Screening for hypertension at the hairdresser: a feasibility study in France and Morocco.

Purpose: Worldwide, hypertension awareness remains largely insufficient. This is particularly true in some population subgroups with a low socioeconomic status or in young adults who have limited interactions with healthcare systems. Performing Blood Pressure (BP) screening in non-conventional settings, such as in barbershops, has been suggested by a number of American authors. Whether this approach is feasible in Europe or in North Africa has not been evaluated, however. We, therefore, undertook a study to assess the value of BP screening at hairdressers in France and in Morocco.Materials and Methods: This was a prospective multicenter feasibility study. Twenty-three hairdressers in France and six in Morocco participated in the study. After being provided the relevant information, all consenting customers aged over 18 years were included. Three BP measurements were performed by the customers themselves using a validated Omron M7 automatic BP device connected to a printer.Results: In France, 1025 subjects were enrolled, while 300 subjects participated in Morocco. Three hundred and seventy French participants (36%) had an elevated BP. Among the subjects claiming to be normotensive or who did not know their hypertension status, 31.7% had a BP ≥ 135/85 mmHg. Only 42% of the subjects with an elevated BP contacted their physician within 3 months, although hypertension was confirmed in ¾ of them. In Morocco, the participants were older, with only 11.7% of the subjects aged <50 years. They more frequently had unknown elevated BP values (71.9%). The rate of BP monitoring in known hypertensive individuals was 42.7% in France and 17.1% in Morocco. The procedure was very well accepted and considered to be useful in both countries.Conclusion: BP screening at hairdressers is feasible and well-accepted, although it does suffer somewhat from a relatively low efficacy.

[General medical practice and medicinal voluntary termination of pregnancy in Grand Est, France]. / Médecine générale de ville et interruption volontaire de grossesse médicamenteuse en région Grand Est, France.

BACKGROUND: Access to VTOP (Voluntary Termination of Pregnancy) is a national priority in France. Once legalized in 1975, several laws contributed to improve access to VTOP, such as the 2004 family planning law which enabled urban practitioners to carry out orthogenic work. This law was supplemented by the 2016 health care modernization act. On the whole, the organization for VTOP access in the Grand Est region, complies with legislation and recommendations. However, private practitioners contribute little to this activity. Since there are very few gynecologists in certain areas (whether private or hospital practitioners), general practitioners seem to be the first line actors. This study aims at describing the orthogenic work of urban, government-regulated general practitioners, in the Grand Est region of France. MATERIAL AND METHOD: Data were collected from semi-directive interviews with the set of the government-regulated general practitioners doing family planning work in the Grand Est region. RESULTS: Out of the fifteen doctors who were interviewed, twelve actually suggested family planning work to their patients, and out of those twelve, seven practiced it in reality. What comes out is that the main motivation of professionals was to improve access to VTOP. Besides, they also mentioned the importance of being able to answer a real demand from their patients as well as an interest in gynecology. Hence the professionals' practice both benefits from services provided to their patients and from a diversification of their work, even though they regret that the value of this time-consuming procedure is not recognized. This study also brings out that although these medical acts were individualized and allowed better confidentiality for the patient, the risk for complications and home birth remained an obstacle. Finally, it emerges that the whole set of recommendations was not always implemented. DISCUSSION: Urban family planning, performed by general practitioners, seems to be a major line to focus on for better timeliness and quality of care. However, some obstacles have been identified such as its specificity, its time-consuming aspect, its lack of status, as well as the difficulty to comply with recommendations. CONCLUSION: The development of this practice is necessary to maintain an appropriate response to VTOP but actions to remove certain obstacles have to be carried out.

[Impact of the A influenza pandemic on anti-seasonal influenza vaccination of French general practitioners: A cohort follow-up 2007-2010]. / Impact de la pandémie de grippe A sur la vaccination des médecins généralistes français contre la grippe saisonnière : suivi d'une cohorte entre 2007 et 2010.

BACKGROUND: Our objective was to assess the impact of the A influenza pandemic on the anti-seasonal influenza vaccination of French general practitioners. METHODS: A survey was conducted in 2007 in a random sample of general practitioners. A second survey conducted in 2010 included all general practitioners who had not been vaccinated in 2007 and one-third of those who had been. RESULTS: Responses were obtained from 1010 general practitioners in 2007. The coverage rate of anti-seasonal influenza vaccination reached 73%. In 2010, the coverage was 73.5% and rate of anti-A influenza vaccination was 59% (weighted numbers). Between the two surveys, 130 family physicians (15.5%) changed their behavior. Analysis showed that the A influenza pandemic had a slight positive impact on anti-seasonal influenza vaccination. CONCLUSION: This first cohort of French general practitioners concerning influenza vaccination found the same anti-seasonal influenza vaccination rates widely reported in the literature and showed that the A influenza pandemic had slight impact on it.

[Hypertension and menopausal hormone therapy]. / HTA et traitement hormonal de la menopause.

Can menopausal hormone therapy (HT) be used in hypertensive women? The group of experts of the French Society of Hypertension has carried out a review of the recent literature in order to answer this question, based on the most recent scientific publications. If use of oral HT is associated with a discreet increase in blood pressure, the transdermal route seems to be safer. The first results of major randomized trials of HT had alerted to an increase in cardiovascular events and breast cancer with the use of oral HT, generally, tipping the benefit-risk balance of the deleterious side. Complementary analyzes have shown the importance of the window of intervention (less than 10 years after the menopause) and the age of the woman to start the HT. On the contrary, they have shown a significant decrease of the coronary events. For woman suffering from hypertension and important climacteric symptoms, it is important to evaluate the whole cardiovascular risk in order to decide the possibility of prescribing a HT. Thus, the group of experts proposes a prescription assistance algorithm based on the stratification of cardiovascular risk, always favoring, when it is authorized, HT by transdermal route of administration.

[Management of paediatric fever: is parents' skill appropriate?]. / Prise en charge de la fièvre de l'enfant: les connaissances et pratiques des parents sont-elles satisfaisantes?

UNLABELLED: Paediatric fever is a frequent reason of consulting a paediatrician or a general practitioner (30% of paediatric consultations). AIM OF THE STUDY: This investigation aimed at reporting the knowledge level concerning child's and infant's fever in a urban population and the resulting practices. Two thousand and six hundred questionnaires were distributed in June 2004 in the 29 scholar institutions of Metz agglomeration (France) classified in 3 categories according to socio-economical conditions of parents: 3 institutions of city centre (high socioeconomical conditions), 18 sub-urban institutions (intermediary conditions) and 8 institutions located in priority education zones (ZEP) (defavorable conditions). RESULTS: One thousand and thirty-eight questionnaires could be analyzed (40%): 176 in city centre, 634 in sub-urban zones and 228 in ZEP. Fever threshold at 38 degrees C is well-known and fever measuring methods used are mostly in accordance with the recommendations. The best room temperature was known and the use of antipyretic physical means underlined only a few cases of obvious mistakes. All parents were informed about worrying signs related with fever even if doctor's resort was excessive. Acetaminophen was the reference molecule before ibuprofen whereas the use of aspirin was decreasing. Antipyretic treatments methods used by parents were often unsuitable, leading to therapeutical inefficacy, overdosage or noxious drug interactions, mainly because of a lack of knowledge about drug components. CONCLUSION: This investigation underlines insufficient knowledge and noxious management practices among parents with unfavourable socio-economical conditions which lead us to recommend targeted information preferentially in areas gathering together most unfavourable socio-economical condition populations.

Reliability of self-reported recent antibiotic use among the general population: a cross-sectional study.

OBJECTIVES: This study aimed at evaluating the reliability of self-reported recent antibiotic use, including ability to name the antibiotic, among pharmacy customers from the general population. METHODS: This cross-sectional observational study of adults took place in pharmacies in northeastern France from January to April 2016. Participants were asked if they had used any antibiotics in the preceding 4 months and if so, to name them. Their reports were compared with an electronic pharmacy dispensing record listing all of the medication dispensed to them in France. RESULTS: The study included 653 individual customers from 15 pharmacies. Antibiotics had been dispensed 325 times, according to the records, but the patients reported only 237 courses of treatment. Agreement between self-report and the electronic record about whether or not they had used an antibiotic was 80% (κ 0.60). Among the discordant responses, 57% (81/143) involved underreporting. Only 24% (79/325) of the patients could name the antibiotic for each course of treatment; 49% (160/325) could not. The multivariate analysis showed that patients who had purchased an antibiotic in the previous 30 days were 2.5 times more likely to know its name (p 0.01). CONCLUSIONS: Participants' self-reports were relatively reliable for recent use of an antibiotic, but not for its name. Because physicians cannot base prescription decisions on these self-reports only, an electronic pharmacy dispensing file shared among prescribers would be useful.

[Creation of a complete organised care network allowing facilitated access to ophthalmological care for patients living in socially "at-risk" situations, feasibility study]. / Mise en place d'un réseau de prise en charge facilitant l'accès aux soins ophtalmologiques des patients vivant en situation de précarité, étude de faisabilité.

BACKGROUND: Currently, renouncement to healthcare by socially "at-risk" patients continues to increase and access to ophthalmological care is complex. The main objective of this study is to test the feasibility of a complete organised care network allowing facilitated access to ophthalmological care for patients living in socially "at-risk" situations. METHOD: A prospective interventional study was conducted within four social housing infrastructures to screen for vision problems in the "at-risk" socially population in question. Partnering with the ophthalmological department of the CHRU de Nancy, an interventional and supportive care trial for the affected population was conducted with the assistance of social workers, nursing aides, opticians, and the author. RESULTS: Ten screening sessions were conducted between December 2015 and April 2016 allowing a vision exam of sixty-five patients living in social housing. Twenty-five patients benefited from specialised care within a three-month time frame provided by the ophthalmological department, of which nineteen patients received corrective lenses. The remaining six patients received other types of ophthalmological care. CONCLUSION: The study allowed to demonstrate that the cooperation of willing actors makes it possible to improve access to visual healthcare for patients living in socially "at-risk" situations, in particular in the frame of ophthalmological care, often taking second place in a general medical consultation.

Awareness of obstructive sleep apnea-hypopnea syndrome among the general population of the Lorraine Region of France.

OBJECTIVE: Obstructive sleep apnea-hypopnea syndrome (OSAHS) seems to be underdiagnosed. The aim of this study was to assess awareness of OSAHS among the general population of the Lorraine Region of France. METHODS: A descriptive epidemiological study was carried out from July to November 2015 in the Lorraine Region, using an anonymous questionnaire that assessed knowledge of OSAHS-related symptoms and complications. The survey was also circulated on the Internet via social media. Exclusion criteria comprised age under 18 years, refusal to fill out the questionnaire and linguistic barrier. RESULTS: 1307 subjects filled out the survey: 1020 on paper format and 287 via the Internet. About two-thirds of the population recognized a majority of symptoms. However, there was a significant lack of knowledge of complications, especially cardiological and neurological. Suffering from OSAHS, having had higher education, and being under 40 years of age, were factors linked to better awareness of the syndrome. Internet respondents also showed better awareness. CONCLUSION: Despite encouraging results regarding OSAHS symptoms, the general population showed limited awareness of its complications. Innovative educational campaigns must be organized to inform practitioners and the general public about the disease and raise awareness of its complications.

Perception of acceptable antibiotic stewardship strategies in outpatient settings.

INTRODUCTION: Antibiotics are still often inappropriately prescribed in France despite specific measures being taken for over 10years. The 25% decrease in antibiotic prescription advocated in the 2011-2016 National Antibiotic Plan seems difficult to achieve. One of the strategies currently considered in France is the use of a specific prescription form dedicated to antibiotics, with an educational message for patients. We aimed to evaluate the acceptability - by primary care prescribers - of this measure and to evaluate their perception of other antibiotic stewardship strategies. METHODS: Qualitative study conducted among family physicians, pediatricians, dermatologists, dentists, and ENT specialists using semi-structured interviews. A thematic and framework analysis was then performed. RESULTS: Thirty prescribing physicians practicing in a specific region of France were included in the study. The dedicated prescription form for antibiotics was deemed excessive and questionable. Other measures, not directly targeting prescribers, were rather well perceived: the unit sales of antibiotics, the restricted reporting of susceptibility tests, or the limitation of the number of molecules available in outpatient settings. CONCLUSION: The results of this exploratory study may guide the national antibiotic stewardship policy in France.

[Parental representations of children's cough and expectations on its management]. / Représentation parentale de la toux du nourrisson et attentes sur sa prise en charge.

BACKGROUND: Providing medications for the management of acute cough in infants less than 24 months, a frequent reason for medical consultation, has recently been reduced by the contraindication of various antitussive specialties in France. OBJECTIVES: The objective of this study was to assess the expectations and fears of coughing infants' parents, to determine their representations of coughing, and to quantify the use of self-medication and the risk of a deferral requests to prescribe other drug classes. METHODS: An opinion and cross-survey was carried out with parents of infants under 24 months of age. A multiple-choice questionnaire was proposed to them in day care centers and Mother and Infant Welfare centers. The data collected were analyzed descriptively and using the Chi(2) test. Logistic regression enabled us to interpret some of the results. RESULTS: Sixty-four percent of parents expect an antitussive treatment from the doctor. For most parents, lifestyle modifications are well integrated (nasal irrigation, considered effective cough relief, hydration, smoking cessation). For 33 % of parents, corticosteroids are an alternative therapy to stop cough. Nearly half (43 %) of parents have sought treatment from their doctor, usually nasal suspensions, corticosteroids, and saline irrigation. Regarding self-medication, 30 % of parents have already given cough syrup or an antitussive suppository without a prescription, in order to stop the cough rapidly for 66 % of them. These parents seem more worried by coughing than other parents (P=0.0110, CI: 0.217; 1.751) as did those who had only one child (P=0.0029, CI: 0.120; 0.582). CONCLUSIONS: This study suggests that a large majority of parents understand and accept the new recommendations. But one-third of parents are still worried, not knowing what to do without prescribed medications, which led them to give nonprescription cough syrups and ask for inappropriate treatments. It seems essential to inform parents about the natural history of infant coughing and educate them on lifestyle rules to reduce the risk of deferral prescription.

Acceptability of antibiotic stewardship measures in primary care.

OBJECTIVE: We aimed to assess the acceptability of antibiotic stewardship measures by family physicians. MATERIAL AND METHODS: We conducted an online cross-sectional survey in 2015 with a sample of family physicians practicing in a specific French region. RESULTS: Overall, 283 of 1171 family physicians (24%) completed the questionnaire. Decision-support tools for antibiotic prescribing and educational measures were well accepted by family physicians: 71% strongly agreed with a free distribution of urine dipstick tests and 54% with incentives to participate in antibiotic training sessions. Almost all family physicians did not agree with restrictive measures: 68% were for instance opposed to having to justify the prescription's compliance with guidelines on the prescription itself. Physicians also did not agree with restrictive measures when they only applied to physicians prescribing many antibiotics. CONCLUSION: Participants were probably the most motivated and aware of the topic physicians, but they were particularly hostile to the introduction of restrictive measures related to antibiotic prescribing. Our survey was conducted with a large sample of family physicians and could help orientate our country's antibiotic stewardship policy. However, family physicians are likely to oppose any measure aiming at restricting their freedom of prescription.

[Prevalence of target organ damage in patients treated for primary arterial hypertension: Comparison between men and women. ESSENTIELLE study]. / Prévalence de l'atteinte des organes cibles chez des patients traités pour une HTA : comparaison homme/femme. Étude ESSENTIELLE.

OBJECTIVES: To compare the percentages of men and women treated for primary arterial hypertension presenting with at least one target organ damage; to identify factors associated with target organ damage and/or blood pressure control. METHODS: Observational, transverse study carried out between March 2012 and July 2013 on a representative sample of 2666 outpatients (including 1343 men) consulting general practitioners (n=469) or cardiologists (n=250) in routine follow-up. RESULTS: Characteristics "men vs. women" were: mean age (62.6 ± 11.6 vs. 57.4 ± 14.7 years; P<0.0001); ≥ 60 years (61.1% vs. 43.9%; P<0.0001); waist circumference (98.9 ± 12.2 vs. 89.4 ± 14.3 cm; P<0.0001); SBP (146.5 ± 16.1 vs. 145.8 ± 17.0 mmHg; NS); DBP (85.1 ± 10.3 vs. 84.2 ± 10.4; P=0,03). Target organ damage was more frequent in men (37.6% vs. 22.9%; P<0.0001), whether it was subclinical (20.4% vs. 13.6%; P<0.0001) or documented (26.3% vs. 13.5%; P<0.0001); some patients presented with both types of damages. Men developed more often microalbuminuria (6.5% vs. 4.3%; P=0.01) and LVH (16.3% vs. 10.5%; P<0.0001); some patients presented with both types of subclinical injuries. Target organ damage was more common in men without regular physical activity than in those exercising regularly (42.1% vs. 32.5%; P=0.0004). Regular exercises had no effect in women (24.1% vs. 21.3%). For both sexes, other factors associated with target organ damage were: age ≥ 60 years, myocardial infarction/sudden death in family history, LDL-cholesterol ≥ 1.60 g/L, HDL-cholesterol ≤ 0.40 g/L. Stroke before 45 years in family history was a predictive factor in women. Hypertension was controlled in one third of patients without difference between sexes. In women, hypertension was less often controlled in case of excessive alcohol consumption compared to normal alcohol intake (17.9% vs. 36.1%; P=0.0007); this factor had no effect in men (28.1% vs. 32.6%). Other factors associated with poor blood pressure control were: BMI (P=0.002), LDL-cholesterol ≥ 1.60 g/L in women. In men, the factors were: tobacco, presence of LVH, absence of physical activity, HDL-cholesterol ≤ 0.40 g/L, absence of diet. CONCLUSION: In a hypertensive population, target organ damage is more common among men despite similar blood pressure control rates for both sexes.

[AFSSAPS 2005 recommendations have not modified the way parents take care of children's fever]. / Les recommandations Afssaps de 2005 n'ont pas modifié la prise en charge parentale de la fièvre de l'enfant.

INTRODUCTION: Fever in children is frequent. Often mild, initial care is the parents' responsibility: medicinal treatments and medical consultations. Unfortunately, the efficiency of parental care is poor. Therefore, in 2005 the AFSSAPS updated its recommendations. One and 6 years after publication of the guidelines, this study rates their impact by describing and comparing parents' knowledge and behavior when faced with fever in their children. MATERIAL AND METHODS: This survey was conducted in families whose children were attending preschool in and near Metz (France) in 2006 and 2012. The same questionnaire was given to assess the knowledge, care, and symptoms of serious fever. The results were processed based on the number of children in the family and the family's socioeconomic category. RESULTS: In 2006, 1038 questionnaires were distributed and 1273 in 2012. The fever threshold was not better known in 2012. Bathing and uncovering children remained the predominant physical methods used. Treatment was based on the use of ibuprofen and alternating treatments. However, the conditions of administering medication were well known to parents. The causes and motives for consultation were not better understood in 2012 however. The main source of information was physicians. DISCUSSION: The message disseminated since 2005 has not been efficient. Its complexity has not eradicated old beliefs and inappropriate parental practices. A campaign based on a brief, simple message has to be organized, providing better chances of being assimilated by the public. Medical practices should be standardized.

Inventory of antibiotic stewardship programs in general practice in France and abroad.

OBJECTIVES: The authors conducted a survey of measures implemented in France and abroad for a better use of antibiotics in general practice. METHODS: A literature review was conducted from January 2000 to July 2014. Emails were sent to every infectious diseases department, to all regional health authorities (ARS), to the health insurance offices (CPAM) with the highest and lowest antibiotic use, and to the ministry of health to make an inventory of all antibiotic stewardship programs. The ministry of health, the board of general practitioners, infectious diseases specialists, pharmacists, and the medical and pharmacy schools of the nation's capital were contacted in 17 countries of Europe and North America. RESULTS: The main measures implemented in France were training of healthcare professionals, publishing guidelines, feedback to the practitioners on their prescriptions, and availability of rapid diagnostic tests. Telephone networks were created in some regions, such as Antibiolor or Medqual, to help physicians with antibiotic prescription. Many foreign countries issued pedagogical material to physicians, for patients to explain what to do in case of viral infection or delayed prescription. In Alberta (Canada), the government introduced an optional authorization for quinolones. In Denmark, the government temporarily suspended the reimbursement of some agents to preserve them according to bacterial ecology. In the United-Kingdom, the antibiotic susceptibility test report must include less than 5 agents. CONCLUSIONS: The measures implemented in France and abroad were usually more persuasive than restrictive. But the bacterial resistance crisis should lead to implementing more restrictive measures.

Can we identify response markers to antihypertensive drugs? First results from the IDEAL Trial.

Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was -11.5 mm Hg (indapamide) and -8.3 mm Hg (perindopril). In men, the response was significantly smaller: -4.8 mm Hg (indapamide) and -4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori.

Ambulatory 24-h blood pressure assessment of the felodipine-metoprolol combination versus amlodipine in mild to moderate hypertension. Lorraine General Physician Investigators Group.

OBJECTIVE: To measure the time effect profiles of a once daily administered combination tablet felodipine-metoprolol 5/50 mg (Logimax, Astra) and amlodipine 5 mg (Norvasc, Pfizer) on blood pressure and heart rate using 24-h ambulatory blood pressure monitoring. DESIGN: Randomized multicentre parallel-group study with a single-blind placebo run-in period of 4 weeks duration and a 6-week double-blind active treatment period. PATIENTS AND METHODS: Out of 245 randomized outpatients (90 men, 155 women) with uncomplicated mild-to-moderate primary hypertension and mean sitting diastolic blood pressure (DBP) 95-115 mmHg inclusive, 212 (102 on felodipine-metoprolol, 110 on amlodipine) were eligible for analysis. 24-h ambulatory blood pressure monitoring was performed at the end of the placebo run-in (baseline) and after 6 weeks active treatment (posttreatment). RESULTS: Both felodipine-metoprolol and amlodipine induced smooth and consistent reduction in DBP and systolic blood pressure throughout the 24-h period, hence not altering the diurnal rhythm. However, felodipine-metoprolol reduced all average blood pressures (24-h, day- and night-time) more than amlodipine (for 24-h average blood pressure 14.4/9.5 mmHg and 8.9/5.5 mmHg, respectively). Medians of individual diastolic trough-to-peak (T/P) ratios were similar for felodipine-metoprolol and amlodipine (54 and 50%, respectively), while for the systolic T/P ratios, the corresponding values were 74 and 35%, repectively; no significant difference between treatments was seen. As distinguished from amlodipine, both heart rate and rate pressure product were markedly decreased on felodipine-metoprolol throughout the 24-h period and even during the early morning hours. In general, both treatments were well tolerated. CONCLUSIONS: Both felodipine-metoprolol and amlodipine achieved optimal control of blood pressure during the inter-dosing interval in line with their pharmokinetic profiles. The vasodilatory adverse events were slightly more reported with felodipine-metoprolol combination, but due to more pronounced lowering of the average blood pressures and the potent additional effect on heart rate and rate pressure product, the efficacy/tolerability balance seems to be equal to or better than that obtained with monotherapy such as amlodipine.

Differential effects of aging on heart rate variability and blood pressure variability.

Previous studies investigating autonomic cardiovascular control in elderly persons usually included analysis of R-R interval but not of blood pressure variability. "Physiological" blood pressure rise during the aging process was not accounted for as a possible confounding factor. This study was designed to characterize the relationship between age and short-term heart rate (HR) and blood pressure (BP) variability, independently of the "physiological" rise in BP associated to aging. The study was carried out in 65 "normotensive" (BP< or =140/80 mm Hg) healthy subjects, ranging in age from 18 to 80 years. BP and HR were recorded at rest with a Finapres device. Low-frequency (LF = 0.066 to 0.129 Hz) and high-frequency (HF = respiratory peak +/-0.05 Hz) components of HR and BP variability were assessed using fast-Fourier spectral analysis. Transfer-function analysis between systolic BP and HR variability permitted the calculation of the gain of baroreflex sensitivity. Significant results of this study include a continuous and linear decline with age of normalized LF spectral power of HR in the standing position and of normalized HF spectral power of HR during paced breathing. No correlation was found between age and BP variability, except for LF diastolic BP spectral power in the standing position. The baroreflex gain was negatively correlated with age. The effect of aging on autonomic nervous system cardiac control is progressive and continuous throughout an 18-80 years age range. Although the aging process diminished HR variability and diastolic BP variability, it had no influence on systolic BP variability.

[Double-blind and randomised parallel study of minocycline 100mg (Mynocine) vs roxithromycin 300mg (Rulid), in the treatment of seasonal acute bronchitis in clinical practice]. / Etude randomisée en parallèle et en double insu de la minocycline 100 mg (Mynocine) vs roxithromycine 300 mg (Rulid), dans le traitement des bronchites aiguës saisonnières, en pratique de ville.

46 general practitioners of the vicinity of Nancy carried out a randomised, parallel and double blind study comparing the efficacity and the tolerance of two drugs: roxithromycin (Rulid) 300 mg per day, and minocycline (Mynocine) 100 mg per day in the treatment of adult acute bronchitis, in clinical practice. 124 patients were included from January 1992 to June 1992. Efficacy of the treatment was estimated by both practitioners and patients to be good and excellent at the same time in 90 to 95 per cent of cases, in the two groups. Clinical tolerance was estimated to be excellent (90 per cent of cases) in the two groups. Roxithromycine and minocycline are effective and well tolerated in the treatment of adults acute bronchitis in clinical practice. Among the two drugs, we prefer to use minocycline because it is 2.5 to 5 times less expensive than roxithromycine.