Re-Validation of the COmprehensive Score for Financial Toxicity (COST): Assessing the Scale's Utility in Chronic Disease Populations.

OBJECTIVE: To report the psychometric properties of the COmprehensive Score for financial Toxicity (COST) patient-reported outcome measure (PROM), an 11-item scale previously validated among patients diagnosed with cancer and receiving chemotherapy. METHODS: Data come from a cross-sectional survey (n = 2755 response rate of 87%) of participants in a remote digital health coaching intervention collected between January 2017 and February 2019. RESULTS: COST demonstrated very good internal consistency (Cronbach's alpha = .89) and good convergent validity. Lower financial toxicity was associated with improved physical and mental well-being HRQOL measures after controlling for covariates (b = 0.13, P < .0001; b = 0.28, P < .0001, respectively). Supplemental analyses indicated that the COST instrument loaded on 2 factors. CONCLUSIONS: The COST measure of financial toxicity has good internal consistency and predictive validity in a sample of patients with chronic conditions. However, contrary to previous research examining the psychometric properties of COST in a sample of individuals with cancer, which found COST to be unidimensional, our analyses indicated that the COST measure of financial toxicity is multidimensional in a sample of individuals with chronic conditions. In particular, the items that asked about "general financial wellbeing" loaded on the second factor while "illness-related financial wellbeing" loaded on the first.

[Partial nephrectomy on solitary kidney: Renal function outcome and predictive factors of impairment]. / Néphrectomie partielle pour cancer sur rein unique : évolution de la fonction rénale et facteurs prédictifs de son altération.

OBJECTIVES: To assess the postoperative functional outcome of PN in solitary kidney and define some predictive factors of renal change. MATERIAL AND METHODS: A monocentric series of 45 partial nephrectomies on solitary kidneys, performed between 1988 and 2014, was retrospectively analyzed. Pre-, per- and postoperative clinicopathological data were collected in the UroCCR database. The evolution of early, medium and long-term postoperative Glomerular Filtration Rate (GFR) was evaluated. Predictive factors of GFR decline and hemodialysis were assessed in multivariate analysis. RESULTS: Mean age was 61 years old (±10.8). Mean preoperative GFR and tumor size were respectively 59.6 mL/min (±18.7) and 3.9 cm (±2.6). Vascular clamping was performed in 41 cases (91%). Median time of warm ischemia was 20 minutes (2-60). Mean follow-up was 66 months (±47). Mean GFR at day 5, 1 month and last follow-up were respectively 46.4 mL/min, 50.3 mL/min and 53.1 mL/min. At day 5 and at last follow-up, a GFR decrease ≥ 20% was found in 20 patients (44.4%) and in 16 patients (35.5%), respectively. Five patients (11%) required definitive hemodialysis (HD) at last follow-up. At day 5, tumor size>4 cm (0.006) and operative time (P=0.003) were independent predictive factors of GFR decline. At 1 year, RENAL ns ≥ 10 was the only independent predictive factor of GFR alteration (P=0.0007). Preoperative GFR was significantly associated with final hemodialysis (P=0.023). CONCLUSION: Partial nephrectomy allows most of the patients presenting with renal cell carcinoma on solitary kidney to be free of hemodialysis. Tumor complexity, tumor size and preoperative GFR seems to play a determinant role on postoperative functional outcome. These non-modifiable predictive factors should be recognized and taken into account to better select patients with high risk of postoperative renal failure. LEVEL OF EVIDENCE: 5.

[Predictive value of combined fibronectin and ultrasound cervical assessment in twin pregnancies]. / Valeur prédictive du couplage de la fibronectine à l'échographie du col chez les grossesses gémellaires.

OBJECTIVE: To test a sequential test with fetal fibronectin detection after ultrasound measurement of cervical length to predict preterm delivery in twin pregnancies with preterm labor. PATIENTS AND METHODS: Descriptive retrospective study on 50 women with twin pregnancy hospitalised for preterm labor between 24 and 34 weeks and 6 days of gestation. The primary outcomes were preterm delivery before 34 or 37 weeks of gestation or within 7 or 14 days. Selective use of fibronectin after cervical length measurement has been tested, with a sequential test considered positive if cervical length was less than or equal to 15mm or if cervical length was between 16 and 30mm with fetal fibronectin positive. RESULTS: The sensitivity/specificity/and positive and negative predictive values of fetal fibronectin positive were 71%, 64%, 26%, et 93% for delivery within 7 days; those of cervical length less than or equal to 20mm were 89%, 51%, 31%, et 95% for delivery before 34 weeks and 6 days. The efficiency of the sequential test seemed better than each test and than for singleton pregnancies keeping an excellent negative predictive value: sensitivity of 75%, specificity of 63%, positive predictive value of 26% and negative predictive value of 93.5% for prediction of preterm delivery within 14 days. The use of this sequential test could have decreased half of fibronectin tests. DISCUSSION AND CONCLUSION: A sequential test with selective use of fetal fibronectin detection in twin pregnancies selected by ultrasound measurement of cervical length appears to be effective for predicting preterm birth if preterm labor, avoiding half of fibronectin tests.

[Interest of lactate micro-dosage in scalp and umbilical cord in cases of abnormal fetal heart rate during labor. Prospective study on 162 patients]. / Place du microdosage des lactates au scalp et au cordon devant des anomalies du rythme cardiaque fœtal pendant le travail. Étude prospective sur 162 patientes.

OBJECTIVE: To compare the interest of lactate microanalysis with pH measurement (Gold Standard procedure) in cord blood and fetal scalp blood samples for the assessment of abnormal fetal heart rate (FHR) during labour. STUDY DESIGN: A prospective observational study conducted from July 1st 2007 till March 31st 2008 on 162 patients with abnormal FHR during labour. RESULTS: Sampling failure for scalp lactate was less than 1 % compared to a failure of 10.5 % for scalp pH (P<0.001). There was a good correlation between pH and lactates in fetal scalp blood samples and in cord blood samples, between lactate in the last fetal scalp sample and in cord blood. When there was umbilical acidosis (pH≤7.15 or lactate≥5mmol/L), Apgar score at 5 minutes was significantly lower than when there was no acidosis (4.66±3.59 versus 8.35±2.73 for pH ; 6.6±3.77 versus 8.45±2.58 for lactate). The specificity of the lactate in the umbilical cord artery (≥5 mmol/laws) was 76.4 % for predicting an Apgar score at 5 minutes less than 7 ; 79.7 % for predicting the need for immediate neonatal care ; 77.3 % for predicting an hospital stay in neonatal unit. These figures were generally worse but close to those found for a threshold value of umbilical artery pH≤7.15. CONCLUSION: The values of lactate in cord blood and fetal scalp blood samples were comparable to pH values (Gold standard procedure). This method is easy to perform and is an attractive alternative to pH for monitoring fetal asphyxia. It is our opinion that the combination of the two methods is of interest.

[Comparative study of periprostatic tissues thickness after retropubic or laparoscopic radical prostatectomy]. / Comparaison de l'épaisseur des tissus périprostatiques après prostatectomie rétropubienne ou laparoscopique.

OBJECTIVE: Analysing periprostatic tissue (PPT) thickness after retropubic (RP) or laparoscopic (LP) prostatectomy. MATERIAL: From January to December 2007, 114 consecutives prostatectomies were performed in our institution (38 RP, 76 LP). Clinical data were prospectively collected in a database. Gardner et al.'s (1988) procedure was used for pathological analysis. PPT thickness was measured on pathological specimens by a single observer on a single microscope. The observer had no knowledge of either clinical data or surgical approach. Four levels were chosen (at the base, the proximal part, the distal part, the apex) and 12 standardized measures were performed on each level, 48 measures: a prostate. We compared PPT thickness and surgical margins according to surgical approach and clinical data. RESULTS: Comparative analysis confirmed that LP and RP groups were similar as far as it concerns preoperative and pathological findings. Positive margin rate was also similar in LP and RP groups (4% versus 5.3%; P=0,37). Overall PPT thickness was thinner after LP than after RP except at the apex and the anterior face. Nevertheless, in the "complete preservation" group, PPT thickness was thinner at the apex in the RP group, thinner at the base in the LP group. CONCLUSION: Measuring PPT thickness was an original objective and reproducible way to compare different techniques and new technologies for radical prostatectomy. PPT sparing was different but not better with the laparoscopic approach.

[Repeat visits in a pediatric emergency department]. / Consultations itératives aux urgences pédiatriques.

OBJECTIVE: The objective of this study was to characterize children who frequently use the pediatric emergency department. METHODS: This retrospective study selected children who consulted five times or more at the Pellegrin University Hospital emergency department in Bordeaux during the year 2006. We looked for risk factors for recurrent visits first in a comparative study and then conducted a phone survey with their GP. RESULTS: Among the 157 frequent-user children, 30.6% suffered from a chronic disease (more than half of them regularly seeing CHU doctors). For the other 59.4%, the risk factors for recurrent visits were age (children under the age of 1 year account for 35% of frequent users), distance from home to hospital (71.3% live within a 10-km perimeter), parental worry (44%), a precarious socioeconomic family situation, and being a beneficiary of the CMU (universal free health care coverage for low-income individuals) (37.6%). These children consulted more for a medical pathology (81.9%) than for a surgical pathology (18.1%) and were more often hospitalized (53.3% were hospitalized at least once). The degree to which these consultations followed an emergency situation was the same for both groups (i.e., 25% true emergencies). CONCLUSION: Approximately one-third of emergency department frequent-user children are children with a chronic disease, the others being young children, living close to the hospital, from unfavorable socioeconomic groups (using CMU health coverage), or with anxious parents.

[Sequential use of cervical length measurement before fetal fibronectin detection to predict spontaneous preterm delivery in women with preterm labor]. / Utilisation séquentielle de la longueur échographique du col utérin puis de la détection de la fibronectine foetale pour prédire une prématurité spontanée en cas de menace d'accouchement prématuré.

OBJECTIVE: To test a sequential test with fetal fibronectin detection after ultrasound measurement of cervical length to predict preterm delivery in women with preterm labor. STUDY DESIGN: Descriptive retrospective study on 111 women hospitalised for preterm labor between 24 and 34 weeks and six days of gestation. The primary outcomes were preterm delivery before 34 or 37 weeks of gestation or within seven or 14 days. Selective use of fetal fibronectin detection after cervical length measurement has been tested, with a sequential test considered positive if cervical length was inferior or equal to 15 mm or if cervical length was between 16 and 30 mm with fetal fibronectin positive. RESULTS: The sensitivity/specificity/and positive and negative predictive values of fetal fibronectin positive were 75, 71, 17 and 97% for delivery within 14 days; those of cervical length inferior or equal to 20mm were 75, 52, 21, and 92% for delivery before 34 weeks. The efficiency of the sequential test was similar with excellent negative predictive value: sensitivity/specificity/and positive and negative predictive values of 75, 63, 26, and 93.5% for prediction of preterm delivery before 34 entire weeks. The use of this sequential test could have avoided 37% of fibronectin tests. CONCLUSION: A sequential test with selective use of fetal fibronectin detection in population selected by ultrasound measurement of cervical length appears to be as effective than fetal fibronectin detection or cervical length alone for predicting preterm birth, if preterm labor, avoiding more than one third of fibronectin tests.

[Morning snack offer in kindergarten: outlook and practices in Aquitaine, France, between 2004 and 2008]. / La collation à l'école maternelle: évolution des perceptions et pratiques des enseignants d'Aquitaine entre 2004 et 2008.

The Nutrition, Prevention and Health for Children and Teenagers in Aquitaine program is a regional implementation of the French National Program of Nutrition and Health (PNNS). The first of two surveys of a representative sample of Aquitaine preschools was conducted in 2004-2005. This survey showed that more than 2/3 of teachers offered a morning snack to their pupils at around 10 o'clock in the morning, mainly composed of sweet cakes, cookies, or candies. Following this initial survey, actions were implemented starting in September 2005, aiming to stop systematic morning snacks or improve their composition. The same survey was repeated during 2007-2008 in order to analyze the changes in morning snack practices in preschools between 2004-2005 and 2007-2008. Data were collected from teachers of Aquitaine's preschools who filled out questionnaires. Schools were randomly chosen according to their size and whether or not they belonged to a priority education zone (ZEP). The results show that 57.9% of teachers organized a morning snack in 2007-2008, versus 68.7% in 2004-2005. In 2004-2005, 22% of teachers considered the morning snack as "unjustified" compared to 44% in 2007-2008. The composition of morning snacks improved: 17.7% of teachers offered fruit and/or milk in 2007-2008 versus 8.5% in 2004-2005. Morning snacks composed of other foods (such as sweets, chocolate pieces, cookies, pastries, bread, fruit juice) decreased from 60.2% in 2004-2005 to 40.2% in 2007-2008. In 2007-2008, 19% of the teachers reported that children had snacks in their schoolbag versus 34% in 2004-2005. The proportion of teachers reporting children having snacks in their schoolbag decreased from 34% in 2004-2005 to 19% in 2007-2008. Comparison between these two surveys is encouraging as it shows an improvement of the perception and practices of teachers regarding morning snacks. These results encourage the partners of this program to continue the fieldwork actions.

Impact of a long specialized training in anaesthesia on the quality of care in a developing country: experience in Laos.

OBJECTIVES: Assess the impact on the quality of practices in a developing country (Lao Democratic People's Republic) of a long specialized course in anaesthesia (Certificate of Specialized Studies in Anesthesia-Intensive care and Emergency Medicine [Cesarmu]) versus accelerated trainings. POPULATION AND METHOD: Study concerned all surgical hospitals and all anaesthesiologists of Lao PDR. At hospital level, the quality of care was assessed and compared between hospitals with and without Cesarmu anaesthetists by using the quality of anaesthesia record and the spinal anaesthesia frequency in lower gyneco-obstetrical surgery. On an individual level, we assessed and compared anaesthetists who were Cesarmu trained and those who were not by using theoretical and practical scores. The latter were acquired by observing complete perisurgical care (pre-, per- and postoperative practical scores). RESULTS: We visited 29 of the 34 surgical hospitals in Lao PDR and met 90 of the 111 anesthesiologists. At hospital level, quality criteria were higher in the group of hospitals with Cesarmu anaesthesiologists without that difference being significant. On the other hand, all individual scores measured were significantly higher in the Cesarmu group. DISCUSSION: The improvement of practices resulting from training was obvious at the individual level but its impact at hospital level was not significant. There were most likely not enough trained anaesthetists to significantly influence practices in their departments. CONCLUSION: According to the criteria used, the impact of Cesarmu on the quality of anaesthesia in Lao PDR seems positive. However, training needs to be continued and practices homogenized.

[Early screening criteria for children at risk of overweight]. / Critères de repérage précoce des enfants à risque de développer un surpoids.

BACKGROUND: Health professionals who monitor the growth of children are also involved in the early detection of overweight. Appropriate tools are required for this purpose. OBJECTIVE: The study sought to identify predictive markers of the development of subsequent overweight using a simple set of criteria. METHODS: A consecutive cohort was composed of 1424 grade 4 children in Aquitaine, France, aged 8-9 years. Body mass index (BMI) was calculated during school health assessments at 8-9 years of age. Data from previous assessments at 3-4 and 5-6 years of age were also collected. RESULTS: Of the 189/1424 children (13.9 %) who were overweight according to the French national cut off for children aged 8-9 years, 67 (33.8 %) were already overweight at 3-4 years and 107 (54.1 %) at 5-6 years. Of the 134 (9.4 %) who were overweight at 5-6 years, 43.3 % were already overweight at 3-4 years and 79.9 % were overweight at 8-9 years. On the other hand, 76 of these 134 children (56.7 %) were not overweight at 3-4 years, so they had become overweight between the two assessments. The combination of the criterion "overweight at 3-4 years or 5-6 years" and "increase in BMI>1kg/m(2) between 3-4 years and 5-6 years" appears to be the best predictor of the risk of overweight at 8-9 years, with good sensitivity (75.3 %) and specificity (87.9 %). CONCLUSION: A predictive tool based on BMI changes between ages 3-4 years and 5-6 years could be used for the early detection of the risk of developing overweight and obesity. The tool is easy to use, especially for health care in schools. Furthermore, the present findings confirm the value of following up and managing children who are already overweight between the ages of 3 and 6 years.

Long-term single-center results of management of ethmoid adenocarcinoma: 95 patients over 28 years.

OBJECTIVES: To assess management options for ethmoid adenocarcinoma. STUDY DESIGN: Retrospective review over 28 years. PATIENTS AND METHODS: Ninety-five patients were included. Statistical analysis using the Kaplan-Meier method was performed to establish survival rates, and univariate analysis to determine prognostic factors. Independent chi(2) test was used to compare survival rates between T3 and T4a stages operated by transfacial and craniofacial approaches, respectively. RESULTS: Mean age was 64 years, and 76% patients were stage T3 or T4. Three patients had node metastasis, none of whom had distant metastases at time of diagnosis. Eighty-three percent of patients received surgery and adjuvant radiotherapy on tumor bed. Mean follow-up was 5 years. The recurrence and metastasis rate were 31 and 9% at median time of 3 years, respectively. The disease-specific 5- and 10-year survival rates were 78 and 64%, respectively. The disease-free survival rate was 61 and 44%, respectively, at the same time points. Meningo-encephalic (P = 10(-8)), orbit or infratemporal fossae (P = 0.046), and frontal sinus extension (P = 0.02) negatively impacted survival. There was no statistically significant difference in survival rate between T3 and T4a. CONCLUSIONS: Our data suggest that less surgical treatment may be needed than is usually advocated for T1-T4a tumors and that surgery alone may be appropriate for T1-T3 tumors that have been resected with adequate margins in those patients for whom excellent follow-up is anticipated. No neck irradiation is indicated for N0 disease.

[Inquiry into the oral follow-up of diabetic patients: knowledge and application of the recommendations of the Haute Autorité de Santé]. / Enquête sur le suivi bucco-dentaire des patients diabétiques: connaissance et application des recommandations de la Haute Autorité de Santé.

In 1999, the Haute Autorité de Santé (HAS) issued recommendations on the follow-up in France of diabetic patients. It recommends at least an annual dental examination with special attention on the periodontal environment. The results of studies suggest that recommendations on the monitoring of oral diabetes are few or not implemented. In this work, we sought to evaluate the application of the recommendations of the HAS for patients with diabetes and in particular the recommendations on oral follow-up, from a cross-sectional survey using questionnaires to dentists (CD), general practitioners (MG) and diabetic patients in the region of Pays de la Loire. The results of this cross-sectional study shows that the requirements for monitoring oral health of these patients are poorly known and therefore far from being massively applied by health professionals. Our study revealed a lack of knowledge among health professionals, in monitoring oral diabetic patients. The causal association between diabetes and periodontal diseases are now well established; the dentist should be more involved in the medical team during the monitoring of diabetic patients. His role involves the prevention and care oral disease early. The patient information is the first step of prevention and care that it should be issued in any consultation with a dentist and relayed by the associations of diabetic's patients who should also be better informed.

The growing incidence of type 1 diabetes in children: the 17-year French experience in Aquitaine.

BACKGROUND: While the incidence of type 1 diabetes in children has increased in various parts of the world, in France, no actual figures have been available since 1997. OBJECTIVE: The aim of this study was to determine whether or not the pattern of increase in the incidence of type 1 diabetes in children aged less than 15 years varies with age at onset in Aquitaine (France) over a 17-year period. PATIENTS AND METHODS: From 1988 to 1997, all newly diagnosed cases of type 1 diabetes were confirmed by registration into the French Registry of Incidence of Diabetes. Subsequently, all cases registered from 1998 to 2004 were collected within paediatric centres in Aquitaine as part of their hospital-based prospective records. RESULTS: In the overall population, the age- and gender-adjusted incidence rate increased from 8.86 per 100,000 per year (95% CI: 6.27-11.45) in 1988 to 13.47 per 100,000 per year (95% CI: 10.29-16.65) in 2004, indicating an annual increase in incidence of 3.34% (95% CI: 3.33-3.34). Median age at diabetes onset for cases in the first registration period (1988-1996) was significantly higher than that in the second registration period (1997-2004): 10.04 years (range: 6.64-12.53) versus 8.83 years (range: 5.48-11.73), respectively (P=0.01). The annual increase in incidence rate was highest in the youngest children and varied significantly with age (0-4 years: 7.59%; 5-9 years: 4.06%; 10-14 years: 1.28%). CONCLUSION: These results indicate a doubling of the incidence of type 1 diabetes in children every 30 years in Aquitaine, with an even steeper increase among younger children, thus underscoring the need for appropriate adaptation of the system of healthcare provision.

Epicutaneous aeroallergen sensitization in atopic dermatitis infants - determining the role of epidermal barrier impairment.

BACKGROUND: Sensitization to atopens is an early phenomenon that overlaps with the onset of atopic dermatitis (AD) in infancy. Early epidermal barrier impairment may facilitate the epicutaneous penetration of atopens. OBJECTIVE: To correlate transepidermal water loss (TEWL) and aeroallergen sensitization in infants with AD. METHODS: In this cross-sectional study we enrolled 59 AD children and 30 controls aged 3-12 months. Transepidermal water loss in uninvolved skin, specific immunoglobulin E, atopy patch test (APT) and skin prick tests were performed with respect to seven aeroallergens, i.e., Dermatophagoides pteronyssinus, D. farinae, cat, dog, birch pollen, ambrosia, and cockroach. Environmental conditions were assessed by a questionnaire, and the house dust mite (HDM) concentration was determined in dust samples. RESULTS: Eighty-nine percent of AD infants had a positive APT vs one out of eleven controls. AD infants had a significantly higher mean TEWL than controls (27.4 vs 11.1 g/m(2)/h, P < 0001). Children with two or more positive APT had higher TEWL than the others (31.1 vs 19.0 g/m(2)/h, P < 0.025). No correlation was found between indoor APT results and exposure to HDM, cats, and dogs at home. CONCLUSIONS: This study confirms the high prevalence of delayed sensitization to indoor and outdoor aeroallergens in AD infants, and shows that the higher the TEWL, the higher the prevalence of sensitization to aeroallergens. These data are in favor of a major role of a constitutive epidermal barrier impairment in determining early atopen sensitization in infants with AD.

Oat sensitization in children with atopic dermatitis: prevalence, risks and associated factors.

BACKGROUND: Topical treatments of atopic dermatitis (AD) may be responsible for cutaneous allergies. Percutaneous sensitization to oat used in emollients/moisturizers has already been reported. Our objectives were to measure the prevalence of oat sensitization in AD children, to assess its relevance, and to look at related parameters. METHODS: We recruited prospectively children with AD referred for allergy testing between June 2001 and December 2004. Atopy patch tests (APT) and skin prick tests (SPT) to oat proteins (1%, 3% and 5%) and to the European standard series were performed followed by oral food challenge (OFC) and repeated open application test (ROAT) in the oat-sensitized group. RESULTS: About 302 children were enrolled. Oat APT and SPT were positive in 14.6% and 19.2% of cases, respectively. Children under 2 years of age were more likely to have positive APT. In oat-sensitized children, OFC and ROAT were positive in 15.6% (five of 32) and 28% (seven of 25) of cases, respectively. Thirty-two percentage of oat cream users had oat-positive atopy patch test (APT) vs 0% in the nonusers group. CONCLUSIONS: Oat sensitization in AD children seen for allergy testing is higher than expected. It may be the result of repeated applications of cosmetics with oats on a predisposed impaired epidermal barrier. We suggest avoiding topical-containing oat proteins in infants with AD.

[Determining students health information needs at the Service of Inter-university Preventative Medicine in Bordeaux]. / Besoins d'information en santé des étudiants au service inter-universitaire de médecine préventive de Bordeaux.

At the request of the Service of Academic Preventative Medicine (APM) in Bordeaux, this study was carried out in the year 2000 and aimed to identify the health information needs of the university's student population. The questionnaire, which was completed by the students themselves, mainly explored health information needs, health status and the students' living conditions. Of the 370 total students coming from all University disciplines who participated in this study, a majority of them were women (61%), with the median age of 21 years old. The majority of students (69%) said that they were stressed and/or depressed and more than one-third were tired. Nearly 20% of the students were smokers, 9% declared that they regularly drank alcohol and 7% of them reported that they never consulted a physician. When asked specifically about their health information needs, they expressed a preference for receiving information on sexually transmitted diseases, how to stay in good health and on issues like psychology, depression and suicide. These themes differed according to gender and risk behaviour. These results permitted a better understanding of the students' health information needs and provided the knowledge necessaryin order to streamline and appropriately adapt the APM's activities for the following academic year in order to be more focused to respond to these needs.

[Prevalence of depressive disorders in children and adolescents attending primary care. A survey with the Aquitaine Sentinelle Network]. / Prévalence des troubles dépressifs chez l'enfant et l'adolescent consultant en médecine générale.

UNLABELLED: Since depressive disorders in children and adolescents have not been widely studied in the context of gene-ral medicine, we conducted an epidemiological survey among general practitioners (GP's) consulted by young subjects aged 7 to 17 years for various reasons. OBJECTIVE: The aims were the following: to estimate the prevalence of depressive disorders in general practice, to detect the eventual existence of particular clinical forms, to assess the frequency of comorbid disorders and to determine to what degree these disorders were diagnosed by GP's. METHOD: The study was conducted over 6 months in concert with 45 practitioners of the Aquitaine Sentinelle Network because of their strong experience in the field of epidemiological surveys, especially regarding psychiatric disorders. The population included all consecutive attenders aged 7 to 17 years. Consent to participate was obtained from children and adolescents and their parents. Finally 155 patients took part. A two-stage epidemiologic strategy was used, including screening tests in the first stage and semi structured interview by clinician in the second stage for diagnostic confirmation. During the first stage, information was obtained from children and adolescents and general practitioners using three questionnaires. The self-report questionnaire Center for Epidemiological Studies Depression (CES-D) was used for screening depression in 13 to 17 years old adolescents and the 20 items of the scale were modified to make it more comprehensible and relevant for children aged 7 to 12. The cut-off of 21 used in France appeared to be the more appropriate in both males and females and was taken to indicate high likelihood of depressive disorder. Therefore people with score 21 or more were approached for the second stage. The Child Behavior Checklist (CBCL), an instrument of well-established validity and reliability, provided information from parents about the child's behavior and competencies. Demographic and environmental data, as well as the reason for the visit and the presence of associated psychological factors were collected from a questionnaire devised for the study and completed by the practitioner. The 21 patients initially detected were invited to take part in the second stage. A total of 18 agreed to meet the psychiatrist. Sex-ratio female/male of this sample was 1,25 and mean age was 12,5 years. All of them underwent the Schedule for Affective Disorders and Schizophrenia for School Aged Children (Kiddie-SADS), a semi structured research interview of established validity. Diagnoses were made according to the DSM IV criteria (American Psychiatric Association). RESULTS: Results showed that more than one child out of 10 aged less than 13 years had a depressive disorder, and that the prevalence in the adolescent sub-group was 5%. Major depressive episode was present in 6% of the children sample, dysthymia in 4% and maladjustment disorder with depressive mood in about 1%. All depressive disorders were moderate. Atypical depression (in the Anglosaxon sense of the term) was present in half of the depressed adolescents. Other disorders included anxiety disorders with a rate of about 4% overanxious in the adolescent sample, obsessive compulsive disorder, panic disorder. Disruptive disorders were considerably less common. Psychiatric comorbidity, usually involving different types of emotional disorders, was present in about 50% of psychiatric cases, with a prevalence of anxiety disorders. The reasons why depressed subjects consulted were not specific. The most common reasons for visiting the GP were the somatic complaints with a rate of 50% in both populations, whatever the CES-D's score was. A few per cent of patients attending primary care presented with mental health complaints, and the rate was similar in the two populations. Frequency of consultation was not a discriminant factor of depression. Familial cohesion and school performance were not associated with the CES-D's score, nor familial psychiatric history. Personal psychiatric history was related to depression, whereas the occurrence of bereavement made the CES-D score positive but was not significantly associated with fully- blown depression. Finally, we estimated that 70% of diagnoses of depression were not made during the consultation with GP's. CONCLUSION: No particular characteristic of depressed children consulting GP's could be established. These findings underline the importance of training GP's in the screening of depressive disorders in children and adolescents. A better knowledge that young general practice attenders have high rates of depressive disorders may facilitate more rapid referral for psychiatric assessment and treatment.

[Access to early speech therapy in Gironde: evaluation of a language-screening campaign for 4-year-old children (1999-2001)]. / Accès aux soins orthophoniques précoces en Gironde: évaluation d'une campagne de dépistage des troubles du langage à 4 ans (1999-2001).

OBJECTIVE: The objective of this article was to evaluate the results of a prevention campaign on the access to early speech therapy for 4-year-old children. POPULATION AND METHODS: A prevention campaign of speech disorders was conducted in Gironde area in 1999, offering a systematic screening by ERTL4 test and free speech therapy. The campaign results were evaluated by quality and efficiency indicators. RESULTS: In 1999, 14037 children born in 1995 were included and 1363 children randomly selected from the schools benefited from the campaign. One child out of four failed in the screening test by ERTL4. The percentage of the assessment and speech therapy in the children of the campaign (16.0 and 8.2%) were significantly higher than the other children of the area (8.9 and 6.7%). CONCLUSION: The campaign evaluation has demonstrated its capacity to access to speech therapy for children language disorders, allowing gains of frequency and earlier treatment.