[Evaluation of the quality of life in chronic respiratory diseases].
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Chronic Disease↗
Biomedical subjects
S Briançon
Publications and source records attributed to S Briançon.
The assessment of functional status in rheumatoid arthritis: a cross cultural, longitudinal comparison of the Health Assessment Questionnaire and the Groningen Activity Restriction Scale.
OBJECTIVE: To compare a disease specific measure of functional status, the Health Assessment Questionnaire (HAQ) with a generic measure of functional status, the Groningen Activity Restriction Scale (GARS) in a cross cultural and longitudinal setting. Besides the comparison of psychometric properties, sex differences were also studied. METHODS: In a sample of 634 patients with rheumatoid arthritis (RA) (290 from The Netherlands, 116 from France, 228 from Norway), the psychometric properties (Cronbach's alpha and rho) of the GARS and the HAQ were compared among countries. The sensitivity for change between T1 and T2 was tested by means of the standardized response mean for a one year followup; furthermore, the relative efficiency of both instruments was computed. A t test was used to trace sex differences. RESULTS: The psychometric properties of both the HAQ and the GARS were very good. Both form unidimensional scales of hierarchically ordered items; alpha and rho are > 0.91 for both instruments. For patients who improved between T1 and T2, measured by the Ritchie Articular Index, the standardized response mean of the HAQ and the GARS were moderate, whereas for patients who worsened, the standardized response means were small. The results based on the relative efficiency were ambiguous. Furthermore, the mean score for women on the HAQ was 0.25 higher in contrast to scores for men. The GARS did not yield different scores for women and men. CONCLUSION: The internal consistency of the GARS and the HAQ are comparable. The HAQ has yielded different results for women and men. Therefore, when the HAQ is used, sex differences should be taken into account. With respect to sensitivity to change, the GARS and the HAQ obtained much better results for patients who improved in contrast to patients who worsened. The GARS was found to be more sensitive to change for patients who improved.
Arthritis, Rheumatoid↗
Tumors of the colon increase the risk of developing Streptococcus bovis endocarditis: case-control study.
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Case-Control Studies↗
The Groningen Activity Restriction Scale for measuring disability: its utility in international comparisons.
OBJECTIVES: The Groningen Activity Restriction Scale (GARS) is a non-disease-specific instrument to measure disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). It was developed in studies of Dutch samples consisting of elderly or chronically ill people. The psychometric properties of the GARS demonstrated in these studies were highly satisfactory. This paper addresses the psychometric properties of the GARS across countries. METHODS: Data of 623 patients with recently diagnosed rheumatoid arthritis from four European countries were analyzed by means of a principal components analysis and a Mokken scale analysis for polychotomous items. RESULTS: The results of the analyses were highly satisfactory: there was one strong and reliable general factor representing one underlying dimension of disability in ADL and IADL, and there was a clear hierarchical ordering of the items included in the GARS. The validity of the GARS was strongly suggested by the pattern of associations of the GARS with age, sex, and other existing health status measures. CONCLUSIONS: The psychometric characteristics of the GARS, which measures disability in ADL and IADL simultaneously, make this instrument very useful for comparative research across countries.
Activities of Daily Living↗
Low incidence of rheumatoid arthritis in France.
The incidence of rheumatoid arthritis (RA) was estimated in the Lorraine district, eastern France, over the period 1986-1989. Cases were identified from in- and outpatients at the district Rheumatology Hospital Centre, private rheumatologists, general practitioners and by regional media announcements. Supplementary cases resident in the area were sought by extending the procedure to adjacent districts. The population count was obtained from the national Census. An overall age-adjusted incidence rate of 8.8/100,000 was found using the 1987 ACR criteria (12.7/100,000 in females, 4.7/100,000 in males; sex ratio = 2.65) and 9.5/100,000 using the 1958 ARA criteria (definite and classic RA). These rates were compared, using the same standard population, with the age-adjusted incidence rates in other incidence studies mainly conducted in Caucasian populations. The RA incidence rates appeared lower in France than in any other country in Europe, USA and Japan.
Adult↗
Functional disability in early rheumatoid arthritis: description and risk factors.
OBJECTIVE: To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA). METHODS: A cohort of 337 patients with early RA with disease duration under 5 years was constituted in 2 areas in France and The Netherlands. Examination included the Ritchie index, the presence of nodes and other extraarticular manifestations, and the erythrocyte sedimentation rate (ESR). The Health Assessment Questionnaire, adapted and validated in the French and Dutch languages, was used to assess functional disability. RESULTS: The results allowed for the cross sectional description of a marked early functional disability, with a score of 1 (adjusted for disease activity variables) from the first year of the disease. Functional disability was increasing nonlinearly with the disease duration in a quadratic model. Disease activity variables, namely ESR and Ritchie index, were identified as other important components of functional disability. CONCLUSION: Consequences for the early management of RA are underlined.
Arthritis, Rheumatoid↗
Clinical significance of rapid ventricular tachycardia (> 270 beats per minute) provoked at programmed stimulation in patients without confirmed rapid ventricular arrhythmias.
Rapid uniform ventricular tachycardia (VT) (> 270 beats/min) or ventricular flutter induced during electrophysiological studies is thought not to be clinically significant in patients without cardiac arrest or documented rapid VT. The purpose of the study was to follow up 73 patients with inducible ventricular flutter but without confirmed rapid spontaneous VT. A long follow up (mean 3.5 years) identified two groups of patients. The first group had an excellent outcome and was characterised by a normal 24 hour Holter monitoring. In the second group, however, the risk of cardiac mortality was high (35%) and spontaneous VT was < 270 beats/min (26%) and was characterised by couplets or salvos of extrasystoles on Holter monitoring. In this group the history of syncope and decreased left ejection fraction increased the risk of mortality and VT. The presence of late potentials increased the risk of spontaneous VT. Electrophysiologically guided antiarrhythmic therapy reduced the risk of VT. Ventricular flutter was a non-specific finding in patients with normal Holter monitoring. In contrast, in patients with salvos of extrasystoles, ventricular flutter was associated with a high risk of cardiac mortality and VT.
Adult↗
[Epidemiology of bacterial endocarditis in France in 1991].
In order to update our information about the incidence and demographic, microbiological and clinical characteristics of infective endocarditis (IE) in France, a 12 month long study was carried out in three regions: Ile de France, Rhône-Alpes and Lorraine. Four hundred and fifteen cases of IE were recensed: certain (32%), probable (53%) or possible (15%). The annual incidence was 24.3 per million. The average age was 56 +/- 19 years. There was no past history of cardiac disease in 34% of cases; 33% had native valvular heart disease and 22% had one or more valvular prostheses. The site of IE was mitral in 39%, aortic in 36%, tricuspid in 6% and other or multivalvular in 19% of cases. The causal microorganism was isolated in 92% of cases. It was a streptococcus in 58% of cases (S. viridans in 27%; group D streptococcus + enterococcus in 23%); a staphylococcus was isolated in 23% of cases (Staphylococcus Aureus in 18%) and another microorganism in 11% of cases. The presumed portal of entry was dental in 24%, gastro-intestinal in 13%, cutaneous in 6% and urinary in 4% of cases. Twenty patients were intravenous drug addicts. Forty-five patients had medical or surgical procedure. Twenty-four per cent of patients were operated during the first two months, 17% died during this period (15% of operated and 18% of non-operated patients). Despite the advances in antibiotic therapy and in cardiac surgical techniques, IE seems to be as common and as severe as ten years ago.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Right ventricular overload and induced sustained ventricular tachycardia in operatively "repaired" tetralogy of Fallot.
The aim of the study was to evaluate the main predictors of the inducibility of sustained ventricular tachycardia (VT) in patients with repaired tetralogy of Fallot. Thirty-five patients (age 12 +/- 6 years) underwent right-sided cardiac catheterization, echocardiography, radionuclide angiography and ventricular stimulation; 10 had (group 1) and 25 had no (group 2) sustained VT. Group 1 patients were significantly older at the time of surgery and had longer follow-up periods (7 +/- 3 vs 4 +/- 4 years, p less than 0.02; and 12 +/- 4 vs 5 +/- 2 years, p less than 0.001, respectively). Right ventricular (RV) systolic pressure, end-systolic and end-diastolic normalized RV volumes were higher in group 1 (48 +/- 14 vs 38 +/- 11 mm Hg, p less than 0.05; 1.23 +/- 0.2 vs 0.86 +/- 0.17, p less than 0.001; and 2.35 +/- 0.37 vs 1.70 +/- 0.22, p less than 0.001, respectively). RV end-diastolic pressure, left ventricular and RV ejection fractions were similar in the 2 groups. A stepwise discriminant analysis was made to predict patients with inducible sustained VT (group 1): Time period from surgery to follow-up (p less than 0.001), normalized RV end-systolic volume (p less than 0.002) and RV systolic pressure (p = 0.01) were higher in group 1 and allowed classification of 90% of patients in group 1 and 96% in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Functional disability in rheumatoid arthritis: two different models in early and established disease.
A hypothesis that the development of functional disability in rheumatoid arthritis (RA) would be more rapid at the beginning than in established disease was studied in a group of 82 patients with RA referred to the Rheumatology Unit of Nancy, France. The relationship between disease activity, articular destruction and functional disability indicated a significant interaction (moderating effect) of disease duration. Two different models are proposed to explain functional disability. A model for early RA (less than 5 years duration) includes biological activity, and a model for established disease (more than 5 years) includes disease duration, extraarticular lesions and radiographic damage. These models could be useful in designs of therapeutic trials.
Arthritis, Rheumatoid↗
Factors determining the occurrence of late potentials on the signal-averaged electrocardiogram after a first myocardial infarction: a multivariate analysis.
To determine the natural history of late potentials on the signal-averaged electrocardiogram (ECG), multivariate analysis was performed in 167 patients (138 men, 29 women) with a first anterior or inferior acute myocardial infarction. Seventy-four patients received thrombolytic therapy; the remaining 93 patients were treated conventionally. All patients underwent coronary angiography, left ventricular ejection fraction determination and signal-averaged ECG recording. Eight variables thought to be correlated with the presence of late potentials were studied; that is, age, infarct location, number of diseased coronary vessels, left ventricular ejection fraction, infarct-related coronary artery patency, treatment received, delay between admission and signal-averaged recording and delay between admission and coronary angiography. Statistical analysis showed that two independent factors (coronary artery occlusion and impaired left ventricular ejection fraction) were highly correlated with the incidence of late potentials. The occurrence of late potentials was multiplied by 5 in case of an occluded infarct-related vessel and by 1.75 each time the left ventricular ejection fraction value decreased by 0.10. This study suggests that coronary artery patency is the most important factor that decrease the rate of late potentials after a first acute myocardial infarction and it occurs independently of infarct location and left ventricular function.
Coronary Angiography↗
Long-term disability and prolonged sick leaves as outcome measurements in ankylosing spondylitis. Possible predictive factors.
Prognostic factors for the occurrence of longterm disability and prolonged sick leave were determined in 182 patients with ankylosing spondylitis. A significant relationship appeared between functional disability (determined by the Stanford Health Assessment Questionnaire) and sex, age at disease onset, and the number of peripheral joints involved. Using a life-table approach, the probability of prolonged sick leaves was associated with peripheral joint involvement and work that involved carrying heavy loads. Long-term disability was more frequent after work involving exposure to cold conditions (relative risk [RR] = 2.01) and prolonged standing postures (RR = 1.34), while sedentary work (RR = 0.35) and formal vocational rehabilitation programs (RR = 0.57) seemed to protect against long-term disability.
Adult↗
Blood activity of Cu/Zn superoxide dismutase, glutathione peroxidase and catalase in Alzheimer's disease: a case-control study.
Cu/Zn superoxide dismutase (Cu/Zn SOD), glutathione peroxidase (GPx) and catalase, which are the three main enzymes involved in cellular protection against damage due to oxygen-derived free radicals have been assayed in plasma and erythrocytes obtained from subjects with dementia of the Alzheimer type (DAT) and from controls. Blood samples were obtained from 25 patients with DAT and from age-matched subjects without diagnoses of neurological disease (non-DAT), as well as from younger individuals (reference group). Using appropriate statistical procedures, the three enzyme activities measured in blood of the elderly were decreased if compared to the younger reference group. Moreover, a significant increase in erythrocyte Cu/Zn SOD and catalase activities of DAT patients was observed compared to the non-DAT group. These results are discussed taking the free radical theory of aging into consideration.
Aged↗
[Survival in primary dilated cardiomyopathy as a function of tobacco smoking. A retrospective study].
In order to determine the influence of tobacco smoking on the course and long-term prognosis of idiopathic dilated cardiomyopathy, we conducted a retrospective study of 111 patients (95 men and 16 women, mean age 45.5 +/- 8.1 years) who had undergone cardiac catheterization between January 1970 and December 1979 and had been followed up for 6 to 16 years. The criteria of inclusion was diffuse hypokinesia of the left ventricle with an ejection fraction of 50 per cent or less, normal coronary arteriography and cardiomyopathy of unknown origin. The overall mortality rates at 1, 5 and 10 years were 10, 50 and 66 per cent respectively, and the main predictive factor was the left ventricular ejection fraction. Forty-six per cent of these patients were smokers, 19 per cent were non-smokers and 35 per cent had undetermined smoking habits. A univariate analysis showed a favourable predictive effect of smoking on survival (P less than 0.01), and this was confirmed by the statistical hypothesis of maximum bias for patients with undetermined smoking habits. On multivariate analysis, this predictive effect was superseded by the left ventricular ejection fraction, but after stratification of the sample according to the mean value of ejection fraction (30 per cent), the predictive value of smoking reappeared clearly in the group with a less than 30 per cent ejection fraction (P less than 0.003).
Adult↗
[A model for evaluating screening tests. The case of colorectal tumors].
The results of numerous studies on screening are restricted to crude estimates of the predictive value of different tests. This is notely the case for early diagnosis of colorectal adenoma and cancer. The reference examination is in principle a total colonoscopy. Usually, it is not performed on the subjects for which the screening test gives a negative result. Moreover, the distribution according to age and sex is not taken into account. Both variables are strongly associated with the prevalence of the disease. After a presentation of the problems arising from screening evaluation performed in such situations, a method is proposed for comparing different tests in several populations. An estimate of the expected number of cases within a fictitious control group matched for age and sex with the people whose the test result is positive is computed according to an hypothesis on the duration of asymptomatic cancer and using available descriptive data on symptomatic cancer incidence and on the prevalence of adenoma in the population. The selection power of the test, i.e. the number of observed cases divided by the number of expected cases, is proposed as a standardized parameter for measuring and comparing the validity of screening tests. The method is illustrated by an example of its application procedure. The discussion stresses the limitations of such an approach.
Adenoma↗
[Prospective evaluation of admission for acute abdominal pain in children].
Acute abdominal pain (AAP) is one of the most frequent causes of admission to an emergency department of a childrens' hospital. The diagnosis viewed with the most apprehension is acute appendicitis. We present the results of a prospective study on the evaluation of the clinical and paraclinical symptoms generally observed in an AAP, and discuss the benefit of a diagnostic score for acute appendicitis. Twenty-five different diagnoses were observed, the 5 most frequent being: "non specific" (34.2%), constipation (16%), otorhinolaryngological infection (11.6%), gastroenteritis (10.7%) and acute appendicitis (10.5%). The study of 12 symptoms showed an elevated sensitivity for each one (92-50%), but a low positive predictive value (72-12%). Rigid adhesion to a diagnostic score would have led to unnecessary medical examination.
Abdominal Pain↗
Dilated cardiomyopathy: long-term follow-up and predictors of survival.
To determine long-term survival and the prognostic factors of dilated cardiomyopathy, we retrospectively studied a consecutive series of 111 patients (95 men, 16 women, mean age: 45.5 +/- 8.1 years) undergoing cardiac catheterization and diagnostic coronary angiography from January 1970 to December 1979. The inclusion criteria were: normal coronary angiography, diffuse hypokinesia of the left ventricle and left ventricular ejection fraction less than 50%. Base-line clinical data were collected from the hospital records and follow-up data were obtained from the general practitioners and cardiologists. A questionnaire was sent to all living patients. The length of follow-up ranged from 6 to 16 years. Six patients (5%) were lost to follow-up. At the time of catheterization, a majority of the patients had dyspnea and were in New York Heart Association (NYHA) classes II (41%) and III (31%). Clinical history revealed an excessive alcohol consumption in 56% of the patients. During follow-up, 66 patients (63%) died (heart failure: 37%; sudden death: 19%; non-cardiac death: 15%; unknown cause: 27%). Actuarial survival was 90, 50, and 33% at 1, 5, and 10 years, respectively. Univariate analysis revealed that 10-year mortality was related to: left ventricular ejection fraction less than 30%; left ventricular end-diastolic pressure greater than 10 mm Hg; cardiothoracic ratio greater than 54%; episodes of heart failure; left ventricular end-diastolic volume greater than 200 ml/m2, dyspnea of NYHA class III or IV; absence of smoking; absence of moderate systemic hypertension; electrocardiographic evidence of left ventricular hypertrophy and mean systemic arterial pressure greater than 95 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Ten year follow up of patients with single vessel coronary artery disease that was suitable for percutaneous transluminal coronary angioplasty.
The 10 year outcome of patients with single vessel coronary artery disease who underwent coronary angiography more than 10 years before and who would have been potential candidates for percutaneous transluminal coronary angioplasty had it been available then is reported. Long term follow up data were obtained in 96 (91 men, five women; mean age 48 years) of 105 consecutive patients with single vessel coronary artery disease (greater than 70% stenosis), judged suitable for coronary angioplasty. Fifty patients had coronary bypass surgery within six months of catheterisation (surgical group) and 46 were treated medically (medical group). At entry to the study more patients in the surgical group had unstable angina, but fewer had a previous history of myocardial infarction. Ten year survival was 91% and remained excellent in all the subsets analysed. Moreover, the quality of life of these patients was good. Over the 10 year follow up, 16 (36%) of the patients treated medically and 13 (26%) in the surgical group were admitted to hospital because of cardiovascular events (including late coronary surgery in four of the patients treated medically). Lastly, 54/69 (78%) of the patients who were employed before catheterisation resumed work and 29 (42%) were still employed 10 years later. Although these data must be interpreted with care because of the limitations inherent in all retrospective studies, it appears that the long term results of conventional medical or surgical treatment are excellent in patients with single vessel coronary artery disease in whom percutaneous transluminal coronary angioplasty is now an option.
Adult↗