COgnitive enhancement and consumption of psychoactive Substances among Youth Students (COSYS): a cross-sectional study in France

OBJECTIVES

This descriptive and analytical study investigated the consumption rates of psychoactive substances among individuals aged 18-25 years in France. More specifically, it enabled assessment of the extent of the neuroenhancement (NE) phenomenon among students in France (including study of the misuse of psychostimulant medicines).

STUDY DESIGN

COgnitive enhancement and consumption of psychoactive Substances among Youth Students (COSYS) is a cross-sectional survey of students in France.

METHODS

Between January and June 2017, a questionnaire was mailed to students. All questionnaires were completed anonymously and included questions regarding the use of all kind of psychoactive substances, motivations for use and socio-economic situations. Statistics for all variables and the results of a multiple correspondence analysis (MCA) are presented.

RESULTS

This study recorded 46,203 respondents, mostly in universities (>60%), mostly women (63.4%), with an average age of 21.4 years. In terms of substance use, medications were cited in the third position after alcohol and tobacco by women (22.48%) and in the fourth position after alcohol, tobacco and cannabis by men (15.14%). Among medications, opiates were the most frequently used, followed by benzodiazepines. Students who declared a non-medical use (NMU) of drugs obtained these through various ways (e.g. family medicine cabinet, a friend, a dealer or via the Internet), or by increasing their recommended doses (e.g. codeine). In total, 18.6% of students consumed psychoactive substances for 'stress management' and 14.1% for 'sleep management'. Results indicated that NE in students is a problem, with 18.6% of students in the COSYS survey confirming the use of psychoactive substances for this reason. There was a very low prevalence for psychostimulant medications (0.57% of men), mostly NMU (67%). MCA yielded three different profiles (doping candidate, experimenter and psychiatric profile) of psychostimulant users, which complicates the implementation of prevention programmes.

CONCLUSIONS

It is evident that NMU and 'conventional' use of medications are highly prevalent in French students, especially females. NMU is associated with substance use disorders, psychopathology and suicidality. Social norms and social media increase NMU of psychoactive substances, but also provide a potential platform for anti-NMU campaigns.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02954679.

[How health care professionals perceive chronic disease: Changes in therapeutic patient education (TPE) assessment from 2011 to 2017 in a French university hospital]

BACKGROUND

Since 2010, in France, Therapeutic Patient Education (TPE) programs have applied to the Regional Health Agency (RHA) for authorization. Every four years, these programs are mandatorily re-evaluated, and the assessment allows for change in the program management criteria. In our hospital, we studied the evolution of the Therapeutic Patient Education (TPE) appraisal benchmarks, otherwise known as "indicators", in the 17 programs having been authorized and renewed at least once by the RHA.

METHOD

The TPE program appraisal benchmarks are classified in terms of structure, process and outcomes; program activity itself as well as pedagogic, psychosocial and bioclinical indicators are taken into consideration. We wished to determine the extent to which these indicators were addressed, applied and renewed or created during renewal of the TPE programs. Statistical tests were carried out in order to compare changes in the number of benchmarks in each category before and after the renewal process.

RESULTS

During the first authorization, there existed 533 appraisal benchmarks, while they numbered 550 for the second. As for "before-and-after" changes, they consisted in a reduced number of outcome indicators (43.7% to 35.1%), whereas process indicators increased (36.8% to 43.1%) (P=0.0141). In comparison to the category pertaining to pedagogic, psychosocial and bioclinical indicators, the most widely registered indicator category (55.5%) and the most frequently collected indicator category involved the program activity itself (54.7%) (P<0.0001), which increased pronouncedly during renewal periods (67.6%) (P=0.0002). Conversely, the pedagogic and psychosocial indicators were little if at all collected. As regards the latter, there was nevertheless a considerable increase in indicators related to skills and changes favoring health-promoting behaviours. Strictly bioclinical indicators have been largely supplanted by those having to do with the disease evolution, its impact and risk management.

CONCLUSION

The major role assigned to process and structure indicators reflects the fact that they are predominantly structured by RHA requests. Even if this initial study necessitates further research, it highlights a change in the design of educational and psychosocial assessments among caregivers, a change likely to reflect their interest in how patients go about managing their illnesses, (more or less healthy) lifestyles and daily lives.

Tuberculosis screening for foreign students change: good saving and bad idea?

Issue

There was a mandatory screening of tuberculosis (TB) for the 60.000 foreign students (out of European Union) annually newcomer in France. It was organized by screening centers of the Office of Immigration and Integration, a State agency. There was a link with university students’ health services (USHS) by systematic exchange of data, and sometimes the USHS was in charge of this screening and financed for that. In March 2016, a law, applied since January 2017, stopped this obligation, and transferred the responsibility of a “preventive survey” to USHS, without any means and financing.

Problem

As the decision was made without any data, thanks to the national network of UHSH, we made a brief national survey showing a 2,7 to 7,9/1.000 incidence, from year to year, 40% being active. About 50% of the cases came from North Africa and China. These data did not changed the decision, and we present its consequences in one French University, which was a previous TBI screening center. We computed all the cases of TB known in our USHS, since 2010, completed by the data form health authorities.

Results

Since screening is not anymore mandatory we faced a global refusal from Chinese and Moroccan students arguing that there was no TB in their country. Number of foreign students and their origin were approximately stable from 2010 to 2016, and mean TB incidence was 1,97/1.000. Students from China and North Africa represented half of the cases and 40% were latent TB. Since January 2017, TB incidence lowers to 1,51/1.000. Latent TB represent less than ¼, and there was no more cases screened from North Africa and China, while there was no change in foreign students origins, showing a significant degradation of screening effectiveness.

Lessons

The main reason for screening cessation was to save public money. Due to important lack of knowledge among French state authorities, we couldn’t change a decision which threatens the TB epidemic control.

Key messages

Cost saving policy reduced the effectiveness of tuberculosis screening. Health policy decisions may not take into account epidemiologic objectives.

Health relay students’ goals, training and assessment: result from a French national consensus

Issue

Health relay students (HRS) is one of the prevention policy rapidly increasing for the French students. It is mainly based on peer effects, peer to peer communication, but the state of play show very various practices.

Description of the problem

The variety of practices may imply heterogeneity, and actions that are too disparate. In October 2016, the national association of directors of Health Services for Students (SSU) decided to make a formal consensus process (based on single scripting strategies developed in parallel by 10 to 20 people) involving 61 persons (physician, nurses, prevention officer, members of prevention associations) from 29 French universities and based on three axes: goals; training and assessment.

Results

No disagreement was left. The goals must be validated by the SSU, as it is the unit that is able to link students ’associations wishes and health policy objectives. This need a constant dialogue with the university board, students associations, local authorities and health administration. The HRS are also important to help to know the students practices, notably thanks to their presence on social networks. Institutional policies for HRS must be consistent to the goals, and HRS must be managed by specific prevention officers. Training always associate health education topics and health prevention knowledge. It may be more or less intensive according to the goals, but need the help of association of health prevention and a validation by the SSU. HRS must be diverse, in genders and type of studies. The training must encourage HRS autonomy and creativity in their actions, while accepting to respect the University health policy. Creativity means also to open any way of communication wanted by HRS, such as social networks.

Assessment is based on lean management, HRS satisfaction and University satisfaction (institution as well as teachers, administrative workers and students). HRS empowerment is perhaps the main criteria of assessment.

Key messages

Health relay students policies are very varied and need a consensual framework under the control of health services for students. Training must associate health education and prevention objectives, develop students’ empowerment.

Abortion among French students: result of a 15 years follow-up in a French university

Issue

The level of abortion in France is judged high, and since 2002 a policy is developed among students to lower it in this particular population

Methods

Since 2003, every 2 years we made an anonymous survey on abortion frequency, reasons and care in our university, which has between 12.000 and 12.000 she-students. We work on data from abortion centres of our area.

Results

Abortion rates are stable (5,3-8,5%0), half of the French rate for women (12,0-15,1%0).The risk is significantly lower for French students (6,3%0) compared to students from China (relative risk - RR 1,7, with a significant fall since 2011 - after a specific information campaign on contraception in France), North Africa (RR 2,0 stable) and Sub-Saharan Africa (RR 7,6 stable). ¼ had no contraception, ½ used condoms and 1/3 used oral contraception. 7,2% took emergency contraception. Medical abortion count for 1/3, but ¾ of the surgical techniques could have been replaced by medical drugs. After abortion, condoms are no more used and only 1% of the she-students decided not to take contraception. The main change is the fall down of the use of oral contraception after abortion (from 77% to 43%) replaced by intra-uterine device (IUD- from 1,7% to 22,5%) and contraceptive implant (CI- from 6,4% to 19,6%). Complete qualitative and quantitative results for 2018 will be also presented.

Lessons

General information on contraception did not change abortion rates, except for Chinese students. But, the increase use of hidden contraception (IUD and CI) after abortion encourage us to insist to the use of these hidden devices for the she-students belonging to social groups where contraception is discredited as a way to promote “bad habits”.

Key messages

Since 2003, abortion rates are stable among french students, and concerned mainly foreign students. The greater use ’hidden’ devices of contraception may improve this situation.

Perceived barriers to and facilitators of physical activity in people with knee osteoarthritis: Development of the Evaluation of the Perception of Physical Activity questionnaire

BACKGROUND

The physical activity (PA) level of individuals with knee osteoarthritis is lower than in the general population. International recommendations recommend a non-pharmacological intervention including a self-management education program, weight loss and an adapted exercise program. However, we have no scale assessing the perceived barriers to and facilitators of PA in this population.

OBJECTIVE

We constructed and validated a self-administered questionnaire assessing perceived barriers to and facilitators of regular practice of PA in people with knee osteoarthritis.

METHODS

Semi-structured interviews identified 24 barriers and facilitators. We developed a 24-item questionnaire, Evaluation of the Perception of Physical Activity (EPPA) that was completed by 548 individuals with knee osteoarthritis, to assess acceptability, construct validity, internal consistency and convergent validity. Participants also completed the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and International Physical Activity Questionnaire (IPAQ). Reliability and sensitivity to change were evaluated in a second group of 168 people with knee osteoarthritis at a 3-week spa therapy resort.

RESULTS

Factorial analysis identified 17 items grouped into 4 subscales (Barriers, Facilitators, Motivation and Beliefs). The internal consistency was good for Barriers, Facilitators and Motivation subscales (Cronbach α>0.70) and intermediate for the Beliefs subscale (Cronbach α=0.64). The EPPA subscale scores were significantly correlated with KOFBeQ and WOMAC scores but not associated with IPAQ physical activity level. Reliability was good for all subscales, with intraclass correlation coefficients>0.60. A sensitivity to change was found for only the Beliefs subscale, with a moderate effect size.

CONCLUSIONS

The EPPA questionnaire has good psychometric properties and can help guide the management of knee osteoarthritis. It can be used in research for evaluating the perception of physical activity.

Anterior ischemic stroke: Comparison of two clinical outcome prediction scores through the investigation of cerebral collaterals using multiphase CT angiography

PURPOSE

To compare the evaluation of collaterals on multiphase computed tomography (CT) angiography using the score proposed by the reference study by Menon et al. and the Alberta Stroke Program Early CT (ASPECT) score for the prediction of favorable clinical outcome in patients with anterior ischemic stroke (IS).

MATERIALS AND METHODS

Retrospective single center study including 199 patients with anterior ischemic stroke and evaluated using multiphase CT angiography. Collaterals were assessed using the reference score and ASPECT score. The early clinical outcome [National Institute of Health Stroke Score (NIHSS) over day 1] and later clinical outcome [90-day modified Rankin Scale (mRS)] were collected. The primary analysis related to the association between collateral scores and clinical outcome.

RESULTS

Collaterals are an independent predictive factor of favorable clinical outcome with the two scores, ranging from an odds ratio (OR) [95% confidence interval (CI)] = 1.84 [1.23; 2.76], P = 0.003 for the reference score to an OR [95% CI] = 2.63 [1.21; 5.73], p = 0.015 for the phase 3 ASPECT score. The phase 3 ASPECT score offers better sensitivity (Se) for the prediction of a favorable clinical outcome [Se = 95%, specificity (Sp) = 37% for a threshold of 7/7] than the reference score (Se = 83%, Sp = 47% for a threshold of 4/5).

CONCLUSION

This study demonstrates the value of the ASPECT score in analyzing collaterals using multiphase CT angiography for the prediction of clinical outcome.

Improving image quality of mid-trimester fetal sonography in obese women: role of ultrasound propagation velocity

OBJECTIVE

The quality of ultrasound images is impaired in obese patients. All ultrasound scanners are calibrated for an ultrasound propagation velocity of 1540 m/s, but the propagation in fatty tissue is slower (in the order of 1450 m/s). The main objective of this study was to evaluate the quality of images obtained with different ultrasound propagation velocity settings during the mid-trimester fetal ultrasound examination in obese patients.

METHODS

This was a cross-sectional study using image sets of four recommended scanning planes collected from 32 obese pregnant women during their mid-trimester fetal scan. Each image set comprised three images obtained successively at three different propagation velocity settings (1540 m/s, 1480 m/s and 1420 m/s). A panel of 114 experts assessed the quality of 100 image sets, grading them from A (most acceptable) to C (least acceptable). Scanning-plane-specific indicators of adiposity (fatty layer thickness, probe-to-organ distance) were analyzed for each scanning plane.

RESULTS

The experts had a mean of 18.1 ± 10.2 years of experience. The grade distribution (A, B, C) differed significantly (P < 0.0001) between the three propagation velocity settings tested; at the lower speed of 1480 m/s, images were most often graded A, while at the conventional speed of 1540 m/s, they were most often graded C. Regardless of the scanning plane, the thicker the fatty layer of the abdominal wall in a given plane, the lower the preferred speed (P < 0.0001).

CONCLUSION

The construction of images taking into account ultrasound propagation velocities lower than 1540 m/s can improve significantly the quality of images obtained during mid-trimester fetal ultrasonography in obese women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Smoking cessation attempts: is it useful to treat hard core smokers?

Background

Hard core smokers have been studied in many countries but only a few trials have compared the effectiveness of smoking cessation with other smokers. The objective of this study was to compare the frequencies of success in smoking cessation between hard-core smokers and other smokers.

Methods

Data were collected in Clermont-Ferrand from the Emile Roux dispensary ‘Pneumology and Tobaccology Centre’ between 1999 and 2009. Assistance with smoking cessation was proposed to 1367 patients but only 1296 patients were included: 219 HCS and 1077 other smokers. Smoking cessation was considered a success when patients were abstinent 6 months after the beginning of cessation. The profiles of the two types of smokers were compared using Chi square test and Student’s t test. Multivariate logistic regression was used to investigate the association between the smoking cessation result and the type of smokers.

Results

HCS more frequently consumed other psychoactive substances (41.1 % vs 25.7 % for other smokers; p < 0.001). Current depression was more frequent in HCS (46.6 % vs 34.8 % for other smokers; p = 0.001). Smoking cessation was less frequent in HCS (45.2 % vs 56.5 % for other smokers ; p = 0.002). In multivariate analysis, after controlling for other factors, the frequency of smoking cessation was not significantly associated with the type of smokers (p = 0.47). After limiting to initial factors (present before the beginning of smoking cessation), the frequency of smoking cessation was still not significantly associated with the type of smokers (p = 0.78).

Conclusion

Smoking cessation is possible for hard core smokers, who should be treated as other types of smokers taking into account other factors:the problem is how to encourage them to try to stop smoking.

Low socio-economic status is a newly identified independent risk factor for poor vitamin D status in severely obese adults

BACKGROUND

Hypovitaminosis D is very prevalent, especially in the obese population. However, the degree of severity and the parameters involved in vitamin D deficiency in this population are still unclear. The present study aimed to identify, from among the factors known to influence vitamin D status in a healthy population, those impacting the same parameter in obese population.

METHODS

Serum 25-OH-D concentration was measured in 564 patients with class III obesity [i.e. severe and morbid obesity; mean (SD) body mass index (BMI) 42.04 (6.92) kg m^-2 ] and their demographic, clinical, biological, anthropometric, dietary and socio-economic data were collected.

RESULTS

We observed that 96% of the obese patients had serum 25-OH-D lower than 30 ng mL^-1 . Severe vitamin D deficiency (serum 25-OH-D concentration <10 ng mL^-1 ) affected 35% of this population. We found an inverse relationship between 25-OH-D levels and BMI (P = 0.012), fat mass (P = 0.041), metabolic syndrome (P < 0.0001), fasting blood glucose (P = 0.023), homeostasis model assessment for insulin resistance (P = 0.008), waist circumference (P = 0.001), and fasting blood triglycerides (P = 0.002) and C-reactive protein (P = 0.005). Low socio-economic status independently increased the risk of severe vitamin D deficiency [odds ratio (OR) = 1.98; 95% confidence interval (CI) 1.25-3.13], especially in the autumn-winter season (OR = 2.94; 95% CI 1.98-4.36), morbid obesity (OR = 3.19; 95% CI 1.49-6.82), metabolic syndrome (OR = 1.6; 95% CI 1.06-2.42) and inflammation (OR = 1.03; 95% CI 1.01-1.06).

CONCLUSIONS

Vitamin D deficiency is extremely common among obese patients, and the prevalence of severe deficiency is high. The association of adiposity, high body mass index, metabolic syndrome and inflammation with vitamin D status is marked, whereas low socio-economic status appears to be a major risk factor for severe vitamin D deficiency, suggesting that vitamin D deficiency may at least in part be responsible for the greater health vulnerability of populations with low socio-economic status.

Smoking during pregnancy: a difficult problem to face. Results of a French multi-center study

INTRODUCTION

Smoking tobacco during pregnancy is a preventable risk factor for adverse pregnancy outcomes. The aim of the study was to assess the impact of an information and training program implemented by the perinatal network of Auvergne, France, on smoking during pregnancy.

METHODS

A multi-center before-and-after population-based study, based on two cross-sectional surveys, was carried out between July 2003 and June 2004, and between December 2008 and January 2010. Pregnant women aged over 18 years, with a fluent command of written and spoken French, were eligible. The main outcome was the prevalence of pregnant women who smoked daily. The preventive program consisted of informing women and healthcare providers and training healthcare providers. Multivariate analysis was performed by means of manual logistic regression and crude and adjusted Odds Ratios were calculated.

FINDINGS

"Before" and "after" surveys involved 1027 and 720 women, respectively. In the "after" survey, a higher percentage of women smoked daily at the time of diagnosis (43.49% vs 51.94%, adjusted Odds Ratio 1.45 [1.10; 1.90]) and during the third term (40.53% vs 51.94%, adjusted Odds Ratio 1.62 [1.24; 2.12]). Environmental tobacco smoke exposure among non-smokers was higher in the "after" survey: 52.83% vs 69.57% adjusted Odds Ratio 1.95 [1.54; 2.47].

CONCLUSIONS

The program did not reduce smoking during pregnancy. Exposure to environmental tobacco smoke increased. French public health authorities should introduce a new policy aimed specifically at tackling tobacco use during pregnancy and exposure to second-hand smoke, and which takes into account the entire environment of pregnant women.

Assessment of Health Inequalities Among Older People Using the EPICES Score: A Composite Index of Social Deprivation

BACKGROUND: Most of the indicators commonly used to assess social deprivation are poorly suited to study health inequalities in older people. The EPICES (Evaluation of Deprivation and Inequalities in Health Examination Centres) score is a new composite index commonly used to measure individual deprivation. OBJECTIVE: To assess the relationships between health indicators and the EPICES score in older people. Design, Setting, and participants: We performed a cross-sectional study using the data from the 2008 ESPS Survey (Health, HealthCare and Insurance Survey). Of the 4235 survey respondents aged 60 and over in 2008, 2754 completed the 11 items of the EPICES score and were included in the study. MAIN OUTCOMES AND MEASURES: Deprivation was measured using the EPICES score. Health indicators were: Disability, physical performance, cognitive decline, self-perceived health status, and health-care use and participation in prevention programs (missing teeth not replaced, healthcare renunciation, no hemoccult test [60-75 years] and no mammography [60-75 years]). RESULTS: Of the 4235 survey respondents aged 60 and over in 2008, 2754 completed the 11 items of the EPICES score and were included in the study. The mean age was 70.5± 8.2 years. 52.8% were women. 25.8% were living in poor households. According to the EPICES score, 35.1% were deprived. The EPICES score is linked to all the health indicators assessed in this study: Physical disability, cognitive decline; lifestyle and health care accessibility. These relationships increase steadily with the level of social deprivation. For example, the risk of having difficulties in walking 500m without help or an assistive device is multiplied by 13 (RR=13.5 [7.9-20.8]) in the elderly of quintile 5 (maximum precariousness). Limitations: The observational nature limits inferences about causality.CONCLUSION: The EPICES score is linked to health indicators. It could be a useful instrument to assess health inequalities in older people living in the community.

French validation of the Foot Function Index (FFI)

OBJECTIVE

French validation of the Foot Function Index (FFI), self-questionnaire designed to evaluate rheumatoid foot according to 3 domains: pain, disability and activity restriction.

METHODS

The first step consisted of translation/back translation and cultural adaptation according to the validated methodology. The second stage was a prospective validation on 53 patients with rheumatoid arthritis who filled out the FFI. The following data were collected: pain (Visual Analog Scale), disability (Health Assessment Questionnaire) and activity restrictions (McMaster Toronto Arthritis questionnaire). A test/retest procedure was performed 15 days later. The statistical analyses focused on acceptability, internal consistency (Cronbach's alpha and Principal Component Analysis), test-retest reproducibility (concordance coefficients), external validity (correlation coefficients) and responsiveness to change.

RESULTS

The FFI-F is a culturally acceptable version for French patients with rheumatoid arthritis. The Cronbach's alpha ranged from 0.85 to 0.97. Reproducibility was correct (correlation coefficients>0.56). External validity and responsiveness to change were good.

CONCLUSION

The use of a rigorous methodology allowed the validation of the FFI in the French language (FFI-F). This tool can be used in routine practice and clinical research for evaluating the rheumatoid foot. The FFI-F could be used in other pathologies with foot-related functional impairments.

[Health-related quality of life evaluation of elderly aged 65 years and over living at home]

BACKGROUND

To assess health-related quality of life in French adults aged 65 years and over, living at home, with a specific self-administered questionnaire, the LEIPAD, cross-culturally adapted in French.

METHODS

Elderly completed socio-demographic and medical questionnaires, a questionnaire about negative life events during the last 12 months and the LEIPAD.

RESULTS

Data of 195 subjects (mean age: 72.6 years, men: 56.5%) were analyzed. The response rates to the LEIPAD scales were superior to 90%. Elderly reported on the whole a good health-related quality of life. Age had a negative effect on quality on life, which deteriorates over years. Age was correlated to the scales "Physical function", "Self-care", "Cognitive functioning" and "Sexual functioning". Elderly hospitalized in the last year had worse quality of life with a significant difference for "Physical function" scale. The number of health problems was positively correlated to "Physical function" scale. Elderly declaring at least one health problem had worse quality of life for this scale. Problems in couple, materials and financial problems had also negative effects on health-related quality of life.

CONCLUSION

Our study highlights a good health-related quality of life for the majority of these adults aged 65 years and over, as well as the negative effect of age, health, couple, materials and financial problems on their quality of life.

[The access of independent midwives to maternity ward technical facilities: the experimentation of a level-1 department]

OBJECTIVES

The first aim of this study was to evaluate the access of independent midwives to the technical facilities of a level-1 maternity hospital, with a follow-up of 2 years. The second aim was to evaluate the transfer of clinical responsibility, when a patient stops being managed by the independent midwife to be taken care of by the hospital team.

PATIENTS AND METHODS

A retrospective study including 51 patients. Analysis of maternal and perinatal data.

RESULTS

Of the 51 births, there were 42 vaginal deliveries without intervention (82.35%), 3 instrumental deliveries (5.88%), 6 caesarean sections (11.76%). The midwife-led care was completed in 70.59% of cases. The rate of transfer of clinical responsibility during labor was 25.49%. We conducted a neonatal transfer due to a respiratory distress syndrome.

DISCUSSION AND CONCLUSION

The access to technical support appears as an opportunity for independent midwives to establish a special relationship with their patients. However, this device preserves the possibility of a traditional hospital care when needed. This way, access to the technical support is a safe alternative that has the consent of the users (patients and midwives) as well as of the entire hospital team. Moreover, such device allowed an increase of 5% per year of our obstetrical activity with an estimated increase of 10% per year.

Transcultural validation of the Risk Assessment and Predictor Tool (RAPT) to predict discharge outcomes after total hip replacement

OBJECTIVE

To assess the relevance of the RAPT (Risk Assessment and Prediction Tool), among a cohort of patients undergoing total hip arthroplasty (THA).

METHOD

Prospective study of a cohort of patients evaluated before and after THA. The difference between the postoperative orientation predicted by the RAPT and the real one is assessed. Clinical, environmental and psychosocial criteria that could significantly change the orientation are discussed.

RESULTS

One hundred and thirty-four patients (94 women and 40 men) were included. The average age was 71.6 (±10) years. Primary hip osteoarthritis was the indication for surgery in 78% of cases. The average length of stay in the surgery ward was 10 (±3) days. It was significantly higher for patients referred to a rehabilitation ward (P<0.0001). Sixty-six percent of patients were referred to a rehabilitation ward and 34% returned directly home. The average length of stay in rehabilitation ward was 27 (±13) days. The validity of the RAPT as a help decision tool has been confirmed. Thus, a low RAPT score was significantly associated with more frequent referral to a rehabilitation ward, conversely, a high RAPT score is significantly related to more frequent direct return to home.

CONCLUSION

This study confirmed the usefulness of the RAPT to help in patient orientation decision after total hip arthroplasty. The patient preference remains the main variable for orientation after THA. By the way, the patient preference must not be integrated into the RAPT, but need to be collected and be discussed with the patient.

[Management of allergic conjunctivitis. An observational study among ophthalmologists]

PURPOSE

To describe the management of allergic conjunctivitis in private ophthalmology practice and to evaluate the collaboration between ophthalmologists and allergists.

PATIENTS AND METHODS

Multicenter retrospective study. Each ophthalmologist was required to collect demographic and clinical data from the records of 10 patients with a 2- to 3-year history of allergic conjunctivitis.

RESULTS

A total of 353 records were interpretable, corresponding to 885 visits. Slightly more than 60% of patients had a history of allergy (rhinitis, asthma or cutaneous allergy), and 40% of patients had had allergy testing. Fewer than 2% of patients had seen an allergist. Analysis of presenting symptoms reveals that itching, burning, tearing, photophobia and discomfort led frequently to the diagnosis of allergic conjunctivitis. This was confirmed through the interview concerning the circumstances of symptom development (most frequently involving exposure to trees and flowers) and ophthalmologic examination (presence of hyperemia, follicles, watery discharge, chemosis). The presence of non-specific symptoms such as ocular dryness was relatively frequent in association with perennial conjunctivitis. Over 95% of patients were given a topical treatment while fewer than 10% were referred to an allergist.

CONCLUSION

Allergic conjunctivitis, particularly seasonal, is easily identifiable by an ophthalmologist. Perennial and more serious forms of conjunctivitis could be referred to an allergist more frequently.

Rates of progression of weight and forced vital capacity as relevant measurement to adapt amyotrophic lateral sclerosis management for patient Result of a French multicentre cohort survey

OBJECTIVES

To compare survival, to describe the progression of anthropometry, pulmonary capacity and functioning in ALS (Amyotrophic Lateral Sclerosis) and to identify the most relevant variables to adapt ALS management for patients.

METHODS

A cohort study was performed in French ALS centres between January 2003 and July 2005. Eligible patients were treated by Riluzole and had a slow vital capacity (SVC) or a forced vital capacity (FVC) at least equal to 60%. Demographic, medical and ALS characteristics were registered. Manual Muscular Testing (MMT) and ALS Functional Rating Scale (ALSFRS) were performed. Kaplan Meier method was used to analyse survival. ALS progression was measured by the percentage weight, FVC, SVC, MMT and ALSFRS loss and was analysed as longitudinal data using mixed model.

RESULTS

Three hundred and eighty three patients were included. The median survival since ALS diagnosis was 2.34 years (95%CI 2.10-2.65). Mixed model analyses revealed a more significant worsening progression of weight and FVC loss for bulbar onset. The drop of ALSFRS and SVC is similar whatever the ALS forms.

CONCLUSIONS

Rates of progression of weight and FVC should be regularly watched over to support neurologists to adapt ALS management for patients.

Cross-cultural evaluation of the French version of the LEIPAD, a health-related quality of life instrument for use in the elderly living at home

PURPOSE

To cross-culturally adapt a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life (HRQoL) in adults aged 65 years and over living at home, and to evaluate its psychometric properties.

METHODS

After having translated LEIPAD in accordance with guidelines, we studied psychometric properties: reliability and construct validity-factor analysis, relationships between items and scales, internal consistency, concurrent validity with the Medical Outcome Study Short-Form 36 and known-groups validity.

RESULTS

The results obtained in a sample of 195 elderly from the general population showed very good acceptability, with response rates superior to 93 %. Exploratory factor analysis extracted eight factors providing a multidimensionality structure with five misclassifications of items in the seven theoretical scales. Good internal consistency (Cronbach's alpha ranging from 0.73 and 0.86) and strong test-retest reliability (ICCs higher than 0.80 for six scales and 0.70 for one) were demonstrated. Concurrent validity with the SF-36 showed small to strong expected correlations.

CONCLUSION

This first evaluation of the French version of LEIPAD's psychometric properties provides evidence in construct validity and reliability. It would allow HRQoL assessment in clinical and common practice, and investigators would be able to take part in national and international research projects.

[Assessment of topical steroid treatment for childhood phimosis: review of the literature]

OBJECTIVES

Questions concerning nonretractile foreskin are frequently asked by parents in infant consultations. Topical steroid treatment could be a less expensive and less traumatizing alternative to surgery.

AIM

To assess the effectiveness of topical steroid therapy in boys with phimosis.

METHODS

Literature review. All randomized controlled trials were selected, using the following research sources: Medline, Cochrane Library, Pascal, Embase, Blackwell Science, Google, Google scholar, SUDOC, international register of trials, and congress abstracts. Unpublished trials were also searched. The trials were analyzed using the ANAES guide from a therapeutic article.

RESULTS

Seven randomized controlled trials (n=714 patients) were in accordance with the inclusion criteria. The patients were between 1 and 12 years old. The treatment lasted for 4-8 weeks. The success rate at the end of the study was higher with the steroid (53.8-95%) than with the placebo (6.25-52%), P<0.05 for 6 randomized control trials.

DISCUSSION

According to the ANAES criteria, the level of scientific evidence is low (gradeC) because of the lack of power in clinical trials and numerous methodological shortcomings and biases, even when examining both randomized control trials and nonrandomized trials. Only a few local side effects were noted.

CONCLUSION

The use of topical steroids can be recommended in first-intention treatment before surgery for the management of phimosis.

How a university hospital improves its prevention performance: results of two biennial studies 2004-2006

INTRODUCTION

Prevention is a legal obligation for French hospitals and should be systematically assessed.

AIM

To measure how a French University Hospital improved its prevention performance between two biennial prevention studies after incentives measures were applied.

METHODS

45 medical, obstetrical or surgical units were included. A doctor-nurse pair was free to select inpatients at random. 14 preventive procedures were evaluated: blood pressure check, measures of weight, height and body mass index, screenings for diabetes, cervix and breast cancers, tetanus and influenza immunizations, serologies of viruses, research for a prostatic and cognitive disorder and evaluation of alcohol and tobacco consumptions and addictions. Incentives measures for prevention were enacted during the same time.

RESULTS

In 2004 and in 2006, respectively 253 inpatients and 243 inpatients were respectively included. Tetanus immunization was checked in less than one tenth of cases in both the studies. Seven acts were performed more in 2006 and only body mass index was measured less.

DISCUSSION

The results were encouraging but insufficient especially for tetanus immunization. Weight was measured more than body mass index, probably meaning that's weight and more precisely its variations are a better clinical sign. Bad results for tetanus immunization meant that incentive strategies only displayed within the hospital were ineffective. Lastly, two propositions were done to improve the questionnaire and the prevention performance: to add five preventive services and a medical file first page, common to all units, summing up all preventive procedures evaluated.

CONCLUSION

The ability of this University Hospital to improve its prevention performance answering to local incentive measures was weak. Another solutions need to be found.

[The evaluation of the level of integration within a perinatal network]

OBJECTIVES

Our goal was to evaluate the level of integration of general practitioners within the perinatal network in the Auvergne.

MATERIALS AND METHODS

A cross-sectional study was realized. The questionnaire was sent by post to the 1346 general practitioners who were members of the "Union régionale des médecins libéraux" (Regional association of private doctors in the Auvergne). Follow-up phone calls were also made.

RESULTS

The overall response to the questionnaire was 29.8%. Of those who replied, 76.3% were involved in the care of pregnant women or newly born babies. Among them, 51.2% had a consultation with a pregnant woman less than once a week and 53,5% had a consultation with a newly born more than once a week. A third were aware of the network and 25.7% had knowledge of the medical record provided by the network. Among them, 91.3% thought that a common medical record was necessary to improve the coordination of care. The answers differed according to age, area of responsibility, the administrative geographic position in the Auvergne, type of practise (hospital, private), and the sex of those who replied.

CONCLUSION

Despite a high a priori agreement, we must improve the level of information and training given to general practitioners within our perinatal network.

[Assessment strategies of the impact of healing touch in nursing care]

New care methods have emerged in the last few years. Healing Touch is relaxing and as such, helps prepare the patient for the medical act, the pain of which he may often feel anxious about As they foster confidence between the patient and the medical practitioner, such practices create better conditions for the medical care act to be performed. Even if there is no doubt about its impact on the patient, the effect of Healing Touch has never been scientifically assessed, and the only available references are rather scarce. This is the reason why we wished to assess the impact of this care in a number of clinical situations through a randomised clinical experiment. The object of this paper is to assert the efficacy of such care on the patient, especially on pain relief and the decrease of anxiety. To this end, authenticated assessment scales were used, such as the visual analog pain scale or Spielberg's test anxiety inventory. A prospective multicentre randomised study was carried out to create a control group to be compared to the group treated with Healing Touch. Only willing patients who were prescribed healing touch were included in the experiment. Patients with cognitive problems - be they temporary (linked to a temporary clinical conditions) or not - or those suffering from some disabilities preventing them from using assessment scales and questionnaires are excluded. The recruitment of a 784-patient panel was needed to set out the 8 situations in which a Healing Touch indication may be effective.