[Disabilities, access to medical care, and way of life of adults with cerebral palsy. APIB study: initial results]. / Handicaps, recours aux soins et conditions de vie des Adultes atteints de paralysie cérébrale infantile en Bretagne (APIB): premiers résultats.

UNLABELLED: Cerebral palsy is defined as a nonprogressive brain lesion that occurs during prenatal or perinatal development. The Breizh IMC health network objective is to improve the knowledge about the way of life and the health status of adults with cerebral palsy. OBJECTIVE: To describe disabilities, way of life and access to medical care for older teens and adults with cerebral palsy. METHOD: We conducted a descriptive study using health insurance data to contact patients. A questionnaire was addressed to people with cerebral palsy who were older than 16 years. Data were then compared to data of a general population sample. RESULTS: In total, 562 persons responded: 56% male and 44% female, mean age 36. Motor disability was more important with age (50% at age 20 and 70% after 60). A total of 66% of the sample? had cognitive impairment or mental retardation, 60% needed help when going outside, and 40% required assistance with eating, bathing and dressing. The level of education was variable. Health problems were more frequent in patients with cerebral palsy than in the general population and were progressive. Of the sample, 75% experienced pain and half felt depressed or lonely. Medication use was higher in the sample than in the general population. CONCLUSION: More study is needed to improve the knowledge of the health status of patients with cerebral palsy. This study highlights health problems that may be considered a basis for the development of care programs.

[District program to improve the cardiovascular risk of resistant hypertensive patients in general medicine]. / Programme régional d'amélioration de la prise en charge en médecine gnérale du patient hypertendu résistant.

PURPOSE: To try to improve the cardiovascular risk of resistant hypertensive patients in general medicine in Brittany after using french hypertension recommendations. METHODS: 581 hypertensive patients under 3 antihypertensive drugs have asked for an exoneration of the patients' social contribution: 297 (51%) were uncontrolled at their general practitioner (GP) among whom 106 (36%) have refused to take part in the program. 191 resistant hypertensive patients followed by 170 different GP have been pre-included. After a meeting between the social security physician, the GP measured blood pressure (BP) with a validated BP device and passed it on to the patient for a self-BP measurement (SBPM). In the case of a confirmed resistance, after specialist opinion, the treatment was then modified and the patient was checked after four months by his GP for a new clinical and self BP measurement. RESULTS: After the initial automated BP measurement by GP, 51 patients (27%) had in fact controlled hypertension. Out of 136 resistant hypertensive patients (mean: 63 ys) during consultation (60% with systolic isolated hypertension), 121 (89%) have been closely followed during the whole study period among who 114 were also resistant with SBPM (94%). Only 8 patients (6%) were controlled at home. A check-up with specialist opinion was conducted: ECG (82%), echocardiography (59%), vascular echography (35%), funduscopy (30%), plasma renin/aldosterone measurement (15%), renal artery exploration (26%). Eight (7%) secondary hypertension have been founded. After 4 months, 32 (26%) obtained controlled hypertension during GP consultation and 15% during SBPM but the 20/32 controlled patients (62%) had a masked hypertension. Cholesterol levels (63% of dyslipidemics) and the body mass index (80% of overweighed patients) have not varied. On the contrary, 12/28 (48%) has stopped smoking. The coronary risk using Anderson's model has only decreased from 16.5% to 13.8%. CONCLUSION: If this health program has shown its feasibility and the good participation of the GPs, treatment of hypertension and others risk factors really remains insufficient. On the contrary, the use of a validated automatic BP device has been really well carried out. Its use has allowed reclassifying as controlled one third of the resistant hypertensive patients and as uncontrolled at home one patient out of two which were controlled with GP. These results prove the necessity to increase this BP measurement technique in this population.

[Hysterectomy for benign lesions in Brittany: analysis of medical practices]. / Hystérectomies pour pathologie bénigne en région Bretagne: analyse des pratiques.

OBJECTIVES: By who, why and how are done hysterectomies for benign lesions. MATERIAL: and methods. The 413 medical files of all the patients who underwent an hysterectomy for benign lesion during the last trimester of 1997 were recorded by the Medical Information Departments of the 53 health establishments of the Brittany Region. Surgical procedures, medical indications, pathological findings were analyzed according to the guidelines encountered in the medical literature. RESULTS: Hysterectomies were done by many surgeons (112). Inaugural signs noted in the medical files were classical, but various and often associated without a main indication of hysterectomy. Histological diagnose were identical with those found usually in the literature. The abdominal route was mainly used, particularly when the operation was done by a generalist surgeon and in case of uterus weight superior to 250 g. The post operative outcome has revealed the same nature and frequency of complications as usually described. CONCLUSION: In this study, it appears that efforts remain necessary to clarify the indications for hysterectomy in the medical files (in order to promote the alternative procedures to the hysterectomy), and that the proportion of hysterectomies performed by the abdominal route should be reduced in aid of the others surgical routes.