Sleep Disorders and Therapeutic Management: A Survey in a French Population of Prisoners.

In a French prison, most inmates reported not being satisfied with their sleep. Life habits between good and bad sleepers were not significantly different except for television and smoking. The most frequently reported symptom of insomnia was several awakenings at night, and the most frequently cited etiologies were rumination of thoughts and noise. Most patients reported that their sleeping problems began or worsened after incarceration. A quarter of the inmates were following a hypnotic treatment, and most of these treatments began in prison. Only 42% of patients were satisfied with its effectiveness. These observations enabled us to make recommendations for healthy sleep patterns such as respecting normal night-and-day cycles, encouraging to stop smoking, and promoting appropriate use of hypnotic treatments.

[Emergent adverse effects of proton pump inhibitors]. / Effets indésirables émergents des inhibiteurs de la pompe à protons.

BACKGROUND: Recent literature reports of potential adverse effects (AEs) of proton pump inhibitors (PPIs), especially during long-term treatments. PURPOSE: To present a literature review of major AEs: digestive infections, pneumonia, bone fracture, hypomagnesemia, interstitial nephritis, gastric cancer and neutropenia. DATA SOURCES: The authors used Pubmed; articles in English or French, published between August 2006 and August 2011 were analyzed. STUDY SELECTION: Two reviewers analyzed the references of title and summary to retain mainly observational studies, controlled clinical trials, meta-analyzes, case reports. RESULTS: For digestive infections: observational studies have shown a link moderate to high (OR 1.4 to 8.3) with exposure to PPIs. For pneumonia: some case-control studies reported a modest significative risk (OR 1.2 to 1.6), some not. The risk appears dose dependent and greater in subjects at risk. For fractures: the majority of observational studies report a significative increase in low to moderate risk (OR 1.2 to 3.1), correlated with the dose and duration of treatment. For magnesium deficiency: rare but potentially severe, they are described in case reports. Interstitial nephritis are described in case reports and for different PPIs, suggesting a class effect. For the stomach neoplasm: if three observational studies show an increased cancer risk (OR 1.5 to 2, 3), confounding factors make the causal link uncertain. Neutropenia is reported in a clinical observation, a class effect is suggested. LIMITATIONS: One can regret the absence of controlled clinical trials; indeed the observational studies have the interest to move closer to "real life", but often have methodological bias. CONCLUSION: Although AEs PPIs do not call into question the usefulness of this drug class, they show the need to limit their prescribing to indications for which efficacy has been proven. Moreover, PPIs treatment must be regularly reassessed to avoid exposing patients to unnecessary risks.

[Number and nature of drug interactions concerning antineoplastic drugs]. / Estimation du nombre et de la nature des interactions médicamenteuses concernant les médicaments anticancéreux.

Antineoplastic drugs are prone to drug-drug interactions. Cancer patients often receive multiple concurrent medications and health care professionals are not always aware that patients are also taking others treatments. The aim of this study was to assess the number of drug-drug interactions of antineoplastic drugs used in solid tumours and to find out and collect recommendations for each of them. We performed a bibliographic search from the Vidal dictionary, the "thesaurus de l'Afssaps", the "dossier du CNHIM" and from literature of scientific journals. For the 40 antineoplastic drugs studied, 726 drug-drug interactions were identified; 186 from the Vidal dictionary, 356 from scientific literature and 184 from others bibliographic sources. The most frequently involved antineoplastic drugs are ifosfamide, paclitaxel and erlotinib. The ATC groups of associated drugs are antiinfectives for systemic use, alimentary tract and metabolism and nervous system. Antiretrovirals are prone to drug interactions with antineoplastic drugs, particularly ritonavir, tipranavir and efavirenz. 7 contraindications and 15 unadvised associations were held. For 58% of interactions, no management recommendation was specified in the bibliographic source. Healthcare professionals must be aware that the Vidal dictionary gave information for only 26 % of registered drug-drug interactions. Our database gather in one document drug-drug interactions that come from different bibliographic sources. The setting of this database is part of the multidisciplinary caring of cancer patient. Drug-drug interaction is a field which for physicians and pharmacists should developed collaboration for patient care.