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P Auquier

Publications and source records attributed to P Auquier.

At least 19 recordsLinked to original sources

[Quality of life measurement: a fashion or a valid assessment?].

During 20 last years, there has been an exponential growth in the literature related to quality of life (QoL). The usual indicators of results are not always responsive to new strategies or new systems of care organization. While assessment of QoL by patients and by the medical community is an old concern, the issue of standardized instruments is more recent. Despite the need, the use of QoL questionnaires remains rare because of the lack of sufficiently dedicated tools. In the specific field of motoneuron diseases, a search of the literature should be helpful to clarify the definition of quality of life. It should also be helpful in determining the limits of the debate on quantification of an impression considered to be subjective. The goal is to clarify methods for standardizing QoL evaluation, to specify nosographic notions affecting the choice of measuring instruments, to recall the prerequisite of validation before use, and finally to specify the fields of application of such tools. Thus in the field of motoneuron diseases, recognizing the limitations of QoL instruments should enable a more enlightened approach to overall assessment of the burden of these diseases.

Adolescent↗

[Validation of the French version of the Princess Margaret Hospital Patient Satisfaction with their Doctor Questionnaire].

BACKGROUND: The evaluation of patient satisfaction receives increasing attention partly due to pressure from state agencies involved in the administration of health care. Outpatients' satisfaction with their doctor is a major component of total patient satisfaction. However, a validated instrument for assessing this has not previously been available in French. PATIENTS AND METHODS: The Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire (PMH/PSQ-MD) is a recently validated tool available in English for this purpose. A three-step procedure was conducted to obtain a validated French translation of the PMH/PSQ-MD. Subsequently, outpatients receiving chemotherapy, symptomatic treatment or attending a follow-up clinic were approached to participate in the study and complete the questionnaire. Acceptability and reliability (Cronbach's alpha score), as well as internal and external (Pearson correlation coefficient with the Patient Satisfaction Questionnaire IV) validities were studied. RESULTS: 137 patients were approached and 116 fully completed the study. The PMH/PSQ-MD's acceptability was high (<10% of non-responders). Internal validity was also high (Cronbach's alpha score > 0.7 for each dimension). External validity in comparison with the PSQ IV was high as well. Women demonstrated higher satisfaction scores, while age had no influence on patient satisfaction. CONCLUSIONS: The F-PMH/PSQ-MD is a questionnaire which addresses outpatients' satisfaction with their doctor, and is now available for research purpose as well as for daily practice.

Aged↗

[Quality of life: attitudes and perspectives of doctors in a thoracic oncology regional care network].

BACKGROUND: The evaluation of health-related quality of life (HRQOL) of lung cancer patients is significant given their poor prognosis. Consequently, HRQOL is often currently assessed throughout clinical trials and sometimes in daily medical practice. The objective here was to determine physicians' perspectives on evaluating HRQOL. MATERIAL AND METHODS: The team carried out a prospective study of physicians belonging to a thoracic oncology network using an original questionnaire of 33 items. RESULTS: 102 physicians were questioned and 51 responded. Physicians' knowledge on HRQOL was frequently of a low level and incomplete, but most of them considered HRQOL as important HRQOL assessment in daily practice was often done intuitively. Many physicians noted that they lacked adequate time to explore and integrate all of the fields which should be covered by HRQOL in their clinical practice, but they felt overall that the HRQOL study improved doctor/patient communication and interaction. Physicians described an "ideal" HRQOL questionnaire as one containing 10-15 items within 6 domains (physical, psychological, general health, respiratory symptoms, family and social) and which could be completed in 5-8 minutes. In addition, such a questionnaire might integrate an opportunity for patients to isolate and identify items and issues that they consider to be most important to them. CONCLUSIONS: Physicians' will to consider and integrate the evaluation of HRQOL in the management of lung cancer patients is strong but meets some structural challenges (related to HRQOL assessment and interpretation of data) but also conjectural difficulties (with respect to a lack of knowledge). Training efforts are needed as well as the development of easier tools to facilitate the evaluation of HRQOL.

Adult↗

Outcome of ICSI in HIV-1-infected women.

BACKGROUND: Since 2001, French law has permitted the use of assisted reproductive technology in human immunodeficiency virus (HIV)-1 infected women under strict conditions. This report describes a preliminary series of seropositive women who underwent assisted reproduction treatment at our facility. To minimize contamination of culture media, equipment, and therefore of male gametes and embryos, we chose to perform ICSI in all cases. The outcome of ICSI was compared with the outcome in an age-matched group of non-HIV-1-infected women. Since several previous reports have indicated that HIV infection may be associated with a decrease in spontaneous fertility, our goal was also to assess the fertility status of the HIV-1-infected women entering our ICSI programme. METHODS: The French law governing the use of assisted reproduction protocols in HIV-1-infected women was strictly applied. The inclusion criteria were absence of ongoing disease, CD4((+)) count >200 cells/mm(3), and stable HIV-1 RNA level. Since mean age at the time of ICSI was higher in HIV-1-infected women than in the overall group of non-HIV-infected women, we compared outcome data in HIV-1-infected women (group I) to a group of non-HIV-1-infected women matched with regard to age and follicle retrieval period (group II) as well as to the overall group of women who underwent ICSI at our institution (group III). RESULTS: A total of 66 ovarian stimulations was performed in 29 HIV-1-infected-infected women. The percentage of cancelled cycles was higher in infected women than in matched controls (15.2 versus 4.9%, P < 0.05). The duration of ovarian stimulation (13.3 versus 11.7 days, P < 0.05) and amount of recombinant FSH injected (2898 versus 2429 IU, P < 0.001) were also higher in infected women. The number of retrieved oocytes, mature oocytes, and embryos obtained as well as embryo quality was similar in all groups. The fertilization rate was higher in infected women than in matched controls (67 versus 60%, P < 0.01). The pregnancy rate was not significantly different between groups I and II (16.1 versus 19.6%) in spite of the fact that the number of embryos transferred was purposefully restricted in the HIV-1-infected group to minimize multiple pregnancy (2.0 versus 2.4, not significant). CONCLUSION: The results of this preliminary series of ICSI cycles in HIV-1-infected women indicate that optimal ovarian stimulation is slightly more difficult to achieve than in matched seronegative women. However, when criteria for oocyte retrieval were fulfilled, ICSI results were similar to those of age-matched controls.

Adult↗

[Analysis of transfer from one hospital to another in patients with myocardial infarction in the Provence-Alpes-Côte-d'Azur].

OBJECTIVE: The aim of the study is to assess the transfer from one hospital to another in patients with myocardial infarction in the Provence Alpes CBte d'Azur (PACA). METHODS: To apply a methodology initially used in sociology "social network analysis" which allow us to describe and model the relational structure of a whole of actors, represented in this work by the establishments of care. Flows between the actors are represented by the transfers of patients. This approach is innovating in the analysis of the medical system. RESULTS: - A total of 2049 patients were admitted in 74 hospitals. The average age is 68.9 years. The density of the hospital network is 0.12. The number of click is 51. Multivariate analysis showed that the following factors were associated with decreased mortality: prestige, age < 65 years, angioplasty alone or thrombolysis associated to angioplasty. CONCLUSION: Social Network Analysis offers a synthetic sight of the relational systems in the health system. It constitutes an open field of search in Public health, and can also be applied to the evaluation of the networks.

Age Factors↗

Incidence of herpes simplex virus keratitis in France.

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

Adolescent↗

[Media and public health: example of heat wave during summer 2003].

BACKGROUND: The summer of 2003 was the hottest for France in the last 50 years with record day and nighttime temperatures. INSERM statistics estimated that 14,802 heat-related deaths occurred during August 2003 heat wave in France. In the aftermath of this crisis, we thought that it was useful to analyze how the French media dealt with public health during the period from June 1 to August 31, 2003. The objective was to analyze French coverage of public health information during the August 2003 heat wave. METHODS: Manual and computerized analysis of newspaper and radio reports published from June 1 to August 31, 2003. Articles were obtained by searching the EUROPRESS database. Text analysis was performed using the ALCESTE software package. RESULTS: A total of 1,599 articles were analyzed. Few articles contained warnings about heat exposure and preventive measures. Public health policy was relegated to third place after business and ecology themes. The special problems of the high-risk populations were not mentioned until after the rising death toll was known and emphasis was placed on the implications of the crisis in the political process. The findings of this study show the poor performance of public health policy in France and that media must be given guidance to fulfil its role in providing public health information. CONCLUSION: This crisis discloses the absence of public health culture in France and involves the "social exclusion" related to a breakdown of social cohesion. More cooperation is needed between the media and public health professionals to avoid future heat-wave and other public health crises. France must develop a public health culture to promote involvement of both the community and individuals in public health issues.

Communications Media↗

Comparative study of the impact of chronic urticaria, psoriasis and atopic dermatitis on the quality of life.

BACKGROUND: A better management of chronic skin disorders (CSDs) requires a knowledge of their impact from the patient's point of view. OBJECTIVES: To determine which aspects of the patient's life are mainly impaired in the different CSDs, and provide comparative references to estimate better the real impact of the different CSDs. PATIENTS AND METHODS: A prospective cross-sectional and matched study of 1356 adult outpatients to compare the health-related quality of life (HRQL) profile in chronic urticaria (466 CU), psoriasis (464 PSO) and atopic dermatitis (426 AD), using the VQ-Dermato, a multidimensional instrument in French validated for CSDs. RESULTS: After adjustment for confounders, HRQL dimensions were differently affected in the three CSDs. The 'physical discomfort' dimension was more degraded in AD and CU than in PSO (P < 0.001), and 'leisure activities' more in PSO than in CU (P < 0.001). 'Self-perception' and 'treatment-induced restrictions' dimensions were much less affected in CU than in PSO and AD (P < 0.001). In PSO, the 'daily living activities' dimension was much less impaired than in CU and AD (P < 0.001). No aspect of HRQL was really spared in AD. CONCLUSIONS: The comparison shows that CU, PSO and AD are characterized by completely different qualitative profiles of impact on HRQL, which are influenced by their clinical characteristics and usual treatment options. It underlines the severe impairment of CU which is often underestimated.

Adult↗

[Applying social network analysis to the health system].

BACKGROUND: Social network analysis is a method for describing and contextualising the structural relationships amongst social entities. The aim of this study was to assess the relationships between hospitals through the use of an example of a hospital that takes care of myocardial infarction in the region of Provence Alpes Côte d'Azur (PACA). METHOD: This retrospective study included all patients hospitalised for acute coronary syndrome in the PACA region between January and June 2000. The description analysis consisted of making a graph describing the transfer of patients between hospitals to calculate indicators for the centrality of the hospital and its prestige. The graph was also used to determine and measure the sub-group cohesion (cliques) and the density of the hospital network. RESULTS: A total of 2049 patients suffering from myocardial infarction were admitted to 78 hospitals during the study period. There were 867 transfers from one hospital to another. 51 cliques were highlighted; 29 hospitals do not belong to a clique. Among the 49 hospitals who do belong to sub-groups, 50% are linked to two cliques. Eight hospitals belong to more than 8 sub-groups, and the maximum number of sub-groups to which a hospital is linked is 12. The density of the hospital network is 0.12. CONCLUSIONS: Social network analysis is a field of research open and adaptable to the public health scene. This method could be applied to the evaluation of health and hospital administration and management networks.

Community Networks↗

[The profile of drug addicts attending the Sainte Marguerite University Hospital in Marseille analysis of the active file from 1996 to 2001].

OBJECTIVES: Present the evolution in the characteristics of drug addicts treated in the Addictions-Sud centre (Marseille) between 1996 and 2001, and compare the profile of patients according to the substitution therapy prescribed. METHODS: Descriptive analysis of the data collected from the inclusion questionnaire of patients seen during a hospital consultation in the centre and registered in a substitution program (n = 585 patients). RESULTS: In our active file, the use of heroin and injections has decreased since 1996, whereas the consumption of cocaine and above all amphetamines and LSD has greatly increased. When treated, 60% of the patients were administered methadone and 40% BHD. (The patients included in the methadone program (n = 348) were considerably older and frequently HIV or hepatitis C-infected than those treated with BHD (n = 229)). The proportion of patients who had previously undertaken withdrawal or substitution measures, and who continued to inject drugs, was greater in the group of patients in the methadone program. The presence of depression, psychotic disorders and anxiety was noted respectively in 46, 30 and 24% of the patients treated. DISCUSSION AND CONCLUSION: Today, it is crucial that information on the treatment of drug addicts should be reinforced, so as to measure the progression of the problems encountered, specify the indications of the two substitution products currently prescribed and understand the impact they have on the psychiatric disorders and viral pathologies frequently noted in drug addicts.

Adult↗

Shortening the VSP-A: preliminary development of the VSP-A12, a 12-item short-form.

The 'Vécu et Santé Perçue des Adolescents' (VSP-A) questionnaire is a French generic self-administered health-related quality of life (HRQL) instrument for adolescents which comprises 40 items, allowing the calculation of six dimensions as well as an index. Regression methods were used to select 12 items from the VSP-A to reproduce its HRQL index. The resulting 12-item short-form (VSP-A12) achieved an adjusted R2 of 0.907 in prediction of the VSP-A index. Scoring algorithm used to score this 12-item index achieved a R2 of 0.901 with the VSP-A index when cross-validated in the validation sample (n = 2941). Numerous tests of empirical validity previously published for the VSP-A were replicated for the VSP-A12, including comparisons between groups known to differ in terms of gender, age or health status. All the significant results shown by the VSP-A index were also encountered by the VSP-A12 summary measure. The ability of VSP-A12 to discriminate between healthy and ill adolescents was also proven. A test-retest correlation (4 weeks) of 0.745 was observed for the 12-item HRQL index in the target population (n = 664). Average score for this shorter index closely mirrored VSP-A index, although standard deviation was always greater for the VSP-A12.

Adolescent↗

Development and validation of a patient-based health-related quality of life questionnaire in schizophrenia: the S-QoL.

We developed a self-administered instrument to assess health-related quality of life (HRQL) among people with schizophrenia. The S-QoL, based on Calman's approach to the subject's point of view, is a multidimensional instrument that is sensitive to change. The scale is a 41-item questionnaire with eight subscales (psychological well-being, self-esteem, family relationships, relationships with friends, resilience, physical well-being, autonomy and sentimental life) and a total score. In-depth interviews with patients determined the pertinent issues for item development. The validation study, performed with 207 patients, showed high internal consistency reliability, reproducibility and responsiveness. Construct validity was confirmed using established clinical and HRQL measures. S-QoL covers domains that differ from areas tapped in other measures, with greater responsiveness. The S-QoL is an efficient instrument for the measurement of the impact of schizophrenia on individuals' lives.

Adolescent↗

Depression and subjective quality of life in chronic phase schizophrenic patients.

OBJECTIVE: To evaluate the influence of depression on subjective quality of life in schizophrenic patients. METHOD: Sixty-seven schizophrenic patients in a stabilized phase were included. Schizophrenic symptoms were evaluated using the Positive and Negative Symptoms Scale (PANSS). The subjective quality of life was evaluated using the short version of the Lehman quality of life scale (QoLI). Depression was evaluated using the Calgary Depression Scale for Schizophrenia (CDSS) and extrapyramidal effects with the Extrapyramidal Symptoms Rating Scale (ESRS). RESULTS: The PANSS total score, PANSS general psychopathology subscore, PANSS depression factor, the total CDSS and some ESRS scores were negatively correlated with the overall life satisfaction score. The CDSS score was negatively correlated with all except one QoLI score. QoLI scores were significantly lower in depressed patients, and this result remained consistent for four QoLi dimensions when adjusted on ESRS and PANSS scores. When analysing the association between high depression scores and high parkinsonism scores with reduced quality of life, multivariate analysis showed that depression was the main explanatory factor: the CDSS total score explained 22% of the variance of the overall subjective quality of life score. The patient questionnaire at the ESRS explained 10.5% of the variance of the 'mental and physical health' QoLI score. CONCLUSION: In schizophrenic patients, depressive symptoms should be focused because of their strong association to overall subjective quality of life.

Adult↗

[Patentability of living material: public health concerns (1/2)].

A TOPICAL SUBJECT: The patentability of living material provokes debate in the scientific and medical world, but also concerns the political and legal circles. REGARDING PATENTS: Laws govern intellectual property rights and patients. There are contradictory arguments advanced by those who are in favour or who are opposed to patents, and particular problems related to the patenting of living organisms, particularly since the progress made in genomic research. ESSENTIAL PUBLIC HEALTH REQUIREMENTS: It is important to underline the limits imposed by the protection of intellectual property, regarding the access by all to any progress issued from research. The provisions must be widened in order to bypass the patents, when the health and nutrition of populations are at stake. It is essential to come to the universal accessibility, particularly in developing countries, to all innovations and that all knowledge be shared.

Animals↗

[Validation of the French language version of the Parkinson's Disease Questionnaire - PDQ-39].

After Alzheimer's disease, Parkinson's disease (PD) is the second most frequent degenerative disease of the central nervous system. The consequences of PD at the functional, social and emotional levels warrant a better understanding the patient's perceptions as measured using a specific instrument rather than restricting the medical approach to the clinical evaluation of the motor component. In 1996, we began implementation of a project to transculturally validate the single specific instrument that had been published and was available at that time: PDQ-39. The scale consists in a 39-item questionnaire enabling determination of an overall quality-of-life score and scores for 8 specific dimensions: mobility, activities of daily living, emotional well-being, stigma, social support, cognitions, communication and bodily discomfort. Eighty-nine patients taking part in an open-label study of the safety of a combination of pergolide and dopa therapy were included and followed up on D15 and after 8 weeks. The process of "Forward-Backward" translation, conducted in close liaison with the authors, enabled semantic and linguistic validation of the French language version. The content was validated by PD experts. At baseline, the patients presented quality-of-life scores that were particularly impaired for the dimensions exploring Mobility, Emotional well-being and Bodily discomfort. The main metric properties of the scale were confirmed. The PDQ-39 scores were closely correlated with the related concepts investigated by generic scale, SF-36. The PDQ-39 scores were correlated with the "Mental and Mood Status", "Everyday Activities" and "Motor Status" dimensions determined by the UPDRS. The reliability, expressed by Cronbach coefficients alpha, showed strong consistency of the instrument, very similar to the data for the original version. In contrast to what was observed with SF-36, the scale was particularly sensitive to clinical changes. The initial results make PDQ-39 a precious tool for the optimization of management of patients presenting with PD.

Female↗

[The use of exit questionnaires, a survey at 7 hospital centers].

Measuring the satisfaction of hospitalised patients has been mandatory in France since 1996. The most common tool for assessing the level of satisfaction is the use of self-administered questionnaires given to the patient upon his/her release from the hospital. A survey was conducted among seven public hospitals to appraise the development and use of such questionnaires, their results and the way in which these results are taken into account in order to improve the quality of care. The survey's results illustrate that the policy with respect to their construction varies between hospitals, without any evaluation of the validity of the questionnaires produced. In most cases, the questionnaires are passively distributed to the patient at the time of discharge. The response rates are low (ranging from 4 to 18%), and the analysis of the collected questionnaires, to the extent to which it is done, is not necessarily used to improve the quality of care. An appropriate evaluation strategy, one capable of effecting change and improving hospital care, still remains to be established in the hospitals which participated in the survey.

France↗

[Mandatory notification of HIV infection. Epidemiologic justifications and ethical questioning].

Since the appearance in May 1999 of the two decrees on the application of the law relative to the reinforcement of sanitation quality control established in July 1998, the disclosure of HIV infection "irregardless of the stage" has become mandatory. This is the first time that it is imposed that one must declare a serologic diagnosis, that is to say an infection in the asymptomatic stage. The sensitive nature of all of the information available on AIDS provides an explanation for the numerous contradictory reactions linked to this decision. We attempt to organise the arguments brought forth according to two approaches: 1) the epidemiological arguments that justify the compilation of the precise data thought to be necessary for the follow-up of the disease and for the implementation of well-targeted prevention actions; and 2) the ethical reservations concerning such an imposed measurement, as well as the questions related to anonymity and confidentiality.

Disease Notification↗

[Glucose-6-phosphate dehydrogenase et neonatal jaundice].

OBJECTIVE: Since 1986, quantification of G6PD activity has been a routine test for all babies born at the public maternity hospitals of Marseilles. The objective of our study was to determine the prevalence of G6PD deficiency in the population tested and to evaluate the relative risk of neonatal jaundice in newborns with G6PD deficiency. METHODS: Neonatal screening is performed on cord blood by spectrophotometric measurements of G6PD activity. A group of 7779 newborns was studied retrospectively. The occurrence of neonatal jaundice was evaluated in 85 children with G6PD deficiency and compared to 85 children with normal G6PD activity. RESULTS: The incidence of G6PD deficiency in male newborns was found to be 2.1%. The relative risk for neonatal jaundice in the G6PD deficient population compared to the non-deficient population is estimated to be 2.6. CONCLUSION: Neonatal jaundice with pathological hyperbilirubinemia develops more frequently in cases of G6PD deficiency. The early characterization of G6PD activity provides an etiological diagnosis for neonatal jaundice, as well as the opportunity to give the newborn's family information concerning hemolytic crisis prevention.

Cohort Studies↗