[Alteration in quality of life in anorexia nervosa and improvement under treatment: validation of a new questionnaire, the QUAVIAM]. / Altération de la qualité de vie dans l'anorexie mentale et amélioration sous traitement : validation d'un nouveau questionnaire, le QUAVIAM.

Anorexia nervosa (AN) is a chronic and often severe eating disorder, which could have a serious impact on various life domains. AN may lead to physical, mental, behavioural and socioprofessional impairment. Thus, one could expect a poor quality of life (QoL) in AN patients. QoL is certainly a key factor to provide quantitative measurement of treatment efficacy that will facilitate clinical decision-making and treatment planning. Despite that QoL was rarely prospectively analyzed in AN patients, one could conclude that AN patients showed reduced QoL, as compared to normal controls and other psychiatric-disordered patients. It seems that mental health components of QoL are more impaired than the physical ones in AN patients, who showed a modest impact in the physical domain. Thus, our aim was to analyse the QoL using a new, French, questionnaire, the QUAVIAM (qualité de vie dans l'anorexie mentale). After a bibliography research (including EDE, EDI, SF-36, QOL.ED), the choice of 12 themes, regrouped in six scores, was made by three eating disorder specialists and two recovered patients. For each score, 10 to 15 questions were written by the experts, and then corrections and validation were made by the five experts and 21 patients. After this, we prospectively determined the reproducibility (3 days interval), the specificity, and the sensitivity for short-term change in patients exhibiting an "active" AN (n=54, mean age: 31 ± 9 yrs, mean BMI: 14.1 ± 2.8 kg/m(2), AN duration: 2.6 ± 1.9 yrs), and again after cognitive behavioral therapy (CBT). We also analyzed the QUAVIAM score and subscores in 48 recovering patients and in 56 subjects without eating disorder. The QUAVIAM final version (61 questions) was collected in 76 patients and the 56 healthy controls matched for sex and age. Its reproducibility was 91% (intra-questionnaire) and 94% (inter-questionnaire), its specificity 98% (versus controls; P<0.0001) and its sensitivity 99%. The QUAVIAM global score of the AN patients was more impaired (389 ± 87) than that of the recovering patients (157 ± 82) and the normal controls (89 ± 49; P<0.0001). Each of the six subscores was higher (more altered) in active AN than in recovering AN patients and in normal subjects: the somatic, the psychological, the hedonic, the socioprofessional, the affective and the TCA-related ones (P<0.001 for each comparison). The QUAVIAM global score and its subscores were significantly improved (decreased) by the 3-month CBT: 385 ± 25 before and 189 ± 30 after CBT (P<0.0001). The changes were observed for all the subscales (P<0.0001). The somatic subscore did not decrease less than the other subscores. Thus, the present study permits proposing the QUAVIAM for analysis of physical, mental, behavioural and socioprofessional impairment or improvements in AN patients.

Underreporting of food intake in obese "small eaters".

Thirty sedentary and stable weight obese women were classified as small, normal or large eaters depending on their report of 24 h energy intake (EI) through a dietary history questionnaire. For each subject, resting metabolic rate (RMR) was assessed through indirect calorimetry, physical activity through a self-administered questionnaire and psychological evaluation through psychometric tests. Neither RMR nor indices of physical activity were different between the three groups; however for small eaters, RMR was higher than reported EI (p < 0.001). Thus, the low EI reported by obese small eaters reflected an underreporting of food intake. Psychometric evaluation was not different between normal and large eaters. Small eaters exhibited a better perception of food size than normal or large eaters, and no difference in tests assessing memory or attention; their score (2.8 +/- 1.3) in a nutritional dissimulation test was higher (p = 0.015) than that of normal (1.0 +/- 0.7) or large eaters (1.5 +/- 0.09). This suggests that underreporting in obese small eaters might be due to specific nutritional concealment; because small eaters reported a low intake particularly in foods which are often perceived as unhealthy (fats, sugars, extra-prandial consumption), they probably reported what, in their opinion, they should have eaten, instead of what they did eat.

Early or late monitoring of stimulation of ovulation for in-vitro fertilization? A methodological discussion of a randomized study.

Two GnRH agonist long-stimulation protocols, in association with HMG, are compared on a random basis. Group A (n = 53) was monitored daily from the 6th day of stimulation, whereas monitoring in group B (n = 55) began on the 11th day of stimulation. There was no significant difference in the numbers of follicles which matured, the numbers of collected oocytes, the numbers of embryos obtained in vitro and the clinical pregnancy rate. But the power of such a study is very weak (6%). It would have been necessary to include greater than 1000 patients in each group to obtain a bioequivalence test. Such a study is unrealistic for a single centre and multicentric studies are very difficult to achieve because of practical difficulties. A pooled analysis is perhaps the methodological answer.

[RU 486 and induction of labor in 3d trimester pregnancy interruptions. Preliminary clinical studies]. / RU 486 et déclenchement du travail dans les interruptions du troisième trimestre de la grossesse. Etude clinique préliminaire.

The authors report 12 cases of induction of labour which was carried out with the help of RU 486 in the 3rd trimester of pregnancy (mean duration of the pregnancy 34.2 weeks). Nine cases had malformed fetuses and 3 cases had normal infants. In 6 cases out of the 12 delivery took place within 48 hours after RU had been administered by itself and in 3 cases induction with Syntocinon was helped when RU was given beforehand. In 3 cases the live-born children showed no secondary ill effects.