Hepatitis C awareness among adolescents in the Alpes-Maritimes area of France

OBJECTIVES: Certain practices with a potential risk of hepatitis C virus (HCV) transmission begin early, during adolescence. In 2004, primary prevention interventions targeting adolescents aged 13-17 years attending school in the Alpes-Maritimes region of France were conducted by the "Réseau Hépatite C Ville H?pital C?te d'Azur". The aim of this study was to assess the adolescents' knowledge about HCV and to evaluate the impact of such interventions.METHODS: A random sample of secondary state schools in the Alpes-Maritimes was invited to participate in the study. Before and after presenting a slide show about HCV in the selected classrooms, the investigators asked the students to complete an anonymous self-administered questionnaire designed to assess their knowledge about HCV infection.RESULTS: The intervention concerned a study population of 2,946 students, mean age 14.4 +/- 2.5 years. Before the interventions, 21% had good knowledge of HCV infection and 24% had good know-ledge of disease contagion. These percentages increased significantly after the interventions to 95% and 84% respectively. Knowledge improvement was more significant among high school students and among students whose parents had an employment.CONCLUSIONS: Adolescents are poorly informed about HCV infection. The present intervention enabled significant improvement in their knowledge about the infection and disease contagion, independently of gender, age and geographical area.     

International consensus in Paris, 2006, on the indications and use of the endoscopic videocapsule test. Report of the SFED Capsule Commission

Following the 4th International Conference on Capsule Endoscopy (ICCE, Miami 2005), the main indications for videocapsule endoscopy (VCE) were reviewed. The consensus guidelines were published in Endoscopy in 2005. These propositions for VCE were based on an analysis of evidence reported in the literature published through 2005. A small working group of experts examined each methodology and presented their report at the plenary session. The final conclusions were then published. At the ICCE 2006 held in Paris, this first version of the consensus guidelines was improved and completed.     

How to treat hypertension in patients with peripheral artery disease

The risk of peripheral artery disease is underestimated by many physicians; such risk is further augmented by the presence of hypertension. Detection of these conditions is essential to prevent cardiovascular accidents. This review deals with the management of peripheral artery disease as a risk factor, highlighting the need for triple therapy (antiplatelet drugs, angiotensin-converting enzyme inhibitors, and statins). Treatment of hypertension is approached by reviewing the essentials of the different antihypertensive drugs available, focusing on their peripheral circulatory effect. However, because individual antihypertensive drugs seem not to differ largely in this respect, attention is drawn to the message that the most important task in these patients is to control total cardiovascular risk rather than focusing on the choice of the individual antihypertensive drug.     

Dyspnea and activity limitation in COPD: mechanical factors

Dyspnea and activity limitation are the primary symptoms of chronic obstructive pulmonary disease and progress relentlessly as the disease advances. In COPD, dyspnea is multifactorial but abnormal dynamic ventilatory mechanics are believed to be important. Dynamic lung hyperinflation occurs during exercise in the majority of flow-limited patients with chronic obstructive pulmonary disease and may have serious sensory and mechanical consequences. This proposition is supported by several studies, which have shown a close correlation between indices of dynamic lung hyperinflation and measures of both exertional dyspnea and exercise performance. The strength of this association has been further confirmed by studies that have therapeutically manipulated this dependent variable. Relief of exertional dyspnea and improved exercise endurance following bronchodilator therapy correlate well with reduced lung hyperinflation. The mechanisms by which dynamic lung hyperinflation give rise to exertional dyspnea and exercise intolerance are complex. However, recent mechanistic studies suggest that dynamic lung hyperinflation-induced volume restriction and consequent neuromechanical uncoupling of the respiratory system are key mechanisms. This review examines, in some detail, the derangements of ventilatory mechanics that are peculiar to chronic obstructive pulmonary disease and attempts to provide a mechanistic rationale for the attendant respiratory discomfort and activity limitation.     

The patient-physician relationship and medical utilization

Objective: The goal of this study was to (1) explore the relationship between medical utilization and characteristics of the patient-physician relationship and (2) evaluate the relationship between physician perception of patient difficulty, chronic medical problems, and patient somatizing tendencies.Method: Patients in an academic family practice center were asked to complete a demographic data sheet, the PRIME-MD Patient Questionnaire, and the Barrett-Lennard Relationship Inventory regarding their relationship with their physicians. Their physicians completed the Difficult Doctor-Patient Relationship Questionnaire. Patient charts were examined for number of office visits and phone calls in the previous year, as well as number of chronic problems and medications. The study was conducted from September 2000 to November 2001.Results: Forms were completed by 165 patients and 20 physicians. Forty-three patients who were approached refused to participate. Patient ratings on the Barrett-Lennard Relationship Inventory were not related to utilization measures. Physician ratings of difficulty were significantly related to phone calls and visits (p < .05), as well as PRIME-MD Patient Questionnaire somatization tendencies (p < .05) but not to number of chronic problems. Patient and physician ratings were not significantly correlated. Gender (p < .001), marital status (p < .04), education (p < .03), and employment status (p < .002) were all related to utilization measures.Conclusion: Medical utilization was associated with somatizing tendencies of patients and the physicians' perception of patient difficulty. Physicians rated patients as difficult if they tended to somatize but not if they had a number of chronic problems.     

Alzhemed: a potential treatment for Alzheimer's disease

As a potential disease-modifying treatment for AD, Alzhemed (tramiprosate) is a compound that binds to soluble amyloid-beta peptide (Abeta) and inhibits the formation of neurotoxic aggregates that lead to amyloid plaque deposition in the brain. The safety, tolerability, and pharmacodynamic effects of Alzhemed were assessed in a double-blind study in which 58 individuals with mild-to-moderate AD (MMSE 13-25) were randomized to receive placebo or Alzhemed 50, 100 or 150 mg BID for 3 months. At the end of the double-blind phase, 42 of these subjects entered a 36-month open-label (OL) phase in which they received Alzhemed 150 mg BID. Assessments included plasma and cerebrospinal fluid (CSF) Alzhemed concentrations, CSF levels of Abeta, as well as cognitive (Alzheimer's Disease Assessment Scale-cognitive subscale, Mini-Mental State Examination) and clinical performance (Clinical Dementia Rating scale, Sum-of-Boxes) measures. Alzhemed was safe and well tolerated, crossed the blood-brain barrier, and dose-dependently reduced CSF Abeta(42) levels after 3 months of treatment. Mild AD subjects (MMSE 19-25 at entry) displayed greater reduction of CSF Abeta(42) levels than moderate AD participants (MMSE 13-18 at entry). There was no effect of Alzhemed on the cognitive or clinical measures after 3 months of treatment. The OL follow-up suggested a stabilization of cognitive function especially in mild AD subjects over the 36-month study period. Alzhemed thus appears to be well tolerated with long-term exposure and reduces CSF Abeta(42) levels in mild-to-moderate AD subjects. These findings will be discussed in the context of two large-scale randomized, double-blind, placebo-controlled Phase III clinical trials that are currently being conducted to test the long-term safety and efficacy of Alzhemed.     

Effects of tapering on performance: a meta-analysis

PURPOSE: The purpose of this investigation was to assess the effects of alterations in taper components on performance in competitive athletes, through a meta-analysis. METHODS: Six databases were searched using relevant terms and strategies. Criteria for study inclusion were that participants must be competitive athletes, a tapering intervention must be employed providing details about the procedures used to decrease the training load, use of actual competition or field-based criterion performance, and inclusion of all necessary data to calculate effect sizes. Datasets reported in more than one published study were only included once in the present analyses. Twenty-seven of 182 potential studies met these criteria and were included in the analysis. The dependent variable was performance, and the independent variables were the decrease in training intensity, volume, and frequency, as well as the pattern of the taper and its duration. Pre-post taper standardized mean differences in performance were calculated and weighted according to the within-group heterogeneity to develop an overall effect. RESULTS: The optimal strategy to optimize performance is a tapering intervention of 2-wk duration (overall effect = 0.59 +/- 0.33, P < 0.001), where the training volume is exponentially decreased by 41-60% (overall effect = 0.72 +/- 0.36, P < 0.001), without any modification of either training intensity (overall effect = 0.33 +/- 0.14, P < 0.001) or frequency (overall effect = 0.35 +/- 0.17, P < 0.001). CONCLUSION: A 2-wk taper during which training volume is exponentially reduced by 41-60% seems to be the most efficient strategy to maximize performance gains. This meta-analysis provides a framework that can be useful for athletes, coaches, and sport scientists to optimize their tapering strategy.     

Angioplasty of Long Venous Stenoses in Hemodialysis Access: At Last an Indication for Cutting Balloon?

PURPOSE: To compare the postintervention primary patency rates of cutting balloon angioplasty (CBA) with those of conventional percutaneous transluminal angioplasty (PTA) in the treatment of hemodialysis-related stenoses at least 2 cm long. MATERIALS AND METHODS: This retrospective and controlled study included 29 patients with a hemodialysis-related stenosis at least 2 cm long. From August 2002 to August 2003, nine patients (PTA group, six upper-arm and three forearm fistulas) were treated with a conventional balloon (5-8 mm, 4 cm long). From September 2003 to December 2005, 20 patients (CBA group, 12 upper-arm and seven forearm fistulas; one polytetrafluoroethylene hemodialysis graft) were treated with a cutting balloon (5-7 mm, 1 cm long). The median follow-up was 22.1 months for the CBA group and 15.6 months for the PTA group. The Kaplan-Meier method was used to calculate the primary cumulative patency rates, and the log-rank test was used for comparison. Multivariate Cox models were generated by combining three variables: patient age, stenosis length, and treatment type (CBA or PTA). RESULTS: In the CBA group, the postintervention primary patency was 85% +/- 16 at 6 months, 70% +/- 20 at 1 year, and 32% +/- 26 at 18 months. In the PTA group, the postintervention primary patency was 56% +/- 32 at 6 months and 21% (range, 0%-53%) at 1 year. When comparing PTA versus CBA with the log-rank test, there was a statistically significant difference (P = .009). With the multivariate Cox models, treatment was again a statistically significant (P = .007) determinant of primary patency; patient age and stenosis length were not. CONCLUSION: The use of a cutting balloon as the first-line treatment for stenoses at least 2 cm long significantly improves the postintervention primary patency rate.