Prevalence of severe cardiovascular disease in patients with schizophrenia.

OBJECTIVES: We assessed the prevalence of severe cardiovascular (CV) disease requiring hospitalization among patients with schizophrenia in France. METHOD: We included patients hospitalized with schizophrenia or psychotic disorder during 2015, in five French psychiatric hospitals. Patients with CV disease were defined as those with a correspondent ICD-10 code during a hospital stay in any general hospital, five years before or three years after the psychiatric hospitalization. CV disease included myocardial infarction (MI), stroke, heart failure (HF), coronary artery disease (CAD) or peripheral artery disease. Risk factors such as hypertension, obesity and diabetes were recorded. RESULTS: In total, 4424 patients with schizophrenia were included. Overall, 203 (4,6%) patients were diagnosed with CV disease, 93 (2.1%) with CAD, 86 (1.9%) with HF and 49 (1.1%) with stroke. The prevalence of hypertension, obesity and diabetes was 11.3%, 9.7% and 7.8%. The median (interquartile range) age of patients with MI and diabetes was 57 (49-70) and 56 (48-66) years. CONCLUSION: Patients with schizophrenia develop severe CV disease requiring hospitalization at an early age. These severe events are associated with a high prevalence of risk factors. Early screening and treatment of CV disease and risk factors is important to improve life expectancy and quality of life of these patients.

[Impact of training conferences on medical student's performance for the French National Ranking Examination in Lorraine University. The ETIMCEL experimental study]. / ÉTude de l'IMpact de Conférences sur la réussite aux ECN en Lorraine. Étude interventionnelle ETIMCEL.

PURPOSE: To describe factors associated with a better rank, and to assess the impact of training conferences on medical student's performance for the French National Ranking Examination (FNRE) in Lorraine University, France in 2012. METHODS: Between October 2011 and May 2012, assistant professors of the faculty of medicine of Nancy, France, organized a cycle of 15 conferences combining clinical cases theoretical training and student peer assessment. Data were recorded with a self-administered questionnaire in January 2012 to collect potential confounders. RESULTS: Among 287 students enrolled in the last year of medical school in 2011-2012 in Lorraine University, 195 (67.9%) of them registered to the cycle of conferences. Among the potential prognostic factors assessed, not repeating the first year of medical curriculum (P=0.013), the number of courses validated at the first session during the second part of the medical curriculum (P=0.002), absence of difficulties experienced in the fifth and sixth year (P=0.032) and a desired ranking among the best (P=0.011) were independently associated with a better rank at the FNRE. Regular participation in conferences was significantly and independently associated with a higher ranking (mean gain for the participation in 13 or more conferences: 873; mean gain by conference: 63). CONCLUSION: Regular participation in conferences provided by assistant professors and based on clinical cases theoretical training and student peer assessment was significantly associated with a higher ranking to the FNRE in Lorraine University in 2012.

[Quality of life of living kidney donor: a national report]. / Rapport qualité de vie des donneurs vivants de rein. Étude QV DVR transversale.

The renal transplantation is nowadays the reference treatment of ESRD. Living donor kidney transplantation is less often performed in France than in other countries. Nevertheless, numerous French and international surveys have evidenced that it provides the recipients a longer life expectancy and a better quality of life. Donors themselves, what do they become? How are they? For the first time in France, a survey has been implemented to investigate the quality of life of living kidney donor to one of their close relations. This study has been undertaken by the Agency of the biomedecine and the service Clinical Epidemiology and Evaluation (EEC), of the University teaching hospital of Nancy. The main objective was to describe the quality of life of the living donors having given a kidney for more than a year and less than 5 years. The secondary objective was to contribute to the knowledge of the main factors associated to the living kidney donor quality of life, one year after the donation. Participants had to be living in France at the time of the donation which had taken place between June 30(th), 2005 and March 1(st), 2009. A folder gathering various self-administrated questionnaires was sent to the place of residence of the donor between March and April, 2010. These data were completed by medical data collected near the transplantation centres by the Agency of biomedecine within the framework of the register CRISTAL. They included the characteristics of the donation and of the donor at the very time of the donation, 3 months after the donation and at the last annual assessment. Three living donors in four, that is 501 persons, agreed to fully participate. They constituted a representative national sample of all the living donors of this period. The non participants were younger (4.5 years on average) and had a less adequate annual follow-up. The women were more represented (61 %) than men. The median age was 53 years. More of 2/3 were employed at the time of the survey. The three main categories of donors were ascendants (36 %), collateral (33 %) and spouses (26%). The donation decision was taken without hesitation (94 %) and at an early stage of the evolution of the recipient renal disease (64 %). The delivered information was considered globally satisfactory except for the painful consequences and for the scar. The living donors were, long after their donation, in an excellent physical health state according to the SF36 summarized physical score and this especially when they were old as compared to the same age and sex general population. This phenomenon highlights the drastic selection of the potential donors. The only factor influencing the level of long term physical health was the surgical technique: the 261 subjects having undergone a coelioscopy had less often presented post operative pain (OR=0.5; 0.3-0.8; P<0.002) and had more often recovered completely without any residual pain (OR=1.7; 1.2-2.5; P<0.004). The quality of life mental dimension according to the SF36 summarized mental score was very close to that of the same age and sex of the general population although a slightly lower. It is influenced by characteristics related to the way the donation had been lived, particularly the understanding of their donation by their circle of acquaintances (average score 74.2/100), the perception of a feeling of owing on behalf of the recipient (46.5 %) and the fact of having lived a competition to be retained as the donor (for 266 cases another potential donor did exist and 21 lived the donation as a strong competition). More than 84 % of the donors was still followed by a healthcare professional at the time of the survey. The main expressed complaints concern the quality of the medical follow-up (70 donors expressed themselves openly on this topic) and the pain and scar after effects of the intervention. In spite of the surgical complications, of the dissatisfactions regarding their medical follow-up, of dismissals or of necessary adjustments of their professional life (13 %), of their difficulties to carry heavy loads, of sometimes complex relations with the recipient (23 % positive, 10 % negative) or their circle of acquaintances, of expenses non reimbursement and of losses of salary (12 %), they would be 95 % to recommend the donation and if it was to be redone 98 % would do it again! Benefits brought to the recipient won largely over the encountered difficulties. This retrospective and cross-sectional study allows to state recommendations which have to be confirmed by the 2009-2012 longitudinal study: to favour the coelioscopy which offers an advantage in terms of less frequent pain and a better post operative recovery, to better understand the phenomena of competition between potential and donors recipients, to improve the information about the potential consequences of the donation on the pain and on the scar, to inform the donor about the importance to associate the proxies with the decisionmaking or at least with the discussion and finally to improve the society recognition of the donation.

[Evaluation of the benefit of early valve surgery in the treatment of infective endocarditis. Contribution of propensity analyses]. / Evaluation du bénéfice de la chirurgie valvulaire précoce dans le traitement de l'endocardite infectieuse. Apport des analyses de propension.

Early valve surgery for infective endocarditis, that is surgery performed during the course of antibiotic therapy, is widely used. However, this intervention has never been proven effective in any clinical trial. Five recently published observational studies, using propensity analysis, analyzed the relationship between surgery and mortality. But they gave conflicting results, mainly because of their methodological limitations. Thus, to date, there is no reliable estimation of early valvular surgery impact on mortality. In addition, this example allows for discussing the interest of propensity analyses and to emphasizing their limitations.