Better characterizing sleep beliefs for personalized sleep health promotion: the French sleep beliefs scale validation study.

Background: The Sleep Beliefs Scale (SBS) is a well-known tool to design and monitor personalized sleep health promotion at an individual and population level. The lack of an established French version limits the development of effective interventions targeting these populations. Thus, the aim of this study was to validate the French version of the SBS in a representative sample of the general population. Methods: Quota sampling was used to recruit 1,004 participants (18-65 years, mean age: 43 years, 54% of female) who underwent an online survey to complete the SBS, and to assess sleep schedules, sleep quality and disorders, and mental health. Cronbach's α coefficient, confirmatory factor analysis, item-internal consistency (IIC), and item discriminant validity (IDV) of the SBS were computed to assess internal validity while bivariate associations with sleep schedules, sleep quality and disorders, and mental health were used to assess external convergent and discriminant validity. Results: The mean score on the SBS was 12.3 ± 4.9. Item 19 ("Quiet & Dark") showed the highest rate of correct answers (n = 801, 79.8%), while item 20 ("Recovering sleep") showed the lowest rate of correct answers (n = 246, 24.5%). Overall, the SBS showed satisfactory internal consistency (α = 0.87) and confirmed the three-factor structure proposed by the original study. All items were found consistent (IIC > 0.4) and discriminant (IIC > IDV) except for item 20 ("recovering lost sleep by sleeping for a long time"). Females, older participants, and subjects with short time-in-bed, poor sleep quality, insomnia, and circadian rhythm disorder had higher SBS scores while participants with depressive symptoms had lower SBS scores. Conclusion: We successfully translated and validated the French version of the SBS in a representative sample, making it a reliable instrument for researchers and clinicians to assess and target sleep beliefs. Correct answers vary from 25 to 80% which underlines the importance of continuing sleep health promotion campaigns by targeting poorly understood behaviors. Our findings also shed light on the fickleness of beliefs that are prone to vary within individuals across time, in step with societal changes. Several associated factors were identified, thus contributing to our understanding of sleep beliefs and offering insights for personalized approaches to enhance sleep health and overall well-being.

Stroke thrombolysis in the emergency department as an alternative service for community hospitals lacking a stroke unit.

OBJECTIVE: A significant advancement in the management of acute ischemic stroke has been the use of the recombinant tissue plasminogen activator (rtPA). French guidelines recommend that stroke patients should be treated in stroke units (SU); however, community hospitals experience practical difficulties in treating their patients because SUs are not sufficient in number. Only one SU is available in the Aquitaine area (southwest of France) and it is located in Bordeaux. To improve quality of care and to provide modern stroke therapy, we decided to assess whether thrombolysis was feasible in our community hospital located in Pau, 200 km from Bordeaux. METHODS: Selected patients were treated with rtPA and observed for 24 h in the emergency department. According to French legislation, rtPA therapy was defined as 'off-label use'. National Institutes of Health stroke scale (NIHSS) was obtained on admission, immediately after treatment and 24 h after treatment. RESULTS: Results from the first 40 patients are reported in this study. They were treated between September 2004 and June 2006. In total, 1169 patients were admitted for stroke during this period. Outcomes and mortality rates were consistent with experience elsewhere. CONCLUSIONS: According to the local infrastructural criteria and prerequisites described in this study, thrombolysis is a viable and feasible treatment option for stroke patients in emergency departments of French community hospitals. In the absence of an SU, this type of emergency treatment can be used as an alternative until SUs become more numerous throughout the country.

[Feasibility of stroke thrombolysis at Pau Hospital, France]. / Faisabilité et sécurité de la thrombolyse des accidents vasculaires cérébraux du Centre hospitalier de Pau.

BACKGROUND: Stroke is the most common cause of permanent disability in Europe and is a major public health problem. A recent significant therapeutic advance is the administration of recombinant tissue plasminogen activator (rtPA) for cerebral infarcts within three hours of symptom onset. French guidelines limit its use to patients in specialized stroke units. There is only one stroke unit in the region of Aquitaine, in Bordeaux, 200 km from Pau and too far to transfer patients within the necessary time. With the collaboration of our colleagues in Bordeaux we decided to assess whether stroke thrombolysis could be feasibly and safely administered in our district general hospital. DESIGN: From September 2004 through August 2005, eligible patients received rtPA treatment in the emergency department. The National Institutes of Health Stroke Scale (NIHSS) was administered at admission, immediately after treatment, and 24 hours later. In January 2006, a prospective follow-up assessed the NIHSS, Modified Rankin Scale (MRS) and Barthel Index Score (BIS) for all subjects still alive and collected data about those who had died. RESULTS: In all, 553 patients were admitted for stroke: 306 had cerebral infarcts and 25 (8.1%) were treated by intravenous thrombolysis. The mean age of the patients who received thrombolysis was 67 years (range: 33-80), and the sex ratio was 4/1 (20 men and 5 women). Mean delay from symptom onset to treatment was 150 min (range 105-180). The median NIHSS score was 13 (range 8-22) at admission, 10 (range 0-22) after treatment, and 7 the next day (range 0-22). Two patients (8%) died during the acute phase. On January 2006, after a median follow-up of 11.6 months (range: 6-16), 18 (72%) patients were still alive: 13 (52%) with good outcomes (MRS, 0-1) and 3 severely disabled and institutionalized (BIS, 0-50). CONCLUSION: Our results show that thrombolysis is possible in Pau. The population in our catchment area has a good proportion of stroke patients eligible for thrombolytic treatment. Outcomes and mortality rate are consistent with experience elsewhere. The creation of a stroke unit should help improve prognosis while complying with management guidelines.

[Headaches and acute hemiplegia of nonvascular origin: two cases]. / Céphalées et hémiplégies brutales d'origine non vasculaire: deux cas.

BACKGROUND: Acute hemiplegia with headaches does not always have a vascular origin. CASES: We describe two cases with headaches that included motor weakness symptoms. One patient had sporadic hemiplegic migraines. The second met the diagnosis criteria for a transient syndrome with headache, neurological deficits and cerebrospinal fluid pleocytosis. DISCUSSION: These two case reports demonstrate the diagnostic difficulty that can be associated with acute motor weakness. A nonvascular origin should always be considered to prevent treatment errors, especially in the differential diagnosis of stroke.