Effects of three prophylactic interventions on French middle-schoolers' mental health: protocol for a randomized controlled trial

Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/ . This is the first version of the protocol.

Exploring the Use of a Learning-Based Exergame to Enhance Physical Literacy, Soft Skills, and Academic Learning in School-Age Children: Pilot Interventional Study

BACKGROUND

There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children's interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant.

OBJECTIVE

The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration).

METHODS

This interventional study had a pre-post design and used the Play LÜ exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play LÜ requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play LÜ and a motor skills circuit behind the LÜ setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Grööve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Gaïa application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills.

RESULTS

The implementation of this exergaming program was welcomed by the school's administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6%; W=933.0; P=.002; rrb=-0.39, 95% CI -0.58 to -0.16) and motivation in mathematics (+0.7, +9.8%; W=381.5; P=.005; rrb=-0.44, 95% CI -0.66 to -0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups.

CONCLUSIONS

The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children.

Relationship between Fear of COVID-19, Intolerance of Uncertainty, and Coping Strategies on University Students' Mental Health

BACKGROUND

the mental health of students was particularly affected by the COVID-19 pandemic. The present study therefore examined the relationships between anxiety and depressive symptoms, eating-related problems, coping, fear of COVID-19, and intolerance of uncertainty.

METHODS

2139 French students of 54 universities were recruited in the different regions of France during a French lockdown (between 21 April and 3 May 2021). Six variables were measured: fear of COVID-19, intolerance of uncertainty, coping, anxiety and depressive symptoms, and eating-related problems. To explore the directions of the relationships between our variables of interest, we calculated a directed acyclic graph.

RESULTS

our data highlighted the central roles of intolerance of uncertainty in students' anxiety and depressive symptoms, and the direct role of prospective intolerance of uncertainty on eating-related problems.

CONCLUSIONS

these findings indicate that intolerance of uncertainty should be targeted by interventions designed to help students with high levels of anxiety, depressive symptoms, and/or eating-related problems.

Influence of illness representations on coping strategies and psychosocial outcomes of infertility: Systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis was based on the Common Sense Model, applied to infertility.

AIMS

The aim was to examine the relationships between cognitive (i.e. cause, coherence, consequences, controllability, identity and timeline) or emotional representations of infertility and both coping (i.e. maladaptive and adaptive) and psychosocial outcomes (i.e. distress, anxiety, depressive symptoms, social isolation, low well-being and poor quality of life), reporting followed PRISMA guidelines.

MATERIALS & METHODS

Five databases (PubMed, PsycINFO, PsycARTICLES, PubPsych and CINAHL) were searched, and 807 articles were initially identified.

RESULTS

Seven cross-sectional studies (N = 1208 participants) were retained in qualitative and quantitative analyses. These studies assessed the associations of seven types of representations with either maladaptive or adaptive coping (20 effect sizes), or with psychosocial outcomes (131 effect sizes). A multivariate meta-analysis revealed that none (0/2) of the associations between the sole type of representation considered (i.e. controllability) and coping strategies were statistically significant, whereas three (3/7) of the associations between representations of infertility and psychosocial outcomes were statistically significant. Regardless of p-values, pooled estimates ranged from low (r = .03) to very high (r = .59).

DISCUSSION

Future studies should validate specific measurement tools for measuring cognitive and emotional representations of infertility.

CONCLUSION

Our results highlight the influence of representations of infertility (particularly cognitive representations of consequences and emotional representations) on the psychosocial outcomes of infertility.

Exploring the Health Effectiveness of a Physical Activity Program Co-Constructed with Students after the COVID-19 Pandemic

BACKGROUND

University students have low levels of physical activity and high levels of sedentary behaviors that were exacerbated by the COVID-19 pandemic. Even before the pandemic, there was poor uptake of university sports activities. Therefore, it is essential to develop and test innovative programs to increase students' motivation to engage in physical activity in order to prevent any future deterioration in their general health.

OBJECTIVE

This exploratory study was conducted to test the effectiveness of a physical activity program that was co-constructed with students.

METHODS

First, a workshop drawing on social design methodologies and the fundamentals of physical activity programs was conducted to assess students' needs and desires in terms of physical activity. Second, the effectiveness of a program co-constructed with students on the basis of this workshop was assessed on physical and mental health parameters. The results showed that the workshop outcomes allowed the physical activity program to be tailored to meet students' expectations (e.g., session duration and type of activities). This innovative physical activity program was found to improve body image, autonomous motivation, and certain physical parameters. At the end of the 8-week program, the adherence rate was 89%, and 83% of the final respondents expressed a wish to re-enroll for the following semester.

CONCLUSIONS

Involving students and considering their wishes, needs, and objectives could facilitate the development of attractive and innovative programs.

The Effect of Intervention Approaches of Emotion Regulation and Learning Strategies on Students' Learning and Mental Health

University students are a vulnerable population, and many recent studies show that anxiety, depressive symptoms, and academic burnout have been on the increase since the beginning of the COVID-19 pandemic. These findings point to a need for interventions to reduce these difficulties. The purpose of the present study was to assess the effects of 2 formats of an innovative program on students' mental health (anxiety, depressive symptoms, and academic burnout), intolerance of uncertainty, learned helplessness, and learning. Our sample was composed of 105 university students, recruited on a voluntary basis. They were divided into 3 groups: online intervention group (n = 36), face-to-face intervention group (n = 32), and control group (n = 37). The following variables were measured through online questionnaires: anxiety and depressive symptoms, academic burnout, intolerance of uncertainty, learned helplessness, perceived social support, learning strategies, and beliefs. There were 2 assessments 10 weeks apart (ie, before and after the program in the case of the 2 intervention groups). We performed nonparametric analyses to run comparisons between the 2 assessment timepoints in each group. Results showed that participants in the 2 intervention groups had lower levels of learned helplessness and intolerance of uncertainty at the end of the program. Furthermore, participants in the face-to-face group reported higher levels of perceived social support, academic self-efficacy, and help-seeking strategies. The present study highlighted the benefits of our innovative program, especially its face-to-face format.Clinical Trial - ID: NCT04978194.

Effects of a Cognitive Schema Account on the Stigma of Schizophrenia: A Study in a French University Student Sample

Among people with psychiatric disorders, those with schizophrenia are subject to high levels of stigmatization. Research is necessary to identify new strategies that may help reduce the stigma of schizophrenia. Educational strategies using cognitive accounts, particularly early maladaptive schemas (EMSs), have shown promising results in the context of depression, but they have not been evaluated in the context of schizophrenia. The present study compared the effect on the stigma of three different educational strategies, based on cognitive distortions, biogenetics, and EMSs. A total of 378 students were randomly assigned to 1 of 4 groups. Three experimental groups were presented with a vignette that introduced 1 of 3 different etiological accounts of schizophrenia (cognitive distortions, EMSs, or biogenetics). The fourth group was presented with a text unrelated to schizophrenia. The participants completed questionnaires that measured their attitudes, empathic concern, and social distance toward people with schizophrenia, before and after reading the text. The intervention using the EMS etiology account for schizophrenia was the only one that led to a significant decrease in stigma. The latter effect was driven mainly by an increase in the level of empathic concern toward people with schizophrenia. Given that similar results have been observed for depression and that the role of EMSs in many psychiatric disorders has been demonstrated, studying the effects of EMS explanations for other stigmatized disorders may be promising for reducing the stigma of psychiatric disorders.

Hypnosis and cognitive behavioral therapy with online sessions to reduce fatigue in patients undergoing chemotherapy for a metastatic colorectal cancer: Rational and study protocol for a feasibility study

Background

In metastatic colorectal cancer (CRCm), fatigue is pervasive, reduces quality of life, and is negatively associated with survival. Its course is explained in part by psychosocial variables such as emotional distress, coping strategies, or perceived control. Thus, to reduce fatigue, psychosocial interventions appear to be relevant. In some cancers, Cognitive Behavioral Therapies (CBT) reduce fatigue. Hypnosis is also used as a complementary therapy to reduce the side effects of cancer. While CBT requires specific training often reserved for psychologists, hypnosis has the advantage of being increasingly practiced by caregivers and is therefore less expensive (Montgomery et al., 2007). On the other hand, CBT and hypnosis remain understudied in the CRC, do not focus on the symptom of fatigue and in Europe such programs have never been evaluated.

Objectives

Implementing an intervention in a healthcare setting is complex (e.g., economic and practical aspects) and recruiting participants can be challenging. The primary objective will therefore be to study the feasibility of two standardized interventions (hypnosis and CBT) that aim to reduce fatigue in patients with CRCm treated in a French cancer center.

Methods and design

A prospective, single-center, randomized interventional feasibility study, using mixed methods (both quantitative and qualitative). A total of 60 patients will be allocated to each intervention group [Hypnosis (n = 30) and CBT (n = 30)]. Participants will be randomized into two parallel groups (ratio 1:1). Both programs will consist of 6 weekly sessions focusing on the CRF management over a period of 6 weeks. Trained therapists will conduct the program combining 3 face-to-face sessions and 3 online sessions. The feasibility and experience of interventions will be evaluated by the outcome variables, including the adhesion rate, the reasons for acceptability, relevance or non-adherence, the satisfaction, the fatigue evolution (with ecological momentary assessments), and the quality of life. All questionnaires will be self-assessment using an online application from the cancer center.

Discussion

Results will highlight the barriers/facilitators to the implementation of the program and the relevance of the program to the patients, and will be used to generate hypotheses for a randomized control trial.

Clinical trial registration

ClinicalTrials.gov Identifier: NCT04999306; https://clinicaltrials.gov/ct2/show/NCT04999306.

Promoting Physical Activity Among University Students During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial

Background

Since the beginning of the COVID-19 pandemic, sanitary context and e-learning have greatly modified student lifestyles and led to deteriorations in their mental health. An increase in anxiety and depressive symptoms and sedentary behaviors, reduction in physical activity, and a stronger tendency to move toward unhealthy diet have been demonstrated. This finding highlights the need for innovative interventions to promote healthy lifestyle among students.

Objective

This research protocol aims to evaluate the effects of an intervention program on the lifestyle and psychological state of students.

Methods

Students from University of Nîmes were recruited and randomly assigned to 1 of 2 following conditions: an intervention group and a control group. Participants in the intervention group were engaged in an 8-week physical activity program. Prior to the start of the program, design-based innovative workshops were conducted with participants to ensure that the program was co-constructed by the users and met their specific needs. Students in the control group did not receive any intervention. For each group, measures of physical activity, sedentary time, anthropometric data, sleep, physical condition, and psychological variables (eg, anxiety, depression, motivation, body appreciation, perceived control, well-being) were conducted at baseline and 9 weeks later.

Results

A total of 110 participants were initially included. Reporting of the results is projected for the spring of 2022.

Conclusions

It is anticipated that this innovative intervention co-constructed by pairs will promote a healthier lifestyle and psychological health in students. There is every reason to believe that a mobilized co-construction approach is a promising strategy to limit unhealthy habits and promote physical activity while increasing motivation. The development and evaluation of interventions to address the specific needs of university students is essential and could be transferred to other vulnerable populations such as people with chronic diseases or older people.

Trial Registration

ClinicalTrials.gov NCT05019482; https://clinicaltrials.gov/ct2/show/NCT05019482

International Registered Report Identifier (IRRID)

DERR1-10.2196/36429

Promoting physical activity among university students with a co-constructed program during Covid-19 pandemic

Introduction

Since the beginning of the COVID-19 pandemic, sanitary context and e-learning has greatly modified students’ lifestyles. An increase of sedentary behaviors, a reduction in physical activity (PA) and a stronger tendency to move towards unhealthy diet have been demonstrated. Most of the research is largely descriptive and to date, no interventional studies have been conducted to prevent the deterioration of students’ health.

Objectives

The objective of the present research aims to evaluate the effects of an intervention program on the lifestyle and psychological state of student. Its primary objective is to promote PA among students, to improve both physical condition and motivation to engage in physical activity for one’s health by promoting motivational levers. Its second objective is to reduce and/or prevent the deterioration of the health of university students.

Methods

Students from University of Nîmes were recruited and randomly assigned to one of the two following conditions: an experimental group and a control group. The experimental group participated to an 8-weeks program of PA (co-constructed by users during design-based innovative workshops) whereas the control group did not. For each group, measures of PA, sedentary time, anthropometric data, sleep, physical condition and psychological variables (anxiety, depression, motivation, body appreciation, perceived control, well-being, …) were carried out before (T1: october 2021) and after (T2: December 2021) these 8-weeks in order to evaluate the benefits from the PA program.

Results

These assessments were performed in October 2021 (T1) and December 2021 (T2).

Conclusions

Data are still being collected and will be presented in April 2022.

Disclosure

No significant relationships.

Student mental health during the first two years of the COVID- 19 pandemic

Introduction

The COVID-19 pandemic have had deleterious effects on mental health of students. Authors suggest that the psychological effects will persist long after COVID-19 has peaked, but we have no data to confirm this.

Objectives

Objective: The objective of this study is to compare clinical issues (concerns, anxiety and depression symptoms) and adjustment (coping strategies) in French university students during different phases of the COVID-19 pandemic in 2020 and 2021 (during two periods of lockdown and two periods after lockdown)

Methods

Method: Data were collected anonymously at four timepoints: during France’s first national lockdown (23 April- 8 May 2020; n_T1 = 1294); during the period after lockdown (9‑23 June 2020; n_T2 = 321); 1 year after the first lockdown, which was also a lockdown period (23 April- 8 May 2021; n_T3 = 2357); and 1 year after the first unlockdown, which was also a unlockdown period (9‑23 June 2021, n_T4 = 1174). The following variables were measured: concerns, coping strategies, anxiety and depressive symptoms.

Results

In 2021, students have significantly higher levels of anxiety and depressive symptoms than in 2020, and this is even more pronounced during the lockdown periods. For example, 44.1% had probable anxiety symptoms in the 2021 lockdown, compared to 33% in the 2020 lockdown. In the unlockdown periods, the rates are 21.7% in 2020 and 26.4% in 2021.

Conclusions

Our results suggest that university students, known to be a vulnerable population with significant mental health deterioration, have become even more vulnerable with the COVID-19 pandemic.

Disclosure

No significant relationships.

Effects of an online self-help intervention on university students' mental health during COVID-19: A non-randomized controlled pilot study

The COVID-19 pandemic has had a major impact on university students, particulary on their mental health. However, little is yet known about how to prevent and/or reduce this impact. Prior to COVID-19, some studies have shown that online stress management programs were successful enough to improve students' mental health and stress adjustment strategies, suggesting that these interventions should be further developed during the pandemic. Our study explored the effects on mental health of an online program that targeted stress management and learning. A total of 347 university students were initially recruited to take part in a non-randomized controlled study. After dropout, our final sample consisted of 114 participants, divided into two groups: an intervention group (participants who took part in the program) and the control group (participants who did not participate in the program). The variables measured were: anxiety and depressive symptoms, academic burnout, learned helplessness, and coping strategies. Means comparisons between baseline (T0) and an assessment at 8 weeks (T1) revealed reductions in anxiety symptoms and learned helplessness in the intervention group, but not in the control group. Our pilot study reports promising effects of an online program on students' psychological state.

Psychological Vulnerability of French University Students during the COVID-19 Pandemic: A Four-Wave Longitudinal Survey

BACKGROUND

Many studies have highlighted the negative mental health consequences of lockdowns. However, to date, we do not know how these consequences change over time. The first objective of the present study was to track changes in adjustment strategies and clinical issues among French university students at different times of the pandemic. The second objective was to investigate the psychological and situational factors contributing to students' anxiety and depressive symptoms.

METHOD

This cohort study was conducted between 23 April and 11 December 2020. Measurements were performed four times: during France's first national lockdown, during the period after lockdown, when universities were open, and finally during the second national lockdown. A total of 1294 university students were initially included, and 91 students completed the four measurement points over a 7-month period. Coping strategies (with the Brief-COPE), health concerns (with two questions), anxiety and depressive symptoms (with the HADS) were measured.

RESULTS

Results showed an evolution over time of anxiety (χ2 = 21.59 ***) and depressive (χ2 = 29.73 ***) symptoms. Depressive symptoms are significantly higher during lockdown periods compared to unlockdown periods. Anxiety symptoms are likewise particularly high during the two lockdowns, but also when the universities reopen. At different times, anxiety and depressive symptoms were positively associated with maladaptive strategies, such as the self-blame (rho between 0.33 and 0.51) and negatively with adaptive strategies, such as the positive reframing (rho between -0.23 and -0.44).

CONCLUSIONS

The trajectory of anxiety, which is elevated even in the absence of lockdown, raises concerns about the long-term effects of the pandemic on these symptoms.

University Students' Lifestyle Behaviors during the COVID-19 Pandemic: A Four-Wave Longitudinal Survey

Many studies have highlighted the impact of lockdowns on the lifestyle of university students. We do not, however, know how these lifestyles have changed over the course of the COVID-19 pandemic. The objective of the present study was to describe changes in the levels of physical activity, sedentary behaviors, and alcohol consumption in French university students during different periods of the pandemic. This cohort study was conducted between 23 April and 11 December 2020. Measurements were performed four times: Twice during two successive lockdowns and twice during the intervening period. A total of 1294 university students were initially included, and 91 students completed the four measurement points over a seven-month period. Alcohol consumption, physical activity, and sedentary behaviors were measured. The results revealed high levels of physical activity during the first lockdown, but a subsequent decline during the pandemic that was partly explained by time. The pandemic had a positive effect on alcohol consumption. Sedentary levels were higher during both lockdowns, and sedentary behaviors tended to persist over time. This study raises concerns about the long-term effects of the pandemic on students' health and lifestyle. The preponderance of distance learning should be reconsidered, given the negative impact of physical inactivity and sedentary behavior on long-term health, especially in young adults.

Assessment of illness representations in mental disorders: A mini review

Health beliefs, and especially illness representations, have been widely used to understand clinical outcomes and psychosocial adjustment in people with physical diseases. However, this area of research has been under-explored in the field of mental health, and the few studies that have been conducted have used very different methods. Therefore, the aim of our study was to identify the tools and methods that have been used to evaluate illness representations in psychiatry. To this end, a mini review has been conducted and 58 articles were retained. This mini review highlights that the quantitative method is the most used, and that the scales mobilised are often adapted for the study, but not validated. Indeed, multiple modifications and adaptations have been made by the authors (e.g. deletion of subscales, addition of items), which lead to questions about the reliability of what is measured. In the future, it is essential to have a validated generic tool for mental disorders, which could be based on the Illness perceptions questionnaire for schizophrenia.

The Psychological Vulnerability of French University Students to the COVID-19 Confinement

Even before the current pandemic, university students were known to have high levels of hassles, anxiety, and depressive symptoms. In all probability, the advent of COVID-19 has substantially raised these levels. The present study measured the emotional state of university students during lockdown and identified the relevant situational and psychological factors. To this end, 1,297 French university students were assessed during lockdown, which lasted from 16 March to 11 May in France. Situational factors included the belief that lockdown was compromising their future job prospects, COVID-19 symptoms, and health concerns. Psychological factors included students' implicit theory of emotion, and the coping strategies they used during lockdown. We explored the extent to which these factors were associated with levels of hassles, anxiety, and depressive symptoms. Results indicated that students' belief that lockdown was compromising their future job prospects was positively related to hassles (r = .34, p < .001), while concerns about their own health and that of relatives were positively associated with anxiety (r = .37 and .34; p < .001). In addition, use of the positive reframing coping strategy mediated the effect of students' implicit theory of emotion on their depressive symptoms. Even though the national lockdown is now over, the pandemic will continue to have a major impact on university students over the coming months. It is therefore essential for universities to provide them with adequate psychological support.

Relationship Between Illness Representations, Psychosocial Adjustment, and Treatment Outcomes in Mental Disorders: A Mini Review

Understanding and improving the psychosocial adjustments (e.g., quality of life, depression) and treatment outcomes (e.g., adherence, beliefs about treatments) of people with mental disorders are major health issues. The self-regulation model (SRM) postulates that illness representations play a central role on adjustment and treatment of people with physical illnesses. Recently, the SRM has been used with people with mental disorders. However, the manifestations of somatic and psychiatric disorders can be very different. Therefore, the use of SRM in the field of mental health is very complex. This difficulty, as well as the growing interest for illness representations in the field of mental health, justifies the utility to conduct a review on this topic. The current review shows that illness representations are related to psychosocial adjustment and/or treatment outcomes for people with various mental disorders [e.g., psychotic disorders, mood disorder, posttraumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD)]. However, some limitations to the applicability of SRM to mental disorders have been highlighted. These limitations should be considered in future studies.

High-normal blood pressure and impaired renal function. A prospective study in a population-based cohort

AIM

The association between high-normal blood pressure and the impairment of renal function is highly controversial. We analysed the contribution of high-normal blood pressure on incident impaired renal function.

METHODS

The study was performed in a population-based cohort of 1307 subjects free of diabetes, cardiovascular and renal disease at baseline, who attended both at baseline and after 6-year follow-up a metabolic screening. The outcome was incident impaired renal function, defined as a glomerular filtration rate <60 mL/min/1.73 m2.

RESULTS

Incidence of impaired renal function was 2.5%, 4.5%, 8.7% and 10.8% in optimal, normal, high-normal blood pressure and hypertension, respectively. Adjusted relative odds ratio (OR) of impaired renal function were modelled using logistic regression analyses including multiple confounders. The adjusted OR were 1.6 (95% CI 0.5-5.0) for normal blood pressure, 3.4 (1.2-10.3) for high-normal blood pressure and 3.7 (1.3-10.7) for hypertension. Results were similar after excluding overweight or obese patients.

CONCLUSION

High-normal blood pressure is an independent predictor of impaired renal function. Trials are warranted to test if therapeutic intervention on blood pressure is justified also in subjects with high-normal blood pressure to preserve renal function.

Modulation of white adipose tissue lipolysis by nitric oxide

In isolated adipocytes, the nitrosothiols S-nitroso-N-acetyl-penicillamine (SNAP) and S-nitrosoglutathione stimulate basal lipolysis, whereas the nitric oxide (NO.) donor 1-propamine, 3-(2-hydroxy-2-nitroso-1-propylhydrazine) (PAPA-NONOate) or NO gas have no effect. The increase in basal lipolysis due to nitrosothiols was prevented by dithiothreitol but not by a guanylate cyclase inhibitor. In addition the cyclic GMP-inhibited low Km, cyclic AMP phosphodiesterase activity was inhibited by SNAP suggesting that SNAP acting as NO+ donor increases basal lipolysis through a S-nitrosylation mediated inhibition of phosphodiesterase. Contrasting with these findings, SNAP reduced both isoproterenol-stimulated lipolysis and cyclic AMP production, whereas it failed to modify forskolin-, dibutyryl cyclic AMP-, or isobutylmethylxanthine-stimulated lipolysis, suggesting that SNAP interferes with the beta-adrenergic signal transduction pathway upstream the adenylate cyclase. In contrast with SNAP, PAPA-NONOate or NO gas inhibited stimulated lipolysis whatever the stimulating agents used without altering cyclic AMP production. Moreover PAPA-NONOate slightly reduces (30%) the hormone-sensitive lipase (HSL) activity indicating that stimulated lipolysis inhibition by NO. is linked to both inhibition of the HSL activity and the cyclic AMP-dependent activation of HSL. These data suggest that NO. or related redox species like NO+/NO- are potential regulators of lipolysis through distinct mechanisms.