[Asthma and scuba diving: Creation and evaluation of a website (For doctors, asthmatics and diving instructors)]. / Asthme et plongée sous-marine : création et évaluation d'un site internet (à destination des médecins, plongeurs asthmatiques et moniteurs de plongée).

INTRODUCTION: Scuba diving has long been strictly contraindicated for asthmatics; this contraindication has been questioned in recent years. Our objective was to provide a website, evaluated by its users, for doctors, diving instructors and asthmatics. MATERIALS AND METHODS: Creation of the site Asthme-Plongee.com based on a peer-reviewed literature review, then distribution of a questionnaire in summer 2018 to diving clubs, general practitioner groups, pulmonologists and FFESSM federal offices, and via social networks. RESULTS: Our sample consisted of 413 assessors, including 264 health professionals (63.9%), 74 asthmatics (17.9%) and 92 diving instructors (22.3%), spread over the entire territory of France. The structure of the website, the clarity of the information written and its relevance were generally appreciated by the entire population with a median score of 8/10. The site was found useful: 72.9% of respondents thought they would visit it later. CONCLUSION: Faced with a growing number of amateur divers, it seems essential to raise awareness of current recommendations and good diving practices.

[Study of practices: What do general practitioners first propose when faced with asymptomatic lower extremity peripheral artery disease?] / Enquête de pratiques : que proposent en premier les médecins généralistes devant une artériopathie asymptomatique des membres inférieurs ?

INTRODUCTION: Peripheral artery disease of lower limbs (PAD) can be discovered at an asymptomatic stage by the realization of systolic pressure indices. The 2006 recommendations of the French National Authority for Health on AOMI encourage the systematic prescription of antiplatelet agents; the 2012 recommendations on the proper use of antiplatelet agents no longer encourage it in the case of asymptomatic PAD. These two recommendations still coexist. Our objective was to determine the management of an asymptomatic PAD by general practitioners. METHODS: Descriptive and analytical epidemiological study, with analysis of practices, prospectively addressed by postal questionnaire to a randomized sample of 220 GPs practicing in the European Metropolis of Lille between December 15, 2016 and February 15, 2017. The question was: "if an asymptomatic PAD is discovered in a 50-year-old patient who is otherwise in good general condition, what do you generally do?" RESULTS: Our sample was 92 general practitioners (42% participation). Of these, only 6 were practicing HPIs. Before an asymptomatic PAD, management included an opinion from an angiologist (84%) and/or a cardiologist (75%) before the drug was prescribed (antiplatelet agent for 57%, statin for 33% and ACE inhibitor for 14%). CONCLUSION: The extension assessment was carried out in more than 8 out of 10 cases. The use of antiplatelet antiaggregants was significant, which can be explained by the coexistence of divergent recommendations. The rapid clarification of recommendations is essential with the evolution of scientific data.

[Changes in blood pressure after introduction of an antidepressant in a public institution of mental health]. / Évolution de la pression artérielle après introduction d'un antidépresseur en établissement public de santé mentale.

INTRODUCTION: Primary prescribing of antidepressants is common in general practice. The relationship between antidepressant introduction and blood pressure (BP) changes is not well established in the literature. The purpose of our study was to examine the short-term course of AHR with and without the introduction of an antidepressant into a public institution of mental health (EPSM). MATERIALS AND METHODS: An exposed/non-exposed single-centre analytical epidemiological study on a retrospective cohort, with a collection of data on stays between 2013 and 2015 at the EPSM in Armentières. The stays were divided into two groups: antidepressant treatment (introduced during the stay) and control (without antidepressant). BP measurements were taken over a 30-day period per stay. To assess the evolution of AHR across groups, we used a nested mixed linear regression model with multivariate adjustment. RESULTS: Out of 1241 stays analysed, 124 were in the treated group and 1117 in the control group. The average age was 44.6±14.7 years. The two groups were comparable on most of the variables analyzed. The change in systolic BP was associated with systolic BP values at baseline, history of hypertension, presence of an antihypertensive drug and BMI; the change in diastolic BP was associated with diastolic BP values at baseline, presence of an antihypertensive drug, BMI and history of bipolar disorder. We find no significant difference in the evolution of BP over time between the treated group and the control group over the 30 days of measurement per stay, after adjustment (evolution coefficient of +0.12mmHg systolic BP and -0.1mmHg diastolic BP, P=0.45 and 0.38 respectively). CONCLUSION: These results are reassuring on the early development of BP after the introduction of antidepressants. They should not overlook the frequent effects of depression and antidepressants on cardiovascular risk (decreased physical activity, dyslipidemia, weight gain, etc.).

Shift in Hospitalizations for Alzheimer's Disease to Related Dementias in France between 2007 and 2017.

INTRODUCTION: Alzheimer's disease (AD) is the first cause of dementia. Diagnostic criteria have evolved: proposals to revise the NINCDS-ADRDA criteria were published in 2007. Our aim was to analyze the evolution in the coding of AD in the French nationwide exhaustive hospital discharge database (PMSI) between 2007 and 2017. METHODS: We analyzed evolution of International Classification of Diseases and Related Health Problems, 10th edition (ICD-10) coding for AD and AD dementia in the PMSI database from 2008 to 2017 (285,748,938 inpatient stays). RESULTS: We observed a 44% decrease in the number of inpatient stays with a principal diagnosis of AD or AD dementia from 2007 (46,313 inpatient stays) to 2017 (25,856 inpatient stays) in France. Over the same period, we observed a 49% increase in the number of inpatient stays with a principal diagnosis of related dementias (other organic mental disorders or other degenerative disorders). Overall, the number of inpatient stays for dementia remained stable despite the increase in the total number of inpatient stays: 95,377 in 2007 (0.409% of inpatient stays) and 99,190 in 2017 (0.344%). CONCLUSION: We therefore note a shift from AD and AD dementia to other dementia diagnoses since 2007. This study suggests a more accurate use of AD related ICD-10 codes since the revised criteria in 2007.

Factors Associated with Alzheimer's Disease: An Overview of Reviews.

Alzheimer's disease (AD) is a frequent pathology, with a poor prognosis, for which no curative treatment is available in 2018. AD prevention is an important issue, and is an important research topic. In this manuscript, we have synthesized the literature reviews and meta-analyses relating to modifiable risk factors associated with AD. Smoking, diabetes, high blood pressure, obesity, hypercholesterolemia, physical inactivity, depression, head trauma, heart failure, bleeding and ischemic strokes, sleep apnea syndrome appeared to be associated with an increased risk of AD. In addition to these well-known associations, we highlight here the existence of associated factors less described: hyperhomocysteinemia, hearing loss, essential tremor, occupational exposure to magnetic fields. On the contrary, some oral antidiabetic drugs, education and intellectual activity, a Mediterranean-type diet or using Healthy Diet Indicator, consumption of unsaturated fatty acids seemed to have a protective effect. Better knowledge of risk factors for AD allows for better identification of patients at risk. This may contribute to the emergence of prevention policies to delay or prevent the onset of AD.

[Are abdominal aortic aneurysm screening guidelines followed? Prospective study in Dunkerque's hospital emergency room]. / Les recommandations de dépistage de l'anévrysme de l'aorte abdominale sont-elles respectées ? Étude prospective aux urgences de Dunkerque.

AIM OF THE STUDY: Are the recommendations issued by the Haute Autorité de santé in 2012 on screening for abdominal aortic aneurysm (AAA) being applied? METHOD: We interviewed the target patients, ex. male patients aged 65 to 75, smokers or former smokers, or as young as 50 in the event of a family history of AAA in the parents or siblings, entering the emergency room of Dunkerque between May 7 and December 31, 2015. We asked them if they had had an abdominal aortic ultrasound, or an abdominal ultrasound, or an arterial Doppler ultrasound of the lower limbs, and when, to see if they had had an AAA test since November 2012. RESULTS: We included 55 patients and excluded 5 of 180 eligible patients (31 %). It was not possible to conclude for 4 patients due to missing data. Thirteen of 46 patients (28.3 %, 95 % CI [16.0-43.5]) have had AAA ultrasound screening since November 2012; 33 have not (71.7 %, 95 % CI [56.5-84.0]) and no screening was offered. Of the 13 patients screened, 7 were screened by the attending physician (53.9 %, 95 % CI [25.1-80.8]) and 6 by another specialist (46.2 %, 95 % CI [19.2-74.9]). CONCLUSION: AAA screening in our population is low. Physicians should be urged to publicize and implement the November 2012 French recommendations to reduce AAA-related mortality.

Vascular dementia encoding in the French nationwide discharge summary database (PMSI): Variability over the 2007-2017 period.

OBJECTIVE: Vascular dementia (VaD) is the second leading cause of dementia. Diagnostic criteria have evolved from the concept of multiple infarctions to different subtypes: acute onset VaD, subcortical VaD, mixed cortical and subcortical VaD. Our aim was to analyze the evolution in the coding of these different subtypes of VaD in the French nationwide exhaustive hospital discharge database (PMSI) between 2007 and 2017. METHOD: We included all principal diagnoses of VaD in the PMSI hospital stays from 2007 to 2017. RESULTS: Between 2007 and 2017, we show a relative decrease in the number of hospital stays for VaD compared to all hospital stays (0.0437% to 0.0404%). The 11,654 hospital stays for VaD in 2017 represent 13.5% of mental organic disorders. Subtype analysis shows a decrease in hospital stays for multiple infarctions between 2007 and 2017 (-50%), an increase for subcortical or mixed VaD (+20%), acute onset VaD (+184%) and an increase in "other VaD" (+85%). CONCLUSION: These data suggest a slight decrease in hospital stays for VaD, possibly related to better control of cardiovascular risk factors. They also suggest that the coding should be consistent with the evolution of diagnostic criteria.

[Abortion in Hauts-de-France: When to expect the first appointment?] / Interruption volontaire de grossesse dans les Hauts-de-France : quel délai pour un premier rendez-vous ?

BACKGROUND: According to the French National Authority for Health ("Haute Autorité de santé"), the first appointment for an abortion should take place within five days of the request. Whether this deadline is met or not in the Hauts-de-France region is not known. AIM: The aim of this study was to measure the time needed to get a first appointment for an abortion in Hauts-de-France. METHOD: We conducted a telephone survey of health facilities, family planning and registered practitioners practicing abortions in the Hauts-de-France region, to determine the next appointment available for a woman requesting an abortion. The calls took place between April 10 and 14, 2017. The time needed to get a first appointment (means±standard deviations) was calculated for the region, the departments, the districts and the health facilities and practitioners. RESULTS: We contacted 93 health facilities and practitioners and 70 were included in the study. The time needed to get a first appointment for an abortion in Hauts-de-France was measured at 5.25±5.20 days: 6.32±4.72 days for health facilities, 3.84±5.11 days for gynecologists, 5.22±5.88 days for general practitioners and 0.67±0.58 days for private-practice midwives. Fifty-six percent of health facilities and practitioners gave the appointment within five days. Between the districts, the average time varied from 1 to 15.5 days. CONCLUSION: The average time needed to get a first appointment for an abortion in Hauts-de-France was near the 5-day deadline recommended by the French National Authority for Health. The training of private practice midwives and general practitioners may be the first step in shortening it in some districts where access to health care is limited.

[Diving and asthma: Literature review]. / Plongée sous-marine et asthme : revue de littérature.

INTRODUCTION: Scuba diving has long been contraindicated for asthmatics. Recommendations are evolving towards authorisation under certain conditions. Our objective was to review the literature on the risks associated with scuba diving among asthmatics and about recommendations on this subject. MATERIALS AND METHODS: We used the MEDLINE and LiSSa databases, until June 2018, in French, English or Spanish language, with the keywords "asthma AND diving" and "asthme plongée" respectively. References to the first degree were analyzed. RESULTS: We have included 65 articles. Risk of bronchospasm is well documented, particularly in cold and/or deep water, or in the event of exposure to allergens (compressor without filter). Nonasthmatic atopic divers may be at greater risk of developing bronchial hyper-reactivity. Although the theoretical risk exists, epidemiological studies do not seem to show an over-risk of barotrauma, decompression sickness or arterial gas embolism in asthmatics. French, British, American, Spanish and Australian societies agreed on the exclusion of patients with moderate to severe persistent asthma, FEV1<80%, active asthma in the last 48hours, exercise/cold asthma and poor physical fitness. CONCLUSION: A diver's examination should include a triple assessment: asthma control, number of exacerbations and treatment compliance. Homogenizing the recommendations would improve the framework for the practice of diving among asthmatics and allow larger studies in this population. Communicating the current recommendations remains important to divers, dive instructors and doctors in the context of the development of scuba diving.

[Androgens and cardiovascular risk: A series of case report in the French and Canadian pharmacovigilance databases]. / Androgènes et risque cardiovasculaire : série de cas dans les bases de pharmacovigilance française et canadienne.

INTRODUCTION: Age-related androgenic deficiency (DALA) is a pathology that is increasingly cited in recent publications. The cardiovascular risk of testosterone is debated: present for the FDA, absent for the European Medicines Agency in 2015. Our objective was to analyze the association between androgens and vascular pathologies in adverse reactions reported in pharmacovigilance databases. MATERIAL AND METHOD: We conducted a retrospective case series study of the French and Canadian pharmacovigilance databases for the period 2005-2015. Cases were defined as the association of the occurrence of a cardiovascular event (myocardial infarction or stroke) and the presence of testosterone in the treatment of patients. RESULTS: Of the 10 years analyzed, 12 French cases and 6 Canadian cases (representing 13 MIs and 5 strokes) were recorded in men aged 55 years on average. All were doubtful: differential diagnoses were possible (2.4 confounding conditions on average per patient) and overall cardiovascular risk was high for the majority of cases. CONCLUSION: Our study shows a very low report of cardiovascular effects under testosterone, all doubtful. Pending further studies, it seems reasonable to consider the cardiovascular risk of patients who are candidates for hormone therapy for age-related androgen deficiency. LEVEL OF EVIDENCE: 3.

[Preferences of general practitioners in metropolitan France with regard to the delegation of medico-administrative tasks to secretaries assisting medico-social workers: Study in conjoint analysis]. / Préférences des médecins généralistes libéraux en France métropolitaine quant à la délégation des tâches médico-administratives aux secrétaires assistant(e)s médico-social(e)s : étude en analyse conjointe.

BACKGROUND: A general practitioner's office is an economic unit where task delegation is an essential component in improving the quality and performance of work. AIM: To classify the preferences of general practitioners regarding the delegation of medical-administrative tasks to assistant medical-social secretaries. METHOD: Conjoint analysis was applied to a random sample of 175 general practitioners working in metropolitan France. Ten scenarios were constructed based on seven attributes: training for medical secretaries, logistical support during the consultation, delegation of management planning, medical records, accounting, maintenance, and taking initiative on the telephone. A factorial design was used to reduce the number of scenarios. Physicians' socio-demographic variables were collected. RESULTS: One hundred and three physicians responded and the analysis included 90 respondents respecting the transitivity of preferences hypothesis. Perceived difficulty was scored 2.8 out of 5. The high rates of respondents (59%; 95% CI [51.7-66.3]) and transitivity (87.5%; 95% CI [81.1-93.9]) showed physicians' interest in this topic. Delegation of tasks concerning management planning (OR=2.91; 95% CI [2.40-13.52]) and medical records (OR=1.88; 95% CI [1.56-2.27]) were the two most important attributes for physicians. The only variable for which the choice of a secretary was not taken into account was logistical support. CONCLUSION: This is a first study examining the choices of general practitioners concerning the delegation of tasks to assistants. These findings are helpful to better understand the determinants of practitioners' choices in delegating certain tasks or not. They reveal doctors' desire to limit their ancillary tasks in order to favor better use of time for "medical" tasks. They also expose interest for training medical secretaries and widening their field of competence, suggesting the emergence of a new professional occupation that could be called "medical assistant".

[Theoretical and practical assessment of Lille general practice and pharmacy students' knowledge about use of inhaler devices for asthma control]. / Évaluation théorique et pratique de la connaissance d'utilisation des dispositifs inhalés dans l'asthme chez les internes en médecine générale et les étudiants en pharmacie de Lille.

INTRODUCTION: Asthma is a potentially serious chronic respiratory disease impacting patients quality of life. Satisfactory control requires proper use of inhaled devices. This study assesses general medical residents and pharmacy students knowledge about proper use of inhaled asthma devices. MATERIALS AND METHODS: We evaluated knowledge of 43 general practice students and 43 pharmacy students in Lille for three inhaler devices (metered-dose inhaler, Turbuhaler® and Diskus®) during individual interviews. Students were assessed on 8 proper use criterias for each device. RESULTS: General practice and pharmacy students are unfamiliar with proper use of inhaler devices. However, pharmacy students get better average scores than general practice students for all devices included in this study: 6.3/8 respected criterias against 5/8 for metered-dose inhaler; 5.3/8 against 3.2/8 for Turbuhaler®; and 6/8 against 4.3/8 for Diskus®. Pharmacy students more frequently perform a demonstration of proper use to patients when a device is first prescribed or when a prescription is renewed; general practice students more frequently ask patients themselves to perform a demonstration of proper use. CONCLUSION: Introducing trainings workshops for inhaler devices to pharmacy and general practice students appears appropriate in order to promote therapeutic patient education, to increase asthma control and better patients life quality.

[Antiemetics and cardiac effects potentially linked to prolongation of the QT interval: Case/non-case analysis in the national pharmacovigilance database]. / Antiémétiques et effets cardiaques potentiellement liés à un allongement de l'intervalle QT : analyse cas/non-cas dans la Base nationale de pharmacovigilance.

OBJECTIVES: Observational retrospective studies have linked domperidone and prolonged QT interval, ventricular arrhythmias and risk of sudden death. Since then, antiemetic prescription was applied to other molecules (including metopimazine). The aim of this study was to evaluate the profile of adverse cardiac effects associated with QT prolongation for each antiemetic available in France. METHODS: We conducted disproportionality analyses (case/non-case method), based on the observations recorded consecutively in the French national pharmacovigilance database between 2004 and 2013. Cases were defined by following MedDRA terms: prolongation of the QT interval, syncope, sudden death, cardiac arrest, ventricular arrhythmias including torsades de pointes; non-cases were other adverse events reported during the same period. We analyzed the presence of each antiemetic among cases and non-cases and measured the disproportionality by reporting odds ratios (ROR). We validate the assay with a positive control (methadone) and a negative control (acetaminophen). RESULTS: We compared 2093 cases (94 with antiemetics) to 253,665 non-cases (7015 with antiemetics). Among antiemetics, adverse cardiac effects studied were more frequently found with notifications including domperidone (ROR=2.0, 95% CI=[1.3; 3.0]), ondansetron (ROR=1.8, 95% CI=[1.3; 2.6]) and granisetron (ROR=3.4, 95% CI=[1.5; 7.6]). Metopimazine was not statistically associated with that risk (ROR=2.0; 95% CI=[0.8; 4.8]). CONCLUSION: We confirmed a risk of cardiac adverse event related to prolongation of the QT interval with domperidone and setrons. These results suggest caution when prescribing antiemetics and encourage systematic reporting of adverse cardiac effects observed with these molecules.

[Pharmacovigilance center --internal medicine interactions: A useful diagnostic tool]. / Interactions pharmacovigilance--service de médecine interne: une aide précieuse au diagnostic.

PURPOSE: Patients hospitalized in internal medicine often have unexplained clinical symptoms for which a drug origin can be considered. The prevalence of patients hospitalized for iatrogenic is estimated between 4-22%. We wanted to evaluate the diagnostic value of the regional center of pharmacovigilance to identify or confirm an iatrogenic disease in the department of internal medicine of Lille and characterize factors associated with drug-related side effect. METHODS: This is a single-center prospective diagnostic study. We included all subsequent requests from the department of internal medicine with the Nord-Pas-de-Calais regional pharmacovigilance center between 2010 and 2012. The opinion of the regional pharmacovigilance centre was held on the record of the adverse drug reaction in the national pharmacovigilance database and analyzed according to the conclusion of iatrogenic used by clinicians in internal medicine (reference diagnosis) with a follow-up to June 2013. The variables relating to the patient, medication and adverse events were analyzed by binary logistic regression. RESULTS: We analyzed 160 contacts: 118 concordant cases, 38 false-positives (drug-related side effect retained by the regional pharmacovigilance center only), 4 false negatives. Registration in the national pharmacovigilance database had a sensitivity of 96% (95% CI [0.92 to 0.99]), a specificity of 46% (95% CI [0.38 to 0.53]), a value positive predictive of 69% (95% CI [0.62 to 0.76]), a negative predictive value of 89% (95% CI [0.84 to 0.94]) and a negative likelihood ratio of 0.1. False-positive had chronological and semiological accountabilities questionable (adjusted RR=2.1, 95% CI [1.2 to 2.8]). CONCLUSION: In our study, the regional pharmacovigilance center confirms the clinician's suspicion of drug-related side effects and helps to exclude drug-induced with a high negative predictive value.