Biomedical subjects

J Fermanian

Publications and source records attributed to J Fermanian.

At least 37 records · Page 2Linked to original sources

PubMed1996

Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap.

OBJECTIVE: To construct a functional disability scale for the rheumatoid hand and to determine if this scale also assesses functional handicap. METHODS: Outpatients and inpatients with rheumatoid arthritis (RA) according to the ACR criteria answered a set of questions on their daily hand activities. Intrarater and interrater reliability were examined. Criterion referenced validity, and convergent and divergent validities were investigated. Factor analysis followed by varimax rotation was performed. Spearman's (rs) correlation coefficients between 2 quantitative variables were examined. The level of significance was p < 0.05. RESULTS: 96 patients with RA were recruited. The provisional scale had 41 questions. The elimination process left 18 hand activity questions with 6 levels of answers. The intrarater and interrater reliabilities of the scale were 0.97 and 0.96, respectively. Correlation of the scale's total score with visual analog scale (VAS) measure of functional handicap (rs = 0.78) showed good criterion referenced validity. The scale had good convergence with Revel's Functional Index (rs = 0.91) and a moderate relation to the Hand Functional Index (HFI) (rs = 0.58). The scale had a moderate, fair, or no relation to age, morning stiffness, pain measures, and hand swelling. The scale had 3 main factors by factor analysis. An English translation of the scale was validated. CONCLUSION: We have developed a practical functional disability scale for rheumatoid hands that also assesses functional handicap. It has 18 hand activity questions and has been validated in a French population.

Adolescent↗

PubMed1995

Analysis of the terms used by general practitioners to characterize patients considered by them as depressed. A prospective study on 682 patients.

The aim of the study was to investigate the terms used by general practitioners (GPs) to describe the patients considered by them to be depressed. 682 patients were diagnosed as depressed by 79 GPs selected at random in four regions of France. The frequency of the diagnosis of depression made by GPs in the total patient population was 3.6-5%. The GPs were asked to describe the main symptoms of these patients on a plain chart. The percentage of use of each term was calculated in each region. In all the regions, the most frequent symptoms were insomnia (31.8%), fatigue (29.9%) and anxiety (24.6%). The results suggest that the three main terms used by GPs to describe depression differ from those used by psychiatrists.

Adult↗

PubMed1995

Methodological and statistical problems in the construction of composite measurement scales: a survey of six medical and epidemiological journals.

Composite measurement scales (CMS) are increasingly used in medicine to measure complex phenomena or concepts such as disease risk and severity, physical and psychological functioning and quality of life. To investigate the methodology currently used in the construction of CMS, we examined 46 studies recently published in six major medical and epidemiological journals. Important measurement properties such as measurement level, content and construct validity and reliability are often neglected. Statistical methods, particularly multivariate methods are frequently misused; verifications of model relevance and assumptions, and cross-validations to avoid overfitting are seldom performed. We propose recommendations for the construction and the presentation of CMS, to help authors and investigators to report and choose, respectively, measurement instruments for a complex phenomenon.

Data Collection↗

PubMed1995

Transrectal and transurethral hyperthermia versus sham treatment in benign prostatic hyperplasia: a double-blind randomized multicentre clinical trial. The French BPH Hyperthermia.

OBJECTIVE: To compare the safety and efficacy of hyperthermia for the treatment of benign prostatic hyperplasia (BPH), by either the transrectal or transurethral approach, relative to sham treatment. PATIENTS AND METHODS: Two hundred patients from seven urological departments were randomized and treated in a single centre. Principal inclusion criteria were a peak flow rate (PFR) < 15 mL/s and residual urine < 300 mL/s. Comparisons were made between transurethral hyperthermia (TUH) and transurethral sham (TUS) and between transrectal hyperthermia (TRH) and transrectal sham (TRS) 12 months after treatment. Outcome was assessed by improvements in the Madsen score and PFR, and the incidence of side-effects. RESULTS: After 12 months, 145 patients were evaluated; 12 patients withdrew during treatment, 43 withdrew during follow-up and two were lost to follow-up. Withdrawals were mainly due to side-effects during treatment (17% in the TRH and 1.5% in the TUH group) and to a lack of improvement during follow-up (14% in the TUH group, 19% in the TUS, 15% in the TRH and 10.5% in the TRS group received other treatments for BPH). Complications during treatment consisted mainly of local pain, urethral bleeding, urethral pain and acute retention, and were five times more frequent in the TRH than the TUH group (34% versus 6%). There was no improvement in PFR after TUH and TRH (response < 20%). Only TUH improved the Madsen score (TUH, +50% and TUS, +17%). CONCLUSION: Hyperthermia was not an effective treatment for BPH.

Aged↗

PubMed1995

Is there a relationship between antipsychotic blood levels and their clinical efficacy? An analysis of studies design and methodology.

There are now more than 50 studies concerning neuroleptic blood levels and clinical outcome relationships. Haloperidol, the most studied, is the only antipsychotic permitting some conclusions. A number of authors suggest that the striking lack of agreement between different studies results from heterogeneity of their quality. Here, we have used a scoring system for assessing the quality of those studies. According to this system, none (0/14) of the studies having a score < 0.60 was able to show a therapeutic window, as compared to 53% (10/19) of those having a score > or = 0.60 (p = 0.002, Fisher exact test). Also, the studies able to identify the presence of a therapeutic window during haloperidol treatment were those having sample size > 20 (p = 0.06) and those whose patients were treated with fixed doses (p = 0.02). The diagnosis of schizophrenia in the studies seems not to be an exclusive condition, as compared with those also including schizophreniform and schizoaffective disorders (p = 0.12). Our qualitative analysis of haloperidol blood level publications seem to indicate that an upper limit may exist for haloperidol efficacy; values above this limit seem not to provide any supplementary clinical improvement and may even reduce therapeutic effect.

Antipsychotic Agents↗

PubMed1995

Lipoprotein(a) in childhood: relation with other atherosclerosis risk factors and family history of atherosclerosis.

The relation between lipoprotein(a) [Lp(a)], apolipoprotein (apo) E phenotypes, cholesterol, triglycerides, apo A-I, apo B, and a family history of atherosclerosis or risk factors was studied in 2- and 4-year-old French Caucasian children (n = 499). Lp(a) concentrations were distributed in a typical skewed manner and were found to be an independent lipid variable. The distribution of apo E phenotypes did not differ by gender. Cholesterol and apo B were under apo E phenotype control; Lp(a) was not. A significant positive relation was found between Lp(a) concentrations and the number of parental risk factors. Children whose grandparents had a history of cardiovascular disease had Lp(a) concentrations shifted towards higher values. Measurement of Lp(a) in children may help to identify those at an increased risk of atherosclerotic disease, especially when their parents have at least two relevant risk factors.

Apolipoprotein A-I↗

PubMed1993

Psychological factors in the aetiology of infertility: a prospective cohort study.

The objectives were to identify and measure psychological factors characterizing the period following the cessation of contraception and to assess these psychological factors as predictors of the couples' fertility. A cohort of 63 couples with initially undetermined fertility status was prospectively studied, first shortly after the cessation of contraception, then 13 months later. The Child Project Questionnaire was constructed to assess psychological variations following the cessation of contraception. An Interspouse Difference Score was constructed to measure the difference between the spouses' responses. Three male and three female factors were derived from the questionnaire. The Interspouse Difference Score was significantly greater in infertile than in fertile couples. Two psychological factor scores were significantly higher in fertile subjects: the wives' level of positive expectations related to motherhood, and the husbands' quality of integration between the wish for a child and sexual relationships. Within the group of fertile couples, time to pregnancy was predicted by the husbands' above-cited factor and by the wives' frequency of thoughts and concerns related to the desired child. The results support the conclusion that in both women and men, psychological factors specifically related to the project of conceiving a child are significant predictors of the couple's fertility status.

Adult↗

PubMed1993

Prevalence of apolipoprotein E phenotypes in ischemic cerebrovascular disease. A case-control study.

BACKGROUND AND PURPOSE: Apolipoprotein E polymorphism may influence the early development of coronary artery disease. We investigated the putative role of apolipoprotein E phenotypes in cerebral infarction. METHODS: The apolipoprotein E phenotypes of 69 patients (mean +/- SD age, 72 +/- 11 years) who had suffered completed stroke or a transient ischemic attack and 68 sex- and age-matched control subjects free of cerebrovascular disease were determined by isoelectric focusing. The relative frequency of the apolipoprotein E phenotypes in the general population was estimated in 498 healthy blood donors (mean age, 37 years). RESULTS: The prevalences of hypertension, diabetes mellitus, obesity, and intermittent claudication were significantly higher in patients than in control subjects. Serum lipid and apolipoprotein B concentrations and the composition of very low density lipoproteins were not significantly different between patients and control subjects. Apolipoprotein A-I and E levels were significantly lower in patients. Cholesterol levels were higher in male patients than in male control subjects (5.10 +/- 1.46 versus 4.41 +/- 0.80 mmol/L; p = 0.036), and the ratio of apolipoprotein A-I to B was lower (0.77 +/- 0.29 versus 1.03 +/- 0.37; p < 0.001). The E3/E3 phenotype was more frequent in control subjects (85%) than in patients (72.5%; p < 0.05) and healthy blood donors (64%; p < 0.02). The E3/E2 phenotype was more frequent in patients (10.1%) than in control subjects (1.4%; p < 0.05). A stepwise logistic regression showed that the presence of stroke was significantly related to high blood pressure (p < 0.0001), low apo E levels (p < 0.008), obesity (p < 0.041), the apo E phenotype (p < 0.05), and diabetes mellitus (p < 0.05). CONCLUSIONS: The E3/E3 phenotype may protect against early vascular morbidity, and the epsilon 2 gene may be a risk factor for cerebrovascular morbidity, possibly related to diabetes, hypertension, and/or obesity.

Aged↗

PubMed1993

Surgical management of brain-stem tumors in children: results and statistical analysis of 75 cases.

A study was made of 75 children treated between 1970 and 1990, with partial, subtotal, or total removal of three intrinsic and 72 exophytic or surface brain-stem tumors. In all cases, the goal of surgery was to remove as much tumor as possible. Extent of removal was defined according to data obtained from postoperative computerized tomography or magnetic resonance imaging, and was considered partial when only a small amount of tumor was removed, subtotal when a few cubic millimeters of tumor was left, and total when no residual tumor was seen on postoperative radiological investigations. An ultrasonic aspirator was used for the 43 most recent operations. Among tumor removals without the aspirator, 24 (75%) were partial, eight (25%) subtotal, and none total; with the use of the aspirator, the number of partial removals decreased to 44.5% while that of subtotal and total removals increased to 32% and 23.5%, respectively. There were 69 gliomas (92%) and 47 benign tumors (62.6%). Forty-nine patients were irradiated postoperatively, and 14 of the 23 patients whose benign tumors were removed totally or subtotally did not undergo irradiation. This study showed that: 1) the overall prognosis of patients with malignant tumors was poor and was not improved by surgery; 2) the survival rate of those with benign tumors was significantly (p < 0.01) lower after partial removal than after total or subtotal removal (52% and 94%, respectively, at 5 years); 3) comparison of means and proportions (Student's and chi-squared tests) between benign and malignant tumors showed a significant difference relating to patient age (p < 0.03), peritumoral hypodensity (p < 0.001), and preoperative duration of symptoms (p < 0.001); 4) stepwise logistic regression analysis confirmed that two of these three variables were related to malignancy: namely, patient age at surgery (p < 0.03) and presence of peritumoral hypodensity (p < 0.001); and 5) routine postoperative irradiation was contraindicated after total or subtotal removal of benign tumors.

Adolescent↗

PubMed1993

[Conscious, unconscious and not conscious in coma].

In this work, the relation between the consciousness and the unconsciousness was studied in patients presenting a neurosurgical coma state. The study includes 29 patients with clinical observations during their hospitalisation period and a follow up for one year after the emergence from the state of coma. The psychoanalytic methods were used, taking in consideration the emotional and personal history of each patient. We attempted to demonstrate the persistence of the unconscious psychic life during coma and the early period after awakening from the coma. In addition, we felt the existence of a sort of direct confrontation with the unconscious psychic life in some patients emerging from a comatose state. The question is also what are the effects of such experience and how would they affect the life of the patients in the future?

Coma↗

PubMed1992

Assessing the reliability of clinical scales when the data have both nominal and ordinal features: proposed guidelines for neuropsychological assessments.

The purpose of this article is to present, for the first time, a comprehensive methodology for assessing the reliability of a clinical scale that is frequently utilized in neuropsychological research and in biomedical studies, more generally. The dichotomous-ordinal scale is characterized by a single category of "absence" and two or more ordinalized categories of "presence" of a symptom trait, state, or behavior, and it also has special properties that need to be understood in order for its reliability to be appropriately assessed. Using the Brief Psychiatric Rating Scale (BPRS) as a clinical example, we cover the principles of expressing scale reliability in terms of a dichotomy ("absence" - "presence" of a given BPRS symptom); as a trichotomy ("none"; "mild to moderate" symptomatology; and "severe" symptomatology); and as the full 7-category dichotomous-ordinal scale: "none," "very mild," "mild," "moderate," "moderately severe," "severe," and "extremely severe." Criteria are presented that can be used to evaluate which of these three formats produces the most reliable results. Finally, we address, with a second sample, the important issue of replication, or whether the original reliability findings generalize to other independent populations.

Adult↗

PubMed1992

Moclobemide versus clomipramine in endogenous depression. A double-blind randomised clinical trial.

The effects of moclobemide (300-600 mg/day), a reversible monoamine oxidase inhibitor - A (MAOI-A), were compared in a double-blind, multi-centre trial with those of clomipramine (100-200 mg/day) on 129 in-patients suffering from endogenous depression (according to ICD-9 and the Newcastle Scale). No significant differences in efficacy were seen between the two treatment groups. In the moclobemide group the mean scores on the MADRS were 36.4 on day 0 and 13.2 on day 42 (end-point analysis); scores were 37.4 and 10.9 respectively in the clomipramine group. An earlier onset of antidepressant activity was noted for moclobemide. Tolerability was significantly better for moclobemide, as shown by the Clinical Global Impression of Tolerance (CGIT). Anticholinergic effects, weight gain and orthostatic hypotension were more frequent in the clomipramine group. No biological treatment-related changes were observed.

Adult↗

PubMed1992

Urinary trypsin inhibitory activity for the diagnosis of bacterial infection: a prospective study in 690 patients.

OBJECTIVES: During the acute phase response, interleukin-1 induces production of inter-alpha-trypsin inhibitor. The measurement of urinary trypsin inhibitory activity which results from the effects of inter-alpha-trypsin inhibitor degradation products is easy, quick and inexpensive. We conducted a prospective study to investigate its value as a diagnostic tool in comparison with C-reactive protein. METHODS: Comparisons were made in 690 consecutive patients at admission to a department of internal medicine. RESULTS: The level of urinary trypsin inhibitory activity was significantly higher in patients with bacterial infection (mean = 123 IU/g creatinine) than in patients with either viral infection (34 IU), cancer (50 IU), elevated erythrocyte sedimentation rate without infection (45 IU), miscellaneous non-inflammatory diseases (27 IU) or in non-organic controls (19 IU) (Dunnet's test, p << 0.01). The receiver operating characteristic curve showed that sensitivity and specificity of urinary trypsin inhibitory activity were higher than those of C-Reactive protein for the diagnosis of bacterial infection. For levels > or = 60 IU, sensitivity was 75% and specificity 89%. Urinary trypsin inhibitory activity levels fell within 2 days in patients treated for acute bacterial infection. CONCLUSION: Urinary trypsin inhibitory activity could be a useful marker of bacterial infection particularly in patients with fever of unknown origin and/or elevated erythrocyte sedimentation rate.

Alpha-Globulins↗

PubMed1991

[The outcome of anorexia nervosa: a prospective study of 129 patients evaluated at least 4 years after their first admission].

This is a follow-up study with an interval of 4 to 20 years (mean: 11 years) of 146 cases of anorexia nervosa of which 129 could be contacted. The investigation is based on various measures: BPRS scale, HSCL, a chart of clinical assessment made by the examiner (10 items), a global self-evaluation by the patient, a clinical interview. Results and factors of prognosis are discussed. Our findings stress the importance of good outcome on a long term basis but also the potential severity of anorexia nervosa with both a death risk and a risk of chronicity. It becomes obvious that the major challenge of anorectic conduct are the residual disturbances of the personality. These disturbances are mainly difficulties in investing and the antagonism between the objectal inclination of these patients and the need to protect their narcissistic balance. A posteriori we understand the defensive meaning of the anorectic conduct and its value as a reorganizing of objectal relations. The psychopathological significance of this conduct, its stakes and its therapeutical consequences are discussed.

Adolescent↗

PubMed1991

[Epidemiological study of maternal depression as a risk factor in the developing of early childhood psychosis].

After reviewing epidemiological literature on the relationships between depression in parents and onset of a psychiatric disturbance in children as well as investigations of the interactions between a depressed mother and her infant, the authors discuss the psychoanalytical concepts of these interactions and the findings of their research. This epidemiological research is based on the assumption that depression in the mother during pregnancy and the first few months of the post-partum constitutes a risk factor for the onset of an early psychosis in the child. This research is a comparative study between a group of mothers with early onset psychotic children and a group of mothers with non patient children, the age and sex of the children in both groups being equally distributed. The methodology includes two instruments aimed at a retrospective assessment of mothers' depression: the SADS-LA questionnaire and a standardized scoring system for semi-structured interviews investigating the mother's feelings during pregnancy and early development of her baby. Results show that there is a statistically significant relationship between a major depressive condition in the mother during pregnancy and/or during the first year of the infant's life and the onset of an autism in the child. It might be that major depressive conditions starting before delivery could by themselves account for the risk. Depression in the mother therefore constitutes a risk factor for early psychosis, the relative risk being about four. This study also emphasizes particular features of the mother's depressive conditions: difficulties to accept the real child, difficulties in perceiving the infant's psychic evolution, decrease of interactive skills. The statistically significant relationship in no way points to a linear causal relationship, which hypothesis seems to be negated by the statistical findings of this research.

Child Development Disorders, Pervasive↗

PubMed1991

Free erythrocyte protoporphyrin assay in the diagnosis of iron deficiency in the anemic aged subject. A prospective study of 103 anemic patients.

We determined the relative value of the free erythrocyte protoporphyrin (FEP) assay compared to those of total iron-binding capacity (TIBC) and serum ferritin in the diagnosis of iron deficiency in a population of elderly anemic subjects. One hundred and three patients, 65 to 98 years old (mean +/- SD: 81.5 +/- 8.8), with hemoglobin levels of less than 110 milligrams (mean +/- SD: 97 +/- 12, range 53-109) were included in the study. In the patients with iron-deficiency anemia due solely to chronic bleeding, mean values for the three parameters were highly different from those in patients without chronic bleeding. In the patients with anemia due to an association of chronic bleeding and chronic inflammation, the mean FEP value was very significantly different (p less than 0.001) from that in the patients with chronic inflammation but without bleeding, whereas this was not the case for TIBC or serum ferritin. The sensitivity of FEP in the diagnosis of iron deficiency due to chronic bleeding in this population of anemic subjects was 60% (specificity 90%), compared to 13% (specificity 96%) for TIBC and 20% (specificity 100%) for serum ferritin. The FEP assay thus emerges as being highly suitable for the diagnosis of iron-deficiency anemia in the elderly subject, particularly when bone marrow is not examined.

Aged↗

PubMed1990

The Behavioral Summarized Evaluation: validity and reliability of a scale for the assessment of autistic behaviors.

The Behavioral Summarized Evaluation (BSE), is a 20-item paper-and-pencil rating scale specifically designed for the measurement of behavioral parameters which could be related to biological data in autistic children involved in educational programs, neurophysiological studies, and therapeutic trials. The development of the scale, the validity, and reliability studies are presented in this paper. The results suggest that the BSE is an acceptable tool for the assessment of autistic behaviors, easy to handle, and accessible to both professionals and paraprofessionals of the medico-educative staff. It is a useful addition to the bioclinical researcher's evaluation battery for bioclinical and therapeutic studies. However, more work is suggested to further investigate the psychometric properties of this behavior assessment instrument.

Adolescent↗

PubMed1990

Circadian variations in vigilance states in the alcohol-dependent rat.

Waking and sleep states were studied in the alcohol-dependent rat after administration of ethanol (416 mg/kg/hr) by indwelling intragastric catheter (IGC) for 13 days. Electropolygraphic recordings performed for a total of 24 hr from the start of withdrawal were compared with those of control rats receiving water by IGC and showed 1) that rapid eye movement sleep was the most sensitive of the four vigilance states studied. A decrease was noted both for the total duration of recording and for the light period; 2) that nonactive wakefulness was the only vigilance state to show an inversion of percentages between the light and dark period; 3) that the light period was the best time for studying changes in vigilance states. Changes included increased percentages of active and nonactive wakefulness and decreased percentages of slow-wave and rapid eye movement sleep. This was due to a change in the number of episodes rather to a change in their mean duration. No significant change occurred during the dark period.

Alcohol Withdrawal Delirium↗