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Dramé M, Novella JL, Joachim C, Sanchez S, Blanchard F, Jolly D. Facteurs prédictifs du devenir à six mois de personnes âgées hospitalisées en urgence : la cohorte SAFES (sujet âgé fragile – évaluation et suivi). Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Commenges D, Jolly D, Drylewicz J, Putter H, Thiébaut R. Inference in HIV dynamics models via hierarchical likelihood. Comput Stat Data Anal 2011. [DOI: 10.1016/j.csda.2010.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wolak A, Novella JL, Drame M, Morrone I, Boyer F, Blanchard F, Jolly D. Is the screening test of the French version of the dementia quality of life questionnaire indispensable? Dement Geriatr Cogn Dis Extra 2011; 1:84-92. [PMID: 22279447 PMCID: PMC3265805 DOI: 10.1159/000326782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to evaluate the usefulness of the screening questions in the French version of the Dementia Quality of Life (DQoL) questionnaire. To assess the psychometric properties of the French DQoL, 155 patients with mild-to-moderate dementia were recruited. Here, we compared the psychometric properties of the instrument between patients who passed the screening test (n = 109) and the whole study population (n = 155). The French DQoL version showed a good test-retest reliability at a 2-week interval (0.95 ≤ intraclass correlation coefficients ≤ 1.0), and an average internal consistency (0.58 ≤ Cronbach's α ≤ 0.87) for the 2 study groups. Significant differences were observed in the 2 groups for 4 dimensions of the DQoL regarding dementia severity (Cornell scale), and for 3 dimensions evaluating depression (MMSE). Convergent validity with the Duke Health Profile revealed many significant correlations between dimensions not only in the 109 patients, but also in the whole study population. Our study demonstrated that patients who failed the screening procedure nonetheless seemed to be able to answer the DQoL questionnaire, the whole study group showing acceptable psychometric properties.
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Wolak A, Jolly D, Dramé M, Boyer F, Morrone I, Aquino JP, Rouaud O, Perret Guillaume C, Ravenel E, Dantoine T, Ankri J, Blanchard F, Novella JL. Quality of life in dementia: Psychometric properties of a French language version of the Dementia Quality of Life questionnaire (DQoL). Eur Geriatr Med 2010. [DOI: 10.1016/j.eurger.2010.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bonnetain F, Conroy T, Velten M, Jolly D, Mercier M, Causeret S, Cuisenier J, Graesslin O, Gauthier M, Guillemin F. Impact of response shift in longitudinal postoperative quality of life (QoL) analysis among breast cancer (BC) patients: A randomized multicenter cohort study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jolly D, Meyer J. A brief review of radiation hormesis. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2010; 32:180-7. [PMID: 20169836 DOI: 10.1007/bf03179237] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews physical, experimental and epidemiological evidence for and against radiation hormesis and discusses implications with regards to radiation protection. The scientific community is still divided on the premise of radiation hormesis, with new literature published on a regular basis. The International Commission on Radiological Protection (ICRP) recommends the use of the Linear No Threshold (LNT) model, for planning radiation protection. This model states that the probability of induced cancer and hereditary effects increases with dose in a linear fashion. As a consequence, all radiation exposures must be justified and have a sufficient protection standard in place so that exposures are kept below certain dose limitations. The LNT model has sufficient evidence at high doses but has been extrapolated in a linear fashion to low dose regions with much less scientific evidence. Much experimentation has suggested discrepancies of this extrapolation at low doses. The hypothesis of radiation hormesis suggests low dose radiation is beneficial to the irradiated cell and organism. There is definite standing ground for the hormesis hypothesis both evolutionarily and biophysically, but experimental evidence is yet to change official policies on this matter. Application of the LNT model has important radiation protection and general human health ramifications, and thus it is important that the matter be resolved.
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Lang PO, Zekry D, Michel JP, Drame M, Novella JL, Jolly D, Blanchard F. Early markers of prolonged hospital stay in demented inpatients: a multicentre and prospective study. J Nutr Health Aging 2010; 14:141-7. [PMID: 20126963 DOI: 10.1007/s12603-009-0182-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dementia is a serious, chronic, and costly public health problem. Prior studies have described dementia as increasing length of hospital stay, but so far no explanations have been proposed. METHODS To identify early markers for prolonged hospital stay in demented elderly inpatients, 178 community-dwelling or institutionalized subjects aged 75+, hospitalized through an emergency department in 9 teaching hospitals in France, were analyzed. Prolonged hospital stays were defined according a limit adjusted for Diagnosis Related Group. All patients underwent a comprehensive geriatric assessment at admission. Logistic regression multifactorial mixed model was performed. Center effect was considered as a random effect. RESULTS Of the 178 stays, 52 were prolonged. Most concerned community-dwelling patients (86%). Multifactor analysis demonstrated that demographic variables had no influence on the length of stay, while diagnosis of delirium (OR 2.31; 95% CI 1.77 - 2.91), walking difficulties (OR 1.94; 95% CI 1.62 - 2.43) and report by the informal caregiver of moderate or severe burden (OR 1.52; 95% CI 1.19 - 1.86) or low social quality-of-life score (OR 1.25; 95% CI 1.03 - 1.40), according to the Zarit's Burden Inventory short scale (12 items) and the Duke's Health Profile respectively, were identified as early markers for prolonged hospital stays. CONCLUSION At the time of the rising incidence of cognitive disorders, these results suggest that preventive approaches might be possible. In a hospital setting as well as in a community-dwelling population, more specific, specialized and coordinated care, using the expertise of multiple disciplines appears as a probable effective measure to limit prolonged hospital stay. Such approaches require (i) clear patient-oriented goal definition, (ii) understanding and appreciation of roles among various health care and social disciplines and, (iii) cooperation between partners in patient's management. However, the cost- and health-effectiveness of such approaches should be evaluated.
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Tiffreau V, Rapin A, Serafi R, Percebois-Macadré L, Supper C, Jolly D, Boyer FC. Post-polio syndrome and rehabilitation. Ann Phys Rehabil Med 2009; 53:42-50. [PMID: 20044320 DOI: 10.1016/j.rehab.2009.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 11/06/2009] [Indexed: 11/18/2022]
Abstract
Post-polio syndrome (PPS) is the commonly affected term to describe the symptoms that may develop many years after acute paralytic poliomyelitis. The etiology of PPS is still unclear. An overuse of enlarged motor units is suspected causing denervation again due to distal degeneration of axons. Metabolic and functional changes has been described in muscle fibers of partially denervated muscles. Nevertheless, submaximal aerobic training and low intensity muscular strengthening have shown positive effects on muscular strength and cardiorespiratory system in patients affected by PPS. Aquatic therapy has a positive impact on pain and muscle function. In patients with severe fatigue, it is recommended to adapt the daily exercise routine to their specific case.
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Lemonnier I, Baumann C, Vitry F, Arveux P, Jolly D, Woronoff-Lemsi M, Velten M, Guillemin F. Nodule pulmonaire isolé (NPI) : l’impact sur la qualité de vie (QV) des patients. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dramé M, Kack M, Debart A, Courtaigne B, Lanièce I, de Wazières B, Jeandel C, Blanchard F, Jolly D, Novella JL. Facteurs prédictifs de mortalité à long terme chez des patients âgés hospitalisés en urgence : la cohorte Safes. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wolak A, Novella JL, Guillemin F, Toussaint É, Marchand A, Collart M, Parent A, Morrone I, Blanchard F, Jolly D. Adaptation transculturelle et validation psychométrique du Quality of Life in Alzheimer's Disease (QoL-AD) en version française. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Metz D, Chapoutot L, Brasselet C, Jolly D. Randomized evaluation of four versus five French catheters for transfemoral coronary angiography. Clin Cardiol 2009; 22:29-32. [PMID: 9929752 PMCID: PMC6655902 DOI: 10.1002/clc.4960220111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND HYPOTHESIS In coronary angiography there is a trend toward using smaller catheters to avoid puncture site complications. An increased utilization of outpatient facilities may result. This study was undertaken to determine whether using 4Fr diagnostic catheters in comparison with 5Fr catheters would reduce the vascular complication rate, after patient ambulation following 4 h bedrest, without altered technical performance and or procedural duration. METHODS The study population comprised 100 consecutive, unselected patients, who were randomly assigned for transfemoral coronary angiography with 4 or 5Fr diagnostic catheters. Procedural characteristics, quality of angiogram, and clinical assessment of puncture site at 4, 12, and 24 h were analyzed. RESULTS No significant difference was demonstrated concerning procedural characteristics, ventriculography, coronary contrast quality, or local vascular damage. However, two patients crossed over in the 4Fr group and one in the 5Fr group. CONCLUSION As a consequence, the feasibility, reliability, and utility of catheter size on vascular complication rates must be considered to be similar with either 4Fr or 5Fr diagnostic catheters.
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Drame M, Jovenin N, Novella JL, Lang PO, Somme D, Laniece I, Voisin T, Blanc P, Couturier P, Gauvain JB, Blanchard F, Jolly D. Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging 2008; 12:599-604. [PMID: 18810299 DOI: 10.1007/bf02983207] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was, by early identification of deleterious prognostic factors that are open to remediation, to be in a position to assign elderly patients to different mortality risk groups to improve management. DESIGN Prospective multicentre cohort. SETTING Nine French teaching hospitals. PARTICIPANTS One thousand three hundred and six (1 306) patients aged 75 and over, hospitalised after having passed through Emergency Department (ED). MEASUREMENTS Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. A Cox survival analysis was performed to identify prognostic variables for six-week mortality. Receiver Operating Characteristics analysis was used to study the discriminant power of the model. A mortality risk score is proposed to define three risk groups for six-week mortality. RESULTS Crude mortality rate after a six week follow-up was 10.6% (n=135). Prognostic factors identified were: malnutrition risk (HR=2.1; 95% CI: 1.1-3.8; p=.02), delirium (HR=1.7; 95% CI: 1.2-2.5; p=.006), and dependency: moderate dependency (HR=4.9; 95% CI: 1.5-16.5; p=.01) or severe dependency (HR=10.3; 95% CI: 3.2-33.1; p < .001). The discriminant power of the model was good: the c-statistic representing the area under the curve was 0.71 (95% IC: 0.67 - 0.75; p < .001). The six-week mortality rate increased significantly (p < .001) across the three risk groups: 1.1% (n=269; 95% CI=0.5-1.7) in the lowest risk group, 11.1% (n=854; 95% CI=9.4-12.9) in the intermediate risk group, and 22.4% (n=125; 95% CI=20.1-24.7) in the highest risk group. CONCLUSIONS A simple score has been calculated (using only three variables from the CGA) and a practical schedule proposed to characterise patients according to the degree of mortality risk. Each of these three variables (malnutrition risk, delirium, and dependency) identified as independent prognostic factors can lead to a targeted therapeutic option to prevent early mortality.
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Lemonnier I, Baumann C, Jay N, Alzahouri K, Arveux P, Jolly D, Lejeune C, Velten M, Vitry F, Woronoff-Lemsi MC, Guillemin F. La tomographie par émission de positon (TEP) modifie t-elle la prise en charge diagnostique du nodule pulmonaire isolé (NPI) ? Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Freasier B, Jolly D, Bearman RJ. Local structure in fluids of heteronuclear dumb-bells according to the RISM model. Mol Phys 2006. [DOI: 10.1080/00268977600102811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Miskin J, Chipchase D, Rohll J, Beard G, Wardell T, Angell D, Roehl H, Jolly D, Kingsman S, Mitrophanous K. A replication competent lentivirus (RCL) assay for equine infectious anaemia virus (EIAV)-based lentiviral vectors. Gene Ther 2005; 13:196-205. [PMID: 16208418 DOI: 10.1038/sj.gt.3302666] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lentiviral vectors are being developed to satisfy a wide range of currently unmet medical needs. Vectors destined for clinical evaluation have been rendered multiply defective by deletion of all viral coding sequences and nonessential cis-acting sequences from the transfer genome. The viral envelope and accessory proteins are excluded from the production system. The vectors are produced from separate expression plasmids that are designed to minimize the potential for homologous recombination. These features ensure that the regeneration of the starting virus is impossible. It is a regulatory requirement to confirm the absence of any replication competent virus, so we describe here the development and validation of a replication competent lentivirus (RCL) assay for equine infectious anaemia virus (EIAV)-based vectors. The assay is based on the guidelines developed for testing retroviral vectors, and uses the F-PERT (fluorescent-product enhanced reverse transcriptase) assay to test for the presence of a transmissible reverse transcriptase. We have empirically modelled the replication kinetics of an EIAV-like entity in human cells and devised an amplification protocol by comparison with a replication competent MLV. The RCL assay has been validated at the 20 litre manufacturing scale, during which no RCL was detected. The assay is theoretically applicable to any lentiviral vector and pseudotype combination.
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Boyer F, Novella JL, Morrone I, Jolly D, Blanchard F. Agreement between dementia patient report and proxy reports using the Nottingham Health Profile. Int J Geriatr Psychiatry 2004; 19:1026-34. [PMID: 15481077 DOI: 10.1002/gps.1191] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of the study was to examine the agreement between patient reports and their proxy reports (family and care provider proxies) on Health Status in a sample of patients with dementia. METHOD Ninety-nine patients with mild to moderate dementia and proxies completed the 38-item Nottingham Health Profile (NHP) questionnaire. RESULTS Completion rates for the different NHP dimensions ranged from 78 to 90% for the dementia subjects. Inter-rater agreement between different proxies and subject was from moderate to good for physical assessment (ICCs from 0.54 to 0.78 for physical mobility scales). Patient/family proxy concordance was moderate to good for five out of six dimensions (physical mobility, social isolation, pain, energy, sleep) and poor for emotional reaction. Family proxies systematically reported lower functioning than did patients in the four subscales assessing: physical mobility (p <0.0001), energy (p <0.005), social isolation (p <0.01) and sleep (p <0.03). Care provider proxies only estimated physical mobility as lower (p <0.0001). CONCLUSION Age and physical status of the patient significantly affected agreement in patient-care provider proxy ratings. Thus, caution is appropriate when resorting to proxies to estimate the Health Status of a dementia patient.
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Jovenin N, Novella J, Drame M, Ankri J, Gauvain J, Couturier P, Blain H, Voisin T, Heitz D, Gonthier R, De Wazieres B, Somme D, Jeandel C, Colvez A, Jolly D, Saint Jean O, Blanchard F. E4-4 Cohorte SafeS (Sujets âgés fragiles évaluation et Suivi) : facteurs pronostiques de mortalité à 45 jours. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Bonnefille R, Potts R, Chalié F, Jolly D, Peyron O. High-resolution vegetation and climate change associated with Pliocene Australopithecus afarensis. Proc Natl Acad Sci U S A 2004; 101:12125-9. [PMID: 15304655 PMCID: PMC514445 DOI: 10.1073/pnas.0401709101] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Plio-Pleistocene global climate change is believed to have had an important influence on local habitats and early human evolution in Africa. Responses of hominin lineages to climate change have been difficult to test, however, because this procedure requires well documented evidence for connections between global climate and hominin environment. Through high-resolution pollen data from Hadar, Ethiopia, we show that the hominin Australopithecus afarensis accommodated to substantial environmental variability between 3.4 and 2.9 million years ago. A large biome shift, up to 5 degrees C cooling, and a 200- to 300-mm/yr rainfall increase occurred just before 3.3 million years ago, which is consistent with a global marine delta(18)O isotopic shift.
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Ankri J, Beaufils B, Novella JL, Morrone I, Guillemin F, Jolly D, Ploton L, Blanchard F. Use of the EQ-5D among patients suffering from dementia. J Clin Epidemiol 2004; 56:1055-63. [PMID: 14614996 DOI: 10.1016/s0895-4356(03)00175-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE This study was designed to determine the acceptability, feasibility, reliability, and validity of the French version of EQ-5D measuring HRQol in subjects with dementia. METHODS EQ-5D was administered to 142 subjects. The feasibility and acceptability were determined by the refusal rate, the type of administration, and the percentage and distribution of missing data. Test-retest reliability was studied by kappa coefficients and validity by agreement between subjects' and proxies' assessments. RESULTS The response rate was satisfactory. The instrument discriminated well among the subjects. Test-retest reliability was average. The validity was poor if we consider the agreement between patients' and caregivers' reports, but other criteria of validity produced better results. Subjects' responses on each dimension were related with their global judgment of health in the expected direction. Significant relations were found between the Katz index of ADL and self-rated difficulties only for expected dimensions. Relations with age and with gender were in line with expectations. CONCLUSION Results led to consider that patients' responses are not entirely devoid of judgment. It seems that dementia patients are capable of expressing their health-related quality of life through a brief instrument as the EQ-5D.
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Novella JL, Jochum C, Jolly D, Morrone I, Ankri J, Bureau F, Blanchard F. Agreement between patients' and proxies' reports of quality of life in Alzheimer's disease. Qual Life Res 2002; 10:443-52. [PMID: 11763206 DOI: 10.1023/a:1012522013817] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Agreement between self reports and proxy reports of health-related quality of life (H RQoL) was examined in a sample of 76 patients with mild to moderate Alzheimer's disease and their proxies. Patients and proxies completed an '17-item Duke health profile'. The items were rephrased for the proxy. The proportion of exact agreement between patients and proxies on the 17 items ranged from 26.3 to 52.6%. Results reveal poor to moderate agreement (intraclass correlation coefficients (ICCs) from 0.00 to 0.61 for 10 subscales) between patients' and proxies' reports. Agreement was higher for measures of function that are directly observable (physical health, disability) and relatively poor for more subjective measures. Proxy reliability varied according to the relationship of the proxy to the index subject. Spouses and nurses agreed more closely with index subjects than did children or nurses' aides. Agreement decreased with increasing severity of dementia. Statistically significant differences in mean scores were noted for several dimensions, with proxies tending to rate the patients as having a lower quality of life than the patients themselves. This study indicates the importance of considering the information source of a patient's HRQoL. However, assessments by proxies should be used with caution.
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Novella JL, Jochum C, Ankri J, Morrone I, Jolly D, Blanchard F. Measuring general health status in dementia: practical and methodological issues in using the SF-36. Aging Clin Exp Res 2001; 13:362-9. [PMID: 11820709 DOI: 10.1007/bf03351504] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to examine the measurement properties of the Medical Outcomes Study (MOS) 36-Item Short-Form health survey (SF-36) in a representative sample of dementia patients. A total of 138 subjects with dementia were evaluated with the SF-36. They were recruited from 16 centers, including 7 university hospital centers. Dementia severity, demographic variables, co-morbidity and functional limitations were also measured. The measurements obtained were compared by source of information (patient, family proxy, and care provider proxy). Thirteen patients refused to complete this questionnaire. Help from the interviewer was necessary in 72.8% of the cases. The average completion time was 18.8 minutes. Missing data exist in only 5.6% of the cases on average, except among patients with severe dementia (Mini Mental State Examination <10). With regard to reliability, internal consistency was acceptable to good; Cronbach's a ranged from a low of 0.59 to a high of 0.92 across subscales (median 0.75). Test-retest intraclass correlation coefficients were moderate to good (range 0.51-0.81) except for Role emotional (0.17), Bodily pain (0.49) and Mental health (0.45). For patients with MMSE > or = 15, test-retest coefficients were better (range 0.53-0.90). Intraclass correlation coefficient suggests that proxies are a poor substitute for obtaining a patient's perspective of his/her health status. In conclusion, the SF-36 is unsuitable for severe dementia, because severity of disease mainly affected the feasibility, acceptability, and reproducibility of the instrument. This study, however, confirms that it is possible to question subjects with mild to moderate dementia on their health status.
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Toupance O, Bouedjoro-Camus MC, Carquin J, Novella JL, Lavaud S, Wynckel A, Jolly D, Chanard J. Cytomegalovirus-related disease and risk of acute rejection in renal transplant recipients: a cohort study with case-control analyses. Transpl Int 2001; 13:413-9. [PMID: 11140239 DOI: 10.1007/s001470050723] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The relationship between a cytomegalovirus (CMV) infection and the acute rejection of a renal transplant is not well established. The aim of the study was to document whether the clinical presentation of a CMV infection as a diffuse inflammatory disease or as a clinically asymptomatic illness is a risk factor of acute renal transplant rejection. One hundred and ninety-two consecutive renal transplant recipients were included in a historical cohort study for exposed-non exposed analyses. CMV infection after transplantation was the exposure factor. Before transplantation, 113 patients had antibodies against CMV and 79 were seronegative. The patients were divided into three groups: Group 1 consisted of 64 patients who had neither clinical signs of CMV disease nor CMV serological changes after transplantation, Group 2 consisted of 77 seropositive patients with asymptomatic viremia, and Group 3 consisted of 51 seropositive patients with clinical signs of diffuse inflammation that included fever, neutropenia, and various visceral involvements (CMV disease). Groups 2 and 3, the seropositive patients, were paired with Group 1 patients. Acute rejection was considered as CMV-induced when it occurred within one month following viremia, during the first year after transplantation. Transplant patients with CMV disease, had a significant likelihood of developing acute rejection after CMV infection or reactivation (P < 0.01). The odds ratio for developing rejection was 5.98, 95% confidence interval: 1.21-29.40. Such a link was not documented for recipients with asymptomatic CMV infection. In conclusion, CMV disease, but not asymptomatic viremia, is a risk factor of acute renal transplant rejection. On epidemiological grounds, these results support the hypothesis that factors controlling both the viral replication and the diffuse inflammatory process are implicated in acute graft rejection.
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Novella J, Ankri J, Morrone I, Guillemin F, Jolly D, Jochum C, Ploton L, Blanchard F. Evaluation of the quality of life in dementia with a generic quality of life questionnaire: the Duke Health Profile. Dement Geriatr Cogn Disord 2001; 12:158-66. [PMID: 11173890 DOI: 10.1159/000051251] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study was designed to determine the acceptability, feasibility and validity of measuring quality of life in a representative sample of dementia patients with a generic instrument, the Duke Health Profile. METHOD The French version of the Duke Health Profile was administered to 148 subjects with a mental disorder according to the DSM-III-R diagnostic criteria. The feasibility and acceptability of employing the instrument were determined by the refusal rate, the type of administration, and the percentage and distribution of missing data. Reliability was determined with Cronbach's alpha coefficient. Instrument reproducibility was assessed with the intraclass correlation coefficient for test-retest values. Internal construct validity was determined by factor analysis. Discriminant capacity was determined by comparing the average scores on each measure among patients with and without an additional chronic pathology. The measurements obtained were compared by source of information (patient, family proxy and care provider proxy). RESULTS The feasibility and acceptability of the instrument was good. Only 2% of the patients refused to complete the questionnaire. Help from the interviewer was necessary in 79% of the cases. The average completion time was 10.6 min. Missing data exist in only 3.5% of the cases on average, except among patients with severe dementia (Mini Mental State Examination <10). For reliability, internal consistency was acceptable (Cronbach's coefficient alpha = 0.5--0.7) when the self-esteem (0.23) and social health (0.26) concepts were eliminated. Reproducibility as measured by test-retest scores was moderate to good (intraclass correlation coefficient r = 0.53--0.80), except for anxiety (0.48) and perceived health (0.45). Severity of dementia mainly affected the feasibility, acceptability and reproducibility of the instrument. The family proxy seemed to agree more with the patient than did the care provider proxy. CONCLUSION Quality of life can be measured in patients with dementia, but special tools need to be developed for severe dementia.
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Uzan A, Jolly D, Berger E, Diebold MD, Geoffroy P, Renard P, Vandromme L, Bourgeois L, Ramaholimihaso F, Bouché O, Zeitoun P, Cadiot G, Thiéfin G. [Protective effect of appendectomy on the development of ulcerative colitis. A case-control study]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2001; 25:239-42. [PMID: 11395669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
AIMS To examine by a case-control study the relationship between appendectomy and subsequent ulcerative colitis development in a French population. METHODS A total of 150 patients with ulcerative colitis were matched for age (+/- 5 years) and sex, with 150 controls recruited in a preventive medicine center. The following data were collected from medical records and by standardised questionnaire in consultation or by phone: appendectomy and tonsillectomy before the onset of ulcerative colitis, smoking habits and area of residence. RESULTS The rate of previous appendectomy in patients with ulcerative colitis was 8% (12/150) compared with 30.6% (46/150) in the control group (P=0.001). There was no significant association between ulcerative colitis and tonsillectomy (25.3 and 27.3% in the control and the ulcerative colitis groups, respectively). Smoking was more frequent in the control group (36%) than in the ulcerative colitis group (25.3%) but the difference was not significant (P=0.07). In multivariate analysis, the risk of developing ulcerative colitis was significantly lower after previous appendectomy (odds ratio=0.26; 95% confidence interval: 0.13-0.55; P=7 x 10(-4)). CONCLUSION Our study confirms the inverse association between appendectomy and subsequent ulcerative colitis, in a French population, after adjusting on smoking.
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