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Purpose: To evaluate the ARAMAV 13-30 questionnaire, a new autonomy and quality of life questionnaire developed for visually impaired patients., Methods: We carried out a single-center prospective study at the ARAMAV institute in collaboration with the University Hospital of Nîmes. The patients included were admitted for low vision rehabilitation. Each patient received an occupational therapy assessment, the Short Forms 36 (SF36) quality of life questionnaire and the ARAMAV 13-30 questionnaire at the start and at the end of rehabilitation. We verified the reproducibility, the sensitivity to change, and internal and external consistency of the questionnaire., Results: We included 231 patients over a period of 4 years. All the patients were blind or visually impaired. We observed excellent intra- and interuser reproducibility of the questionnaire, with a Lin coefficient>0.9 (0.99 and 0.91, respectively). By comparing the variations of the different scores between before and after low vision rehabilitation, we observed excellent sensitivity to change for both the autonomy and quality of life portions of the questionnaire. Finally, we observed excellent internal and external consistency., Conclusion: We therefore propose the ARAMAV 13-30 questionnaire as a new tool in evaluating autonomy and quality of life specifically in visually impaired patients, which may also be used to assess the effect of low vision rehabilitation., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the ability of patients with exudative AMD to detect exudative recurrence. Another objective was to assess if self-monitoring, as currently taught, improves this ability., Materials and Methods: An observational cross-sectional study was carried out in the ophthalmology center of BeauSoleil clinic in Montpellier between March 1 and April 1 2016. Inclusion criteria were presence of neovascular age related macular degeneration treated with the loading dose of three monthly intravitreal anti-VEGF injections, with at least one injection in the past 12 months and at least one exudative recurrence. All patients underwent a visual acuity measurement with ETDRS charts at 4 meters. A questionnaire assessed familiarity with the Amsler grid and its proper use, performance of and type of self-monitoring at home and the subjective feeling of an exudative recurrence at the visit with a 5-level Likert scale., Results: A total of 94 eyes of 70 patients were included in this study with 69.0 % women and a median (interquartile range) age of 83 (77-96) years. Among them, 81 % performed regular self-monitoring, mostly with environmental Amsler tests (70 %). Only 63 % of the patients knew of the Amsler grid, among which 52 % used it correctly. Sensitivity (95 % confidence interval, 95 % CI) and specificity (95 % CI) of the subjective sensation of exudative recurrence were 0.32 (0.14-0.55) and 0.85 (0.74-0.92), respectively, for the entire population. Sensitivity (95 % CI) and specificity (95 % CI) were 0.33 (0.13-0.59) and 0.85 (0.74-0.93); 0.25 (0.0063-0.81) and 0.82 (0.48-0.98), respectively, in patients performing and not performing self-monitoring., Conclusion: Patients' prediction in wet AMD is insufficient in detecting exudative recurrences, even if regular self-monitoring with Amsler grid or environmental Amsler is performed., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: Intramedullary gliomas are rare tumors accounting for less than 4% of all primary central nervous system tumors. The aims of this retrospective multicenter study were to assess their natural outcome as well as management., Methods and Materials: We studied 332 patients from 1984 to 2011. Histopathological examination revealed 72% ependymomas (94% were low grade tumors), 24% astrocytomas (29% were high grade tumors), 2.4% mixed gliomas and 1.7% oligodendrogliomas., Results: The mean age at diagnosis was 42.4 years for ependymomas, with male predominance, versus 39.6 years for astrocytomas. Pain was the most common initial presentation. In 20% of cases, astrocytomas were biopsied alone, but more than 80% of ependymomas had surgical resection. Radiotherapy and chemotherapy were reserved for malignant tumors, especially if they were ependymomas. The 5-year survival rate was 76.8% for astrocytomas and 94.5% for ependymomas. Histology, functional status prior to surgery, and tumor grade are among the prognostic factors., Conclusion: Our study showed that surgical treatment of gliomas is well codified, at least for ependymomas, but adjuvant treatment continues to play a marginal role in the management even in astrocytomas, which are infiltrative tumors., (Copyright © 2017. Published by Elsevier Masson SAS.)

Background: Many clinical scales contain items that are scored separately prior to being compiled into a single score. However, if the items have different degrees of importance, they should be weighted differently before being compiled. The principal aims of this study were to show how the "analytic hierarchy process" (AHP), which has never been used for this purpose, can be applied to weighting the six items of the "London handicap scale", and to compare the AHP to the "conjoint analysis" (CA), which was previously implemented by Harwood et al. (1994) [1]., Design: In order to assess the relative importance of the six items, we submitted AHP and CA to a group of 10 physiatrists. We compared the methods in terms of item ranking according to importance, assessment of fictitious patients based on weights determined by each method, and perceived difficulty by the physiatrist., Results: For both techniques, "Physical independence" (PHY) was the best-weighted item, but other ranks varied depending on the technique. AHP was better than CA in terms of accuracy (global assessment of the clinical status) and perceived difficulty., Conclusion: AHP may be used to reveal the importance that experts assign to the items of a multidimensional scale, and to calculate the appropriate weights for specific items. For this purpose, AHP seems to be more accurate than CA.

Background: In France, lung cancer is the third most common cancer and the third leading cause of cancer death in women. The main objective of this study is to analyse specificities of lung cancer in the female population in an administrative district in France, focusing on histology, staging and trends over time., Methods: Incidence data from 1987 to 2004 were extracted from the Hérault cancer registry. The variables of interest considered at diagnosis were stage, histology and age. Mortality data were extracted from the CépiDc-Inserm database for the same period., Results: Among the 6,650 patients studied, 16.8% were women. 18.3% of whom were aged less than 50 at diagnosis, (9.9% of men, p<0.001). Lung cancer incidence is increasing in the female population (+6.4% per year) as well as lung cancer mortality (+3.5% per year). This occurred faster for adenocarcinoma, young women and stages III-IV., Conclusion: This population-based study confirmed the specific features of lung cancer in women: younger age at diagnosis, adenocarcinoma and stage at diagnosis with poor prognosis. These results raise the question of possible differences to lung cancer susceptibility between males and females.

Background: We surveyed survival and prognosis factors in tetraplegic spinal cord injured persons (TSCI) after their admission to a physical medicine and rehabilitation center., Methods: This multicenter study included 697 individuals, the entire cohort of patients admitted to three of the principal French centers caring for spinal cord injured persons from 1949 to 1997. The data set was drawn from the medical files and included data on the accident and its complications, social and demographic features, and the characteristics of the spinal injury. Survival data were obtained for all subjects from the official registries of their place of birth. Univariate (Kaplan-Meier) and multivariate (Cox regression) analysis was made to study links between these data and survival., Results: Univariate analysis indicated that the principal variables significantly related to survival were: level of the lesion, age at the time of the accident, the cause of the accident, and the presence of a permanent tracheotomy or a depressive syndrome requiring medical care. Multivariate analysis showed that the risk of dying was 82% lower for persons who did not have a permanent tracheotomy. The risk declined by 92%, 89% and 69% for TSCI aged 20 years or less, 20-39 years and 40-59 years respectively at the time of the accident compared with those aged more than 60 years. This risk was 37% lower for TSCI without depressive syndrome and 52% lower for persons injured at levels C6, C7, C8 compared with those injured at levels C2, C3, C4., Conclusion: Multivariate analysis showed that the principal prognosis factors for survival are the presence of a permanent tracheotomy, the age at the time of the accident, the presence of a depressive syndrome and the level of the lesion. No statistical improvement of survival was observed related with time (corresponding to the year of inclusion) but, over the study period, there was an increasing number of spinal cord injured person who survived with high lesions.

Objective: Increasing prevalence of skin cancer over the past few decades and their relationship with childhood sun exposure, show that educational campaigns on sun protection are urgently needed. The aim of this study is to estimate the degree of children's sun exposure in the south of France (43 degrees latitude north) and to study sun protection behaviors according to phenotypic characteristics., Population and Methods: The population was a randomly selected sample of 573 schoolchildren between 3 and 15 years of age living in Montpellier. The questionnaire provided information about sociodemographic characteristics, summer sun exposure and sun protection. Phenotypic characteristics, reactivity to sunlight and number of sunburns since birth were also reported., Results: Exposure time was very high: half of children spend over 6 hours per day outside in summer. The youngest children were the most protected either by sunscreen, or by shirt. On the beach, sunscreens were used more than half of the time of exposure by 70 p. 100 of the children. At the swimming pool, sunscreens were used by 45 p. 100 of the children and only by 14 p. 100 of them during other outdoor activities. A tee-shirt was only wore by 50 p. 100 of the children when playing on the beach, and by 75 p. 100 of them at the swimming pool. In addition, the application of sunscreen varied by body site. The adolescents, although they were exposed less than the youngest children, were very poorly protected. Light skinned children who do not tan easily had highest risk of sunburns, although they were generally more protected., Conclusion: The parents are able to identify highly sensitive children according to phenotype, but in practice the use of sunscreens and tee-shirt is very low. Parents and adolescents must be the target population but also insufficiently protected children. Health education at school must be an important measure for prevention.

Background: The ain of this study was to demonstrate risk factors for deep-vein thrombosis in adults in a hospital setting., Materials and Methods: From May 1993 to Februrary 1995, 233 patients hospitalized in the internal medicine unit at the Montpellier University Hospital for deep-vein thrombosis were included. Each case was matched to a control case for age, hospitalization unit, and use or not of anti-thrombosis prophylaxy. Venous thrombosis was diagnosed in patients and confirmed to be absent in controls using duplex Doppler when phlebography findings were unconvincing. To eliminate possible false negatives (poor sensitivity of duplex Doppler in asymptomatic patients), all controls were contacted by telephone 3 to 6 months after discharge to ascertain whether or not they had been rehospitalized and if so for what reason. The patients and controls responded to questions designed to identify risk factors for deep-vein thrombosis described in the literature (patient characteristics, personal and family history, surgical history, associated diseases, abnormal blood tests, medical treatment, life style)., Results: The three main risk factors for deep-vein thrombosis for all ages and both sexes identified by multivariate analysis were: personal history of venous thrombosis (OR = 4.7, 95% CI = [2.4; 8.9]), family history of venous thrombosis (OR = 3.3, 95% CI [1.8; 5.9]) and surgical during the preceding 45 days (OR = 3.7, 95% CI = [1.2; 10.9]). In non-menopaused women, the main risk factor was minidose oral contraception (OR = 6.9, 95% CI = [1.9; 25.4])., Conclusion: In our population of hospitalized patients in an internal medicine unit, the main risk factor for thrombosis appeared to be, in general, a past history of venous thrombosis and in non-menopaused women, minidose oral contraception.

Background: Unbiased and reliable data are presently required for health planning concerning end stage renal diseases (ESRD) in Languedoc-Roussillon region of France., Methods: A comprehensive retrospective study has been carried out on patients with ESRD in 1994 in this area. Information was collected from medical and social documents by physicians. The present report describes the management of patients and their demographic and epidemiologic characteristics. Multiple correspondence analysis was carried out to estimate to what extent mode of renal replacement therapy is determined by patient characteristics., Results: An incidence of 11.4 for new cases of renal replacement therapy was found per 100,000 inhabitants. This represents an increase of 4.8% in the total number of patients. The patients were found to be elderly (25% being over 72 years) and to present with multiple pathologies (32.5% severe cardiac pathology; 20.7% arteritis of the lower limbs; 15.1% diabetes; 11.2% manifesting malignant tumors). Only 57.5% received dialysis within a hospital setting; 30.1% received dialysis at home; 13% perform autodialysis; 1.2% were being trained for home dialysis in December. The renal transplantation rate was 5.5%. No significant relationship was found between choice of therapy and age, renal disease, comorbidities and place of dwelling., Conclusions: This study demonstrates the great variety in the modes of treatment used, the facilities provided and the evolutive trend, which together make programming planning difficult.

We studied the modalities and delays of restructuring of consciousness in a series of 89 consecutive survival cases, ranging over a large variety of age and severity and leading to any degree of awareness and results. We used the Glasgow coma scale, the study of brain-stem reflexes, and the Glasgow outcome scale. The recovery of awareness (eye opening to pain and fronto-orbicular reflex) was obtained mainly on the 9th day, with a limited variance. Recovery of a basic responsiveness to pain was concomittant of spontaneous eye opening mainly on the 15th day. A true relationship obeying orders was noticed on the 21st day, and a verbal response ranging mainly from the 30th day (confused) to the 60th (oriented). There was not any significative correlation of the delays with other early indicators of prognosis (Initial Glasgow score, C.T. scann lesions). Relating to the used sedation the effect was significant for the delays of eye opening only, with a possible analyse of the relationship. An inter-relationship between the steps and delays, leading to define an optimum for eye opening before day 15, for a motor response localizing pain before day 21, and for the item "obey to orders" before day 30 can be define as related to G.O.S. 4 and 5. A final analysis gave 79% of positive correlation with good results. We find a correlation between the delays of restructuring of consciousness and the functional results.

A random sample of 4-5 years old children born in the same year was taken from the infant schools of the Herault (France) and examined by pediatricians during a systematic check carried out by the Mother and Child Protection Department of the Health Service. This gave and estimation of the prevalence of the most widespread health problems: language, motricity, eyesight, hearing, obesity and asthma. Differences according to social and familial factors were found for language and motricity problems, as well as for access to preventive care.

A case-control investigation about bladder cancer was carried out in Herault department with 219 incident cases from January 1987 to May 1989 and two control groups: 196 hospital controls randomized from hospital admission lists and 794 population controls randomized from census data. According to the comparison for those two groups, there are few socio-demographic differences; but hospital controls are more exposed to smoking, coffee, alcohol, artificial sweetners. So, the odds ratios with those hospital controls are under-estimated. We can evaluate the resulting biais.

The main reason for using low molecular weight heparin (LMWH) is its capacity to keep the antithrombotic effect of standard non-fractioned heparin (NFH) while reducing its hemorrhagic power. Various studies comparing LMWH to NFH gave contradictory results, so we carried out a meta-analysis of randomized trials comparing these two treatments in prevention of deep-vein thrombosis (DVT) (and in prevention of deep-vein thrombosis or pulmonary embolism). From a selection of ten trials we could not show any significant difference in the DVT rates, as well as for the whole of surgical indications as for the subgroups of abdominal and orthopedic surgery. The weighted global difference between the DVT rates is so low that, in spite of the use of meta-analysis, the power is clearly insufficient. The hemorrhagic risk is not statistically reduced as well for the whole of surgical indications as for the subgroups.