The prevalence of overweight and obesity, and distribution of waist circumference, in adults and children in the French Overseas Territories: the PODIUM survey.

AIM: This study aimed to describe the prevalence of overweight (excluding obesity) and obesity, and distribution of waist circumference, in children and adults in four French Overseas Territories (Guadeloupe, Martinique, French Guiana in the Caribbean and French Polynesia in the Pacific Ocean). METHODS: The survey was designed to provide a sample representative of the population in each of the four territories. The protocol aimed to evaluate 600 adults (aged ≥ 15 years) and 300 children (aged: 5-14 years) in each territory. RESULTS: In children, the differences were small among the territories in the prevalence of overweight (excluding obesity), as defined by the International Obesity Task Force (IOTF): Guadeloupe, 15.4%; Martinique, 17.0%; French Guiana, 13.2%; and French Polynesia, 17.2% (P = 0.49). Larger, significant, differences were observed for obesity, with prevalences of 7.2%, 7.7%, 5.4% and 15.9%, respectively (P < 0.002). In adults, the prevalence of obesity also differed significantly among the territories: 22.9%, 22.0%, 17.9% and 33.1% in Guadeloupe, Martinique, French Guiana and French Polynesia, respectively (P < 0.001, adjusted for age and gender). However, overweight (excluding obesity) was again more homogeneously distributed, with prevalences of 31.7%, 33.6%, 30.3% and 34.4%, respectively (P = 0.43, adjusted for age and gender). Waist circumference was larger in French Polynesia than in the other territories in both genders, and in both children and adults. CONCLUSION: While the distribution of overweight was relatively homogeneous, the prevalence of obesity differed considerably across the four territories. It was especially high in French Polynesia, and in children and women. Appropriate programmes are urgently needed in these populations, especially in children, to avoid the morbidity associated with obesity.

Discrimination of single features and conjunctions by children.

Stimuli that are discriminated by a conjunction of features can show more rapid early processing in adults. To determine how this facilitation effect develops, the processing of visual features and their conjunction was examined in 7-12-year-old children. The children completed a series of tasks in which they made a target-non-target judgement as a function of shape only, colour only or shape and colour features, while event-related potentials were recorded. To assess early stages of feature processing the posteriorly distributed P1 and N1 were analysed. Attentional effects were seen for both components. P1 had a shorter latency and P1 and N1 had larger amplitudes to targets than non-targets. Task effects were driven by the conjunction task. P1 amplitude was largest, while N1 amplitude was smallest for the conjunction targets. In contrast to larger left-sided N1 in adults, N1 had a symmetrical distribution in the children. N1 latency was shortest for the conjunction targets in the 9-10-year olds and 11-12-year olds, demonstrating facilitation in children, but which continued to develop over the pre-teen years. These data underline the sensitivity of early stages of processing to both top-down modulations and the parallel binding of non-spatial features in young children. Furthermore, facilitation effects, increased speed of processing when features need to be conjoined, mature in mid-childhood, arguing against a hierarchical model of visual processing, and supporting a rapid, integrated facilitative model.

Intravenous lidocaine and small-intestinal size, abdominal fluid, and outcome after colic surgery in horses.

Twenty-eight horses with the diagnosis of an intestinal disorder requiring surgical intervention were randomly assigned to lidocaine (n = 13) or saline (control, n = 15) treatment groups. After induction of anesthesia, treated horses received a loading dose of 2% lidocaine (0.65 mg/kg) intravenously, followed by a continuous rate of infusion of 1% lidocaine (0.025 mg/kg/min) until the discontinuation of anesthesia. Upon recovery from anesthesia, a 2nd loading dose of 2% lidocaine (1.3 mg/kg) was administered, followed by an infusion of 1% lidocaine (0.05 mg/kg/min) for 24 hours postoperatively. The control group received equivalent volumes of saline. Lidocaine-treated horses had significantly better minimum jejunal cross-sectional area scores (P = .011), minimum jejunal diameter scores (P = .002), and intestinal ultrasound index (IUI) (P = .007). Peritoneal fluid was detected by percutaneous ultrasound examination in 8 of the 15 control animals but in none of the treated animals (P = .003). Failure to obtain fluid via abdominocentesis was significantly more frequent for lidocaine-treated horses (P = .025). No significant differences between the groups were found in the presence of gastrointestinal sounds, time to passage of 1st feces, number of defecations in the 1st 24 hours, presence of gastric reflux, duodenal or jejunal wall thickness, maximum duodenal or jejunal diameter or cross-sectional area, minimum duodenal diameter or cross-sectional area, duodenal and jejunal intraluminal echogenicity, small-intestinal contractions per minute, rate of complications, or outcome. On the basis of this study, lidocaine infusion may have some desirable effects on jejunal distension and peritoneal fluid accumulation and was well tolerated perioperatively in horses with colic. The low incidence of small-intestinal lesions and gastric reflux in the study makes it difficult to assess the use of lidocaine in the prevention of postoperative ileus (POI).

Binding occurs at early stages of processing in children and adults.

Conjoining features in a high-rate serial presentation was studied in children and adults using event-related potentials. Three blocks of trials were run in which targets were defined by colour, by orientation or by a conjunction of colour and orientation. Only adults had faster RTs when detecting targets defined by a single feature than by a combination of features. Compared with adults, children had longer RTs, longer N1 and P2 latencies, and larger P1 and P2 amplitudes. Amplitudes asymmetries were consistent with differing cortical regions being implicated in the processing of colour and form. There were, however, no ERP latency effects as a function of task, suggesting that the binding of features proceeds in parallel with the processing of single features.

The 1999 French Venous Disease Survey: epidemiology, management, and patient profiles.

A recent (1999) Sofres survey of representative samples of the adult French population aged 15 and over showed that almost half this population suffered from lower limb venous complaints and that 43% of them were untreated. Of those treated, 24.2% received venotropics, including 21.5% by prescription, while 6.0% practiced self-medication. Venous disease sufferers form a relatively underprivileged sector of the population in terms not only of age, income, work and living conditions, but also of general health and medical history. Despite its clinical efficacy and potential social utility, venotropic treatment is possible only if backed by adequate state health insurance coverage supplemented by mutual and private insurance schemes. Any restriction to such coverage will only decrease access to prescription venotropics.

Hexamethyidisiloxane: A 13-week subchronic whole-body vapor inhalation toxicity study in Fischer 344 rats.

Hexamethyldisiloxane (HMDS) is a volatile linear siloxane dimer used in many applications, including precision cleaning, active ingredient carrier, and as a manufacturing intermediate. The purpose of this study was to characterize the subchronic vapor inhalation toxicity of the material as part of a comprehensive toxicology program. Groups of 20 male and 20 female Fischer 344 (F344) rats were exposed to nominal (and mean actual) vapor concentrations of 0, 50 (50), 200 (194), 600 (593), 1,500 (1,509) and 5,000 (5,012) ppm of HMDS, 6 hours per day, 5 days per week, for 13 weeks. No treatment-related signs of clinical toxicity or mortality, statistically significant effects upon body weight gain or food consumption, ophthalmoscopic changes, gross macroscopic necropsy findings, or organ weight changes were noted. Minor hematological, clinical biochemical, and urinalysis changes were seen but were not considered to be of toxicological relevance. Histological lesions in the kidney apparently consistent with male rat-specific alpha-2-urinary globulin nephropathy were observed in male rats exposed to 593, 1,509, and 5,012 ppm of HMDS, accompanied by slightly increased plasma urea and creatinine concentrations. No other treatment-related histological changes were seen in HMDS-exposed rats.

Impulsivity and control of inhibition in Benign Focal Childhood Epilepsy (BFCE).

Childhood epilepsy represents abnormal brain functioning and may affect cognitive functions that depend on the late development of the frontal lobes. This study addresses the possible consequences of benign epilepsy on frontal functions, specifically action regulation and inhibition in the absence of explicit frontal neurological signs. Thirteen children (8 males; 6-12 years old) with benign epilepsy were matched to 13 controls. They performed tasks designed to measure impulsivity and control of inhibition: CPT, Stop Signal Paradigm, Stroop test, and Matching Familiar Figures Test (MFFT). Children with epilepsy made more errors on the MFFT (p < .02), made more errors in the interference condition on the Stroop test (p < .01), and had a longer response time to the Stop Signal (p < .05) than controls, with no differences on nonexecutive functions measures. Thus, children with benign epilepsy have a deficit on some measures of impulsivity and inhibition, which may reflect poor frontal lobe functioning.

[Do general practitioners want to manage chronic hepatitis C and take part in hepatitis C health networks? A national survey]. / Les médecins généralistes souhaitent-ils prendre en charge l'hépatite chronique virale C et participer aux réseaux ville-hôpital?

OBJECTIVES: To assess information that general practitioners had on hepatitis C and on the hepatitis C network in hospitals and private practice. METHODOLOGY: A national telephone survey of 604 general practitioners was conducted between March 18 and 23, 1998. RESULTS: Screening and management of hepatitis C was important for 89% and 97% of general practitioners. Screening was performed in relation to the relative risk (IV drug users 89%, blood transfusion before 1991 88%). General practitioners wanted more information on treatment (54%), patient counselling (42%) and the potential risks of the disease (42%). Of 604 general practitioners, 6% were involved in a hepatitis C network, while 21% were involved in another network (drug users 9%, AIDS 8%). Of the 94% general practitioners who were not part of the network, 33% were willing to join a hepatitis C network. Only 56% were aware of a hepatitis C network (press article 30%, mailing 17% or local meeting 12%). The difficulties for the involvement of general practitioners were: lack of time, topics not adapted to daily practice and geographic constraints (74%), too few patients in their practice (52%), no need (38%), the idea itself of a network and lack of information (28%). CONCLUSION: General practitioners screen patients at risk of hepatitis C. They want to be better informed about treatment, patient counselling, and the potential risks of hepatitis C. They are less involved in hepatitis C networks than in other networks (drug, AIDS). However, one third of general practitioners would like to be involved in a hepatitis C network. These results could be useful for implementing post-graduate courses and general practitioner training.

Evaluation of severe insomnia in the general population: results of a European multinational survey.

The epidemiology of severe insomnia and its effect on quality of life and healthcare consumption was assessed in a survey of the general population of five northern European countries. Applying established consumer sampling techniques, insomnia sufferers were selected from the general population using a questionnaire, conducted by face-to-face interview, and severity of insomnia was ranked (severe, mild/moderate, no sleep complaint) using a specific algorithm. Population samples were matched according to case control methodology for age, gender and geographical region. A second questionnaire gathered information on sleep problems, quality of life (SF-36 scores) and healthcare consumption. The prevalence of severe insomnia ranged from 4% to 22%, was higher in females than in males, but did not increase significantly with age. Patients with severe insomnia had been experiencing sleeping problems for a median of 2-6 years. In all countries, insomnia had a negative impact on quality of life, and the degree of impairment in quality of life was directly related to the severity of insomnia. Individuals with severe insomnia also showed a higher level of healthcare consumption. Despite this, severe insomnia did not appear to feature prominently in the doctor-patient relationship.

[Parcours de femmes. Opinion survey carried out among women treated for gynecologic and breast cancers and their medical care teams]. / Parcours de femmes. Enquête d'opinion réalisée auprès des femmes traitées pour cancers gynécologiques et mammaires et auprès des équipes soignantes qui les ont prises en charge.

The opinion survey "Parcours de femmes" initiated in partnership with Bristol-Myers Squibb was conducted by la Ligue nationale contre le cancer between November 1993 and May 1995 and by Sofres Institute. The aim of the study was to increase knowledge of experience of feminine cancers, both by patients and by different treatment teams. Two thousand eight hundred and seventy-four women treated for one of these diseases answered anonymously on a form with sixty-eight questions. Eighty-one individual interviews gave the opinion of the general practitioners and specialists concerned, as well as nursing and hospital staff, pharmacists, health leaders in the private or public fields. The results of this opinion survey highlight and confirm needs, deficiencies, and aspirations of everyone involved. The data show the importance of information, explanations and dialogue at every stage of the disease. The data specify the lines of support to be developed: calming distress, stimulating hope and the will to recover. They also indicate a need for psychological support outside the family and the medical environment as well as for treatment teams. The necessity to improve the hospital environment as well as access to maternal aid during and after treatment to make reinsertion easier are also demonstrated. Apart from associations and help services (such as home care), institutionals do not all have the same sensitivity expect to this pathology. Many people consider it has nothing specific in comparison to other pathologies or to other women in difficulties. They reject the idea of implementing specific measures and valorize research and prevention actions.

An attempt to improve blood pressure control in the French population: information and outcome awareness at the general practitioner level.

To improve blood pressure (BP) control in general practice, 3122 general practitioners agreed to participate in a result awareness program. A survey carried out 6 months after participating physicians had been informed of the outcome of treatments they had given showed that blood pressure control (cut-off point: BP < 140/90 mm Hg) had not improved. However, using less stringent criteria, a slight improvement in blood pressure control could be observed. Although this improvement was marginal, results are sufficiently encouraging to warrant another study after a new awareness campaign among the medical population.

Prevalence, treatment, and control of hypertension in the French population: data from a survey on high blood pressure in general practice, 1994.

A survey was conducted in a cohort of 235 general practitioners (GP) selected by Sofres Medical who were representative of the French medical population, to measure the percentage of patients with hypertension, treated hypertensives and patients with controlled hypertension. Data were collected over 1 week of office consultation. Practitioners were initially instructed to use the same type of mercury sphygmomanometer, equipped with pneumatic cuffs of different sizes. Three consecutive blood pressure (BP) measurements were made and the last two were recorded. Practitioners had to carry out their own survey over a period of 1 week on all patients > 18 years of age who visited their offices. Patients were considered as hypertensive (HP) if the mean of the two recorded BP measurements was > or = 140/90 mm Hg or if they were taking antihypertensive drug treatment. Three cutoff points were used to define controlled hypertension: < 140/90 mm Hg (overall population of HP), < 160/95 mm Hg (HP < 65 years of age), and < 160/90 mm Hg (HP > or = 65 years of age). Among 12,351 patients (mean age, 48.6 years; women, 58%), 5020 were HP, (41%) of whom 2035 were without treatment (41%) and 2985 were receiving antihypertensive drug treatment (59%). Two hundred-thirty patients (4.6%) remained at high risk with moderate or severe hypertension (BP > or = 180 [systolic] or 105 [diastolic] mm Hg), ie, 1 patient/week/GP. The study confirms the high prevalence of hypertension in general practice and shows that 7 of 10 patients have an acceptable control of their BP (< 160/95 or < 160/90 mm Hg according to age) but only 24% of treated HP achieved the target of a BP level < 140/90 mm Hg, representing 28% of the 18 to 64 year old group and 21% of the elderly group. French GP did not choose an optimal control, and the medical community is waiting for answers to crucial questions, ie, does optimal BP control significantly improve the absolute cardiovascular risk? How far should blood pressure be lowered?

[Prevalence, treatment and control of hypertension in family practice patients in France during 1994]. / Prévalence, traitement et contrôle de l'hypertension artérielle chez les consultants en médecine générale en France en 1994.

The aim of this study was to measure the percentage of patients with hypertension, treated hypertension and controlled hypertension, using data collected over one week by 235 general practitioners well representative of the French medical population and selected by SOFRES Médical. Practitioners had to carry out their own survey over a period of one week on all patients above 18 years of age who visited their office. They were initially instructed to use the same type of mercury sphygmomanometer, equiped with the same pneumatic cuffs of different sizes. Three consecutive blood pressure measurements were effected, the last two were recorded. Patients were considered as hypertensive if the mean of the two recorded BP measurements was > or = 140-90 mmHg, or < 140-90 mmHg under pharmacological treatment. Hypertensive patients were considered as controlled when their blood pressure levels were overall < 140-90 mmHg under treatment. According to age, two other control levels were analysed: blood pressure < 160-95 mmHg before 65 years and blood pressure < 160-90 mmHg at 65 years or more. Among 12,351 patients, 5,020 are hypertensive (4%), 2,985 under pharmacological treatment (59%) and 2,035 without treatment (4%). Among untreated patients, 9% had an hypertension above the borderline values. Before 65 years, 28% had an under treatment blood pressure < 140-90 mmHg and 71% < 160-95 mmHg. Among 65 years or more hypertensive patients, 21% had an under treatment blood pressure < 140-90 mmHg and 60% < 160-90 mmHg. Before 65 years, 25% among patients with a monotherapy remained with a blood pressure > 160-95 mmHg and 34% with a blood pressure > 160-90 mmHg among those of 65 years or more; 230 patients (5%) remained in high risk with a blood pressure > 180-105 mmHg. 176 untreated and 54 despite their treatment. This study carried out in French medical practice yield two main conclusions regarding the management of hypertension: as the prevalence of hypertensive patients is 41%: one patient out of two, high blood pressure has to be a main aim for the medical teaching. Even if a reasonable control of the blood pressure is achieved in most cases, blood pressure got a normal level for 24% only of treated hypertensive patients and too many patients were keeping high risk because they have been not or not enough treated. This study, as a real audit, gives some useful informations to general practitioners in order to improve their scores.

HFA-134a (1,1,1,2-tetrafluoroethane); lack of oncogenicity in rodents after inhalation.

1. Groups of 60 male and 60 female B6C3F1 mice or HanIbm Wistar rats were exposed to HFA-134a using snout-only inhalation exposure techniques for periods of one hour daily for at least 104 weeks. HFA-134a was delivered directly from cylinders at vapour concentrations of 2500, 15,000 and 75,000ppm for mice and from metered-dose inhalers at vapour concentrations of 2500, 10,000 and 50,000ppm for rats. 2. Intended dosages were achieved. 3. Evidence of absorption was found at each dose level and was dose related. 4. Neither species suffered treatment related effects on survival, clinical signs, body weights, haematology nor on the type, incidence, site or severity of gross lesions. 5. There was no effect of treatment on the type, incidence, site or severity of neoplasms in mice or rats. 6. There were no non-neoplastic findings related to treatment in mice. 7. HFA-134a was considered not to be oncogenic and to provide a safe alternative to chlorofluorocarbons for use in pharmaceutical metered-dose inhalers.

[Histiocytic proliferative diseases. Discussion of a case report]. / Proliférations histiocytaires. Discussion à propos d'un cas.

The case of a ten month old female with initial clinical and histological findings suggestive of inappropriate macrophage activation syndrome is reported. Subsequently, clinical and pathological changes refuted this diagnosis and demonstrated that the patient had Langherans cell histiocytosis. Clinical, laboratory and pathological findings characteristic of each type of histiocytosis are reviewed. Histological and immunohistochemical studies allow to establish the diagnosis of Langherans cell histiocytosis. The finding of erythrophagocytosis in our patient suggests that two types of histiocyte proliferation can coexist in the same individual.

[Induction chemotherapy of cancers of the upper respiratory and digestive tract. Analysis of tumor response in 176 patients]. / Chimiothérapie d'induction des cancers des voies aéro-digestives supérieures. Analyse de la réponse tumorale chez 176 malades.

Tumoral responses to 3 courses of induction chemotherapy were investigated in 176 patients with squamous cell carcinomas of the head and neck previously untreated. The number of responses increased with the number of courses. Thus, out of 79 patients with a more than 50% response after the 3 courses, almost one third had no response after the first course, and 98.8% had a less than 50% response after the second course. In consequence, it may be stated that a 3rd and perhaps a 4th course is justified in patients who responded after 2 courses. There seems to be a poor correlation in responders between clinical and histological results: 68.5% of patients with complete response still had a tumour on the excised tissue. No correlation was found between the influence of T in the TNM clinical classification and that of squamous cell differentiation on the one hand and the macroscopic character of the tumour during response on the other hand.

[Preliminary attempt at a classification of rhinopharyngitis]. / Essai préliminaire d'un bilan de rhinopharyngites.

A study was conducted in 113 children with recurrent attacks of rhinopharyngitis, a frequent affection treated in ENT practice, to determine a classification and establish the etiopathogenicity of the disorder. Children were divided into two groups according to age, and clinical, radiologic, bacteriologic, biologic, and histologic data analyzed. An allergic or immunity deficiency origin could be confirmed in some cases, but etiopathogenicity was impossible to determine in many individual cases.

Spontaneous resumption of sinus rhythm in an elderly patient after 13 years of permanent atrial fibrillation.

One female patient--with slight pure mitral stenosis, mild hypertension and ischemic cardiomyopathy and disabling pulmonary emphysema--developed at 54 years of age permanent atrial fibrillation, had a gratuitous mitral commissurotomy four months later, sustained chronic fibrillation for 13 years, then spontaneously resumed sinus node command at age 67 without any discernible reason. Sinus rhythm was being maintained at follow-up nine months later. Her cardiac status of fair compensation under modest digitoxin and diuretic therapy has neither improved nor worsened with the return of atrial systole. The duration, in this observation, of permanent auricular fibrillation before spontaneous return of sinus rhythm, is one of the longest ever published, exceeded, to the best of my knowledge, only by one case of Lewis and by another one of Reeve and associates. Such an exceptional event points out a fascinating enigma: how can major longstanding atrial dysrhythmias (fibrillation, flutter), whose causes and pathogenesis seem at least partly elucidated, spontaneously disappeer in atria so badly diseased? I think we must humbly confess that no satisfactory explanation is at present available for this disconcerting phenomenon.

[Experimental investigations on the tumorigenic activity of cigarette smoke condensate on mouse skin. VII. Comparative studies of condensates from different modified cigarettes (author's transl)]. / Experimentelle Untersuchungen über die tumorerzeugende Wirkung von Zigarettenrauch-Kondensaten an der Mäusehaut. VII. Einzelvergleiche von Kondensaten verschiedener modifizierter Zigaretten.

Condensate from different modified cigarettes were compared with condensate from a standard cigarette with regard to its tumorigenic activity on mouse skin. Significant lower effects were observed in test series with cigarettes from expanded tobacco. Different results were obtained in experiments with cigarettes from the new smoking materials. In one case the effect was higher, in two another cases the effect was lower in comparison to the effect of condensate from reference cigarettes. A certain influence may be referred to the diameter of the cigarette, i.e. a thinner cigarette shows a lower biological effect. The lowest tumoringenic effect was observed in tests with cigarettes with a high content of Burley-stems.