Is there an association between prior anti-inflammatory drug exposure and occurrence of peritonsillar abscess (PTA)? A national multicenter prospective observational case-control study.

The aim of this study was to evaluate whether recent systemic anti-inflammatory agents (AIAs) exposure in patients with sore throat managed with or without antibiotic therapy influenced the risk of peritonsillar abscess (PTA). We conducted a multicenter case-control study in 13 French university hospitals in 2009-2012 comparing patients admitted with PTA to matched controls: patients with sore throat but without PTA who were followed up for 10 days after visiting their primary-care physician. In the multivariate stepwise logistic regression model comparing 120 cases with PTA to 143 controls, factors significantly associated with PTA were male gender (odds ratio [OR], 2.0; p = 0.03), smoking (OR, 2.0; p = 0.03), and prior self-medication with systemic AIAs (OR, 3.5; p = 0.01). Topical treatment was associated with significant protection against PTA (OR, 0.3; p < 0.001). In conclusion, self-medication with systemic AIAs appears to be an independent factor associated with the occurrence of PTA. This is an important message as non-steroidal AIAs access is favored by their over-counter availability in pharmacies. This finding must be interpreted with caution due to the study design and a prospective, randomized study is needed to substantiate these possible causal risk factors.

Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals.

The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009-2012 describing 412 patients. Median age was 29 year (range, 2-84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) had consulted a physician for sore throat within 10 days before admission for PTA diagnosis. Additional symptoms such as visible tonsil abnormalities (83 %), tender cervical adenopathy (57 %) and fever ≥ 38.5 °C (53 %) were also reported. A total of 65 % patients (269/412) reported recent systemic anti-inflammatory agents (AIAs) exposure by medical prescription (70 %), self-medication (22 %), or both (8 %); 61 % and 27 % reported recent exposure to antibiotic and topical treatments for sore throat, respectively. Non-steroidal AIAs were used most often (45 %), particularly arylpropionic derivatives. A rapid diagnosis antigen test (RDT) for Streptococcus pyogenes was performed in 70 (17 %) patients and was positive in 17 (24 %), of whom 9 (53 %) were exposed to AIAs and 14 (82 %) to antibiotics. To treat PTA, antibiotic therapy was given to 392 (95 %) patients. Of 333 antibiotic prescriptions, amoxicillin-clavulanic acid and metronidazole were the most prescribed antibiotics (42 and 17 %, respectively). Surgical drainage of the abscess was performed in 119 (29 %) cases and tonsillectomy in 75 (18 %) cases. The clinical outcome was favorable during the hospital stay in 404 (98 %) patients. In conclusion, patients with sore throat are often exposed to AIAs before PTA diagnosis, and antibiotic prescription was not often based on the RDT positivity.

Management of the neck in the setting of definitive chemoradiation: is there a consensus? A GETTEC study.

BACKGROUND: The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease METHODS: We studied the patterns of care in the French-Belgian Groupe d'Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey. RESULTS: Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND. CONCLUSIONS: Omission of ND based on computed tomographic scan and positron emission tomography-based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus-related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.

[Silent sinus syndrome associated with intrasinusal ossification]. / Syndrome du sinus silencieux et ossification intrasinusienne.

BACKGROUND: The silent sinus syndrome (SSS) is a rare cause of diplopia and facial asymmetry. It is commonly attributed to a sinus atelectasis secondary to ostiomeatal obstruction. Surgical dissection of the maxillary sinus mucosal lining is known to cause auto-obliteration by bone formation. CLINICAL CASE: A 45 year-old female patient was referred for vertical diplopia with enophthalmia, and a slight depression of the left cheekbone. Antrostomy was performed for chronic obstructive maxillary sinusitis six months before. CT scan revealed a major collapse of superior, anterior, and posterior left maxillary sinus with expansion of the orbital volume. The de novo maxillary sinus ossification evolved over two years of follow-up. It was normal lamellar bone. The left orbital floor was rebuilt. Diplopia progressively resolved. DISCUSSION: The association of SSS and intraluminal osteogenesis has never been reported. The first might be due to a peroperative dissection of the maxillary sinus mucosal lining. SSS was due to meatal obstruction secondary to inadequate antrostomy.

[Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly]. / Troubles de la déglutition du sujet âgé et pneumopathies en 14 questions/réponses.

Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).

Diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults.

OBJECTIVES: To study the diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults. MATERIAL AND METHODS: A retrospective study included patients with unilateral vocal-fold immobility undergoing laryngeal electromyography between 2007 and 2015. Neurogenic, normal or myogenic findings were compared to the clinical aspect. Prognosis for recovery was assessed from motor unit potentials on laryngeal electromyography, and compared to subsequent progress on laryngoscopy. RESULTS: Sixty-three patients (mean age, 59 years) were initially included; 2 were subsequently excluded from analysis. Mean time from onset of immobility to laryngeal electromyography was 7 months. 85% of the 61 patients showed neurogenic findings, indicating neural lesion; 13% showed normal electromyography, indicating cricoarytenoid joint ankylosis; and 1 patient showed a myogenic pattern. Neurogenic cases were usually secondary to cervical surgery. Thirty-eight patients were followed up. In total, 75% of patients showing reinnervation potentials recovered. The positive predictive value of laryngeal electromyography was 69.2%. CONCLUSION: Laryngeal electromyography is effective in specifying the origin of unilateral vocal-fold immobility in adults. It also has a prognostic role, lack of reinnervation potentials being a possible indication for early medialization surgery.

Sinonasal mucosal melanoma: A 44-case study and literature analysis.

OBJECTIVES: Sinonasal mucosal melanoma is a rare disease, representing 4% of nasal cavity and paranasal sinus malignancies. The aim of this study was to assess the clinical characteristics, progression and treatment of this disease and to identify prognostic factors. MATERIAL AND METHODS: This retrospective review presents a cohort of 44 patients treated for a melanoma arising from the nasal cavity and paranasal sinuses, in the ENT Head and Neck Surgery Department of the University Hospital of Nantes (France) between 1988 and 2015. RESULTS: Mean age at diagnosis was 71.2 years. The main signs at diagnosis were epistaxis and unilateral nasal obstruction. 25% of patients were initially classified as T4. Surgical treatment was performed in 42 patients. Postoperative radiotherapy was performed in 19 cases and adjuvant immunotherapy in 14 cases. Mean follow-up was 50 months. Cumulative overall survival was 71.5% at 1 year and 33% at 5 years. Clinically, headache, facial pain and trigeminal V2 nerve anesthesia were significant factors for poor prognosis. Exclusively nasal involvement was a factor for better overall survival than sinus involvement. Adjuvant radiation therapy showed a non-significant trend toward improved local control. CONCLUSIONS: Mucosal melanoma of the sinonasal cavities has poor prognosis due to high metastatic potential. Surgical resection followed by radiation therapy is the main treatment. There is no consensus regarding new systemic adjuvant treatments in this indication, unlike for primary cutaneous melanoma.

[Interstitial brachytherapy of peri-orificial skin carcinomas on the face]. / Curiethérapie interstitielle des cancers cutanés des zones périorificielles de la face.

Purpose. - To analyse outcomes after interstitial brachytherapy of facial periorificial skin carcinomas. Patients and methods. - We performed a retrospective analysis of 97 skin carcinomas (88 basal cell carcinomas (BCCs), 9 squamous cell carcinomas (SCCs)) of the nose, periorbital areas and ears from 40 previously untreated patients (group 1) and 57 patients who had undergone surgery (group 2). The average dose was 55 Gy [50-65] in group 1 and 52 Gy [50-60] in group 2 (mean implantation times: 79 and 74 hours respectively). We calculated survival rates and assessed functional and cosmetic results de visu. Results. - Median age was 71 years [17-97]. There were 29 T1, 8 T2, 1 T3 and 2 Tx tumors in group 1. Tumors were<2 cm in group 2. Local control was 92.5% in group 1 and 88% in group 2 (median follow-up: 55 months [6-132]). Five-year disease-free survival was better in group 1 (91% [75-97]) than in group 2 (80% [62-90]), P=0.23. Of the 34 patients whose results were re-assessed, eight presented pruritus or epiphora. One group 2 patient had an impaired eyelid aperture. Cosmetic results were better in group 1 than in group 2, with respectively 72% (8/11) vs 52% (12/23) of good results and 28 (3/11) vs. 43% (10/23) of fair results. Conclusion. - Brachytherapy provided a high level of local control and good cosmetic results for facial periorificial skin carcinomas that pose problems of surgical reconstruction. Results were better for untreated tumors than for incompletely excised tumors or tumors recurring after surgery.

[Evaluation of pulmonary function in the elderly. Intergroupe Pneumo Gériatrie SPLF-SFGG]. / Evaluation de la fonction respiratoire chez le sujet âgé. Intergroupe Pneumo Gériatrie SPLF-SFGG.

Aging is associated with a progressive decrease in lung function. As a consequence of aging, individual's reserve is diminished, but this decrease is heterogeneous between individual subjects. Many factors are involved in the overall decline in lung function. The prevalence of asthma in the elderly is estimated between 6 and 10%. Mortality due to COPD is increasing, especially among older subjects. Older subjects are at an increased risk of developing chronic diseases such as Parkinson's disease, which can have consequences for lung function. Under-nutrition is also common in the elderly and can produce sarcopenia and skeletal muscle dysfunction. The presentation of respiratory disorders may differ in the elderly, especially because of a lack of perception of symptoms such as dyspnea. The impact of bronchodilatators or corticosteroids on respiratory function has not been studied in the elderly. Drugs usually used for the treatment of hypertension or arrhythmias, which are often observed with aging, can have pulmonary toxicity. There is no difference between functional evaluation in younger and older subjects but it is more difficult to find predicted values for older patients. Performing pulmonary function tests in older patients is often difficult because of a higher prevalence of cognitive impairment and/or poor coordination. When assessing pulmonary function in the elderly, the choice of tests will be depend on the circumstances, with the use of voluntary manoeuvres dependent on the condition of the patient.

'Canalization' of the frontal sinus: a functional approach for the management of post-traumatic sinusitis with lateral bony septa. Report of two cases and long-term follow-up.

The patency of the naso-frontal duct is a key issue in the surgical management of chronic frontal sinusitis. Most of the current operative techniques only provide access to the paramedian portions of the frontal sinus. A canalization approach that allows a functional frontal sinus to be maintained while providing good access to the most lateral areas of the sinus is described herein. Two cases of severe post-traumatic frontal sinusitis, operated on successfully by canalization method based on the conservation of the frontal sinus and the maintenance of the patency of the naso-frontal duct, using both open and endonasal approaches, are reported. One patient was followed-up for 8 years and the other for 7 months. Canalization requires validation in a larger series. This approach provides an alternative to both cranialization and strictly endoscopic methods in lateralized frontal sinus retentions and allows mucocele to be avoided.

Accuracy of an automatic and patient-triggered long-term solid memory ambulatory cardiac event recorder.

This study evaluated the R-Test Evolution, a new type of cardiac event recorder bearing both patient-triggered and automatic capabilities. Its 7-day automatic arrhythmia analysis showed promising clinical advantages, especially when investigating patients with unexplained rare events such as syncope, feeling of weakness or faintness, palpitations, stroke, or in patients inconsistent in their use of patient-triggered recordings.

Serum pentosidine as an indicator of Alzheimer's disease.

Pentosidine, an advanced glycation end product (AGE), was assayed by HPLC in serum proteins from patients with Alzheimer type dementia (AD), patients with diabetes mellitus (D), and healthy (C) age-matched old subjects (mean age from each group = 84 years). Serum pentosidine was significantly different between the three groups despite similar renal function (serum creatinine < 160 micromol/L). In all groups of patients, pentosidine was independent of glycated hemoglobin (HbA1C) and the early glycation marker fructosamine and appeared to be an independent marker, mainly bound to serum albumin. Pentosidine could be an important factor useful for the diagnosis of Alzheimer's disease.

Alternative methods in the investigation of adolescents' sexual life.

PURPOSE: To describe two methodological approaches to surveying adolescents' sexual life which were combined within a national survey. METHODS: The questionnaire was designed during a 5-day workshop. Ten adolescents played the roles of imaginary adolescents involved in different situations related to sexual life. The information obtained through the analysis of these role-plays was used to establish the sequence of the questions, their content, and wording. The questionnaire was computerized so that it could be completed by the adolescents using laptop computers. Its arborescent structure, leading each respondent from one module to another, made possible the adjustment of the questions to each respondent's stage of development and type of sexual experience. RESULTS: A total of 4283 teenagers (2075 girls and 2208 boys, and 4 refusals) 16-20 years were included. Only 7.6% did not fill in the whole questionnaire. By the age of 18 years, more than 50% of boys and girls were sexually active. Half of sexually active teenagers have discussed contraception issue before engaging in their first intercourse, but much fewer (14-35%) have discussed issues related to HIV transmission. During their first sexual intercourse, the majority of the respondents used a condom (girls, 63%; boys, 58%) or condom plus oral contraception (girls, 11%; boys, 17%). CONCLUSION: Youth participation and role-play decrease the conceptual biases often associated with professionals' perceptions and bring tools enabling a better exploration of circumstances and negotiations surrounding the sexual encounter. The computerized questionnaire increases confidentiality, attractiveness, easy data collection, and, above all, adjustment of the questions to the respondent's level of experience. These methods could be more systematically used in surveys targeting sensitive issues related to adolescents' health.

PIP: This is a study, conducted among 4283 teenagers aged 16-20 years, describing two methodological approaches in surveying adolescents' sexual life, which were combined within a national survey. A computerized questionnaire was used. The sequence, contents, and wordings of the questions were based on the analysis of role-playing by 10 adolescents in a 5-day workshop. The tree-like structure of the questionnaire led each respondent from one module to another as questions were adjusted according to respondent's stage of development and type of sexual experiences. 2075 of the respondents were girls; 2208 were boys. 7.6% did not finish the questionnaire due to its length. It was found that by age 18 more than 50% of the sample were sexually active. Half of this segment discussed contraception before engaging in their first act of sexual intercourse, and a majority of them used condoms. However, only 14-35% discussed issues concerning HIV transmission. The participation of young people in the design of the questionnaire produced an enormous amount of usable information and increased the acceptability of the survey to the respondents. Moreover, it reduced the influence of professionals' perceptions, which tends to bias the concept of the survey as well as the sequence and wording of the questions. Role-playing produced more creative and spontaneous materials for the survey. This kind questionnaire is advantageous as a general model. Firstly, it strengthens the feeling of confidentiality; secondly, the focus group and role-playing approach in association with computerization favors a qualitative, flexible, and contextual approach to adolescents' sexuality.

[Adolescents and AIDS: knowledge, attitudes, behaviors, perceptions and consequences for prevention]. / Adolescents et SIDA: connaissances, attitudes, comportements, représentations et conséquences pour la prévention.

The vital issues at stake in the credibility and effectiveness of AIDS prevention programs for young people have led to the emergence of a trend in research focused on the study of adolescents' understanding of AIDS, their attitudes and behaviour towards it, and their beliefs about it. This research can be classified under the three main ways of approaching the problem: 1) results of inquiries about knowledge, attitudes and behaviour; 2) research centred on beliefs and their consequences on a social and individual level; 3) reports and analysis of prevention programs. The results obtained by the different authors bring to light certain characteristics among the adolescent population, notably, their understanding of the disease, their attitudes towards people who are HIV positive, their sexual behaviour, their beliefs about AIDS, and the general direction of the prevention programs which are best adapted to this particular population.

[Induced abortion in a Swiss canton from 1990 to 1993: implications for epidemiological surveillance]. / Interruptions de grossesse dans un canton suisse de 1990 à 1993: implications pour la surveillance épidémiologique.

BACKGROUND: To describe abortion utilization in the Canton of Vaud (Switzerland) and to identify desirable changes in the data collection system to improve the epidemiologic monitoring METHODS: Retrospective survey of the 5600 abortion requests to the Canton Health Authority for resident women between 1990 and 1993. RESULTS: Nine women out of 1000 residents requested an abortion, but the abortion rate was higher among women of foreign origin compared to Swiss women (17/1000 vs. 6/1000, p < 0.0001). The proportion of terminated recognized conceptions was 127/1000, and the ratio of IVG to livebirths was 0.18. The abortion rate was lower during adolescence (6/1000) or after 40 years of age (1.8/1000), whereas the proportion of terminated conceptions was highest at these ages (527/1000 and 312/1000). Abortion utilization in Canton of Vaud is among the lowest. CONCLUSIONS: Although these indicators do reflect a satisfactory accessibility and use of family planning services, improvements could be made. A better knowledge of the causes (motives, contraceptive method, reproductive history) and of the consequences of abortion (psycho-social implications, medical complications) would allow to design more focused prevention strategies and to fit health services to current needs. Updating the 1942 Swiss legislation is also desirable.

Body image in adolescence: cross-cultural research--results of the preliminary phase of a quantitative survey.

This preliminary phase of a quantitative research had two main objectives: to identify the emotional and relational components of body image in adolescents, and to determine whether the experience of body changes is dependent upon individuals' context. Two samples of adolescents, both 13 to 17 years of age, who were healthy, middle- or upper middle-class, and randomly chosen, participated in the study. Subjects were 80 French adolescents (40 boys and 40 girls) from a center for preventive medicine, and 60 American adolescents (30 boys and 30 girls), from a suburban high school. Thorough individual interviews were conducted with these adolescents on the basis of a precise interview guide in order to determine their perceptions, attitudes, and beliefs about body image. A thematic analysis of the content of these recorded interviews revealed the differences between adolescents from the two countries. I was found that the main cultural differences were based on the belief that the real body and the ideal body coincide, and on the way physical appearance is included in the diversity of relational experiences. Gender differences were shown to be centered more on the level of control of body changes and on self-assessment modes; the signs of a failing or troubled body image may find their origin on an individual level, in the particularities of the family and parental language about the body, and on a collective level in the social representation of the body. The consequences of these symbolic representations on the adolescents' body image and attitudes toward their own health, are presented and discussed.

[Suicidal behavior in adolescents in Switzerland: role of physicians]. / Les conduites suicidaires chez les adolescents en Suisse: le rôle des médecins.

INTRODUCTION: In most industrialized countries, suicide represents the second leading cause of death among adolescents. Swiss teenagers exhibit one of the highest death rates by suicide in Europe; however, the prevalence of suicidal conducts (suicidal ideas, projects and attempts) in Switzerland is not known. OBJECTIVES: To assess the prevalence of suicidal conducts among Swiss adolescents and to compare these figures with available data from other countries. To establish how suicidal adolescents use health services in comparison with non-suicidal adolescents. METHODS: Bivariate analyses have been performed using data from the "SMASH" study (Swiss Multicenter Adolescent Survey on Health), a national survey on the health and lifestyles of 9,268 15 to 20 years in-school youth (3,993 girls et 5,275 boys). Within a self-administered anonymous questionnaire of 80 items, five specific questions focused on suicidal conducts and lead to the distribution of respondents in four groups: no suicidal concern, suicidal ideas, suicidal plans, suicide attempt. RESULTS: Regarding the last 12 months, 5,144 teenagers (55.5%) report no suicide preoccupation at all; 2,376 (25.6%) report suicide ideas only, 1,366 (14.7%) report suicidal projects and 274 (3%) report suicide attempts. Only 40% of respondents who report a suicide attempt have talked about it to someone in their circle of family or friends. Moreover, less than 20% have spoken of their suicide with a psychologist, and although they see physicians as often as the rest of the sample, only 10% have discussed their attempt with one of them. In comparison with those free of suicidal concerns, suicidal adolescents report significantly more health problems and concerns: they feel more often tired or depressed and use medication more often. They also seem to exhibit more deviant behaviors like alcohol and drug use or runaway. CONCLUSION: Suicidal conducts, especially suicide attempts are much more prevalent among Swiss adolescents, but a small minority is acknowledged and treated by the medical profession. Physicians should be aware of this pathology and better trained both in term of detection and treatment.

[Sports activities of Swiss youths: practices, motivations and links to health]. / L'activité sportive des jeunes en Suisse: pratiques, motivations et liens avec la santé.

BACKGROUND: Despite the relevance of this research topic from a public health perspective, there is currently a lack of objective data on the frequency and context of European adolescents' sport activity, their motivations to engage in sports, as well as the links between their sport habits and their health attitudes and behaviors. OBJECTIVES: 1) to describe the sport habits of adolescents in Switzerland and their motivations to get involved in a physical activity, 2) to define the sociodemographic profile of adolescents defined as athletic, 3) to determine the nature of the associations between the frequency of sport activity and health variables. METHOD: In the 1993 Swiss Multicentric Adolescent Survey on Health, anonymous self-administered questionnaires were distributed to a national representative sample of 10,000 in-school adolescents (15 to 20 years old). The answers were investigated by means of univariate analyses. RESULTS: Half of the sample do sports more than twice a week, boys more often as part of a sports club. Motivations depend on the gender, girls doing sports for self image and health motivations and boys for competition and relational reasons. Almost all the sociodemographic characteristics show statistically significant differences between "non athletic", "fairly athletic" and "athletic" adolescents, which suggests the influence of the sociocultural background on the perception of sport activity. These three groups also differ as regards their health behaviors, attitudes and perceptions; the most athletic adolescents generally give more positive answers in terms of prevention and perceived health. These findings have implications for health promotion, notably as regards the creation of the material conditions more likely to favor adolescents' involvement in physical activity.

[Hypernatremia in the aged: clinical characteristics]. / L'hypernatrémie chez les sujets âgés. Caractéristiques cliniques.

OBJECTIVE: Hypernatremia in young adults is a rare condition, sometimes occurring after gastrointestinal diseases, osmotic diuresis or diabetes insipidus. The clinical characteristics and prognosis of hypernatremia in geriatric patients would be different. Each case must be examined separately. PATIENTS AND METHODS: We conducted a prospective uncontrolled study among patients over 70 with sodium levels equal to or greater than 150 mmol/l (at admission or during the hospitalization). RESULTS: Hypernatremia was found in 77 patients. Mean age was 84.1 +/- 6.7 years. The mean peak serum sodium level was 157.3 +/- 7.4 mmol (two-thirds ranged from 150 to 160). Hypernatremia onset was produced by a wide range of symptoms: 48% had a febrile illness, 470% were on diuretics, 15% had had a stroke, but only 9% were suffering from diarrhea or vomiting. Most of the patients had disabling chronic illnesses (62% loss of two or more ADL of Katz), severe dementia (84% level = 6 on the Reisberg global deterioration scale). In spite of fluid replacement and follow-up treatment, outcome was poor: 62% of the patients died within three months. CONCLUSION: Besides digestive and renal losses, hypernatremia in elderly patients is increased by fluid supply disorders consecutive to hypodipsia contracted at the same time as disability and dementia. Hypodipsia is a sign of poor prognosis. Prevention must be undertaken early, emphasizing the importance of identifying dehydration early among elderly people with chronic disabling illnesses.

[How to develop health education within general medicine and pharmaceutical practice? Implementation methods used in an experiment with pregnant women, adolescents and elderly people]. / Comment pratiquer l'éducation pour la santé en médecine générale ou en pharmacie? Modalités de mise en oeuvre d'une expérimentation auprès de femmes enceintes, d'adolescents ou de personnes âgées.

Through the impetus of the National Institute of Prevention and Health Education (INPES) and the National Funding Agency for Social Security (CNAMTS), five different health education interventions were designed and implemented by 61 general practitioners and pharmacists in 5 pilot locations in France. The projects involved 185 senior citizens, adolescents and pregnant women. The strategic development of these projects required training the participating health professionals for a period of one year within the framework of a structured programme. The educational interventions were subsequently designed to specifically meet health education criteria and standards, namely, incorporating a broad as well as individualised approach to the patient and including active participation in the learning process. The programme elements are not oriented towards a thematic approach, nor around a specific health topic, but rather they focus on the individual as belonging to part of a given population group. It is therefore a population oriented health education approach.