P. Abastado, G. Guiramand, B. Bousquet. Exploring signs of ageing and the lifespan since the 15th century through self-portraits. Ageing & Society, 2005 ; 25 (2) : 147-58.

Summary : Painters’ self-portraits offer the opportunity to study signs of ageing through the centuries. In this paper, we examine 687 self-portraits by 506 painters from the 15th to the 20th century. To qualify for the analysis, painters had to be unquestionably identified, have known years of birth and death, and the self-portraits had to be dated unequivocally. ‘Age scores’ for the characteristics of the lower face were developed. Ptosis of the upper eyelid, bags under the eyes and the characteristics of beards were also recorded. Among the main findings, the painters of self-portraits that exhibited ptosis of the upper eyelid had a higher actual age than those of portraits which did not (55 versus 38 years). Similarly, those that represented bags under the eyes were rated as older painters (47 versus 33 years). The percentages of portraits with eyelid ptosis and bags under the eyes were similar through the centuries and in three zones of Europe. The age scores of the lower half of the face were also consistent in all centuries, except at ages 40-49 years. The painters’ average lifespan significantly increased during the 18th century; and within Europe a north–south lifespan gradient has been evident since the 17th century. We conclude that ageing has had similar facial manifestations over the last five centuries, except between 40 and 50 years of age.

C. Jamin, E. Leutenegger, S. Senoussi, C. Devaux. Fifty and menopause. Complaints expressed and unexpressed by women. Practitioners' perception and therapeutic impact. Gynecol. Obstet. & Fertil. 2005 Mar; 33(3): 119-25.

Summary : 1) Objective. Identification of symptoms appearing at the time of menopause, and evaluation of their spontaneous expression level, connection with menopause and therapeutic impact. 2) Method. Opinion survey carried out with 1,229 French gynaecologists. 3) Results. The classical symptoms of menopause (hot flushes, night sweats, dry vagina) are spontaneously expressed by women. Atypical symptoms of menopause (sexual, relational and neuropsychological troubles) are less expressed. They are considered by practitioners as related to menopause, but less than classical symptoms. The ageing symptoms (muscle loss, joint pain, skin ageing, disappearance of phantasms…) are scarcely expressed by women and connected with menopause by a minority of gynaecologists. The stronger the connection with menopause is, the more the symptom justifies an hormonal treatment of menopause. Thus, when classical symptoms are present, the hormonal treatment is almost always justified but it is less justified in case of atypical symptoms, and more disputable for the ageing symptoms. 4) Conclusion. Beyond the most evident signs of menopause, several other symptoms scarcely expressed by women can justify an hormonal treatment of menopause even when the connection with menopause is not demonstrated. Improvement of menopause treatment strategy requires to take into account all these symptoms, and an hormonal substitution that might be sometimes broader than the estrogenic therapy (androgenic, for example). Résumé en anglais consultable sur PubMed : Lien PubMed

J.-Y. Le Heuzey, O. Paziaud, E. Thibout, M. Ait Said. Traitement préventif des récidives de fibrillation atriale en médecine cardiologique de ville : données de l'observatoire FAUVE. Annales de cardiologie et d'angéiologie, 2004 ; 53(5) : 250-58.

Résumé : Objectif – Analyser les modalités du traitement préventif des récidives de fibrillation atriale (FA) paroxystique ou persistante par les antiarythmiques de la classe IC de Vaughan-Williams. Méthodes – Enquête observationnelle auprès de 326 cardiologues français, comportant d'une part une enquête d'opinion, d'autre part un observatoire transversal de la pratique médicale. Chaque cardiologue devait inclure deux patients âgés de moins de 65 ans ayant une FA non permanente (paroxystique ou persistante) sans dysfonction ventriculaire gauche (DVG) mis sous traitement par un antiarythmique de la classe IC après retour en rythme sinusal. Résultats – L'enquête d'opinion auprès des cardiologues indique que la FA non permanente représente 36,1 % des cas de FA, dont 57,8 % concernent des patients sans DVG. La plupart des cardiologues (85 %) déclarent instaurer un traitement préventif des récidives chez 70–100 % de ces patients après retour en rythme sinusal, par un antiarythmique de classe IC dans plus de 50 % des cas. Sur les 633 patients inclus dans l'observatoire, en majorité des hommes, 409 (64,6 %) avaient une FA paroxystique et 224 (35,4 %) une FA persistante. L'analyse de la prise en charge thérapeutique indique que la modification du traitement antérieur et le choix d'un antiarythmique de classe IC se fondent principalement sur l'efficacité et sur la tolérance du traitement antiarythmique. Conclusion – Les antiarythmiques de classe IC ont une place de choix pour le maintien en rythme sinusal des patients non âgés ayant une FA non permanente sans DVG.

Mouchabac S, Ferreri M, Cabanac F, Bitton M. Residual symptoms after a treated major depressive disorder: in practice ambulatory observatory carried out of city. Encephale. 2003 Sep-Oct;29(5):438-44.

Summary : Introduction - The main therapeutic objective for depression is remission (absence of clinical signs of the disorder and low scores on assessment scales), yet partial remission rates remain high (insufficient criteria for diagnosing the disorder while clinically and psychometrically assessable symptoms continue to linger. The presence of residual symptoms is associated with a higher relapse rate of depression, occurring up to 5 times earlier, an increased suicide rate, significant use of healthcare services and a marked social impairment. The most frequently reported symptoms are specific to depression, i.e. anxiety and irritability, depressed mood, feelings of guilt and loss of interest in activities, asthenia and difficulty falling asleep at night. Residual symptoms constitute a valid and reliable clinical marker of prognosis (especially for relapse and chronicity) and must be treated with specific therapeutic strategies. Studies on depression with residual symptoms are few and mainly focus on populations of hospitalised patients or those with a severe form of depression. Since little work has been done with regard to patients monitored on an outpatient basis, we felt it was appropriate to select a population of depressed patients from private psychiatric practice. Our main objective was to analyse the frequency of residual symptoms after 8 to 12 weeks of antidepressant treatment and to study the clinical and socio-demographic characteristics of these subjects. Design - 1 790 patients who had presented with one major depressive episode per DSM IV criteria and who had been receiving antidepressant treatment for 8 to 12 weeks were included and evaluated. 463 private psychiatrists practising in metropolitan France were randomly selected and stratified by region and sex ratio (30% female and 70% male) to obtain a sample as representative as possible of the French psychiatrist population. The following were measured and assessed: anthropometric and socio-demographic characteristics, the history of depression, a description of the last major depressive episode, a description of its management, current clinical variables, the Hamilton Depression Rating Scale (HDRS) score, the physician's assessment of residual symptoms, and a description of the patient's management on the day of the appointment. Lien PubMed

Mouchabac S, Ferreri M, Cabanac F, Bitton M. Residual symptoms after a treated major depressive disorder: a survey among private psychiatrists. Encephale. 2003 Jul-Aug;29(4 Pt 1):306-12.

Summary : Recent studies suggest that depression with residual symptoms is a frequent progressive form of this disease. It is associated with a poor prognosis that translates into an earlier and higher relapse rate, and has a significant medical and social impact. Several literature reviews emphasise that residual symptoms are under-evaluated and that their treatment should follow an incisive strategy with the goal of complete eradication of symptoms. Specific patterns have not been detected either, and the evaluation of residual symptoms remains subject to numerous biases due to the lack of a validated definition. The purpose of this study was to analyse the opinions and attitudes of psychiatrists about residual symptoms following major depressive episodes treated with antidepressants as part of their daily private practice. Design - 867 psychiatrists were selected from across France to form a representative sample of the medical specialisation. They were questioned with a closed-choice questionnaire on the scope of the residual depressive symptoms concept (definition, professional consensus), determining factors in their onset (factors associated with the patient, with the initial episode, with management) and their practical and therapeutic attitude towards these symptoms. Results - The estimated prevalence of residual symptoms in their depressed patients was 25%. Fifty-seven percent of the physicians queried felt the concept was appropriate, but 70.3% thought that it did not have a strong professional consensus. The definitions deemed most appropriate were those involving the persistence of clinical signs (asthenia or minor cognitive impairment), whereas the use of psychometric criteria was mentioned less often. There is a clear absence of consensus concerning the diagnostic delay of residual symptoms, as 30% diagnosed them after 6 months. Responses about factors that may be predictive or affect the onset of residual symptoms (associated with the patient, the nature of the initial episode and the management) did not reflect a unified position, nor did they necessarily correspond to the data in the literature. However, while the therapeutic attitude seemed adequate (verifying treatment compliance, clinical re-evaluation, therapeutic re-adjustment), 64% of the physicians considered residual symptoms to be a therapeutic challenge. Lien PubMed

Chanard J. Chronic renal failure and hypertension in community cardiology practice. Presse Med. 2001 Sep 22;30(26):1288-94.

Summary : Objective - A sustained increase in the incidence of vascular nephropa-thies has been recently documented in western countries and correlated with aging. Renal failure is often ignored in patients with hypertension and its diagnosis made too late, at the stage of replacement therapy, with an increased mortality rate and prolonged hospitalization time. In clinical practice, the diagnosis of renal insufficiency is based on the measurement of serum creatinine, which depends on muscular mass, gender and age of the subject and is regulated by glomerular filtration. Therefore, serum creatinine level does not give a correct estimate of renal function. According to Good Clinical Practice recommendations, serum creatinine must be used to calculate creatinine clearance, a surrogate of glomerular filtration. To avoid methodological constraints of clearance measurement with precise urine recollection, the index proposed by Cockcroft and Gault is highly reliable and widely used. Patients and method - An epidemiological survey has been carried out to measure the prevalence of renal insufficiency in hypertensive patients regularly followed by cardiologists. This open, transverse study compared estimates of renal function based upon serum creatinine level and creatinine clearance using the Cockcroft and Gault's formula. Among 1,000 private cardiologists randomly selected in metropolitan France, 707 entered the study. During the last week of May 2000, they included 2,100 hypertensive patients using a questionnaire describing individual patient's demographic and clinical characteristics. Results - The mean age of hypertensive patients was 65.9 +/- 12.2 years. They used antihypertensive drugs for a mean 10.3 +/- 7.7 years. The prevalence of renal failure, as defined by a creatinine clearance lower than 60 ml/min, was 32%, whereas 61% of the patients had a creatinine clearance below 80 ml/min. In contrast, 71% of the patients were subjectively considered to have a normal renal function. This discrepancy reflects underdiagnosis of mild to moderate renal failure. Hypertensive patients with renal failure did not present with excess cardiovascular risk factors and comorbidities when compared with those having a normal renal function. Prevalence of type 2 diabetes and hypercholesterolemia was similar in both groups. Lien PubMed

Chanard J. How to prevent the complications of chronic renal insufficiency. Rev Prat. 2001 Feb 28;51(4):385-90.

Summary : The early diagnosis of renal disease and the treatment of its potential complications are mandatory to postpone end-stage renal failure. The serum creatinine level and its derived Cockcroft's index which allows estimate of glomerular filtration rate, is the variable upon which relies the medical strategy. To slow down the progression of renal insufficiency, both the cause of renal disease and its consequences on hemodynamics and metabolic regulations must be treated. The impact of protocols combining appropriate dietetic recommendations and drugs are well documented to treat hypertension and malnutrition. For metabolic disturbances and anemia, at least before end-stage failure, preventive protocols are less well established. Nevertheless, the renal patient must be educated and prepared for dialysis and renal transplantation since the early beginning of renal insufficiency. He must be immunized against HBV and harboring a functional arterio-venous fistula for those allocated to hemodialysis. Lien PubMed

Bousquet B. Étude des caractéristiques d'une population française de sujets âgés dénutris suivis en ambulatoire en médecine générale. Enquête épidémiologique. Age & Nutrition, 1999 ; 10 (3) :: 149–56.

Résumé : La prévalence de la malnutrition est importante chez les personnes âgées. Ses conséquences sont graves et ont une incidence directe sur la morbi-mortalité. Cependant il apparaît difficile de trouver un consensus sur les outils de diagnostic et leur précision à décrire un risque de dénutrition. L'objectif de cette étude transversale était d'appréhender la dénutrition du sujet âgé en France, en termes de description épidémiologique d'une population âgée dénutrie et de prise en charge ambulatoire de la dénutrition. Une enquête a été conduite auprès de 2 202 médecins généralistes et 9 108 patients. Un questionnaire rempli par le praticien était destiné à identifier la population des médecins et les critères utilisés pour diagnostiquer une malnutrition, caractériser la population dénutrie par l'évaluation de paramètres cliniques, diététiques et anthropométriques, et analyser la prise en charge thérapeutique, en pratique de ville. Les critères jugés pertinents par les médecins pour affirmer une dénutrition sont essentiellement la perte de poids et l'index de masse corporelle ; les paramètres biologiques sont moins fréquemment cités. Le sujet âgé dénutri est principalement traité par des médicaments, plus rarement par des compléments nutritionnels. L'ensemble des paramètres, analysés en fonction du sexe et de l'âge, montre que, hormis les effets connus du vieillissement, une association à l'âge n'a été observée que pour la perte de poids, sévère ou modérée, et la fréquence de maladies aiguës et ou stress psychologiques. Ce dernier paramètre semble également fonction du sexe, de même que la situation familiale, la motricité et le type d'infections observées dans cette population.

T. Ponchon, S. Forestier. Detect®. Evaluation d’outils d’aide au dépistage ciblé du cancer colorectal. Acta Endoscopica, 2005 ; 35(4) : 675-680

Summary : 1) Objective. To promote case-screening detection of colorectal carcinoma and to validate easy-to-use tools in this field. 2) Method. Academic Detailing? survey carried out with 500 French hepato-gastro-enterologists. 3) Results. 151 hepato-gastro-enterologists practicing in metropolitan France were randomly selected and had included 446 patients at high risk for colorectal cancer in DETECT? project. Patients were divided into 265 index1 patients and 180 patients with familial history of colorectal neoplasm. From the 446 patients included, 1544 subjects with a high risk of colorectal neoplasm were identified. 45 % of patients with personal history of colorectal neoplasm or adenoma also had a family history of colorectal neoplasm or adenoma. 4) Conclusion. This study showed the important need for information on case-screening of colorectal carcinoma and confirmed that simple helpful tools to inform family and general practicioners are awaited by the hepato-gastro-enterologists. 1 patients to which the diagnosis of colorectal neoplasms or adenoma was carried

Modalités d’utilisation des analogues rapides et mixtes de l’insuline par les diabétologues. L’étude ARAMIS. E. Cosson, F. Elgrably, P. Valensi, G. Slama, D. Roger, A. Champigneulle. Congrés de l’Alfediam. Lyon, 22-26 mars 2005.

Résumé : Introduction - L’observatoire ARAMIS, mené en France entre octobre 2003 et mars 2004 auprès de 245 diabétologues et 922 diabétiques, a eu pour objectif de décrire les modalités d’utilisation par les spécialistes des analogues rapides ou mixtes de l’insuline. Matériel et méthodes - Les diabétologues ont rempli un questionnaire concernant 4 diabétiques de type 1 (DT1) ou 2 (DT2) consécutifs, âgés de 18 ans ou plus, et qui avaient à la fin de la visite une ordonnance reconduisant ou introduisant un analogue rapide et/ou mixte de l’insuline. Résultats - Les données de 354 DT1 et de 549 DT2 ont été analysées. L’âge moyen était respectivement de 47±17 et 65±11 ans, avec une ancienneté du diabète de 15,7±12,0 et 16,0±11,3 ans, Plus de 85% des patients avaient une HbA1c > 7% (DT1 : 8,8±1,8% ; DT2 : 9,3±1,6%). Une complication liée au diabète, le plus souvent rénale, était présente chez 66% des DT1 et 74% des DT2. Au cours des 12 derniers mois, 77% des DT1 et 52% des DT2 rapportaient des épisodes d’hypoglycémie légère (34% des DT1 et 10% des DT2 = 1/semaine), 15% des DT1 et 3% des DT2 des épisodes d’hypoglycémie sévère. En début de consultation, une insulinothérapie était en cours chez 92% des DT1 et 72% des DT2, le plus souvent à 2 injections/jour (39% des DT1 et 58% des DT2). Seuls 24% des DT1 bénéficiaient d’un schéma basal/bolus. Chez les patients déjà insulino-traités, le nombre moyen d’injections à l’issue de la consultation est passé de 2,8 à 3,2 chez les DT1 (46% = 4 injections/jour) et de 2,1 à 2,4 injections chez les DT2 (52% et 25% des patients à 2 et 3 injections/jour respectivement). Un antidiabétique oral concomitant restait prescrit chez 10% des DT1 et 46% des DT2. Conclusion - ARAMIS confirme le mauvais équilibre glycémique chez la majorité des patients, la faible proportion de schémas optimisés et une incidence encore forte d’hypoglycémies chez le diabétique. L’utilisation des analogues rapides ou mixtes de l’insuline se traduit par une augmentation du nombre d’injections. Lien PDF

Rheumatoid arthritis (RA) : eligibility criteria for TNF-blocker therapy in the hospital setting. A multivariate analysis. The PRECEPT study. O. Meyer, J. Sany, French rheumatologists PRECEPT Group. Congrés de l’EULAR. Vienne, 8th - 11th June 2005.

Abstract : Objectives - This cross-sectional survey is aimed at assessing and ranking the eligibility criteria for TNF-blocker therapy of patients with rheumatoid arthritis in real life hospital rheumatology clinics. Methods - French rheumatologists were asked to recruit RA patients currently or formerly treated with methotrexate divided as follows : the first two patients for whom the participating physician decides to start TNF-blocker therapy and the first two patients for whom the physician do not treat with TNF-blocker therapy. A multivariate analysis among all the collected data was achieved to identify and grade the eligibility criteria for treatment. Results - During a six-month period, 189 rheumatologists screened 1888 RA patients and included 688 patients (mean age: 56, women: 75%) with following distribution ; respectively 327 patients (45.5%) treated and 361 (52.5%) not treated with TNF-blockers were included in the survey. The multivariate analysis (see below) show that the main criteria associated with the use of TNF-blockers were high increase of functional disability (OR 10.7 [5.9 – 19.3]) and disease evolution (OR 6.4 [2.8 – 14.5]). Presence of radiographic damages (OR 3.3 [2.0 – 5.6]) and a DAS score = 3.2 (OR 2.0 [1.3 – 3.2]) came out as relevant criteria as well as previous or current corticosteroid treatment(OR 1.8 [1.1 – 3.1]). Moreover, patients sent by private practice rheumatologists are more likely to be treated (OR 3.0 [1.8 – 5.1]). Conversely, rheumatologists did not use TNF-blockers for patients whose RA diagnosis is recent (less than 5 years) (OR 0.6 [0.3 – 1.0]). Conclusion - High increase of functional disability and RA severity (progression and activity) are highly determinant in patient eligibility for TNF blockers therapy while the converse influence of a relative newness of disease (disease duration < 5 years) could reveal a wait-and-see attitude. Lien PDF

Gastro-intestinal (GI) disorders in NSAIDs patients followed by rheumatologists : patients behavior and therapeutic approach. G. Philippe, S. Rozenberg, Z. Hassani, E. Leutenegger, S. Bruley des Varannes. Congrés de l’EULAR. Vienne, 8th - 11th June 2005.

Abstract : Background - GI symptoms are frequently reported by patients receiving NSAIDs. However both patients behaviour and resulting medical attitude are poorly known. Objectives - The aim of this study was to describe the management by rheumatologists of NSAID-treated patients presenting upper GI symptoms. Methods - During a four-month period 508 rheumatologists included anti-ulcer agents-free patients in whom GI symptoms occurred during a NSAID therapy conducted for at least two weeks. Characteristics, previous and current medical history of patients as well as medical attitude were obtained using a standardized questionnaire. Results - 2009 patients (mean age: 57 yr., women: 60%), with mainly chronic rheumatologic affections such as osteoarthritis (51%), rheumatoid arthritis (13%) or ankylosing spondylitis (10%) were included. All patients were free of gastroprotective agents although 55% of patients reported a previous history of drug-induced dyspepsia and 41% presented at least one digestive risk factor (age>65 years, past history of gastro-duodenal ulcer, gastric ulcer perforation and/or hemorrhagic ulcer). After NSAID therapy (75% on non-selective NSAIDs and 25% on coxibs), most of the patients (83%) presented dyspeptic symptoms such as epigastralgia (61%) or pyrosis (32%). 43% of patients did not react following these symptoms, 44% withdrew their NSAID, 16% underwent a GP visit modifying their treatment and 15% tried OTC products such as anti-acid medicines. If these dyspeptic symptoms led only 13% of patients to consult their rheumatologist, a reduction of NSAID observance in 53% of patients was reported by rheumatologists. During the visit, rheumatologists mostly maintained NSAID therapy but with additional proton pump inhibitors (PPIs) in 82% of patients and alone in 3%. They switched from non specific NSAID to coxib for 10% of patients, adding PPI for 82% of them. They stopped NSAIDs in 14% of patients (replaced by analgesics in most cases) and 11% of patients were referred to gastroenterologist for endoscopy. Lien PDF

Surpoids chez les hypertendus non contrôles en Médecine Générale : de la bonne appréciation du risque à l’amélioration thérapeutique. J-P. Fauvel, M. Ducher, O. Crisan, E. Leutenegger. Journées de l’HTA. Paris, 16-17 décembre 2004.

Résumé : Objectifs Méthode - Un observatoire transversal a été mené début 2004 auprès de 2061 médecins généralistes (distribution représentative de la démographie médicale) dans le but de décrire le profil et la prise en charge des patients hypertendus non contrôlés en fonction de la présence d’un surpoids (2 cas IMC?25 / 1 contrôle). Résultats - 6031 patients hypertendus non contrôlés (4080 en surpoids / 1951 contrôles) âgés de 60 (±12) ans, dont 57 % d'hommes, ont été inclus dans cet observatoire. Les médecins traitants apprécient bien l'existence d'un syndrome métabolique et évaluent très bien le risque cardiovasculaire chez leurs patients, d'autant plus qu'ils sont en surpoids. La très grande majorité des médecins se fixe des objectifs de PA, poids, activité physique et régime (lipidique, sodé), jugés significativement plus difficiles à obtenir chez les patients en surpoids. Si l'appréciation du risque par les médecins est excellente, il reste à améliorer la prise en charge thérapeutique en particulier antihypertensive. En effet, trop de patients hypertendus non contrôlés sont en monothérapie (50%) mais surtout restent en monothérapie à l'issue de la consultation. Ceci contraste avec l'optimisme des médecins quant à l'obtention d'un bon contrôle tensionnel qui est pour la quasi totalité d'entre eux bien connu (but < 140/90 mmHg). Pour ceux qui modifient le traitement, les motivations sont l’inefficacité du traitement précédent (65%), l'échec des régimes, la modération de l'hyperactivité sympathique (35%), la cardioprotection (25%), la néphroprotection (20%). Conclusion - La juste appréciation par les médecins du risque cardiovasculaire des hypertendus non contrôlés, en particulier avec surpoids, ne se traduit qu'insuffisamment au plan thérapeutique. Les objectifs tensionnels sont connus et explicités au patient, mais la thérapeutique est insuffisamment adaptée. Une amélioration en matière de prévention cardiovasculaire est donc nécessaire et possible, ce qui est encourageant. Lien PDF