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Abstract: Introduction: Whereas internal medicine physicians frequently prescribe systemic corticosteroids, it is unknown if they assess adequately the frequency and the discomfort caused by corticosteroid-induced adverse events. Methods: Using an e-mail questionnaire sent to the 813 internal medicine physicians, members of the French National Society of Internal Medicine, we assessed their perception of the frequency and the discomfort induced by the adverse events of long-term (that is, over or at three months) corticosteroid therapy. At the same time, 121 corticosteroid-treated patients, consulting in a department of internal medicine completed an anonymous questionnaire about the frequency and the discomfort caused by the adverse events of their therapy. Results: Three hundred and thirty-six out of 813 internal medicine physicians answered to the questionnaire (response rate: 41%) and 115 of the 121 questionnaires distributed to patients were exploitable. The physicians were predominantly male (71%) working mainly in tertiary centers (53%). The mean length of corticosteroids therapy for patients was 44±38 months and the mean daily dosage was 15±14mg. Lipodystrophy, trophic skin disorders, neuropsychiatric disorders and insomnia were frequent and reported by more than half of patients. The frequency of neuropsychiatric and skin disorders and of lipodystrophy estimated by practitioners was markedly lower than the frequency reported by patients. If morphological changes (weight-gain and lipodystrophy) were cited by practitioners as the most discomforting adverse event, in agreement with patients’ opinion, physicians underestimated the discomfort caused by neuropsychiatric disorders and insomnia. Conclusion: Frequency and discomfort caused by corticosteroid-induced neuropsychiatric disorders are underestimated by internal medicine physicians. [Copyright &y& Elsevier]

Abstract: Purpose: Following the commercialisation in France of the varicella vaccine and the European marketing authorization for a vaccine against zoster, this article intends to review the epidemiology of varicella and herpes zoster, to expose the characteristics of the available vaccines, and to consider the advantages and caveats of the different immunisation strategies. Current knowledge and key points: In France, from 550.000 to 750.000 cases of varicella are reported each year, which result in more than 3.500 hospitalizations and about 20 deaths. Subjects≥15 years old represent 8.3% of the total number of cases of varicella, 26% of varicella-related hospitalisations and 69% of all varicella-related deaths. The susceptibility rate for the 15 years old is 10,3 and 79% of these non-immune subjects are expected to contract varicella. The vaccines currently marketed against varicella are safe, have a good immunogenicity and remain effective over the evaluated periods. Two vaccination strategies are considered: a generalized vaccination of the infants and children, or a vaccination targeted against high-risk populations and non-immune teenagers and adults. The incidence of herpes zoster is estimated in France at 235.000 new cases per year, from which 1% is hospitalized. A live attenuated vaccine using the same strain as the varicella vaccine, but at a much higher dose, proved its efficacy in terms of reducing shingles and postherpetic neuralgia incidences, of 51 and 67% respectively. This vaccine received a marketing authorisation in France, for adults≥60 years old. Future prospects: Uncertainties about the impact of vaccination on varicella and herpes zoster epidemiology have yet to be solved, such as the potential increase in herpes zoster incidence or in the absolute number of diagnosed varicella cases in older age groups, or the loss of vaccination-induced immunity with time. These questions demonstrate the need for an operational real-time surveillance network to monitor varicella and herpes zoster incidence in the setting of general population immunisation. [Copyright &y& Elsevier]

La coqueluche est une affection respiratoire pouvant être mortelle à tous les âges mais surtout chez les nourrissons avant leur primo vaccination. Les données épidémiologiques récentes montrent une diminution du nombre de cas de coqueluche mais une résurgence n'est pas à exclure dans les années à venir, en raison de l'évolution cyclique de la maladie et du relâchement des mesures barrières. Deux approches sont actuellement recommandées pour protéger les nourrissons avant leur primo vaccination : la vaccination de la mère durant la grossesse et la vaccination de l'entourage proche du nourrisson (cocooning). La vaccination de la mère durant sa grossesse a montré une efficacité plus marquée. Le surrisque incertain de chorioamniotite, possiblement associé à la vaccination durant la grossesse, n'apparaît pas suffisant pour remettre en question cette stratégie. Pertussis is a respiratory disease that can be fatal at all ages but especially in infants before their mandatory vaccination. Recent epidemiological data shows a decrease in the number of pertussis cases, but a resurgence cannot be excluded in the coming years due to the cyclic evolution of the disease and the loosening of hygiene measures. Two approaches are used to protect infants before their vaccination: vaccination of the mother during pregnancy and vaccination of all the infant's close relatives (cocooning). The vaccination of the mother during pregnancy is more effective. The uncertain risk of chorioamniotitis associated with vaccination during pregnancy is insufficient to question this strategy. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Except for the prevention of osteoporosis, no consensual recommendations are available regarding the therapeutic measures associated with the prescription of long-term corticosteroid therapy. The aim of this study was to assess the internal medicine physicians’ practices regarding the prescription of long-term corticosteroid therapy. Methods: In September 2007, we sent, by e-mail, a questionnaire to 813 internal medicine physicians, members of the French National Society of Internal Medicine. With this questionnaire, we assessed the frequency of prescription of measures sometimes associated with systemic corticosteroids and for whom no consensual recommendations were available (dietary advices, physical training, potassium supplementation, gastric protection, influenza vaccination and prescription of hydrocortisone). Results: Three hundred and thirty-six out of 813 internal medicine physicians completed the questionnaire (response rate: 41%). The practitioners were predominantly male (71%) and mainly engaged in tertiary centres (53%). Regarding the dietary measures associated with the prescription of corticosteroids, low-sodium diet was recommended by most of the physicians, 69% of them prescribing such dietary regimen in more than 80% of their corticosteroid-treated patients. The concomitant prescription of caloric restriction, low-carbohydrate diet and/or high-protein diet was not consensual. The prescription of muscular physiotherapy was unusual, 74% of physicians prescribing such reeducation in less than 20% of their patients. The frequency of recommendation for daily physical training varied between physicians as well as for potassium supplementation, gastric protection, influenza vaccination or hydrocortisone prescription. Conclusion: There is no consensus between French internal medicine physicians regarding most of the measures, which must be prescribed in association with a long-term corticosteroid therapy. [Copyright &y& Elsevier]

Le suicide est un phénomène complexe considéré comme en partie évitable et sa prévention est une priorité de santé publique. Certaines interventions de prévention du suicide ont fait l'objet d'évaluation, comme la formation des professionnels de santé notamment à l'évaluation du potentiel suicidaire (risque suicidaire et surtout urgence/dangerosité suicidaire), le dépistage et la prise en charge des troubles mentaux, la veille post-tentative de suicide, la diminution de l'accès à des moyens létaux fréquents, ou une couverture médiatique des suicides contrôlée et à visée éducative. La stratégie de mise en place de mesures de prévention auprès de groupes à risque, bien que moins rigoureusement évaluée, est également déployée. Une prévention efficace du suicide passe par la mise en place simultanée de plusieurs stratégies de prévention ciblant différents facteurs de risque. Les cliniciens jouent un rôle primordial dans la plupart de ces interventions. Although being complex, suicide is a phenomenon considered as preventable, and its prevention has been made as a public health priority. Some interventions to prevent suicide have been evaluated, such as the education of the healthcare workers, especially in the suicidal assessment (suicidal risk and suicidal emergency/dangerousness), the diagnosis and management of common mental disorders, the care provided after a suicide attempt, the restriction access to common means of suicide, the use of websites to educate the public, or the appropriate reports of suicide in media. Other interventions, even not rigorously evaluated, are implemented in France as in many parts of the world. It is the case of interventions among identified high-risk groups. To be efficient, prevention programs should simultaneously include different strategies targeting several known risk factors for suicide. Clinicians play a crucial role in the suicide prevention strategies. [ABSTRACT FROM AUTHOR]

La prophylaxie préexposition (PrEP) au virus de l'immunodéficience humaine (VIH) consiste en la prise d'antirétroviraux chez des personnes non infectées afin de prévenir le risque d'acquisition du virus. Elle s'adresse aux personnes les plus exposées au VIH. Son efficacité préventive, démontrée dans le cadre d'essais cliniques, a permis sa mise à disposition et son déploiement dans plusieurs pays, dont la France. Cependant, des freins à sa prescription subsistent en raison de craintes liées à une moindre utilisation des autres moyens de prévention ou à une augmentation des prises de risque dans un contexte d'augmentation de l'incidence des autres infections sexuellement transmissibles, et à l'émergence de résistance. Ainsi, demeure encore une différence importante entre la proportion de PrEPeurs et la proportion d'individus qui sont éligibles à la PrEP. La PrEP fait également l'objet d'études complémentaires sur ses effets à long terme, et sur des modalités différentes d'administration et de prise. Pre-exposure prophlaxis (PrEP) is the use of antiretroviral drugs by uninfected people to prevent human immunodeficiency virus (HIV) infection. PrEP is used by people who are at substantial risk of being exposed to HIV. Numerous clinical trials have confirmed its effectiveness in reducing HIV acquisition and PrEP has been approved and allowed in several countries including France. However, PrEP uptake remains low as concerns about increase in sexual risk behaviour with PrEP use in the wake of a growing epidemic of sexually transmitted infections, and fear of drug resistance have been expressed. As a result, the difference between the proportion of people on PrEP and the proportion of people who would be very likely to use PrEP if they could access it -otherwise known as the PrEP gap- remains high. Nowadays, studies continue to explore long-term effects of PrEP as well as expand the array of available technologies and regimens. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: In-patients characteristics generate cost differences between hospitals. In France, there are few data on the characteristics on the patients referred to hospitals by their general practitioners (GPs) and none on the predictors of referral to the public or for-profit hospitals. The aim of this study was to analyze those characteristics and the predictors of referral to the public or for-profit hospitals. Methods: We collected, prospectively, the request for hospitalizations made by the GPs of the Sentinelles network in France, from 2007 to 2009. Patients’ characteristics and also the reasons for that request were analyzed. A logistic regression was used to compare the population between local hospitals. Results: Ten thousand seven hundred and eighteen statements were collected. The median age was 73years. Patients were women in 51% of the cases, and only 14% of the hospitalizations had been planned. Hospitalization in the public sector was preferred for young children and the elderly (P <0.001). When compared to the patients referred to the private sector, patients addressed to the public sector were more often seen for emergencies (OR: 2.3 [2.0–2.8]), by a doctor different from their referring GP (OR: 1.7 [1.4–2.1]) and out of the GP''s office. The reasons for hospital admission were different depending on the sector of hospitalization (P <0.001), patients addressed to the public sector hospitals presented with greater comorbidity or more complex diagnosis (for example: feeling ill, fainting or syncope and fever) or a greater disability (for example: stroke, neurological and psychiatric diseases). Conclusion: This study suggests that GPs send their patients to the public or for-profit hospitals according to criteria of severity, comorbidity and disability. [Copyright &y& Elsevier]

Abstract: Background: In patients treated with systemic glucocorticoids (GCs), it is unknown if beliefs about the treatment are associated with level of reported adherence. Patients and methods: Cross-sectional study conducted in two departments of internal medicine during a six-month period. All patients receiving long-term GCs therapy were asked to fill in a questionnaire regarding their beliefs about (specific scale of the Beliefs about Medicines Questionnaire) and their adherence to (four-item Morisky-Green scale) GCs. Logistic regression analysis was used to assess association between beliefs about GCs and adherence to treatment. Results: One hundred and eighty one questionnaires were analysed (women: 79%, median age [IQR]: 47 [33–61] years, median duration of treatment: 18 [7–72] months, median daily dosage of prednisone equivalent: 10 [6–20] mg). Among these 181 patients, 83 (46%) reported a “concern” score equal to or higher than the “necessity” score. Nineteen percent of patients reported a low adherence level. In multivariate analysis, these patients were significantly younger (OR: 0.96 [0.93–0.98] per increasing year of age, P =0.002) and reported more frequently a “concern” score higher than a “necessity” score (OR: 3.08 [1.27–7.46], P =0.01) as compared to patients reporting a high adherence level. Conclusion: Informing patients about the “necessity” of GCs and taking into account their “concerns” about adverse events or their fear of becoming dependent on the medication may improve their adherence to treatment. [Copyright &y& Elsevier]