Treatment of lower urinary tract symptoms suggestive of benign prostatic obstruction in real life practice in France.

The objective of this work is to describe the profile of prevalent and incident populations suffering from lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and to analyse the management of care by 620 general practitioners (GPs) in France in 1997 and 1998. Patient records were extracted from the THALES database. Special attention was given to the use of medical therapy and switch rates (ie change to another or combination with another drug). In real life practice (RLP) French GPs predominantly utilise alpha(1)-adrenoceptor antagonists for the treatment of LUTS. This is in agreement with available evidence from randomised controlled trials (RCTs) with different medical therapies (alpha(1)-adrenoceptor antagonists, finasteride, plant extracts). On the contrary, the relatively high usage of phytotherapy might be explained by traditional and personal preferences. Using purely descriptive statistics, newer alpha(1)-adrenoceptor antagonists, alfuzosin and tamsulosin, seem to be the most frequently prescribed medical therapy for new patients and are, moreover, associated with a low switch rate.Prostate Cancer and Prostatic Diseases (2001) 4, 124-131

Quality-of-life outcomes and the use of antihistamines in a French national population-based sample of patients with perennial rhinitis.

Our primary objective in designing the first large-scale nationwide population-based survey in France was to assess the impact of perennial rhinitis on quality of life. Our secondary objective was to describe the use of drug treatment, including histamine H1 antagonists, in that population. A pollbase of 20,000 households was screened for symptoms of rhinitis. 16,786 households responded, including 35,615 patients aged over 15 years, giving an overall response rate of 84%. Using an algorithm, 1367 patients with probable perennial rhinitis were selected for a cross-sectional collection of data about the history of their condition, comorbidity, use of medical resources, sick leave and nasal symptom-related quality of life [according to the Medical Outcomes Study 36-Item Short-Form Questionnaire (SF-36)]. Finally, multivariate regression techniques were used to describe the relationship between quality-of-life scores and treatment subgroups, controlling for some other confounding factors. The point prevalence of perennial rhinitis was estimated to be 4.1% [95% confidence interval (CI): 3.9 to 4.3%]. Association of perennial rhinitis with a history of asthma was highly significant (13.4% in those with perennial rhinitis vs 3.8% in those without; odds ratio 3.26; p < 0.001). 38% of the patients with perennial rhinitis reported having taken regular medication during the last 3 months. Antihistamine use was associated with use of decongestant or topical nasal products in about one-third of patients. Four SF-36 dimensions (physical functioning, role physical, bodily pain, social functioning) showed significantly higher mean scores (indicating better quality of life) in patients receiving non-anticholinergic histamine H1 antagonist therapy, relative to those receiving other treatments, a difference that was maintained after controlling for gender, age, level of nasal symptoms, medical history of asthma and number of general practitioner visits. These results established the long term impact of perennial rhinitis on quality of life (generic and specific), and raised questions about appropriate therapy, since a positive association between current use of non-anticholinergic antihistamines with improvements on some SF-36 dimensional scores in patients with perennial rhinitis was observed.

MIG ACCESS: a population-based, nationwide, comparative survey of access to care in migraine in France.

A national control-matched survey was conducted in France to evaluate the access of migraineurs to health care. A validated IHS criteria-based diagnostic procedure for screening was conducted in adults drawn from a sample of 6,000 households. A group of 650 subjects fulfilling the IHS criteria for migraine were matched by sex, age and activity status with a group of non-headache, non-migraine controls. Response rates were 87% and 82% for the migraineurs and the controls, respectively. The comparability of the groups was demonstrated by the absence of statistical differences between either respondents versus non-respondents or migraineurs versus controls for sex, age and occupation. The 3-month prevalence of migraine was estimated at 13% (95% CI: 12-14). The health care consumption of migraineurs was not higher than that of the controls. Migraineurs rarely consult for headaches and seem to content themselves with their routine analgesic treatment. They believe, however, that improvement in their condition is possible and discuss this with their physicians. This ambivalent attitude mainly reflects a fatalistic outlet which may constitute the major obstacle of an improved management of migraine.

[French translation of Schalling-Sifneos Personality Scale Revised and Beth Israel Questionnaire, 2 evaluation tools of alexithymia]. / Traduction Française du Schalling-Sifneos Personality Scale Revised, et du Beth Israel Questionnaire, deux instruments d'évaluation de l'alexithymie.

The concept of alexithymia was first proposed in the 1960's by Sifneos and Nemiah to describe personality traits originally found in psychosomatic patients but which have since been found in other types of patients (alcoholics, drug addicts, traumatic stress disorder patients, sociopaths) as well as in the general population. Etymologically, alexithymia signifies: incapacity to speak one's emotions (from the Greek: a, lack; lexis, word; thymos, sentiments). Alexithymia is not the impossibility of feeling one's emotions, but rather the impossibility of associating them with corresponding mental representations and thus verbalizing them. Such patients tend to act out, to speak circumstantially, and to have difficulty in relationships. A neurophysiological substratum, the absence of connexions between the limbic system and the neo-cortical regions, has been suggested by Sifneos, who has distinguished primary and secondary alexithymia. A "biological" deficit seems to be responsible for primary alexithymia, such as in found in split-brain patients or aprosodias in patients with right hemispheric strokes. Secondary alexithymia, on the other hand, seems to be due to psychodynamic factors such as massive utilisation of defense mechanisms like denial, repression and regression. Appropriate psychotherapy for such patients is debatable, but it seems that in most cases the analytical approach should be replaced by more directive therapies, including relaxation and bio-feedback, to help patients learn to stimulate, master, and verbalize their emotions. The Beth Israel Questionnaire (BIQ) is a rating scale evaluating such traits that is filled out by the rater based on a clinical interview.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-reported psychotropic drug use and associated factors in a French community sample.

Drug use was examined in a French general population adult sample from a household survey conducted in 1987-8 in a newly built town near Paris. Psychotropic drug use was measured by the percentage of subjects reporting their use during the past week. It was prominently represented by benzodiazepines (90% of psychotropic users), differed strongly between genders (4.6% in men, 10.2% in women) and age groups (higher after 40 years). A lifetime history of major depressive episode (MDE) or of anxiety disorders was associated with a higher proportion of psychotropic drug use. Psychotropic drug use also went with a current well-being questionnaire score. Using a logistic analysis, the following set of variables held for women: well-being score, history of both MDE and anxiety disorder, age, and marital status. Making allowance for the cross-sectional nature of this retrospective survey, these finding confirmed the relatively high level of benzodiazepine drug use in an urban French community sample and emphasized its association with mental health status.

[Detection of the anxio-depressive disorders in liaison psychiatry. Contribution of the General Health Questionnaire]. / Dépister les troubles anxio-dépressifs en psychiatrie de liaison. L'apport du General Health Questionnaire (GHQ).

Among self-report inventories of psychopathology for adults, the General Health Questionnaire (GHQ) is one of the prominent instruments developed for the screening of minor psychiatric morbidity. Four versions of the GHQ were provided from the original 60 items (GHQ-30, 28, 20, 12) and three different scorings have been suggested. A large number of validity studies, mostly favourable, have been performed and are reviewed in this paper. Recent work has suggested that the sensitivity of the GHQ to clinical change was fair, compared to the Present State Examination. The most recent version, the GHQ-28, was built from factor analyses of the 60-item version and covered four dimensions, with seven items each: anxiety and insomnia, severe depression, social impairment, somatic complaints, but their subscores were not independent. Several international extensive studies have confirmed that the GHQ was an interesting tool in Community as well as in General Practice. But, as it falls short from detecting all the chronic cases, research aimed at improving its quality in this direction is still in progress. The use of the French version of the GHQ-28 is expected to be encouraged.

Anxiety disorders in a French general psychiatric outpatient sample. Comparison between DSM-III and DSM-IIIR criteria.

In a general psychiatric outpatient sample (n = 1271) gathered through a cross-national French survey, anxiety and somatoform syndromes were assessed according to DSM-III and DMS-III-revised criteria. Lifetime and one-month prevalence rates in this population are provided and the high level of comorbidity between the anxiety syndromes is noted. The patient symptom profiles for panic syndrome, simple attacks, agoraphobia and generalized anxiety are displayed. The conspicuous consequences of the modifications brought in by the Revision-anticipatory anxiety in panic syndrome, and restricted period criteria for generalized anxiety- are discussed, with the conclusion that more field study assessment is required before further revision.

[Prevention of AIDS transmission by syringes and needles in France and Africa]. / Prévention de la transmission par les seringues et aiguilles du V.I.H. en France et en Afrique.

A study made among drug addicts in the Northern suburbs of Paris enables establishing a stabilisation of positive H.I.V. serology prevalence among them, a fact related to the free sale of syringes and needles. In Africa, the nosocomial transmission of H.I.V. by non-sterilisable but reused needles and syringes is demonstrated, and two cases are described. Its importance is certain but must be precise. The prevention of this epidemiological modality must be done by systematic use of reusable and sterilisable injectable material.

PIP: Reuse of disposable needles and syringes plays an important role in the transmission of HIV in France as in Africa. From September 1985-March 1986, 51% of drug addicts systematically screened in the northern suburbs of Paris were found to be HIV positive. Studies in the same population through 1988 indicated that the rate of HIV infection had remained stable, as had the average age of addicts, duration of addiction, and sex ratio. Stabilization of seropositivity rates among drug addicts in the northern suburbs in believed to have been due to information programs alerting addicts to the risk of contamination through sharing of needles and to the legal sale of syringes and needles instituted in May 1987. HIV transmission through reuse of disposable needles and syringes has been demonstrated in Africa. It is attributable to the poverty of health services and of the general population. The significance of HIV transmission by reuse of disposable materials in the health services appears to be considerable but is difficult to quantify. Prevention of transmission by this means will require correct use of sterilizable needles and syringes.

Social, professional conditions and arterial hypertension: an epidemiological study in Dakar, Senegal.

A group of men and women (1315 and 554, respectively) employed by six companies in Dakar, Senegal, underwent a cross-sectional study. The prevalence of arterial hypertension, according to the WHO criteria, was found to be 7.4% among the men and 10.2% among the women. Risk factors for high blood pressure were: age, body mass index, illiteracy and factors related to occupation, such as occupational category and working conditions (e.g. noise and shift work). Therapeutic control was low in this community. Awareness of hypertension was high, but a high percentage of false positive diagnosis was observed among subjects labelled as hypertensives, on the basis of inaccurate blood pressure measurement.

[Hypercalcemia complicating Waldenström's disease: a manifestation of Richter's syndrome]. / Hypercalcémie compliquant une maladie de Waldenström: révélation d'un syndrome de Richter.

Acute hypercalcemia occurred during the following-up of a 70 years old man with Waldenström's Macroglobulinemia (WM). Hematological data were still unchanged in spite of stopping treatment 16 months ago. It is an unusual complication in chronic lymphoproliferative disorders (except, multiple myeloma) and it was never described in the course of WM. It was related to the emergence of diffuse immunoblastic lymphoma, as it has been termed Richter syndrome in chronic lymphocytic leukemias. In WM, this occurrence is less known, but symptoms and prognostic are similar. It is to be pointed out that the spontaneous decrease of the amount of monoclonal IgM is an ominous sign of this immunoblastic transformation. The pathogenesis of hypercalcemia is discussed: the eventuality of a tumoral osteoclast activating factor is suggested.

[Fragmenting of the His potential after atrial stimulation]. / Fragmentation du potentiel hisien après extrastimulus auriculaire.

Splitting of the His potential (H) in sinus rhythm is generally considered to be pathological but its significance during programmed atrial stimulation is not clear. This phenomenon was observed in 10 out of 53 patients aged between 19 and 45 years (average 31.8 years) not suspected of having paroxysmal intranodal block (asymptomatic, sinus rhythm without bundle branch block). Under basal conditions the H and the HV interval (35 to 50 ms; average 41 ms) were normal. Split H was observed with pacing periods of 680 to 885 ms (average 754 ms) and H1 H2 intervals of 325 to 450 ms (average 395 ms). The maximal interval between the split potentials ranged from 80 to 130 ms (average 100 ms). Splitting disappeared at the shortest periods when variable pacing cycles were used. The response to regular atrial pacing up to 150 bpm (10 cases) and to Ajmaline (1 mg/Kg) (4 cases) was normal. All patients but one were followed up to 10 to 41 months (average 21.4 months); the clinical and ECG parameters remained stable during this period. The presence of fragmented potentials between the atrial and ventricular complexes during programmed atrial stimulation may pose a difficult diagnosis problem, especially with respect to delayed atrial potentials. Splitting of the H is generally attributed to dispersion of the depolarisation wave front in the His bundle due to the persistence of the functional refractory state. Other mechanisms, especially longitudinal dissociation of the His bundle, may be discussed. From a prognostic point of view, this finding does not seem to carry more serious implications than simple lengthening of the HV interval or intranodal conduction delay, phenomena usually considered to be non-pathological.