Perceptions of homeopathy in supportive cancer care among oncologists and general practitioners in France.

OBJECTIVES: In France, homeopathy is the most frequently used complementary therapy in supportive care in oncology (SCO); its use is steadily increasing. However, data is limited about the perception and relevance of homeopathy by oncologists and general practitioners (GPs) both with and without homeopathic training (HGPs and NHGPs, respectively). Our aim was to evaluate French physicians' perceptions of homeopathy to clarify its place in SCO through two original observation survey-based studies. MATERIALS AND METHODS: Two cross-sectional surveys of French physicians were conducted involving (1) 150 specialist oncologists; (2) 97 HGPs and 100 NHGPs. Questions evaluated physician attitudes to homeopathy and patterns of use of homeopathic therapies in patients requiring SCO. Survey responses were described and analyzed on the basis of physician status. RESULTS: Ten percent of oncologists stated they prescribe homeopathy; 36% recommend it; 54% think that homeopathy is potentially helpful in SCO. Two-thirds of the NHGPs sometimes prescribe homeopathy in the context of SCO and 58% regularly refer their patients to homeopathic doctors. HGPs have a positive perception of homeopathy in SCO. CONCLUSIONS: Homeopathy is viewed favorably as an integrated SCO therapy by the majority of French physicians involved with cancer patients-oncologists and GPs. Symptoms of particular relevance include fatigue, anxiety, peripheral neuropathy, sleep disturbance, and hot flashes. In such clinical situations, response to conventional therapies may be suboptimal and homeopathy is considered a reliable therapeutic option. These two studies highlight the fact that homeopathy has gained legitimacy as the first complementary therapy in SCO in France.

Safety of low-molecular-weight heparin in pregnancy: a systematic review.

Unfractionated heparin (UFH) remains the anticoagulant of choice during pregnancy. Low-molecular-weight heparins (LMWH) are an attractive alternative to UFH due to their logistic advantages and their association with a lower incidence of osteoporosis and HIT. We reviewed all published clinical reports concerning the use of LMWH during pregnancy. In addition, participants of an international interest group contributed a cohort of pregnant women treated with LMWH. Pregnancies were divided into two groups; those with and those without maternal comorbid conditions. The number of adverse fetal outcomes and the occurrence of maternal complications were evaluated in the two groups. In the group of women with comorbid conditions (n = 290), 13.4% of the pregnancies were associated with an adverse fetal outcome. In contrast, in the group of women without comorbid conditions (n = 196), 3.1% were associated with an adverse outcome, which is comparable to that seen in the normal population. We conclude that LMWH appear to be a safe alternative to unfractionated heparin as an anticoagulant during pregnancy.

Fetal heart rate patterns in postasphyxiated fetal lambs with brain damage.

OBJECTIVE: We previously showed that in asphyxiated fetal lambs the duration of hypotension correlated well with the severity of histologic damage to the brain, whereas the duration of bradycardia did not. This study compares fetal heart rate patterns with the degree of histologic damage to the brain. STUDY DESIGN: Twelve chronically instrumented near-term fetal lambs were subjected to asphyxia by umbilical cord occlusion until fetal arterial pH was <6. 9 and base excess was <-20 mEq/L. An additional 4 fetuses served as sham-asphyxia controls. Fetal heart rate (from electrocardiogram), arterial blood pressure, fetal breathing movements, and electrocorticogram were continuously monitored before, during, and for 72 hours after asphyxia. Fetal brain histologic features were categorized as mild (group 1, n = 5), moderate (group 2, n = 4), and severe (group 3, n = 3). Long-term fetal heart rate variability expressed as amplitude range was assessed visually every 5 minutes from 30 minutes before asphyxia until 2 hours of recovery and at 6, 12, 24, 48, and 72 hours of recovery. RESULTS: Long-term fetal heart rate variability amplitude decreased from 32 +/- 17 beats/min (mean +/- SEM) preocclusion to 4 +/- 13 beats/min at the end of occlusion (P <.001) without significant differences among the 3 groups. During 10 to 45 minutes of recovery, the long-term variability of group 1 was significantly greater than that of groups 2 and 3. At 24 to 72 hours of recovery, the long-term variability of groups 1 and 2 was significantly higher than that of group 3, which was almost 0. The "checkmark" and sinusoidal fetal heart rate patterns were observed during the recovery period in groups 2 and 3. CONCLUSIONS: Decreased long-term fetal heart rate variability and the "checkmark" and sinusoidal fetal heart rate patterns were indicators of the severity of asphyxial histologic damage in the fetal brain.

Modelling mortality and morbidity of newborns.

Data of 10,514 singleton births collected over a ten year period at a single hospital are analysed and models linking birthweight and gestational age with mortality and morbidity defined by low Apgar scores are constructed and compared. Based on these models, charts of mortality and morbidity are drawn and compared with common charts of birthweight centiles. Classification rules for newborns at risk are defined by iso-mortality contours, marginal birthweight centiles, and birthweight centiles adjusted by gestational age, respectively, and compared using receiver operating characteristic (ROC) curves. The results suggest that, as far as neonatal mortality is concerned, classification rules based on simple marginal birthweight centiles perform almost as well as iso-mortality contours and considerably better than birthweight centiles adjusted for gestational age.

[Coping with loneliness: evaluation of a group course for elderly widows]. / Omgaan met alleenstaan: evaluatie van een groepscursus voor oudere weduwen.

The present study was designed to evaluate a group course of 11 sessions, aimed at reducing loneliness in elderly widows. Twenty widows participated (mean age: 67 yrs), who were all reasonably or very satisfied with the experience of participation as well as with the format and leadership of the course. At the beginning of the course, loneliness was a problem for each participant, and questionnaire scores for depression, well-being and social contacts (i.e. loneliness) were unfavourable. At the end of the course, one third of the participants indicated on an evaluation form that feelings of loneliness had become less intense. The corresponding questionnaire scores, however, did not improve significantly. However, rather large positive changes were found for depressive symptoms and for positive social support, which were maintained at a 3-month follow-up measurement. The participants with higher depression scores were also the ones who showed the largest gain, although their scores remained in the pathological range. It is concluded that the latter participants suffer from more serious psychological problems than is desirable in view of the aims of the course. Adaptation of the aims and contents of the course should be considered, so that individual pathology can be more adequately addressed.

[Massive fetal-maternal hemorrhage at term associated with a choriocarcinoma]. / Hémorragie foeto-maternelle massive à terme associée à un choriocarcinome.

A case of malignant choriocarcinoma produced a major feto-maternal transfusion at term. This was proven using routine Kleihauer's test. The newborn died on the 5th day of life from haemorrhagic shock. The diagnosis of choriocarcinoma was made when acute post-partum haemorrhage occurred together with a high level of Beta HCG. The patient was cured by the use of Methotrexate followed by four courses of tri-chemotherapy (Methotrexate, Actinomycin and Cyclophosphamide). After treatment for secondary infertility, the patient had two normal pregnancies. This case makes possible to point out again the possible association of a positive Kleihauer test with choriocarcinoma. It also points out strongly the value of carrying out Beta HCG testing when bleeding occurs post-partum. Early diagnosis improves the maternal prognosis and allows conservative treatment to be carried out in cases of choriocarcinoma in young women.

[Weight and length of newborns. Differences between boys and girls]. / Poids et taille du nouveau-né. Différences entre garçons et filles.

Examination of 8,312 deliveries shows that the difference in weight between boys and girls at birth can be explained completely by the difference in their length. The sex of the child has no influence on the length of the pregnancy. This is influenced by the birth order, the propensity to smoke (tobacco), the mother's weight gain in pregnancy and her social level. The speed of intrauterine growth is influenced by the sex of the fetus, the number of pregnancies she has had, by tobacco, and by the amount of education she has had and her weight gain in pregnancy.

Preterm premature rupture of the membranes: neonatal outcome in 215 cases of an active conservative management.

The aim of the study is to evaluate an active conservative management (tocolysis and antibiotics administration) in preterm premature rupture of the membranes (PROM), applied to 215 singleton pregnancies. Pregnancies are continued until 37 weeks of gestation if the clinical and biological follow-up shows no risk for the mother and the fetus. The neonatal results were analysed by statistical methods and were compared to the outcome of a control group of premature neonates. Our results show that the outcome is mostly determined by gestational age at membrane rupture. No benefit nor risk was added when glucocorticoids were administrated. Clinical suspicion of chorioamnionitis increases the risk of neonatal infection. A prolonged latency period (greater than or equal to 7 days) does not increase the maternal or fetal infection risk. When birth happened before 35 weeks and before 37 weeks, the premature neonate after PROM has a lower incidence of hyaline membrane disease and neonatal death compared with the control group. These results are in favor of an active conservative management in PROM.