Biomedical subjects

J Micallef

Publications and source records attributed to J Micallef.

At least 37 records · Page 2Linked to original sources

PubMed2001

Antipsychotic-associated weight gain and clinical outcome parameters.

Weight gain has been observed with many of the antipsychotics, including the atypical antipsychotics. The assessment of whether, and to what degree, a drug causes changes in body weight is not straightforward, since clinical studies performed during a drug development program are not designed to measure changes in body weight. Even when weight change data are obtained from adverse event data or from part of the vital signs measured during a study, assessment is not standardized. Nevertheless, evidence points to the fact that weight gain with the atypical antipsychotics is becoming an increasing problem. This review examines whether antipsychotic-associated weight gain, when it occurs, is associated with clinical outcome parameters.

Ambulatory Care↗

PubMed2000

Comprehensive critical incident monitoring in a neonatal-pediatric intensive care unit: experience with the system approach.

OBJECTIVE: To examine the occurrence of critical incidents (CIs) in order to improve quality of care. DESIGN: Prospective survey. SETTING: Multidisciplinary, neonatal-pediatric intensive care unit (ICU) of a non-university, teaching children's hospital. PATIENTS: Four hundred and sixty-seven admissions over a 1-year period. METHODS: A CI is any event which could have reduced, or did reduce, the safety margin for the patient. Comprehensive, anonymous, non-punitive CI monitoring was undertaken. CI severity with respect to actual patient harm was graded: major (score 3), moderate (2) or minor (1). The system approach incorporates the philosophy that errors are evidence of deficiencies in systems, not in people. We undertook 2-monthly analyses of CIs. RESULTS: There were 211 CI reports: 30 % major, 25 % moderate, 45 % minor. The CI categories were management/environment 29 %, drugs 29 %, procedures 18 %, respiration 14 %, equipment dysfunction 7 %, nosocomial infections 3 %. The respiratory CIs were the most severe, the drug-related CIs the least severe (score mean, SD: 2.9, 0.26 vs 1.4, 0.76; p < 0.001). However, 20 out of 62 drug-related CIs were potentially life-threatening. Thirteen percent of drug CIs were decimal point errors. Eleven of the 29 respiratory CIs were accidental extubations (2.6/100 ventilator days). CIs were most often precipitated by consultants (32 %), followed by residents (23 %, over-represented in drug CIs, 22/62) and specialized nurses (21 %). Doctors had a greater proportion of major CIs than nurses (p < 0.01). Fifty percent of the CIs were detected by routine checks. The most important method of detection was patient inspection (44 %), alarms accounted for only 10 %. Contributing factors were human errors (63 %), communication failure (14 %), organizational problems (10 %), equipment dysfunction (7 %) and milieu (3 %). CONCLUSIONS: CIs are very common in pediatric intensive care. Knowledge of them is a precious source for quality improvement through changes in the system.

Child↗

PubMed2000

Effects of lorazepam on emotional reactivity, performance, and vigilance in subjects with high or low anxiety.

This study examined the hypothesis that low doses of lorazepam modify emotional response. In accord with the results of prior studies that suggest a differential effect of benzodiazepines according to the subjects' anxiety level, the authors tested the effect of lorazepam (0.5 mg twice daily) on 2 groups of 32 subjects: those with high anxiety (HA) and those with low anxiety (LA). These groups were formed a priori on the basis of their scores on the Cattell Anxiety Scale and the Hamilton Rating Scale for Anxiety. The two groups were evaluated for psychomotor function and vigilance (visual analog scales [VAS], digit-symbol substitution test [DSST], and choice reaction time [CRT]), as well as emotional reactivity. Six emotions (fear, anger, disgust, sadness, joy, and neutral state) were induced by the presentation of six movie excerpts, and subjects' emotional responses were measured using the Differential Emotions Scale. The results suggest that at the doses studied, lorazepam led to an increase in negative emotions and a decrease in positive emotions, compared with placebo. This shift of emotional reactivity toward more negative emotions was slightly stronger with the HA than with the LA subjects. However, no reliable differences in the levels of performance and vigilance (CRT, DSST, and VAS) were observed as a function of either treatment or subject group. These findings suggest a possible relationship between benzodiazepine effects and subjects' anxiety level.

Adult↗

PubMed2000

Quality of life in patients with glioblastoma multiforme participating in a randomized study of brachytherapy as a boost treatment.

OBJECT: Until recently the assessment of outcome in patients treated for glioma has emphasized length of survival with the evaluation of quality of life (QOL) limited to unidimensional, mostly physical, measures. The authors report the multidimensional assessment of QOL as part of a randomized clinical trial of brachytherapy as a boost in the initial treatment of patients with glioblastoma multiforme. METHODS: A questionnaire previously developed by the senior authors and psychometrically validated was completed by patients on randomized entry into the study and at follow-up review every 3 months thereafter. The questionnaire was presented in a linear-analog self-assessment format. Karnofsky Performance Scale (KPS) scores were also recorded on each occasion. No differences were found between patients in either arm of the study (conventional radiation therapy consisting of 50 Gy in 25 fractions or conventional radiation plus a brachytherapy boost of a minimum peripheral tumor dose of 60 Gy) in KPS and QOL scores during the 1st year of follow-up review. However, there was a statistically significant deterioration in patients' overall KPS scores during the 1st year of follow up compared with baseline scores. Of QOL items evaluated, statistically significant deteriorations were found in self care, speech, and concentration, and on subscale analyses, cognitive functioning and physical experience (symptoms) deteriorated significantly during the 1st year of follow up, compared with baseline values. The correlation between QOL and KPS scores was low. CONCLUSIONS: Future studies in patients harboring malignant gliomas must incorporate measures assessing QOL because traditional measures focusing on physical or neurological functioning give an incomplete assessment of the patient's experience.

Adolescent↗

PubMed2000

[Maintenance treatment for opioid dependence in care centers: the OPPIDUM program of the Evaluation and Information Centers for Drug Addiction].

The aim of this study was to analyze information concerning multiple drug addiction, illicit behaviors and use of the venous route by maintenance treatment patients included in the October 1998 survey of the OPPIDUM program. Among 1,462 observations, 71% of the subjects were taking maintenance treatments (60% high-dose buprenorphine and 40% methadone). High-dose buprenorphine was taken without medical supervision in 10% of cases. Indicators of abuse were high in this case: multiple drug addiction and intravenous use of buprenorphine (28%). Patients maintained by methadone were older and living in better socio-economic conditions than patients maintained by high-dose buprenorphine. However, in the two groups, the percentage of patients using the intravenous route was the same (15% and 21%). More cocaine was used by the methadone group (16% versus 7%). Thirty-seven percent of the subjects maintained on high-dose buprenorphine were followed by a general practitioner. They appeared to be more unbalanced and in more precarious condition than subjects treated in specialized care centers but they were not representative of the patients maintained by buprenorphine. It would be important to determine why these subjects consult a specialized care center.

Adult↗

PubMed1999

[Anti-hepatitis B vaccination: after the health authorities' decision].

In 1991, the WHO proposed that the antihepatitis B vaccine be included in national vaccination programs. In France, it was decided in 1994 to move on from a selective immunization scheme aimed at high-risk subjects to a general vaccination policy aimed first at adolescents in school and secondly infants. During this period, several cases of demyelinizing diseases after vaccination led to court actions and were magnified in the popular press, interfering with this new vaccination policy. On October 1, 1988, the French Secretary of Health decided to interrupt the school vaccination programs. This decision, taken as a precautionary measure, had some unexpected consequences. As had been feared by the WHO, there was an overall drop in the public's confidence in the vaccine. Health care professionals highly criticized the spectacular nature of the decision and the absence of scientific argumentation. These events lead us to raise a certain number of questions concerning the use of the public press in the management of health information, the notion of medical responsibility, and the rationality of political decisions in public health.

Adolescent↗

PubMed1998

[Assessment of the quality of life in the surgery of cancer of the esophagus: critical review of the literature].

The surgery of the oesophageal carcinoma is subjected today to a renewed interest. In the objective to draw recommendations for the clinicians wishing to include quality of life measures in clinical trials, it seemed pertinent to us to critically review existing studies. The review of the literature, presented here, is based on a bibliographic research using Medline database (January 1986-December 1996). A precise methodology was adopted to read the eighteen articles retained and the psychometric instruments used in each study were listed and classified. Nine studies considered the issue of quality of life but failed to measure the outcome or used not validated psychometric instruments and 4 others used only indicators of physical performance. Only five studies assessed quality of life using instruments with known psychometric properties (Quality of Life Index of Spitzer, Rotterdam Symptom Checklist and EORTC QLQ-C30 questionnaire) more often associated to ad hoc dysphagia scales. This review of literature shows that the inclusion of validated quality of life measures in the surgery of oesophageal carcinoma is very recent and that it presents some difficulties inherent to the lack of specific tools. The EORTC QLQ-OES24, specific of oesophageal cancer, being not yet validated in french, the authors recommend the use of the EORTC QLQ-C30 jointly with ad hoc dysphagia scales.

Deglutition Disorders↗

PubMed1998

[Measurement of anxiety state in women: a short-form scale].

BACKGROUND: Clinical epidemiology and psychosocial studies often take into account the measurement of anxiety. Our objective was to develop and validate a short form scale of anxiety state from the Spielberger's State Trait Anxiety Inventory (STAI-Y), one of the most widely used scales. METHODS: This study was carried out on French samples of women with different levels of anxiety. The first step was to select from the original 20-items scale, the items susceptible to compose two short forms scales: an 8-items (18-STAI) and a 5-items (15-STAI) one. It was carried out on patients attending cancer genetic clinics (n1 = 160, n2 = 41). The second step was carried out on 3 other samples of women (n3 = 150, n4 = 167, n5 = 105) and measured the psychometric characteristics of the short-form scales obtained previously. RESULTS: The correlation coefficients between the short-forms and the complete 20-items form were very high (> 0.90) in particular for the 18-STAI (r > 0.95). Both short forms are sensitive to change. The internal consistency measured by Cronbach-alpha was comparable to the original scale. The results obtained with the 18 scale and another 10 items Spielberger's short-form scale are comparable and better than those with the 15 scale. CONCLUSION: The 18 French short-form scale, balanced with positive and negative items, can be recommended for the measurement of state anxiety when the complete form cannot be used.

Adult↗

PubMed1996

Thermus oshimai sp. nov., isolated from hot springs in Portugal, Iceland, and the Azores, and comment on the concept of a limited geographical distribution of Thermus species.

We examined aerobic, thermophilic, gram-negative bacteria that were isolated from hot springs in Portugal and were identified as Thermus strains and placed in phenetic groups on the basis of their phenotypic characteristics. We determined the composition of the peptidoglycan, identified the respiratory quinones, and determined the mean base composition of the DNA, and the levels of DNA-DNA homology were determined by both the filter hybridization and reassociation rate methods. Thermus aquaticus, Thermus brockianus, and Thermus filiformis were not detected in this collection of organisms, although three Thermus thermophilus strains were identified. We propose that the isolates that belonged to phenetic clusters E and F are members of a new species, Thermus oshimai; the type strain of T. oshimai is strain SPS17.

Azores↗

PubMed1995

[Pneumocystis carinii pneumonia in infants with vertically acquired HIV infection in Switzerland].

OBJECTIVE: Review of incidence, clinical picture, therapy, and outcome of Pneumocystis carinii pneumonia (PCP) in infants with vertically-acquired HIV infection in Switzerland. METHODS: Inquiry among members of the Swiss Pediatrics AIDS Group, review of the data base of the Swiss Neonatal HIV Study and retrospective analysis of the charts from infants with PCP. RESULTS: Since 1986 PCP has been diagnosed in 10 out of 107 infants with vertically-acquired HIV infection. PCP occurred in 7 infants at the age of 3-6 months and in 3 at the age of 9-11 months. 4 infants showed symptoms related to HIV infection before developing PCP. Before the development of PCP, infection with HIV had been ascertained in 6 infants. In 2 the diagnosis was still unclear and in the 2 remaining the risk of HIV infection was not known. None of the infants was on primary prophylaxis against PCP. Signs and symptoms of PCP included cough and tachypnea (100%) as well as high fever up to 40 degrees C (90%). Transcutaneous oxygen saturation was 70-95%. Chest X-rays revealed interstitial infiltrates in 6 infants, localized infiltrates in 2 and interstitial as well as localized infiltrates in 2. The CD4+ cell count was, with one exception, < 1500/microliters, i.e. below the normal value for age. Side effects of high dose cotrimoxazole were noted in 6 patients. 5 infants required intubation and mechanical ventilation. 4 infants died due to PCP, including 3 of those who required intubation and mechanical ventilation. CONCLUSIONS: PCP in infants with vertically-acquired HIV infection preferentially occurs at the age of 3 to 6 months and is often lethal, especially in patients requiring intubation. Evaluation for HIV infection should be done as early as possible in order to introduce primary PCP prophylaxis in infants at risk for this opportunistic infection.

AIDS-Related Opportunistic Infections↗

PubMed1995

DNA relatedness of Thermus strains, description of Thermus brockianus sp. nov., and proposal to reestablish Thermus thermophilus (Oshima and Imahori)

Aerobic, thermophilic, gram-negative bacteria obtained from Yellowstone National Park that were placed in the genus Thermus on the basis of phenotypic data were examined by chemotaxonomic techniques to determine their peptidoglycan compositions, their respiratory quinones, their mean DNA base compositions, and their levels of DNA-DNA homology as determined by both the filter hybridization and reassociation rate methods. These isolates from hot springs included Thermus aquaticus strains and strains of a new genospecies. We propose the name Thermus brockianus for this new genospecies; strain YS38 is the type strain of this taxon. A collection of 10 strains, including the type strain of "Thermus thermophilus", which were isolated from widely separated geothermal sites, exhibited high levels of DNA-DNA homology with each other and had similar physiological properties. Therefore, we propose that the species Thermus thermophilus (Oshima and Imahori) should be reestablished, with strain HB8 as the type strain.

Base Composition↗

PubMed1992

Consonant-vowel lateralization in dyslexic children: deficit or compensatory development?

Two studies with the same subjects examined dyslexic children's puzzling superiority in forced left ear (LE) dichotic recall with consonant-vowel (CV) combinations. Thirty dysphonemic dyslexics were compared to 30 age-matched and 30 younger reading-matched normal readers. The children were tested in directed attention dichotic listening and in pseudoword decoding, word recognition, reading comprehension, spelling, arithmetic, and general intelligence (IQ). Failure to replicate the LE effect in the first experiment or in free-recall trials suggests its probable origin in aberrant attention/arousal rather than in deviant verbal lateralization. Experiment two replicated the superior LE effect in comparison to both control groups but also found the dyslexics poorer at the right ear (RE). Laterality coefficients confirmed that the dyslexics were more weakly lateralized. Corrections for stimulus dominance revealed that the uncorrected scores (1) concealed the extreme difficulty of the task and (2) obscured floor effects in the LE performance of the normals. Correlations suggest cautiously that CV lateralization may be associated inversely with reading comprehension and word decoding in the dyslexics and normal readers. The results provide mild support for the hypothesis that weak attentional lateralization for CVs in dyslexia may result from the precocious development of posterior right hemisphere attentional systems in compensation for presumed posterior left hemisphere lesions. No support was found for the competing hypothesis that such weak lateralization may be a component of the dyslexics' primary, correlated, or secondary deficit symptomatology.

Brain↗

PubMed1989

High specific activity chemiluminescent and fluorescent markers: their potential application to high sensitivity and 'multi-analyte' immunoassays.

The sensitivities of immunoassays relying on conventional radioisotopic labels (i.e. radioimmunoassay (RIA) and immunoradiometric assay (IRMA) permit the measurement of analyte concentrations above ca 10(7) molecules/ml. This limitation primarily derives, in the case of 'competitive' or 'limited reagent' assays, from the 'manipulation errors arising in the system combined with the physicochemical characteristics of the particular antibody used; however, in the case of 'non-competitive' systems, the specific activity of the label may play a more important constraining role. It is theoretically demonstrable that the development of assay techniques yielding detection limits significantly lower than 10(7) molecules/ml depends on: (1) the adoption of 'non-competitive' assays designs; (2) the use of labels of higher specific activity than radioisotopes; (3) highly efficient discrimination between the products of the immunological reactions involved. Chemiluminescent and fluorescent substances are capable of yielding higher specific activities than commonly used radioisotopes when used as direct reagent labels in this context, and both thus provide a basis for the development of 'ultra-sensitive', non-competitive, immunoassay methodologies. Enzymes catalysing chemiluminescent reactions or yielding fluorescent reaction products can likewise be used as labels yielding high effective specific activities and hence enhanced assay sensitivities. A particular advantage of fluorescent labels (albeit one not necessarily confined to them) lies in the possibility they offer of revealing immunological reactions localized in 'microspots' distributed on an inert solid support. This opens the way to the development of an entirely new generation of 'ambient analyte' microspot immunoassays permitting the simultaneous measurement of tens or even hundreds of different analytes in the same small sample, using (for example) laser scanning techniques. Early experience suggests that microspot assays with sensitivities surpassing that of isotopically based methodologies can readily be developed.

Antibody Affinity↗

PubMed1983

Relationship of high density lipoprotein cholesterol with total and free testosterone and sex hormone binding globulin.

A cross-sectional study was performed to see if the previously described association between high density lipoprotein (HDL) cholesterol and plasma total testosterone concentration reflected a relationship with free testosterone or with sex hormone binding globulin (SHBG). In 295 employed middle-aged men, measurements were made of total testosterone and SHBG in serum and of testosterone in saliva, and also of plasma total and HDL cholesterol, plasma triglycerides and other factors which might influence HDL cholesterol levels such as body mass index, alcohol and smoking habits and thyroid hormone levels. In a multiple regression analysis using the GLIM package programme total testosterone concentrations had a persistent positive association with HDL cholesterol (t = 3.5, P less than 0.001) - this association was independent of SHBG (which had a negative association with HDL: t = -1.8, P less than 0.07. The association of HDL cholesterol with testosterone was independent of and stronger than the association of HDL cholesterol with body mass index, alcohol intake and cigarette smoking. Salivary testosterone (a measure of the circulating free hormone) also had a positive independent association with HDL cholesterol. The relationship between HDL cholesterol and testosterone thus appears to reflect an association with circulating hormone levels rather than with the hormone binding globulin.

Alcohol Drinking↗

PubMedDate not supplied

[Use of antidepressant drugs in schizophrenic patients with depression].

INTRODUCTION: Depression is common in people with schizophrenia and is associated with substantial morbidity explaining also the considerable attention and recognition of this entity as suggested by the inclusion of the post-psychotic depression in DSM IV and ICD 10. The prevalence of this disorder varies according to the type of approach used (range between 7% to 75%). Prescription of antidepressants plus antipsychotic treatment is frequent in clinical practice (11 to 43%). BACKGROUND: Pharmacokinetic and metabolic interactions have been identified. The cytochrome P450 has been identified as being implicated in the metabolism of most psychotropics, mainly through the CYP1A2, CYP2C19, CYP2D6, CYP3A4 isoenzymes. Tricyclic antidepressants are likely to increase chlorpromazine plasma levels. Similarly, antipsychotics such as perphenazine, chlorpromazine or haloperidol can increase antidepressant plasma levels, through the inhibition of CYP 450 isoenzymes (CYP2D6). Most of the Specific Serotonin Recapture Inhibitors (SSRIs) are likely to inhibit one or several CYP450 isoenzymes. The inhibition is moderate to marked for CYP1A2 (fluvoxamine and fluoxetine), CYP2C19 (fluoxetine, fluvoxamine and sertraline), CYP2D6 (paroxetine, fluoxetine and sertraline), and CYP3A4 (fluvoxamine, fluoxetine and sertraline). In the US, one-fourth of psychiatrists report the use of depression-rating scales in schizophrenic patients. Non specific scales (Hamilton Depression Rating Scale or Beck Depression Inventory) are the most commonly used in spite of the fact that these scales do not allow the distinction of depressive from negative symptoms in schizophrenic patients. LITERATURE FINDINGS: Due to these limitations, more specific assessment tools for depressive symptoms in schizophrenia are required. Two specific scales for assessing depressive symptoms in schizophrenic patients have been constructed and validated. The Calgary Depression Scale (CDS) is a nine item scale, each item scored from 0 to 3. This scale was derived from the HDRS and the Present State Examination. Factor analysis showed that the CDS is unidimensional, has high internal consistency, and significant strong correlation with scores on the HDRS, Beck and BPRS depression scales. The CDS has been validated in different languages (Brazilian, Danish, French...). It has been shown that there is no overlap between negative or extrapyramidal and depressive symptoms assessed by the PDS in schizophrenic patients. The Psychotic Depression Scale (PDS) is a 32 item scale derived from the HDRS, PANSS, CPRS and AMDP, each item being rated from 0 to 7. A principal component analysis of the PDS items using a Varimax rotation disclosed 8 orthogonal components that account for 71% of the variance. These components involved the following dimensions : depressive mood, inhibition, vegetative signs, paranoid signs, strangeness of thought, inverse vegetative signs, guilt feelings and cognitive signs. The analysis revealed that the 'depressive mood' factor of the PDS was correlated with the 'depressive' factor and was slightly correlated with the cognitive factor of the PANSS. This first factor was not correlated with either the "negative" factor of the PANSS, or the Positive or Excitement factor of the PANSS. Hence, this PDS, factor distinguished depressive signs from negative symptoms. Due to their metrologic properties, specific scales should be preferred. However, only one open trial (of an antipsychotic) and two double blind controlled trials (one comparison of 2 antipsychotics and one comparison of an cholinesterase inhibitor versus placebo) have been published using the CDS. Likewise, only one double blind controlled trial using the PDS (comparison of 2 antipsychotics) has been published. No study of the effect of antidepressants in depressed schizophrenic patients has been published, using either the CDS or the PDS assessment criteria. DISCUSSION: These specific scales are rarely used in clinical practice. Only about 1% of the US psychiatrists reported the use of the Calgary Depression Scale. Several open clinical trials have assessed the efficacy of antidepressant agents added to antipsychotic in patients with schizophrenia. They have produced inconsistent results but have suffered from methodological limits (short duration of the studies, non homogeneous inclusion criteria, heterogeneous assessment methods...). Due to the lack of a reference drug, double blind placebo-controlled trial are necessary. A recent meta-analysis has been performed on results of trials that have investigated the clinical efficacy of antidepressant medication (either tricyclics, SSRIs or others) in the treatment of depression in schizophrenic patients. In a subset of 5 trials (209 patients), the proportion improved in the antidepressant group was 26% (95% CI 10 to 42) higher than in the placebo group. The estimated number needed to treat was 4. In a subgroup of 6 studies (267 patients), the standardized mean difference on the HDRS score was -0.27 (95% CI - 0.7 to -0.2). There was no evidence that antidepressant treatment induced a deterioration of psychotic symptoms in these trials. CONCLUSION: The results provide weak evidence for the efficacy of antidepressants in patients with schizophrenia and depression. Today, the only SSRI tested in the treatment of depression in schizophrenic patients is sertraline. One study led to positive results. Since the meta-analysis, one additional study has been performed comparing sertraline to placebo. No difference between the 2 treatment groups was demonstrated but the power of the trial was rather low. Further research is required to determine the best approach towards treating depression in patients with schizophrenia, with clinical trials performed for longer periods, using appropriate assessment criteria such as depressive symptoms and quality of life.

Antidepressive Agents↗

PubMedDate not supplied

Neurobiology and clinical pharmacology of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a brain disorder with recognizable periods of onset, course, familial occurrence, epidemiology, phenomenology, and treatment response. Several manifestations of pathophysiology are beginning to be defined, although they may represent intermediate pathophysiology rather than primary etiology. Positron emission tomography studies have consistently identified hypermetabolism in the orbitofrontal cortex, caudate nucleus, and, sometimes, anterior cingulate cortex. Neuropsychologic testing frequently identifies abnormalities in visuospatial function. Abnormal levels of cerebrospinal fluid neurotransmitters and neuromodulators are identifiable in untreated patients with OCD and return toward normal levels after effective treatment. The most consistent pathophysiologic finding in OCD points toward an abnormality in serotonin neurotransmission. Therapeutic response to selective serotonin reuptake inhibitors and the absence of improvement with norepinephrine reuptake inhibitors and dopamine antagonists argue strongly for a role of serotonin in the pathophysiology and treatment of OCD. Despite this clear indication from treatment trials, probes and manipulations of the serotonin system and its specific receptors have not provided a useful understanding of specific abnormalities. Clomipramine or potent selective serotonin reuptake inhibitors are the pharmacotherapy of choice for OCD, with a more limited role reserved for monoamine oxidase inhibitors. If one selective serotonin reuptake inhibitor is ineffective, others may be beneficial, in addition to the different proserotonergic and nonserotonergic augmentation strategies that could be useful in treatment of resistant OCD patients. Nondrug therapies are also important in OCD: behavioral therapy is frequently helpful and neurosurgery is sometimes helpful when other treatments fail.

Animals↗

PubMedDate not supplied

[Dependence on psychotropic drugs and substitution treatment: recent trends. The OPPIDUM study of the Centers for Evaluation and Information on Drug Dependence (CEIP), October 1997].

The aim of this study was to identify the latest trends in psychotropic drug use and the effect of the increase of maintenance treatments for serious opioid addiction. The results are based on data from OPPIDUM, an annual survey primarily concerned with the consumption of licit and illicit drugs. The study involved 1066 drug addicts recruited during the month of October 1997 from 38 French health centres connected with the Centres for Evaluation and Information on Drug Addiction (CEIP). The most frequently reported drugs were benzodiazepines (n = 323), some of which, especially flunitrazepam (Rohypnol, n = 123), are extremely addictive. The data showed a slight decrease in heroin consumption as well as a marked increase in the use of maintenance treatments. The association between benzodiazepines and buprenorphine (Subutex) should consequently be studied, whether buprenorphine is being used illicitly or prescribed as a maintenance treatment.

Anti-Anxiety Agents↗

PubMedDate not supplied

[Public health networks: practical aspects and contribution to clinical research. Round table no. 2. XV].

A public health network involves several and different health professionals who work in synergy to achieve a common objective: to improve the management of a given disease. Per se, this objective could not be achieved by each of these professionals if working separately. In practice, existing public health networks ensue from very different legal frameworks and come up against various impediments. They have been developed mainly for the management of chronic and serious diseases (e.g. asthma, diabetes, virus C hepatitis, Parkinson's disease, drug abuse). Public health networks can be a very valuable source of data for clinical and epidemiological research, mainly because patients are followed up over a very long period and information coming from various health professionals (general practitioners, specialists, nurses, etc.) is centralized and recorded in a common database. It can also be useful for pharmacovigilance purposes (assessment of Type A and delayed reactions). In any case, the relative interest of such networks should be regularly assessed by an ad hoc methodology, e.g. an experimental or pseudo-experimental design vs. a reference. Despite the fact that there are relatively few operational networks, they can be of great interest for clinical research.

Community Networks↗