Search

Background General practitioners’ perception of the discomfort their patients experience because of corticosteroid-induced adverse events is unknown. Methods An observational epidemiological study was conducted in September 2007. Eight hundred and sixty general practitioners belonging to the reseau Sentinelles® were asked to complete an electronical questionnaire. The questionnaire aimed to assess their perception of discomfort induced by adverse events induced by a long-term (i.e., ≥ 3 months) corticosteroid therapy among their patients. Results were compared with the declaration made by 115 long-term corticosteroid treated patients followed in an internal medicine department. Results Two hundred and ninety-three general practitioners responded to the questionnaire (response rate: 34%). They were predominantly male (87%). Forty-eight percent of them reported 400 to 600 monthly visits. The mean length of corticosteroid therapy for patients was 44 ± 38 months and the mean daily dosage was 15 ± 14 mg. They suffered mainly from lupus erythematosus (33%) or giant cell arteritis (15%). The adverse events considered to be the most disturbing by patients were lipodystrophy (25%), followed by weight gain (18%) and neuropsychiatric complaints (16%). Physicians widely overestimated the discomfort caused by weight gain cited as the most disturbing adverse event by 59% of them and underestimated that induced by mood disorders cited as the most disturbing by only 3% of them. Conclusion The discomfort caused by corticosteroid-induced neuropsychiatric adverse events are underestimated by general practitioners.

Resume Introduction Les internistes sont frequemment prescripteurs de corticotherapies systemiques prolongees, mais on ne sait pas si la perception qu’ils ont de la frequence et de la gene induite par les effets indesirables de ces traitements est correcte. Methodes L’enquete a ete menee a l’aide d’un questionnaire electronique compose de questions a choix simple ou a choix multiples et adresse par courriel aux 813 medecins internistes, membres de la Societe nationale francaise de medecine interne, disposant d’une adresse electronique. Dans ce questionnaire, il etait demande aux praticiens d’estimer la frequence et la gene induite par les effets indesirables d’une corticotherapie systemique prolongee (c’est-a-dire, prescrite durant au moins trois mois). A titre indicatif, les resultats obtenus etaient compares aux donnees fournies par des patients traites au long cours par corticoides, vus en consultation d’un service de medecine interne et qui rapportaient leur vecu du traitement en termes de frequence des effets indesirables et de gene induite. Resultats Quarante et un pour cent des internistes ont repondu au questionnaire. Il s’agissait essentiellement d’hommes (71 %) travaillant en centre hospitalo-universitaire (53 %). Chez les 115 patients dont les reponses etaient analysables, la duree moyenne de corticotherapie etait de 44 ± 38 mois, prescrite a la posologie moyenne de 15 ± 14 mg par jour, le plus souvent pour un lupus (33 %) ou une maladie de Horton (15 %). La lipodystrophie, les troubles trophiques cutanes, les troubles neuropsychiatriques et l’insomnie etaient rapportes par plus de la moitie des patients. La frequence estimee par les praticiens des manifestations neuropsychiatriques, des troubles cutanes et de la lipodystrophie etait nettement inferieure a la frequence rapportee par les patients. Si les modifications morphologiques (prise de poids et lipodystrophie) etaient citees par les praticiens comme les effets indesirables les plus genants, en accord avec l’avis des patients, les medecins sous-estimaient la gene induite par les troubles neuropsychiatriques et l’insomnie. Conclusion La frequence et la gene induite par les troubles neuropsychiatriques cortico-induits semblent sous-estimees par les medecins internistes.

Resume Introduction A l’exception des mesures concernant la prevention de l’osteoporose, il n’existe pas de recommandations consensuelles quant aux mesures adjuvantes a prescrire lors d’une corticotherapie systemique prolongee. Nous avons cherche a savoir si les pratiques des internistes concernant ces mesures adjuvantes etaient homogenes ou pas. Methodes L’enquete a ete menee a l’aide d’un questionnaire electronique adresse, en septembre 2007, par courriel aux 813 medecins internistes membres de la Societe nationale francaise de medecine interne disposant d’une adresse electronique. Ce questionnaire concernait la frequence de prescription des mesures associees a une corticotherapie systemique prolongee et pour lesquelles il n’existait pas de recommandations consensuelles (regime alimentaire, mesures d’entretien musculaire, supplementation potassique, protection gastrique, vaccination antigrippale, relais par hydrocortisone). Resultats Trois cents trente-six des 813 medecins sollicites ont repondu au questionnaire (taux de reponse : 41 %). Ces repondeurs etaient majoritairement des hommes (71 %) et travaillaient principalement en centre hospitalo-universitaire (53 %). En ce qui concernait les mesures dietetiques preconisees, seul le regime hyposode etait prescrit de facon relativement homogene par les praticiens (69 % des praticiens le prescrivaient chez plus de 80 % de leurs patients). Un regime hypocalorique, pauvre en glucides et riche en proteines, etait ou non preconise par les praticiens. Une kinesitherapie d’entretien musculaire n’etait pas frequemment proposee (74 % des praticiens la prescrivaient chez moins de 20 % de leurs patients). En revanche, il n’existait aucun consensus concernant la recommandation ou non d’un exercice physique regulier. La supplementation potassique, la protection gastrique, la vaccination antigrippale et le relais hydrocortisone ne faisaient egalement l’objet d’aucun consensus au sein de la communaute interniste. Conclusion Les principales mesures adjuvantes a une corticotherapie systemique prolongee ne font l’objet d’aucun consensus au sein de la communaute interniste francaise.

Except for the prevention of osteoporosis, no consensual recommendations are available regarding the therapeutic measures associated with the prescription of a long term corticosteroid therapy. We assessed the French general practitioners'practices regarding the prescription of these measures.In September 2007, we sent by e-mail a questionnaire to 860 general practitioners members of the reseau Sentinelles, a national survey system which collect data from volunteers French general practitioners. We assessed the frequency of prescription of measures associated with systemic corticosteroids and for whom no consensual recommendations were available (dietary advices, physical training, potassium supplementation, gastric protection, influenza vaccination, prescription of hydrocortisone).293 out of 860 general practitioners completed the questionnaire (response rate: 34%). The practitioners were predominantly male (87%). Regarding the dietary measures, low sodium diet was recommended by most of the physicians, 68% of them prescribing such dietary regimen in more than 80% of their corticosteroid-treated patients. The concomitant prescription of caloric restriction, low carbohydrate diet or high protein diet was not consensual. Prescriptions of muscular physiotherapy and gastric protection were unusual (80% and 67% of physicians prescribing these measures in less than 20% of their patients, respectively). Recommendations for daily physical training, potassium supplementation, influenza vaccination or hydrocortisone prescription were not consensual.There is no consensus in the French general practitioners community regarding most of the measures associated with a long term systemic corticosteroid therapy.

International audience; BACKGROUND: The investigation of dual influenza infection human cases is of major interest specifically for the control of new emerging influenza strains. OBJECTIVES: Using RT-PCR assays, we retrospectively assessed the prevalence of dual influenza virus infections that occurred in patients during the 2006-2007 winter season in Corsica Island (France). STUDY DESIGN: One hundred and thirty-four nasal swabbing samples taken from patients suffering from influenza-like illness between February and March 2007 were analysed using a rapid influenza antigen detection test, cell culture and RT-PCR assays. RESULTS AND CONCLUSION: Influenza viruses were detected in 93 (69.4%) of 134 patients with influenza-like illness using the combination of classical and molecular assays. Dual respiratory infections by influenza viruses were detected in 3 (3.2%) of the 93 influenza positive patients, including two cases of infection by influenza A/H3N2 and B viruses and one case of dual infection by influenza A/H3N2 and A/H1N1 viruses. In the present report, human co-infection cases by two influenza viruses appeared as a rare event in symptomatic patients. However, the virological and epidemiological mechanisms that determine the occurrence of dual influenza infections remain to be fully investigated in further prospective multicentric studies.

Inserm has developed, since 1984, an information system based on a computer network of physicians in France. It allows for constitution of large databases on diseases, with individual description of cases, and to explore some aspects of the mathematical theory of communicable diseases. We developed user-friendly interfaces for remote data entry and GIS tools providing real-time atlas of the epidemiologic situation in any location. The continuous and ongoing surveillance network is constituted of about 1200 sentinel voluntary and unpaid investigators. We studied their motivation, reasons for either withdrawal or compliance using survival analyses. We implemented early warning systems for outbreak detection and for time-space forecasting. We conducted epidemiological surveys for investigating outbreaks. Large available time and space series allowed us to calibrate and explore synchronism of influenza epidemics, to test the assumption of panmixing in susceptibles-infectious-removed type models and to study the role of closing school in influenza morbidity and mortality in elderly. More than 250 000 cases of influenza, 150 000 cases of acute diarrheas, 35 000 patients for whom HIV tests have been prescribed by general practitioners and 25 000 cases of chickenpox have been collected. Detection of regional influenza or acute diarrhea outbreaks and forecasting of epidemic trends three weeks ahead are currently broadcasted to the French media and published on Sentiweb© on a weekly basis. Age-cohort-period models assessed field effectiveness of mass immunization strategies against measles and influenza in the country. Case-control studies with more than 1200 sets of cases of acute diarrheas and their matched controls showed the role of calicivirus and rotavirus as probable major causes of gastroenteritis during recurrent widespread outbreaks in winter in France. An age-specific model for chickenpox showed the probable role of children in disease transmission to their susceptible parents or grandparents. High level of synchronism between influenza epidemics has been demonstrated, either at a regional level (in France) or between France and the USA. The designation of our lab as a WHO collaborating center for electronic disease surveillance stimulates the development of global monitoring of diseases. We developed operational systems that are now available for the global monitoring of influenza (FluNet©), and human and animal rabies (RABNET©). Extension of electronic syndromic surveillance is needed in the world for improving surveillance capacities and real-time response against emerging diseases.