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To describe the prevalence of opioid-induced constipation (OIC) in patients with cancer pain according to the Knowles-Eccersley-Scott symptom score (KESS), the different symptoms of opioid-induced bowel dysfunction (OIBD), and to assess the impact of OIBD on patient's quality-of-life.A cross-sectional observational study, using the KESS questionnaire and the physician's subjective assessment of constipation, and other questionnaires and questions on constipation, OIBD, and quality-of-life, carried out on 1 day at oncology day centres and hospitals.Five hundred and twenty patients were enrolled at 77 centres in France; 61.7% of patients (n = 321) showed a degree of constipation that is problematic for the patient according to KESS (between 9-39). Even more patients, 85.7% (n = 438), were considered constipated according to the physician's subjective assessment-despite laxative use (84.7% of patients). Quality-of-life was significantly reduced in constipated vs non-constipated patients for both PAC-QoL (p 0.0001 for total score and each dimension) and the SF-12 questionnaires (statistically significant for all dimensions except physical state and role physical). OIC and OIBD led to hospitalization (16% of patients), pain (75% of patients), and frequent changes in opioid and laxative treatment.This cross-sectional study, in a selected population of cancer patients, has measured prevalence and impact of OIBD. Further confirmation could be sought through the use of longitudinal studies, and larger populations, such as non-cancer pain patients treated with opioids.Cancer patients taking opioids for pain are very frequently constipated, even if they are prescribed laxatives. This leads to relevant impairments of quality-of-life.

Les troubles psychiatriques sont frequents dans le lupus erythemateux dissemine, mais aucune etude n'a ete realisee, a ce jour, concernant les patients atteints de lupus cutane chronique et de lupus subaigu. Cette etude a pour but d'evaluer les troubles psychiatriques d'un echantillon de patients atteints de lupus cutane. Chaque patient a ete vu individuellement par un psychiatre pour un entretien semi-structure au cours duquel deux questionnaires ont ete proposes : la Symptom Check List -90R et une echelle de qualite de vie pour les patients atteints d'une maladie de la peau (la VQ-Dermato). Resultats. - Neuf patients (45 %) presentent un Trouble Anxieux Generalise selon les criteres du DSM-IV ; 11 patients (55 %) presentent ou ont presente un episode depressif majeur ; six patients (30 %) n'ont aucun trouble psychiatrique. Les troubles psychiatriques sont plus frequents chez les femmes que chez les hommes et semblent egalement plus frequents dans le sous-groupe des lupus evolutifs. Discussion. - Le taux de troubles psychiatriques cliniques retrouve dans le lupus cutane est particulierement eleve par rapport aux taux de la population generale. Les resultats doivent cependant etre moderes, essentiellement du fait de la petite taille de l'echantillon et de la methode de recrutement.

The BFI † (Bowel Function Index) is a 3-item questionnaire for assessing opioid-induced constipation (OIC). The aim of this study was to contribute to the validation of the psychometric properties of the BFI by confirming a constipation threshold, and through correlation with other validated tools: KESS (Knowles Eccersley Scott Symptom) score and generic (12-Item Short Form Health Survey, SF-12) and specific (Patient Assessment of Constipation-Quality of Life, PAC-QoL *) quality-of-life scores.A survey on opioid-requiring cancer-patients was carried out in France. A questionnaire was filled out for all patients that recorded their demographic characteristics, an assessment of their constipation using BFI and KESS scores, and included a self-assessment of quality-of-life using PAC-QoL and SF-12. Correlation of BFI with KESS, PAC-QoL, and SF-12 was investigated.Five hundred and twenty patients participated in the entire data collection with no loss. BFI was shown to be statistically correlated (r = 0.571; p 0.0001) with the KESS score and matches up with PAC-QoL and to a lesser extent with the SF-12 generic quality-of-life questionnaire. A BFI threshold of 27-29 to discriminate constipated from non-constipated patients was confirmed.This cross-sectional study in a selected population of cancer pain patients has validated the psychometric properties of the BFI. Further confirmation of the validity of the BFI could be sought through the use of longitudinal studies, and larger populations, such as non-cancer pain patients treated with opioids.This study contributes to the validation of the psychometric properties of the BFI. It confirms the BFI as an easy-to-use tool to assess constipation and its impact on quality-of-life in chronic pain patients.

An exceptional sequence of raised coral reef terraces is visible at Cape Laundi, on the north coast of the island of Sumba, in the Savu Sea, in which at least eleven terraces wider than 100 m, six of them even being over half a kilometer wide, are geomorphologically distinguishable between an ancient patch reef now at +475 m and the present sea level. ESR date estimations of almost unrecrystallized corals, most of them in situ, make possible a tentative identification of the terraces corresponding to isotope Stages 15 (ca. 600 ka ago) and 9 (ca. 330 ka ago). When the uplift trend deduced from the present altitude of dated terraces (0.49 ± 0.01 mm/yr) is extrapolated to the whole raised section, most geomorphological features appear to correspond to interglacial stages of the astronomically calibrated oxygen-isotope record, up to stage 27 (ca. 0.99 Ma), beyond the Matuyama/Jaramillo geomagnetic boundary. The upper terraces would in this case be twice as old as previously estimated (ca. 0.5 Ma). Main terraces seem to correspond to high sea levels at certain interglacial stages and substages, but in some cases the action of low sea levels at glacial stages cannot be ruled out. For terraces between 30 and 70 m in altitude, Th/U and ESR dates reveal that aragonitic corals at similar elevations may differ in age as much as 100 ka; this can be explained by taking into account a polycyclic origin for several terraces, reconstructions available of changes in the eustatic sea level during the last 250 kyr, and the fact that coral reef development may have been scattered at some periods only, without totally covering subjacent, older formations. The Sumba sequence of marine terraces at Cape Laundi is among the longest and most complete for the past million years reported in the literature. Its relatively good state of preservation will probably give impetus to a number of new studies on the chemical, physical, isotopic, morphological, palaeoclimatic, pedological, ecological and diagenetic changes which have occurred during the past one million years.

Authigenic micrite from a playa in the northern Sahara has been dated by both the U/Th and 14C methods. The U/Th ages can be a few thousand years greater or less than the 14C ages obtained on the smallest crystals of micrite. The latter are considered to form a reasonable chronology for the Holocene deposits. The deviations of the U/Th ages are explained by quantifiable losses and gains of uranium under changing redox conditions. Under conditions where U is conservative (reduced sediments with low permeability), the U/Th method can provide good chronologies for lacustrine deposits.

To evaluate pain management in cancer patients, a study was conducted examining the treatment circumstances and modalities of initial prescription level 3 analgesics used by 122 French cancer specialists. The rationale for moving to level 3, the implementation and the follow-up were evaluated in 1,038 patients. The reasons underlying the initial prescription were in line with recommendations for clinical practice (WHO, SOR) and the professionals generally preferred molecules with which they were already familiar. Though pain intensity was reduced in 67% of patients, treatment follow-up could have been improved in a number of cases. In particular, titration was not systematically performed, and the interruption of the prescribed treatment (owing to inefficacy or negative side-effects) was not sufficiently timely. The awareness-raising campaigns performed over the past few years should be continued, underlining the importance of early follow-up, notably during the titration phase of level 3 analgesic initiation.

The aim of this study was to describe the employment conditions of women with chronic venous disorders of the lower limbs.Cross sectional study conducted by general practitioners who describe the first 3 women, between 18 and 65 years of age, who were employed and who presented with at least CEAP stage I venous disorders.Occupations held by these women indicate significant departures from the general population with an over representation of industrial workers (18.6% vs 11.9%) and an under representation of intermediate professions (12.5% vs 26.6%), (P0.001). At work, 78.2% (n=4,143) of the women remained standing for 6.2+/-2.4 hours per day and/or 52.3% (n=2,771) were seated for prolonged periods, 28.9% (n=1 503) were exposed to sources of high heat on the legs and 18.2% (n=947) wore garments that compressed the abdomen Conditions favorable to the ergonomic evolution of their workstation are limited: only 9.2% (n=397) thought it possible to reduce the time they spend standing; 10.1% (n=319) the time they spend sitting; 12.9% (n=189) their exposure to heat. Combating these factors appears difficult: 74.3% (n=3 883) state that they do not have sufficient breaks to rest their legs, 38.9% (n=2,053) that they do not have the opportunity to stretch their legs and 42.5% (n=1,395) that compression stockings would be permitted, but would be a hindrance in their work (85.6%, n=4,503). For 27% (n=1,424) of respondents, these problems significantly increase the arduousness of their work and 73.7% (n=3,870) think their working conditions have worsened their venous distress.Women who consult for venous problems are employed in work which are characterized by unavoidable conditions constituting undeniable venous risk factors for venous disease and occupational medicine does not pay enough attention to the ''ladies legs'' at work.

A report is presented of a multicenter pharmaco-epidemiological study on chronic venous insufficiency conducted in France on 5043 patients.It was based on a questionnaire that included the demographic characteristics of the patients, their risk factors for venous disease, history of venous insufficiency, physical and functional symptoms, and clinical stage according to the CEAP classification, as well as modalities of treatment and professional practice of the participating doctors. The various treatment modalities (phlebotonics, compression stockings, sclerotherapy and surgery) were related to the stage of the venous insufficiency and to the satisfaction expressed by the patients.The results of the study showed a minimum annual sick leave rate of 7.2%.In conclusion, this study brings to the fore the change in treatment modalities for venous insufficiency according to its severity stage, principally as regards medico-economics.

The efficacy of Cyclo 3 Fort has previously been demonstrated in placebo-controlled trials on plethysmographic and clinical parameters. Its objective was to demonstrate that after one month of therapy, the efficacy and safety of a single dose of two capsules of Cyclo 3 Fort in the morning were comparable to that of a twice daily dose of Cyclo 3 Fort, one capsule morning and noon.This single-center, randomised, double-blind study was conducted on 37 women with chronic lower-limb venous insufficiency, associating clinical or functional signs and abnormal plethysmographic values. Clinical parameters measured were those conventionally used to assess superficial venous insufficiency; the main laboratory parameter evaluated by plethysmography was the index of venous distensibility.The results data show that in each of the study groups, all of the patients attained a significant improvement in their clinical conditions, confirmed by laboratory tests, following one month of therapy with Cyclo 3 Fort. On the other hand, comparison of results data between the two groups did not objectify any significant difference between the two treatment modalities.Thus a single dose of two capsules of Cyclo 3 Fort in the morning appears as effective and as well-tolerated as a twice daily dose of one capsule of Cyclo 3 Fort morning and noon.

International audience; A flight of six major coral reef terraces, up to 700m in altitude, occurs along the eastern and northern sides of Kabola Peninsula, Alor Island, Indonesia. Some adiometric dates have been obtained from unrecrystallizedcoral samples collected in growth position by three different methods ($^{14}$C, $^{230}$Th/$^{234}$U, ESR). This enabled the identification of the terraces corresponding to the Holocene and to oxygen-isotope stages 5c, 5e and 7. According to the present elevation of the dated terraces, a 1.0-1.2 mm/y mean rate of uplift can be discerned. Extrapolation of this trend to the whole sequence of terraces reveals a good correlation between the development of major terraces and interglacial or interstadial stages corresponding to astronomically calibrated oxygen isotope records, up to stage 13. The relatively rapid uplift rate in this region minimized the possibility of polycyclic sea-level stands at the same levels and contributed to the good preservation of some morphological reef features. Two superimposed marine notches are visible near the present shoreline, with retreat points at about 5.0 m and 8.6 m respectively above the present MLWST level. They can be interpreted as corresponding to a glacial interstadial (the upper notch) and to the Holocene sea-level peak (the lower one). As Holocene emergence has been less than what could be expected from a 1 mm/y rate of uplift, a major coseismic vertical displacement may occur in the future.

International audience; A spectacular sequence of coral-reef terraces (six steps broader than 500 meters and many minor substeps) is developed near Cape Laundi, Sumba Island, between an ancient patch reef 475 meters high and sea level. Several raised reefs have been dated with the electron spin resonance and the uranium-series dating methods. The uplift trend deduced from these reefs is 0.5 millimeter per year; most terraces, although polycyclic in origin, appear to correspond to specific interglacial stages, with the oldest terrace formed 1 million years ago. This puts them among the longest and most complete mid-Quaternary terrace sequences.

Objectifs de l'enquete: Identifier les determinants de la prescription d'un arret de travail chez les femmes en activite professionnelle presentant une insuffisance veineuse des membres inferieurs. Materiel et methodes: Nature de l'etude: enquete observationnelle retrospective. Critere principal : existence d'une prescription d'au moins un arret de travail au cours des 12 derniers mois precedant la consultation. Criteres d'inclusion: femme en activite professionnelle presentant une insuffisance veineuse des membres inferieurs. Critere de non-inclusion : aucun hormis la non-satisfaction aux criteres d'inclusion. Methodes statistiques: tests du Chi 2 , analyse de variance et regression logistique, logiciel : SAS. Resultats: Les dossiers de 5 298 patientes âgees de 43,6 ± 9,7 ans, toutes en activite professionnelle, ont ete revus par leur medecin generaliste. Elles presentent les facteurs de risque classiques de l'insuffisance veineuse parmi lesquels les antecedents de grossesses (73,7%; n = 3907), l'heredite (53,7%; n = 2 847), l'existence d'une contraception orale (46,1 %; n = 2440), d'une obesite (27,1 %; n = 1438) et/ou d'un chauffage par le sol (11,9 %; n = 632). Selon la classification CEAP, 29,3 % (n = 1 541) des patientes sont au stade 1, 35,9% (n = 1891) au stade 2, 26,5% (n = 1397) au stade 3, 6,9% (n = 363) au stade 4, 1,2% (n = 65) au stade 5 et 0,2% (n = Il) au stade 6. Parmi ces femmes, 10,2% ont eu au moins un arret de travail au cours des 12 derniers mois, suscitant au total en moyenne 15,4 ± 12,4 jours d'arret sur l'annee. La frequence des arrets de travail est naturellement influencee par le stade clinique mais, parallelement, des elements specifiques aux conditions de travail paraissent jouer un role specifique. L'existence d'un orthostatisme de plus de 6 heures par jour apparait un determinant important avec un taux d'arret de 11,2 % contre 6,6 % chez les autres femmes mais, encore plus, le fait de travailler dans une ambiance thermique elevee (13,7 % versus 8,8 % ; p < 0,001), de porter des vetements serres (13,7% versus 8,6%; p < 0,001) ou de ne pas avoir de pauses suffisantes pour reposer leurs jambes (11,8% versus 7,8%; p < 0,001). On releve aussi que la frequence des arrets de travail est d'autant plus importante que les collegues souffrant d'insuffisance veineuse sont nombreuses dans l'environnement professionnel immediat, traduisant ainsi le fait qu'il ne s'agit pas d'une sensibilite personnelle mais bien de la resultante des conditions de travail auxquelles ces femmes sont exposees. L'insuffisance veineuse n'a ete abordee dans le cadre de la medecine du travail que pour 19,4% (n = 1 009) d'entre elles et ce a l'initiative de la patiente elle-meme dans les deux tiers des cas: 63,7% (n = 606). Conclusion: Par leur retentissement sur l'importance de la symptomatologie de l'insuffisance veineuse, les conditions de travail des femmes apparaissent les determinants majeurs de la prescription des arrets de travail. Ces resultats doivent susciter une reflexion de fond par les responsables de la medecine du travail sur l'ergonomie de nombre des postes de travail essentiellement occupes actuellement par des femmes.

The Labrador Sea is a particularly suitable high-latitude basin for investigating U and Th behavior in deep-sea sediments. During the late Quaternary, the cyclic development and decay of huge ice sheets on adjacent land masses resulted in large-amplitude changes in sedimentation rates and organic paleoproductivities. The resulting magnification of U and Th response is well illustrated by high-resolution studies on piston-cored sediments from the Greenland continental rise at Ocean Drilling Program Leg 105 Site 646 spanning isotopic stages 8 to 1. The results show a clear positive correlation of {sup 238}U/{sup 232}Th ratios with organic paleoproductivity indicators (e.g., dinocyst) due to U uptake in the water column and/or during the early diagenesis of organic matter responding to carbon fluxes and to their climate forcing. {sup 230}Th excesses over {sup 234}U exceed the theoretical value of the {sup 230}Th rain from the overlying water column, indicating lateral input possibly from the Greenland slope and shelf. Because these horizontal fluxes of {sup 230}Th may be partly controlled by physical parameters, {sup 230}Th excesses cannot be unequivocally correlated with sedimentation rates and/or productivity as reported elsewhere. In this subarctic basin characterized by low overall organic carbon burial, the {sup 238}U/{sup 232}Th ratio appearsmore » to be a sensible geochemical indicator of organic activity and paleoproductivity.« less

Sections along the Nelson River in northern Manitoba, outcropping upstream and downstream from Limestone Dam, record a long succession of late Quaternary events. The oldest sediment exposed consists of sandy, nonfossiliferous Sundance till of northwestern provenance and related to a Kansan or Illinoian glaciation. The paleosol developed in the Sundance till is assigned to the Yarmouthian or Sangamon interglacial on its stratigraphic position and depth of weathering. Fossiliferous, clayey Amery till of eastern provenance overlies the Sundance till and underlies the nonglacial Nelson River sediments. Aspartic acid D/L ratios of wood fragments from the Nelson River sediments correlate with an aspartic acid D/L ratio of similar wood from the Missinaibi Formation in Ontario. Beetle analysis indicates the Nelson River sediments were deposited north of the tree line under conditions more severe than those found in the area today. The deposits are believed to be of latest Sangamon or possibly Mid-Wisconsinan age. The Wisconsinan Stage is represented by the Long Spruce and Sky Pilot tills deposited by ice from the east. These tills are texturally and compositionally similar but are different colours. The overlying Henday sediments record glaciofiuvial deposition and mass wasting along the eastward retreating ice margin. Varves indicate the area was covered by glacial Lake Agassiz for less than 100 years after the ice retreated. The breakup of the Laurentide Ice Sheet in Hudson Bay and the final drainage of Lake Agassiz took place 7800–8000 years ago when the Hudson Bay Lowland was inundated by the marine water of the Tyrrell Sea. The area emerged from the Tyrrell Sea about 6500 years BP.

An attempt has been made at dating Middle and Late Pleistocene deposits from Banks and Victoria islands using the Th–U disequilibrium method. Geological correlations are difficult to establish because of the discontinuous nature of the terrestrial units and the relative absence of datable fossil wood and shells. The Th–U geochemical system likely remained closed for extended periods because of the presence of permafrost, which implies very limited or absent water circulation. The Th–U age determinations obtained confirmed the previously established stratigraphic framework and provide chronological information in that samples of Sangamonian age are differentiated from those that are younger (Wisconsinan and Holocene) or older (Middle Pleistocene). The Th–U disequilibrium method carefully used in areas where water circulation is limited can thus provide chronological control for sediments older than those that can be dated by the radiocarbon method.

Mineralogical, chemical, and radiochemical analyses of nodules sampled at various distances from the East Pacific Rise indicate that the mineralogical composition is not clearly linked to distance, but chemical composition seems to be. The pelagic nodules accrete at a lower rate and are, on the whole, richer in manganese, uranium, and thorium and poorer in lead and silicon than nodules from the ridge. The deep-seated nodules display a marked decrease in thorium concentration toward their centers, which can be explained in several ways. One hypothesis involves a decrease in the growth rate as the plate moves away from the ridge and manganese flux diminishes. As suggested in previous studies, some dissolution of the bottom of the nodules may occur and contribute to abnormal element distributions.

Among a set of sixty comagmatic xenoliths of basalts and trachytes coming from the French “Massif Central”, the samples richest in included gases have been selected with a crushing super-stage. Their minerals have been separated, studied under the microscope and, in the end, vacuum crushed. The gases, thus extracted, have been analysed with the mass spectrometer. The results of twenty-two analyses are presented. They show that CO2 is the major fluid constituent of the inclusions of very deep origin minerals. The geochemical implications of this fact are debated.

On Cape Breton Island (Nova Scotia), near the margin of the Wisconsinan ice sheet, karst depressions in Mississippian gypsum-bearing rocks contain interglacial and interstadial organic-rich deposits. Three palynostratigraphic units have been observed and tentatively dated by Th/U measurements on embedded fossil wood. The first, dated at ca. 125 ka, may be assigned to the oceanic /sup 18/O substage 5e; thermophilous forests (Quercus, Ostrya, pinus strobus) developed in response to a climate warmer than the present. The second unit, rich in Abies balsamea pollen and dated at ca. 87 ka, may relate to the /sup 18/O substage 5a; it reflects a cool and wet climate not unlike that of today. The third unit probably spans part of the mid-Wisconsinan (/sup 18/O stage 3); it shows alternating boreal forest-tundra forest assemblages indicative of climatic oscillations during a generally cold interval.

Uranium and thorium content and activity ratios were measured on 20 samples (19 molluscs and 1 calcareous concretion) from the Great Chotts in southern Tunisia. Results were studied by the isochron method and by age frequency histograms. They suggest that two major flood episodes took place about 150 and 90 ka. Uranium activity ratios indicate a ground-water supply of continental origin, in agreement with biological indicators, which show large variations in salinity from fresh to marine-like conditions. The existence of a lacustrine phase, radiocarbon dated to 17-40 ka, as previously suggested for the northern Sahara, is highly questionable.