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Biomedical subjects

S M Consoli

Publications and source records attributed to S M Consoli.

At least 19 recordsLinked to original sources
PubMed2000

[Characteristics of a cohort of 4,000 French patients with angina. The ELAN study].

The ELAN (Etude Longitudinale dans l'ANgor) study was carried out to evaluate factors influencing the occurrence of death, myocardial infarction and revascularization procedures in patients with known angina pectoris. Analysis of baseline data collected in January 1997 involves 4,035 patients throughout France, which were recruited by 613 cardiologists practising on a private, hospital or mixed basis. The study population comprised 75% of men with a mean age of 65 years and 25% of women with a mean age of 70 years. Eighty eight percent of the patients had at least one cardiovascular risk factor, and nearly half of them had two or more factors; hypercholesterolemia and hypertension were the two most frequent ones. Reported cardiovascular past events included myocardial infarction in 47% of patients, PTCA in 33% and aorto-coronary bypass in 24%. Angina pectoris had been diagnosed within the previous year in 39% of patients. Exertional angina was the most common type (66%), with grade I/II angina being most frequently found (more than 70% of all cases). Management strategies are especially described for angina patients diagnosed within the previous year. More than half of the patients had undergone exercise testing within the previous 12 months, while scanning and coronary arteriography had been performed in 15% and 72%, respectively. Ninety five percent of patients were under antianginal drug therapy, with combined therapies being used in 58% of them. The most frequently prescribed drugs were betablockers (63%) and nitrates (53%). In 74% of patients, aspirin was given in addition to conventional antianginal agents. These data will be reviewed in a one-year cohort analysis as potential predictive factors for the occurrence of cardiovascular events.

Adult↗
PubMed2000

[One-year follow-up of a population of patients with angina. Factors influencing mortality and occurrence of cardiovascular events. Results of the ELAN study].

The ELAN (Etude longitudinale dans l'angor) study was carried out both to acquire better knowledge of the occurrence of major cardiovascular events (myocardial infarction, revascularization surgery, death) in patients followed up for angina pectoris, and to determine the factors influencing such events. A cohort of angina patients was formed in January 1997, and 3,284 patients were followed up by 488 French cardiologists during a one-year period. Of these 3,284 patients, 96 (29/1000) died; causes of death included underlying coronary heart disease in 31, sudden death in 8, other cardiac aetiologies in 35, and noncardiac causes in 22. Sixty-nine (21/1000) patients developed myocardial infarction, 240 (73/1000) underwent PTCA, and 119 (36/1000) underwent coronary bypass surgery. Factors associated with an increased risk of death were age, diabetes mellitus, heart failure and angina type, mixed and rest angina being associated with poorer prognosis compared to exertional angina. Infarction risk increased with age and a history of previous infarction. Analysis of therapeutic factors after adjustment for the above risk factors showed a beneficial effect of betablockers on both cardiovascular and all-cause mortality and of aspirin on all-cause mortality.

Adrenergic beta-Antagonists↗
PubMed2000

[Psychosocial distress and its moderating factors in patients living in precarious socioeconomic conditions consulting in a preventive health and social work center].

BACKGROUND: The effects of a precarious socioeconomic condition on mental health have already been widely described. Nevertheless, sociodemographic, biographical, and mainly psychological determinants of psychosocial distress in these populations are still incompletely known. METHODS: 2315 consecutive subjects, aged 16 to 59, consulting for a free work-up in a preventive health center supported by the National French Health Insurance system, were invited to fill out a series of questionnaires, mainly the GHQ-28 (psychosocial distress), the LOT (dispositional optimism) and the WCCL (coping mechanisms). Socioeconomic and administrative criteria were adopted to define populations living in precarious conditions. RESULTS: A total of 78.9% complete records could be analyzed: 55% of the studied population constituted the precarious condition group (44.5% males and 55.5% females; mean age 36.2+/-11). This group was characterized by higher psychosocial distress and higher sub-scores of anxiety, social dysfunction and depression, but not somatisation, as well as by increased emotion focused coping and impaired optimism. Globally, GHQ score was positively correlated with emotion focused coping (r=0.36) and negatively with problem focused coping (r=-0.17) and with optimism (r=-0.39). In a multivariate analysis a set of 9 independent variables explained 38% of GHQ-28 total variance: perceived stress, optimism, emotion focused coping, problem focused coping, age, educational degree, precariousness, money problems and parental quarrels during youth. Introducing precariousness in the model constituted of the set of the remaining variables could explain only 2% of additional variance. CONCLUSION: These results confirm the presence of higher levels of psychosocial distress in subjects living in precarious conditions and underline the moderating role of several psychological variables. They could guide support interventions aimed at helping subjects living in precarious conditions, focused on enhancing their coping resources.

Adaptation, Psychological↗
PubMed1996

Interactive electronic teaching (ISIS): has the future started?

Medical education of hypertensives as well as of other asymptomatic cardiovascular risk patients requires individualized, interactive and attractive strategies. Electronic teaching set up in hospital or clinic settings opens the way of the future, saving time and allowing more advantageous use of caretakers. ISIS (Initiation Sanitaire Informatisee et Scenarisee), a French computer assisted program for cardiovascular risk patients, combines a scientific information, divided in 12 sequential but independent modules, with a recreative imaginary trip in the world of ancient Egypt. To test the impact of this tool on patient health information retention, 158 hypertensives hospitalized in a day-hospital clinic were randomized into an intervention or ISIS group (IG, n = 79) and a control group (CG, n = 79). Both groups received cardiovascular education through standard means. In addition, IG patients underwent a 30 to 60 min session on the computer. Cardiovascular knowledge was tested by a nurse administering a standardized 28-item questionnaire before and two months after education. Retesting was done by telephone interview. A total of 138 completed questionnaires (69 from each group) were analyzed. Overall mean cardiovascular knowledge score before education (14.3 +/- 4.2, range 4-25) improved significantly after education (3.7 +/- 3.5, p = 0.0001). This improvement was more important in the IG than the CG (3.8 +/- 3.6 vs 2.4 +/- 3.2 respectively, p = 0.02), especially in hypertensives having a known disease for more than six months. Isis is now available in two languages: French and English. Patients' satisfaction and the conclusion of this comparative trial encourage confirmation of these first results in other French or English speaking populations, in order to test the long term effects of structured electronic teaching sessions on health behaviour, and to promote a wide use of computers and multimedia communication in hypertension control programs.

Adult↗
PubMed1995

[The borders of hysteria].

Medical writing dealing with the nosology of hysteria has evolved through successive national and international classifications, while in parallel the expression of hysteria has changed with time, with cultural evolution and with increased medical knowledge. Hysteria, by definition, is distinguished both by psychic or physical symptoms reported or voluntarily induced by patients (simulation or pathomimic behaviour) and by somatic disorders having an underlying, associated organic pathology, favoured by an emotional context or a conflictual situation (psychosomatic disorders). The divergence, but above all the analogies between hysterical symptoms and such limits are underlined, showing the frequency of succession with time, associations and transitional forms ("somatisation disorder" of the DSM III, psychogenic pain, and psychosomatic disorders termed "psychofunctional").

Humans↗
PubMed1995

Benefits of a computer-assisted education program for hypertensive patients compared with standard education tools.

ISIS (Initiation Sanitaire Informatisée et Scénarisée), a French computer-assisted hypertension and cardiovascular risk education program, was developed to provide patients at cardiovascular risk with a modern interactive educational tool combining rigorously scientific information with the aesthetic attractiveness of multimedia communication. To test the impact of this tool on patient health information retention, 158 hypertensives hospitalized for initial work-up (day hospital) or therapeutic adjustments (3 days) were randomized into control (n = 79) and ISIS (n = 79) groups. Both groups received cardiovascular education through standard means: physicians, nurses, dietitians and pamphlets. In addition, ISIS patients underwent a 30- to 60-min session on the computer with the ISIS program. Cardiovascular knowledge was tested by the same investigator administering a standardized 28-item questionnaire before and 2 months after education. Retesting was made by telephone. At the time of first assessment, all patients were aware that they would be retested. A total of 138 completed questionnaires (69 from each group) was analyzed. Overall mean cardiovascular knowledge score before education improved significantly after education. This improvement was greater in the ISIS than the control group. These results confirm the potential of computer-assisted education in hypertensives from a specialized center.

Adult↗
PubMed1994

[Evaluation of a computer assisted training program for hypertensive patients].

ISIS tutorial program (French abbreviation for Animated and Computerized Initiation into Health) was carried out for Macintosh type computers to place a modern and interactive learning device at cardiovascular risk patients' disposal. Such a program combines strict scientific explanations and aesthetic attractiveness of multimedia communication. To test the effect of this device on health knowledge gain, 158 hypertensives admitted in one-day or in half-week clinics for an initial check-up or for a therapeutic adjustment were randomised into two groups: a control group (n = 79), receiving usual education (contacts with physicians, nurses, dieticians, health oriented booklets), and an experimental or "ISIS" group (n = 79) undergoing an interactive session with the computer during 30 to 60 minutes, in addition to usual education. Health knowledge of both groups was assessed through a 28-item questionnaire, before any education procedure, two months after the discharge, through a standardized interview by phone, thanks to the same investigator. On the whole, 69 + 69 = 138 complete case records could be analysed. Initial health knowledge mean score, at admission to the hospital, was 14.3 +/- 4.2 (range: 4 to 25). This score significantly improved among the whole population (difference between the two evaluations: 3.7 +/- 3.5 points; p = 0.0001). Improvement was greater in ISIS group than in controls (p = 0.02). Among hypertensives with initial scores < or = 16, improvement was respectively 4.5 +/- 3.6 and 2.9 +/- 3.0 for ISIS and control groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Acceptability, tolerance and quality of life impact of cyproterone acetate treatment in female hirsutism. Comparison of 2 protocols in combination with oral or transdermal estradiol].

67 women (aged 16-40) with hirsutism and/or other signs of hyperandrogenism (acne, androgenic alopecia, cycle disturbances) have been treated for one year with cyproterone acetate + estradiol. Patients have been randomly assigned to therapy with cyproterone acetate and estradiol valerate per or cyproterone acetate and transdermal estradiol. Acceptance, tolerance and effects on quality of life of this treatment have been assessed using a self questionnaire completed with questions for assessment for compliance. Among patients who have had a full course of treatment, 54 have fulfilled the end-of-study quality of life questionnaire. The queries allow calculation of a relational well-being score and of an emotional well-being score. The answers to the initial questionnaire show in a high percentage of patients emotional trouble (depressive state, anxiety, irritability) and disturbances in relational life. The hirsutism score has been found to be significantly correlated with anxious trouble but not with the global quality of life score. The treatment has resulted in a significant improvement in acceptance of being exposed to view (p < 0.01), self-assurance (p < 0.01) as well as emotional well-being score (p < 0.05), without any significant difference between the 2 therapeutics groups. Measurement of treatment acceptance with a visual analogic scale has been found globally very satisfactory by patients from the 2 groups. Compliance of treatment with transdermal estradiol turned out to be lesser in younger patients but is better in patients in whom emotional balance has been improved by therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1993

[Psychological and behavior characteristics predicting blood pressure reactivity to mental stress].

This study was conducted with 58 subjects (31 males and 27 females): a sample of 37 normotensives (NT) (mean age 36 +/- 11) and a sample of 21 hypertensives (HT) without any antihypertensive medication (mean age 46 +/- 9). Cardiovascular reactivity was measured during a sequence of 3 computer assisted mental stress tasks (visual-motor tasks, maze test). Before and following the stress tasks the subjects were asked to respond on the same computer to psychological test and questionnaires measuring anxiety, depression (H.A.D. inventory) type A behavior (impatience, competition and drive for success; Bortner's scale), locus of control (attribution of success or failure to internal or external factors; Levenson's scale), and coping mechanisms used in response to everyday life stresses (Rosenzweig Picture Frustration Test, adapted by S. Consoli and E. Albert). Measurements of systolic (SBP) and diastolic blood pressure and heart rate were obtained automatically every minute during the entire computer session with a Colin Press-Mate BP 8800 sphygmomanometer. Pressure reactivity (PR) was defined as the relative difference between BP measured during mental stress and BP measured during non-stress condition (the reference period). Our hypotheses were that PR would be greater in HT than in NT, and that PR would be correlated with various psychological and behavioral characteristics. During the stress session, SBP in NT increased from 119.8 to 123.7 mmHg (p < 0.001) and in HT from 147.4 to 152 mmHg (p < 0.05): there was no significant difference between the two samples but in HT, SBP elevation persisted after the stress session, contrary to the NT, whose SBP quickly decreased to the reference values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1993

[Stress and the cardiovascular system].

A variety of evidence shows that stress contributes to a more or less sustained elevation of blood pressure, as well as to the triggering and aggravation of cardiovascular pathology, especially coronary heart disease. Experimentally induced changes, that may be pathogenic due to their duration or repetition, can be produced in hemodynamics, lipid metabolism, or hemostasis. High blood pressure, vascular heredity, but also a trend to inhibition of action, seem to be responsible for hyperreactivity to stress. Hypertensives are particularly reactive to active stresses related to controlable situations, experienced as challenges. Several prospective studies in healthy subjects have confirmed the increased risk for coronary heart disease of certain psychological characteristics: the most known of them is Rosenman's and Friedman's type A behavior (hyperactivity, speed and impatience, hard driving, job involvement). It is known that individuals presenting such characteristics exhibit increased neuroendocrine responses to all types of stress. Pattern A predicts the incidence of myocardial infarction, independently of other coronary risk factors, such as hypertension, hypercholesterolemia, or smoking habits. It as been proved that type A individuals deal on average with more stressing conditions than type B individuals and that they set higher goals than general population. On a cognitive level, they tend to have an internal "locus of control" (they are inclined to attribute their personal successes or failures to their own responsibility). Nevertheless, the most reactive to stress among type A individuals are those whose locus of control is external. The predictive validity of pattern A in coronary mortality is more debated.(ABSTRACT TRUNCATED AT 250 WORDS)

Arousal↗
PubMed1993

[Validation of a personality questionnaire designed for defining sub-groups at risk for ischemic cardiopathy or cancer in the Gazel cohort].

Within the context of a prospective survey project among 20,000 volunteers working for "Electricité de France--Gaz de France" Company (GAZEL cohort), we performed a feasibility study using four self-assessment questionnaires: the Jenkins Activity Survey (measuring type A behaviour pattern), the Buss and Durkee Hostility Inventory, the Center for Epidemiologic Studies--Depression Scale and a personality questionnaire developed by Grossarth-Maticek and Eysenck (GME). Questionnaires were sent twice by mail, at an interval of three months, to a random sample of 408 males: 71% returned the filled forms the first time, 66% the second time, and 80% at least once. The test-retest correlation coefficients ranged from 0.62 to 0.87. The validity of the six personality type scores, calculated from GME, was tested by correlations with the scores of the three other instruments. These correlations appeared consistent with the proposed typology, especially for the "Healthy" type, the "Cancer prone" type and the "Coronary Heart Disease prone" type. The labelling of these types was justified by their association with different disease events, suggested from previous studies.

Adult↗
PubMed1992

[Immunology and psychiatry].

This review of scientific literature comes within the interest arisen from ten years by psychoneuroimmunology, a field connecting several disciplines and illustrating in a new way the psychosomatic relationships. A first category of works has been dedicated to the study of psychiatric disorders associated with various diseases concerning immunity (systemic diseases, endocrine diseases, cancers, infectious diseases), but also to the possible effect of distressing life events on the upset activation of immune functions, or even to the discovery of predisposing personality profiles (type C profile, depressive vulnerability). A second category of works concerns the analysis of the immune disturbances associated with certain psychiatric diseases, such as depression or schizophrenia, but also with some distressing life conditions, like bereavement. Animal experimentation and human experimentation provide various informations on the factors conditioning the immunomodulating effects of stress, sometimes in the direction of an inhibition, sometimes in the direction of an activation of immune functions. Finally, several papers shed light on the immunomodulating effects of psychotropic drugs. All these works open new horizons to the scientific knowledge and let us glimpse an extension to the use of psychologic therapeutics, as well of pharmacological ones as of non pharmacological.

Autoimmune Diseases↗
PubMed1992

[Psychological aspects of short-term follow-up in myocardial infarction].

The author analyses the outcome and emotional repercussions of myocardial infarction in the patient, his or her partner, and of the medical team who manages the infarct (coronary care and cardiac rehabilitation). The adaptive value of certain psychological attitudes is emphasised, for example the denial of illness, and the poor prognosis associated not so much with "type A" behaviour reputed to cause coronary disease but more with post-infarction depression or even with a more stable tendency to hostility in the emotional control. Some of these psychological characteristics may explain the difficulties encountered in designing educative programmes or in poor therapeutic observance by patients despite being aware of the risks they run. These considerations led to therapeutic implication ranging from the strategy of communication with the coronary patient to specific relaxation techniques or with help, to the gestion of stress, to the judicious prescription of psychotropic agents.

Coronary Care Units↗