Postnatal melatonin treatment protects against affective disorders induced by early-life immune stimulation by reducing the microglia cell activation and oxidative stress.

BACKGROUND: Systemic inflammation induced by neonatal infection may result as long-term hyper-activation of microglial cells followed by an overproduction of pro-inflammatory cytokines, such as tumor necrosis factor-alpha, nitric oxide and lipid peroxidation. Those inflammation mediators can trigger behavioral disruption and/or cognitive disorders. OBJECTIVE: The present work aims to evaluate the effect of melatonin (a cytokine release modulator and antioxidant agent) in the reduction of the prefrontal microglia activation and depressive-like behaviors induced by lipopolysaccharide (LPS) injection in adult rats. RESULTS: The effect of melatonin (5 mg/kg) was compared to minocycline (50 mg/kg), a well-known anti-inflammatory drug with potent inhibitory effect on microglial activation. Our results showed that LPS injection induced a significant increase in prefrontal cortex tumor necrosis factor-alpha and nitric oxide levels. Furthermore, lipid peroxidation and microglial activation were highly increased in the prefrontal cortex compared to control. The melatonin treatment induced a significant decrease on nitric oxide and lipid peroxidation levels in the prefrontal cortex and significant decrease on tumor necrosis factor-alpha and microglia activation. Melatonin can also induce a significant reduction in the anxiety and depression-like effect induced by PND9 LPS administration. CONCLUSION: Our results demonstrated that melatonin possesses potent protective effect against the depression and anxiety induced by LPS. The underlying effect of melatonin is probably due to the reduction of nitric oxide toxic effect and lipid peroxidation in addition to its anti-inflammatory effect.

The GRIM2005 study of migraine consultation in France. III: Psychological features of subjects with migraine.

The objective of this analysis was to describe psychological and cognitive variables in subjects with migraine and to identify those associated with chronicity. Data were collected from 10 000 subjects during face-to-face interview. Subjects with episodic migraine (n = 1127) or chronic daily headache (n = 407) with migrainous features were identified using an algorithm based on the International Classification of Headache Disorders, 2nd edn classification. Data on headache impact was obtained with the Headache Impact Test-6, on psychological distress with the Hospital Anxiety and Depression Scale, on coping with the Coping Strategy Questionnaire catastrophizing score and the Brief COPE inventory, on illness perception with the Brief Illness Perception Questionnaire and on locus of control. Psychological variables associated with chronicity include perceived headache impact, psychological distress, the use of catastrophizing and avoidance coping strategies and an externalized locus of control. In conclusion, maladaptive coping strategies should be taken into account in the management of patients with migraine. Longitudinal studies will be necessary to address the causality of the relationship observed.

Dispensing of antibiotics, antitussives and mucolytics to asthma patients: a pharmacy-based observational survey.

BACKGROUND: Antibiotics, antitussives and mucolytics are commonly used in asthma, despite limited evidence for their effectiveness. The correlates of use for these medication classes in asthma were identified. METHODS: Asthma patients aged 18-50 who were regular customers of pharmacies were included in an observational study. Patients completed a questionnaire, which was complemented by computerised pharmacy records of previously dispensed medications. Users of each drug class were compared to non-users in terms of demographics, asthma characteristics and management. RESULTS: Among 886 patients (mean age: 37; 55% females), 63.2%, 55.8% and 27.2%, respectively, were users of antibiotics, mucolytics and antitussives during the previous 12 months. In multivariate analysis, dispensing of >2 units of oral corticosteroids was the major correlate of receiving antibiotics (OR=5.47; 95% CI=[3.00-9.97]), mucolytics (OR=3.93; 95% CI=[2.38-6.50]) and antitussives (OR=1.86; 95% CI=[1.18-2.94]). Compared to well-controlled patients, the probability of receiving antibiotics was significantly higher for poorly controlled patients (OR=2.01; 95% CI=[1.28-3.15]). CONCLUSIONS: Our results suggest that these drugs are mainly used during asthma exacerbations. A better understanding of the use of co-medication in asthma is required.

Thymelaea lythroides extract attenuates microglial activation and depressive-like behavior in LPS-induced inflammation in adult male rats.

Thymelaea lythroides extract is widely used as a traditional folk medicine in Morocco, especially for the treatment of diabetes, rheumatism and Inflammatory disease. The aim of the study is to evaluate the possible effect of methanolic extract of Thymelaea lythroides in repressing the inflammatory responses and long-lasting depression-like behavior associated with neuroinflammation in adult rats after neonatal LPS exposure. Male rat pups were treated systemically with either LPS (250??g/kg) or vehicle (phosphate buffer saline) on postnatal day 14. Six hours later, the LPS groups were assigned to intraperitoneal (ip) injection of Minocycline (50?mg/kg) or Thymelaea lythroides (200?mg/kg). Thereafter, in adulthood (postnatal days 90-97), the spontaneous locomotor activity and depression-like behavior were assessed successively in open field and forced swim tests. The levels of proinflammatory cytokines, oxidative damage, and activation of microglia were determined in the hippocampus (HP) of male rats on (PND90-97). Our results showed that open field hypoactivity and increased immobility period in LPS-induced adult rats were normalized on treatment with Thymelaea lythroides and minocycline. Both treatments attenuate the overactivated microglial cells in the CA1 and CA3 of hippocampus (HP) and significantly reduced the oxidative-nitrosative stress markers and cytokine (TNF ?) production in the HP. Thymelaea lythroides seems to have similar neuroprotective effects to Minocycline, and such protection may be due to: reduction of oxidative stress, upregulation of inflammatory mediators production, antidepressant behavior which all are associated with neuroinflammation.

The GRIM2005 study of migraine consultation in France II. Psychological factors associated with treatment response to acute headache therapy and satisfaction in migraine.

The objective of this analysis was to identify variables associated with treatment response in subjects with migraine. Data were collected from a sample of 10,000 subjects. A battery of questionnaires assessing clinical and psychological variables was completed. Migraine diagnosis was attributed using an algorithm based on the IHS criteria and treatment response using the ANAES criteria. We identified 1534 subjects, of whom 1443 were treated. For 54.2%, at least one ANAES criterion for treatment response was unfulfilled. Non-response was associated with female gender, high HIT-6 impact scores and high HAD psychological distress scores. The strongest associations with non-response were identified for four psychological variables: elevated scores on the CSQ catastrophization subscale and the 'Consequences' and 'Acceptance' dimensions of the Brief COPE, and low scores on the 'Positive Reinterpretation' Brief COPE dimension. In conclusion, many individuals with migraine respond inadequately to treatment. Behavioural interventions aimed at modifying coping strategies may improve outcome.

The GRIM2005 study of migraine consultation in France I. Determinants of consultation for migraine headache in France.

The aim of this study was to evaluate determinants of consultation for migraine in a representative sample of the French general adult population. We interviewed 10,032 subjects, of whom 1534 fulfilled the International Headache Society diagnostic criteria for migraine. These were categorized into migraine, probable migraine and chronic migraine. Information was collected on consultation experience; 436 subjects (28.4%) had never consulted for headache, 473 (30.8%) were in active consultation and 625 (40.7%) had previously consulted but lapsed. Subjects with chronic migraine showed the highest active consultation rates (51.8%). All subjects completed rating instruments for headache [Headache Impact Test (HIT)-6], psychiatric (Hospital Anxiety and Depression Scale scale) and psychological [Brief Illness Perception Questionnaire (BIPQ), Brief COPE Inventory and Coping Strategy Questionnaire] variables. The strongest determinants of active consultation were BIPQ scores, HIT-6 scores and migraine type. Consultation was associated with maladaptive coping strategies (social support, emotional expression and acceptance). Determinants of remaining in consultation were catastrophizing coping scores and previous consultation experience.

[Prevalence of smoking cessation during pregnancy according to trimester]. / Taux de sevrage tabagique chez la femme enceinte en fonction des trimestres.

OBJECTIVE: To investigate the smoking cessation period during pregnancy. PATIENTS AND METHODS: Questionnaire-based, descriptive study of 979 pregnant women in four regions of France. The variables analysed included the characteristics of the mother and neonate at delivery, the smoking habits of the mother before and during pregnancy, the perception of risk linked to smoking, and the reasons for giving up smoking. RESULTS: Eighteen percent of women smoked until delivery. Forty-five percent of women gave up smoking during pregnancy, usually in the first trimester. More precisely, about one woman who smoked out of 50 gives up in order to prepare pregnancy. The proportion of women who stop smoking in each of the three trimesters of pregnancy is 84,1, 8,8 and 7,1% respectively. DISCUSSION AND CONCLUSION: Most women appear to stop smoking before any intervention therapy is possible. The first contact with a midwife or an obstetrician takes place whereas smoking cessation is already successful.

Incidence of herpes simplex virus keratitis in France.

OBJECTIVE: To assess the incidence and clinical characteristics of herpes simplex keratitis in France. DESIGN: National multicenter prospective study on herpetic keratitis. PARTICIPANTS: During a 3-month study period (September-December 2002), all cases of herpes simplex keratitis were prospectively reported by a randomly selected sample of 412 ophthalmologists representative of the 5471 French ophthalmologists in terms of gender, geographic distribution, and clinical practice. METHODS: The following set of assumptions were made to calculate the incidence of herpectic keratitis: (1) the participating (self-selected) ophthalmologists in the study could adequately represent French ophthalmologists, (2) estimates based on the 3-month study period could be used to calculate the annual incidence (i.e., no significant seasonal variations), and (3) all patients suffering from herpetic corneal lesions consult or are referred to an ophthalmologist. We calculated the incidence of herpetic keratitis by (1) estimating the average number of incident cases per ophthalmologist per year, (2) multiplying the average number of incident cases by the total number of French ophthalmologists (n = 5471), and (3) dividing the result by the French population. RESULTS: Four hundred twelve ophthalmologists reported 357 cases of herpes keratitis. We estimated that the overall incidence of herpetic keratitis during the study period was 31.5 per 100,000 person-years (95% confidence interval [CI], 25.5-37.5), and incidences were 13.2 per 100,000 person-years for new cases (95% CI, 10.4-15.9) and 18.3 per 100,000 person-years for recurrences (95% CI, 14.6-22.1). The most frequent types were dendritic keratitis (56.3%, n = 153), stromal keratitis (29.5%, n = 81), and geographic keratitis (9.8%, n = 27). Other ocular lesions were associated with keratitis in 35.0% (n = 125) of cases; the most frequent were conjunctivitis (18.8%, n = 67), uveitis (11.8%, n = 42), and/or lid involvement (8.6%, n = 31). CONCLUSIONS: This prospective epidemiological study provides an estimate of the incidence of herpes keratitis in France. Herpetic keratitis remains an epidemiologically important eye disease that justifies the need to pursue health care and research programs aimed at improving the outcome of ocular herpetic disease.

[Migraine in general practice. A French multicenter study]. / Prise en charge de la migraine en médecine générale. Une étude multi-centrique française.

INTRODUCTION: A national survey has been conducted with 349 general practitioners in order to analyze the management of concerned episodic headache in general practice. METHOD: This survey enabled collection of data from 2537 headache patients. The main data concered IHS diagnosis, severity of headache using the MIGSEV scale, management, practices and the impact on daily living (QVM and HIT-6 scales). RESULTS: Out of the 2537 included patients, 52 percent were migraine sufferers according to IHS criteria (code 1.1/1.2), 34 percent presented with migrainous disorders (code 1.7), and 14 percent were non-migraine headache patients. The distribution of management practices showed that 71 percent of them were given non-specific treatments, 46 percent of them specific treatments and 27 percent of them prophylactic treatments. Analysis of the impact of headache using the QVM or the HIT-6 demonstrated a relationship between diagnosis, migraine severity and disability. Analysis of the correlation between the severity of the last migraine attack as evaluated by the patient and that estimated by the doctor showed that the practitioner tended to underestimate the patient's pain. These results highlight the importance of communication between practitioners and migraine sufferers. CONCLUSION: Training of general practitioners in the use of simple tools such as the HIT-6 scale, should be helpful for a better evaluation of the impact of headache on daily living, and hence should lead to more optimal therapeutic management of headache patients.

[Psychotropic drug use and mental psychiatric disorders in France; results of the general population ESEMeD/MHEDEA 2000 epidemiological study]. / Usage des psychotropes et troubles psychiatriques en France: résultats de l'étude épidémiologique ESEMeD/MHEDEA 2000/ (ESEMeD) en population générale.

INTRODUCTION: The use of psychotropic drugs is high in France and has increased over the last two decades. To date, no national study evaluating psychotropic drug use in the context of the diagnosis of psychiatric disorders has been performed. Such data has now been generated in the ESEMeD/MHEDEA 2000 study, which has allowed comparison of the situation in France with that in five other European countries (Germany, Belgium, Spain, the Netherlands and Italy). OBJECTIVES: 1) To describe the declared use of psychotropic drugs (globally and by therapeutic class) in order to evaluate annual prevalence, treatment duration and demographic factors associated with use. 2) To estimate the proportion of subjects with an anxiety disorder, mood disorder or alcohol-related disorder (abuse or dependence) that have been appropriately treated with an antidepressant or anxiolytic drug. 3) to evaluate the proportion of psychotropic drug users who fulfil diagnostic criteria for these three classes of psychiatric disorder. METHODS: This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source used was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used. RESULTS: In France, 21% of subjects interviewed (n = 580) had taken at least one psychotropic drug during the year. For 19%, this was an anxiolytic or hypnotic (AX-HY), for 6.0% an antidepressant (AD), for 0.8% an antipsychotic (AP) and for 0.4% a mood regulating drug (TY). The distribution of users of AX-HY according to treatment duration was the following: 44% (1 to 15 days), 13% (16 to 30 days), 14% (1 to 3 months), 6.7% (3 to 6 months) and 23% (> 6 months). For users of ADs, the distribution was: 21% (1 to 15 days), 7.8% (16 to 30 days), 18% (1 to 3 months), 12% (3 to 6 months) and 42% (> 6 months). For subjects fulfilling diagnostic criteria for a mood disorder in the previous year or over their lifetime, 43% and 29% respectively had taken an AX-HY in the last twelve months and 29% and 16% an AD. For those who fulfilled diagnostic criteria for an anxiety disorder in the previous year or over their lifetime, the use of an AX-HY, in the last twelve months, concerned 43% and 30% of subjects respectively, whilst that of AD concerned 16% and 14%. For previous year or lifetime alcohol-related disorders, AX-HY use, in the last twelve months, concerned 63% and 22% of subjects respectively and use of ADs 9.3% and 7.2%. Amongst users of AX-HY in the last twelve months, a previous year or lifetime diagnosis of mood disorders was made for 16% and 39% of subjects respectively. Amongst users of ADs, the respective prevalence was 31% and 64%. A twelve-month and lifetime diagnosis of anxiety disorders was identified in 22% and 37% of users of AX-HY and among 27% and 50% of users of AD respectively. A twelve-month and lifetime diagnosis of alcohol-related disorders was found in 2.5% and 6.6% of users of AX-HY and among 1.1% and 7.8% of users of AD respectively. 68% of users of AX-HY had fulfilled none of these diagnostic criteria in the previous 12 months and 46% had never fulfilled them in their lifetime. With respect to AD users, the proportion who did not meet these diagnostic criteria in the previous 12 months was 56%, compared to 20% over their lifetime. Comparison of the French data from the study with those of the entire European sample showed that the annual prevalence of AX-HY and AD use was higher in France with mean treatment durations that were shorter. For antipsychotics and mood regulators, no clear differences were observed between France and the six countries of the study taken together. DISCUSSION: Over the last two decades, use of AX-HY seems to have decreased in France, even though it remains higher than that observed in the other European countries participating in this study. This high use can be explained in part by the observation that, in around half the cases, it corresponds to occasional use. In contrast, the use of antidepressants has increased. In subjects with recent mood disorders or anxiety disorders, the use of AX-HY remains higher than that of antidepressants. Finally among users of AX-HY, only half of them had presented a mood disorder, anxiety disorder or alcohol use disorder during their lifetime, whereas this proportion rose to 80% for users of antidepressants.

Prevalence and clinical characteristics of migraine in France.

OBJECTIVE: To determine the prevalence and clinical features of migraine and related headache types in France. METHODS: The authors recruited a population of subjects with headache representative of the national population using a stratified sampling method. They screened 10,585 subjects aged 15 and older who were representative of the general population. They identified 1,486 of these as having headaches, and these subjects were subsequently interviewed for information on clinical features, natural history, and functional impact of headache. The authors categorized subjects based on the International Headache Society (IHS) classification and assessed disability using the MIDAS questionnaire. RESULTS: The authors found a standardized prevalence for migraine (IHS categories 1.1 and 1.2) of 7.9% (11.2% for women and 4.0% for men) and 9.1% for migrainous disorder (IHS category 1.7). Migraine attacks were associated with a considerable degree of handicap in activities of daily living, with a MIDAS grade distribution of 74.7% (grade 1), 13.3% (grade 2), 7.7% (grade 3), and 4.3% (grade 4). The prevalence of migraine with MIDAS grade 3 or 4 was 1.6%. CONCLUSIONS: The prevalence of migraine (IHS categories 1.1 and 1.2) in France is 7.9%, and that of total migraine is 17.0%; this does not seem to have evolved over the past 10 years.

High blood pressure and associated cardiovascular risk factors in France.

OBJECTIVE: To estimate, with respect to age and gender, the prevalence of high blood pressure (BP) in treated and non-treated subjects and its association with other cardiovascular risk factors. DESIGN: A cross-sectional study. SETTING: Healthcare centres in the centre of France. PARTICIPANTS: All subjects (n = 61,108) who had a free health check-up, between February 1995 and September 1996. MAIN OUTCOME MEASURES: High BP (systolic blood pressure (SBP) > 140 mmHg, diastolic blood pressure (DBP) > 90 mmHg or antihypertensive therapy); diabetes (fasting glucose plasma concentration > 1.26 g/l or antidiabetic therapy); hypercholesterolaemia (total cholesterol > 2 g/l or lipid-lowering therapy); hypertriglyceridaemia (fasting triglycerides plasma concentration > 2 g/l or triglyceridaemia-lowering therapy); overweight (body mass index >or= 25 kg/m2); abdominal fat distribution (waist to hip ratio > 0.9 in males and > 0.8 in females). RESULTS: Prevalence of high BP was 37.7% in males and 22.2% in females. BP was normalized in 29.7% of treated males and 44.1% of treated females. High BP was associated with at least another cardiovascular risk factor in 83.8% of the males and 76.7% of the females with high BP. Hypercholesterolaemia was the most frequently associated risk factor. Except smoking, the prevalence of each cardiovascular risk factor was shown to increase with the severity of hypertension. Two or more other cardiovascular risk factors were present in 22.9% of the males and 9.8% of the females with high BP. CONCLUSIONS: Rate of high BP, even in treated subjects, is high. More than three out of four subjects with high BP have at least one other cardiovascular risk factor.

Environmental and experimental procedures leading to variations in the incidence of diabetes in the nonobese diabetic (NOD) mouse.

Environmental factors appear to be nongenetic risks of importance in the progression of insulin-dependent diabetes mellitus (IDDM) or type 1 diabetes, whose mechanisms are not yet well understood. Stressful life events, in particular, have been linked to the expression of overt diabetes in humans. However, in rodent models of IDDM, contradictory data exist concerning the effects of stress on the disease. Here, we show that a stressor, such as long-term repeated injections of vehicle (0.9% saline), was able to delay the appearance and/or decrease the incidence of diabetes in both sexes of NOD mice. Short-term chronic stress applied from the 6th to the 8th week of age by a combination of multiple stressors (overcrowding + immobilization + cold exposure + anesthesia) protected NOD mice from diabetes, particularly males. In contrast, prenatal stress, induced by immobilization of the mothers during the third part of pregnancy, accelerated the onset and increased the prevalence of diabetes at 30 weeks of age in NOD females, while it had no effect in males. Finally, adrenalectomy appears to aggravate the development of diabetes in NOD mice, particularly in males. In conclusion, these data demonstrate that the appearance of diabetes in NOD mice is extremely sensitive to various experimental and environmental conditions. These results are discussed in the context of the complex neuroendocrine-immune interactions which occur during the progression of IDDM, with a particular focus on glucocorticoids and cytokines.

Study and applications of an informational measure of dependence in survival models.

In survival models, when the factor of interest is a continuous variable or is expressed through a group of several variables, the classical measures of risk, i.e. relative risk and odds ratio, are not appropriate and there is no standard measure of dependence between survival and the considered factor. The Information Gain has been proposed by Linfoot (1957) and Kent (1983), giving any parametric model as a generalization of the squared product-moment correlation coefficient of the linear regression model with normal errors. By using simulation methods, we studied the statistical properties of the information gain as a measure of dependence, in the particular case of survival regression models. We suggest several efficient applications of this informational concept to some classical problems of regression analysis and prognostic analysis. Our ideas are illustrated through an example on the prognosis of idiopathic dilated cardiomyopathy.

The development of a French version of a questionnaire on the quality of life in cancerology (Functional Living Index-Cancer: FLIC).

The quality of life has become an indispensable element in the evaluation of treatments, especially as clinical trials are generally conducted in more than one country. In cancerology, numerous questionnaires have been developed and validated, but most of them are in English. This article presents the stages of translation and validation of the French version of the FLIC (Functional Living Index-Cancer). It applies to a sample of 200 patients, 47% of whom have breast cancer. The acceptability of this questionnaire is good (92.2%). The main psychometric criteria were verified. The Cronbach alpha coefficient, equal to 0.90, shows good reliability. A factor analysis was conducted to examine construct validity; it revealed a 5-factor solution accounting for 62% of the variance. These 5 factors are associated with specific domains; physical, psychological and social functioning, current well-being and disease symptoms. The global scores of the FLIC correlate significantly with those of the different scales of the EORTC QLQ-C30. Moreover, clinical relevance is ensured by its correlation with certain clinical variables (WHO index, location of tumour). The French version of the FLIC can be used to measure the quality of life of patients afflicted with cancer, but further studies are necessary to confirm its reliability.

[Cardiovascular risk factors in France. Prevalence and association]. / Facteurs de risque cardiovasculaire en France. Prévalence et association.

The object of this study was to assess the prevalence of modifiable cardiovascular risk factors and their association in 61,108 subjects over 15 years of age who volunteered for a systematic medical check-up, free of charge, and performed in a health centre in central France. The risk factors were defined as follows: hypertension, diabetes, hypercholesterolaemia, hypertriglyceridaemia: medical treatment or value above the upper limits of normal defined by national or international recommendations. obesity and android fat distribution as defined by the principal recommendations. The commonest risk factor was hypercholesterolaemia (60% of men and 64% of women) followed by android obesity. The prevalence of hypertension was greater in men than in women (44 vs 33%). Twenty eight per cent of men and 17% of women admitted to smoking. The percentage of smokers was higher in people under 30. Diabetes was observed in 3% of men and 2% of women. The association of risk factors was observed at an older age in women than in men. The association of 3 risk factors was four times greater in men than in women in the whole population. In conclusion, this study shows that cardiovascular risk factors are very common in persons undergoing a medical check-up and that these factors are often associated at an earlier age in men than in women.

["White-coat" effect in 35 consecutive patients with hypertension. Quantification method, role of physician-patient dialogue]. / L'effet "blouse blanche" chez 35 hypertendus consécutifs. Méthode de quantification, rôle du dialogue médecin-patient.

The "white coat" effect, an alarm reaction to the presence of a doctor, is an important cause of blood pressure variability, the frequency, amplitude and mechanisms of which are only partially understood. In order to evaluate these factors, a prospective study was undertaken in 35 consecutive patients referred for assessment of clinical hypertension. The alarm reaction was investigated during the consultation, at the time of interrogation, in periods of silence, in the sitting and upright positions. Twenty-four to forty-eight measurements (average 36.8) of the blood pressure and heart rate were performed in each patient with a Diasys 200 R monitor. The ambulatory period of 3 to 5 hours after the consultation provided 12 to 24 measurements (average 20.7) which were considered to be the reference for comparison with the consultation period. A total of 2,038 measurement were made and analysed. Analysis of variance (GLM) for each patient and for the whole group gave an assessment of the alarm reaction during the patient-doctor dialogue and periods of silence with reference to the ambulatory period. During the ambulatory period, the average and standard deviation for systolic pressure were 134 +/- 0.7 mmHg, and for diastolic pressure 93.1 +/- 0.6 mmHg. These pressures were significantly lower than during the two periods of consultation, with and without dialogue (p < 0.0001). During the consultation, the systolic and diastolic blood pressure values were significantly higher during the dialogue than during the periods of silence (p < 0.0001). During the dialogue, the systolic pressure attained 153.7 +/- 0.7 mmHg and the diastolic pressure: 107.2 +/- 0.6 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

[How to describe indoor environment in epidemiological studies dealing with respiratory diseases]. / Description de l'environnement domestique et études épidémiologiques sur les pathologies respiratoires.

BACKGROUND: Indoor environment can be partly responsible for respiratory health. The aim of this paper is to summarize epidemiological studies dealing with the relations between indoor pollutions and asthma or atopy, to analyze the ways of characterization of the dwellings and to expose health effects of the studied risk factors and results of the confrontation between data issued from questionnaires and from environmental measurements. METHODS: Thirty two papers were listed on Medline data base since 1990. These are mainly case-control studies and cross-sectional surveys and most often concern children. The health status is objectively evaluated by medical examinations or indirectly characterized by questionnaires on symptoms. All the studies use a questionnaire to describe indoor environment while some environmental measurements, mostly of biological pollutions, could be realized simultaneously. RESULTS: Some associations between different characteristics of the dwellings and respiratory symptoms are commonly found. Thus, exposure to allergens of the dwellings, environmental tobacco smoke, home dampness or characteristics and cleaning of the bedding increase the prevalence of respiratory symptoms. Residential exposure to chemical pollutants, due to the existence of recent paints are also related to different respiratory symptoms. By contrast, for other indoor risk factors, without standardized evaluation, the impact on respiratory health is inconstant. These factors are sociodemographic environment, heating and cooking installations, use of a humidifier, treatment air system or ventilation system, wall-to-wall carpets or pets at home. CONCLUSIONS: On examining this review literature, disparity in description of the indoor environment, depending on the studied pollutants, is pointed out. That is why we advice to use ever validated questionnaires to evaluate environmental tobacco smoke, home dampness and presence of pets, in association with environmental measurements to study indoor sources of allergens. Conversely, to evaluate the home exposure to chemical pollutions poorly studied today, some new questionnaires have to be elaborated and validated with regard to environmental measurements before being used in epidemiological studies.

[The treatment of migraine by pharmacists: a French multicenter study]. / La migraine en pharmacie d'officine: une étude multi-centrique française.

Migraine remains an under-diagnosed disease. Many migraine sufferers are not currently treated within the healthcare system and most of them take self-medication. A prospective national study was conducted in France with 770 pharmacies. Data on symptoms, drug dispensing, patient management, and satisfaction of 7 264 subjects complaining of headache at the pharmacy were collected. Two-third of the subjects were migraine sufferers according to the IHS criteria. 32 p. cent of them came to the pharmacy during a pain attack. 63 p. cent had a medical prescription (46 p. cent in the non-migraine group) with triptans being most often prescribed drug (in almost half of the cases). Nearly one-third of the migraine sufferers without medical prescription were referred to a doctor by the pharmacist. This first study on migraine and headaches and pharmacies highlights the important role that pharmacists can play in improving the management of migraine and headache through advice and proper orientation towards medical practitioners.

[NOEMIE: an epidemiological study of migraine at work: results from 17 occupational health centres]. / NOEMIE: un observatoire de la migraine en entreprise. Résultats obtenus dans dix-sept centres de médecine du travail.

INTRODUCTION: A survey (NOEMIE, Nouvel Observatoire Epidemiologique de la Migraine en Entreprise) was carried out in France in 17 occupational healthcare units in order to identify subjects suffering from migraine headache with the aim of guiding them towards a healthcare program. The data collected in the participating units are presented. METHODS: and patients. NOEMIE was a national cross-sectional, observational, multicentric study with a 6-month follow-up. Two groups of migraine sufferers (according to IHS criteria) were included and divided into two groups: subjects already managed for their migraine (group A) and subjects who had not sought healthcare for migraine for more than 12 months (group B). The main objective was to evaluate changes in the quality-of-life score (QVM) 6 months later. RESULTS: At inclusion, the two groups were comparable for demographic features, history of migraine, and disease severity. A significant difference was observed between the two groups for frequency of attacks, disease management, and evaluation of treatment efficacy and of quality-of-life. At 6 months, patient satisfaction and quality-of-life were significantly improved (6 to 10 point improvement). For the 4753 reported attacks, 12.4 percent of the patients in group A required sick leave versus 10.9 percent in group B. Frequency of sick leave was considerably improved in both groups. CONCLUSION: By identifying subjects suffering from migraine headache who had not sought specific medical care and advising them to seek medical management, the employee healthcare units improved the subjects' quality-of-life, promoted adequate medical management and reduced occupational consequences of migraine headache.