Screening for hypertension at the hairdresser: a feasibility study in France and Morocco

Purpose: Worldwide, hypertension awareness remains largely insufficient. This is particularly true in some population subgroups with a low socioeconomic status or in young adults who have limited interactions with healthcare systems. Performing Blood Pressure (BP) screening in non-conventional settings, such as in barbershops, has been suggested by a number of American authors. Whether this approach is feasible in Europe or in North Africa has not been evaluated, however. We, therefore, undertook a study to assess the value of BP screening at hairdressers in France and in Morocco.Materials and Methods: This was a prospective multicenter feasibility study. Twenty-three hairdressers in France and six in Morocco participated in the study. After being provided the relevant information, all consenting customers aged over 18 years were included. Three BP measurements were performed by the customers themselves using a validated Omron M7 automatic BP device connected to a printer.Results: In France, 1025 subjects were enrolled, while 300 subjects participated in Morocco. Three hundred and seventy French participants (36%) had an elevated BP. Among the subjects claiming to be normotensive or who did not know their hypertension status, 31.7% had a BP ≥ 135/85 mmHg. Only 42% of the subjects with an elevated BP contacted their physician within 3 months, although hypertension was confirmed in ¾ of them. In Morocco, the participants were older, with only 11.7% of the subjects aged <50 years. They more frequently had unknown elevated BP values (71.9%). The rate of BP monitoring in known hypertensive individuals was 42.7% in France and 17.1% in Morocco. The procedure was very well accepted and considered to be useful in both countries.Conclusion: BP screening at hairdressers is feasible and well-accepted, although it does suffer somewhat from a relatively low efficacy.

[Hypertension and menopausal hormone therapy]

Can menopausal hormone therapy (HT) be used in hypertensive women? The group of experts of the French Society of Hypertension has carried out a review of the recent literature in order to answer this question, based on the most recent scientific publications. If use of oral HT is associated with a discreet increase in blood pressure, the transdermal route seems to be safer. The first results of major randomized trials of HT had alerted to an increase in cardiovascular events and breast cancer with the use of oral HT, generally, tipping the benefit-risk balance of the deleterious side. Complementary analyzes have shown the importance of the window of intervention (less than 10 years after the menopause) and the age of the woman to start the HT. On the contrary, they have shown a significant decrease of the coronary events. For woman suffering from hypertension and important climacteric symptoms, it is important to evaluate the whole cardiovascular risk in order to decide the possibility of prescribing a HT. Thus, the group of experts proposes a prescription assistance algorithm based on the stratification of cardiovascular risk, always favoring, when it is authorized, HT by transdermal route of administration.

[General medical practice and medicinal voluntary termination of pregnancy in Grand Est, France]

BACKGROUND

Access to VTOP (Voluntary Termination of Pregnancy) is a national priority in France. Once legalized in 1975, several laws contributed to improve access to VTOP, such as the 2004 family planning law which enabled urban practitioners to carry out orthogenic work. This law was supplemented by the 2016 health care modernization act. On the whole, the organization for VTOP access in the Grand Est region, complies with legislation and recommendations. However, private practitioners contribute little to this activity. Since there are very few gynecologists in certain areas (whether private or hospital practitioners), general practitioners seem to be the first line actors. This study aims at describing the orthogenic work of urban, government-regulated general practitioners, in the Grand Est region of France.

MATERIAL AND METHOD

Data were collected from semi-directive interviews with the set of the government-regulated general practitioners doing family planning work in the Grand Est region.

RESULTS

Out of the fifteen doctors who were interviewed, twelve actually suggested family planning work to their patients, and out of those twelve, seven practiced it in reality. What comes out is that the main motivation of professionals was to improve access to VTOP. Besides, they also mentioned the importance of being able to answer a real demand from their patients as well as an interest in gynecology. Hence the professionals' practice both benefits from services provided to their patients and from a diversification of their work, even though they regret that the value of this time-consuming procedure is not recognized. This study also brings out that although these medical acts were individualized and allowed better confidentiality for the patient, the risk for complications and home birth remained an obstacle. Finally, it emerges that the whole set of recommendations was not always implemented.

DISCUSSION

Urban family planning, performed by general practitioners, seems to be a major line to focus on for better timeliness and quality of care. However, some obstacles have been identified such as its specificity, its time-consuming aspect, its lack of status, as well as the difficulty to comply with recommendations.

CONCLUSION

The development of this practice is necessary to maintain an appropriate response to VTOP but actions to remove certain obstacles have to be carried out.

Awareness of obstructive sleep apnea-hypopnea syndrome among the general population of the Lorraine Region of France

OBJECTIVE

Obstructive sleep apnea-hypopnea syndrome (OSAHS) seems to be underdiagnosed. The aim of this study was to assess awareness of OSAHS among the general population of the Lorraine Region of France.

METHODS

A descriptive epidemiological study was carried out from July to November 2015 in the Lorraine Region, using an anonymous questionnaire that assessed knowledge of OSAHS-related symptoms and complications. The survey was also circulated on the Internet via social media. Exclusion criteria comprised age under 18 years, refusal to fill out the questionnaire and linguistic barrier.

RESULTS

1307 subjects filled out the survey: 1020 on paper format and 287 via the Internet. About two-thirds of the population recognized a majority of symptoms. However, there was a significant lack of knowledge of complications, especially cardiological and neurological. Suffering from OSAHS, having had higher education, and being under 40 years of age, were factors linked to better awareness of the syndrome. Internet respondents also showed better awareness.

CONCLUSION

Despite encouraging results regarding OSAHS symptoms, the general population showed limited awareness of its complications. Innovative educational campaigns must be organized to inform practitioners and the general public about the disease and raise awareness of its complications.

Perception of acceptable antibiotic stewardship strategies in outpatient settings

INTRODUCTION

Antibiotics are still often inappropriately prescribed in France despite specific measures being taken for over 10years. The 25% decrease in antibiotic prescription advocated in the 2011-2016 National Antibiotic Plan seems difficult to achieve. One of the strategies currently considered in France is the use of a specific prescription form dedicated to antibiotics, with an educational message for patients. We aimed to evaluate the acceptability - by primary care prescribers - of this measure and to evaluate their perception of other antibiotic stewardship strategies.

METHODS

Qualitative study conducted among family physicians, pediatricians, dermatologists, dentists, and ENT specialists using semi-structured interviews. A thematic and framework analysis was then performed.

RESULTS

Thirty prescribing physicians practicing in a specific region of France were included in the study. The dedicated prescription form for antibiotics was deemed excessive and questionable. Other measures, not directly targeting prescribers, were rather well perceived: the unit sales of antibiotics, the restricted reporting of susceptibility tests, or the limitation of the number of molecules available in outpatient settings.

CONCLUSION

The results of this exploratory study may guide the national antibiotic stewardship policy in France.

[Prevalence of target organ damage in patients treated for primary arterial hypertension: Comparison between men and women. ESSENTIELLE study]

OBJECTIVES

To compare the percentages of men and women treated for primary arterial hypertension presenting with at least one target organ damage; to identify factors associated with target organ damage and/or blood pressure control.

METHODS

Observational, transverse study carried out between March 2012 and July 2013 on a representative sample of 2666 outpatients (including 1343 men) consulting general practitioners (n=469) or cardiologists (n=250) in routine follow-up.

RESULTS

Characteristics "men vs. women" were: mean age (62.6 ± 11.6 vs. 57.4 ± 14.7 years; P<0.0001); ≥ 60 years (61.1% vs. 43.9%; P<0.0001); waist circumference (98.9 ± 12.2 vs. 89.4 ± 14.3 cm; P<0.0001); SBP (146.5 ± 16.1 vs. 145.8 ± 17.0 mmHg; NS); DBP (85.1 ± 10.3 vs. 84.2 ± 10.4; P=0,03). Target organ damage was more frequent in men (37.6% vs. 22.9%; P<0.0001), whether it was subclinical (20.4% vs. 13.6%; P<0.0001) or documented (26.3% vs. 13.5%; P<0.0001); some patients presented with both types of damages. Men developed more often microalbuminuria (6.5% vs. 4.3%; P=0.01) and LVH (16.3% vs. 10.5%; P<0.0001); some patients presented with both types of subclinical injuries. Target organ damage was more common in men without regular physical activity than in those exercising regularly (42.1% vs. 32.5%; P=0.0004). Regular exercises had no effect in women (24.1% vs. 21.3%). For both sexes, other factors associated with target organ damage were: age ≥ 60 years, myocardial infarction/sudden death in family history, LDL-cholesterol ≥ 1.60 g/L, HDL-cholesterol ≤ 0.40 g/L. Stroke before 45 years in family history was a predictive factor in women. Hypertension was controlled in one third of patients without difference between sexes. In women, hypertension was less often controlled in case of excessive alcohol consumption compared to normal alcohol intake (17.9% vs. 36.1%; P=0.0007); this factor had no effect in men (28.1% vs. 32.6%). Other factors associated with poor blood pressure control were: BMI (P=0.002), LDL-cholesterol ≥ 1.60 g/L in women. In men, the factors were: tobacco, presence of LVH, absence of physical activity, HDL-cholesterol ≤ 0.40 g/L, absence of diet.

CONCLUSION

In a hypertensive population, target organ damage is more common among men despite similar blood pressure control rates for both sexes.

[AFSSAPS 2005 recommendations have not modified the way parents take care of children's fever]

INTRODUCTION

Fever in children is frequent. Often mild, initial care is the parents' responsibility: medicinal treatments and medical consultations. Unfortunately, the efficiency of parental care is poor. Therefore, in 2005 the AFSSAPS updated its recommendations. One and 6 years after publication of the guidelines, this study rates their impact by describing and comparing parents' knowledge and behavior when faced with fever in their children.

MATERIAL AND METHODS

This survey was conducted in families whose children were attending preschool in and near Metz (France) in 2006 and 2012. The same questionnaire was given to assess the knowledge, care, and symptoms of serious fever. The results were processed based on the number of children in the family and the family's socioeconomic category.

RESULTS

In 2006, 1038 questionnaires were distributed and 1273 in 2012. The fever threshold was not better known in 2012. Bathing and uncovering children remained the predominant physical methods used. Treatment was based on the use of ibuprofen and alternating treatments. However, the conditions of administering medication were well known to parents. The causes and motives for consultation were not better understood in 2012 however. The main source of information was physicians.

DISCUSSION

The message disseminated since 2005 has not been efficient. Its complexity has not eradicated old beliefs and inappropriate parental practices. A campaign based on a brief, simple message has to be organized, providing better chances of being assimilated by the public. Medical practices should be standardized.

[Impact of the A influenza pandemic on anti-seasonal influenza vaccination of French general practitioners: A cohort follow-up 2007-2010]

BACKGROUND

Our objective was to assess the impact of the A influenza pandemic on the anti-seasonal influenza vaccination of French general practitioners.

METHODS

A survey was conducted in 2007 in a random sample of general practitioners. A second survey conducted in 2010 included all general practitioners who had not been vaccinated in 2007 and one-third of those who had been.

RESULTS

Responses were obtained from 1010 general practitioners in 2007. The coverage rate of anti-seasonal influenza vaccination reached 73%. In 2010, the coverage was 73.5% and rate of anti-A influenza vaccination was 59% (weighted numbers). Between the two surveys, 130 family physicians (15.5%) changed their behavior. Analysis showed that the A influenza pandemic had a slight positive impact on anti-seasonal influenza vaccination.

CONCLUSION

This first cohort of French general practitioners concerning influenza vaccination found the same anti-seasonal influenza vaccination rates widely reported in the literature and showed that the A influenza pandemic had slight impact on it.

Can we identify response markers to antihypertensive drugs? First results from the IDEAL Trial

Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was -11.5 mm Hg (indapamide) and -8.3 mm Hg (perindopril). In men, the response was significantly smaller: -4.8 mm Hg (indapamide) and -4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori.

Prise en charge de la fièvre de l'enfant: les connaissances et pratiques des parents sont-elles satisfaisantes?

Paediatric fever is a frequent reason of consulting a paediatrician or a general practitioner (30% of paediatric consultations).

AIM OF THE STUDY

This investigation aimed at reporting the knowledge level concerning child's and infant's fever in a urban population and the resulting practices. Two thousand and six hundred questionnaires were distributed in June 2004 in the 29 scholar institutions of Metz agglomeration (France) classified in 3 categories according to socio-economical conditions of parents: 3 institutions of city centre (high socioeconomical conditions), 18 sub-urban institutions (intermediary conditions) and 8 institutions located in priority education zones (ZEP) (defavorable conditions).

RESULTS

One thousand and thirty-eight questionnaires could be analyzed (40%): 176 in city centre, 634 in sub-urban zones and 228 in ZEP. Fever threshold at 38 degrees C is well-known and fever measuring methods used are mostly in accordance with the recommendations. The best room temperature was known and the use of antipyretic physical means underlined only a few cases of obvious mistakes. All parents were informed about worrying signs related with fever even if doctor's resort was excessive. Acetaminophen was the reference molecule before ibuprofen whereas the use of aspirin was decreasing. Antipyretic treatments methods used by parents were often unsuitable, leading to therapeutical inefficacy, overdosage or noxious drug interactions, mainly because of a lack of knowledge about drug components.

CONCLUSION

This investigation underlines insufficient knowledge and noxious management practices among parents with unfavourable socio-economical conditions which lead us to recommend targeted information preferentially in areas gathering together most unfavourable socio-economical condition populations.

Acute postoperative pain management at home after ambulatory surgery: a French pilot survey of general practitioners' views

IMPLICATIONS

We assessed the views of French general practitioners concerning pain relief at home after ambulatory surgery in a cross-sectional prospective survey. The results revealed that there is need for improvement, mainly in prescribing more suitable analgesic protocols and optimizing postdischarge relationships between physicians.

Ambulatory 24-h blood pressure assessment of the felodipine-metoprolol combination versus amlodipine in mild to moderate hypertension. Lorraine General Physician Investigators Group

OBJECTIVE

To measure the time effect profiles of a once daily administered combination tablet felodipine-metoprolol 5/50 mg (Logimax, Astra) and amlodipine 5 mg (Norvasc, Pfizer) on blood pressure and heart rate using 24-h ambulatory blood pressure monitoring.

DESIGN

Randomized multicentre parallel-group study with a single-blind placebo run-in period of 4 weeks duration and a 6-week double-blind active treatment period.

PATIENTS AND METHODS

Out of 245 randomized outpatients (90 men, 155 women) with uncomplicated mild-to-moderate primary hypertension and mean sitting diastolic blood pressure (DBP) 95-115 mmHg inclusive, 212 (102 on felodipine-metoprolol, 110 on amlodipine) were eligible for analysis. 24-h ambulatory blood pressure monitoring was performed at the end of the placebo run-in (baseline) and after 6 weeks active treatment (posttreatment).

RESULTS

Both felodipine-metoprolol and amlodipine induced smooth and consistent reduction in DBP and systolic blood pressure throughout the 24-h period, hence not altering the diurnal rhythm. However, felodipine-metoprolol reduced all average blood pressures (24-h, day- and night-time) more than amlodipine (for 24-h average blood pressure 14.4/9.5 mmHg and 8.9/5.5 mmHg, respectively). Medians of individual diastolic trough-to-peak (T/P) ratios were similar for felodipine-metoprolol and amlodipine (54 and 50%, respectively), while for the systolic T/P ratios, the corresponding values were 74 and 35%, repectively; no significant difference between treatments was seen. As distinguished from amlodipine, both heart rate and rate pressure product were markedly decreased on felodipine-metoprolol throughout the 24-h period and even during the early morning hours. In general, both treatments were well tolerated.

CONCLUSIONS

Both felodipine-metoprolol and amlodipine achieved optimal control of blood pressure during the inter-dosing interval in line with their pharmokinetic profiles. The vasodilatory adverse events were slightly more reported with felodipine-metoprolol combination, but due to more pronounced lowering of the average blood pressures and the potent additional effect on heart rate and rate pressure product, the efficacy/tolerability balance seems to be equal to or better than that obtained with monotherapy such as amlodipine.

Differential effects of aging on heart rate variability and blood pressure variability

Previous studies investigating autonomic cardiovascular control in elderly persons usually included analysis of R-R interval but not of blood pressure variability. "Physiological" blood pressure rise during the aging process was not accounted for as a possible confounding factor. This study was designed to characterize the relationship between age and short-term heart rate (HR) and blood pressure (BP) variability, independently of the "physiological" rise in BP associated to aging. The study was carried out in 65 "normotensive" (BP< or =140/80 mm Hg) healthy subjects, ranging in age from 18 to 80 years. BP and HR were recorded at rest with a Finapres device. Low-frequency (LF = 0.066 to 0.129 Hz) and high-frequency (HF = respiratory peak +/-0.05 Hz) components of HR and BP variability were assessed using fast-Fourier spectral analysis. Transfer-function analysis between systolic BP and HR variability permitted the calculation of the gain of baroreflex sensitivity. Significant results of this study include a continuous and linear decline with age of normalized LF spectral power of HR in the standing position and of normalized HF spectral power of HR during paced breathing. No correlation was found between age and BP variability, except for LF diastolic BP spectral power in the standing position. The baroreflex gain was negatively correlated with age. The effect of aging on autonomic nervous system cardiac control is progressive and continuous throughout an 18-80 years age range. Although the aging process diminished HR variability and diastolic BP variability, it had no influence on systolic BP variability.

[Double-blind and randomised parallel study of minocycline 100mg (Mynocine) vs roxithromycin 300mg (Rulid), in the treatment of seasonal acute bronchitis in clinical practice]

46 general practitioners of the vicinity of Nancy carried out a randomised, parallel and double blind study comparing the efficacity and the tolerance of two drugs: roxithromycin (Rulid) 300 mg per day, and minocycline (Mynocine) 100 mg per day in the treatment of adult acute bronchitis, in clinical practice. 124 patients were included from January 1992 to June 1992. Efficacy of the treatment was estimated by both practitioners and patients to be good and excellent at the same time in 90 to 95 per cent of cases, in the two groups. Clinical tolerance was estimated to be excellent (90 per cent of cases) in the two groups. Roxithromycine and minocycline are effective and well tolerated in the treatment of adults acute bronchitis in clinical practice. Among the two drugs, we prefer to use minocycline because it is 2.5 to 5 times less expensive than roxithromycine.