractures. Among patients with osteoporotic fractures, there were 23 (74%) patients categorized as osteoporotic with a L1 CT-attenuation of 135 HU or less, whereas there were only 13 patients (42%) identified by DXA. CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. This approach may be particularly interesting for RA patients with a high osteoporosis risk.

Objective To evaluate the feasibility of an innovative peer intervention promoting healthy eating and physical activity, which purposefully selected peer facilitators according to socioeconomic status to target less-advantaged overweight receivers. Setting Nine high schools, two middle schools. Participants One hundred and fifty-six adolescents were approached to become facilitators, of whom 18 were trained. Thirty-two of 56 potential receivers agreed to participate. Intervention The peer intervention was carried out in 2013–2014 and embedded in a larger trial: PRALIMAP-INÈS (Promotion de l’ALIMentation et l’Activité Physique-INEgalité de Santé). Facilitanoators were selected and trained to organise weight-control activities with specific peer receivers participating in the programme. Primary and secondary outcome measures Different types of data were collected to assess demand, acceptability, implementation and practicality of the intervention. For the facilitators, this included 6 training sessions, 11 mid-programme interviews, 4 end-of-programme sessions, telephone notes and text message exchanges. All six potential receivers in one school were also interviewed. Sociodemographic and health characteristics were also analysed. Results Agreeing to participate was more likely when asked by a peer compared with a professional (51.2% discordant pairs; p

Background Health effects of sedentary behaviors (SB) may vary depending on their characteristics such as type, purpose, duration, and intensity of the behavior. While a growing number of questionnaires assess sedentary behaviors, it is unclear which characteristics of SB are measured. The aim of this review was to examine the content of self-report SB questionnaires. Methods Three databases were searched for sedentary behavior questionnaires published before January 1st, 2016. Based on the inclusion criteria, 82 articles out of 1369 were retrieved for a total of 60 questionnaires. For each questionnaire, the sedentary behavior characteristics identified were reported and analyzed. Results Most of the questionnaires assessed the time (n = 60), posture (n = 54), purpose (n = 46) and the types (n = 45) of SB performed. Fewer questionnaires assessed the environment (n = 20) social context (n = 11), status (n = 2), and associated behaviors (n = 2) related to sedentary behaviors. All the questionnaires except two assessed time spent in SB with 17 assessing frequency and 6 assessing breaks in SB. The most frequent characteristics identified in the questionnaires were the categories of sitting (90%), a day (95%), watching television (65%) and using a computer (55%). Many characteristics of SB were not measured. Conclusions By knowing the breadth of SB included in questionnaires, this review provides support to shape the design of new questionnaires designed to reduce the gaps in measuring sedentary behaviors.

Objectives To assess the clinically relevant change in health state utility (HSU) in living kidney donors and whether this change value is constant across measures and clinical conditions and is useful for health economics studies. We aimed to 1) measure the change in the HSU score for living kidney donors from before donation to 3 months after donation and 2) estimate the minimal important decrease (MIDe) in the HSU score for living kidney donors and its associated clinical factors. Methods Data from a prospective multicenter observational study measuring quality of life of kidney donors by the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L) and the six-dimensional health state short form (SF-6D) before donation and at 3 months after donation provided HSU scores. Two methods were used to derive the MIDe: the anchor-based method and the distribution-based (standard error of measurement) method. Logistic regression was used to identify clinical factors associated with the MIDe after donation. Results In total, 228 and 216 donors completed the EQ-5D-3L and the SF-6D, respectively. Mean HSU scores were 0.932 and 0.823 before donation and 0.895 and 0.764 at 3 months after donation. HSU scores were significantly decreased at 3 months, and 18.5% of donors rated their global health as "somewhat worse." By the EQ-5D-3L and the SF-6D, the MIDe was estimated at −0.113 and −0.116 with the anchor-based method and −0.075 and −0.077 with the distribution-based method. Risk of decreased HSU score was significantly associated with clinical complications but only marginally with surgical technique. Conclusions A short-term clinically relevant decrease in HSU was significantly associated with clinical complications in kidney donors. Preventing perioperative complications is of prime importance in kidney donation.

Background Social differences among adolescents in physical activity and sedentary behaviour have been identified but are not well explained. The current study aimed to identify socioeconomic, family and school-related associated factors with physical activity and sedentary behaviour among high-school adolescents. Methods This was a cross-sectional analysis of T0 physical activity and sedentary behaviour of 2523 students 14 – 18 years old recruited for the PRALIMAP trial from 24 French state-run high schools. Data were collected by self-administered questionnaire at the start of grade 10. Adolescents completed the International Physical Activity Questionnaire for physical activity and sedentary behaviour and an ad hoc questionnaire for active commuting and sport participation. Statistical analyses involved linear and logistic regressions. Results Socioeconomic, family or school variables were associated with levels of physical activity and sedentary behaviour for both boys and girls, but no factor, except perceived parental physical activity level, was associated with total energy expenditure (total physical activity) for either gender. Adolescents with privileged and less privileged socioeconomic status reported the same total amount of energy expenditure. Conclusions Total physical activity score alone is not sufficient to assess the physical activity of adolescents. These findings may have implications for better understanding of social inequalities in this context and recommendations to prevent overweight. Trial registration This trial is registered at ClinicalTrials.gov (NCT00814554). The date of registration: 23 December 2008. Registration was not required at the time of the start of PRALIMAP for public health and prevention programmes and trials. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4070-9) contains supplementary material, which is available to authorized users.

Background A structured screening strategy led to a significant decrease in overweight and obesity prevalence. Inverse relationship between income and the prevalence of obesity is known. Furthermore, public health interventions may increase health inequalities. The PRALIMAP-INES trial was implemented between 2012 and 2015 and aimed to investigate whether a strengthened care management strategy to prevent and reduce overweight could do …

International audience

International audience

International audience; BACKGROUND:Few studies have focused on relating physical activity (PA) and sedentary behaviour (SB) to identify homogeneous groups. This study aimed to identify patterns of PA and SB in France general population and their correlates.METHODS:A sample of 3294 (mean age 44 ± 17 years) from the general population in France was included. PA and SB were assessed by the World Health Organization Global Physical Activity Questionnaire. Cluster analysis was used to identify PA and SB patterns, with polytomous logistic regression to identify their correlates.RESULTS:Five clusters were identified: (i) 'low total PA, active-transportation and low SB' (41%), (ii) 'low total PA and moderate SB' (22%), (iii) 'low total PA, leisure-time PA and high SB' (15%), (iv) 'high total PA, moderate occupational PA and moderate SB' (17%) and (v) 'high total PA, vigorous occupational PA and low SB' (5%). Occupational PA substantially contributed to total PA which depended on socioeconomic status (SES): low total PA and high SB in higher SES and high total PA and low SB in lower SES.CONCLUSIONS:Based on PA and SB, French adults were clustered into groups with socioeconomic differences emphasizing that adapted interventions may be more beneficial for health.

Background The directionality of the associations of domain-specific physical activity (PA) and sedentary behaviour (SB) with health-related quality of life (HRQoL) in adults remain insufficiently known. This study investigated the longitudinal associations of 10-year cumulative levels of PA and SB with HRQoL and the reverse associations. Methods A sample of 2093 (47.8% men) participants from a cohort of French adult (SU.VI.MAX) was included. Data were collected at 3 time points (1998, 2001 and 2007) using the Modifiable Activity Questionnaire (MAQ) for PA (leisure-time and occupational) and SB (screen-viewing, reading and total sitting time) and the DUKE Health Profile for HRQoL. The cumulative level (from 0 to 3) referred to the number of time points where a high PA level, high SB or good HRQoL was reported. Regression models examined the 10-year cumulative level of PA, SB as predictors of HRQoL and reverse associations. Results The 10-year cumulative level of high PA, both leisure-time and occupational, predicted a higher HRQoL while the 10-year cumulative level of high screen-viewing time and high total sitting time was associated with lower HRQoL. For the reverse association, cumulative level of good HRQoL predicted more leisure-time PA, less screen-viewing time and less total sitting time but was not related to occupational PA. Conclusion Relationships between PA, SB and HRQoL are complex and should not be oversimplified in one or the other direction. Taking into account domain-specific PA and SB in health promotion programs appears of prime importance to design interventions aiming at improving HRQoL.

Background Screening for osteoporosis is crucial in rheumatoid arthritis (RA) patients. Computed tomography (CT) attenuation assessment has been proved to be of interest in general population for detection of osteoporosis. Objectives To assess the value of thoraco-abdomino-pelvic CT-derived bone mineral density (BMD) in L1, compared with dual energy X-ray absorptiometry (DXA) for osteoporosis screening in rheumatoid arthritis patients. Methods Consecutive RA patients who underwent a CT-scan and a DXA within a two-year period are retrospectively included. CT sagittal images are evaluated from T4 to L5 for vertebral fractures according to Genant classification. CT attenuation values (in Hounsfield units [HU]) of trabecular bone in L1 are measured on axial images and compared to DXA results. Results One hundred and five patients (mean age 61.1 years (±9.5), 78.1% women) were included. Twenty-eight patients (26.7%) have DXA-defined osteoporosis and 32 (30%) have osteoporotic fractures (vertebral and/or non-vertebral). According to CT assessment, mean (SD) vertebral L1 attenuation is 142.2 HU (±18.5). The diagnostic performance for vertebral CT-attenuation measurement was good, with an AUC of 0.67 for predicting osteoporotic fractures and of 0.69 for predicting vertebral fractures. Among 31 patients with osteoporotic fractures, 23 (74%) patients are categorised as osteoporotic with L1 CT-attenuation of 135 HU or less, whereas only 13 patients (42%) with DXA. Conclusions This technique offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. This seems of particular interest in RA patients who are at high risk for osteoporosis. Disclosure of Interest None declared

International audience; BACKGROUND:The directionality of the association of physical activity (PA) and sedentary behaviour (SB) with health-related quality of life (HRQoL) remains unknown in adolescents. This study aimed to investigate the association of 2-year cumulative level of PA and SB with HRQoL and the reverse association.METHODS:We included 1445 adolescents in France from a 2-year longitudinal study with three follow-up times (PRALIMAP trial). At each follow-up, adolescents completed the International Physical Activity Questionnaire for PA and SB and the Duke Health Profile for HRQoL. Statistical analyses involved linear and logistic regressions adjusted for socio-demographic characteristics.RESULTS:The cumulative number of times an adolescent achieved the PA recommendations during the 2 years was associated with better physical, mental, social and general HRQoL (p for trend < 0.0001). In contrast, high SB predicted low HRQoL for most dimensions except social HRQoL (p = 0.12). Combining PA and SB, the effect of recommended PA on HRQoL was offset in part by high SB. In the reverse association, high HRQoL predicted high PA (overall, vigorous, moderate and recommended PA), but was not associated with SB.CONCLUSIONS:The association between PA and HRQoL was cumulative and bidirectional among adolescents, whereas low HRQoL seemed to be a consequence of high SB rather than a cause (cumulative but not bidirectional). Promoting recommended PA and low SB may help improve HRQoL among adolescents, with a possible virtuous cycle with regard to PA.

Contexte : L’importance de l’activite physique (AP) et des inegalites sociales afferentes, dans la prevention et la prise en charge de l’obesite fait l’objet de debats. Notre objectif etait d’identifier, au sein du programme PRALIMAP-INES, les determinants de la participation d’adolescents en surpoids de milieu defavorise. Methodes : Cinq seances collectives dont deux specifiques a l’AP et des activites adaptees individuelles ont ete animees par des dieteticiens, professionnels de l’activite physique et psychologues. Elles ont ete proposees a 411 adolescents de 13 a 18 ans en situation de surpoids et d’obesite de milieu defavorise et participant a PRALIMAP-INES, dans 35 colleges et lycees vosgiens. Resultats : La participation a au moins une seance collective etait meilleure chez les collegiens comparee aux lyceens (OR = 2,2) et chez ceux qui declaraient des difficultes financieres pour payer une licence (OR = 5,8). Le nombre de seance augmentait avec l’indice de masse corporelle ; il etait plus eleve chez les collegiens (+ 0,7 seance) et plus faible chez ceux declarant des difficultes financieres (– 1,1 seance). La participation a un entretien en AP etait significativement meilleure chez les filles (OR = 1,8), chez ceux qui participaient a l’Union Nationale du Sport Scolaire (OR = 2,4) et qui declaraient ne pas avoir d’amis avec qui pratiquer (OR = 2,7). Les niveaux d’AP et de sedentarite n’etaient pas associes a la participation. Conclusions : La participation initiale aux activites collectives PRALIMAP-INES etait elevee chez les adolescents defavorises avec difficultes financieres mais son maintien tout au long du programme etait chez eux plus difficile. Identifier les leviers du maintien de la participation est un defi majeur pour la perennite du programme.

Introduction Although physical activity (PA) can alleviate fatigue and improve quality of life (QoL) in patients with breast cancer (BC), not all components of PA may have equal impact. The aim of this study was to examine the longitudinal impact of PA components on the evolution of fatigue and QoL during and after adjuvant treatment for BC. Methods We included women from the 2-year longitudinal FATSEIN study with 10 follow-up: 0, 1, 2, 4, 6, 7 and 8 months (adjuvant treatment period) and 12, 18 and 24 months (adjuvant post treatment period). Fatigue and QoL were measured by the Multidimensional Fatigue Inventory and EORTC QLQC-30 questionnaire respectively. Fatigue and QoL scores have been normalized from 0 (low-level) to 100 (high-level). PA practice has been assessed by frequency (number/week), duration (minutes/session) and intensity (low, moderate or vigorous) of PA. Group-based trajectory analysis was used to determine patterns of PA components evolutions. The selection of the optimal models was based on the Bayesian information criterion maximization, the proportion of patients in each trajectory group (> 5%), the statistical significance of the equation modeled and the clinical relevance of trajectories identified. Cross-sectional and longitudinal association between PA patterns and fatigue and QoL were analyzed by multivariable linear regression and a mixed model for repeated measures, respectively. Results Among 424 women included (mean age 57.1 ± 10.4 years), two trajectories were identified for each of the three PA components: “low and insufficient frequency” (51.2%, Conclusions PA, especially its frequency, is an important determinant of fatigue and QoL during adjuvant treatment for BC. Promoting regular PA among women undergoing treatment for BC may be an effective way to reduce fatigue and improve QoL. This work had led to an article published in the Cancer journal [1] .

Background:explaining why and how overweight prevention programs were effective was a real need; especially the potential role of physical activity (PA) and sedentary behavior (SB) should be highlighted. This study aimed to evaluate the 2-year effectiveness of a screening and care strategy in adolescents’ weight reduction with regards to PA and SB change.Methods:1745 adolescents aged 15.1 years from PRALIMAP trial was included (n = 840 for screening and care group and n = 905 for control group). PA and SB time (international physical activity questionnaire: IPAQ), body mass index (BMI), and BMI z-score were assessed at inclusion and after 2-year intervention. Hierarchical mixed models were applied.Results:Compared with the control group, screening and care strategy was associated with an increase in global PA (58 min/week), a moderate PA (43 min/week), the adherence to the French PA guidelines (OR = 1.3), and a decrease in SB (−198 min/week). The 2-year weight change decreased when adjusted for PA and SB suggesting that the effect of screening and care strategy was partly mediated by PA and SB.Conclusion:Screening and care intervention seemed to be effective in increasing PA and decreasing SB. The induced PA and SB modifications contributed to the observed weight change.