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Disease Knowledge Centres

Family Medicine - Disease Topic Overview

Family medicine or general practice is a specialty, often practiced in the community, which provides primary treatment for many diseases.¹ It is a specialty that diagnoses and treats patients of all ages, and is not limited a specific group of diseases. However, if more specialist knowledge is required, patients are often referred to hospital based colleagues. This has led to general physicians actively co-ordinating patient care.

Children are monitored from birth to ensure that they grow and develop normally, both physically and mentally. Vaccination programmes were introduced in 1974 and are followed to protect children from potentially fatal or disabling infectious diseases, thus reducing childhood morbidity and mortality rates.²

The majority of pre- and post-natal care is provided in the family/general practice, by the physician, nurse, or health visitor. They will confirm pregnancy and monitor the health of both mother and fetus. Following birth the support is given to the mother and she is monitored for post-natal depression which affects 10%-22% of all mothers.³

People visit their general practitioner (GP) throughout life for a variety of reasons. The most common reasons that people in the England visit their GP are; muscle ache, cough and skin infections.1 Family medicine is also responsible for providing preventive medicine, such as screening, as well as monitoring and managing existing conditions.

1. Taylor R.J. et al. General Practice Medicine: An Illustrated Colour Text. Elsevier Health Science. 2003 : 2-15.
2. Bärnighausen T.et al. Rethinking the Benefits and Cost of Childhood Vaccinations: The Example of Haemophilus Influenzae Type B Vaccine. Vaccine. March 2011 ; 29 (13) : 2371-2380.
3. Grussu P. et al. Prevalence and Risk Factors for a High Level of Postnatal Depression Symptomatology in Italian Woman: A Sample Drawn from Antenatal Classes. European Psychiatry. June 2009 ; 24 (5) : 327-333.

SGLT2-Inhibitors eCME Webcast

Type 2 Diabetes Mellitus affects approximately 20.66 million people across the UK, France, Germany, Spain and Italy¹. This leads to many complications including macrovascular and microvascular disease. Glycaemic control in diabetes is particularly important in reducing these complications; a 1% fall in HBA1C results in a 37.5% and 42.5% reduction in microvascular and peripheral vascular disease respectively².

There are numerous treatments for Type 2 Diabetes Mellitus. These act on receptors within various organs including the pancreas, muscle, adipose tissue, gastrointestinal tract and liver. A new class of drugs, SGLT2-Inhibitors act on the kidney, which itself plays an important role in glycaemic control.

The eCME webcast entitled SGLT2-Inhibitors: Assessing the Evidence and the Potential Impact on Future Clinical Practice is ACCME/EACCME accredited. This activity has been designed to inform healthcare professionals on Type 2 Diabetes Mellitus and the role of SGLT2-Inhibitors in the treatment of this disease. To access the eCME accredited webcast click here.

References
1. IDF Diabetes Atlas 2010. http://www.idf.org/atlasmap/atlasmap.
2. Stratton, I. et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321: 405-412.

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The eCME webcast entitled SGLT2-Inhibitors: Assessing the Evidence and the Potential Impact on Future Clinical Practice is ACCME/EACCME accredited. This activity has been designed to inform healthcare professionals on Type 2 Diabetes Mellitus and the role of SGLT2-Inhibitors in the treatment of this disease.

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ADHD

Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous neurobehavioural disorder characterised by inattention, hyperactivity and impulsivity.¹ ADHD is one of the most common neurobehavioural disorders of childhood,^1,2 but can continue to cause impairment throughout adolescence and into adulthood.³

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Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous neurobehavioural disorder characterised by inattention, hyperactivity and impulsivity.¹ ADHD is one of the most common neurobehavioural disorders of childhood,^1,2 but can continue to cause impairment throughout adolescence and into adulthood.³

Learn more about ADHD… by visiting the ADHD Institute

Diagnosis of ADHD often occurs based on the history of ADHD symptoms, which usually develop before the age of 7 years⁴ and are often first noticed in the school setting. This is because the characteristic symptoms of inattention, impulsivity and hyperactivity are problematic in social and school environments.⁵ Teachers in particular may be very well placed to identify ADHD symptoms when children start school.⁶ Symptoms can persist through adolescence and into adulthood.⁷

Learn more about the diagnosis of ADHD…

The aim of treatment is to manage the symptoms of ADHD and improve psychological, social, educational and occupational functioning.⁸ In this respect, treatment should encompass pharmacological and behavioural approaches. Due to the chronic nature of ADHD, a management programme should be put in place that takes into account the need for treatment and monitoring over time.⁹ A guide to managing ADHD may involve setting out desired improvements following discussions with the patient, the treating clinician and, if appropriate, parents, carers and school teachers. It may also be appropriate to set goals for treatment.⁹

Learn more about the treatment options for patients with ADHD…

A range of additional resources are also available. These include; a discussion forum , ADHD Institute meetings, congress reports, a congress calendar and useful links.

References:
1. Remschmidt H. Global consensus on ADHD/HKD. Eur Child Adolesc Psychiatry 2005; 14: 127-137.
2. Brown RT, Freeman WS, Perrin JM, et al. Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics 2001; 107: e43.
3. Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46: 894-921.
4. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (Text Revision): DMS-IV-TR.
5. Faraone SV, Doyle AE. The nature and heritability of attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2001; 10: 299-316, viii-ix.
6. National Institute for Health and Clinical Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults, 2008. Available from http://www.nice.org.uk/nicemedia/pdf/CG072NiceGuidelinev4.pdf. Accessed 1 October 2010.
7. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36: 159-165.
8. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108: 1033-1044.
9. Quinlan DM. Assessment of attention deficit/hyperactivity disorder and comorbidities. In: Brown TE (Ed). Attention-deficit Disorders and Comorbidities in Children, Adolescents, and Adults (1st ed). Washington, DC: American Psychiatric Press Inc, 2000.

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Alzheimer's Disease
Alzheimer's disease (AD) is a progressive, neurodegenerative disease which will affect most of us at one point in time - either directly (as the prevalence is expected to quadruple over the next 50 years) or indirectly through the suffering of a loved one.

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Alzheimer's disease(AD) is a progressive, neurodegenerative disease which will affect most of us at one point in time, and it’s prevalence increases with age.

In the early stages in particular, dementia is often difficult to diagnose, since many symptoms are not recognized as such or are trivialized by the patient. 20% of actual dementia cases are reported to be incorrectly diagnosed as a different disease.

In early dementia the symptoms of Alzheimer’s disease include memory loss, disorientation and confusion. These symptoms are caused by the loss of neurons and worsen with continuous neurodegeneration. The pathology of dementia is not solely the result of a cholinergic deficit. It is known that, chronically and pathologically elevated glutamate concentrations play an important role.

In general two main groups of dementia can be distinguished, requiring different types of treatment:
- Cerebro-organic (primary) forms of dementia
- Non-cerebro-organic (secondary) forms of dementia
Depending on the stage of the disease, clinical symptoms of varying intensity dominate. With the progression of AD, treatment is aimed particularly at improving and stabilizing personal everyday functions, so as to keep patients independent for as long as possible.

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Atopic Dermatitis
Atopic dermatitis is a highly prevalent disease in developed countries, affecting 10-30% of children and 1-3% of adults in developed countries. Often referred to as 'eczema', atopic dermatitis is a chronic inflammatory skin disorder that starts in childhood and can persist into adolescence and adulthood.

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Atopic dermatitis, a chronic inflammatory skin disorder, affects 10-30% of children and 1-3% of adults^1,2 in developed countries.

Atopic dermatitis has traditionally been characterised by periods of exacerbations, known as flares, interspersed with periods of apparent remission.³ It affects patients to varying degrees and is categorised as mild, moderate or severe. The progression of atopic dermatitis also differs considerably from person to person.

The precise cause of the disease is poorly understood but the most common form, extrinsic atopic dermatitis, is strongly associated with a hypersensitivity reaction to environmental allergens.

The specific combination of signs and symptoms associated with atopic dermatitis varies from person to person. However, patients will usually suffer from dry, erythematous skin, with pruritus being a core symptom of the condition.

Following a diagnosis of atopic dermatitis, the choice of management strategy depends on the severity of the condition, and should take into account the patient's and their family's needs and concerns.

There are a number of different treatment options currently available for atopic dermatitis including non-pharmacological options like emollient creams to improve symptoms, and pharmacological options, such as topical corticosteroids or topical calcineurin inhibitors.⁴

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What's in the Atopic Dermatitis Knowledge Centre?
References

1. Leung DY, Boguniewicz M, Howell MD, et al. New insights into atopic dermatitis. J Clin Invest 2004; 113: 651-7.
2. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 1998; 351: 1225-32.
3. Langan SM, Thomas KS, Williams HC. What is meant by a ""flare"" in atopic dermatitis? A systematic review and proposal. Arch Dermatol 2006; 142: 1190-6.
4. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993; 186: 23-31.

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Cholesterol

An elevated level of low-density lipoprotein cholesterol (LDL-C) is a form of dyslipidaemia that has been shown to be strongly associated with an increased risk of developing atherosclerosis and cardiovascular disease (CVD), leading to cardiovascular events.

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Diagnosing and managing coronary heart disease (CHD) can be challenging. In most patients, it takes years or even decades before the underlying coronary pathology leads to clinical manifestations. Major emphasis is needed in controlling overall cardiovascular risk factors in CHD as risk factor control remains poor in these patients and increases the risk of an event.¹

The Cholesterol Knowledge Centre offers you a range of tools that will help you identify, diagnose and decide upon an appropriate treatment strategy for your patients at risk of CHD. The Centre's educational aids will allow you to keep up to date with the latest research, recommendations and guidelines. It also offers you tools to help you keep your patients engaged in their therapy, thereby significantly reducing their risk of future cardiovascular events.
ENTER the Cholesterol Knowledge Centre

References
1. Graham I et al. Eur J Cardiovasc Prev Rehab 2007; 14: E1-E40

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Diabetes

Diabetes is a disease that currently affects approximately 285 million people worldwide and this figure is only expected to increase1. For Europe, the IDF estimates that 55.2 million, or 8.5% of the population aged 20 to 79 years, have diabetes. This is expected to rise to 66.2 million (10.0%) by 2030. Further information on the scale of the type 2 diabetes problem can be found in the overview section of the knowledge centre.

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Diabetes is a disease that currently affects approximately 285 million people worldwide and this figure is only expected to increase1. For Europe, the IDF estimates that 55.2 million, or 8.5% of the population aged 20 to 79 years, have diabetes. This is expected to rise to 66.2 million (10.0%) by 2030. Further information on the scale of the type 2 diabetes problem can be found in the overview section of the knowledge centre.

Complications associated with diabetes mellitus include hypertension, cardiovascular disease, retinopathy, kidney damage, foot ulceration and nerve damage. Discover more about the complications connected to diabetes mellitus, as well as acceptable blood glucose and HbA1C levels and how these differ in people with diabetes mellitus here.

The majority of patients with type 2 diabetes are obese and/or have an increased proportion of visceral fat, factors which in themselves are associated with insulin resistance. Other risk factors include increasing age and sedentary lifestyle. There is also a strong genetic predisposition to type 2 diabetes².

Chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction and failure of various organ systems. Early diagnosis, adequate treatment to control hyperglycaemia, and management of associated risk factors and complications therefore are all essential to reduce the burden of diabetes. Effective screening strategies are therefore of particular importance in reducing this burden. Discover the diagnostic tests necessary to diagnose type 2 diabetes mellitus and intermediate hyperglycaemia or pre-diabetes.

The early and aggressive treatment and management of diabetes mellitus is important for a successful long term outcome in patients with diabetes mellitus. The use of oral agents and lifestyle changes are the generally accepted early treatments followed later by insulin therapy. Current treatment algorithms and IDF guidelines should be used to find the appropriate treatment regime for individual patients.

As with many diseases, our knowledge of diabetes mellitus is increasing through research. Recent developments include the use of new treatments and guidelines in clinical practice. There has been an update to the IDF guidelines concerning GLP-1 agonists. DPP-4 inhibitors are now used in the treatment of diabetes, and SGLT-2 inhibitors are being investigated for this use.

References

1. Unwin, N. et al. The IDF Diabetes Atlas: Providing Evidence, Raising Awareness and Promoting Action. Diabetes Res Clin Pract 87, 2-3 (2010).

2. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 33 Suppl 1, S62-9 (2010).

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Hypertension
Hypertension, an increasingly common and chronic disease, and its consequences like stroke, coronary heart disease, heart failure and renal damage mean an enormous financial burden for the community.

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Hypertension, an increasingly common and chronic disease, and its consequences like stroke, coronary heart disease, heart failure and renal damage mean an enormous financial burden for the community. The risk of cardiovascular morbidity and mortality is proportional to the degree of systolic or diastolic blood pressure elevation at any age and in either sex, and is markedly influenced by risk factors commonly associated with BP elevation.

The term “isolated systolic hypertension” (ISH) describes raised systolic blood pressure with normal or low diastolic blood pressure. Some guidelines recognise two grades of isolated systolic hypertension:^1,3

Increasingly, attention is becoming focused on systolic, rather than diastolic, blood pressure as the major factor to control in patients older than 50 years with essential hypertension.^1,2 Elevated systolic blood pressure (SBP) is a powerful predictor of all-cause mortality, coronary artery disease, stroke and renal disease.⁴

Diagnostic procedures are aimed at: establishing blood pressure levels; identifying secondary causes of hypertension; evaluating the overall cardiovascular risk.

It is now widely recognised that elevated blood pressure is frequently associated with obesity, insulin resistance and dyslipidaemia. The clustering of these symptoms has given rise to the concept of the ‘metabolic syndrome’, which carries a high risk of diabetes and cardiovascular disease.

Guidelines on modern management of hypertension reflect a more preventive approach with reduced target BP and risk factor evaluation. Initiation of antihypertensive treatment is based on two criteria; total level of cardiovascular risk and level of systolic and diastolic BP.

Lifestyle inverventions should be instituted whenever appropriate in all patients. Pharmacological therapy should be started gradually, and target BP achieved progressively. To reach target BP, a large proportion of patients will require combination therapy.

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What’s in the Hypertension Knowledge Centre?
References

1. Williams B, Poulter NR, Brown MJ, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004 - BHS IV. J Hum Hypertens 2004;18:139-185
2. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003;289:2560-2572
3. ESH Guidelines Committee. 2003 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21(6):1011-1053
4. Brooks DP, Ruffolo RR. Pharmacological mechanism of angiotensin II receptor antagonists: implications for the treatment of elevated systolic blood pressure. J Hypertens 1999;17(Suppl 2):S27-S32

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Insomnia
Insomnia is a very common and debilitating disease with major morbidity and social consequences. Despite the negative impact on the ability to function well during the day, insomnia is underdiagnosed and undertreated.

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Insomnia is a very common and debilitating disease with major morbidity and social consequences. Despite the negative impact on the ability to function well during the day, insomnia is underdiagnosed and undertreated. Insomnia is therefore, important to treat. However, treatment has been difficult due to concerns over current treatment options, both from a patient and physician perspective.

Various methods are used to monitor the different stages of sleep. Sleep is not homogenous – its structure, characterised by a sequence of sleep stages, is referred to as ‘sleep architecture’

Traditionally insomnia has been diagnosed on the basis of quantity of sleep
- Sleep latency (time taken to get to sleep)
- Sleep duration (length of time spent asleep)
While it is important not to ignore quantity of sleep, epidemiological surveys show that poor quality of sleep has a greater negative impact on health, well-being and satisfaction with life than the quantity of sleep a person gets.^1,2

Hormones released in the body are involved in certain aspects of homeostasis, including regulating the circadian rhythms established by the SCN of the hypothalamus. Melatonin is an endocrine hormone that is principally produced and released into the blood by the pineal gland. The levels of melatonin fluctuate according to light exposure (highest during darkness and sleep, and lowest in bright sunlight) and it is proposed that melatonin acts as a time ‘cue’, entraining the body’s circadian rhythm to conventional environmental patterns.

Although behavioural and psychological factors have been shown to play an important causative role in many sleep disorders, non-pharmacological/behavioural approaches are underused in the management of these conditions.^3,4

A number of resources for both patients and physicians are avaliable within this Insomnia website.

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What’s in the Insomnia Knowledge Centre?
References

1. Zammit GK, Weiner J, Damato N et al. Quality of life in people with insomnia. Sleep 1999; 22 Suppl 2: S379-85
2. Pilcher JJ. Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res. 1997; 42(6): 583-96
3. National Institute of Health. NIH State of the Science Conference statement on manifestations and management of chronic insomnia in adults statement. J Clin Sleep Med 2005; 1 (4): 412–421.
4. Subramanian S, Surani S. Sleep disorders in the elderly. Geriatrics 2007; 62 (12): 10–32.

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Osteoarthritis Perspectives
The EULAR (European League Against Rheumatism) 2011 satellite symposium was held in London in May 2011. The symposium entitled Clinical Choices in Osteoarthritis Pain Management – Evidence Versus Practice: An Interactive Case-Based Assessment discussed the treatment regimens available for the treatment of OA.

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Osteoarthritis (OA) is a debilitating rheumatological disease that causes significant morbidity; it affects 45% of women over 65 and is a major cause of disability¹. OA is characterised by the degeneration of articular cartilage in synovial joints causing bone hypertrophy. Although this is a disease with no cure, many treatments for OA symptoms are available. Many people with OA have co-morbidities which affect which treatments are appropriate.

A satellite symposium symposium entitled Clinical Choices in Osteoarthritis Pain Management – Evidence Versus Practice: An Interactive Case-Based Assessment which was held at the EULAR Congress 2011 in London, UK, discussed the the treatment regimens available for the treatment of OA.

This interactive webcast contains three multimedia presentations delivered by Michael Doherty MA MD FRCP FHEA, Marc C. Hochberg MD MPH and Francis Berenbaum MD PhD.The first presentation, presented by Michael Doherty, explains how evidence-based guidelines provide the tools for effective, individualised treatment for patients with OA. Marc C. Hochberg discusses the importance of identifying patients with gastrointestinal risk (GI) factors and specific treatments available for these people. Francis Berenbaum completes the webcast with a presentation on treatment of patients with both cardiovascular and GI risk factors.

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What's in the Webcast?
References

1. Chasm R.M. et al. Pediatric Orthopedic Emergencies. Emergency Medical Clinics of North America. November 2010 ; 28 (4) : 907-926

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Third Party Website - Asthma and COPD

Asthma is a disorder defined by its clinical, physiological, and pathological characteristics. The main physiological feature of asthma is episodic airway obstruction characterized by expiratory airflow limitation. The dominant pathological feature is airway inflammation, sometimes associated with airway structural changes.

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Understanding Asthma

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role.

The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.

Learn more about Asthma…by visiting our website

Understanding Chronic Obstructive Pulmonary Disease (COPD)

COPD’s pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.

Learn more about COPD…

Asthma Care

Asthma is a chronic disorder with significant impacts on patients, their family and society. Although there is no cure for asthma, appropriate management often leads to control of the disease.

Learn more about Asthma Care…

COPD Care

COPD is a progressive disease: lung function is expected to worsen over time. Therefore, adherence to therapy and a continuous assessment of the pathology progression are important.
Learn more about COPD Care…

Asthma Therapy

Asthma is a chronic disorder with significant impacts on patients, their family and society. Although there is no cure for asthma, appropriate management often leads to control of the disease.

Learn more about Asthma Therapy…

COPD Therapy

COPD is a progressive disease: lung function is expected to worsen over time. Therefore, adherence to therapy and a continuous assessment of the pathology progression are important.

Learn more about COPD Care…

Resources

A wealth of useful resources including a slide sharing portal, device area, expert’s tips, conference and events calendar and more.

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Latest Multi Media

A Description of TIME Wound Assessment and Treatment Strategies

Family Medicine Drug Data - A-Z English

Drug Updates

Difflam Oral Rinse

Difflam Oral Rinse is a locally acting analgesic and anti-inflammatory treatment for the relief of painful inflammatory conditions of the mouth and throat including: Traumatic conditions: Pharyngitis following tonsillectomy or the use of a naso-gastric tube.

Enalapril 5mg Tablets

Treatment of hypertension : All grades of essential hypertension and renovascular hypertension.

Viskaldix Tablets

Mild to moderate hypertension.

Latest Drug News

CHMP recommends Sancuso (ProStraken) for Nausea - 20-02-2012

The CHMP has adopted a positive opinion, recommending the granting of a marketing authorisation for the medicinal product Sancuso 3.1 mg/24 h transdermal patch from ProStraken Limited which is intended for the prevention of Nausea and Vomiting associated with moderately or highly emetogenic Chemotherapy. The active substance of Sancuso is granisetron.The benefits with Sancuso as compared to an oral formulation of granisetron are its ability to provide effective doses of granisetron for the course of the chemotherapy with single administration of the patch removing the need for repeated oral doses for patients who have difficulties to swallow.

Latest Social Media

Would CCTV cameras make you more likely to wash your hands?
on doc2doc

... information demonstrating impact of improved hand hygiene on hospital infection rates (Pittet, 2001). It is necessary that hospital ...

Would CCTV cameras make you more likely to wash your hands?
on doc2doc

... would have to prove an associated reduction in health care associated infections during / after the monitoring period to prove cost effectiveness for ...

Would CCTV cameras make you more likely to wash your hands?
on doc2doc

... is a great idea, In the US there are lots of physician related infections, and MRSA could be better controlled as well as other nasty bugs ...

Latest Clinical Trials

Blood Markers for Inflammation and Coronary Artery Vasoreactivity Testing in Patients With Chest Pain and Normal Coronary Arteries (ACOVA)

The investigators are hoping to discover the cause of chest pain in patients with a normal coronary arteriogram. For patients with chest pain coronary angiography is the standard method by which the blood vessels of the heart can be visualized and any narrowing can be assessed. In some cases the investigators find totally normal coronary blood vessels or only minor disease. Such a finding is associated with an excellent long term prognosis. However, as a large proportion of patients with normal coronary arteries or mild coronary narrowings often continue to experience recurrent chest pains the investigators are interested in understanding the mechanisms responsible for this. The investigators hypothesise that in many cases, coronary artery spasms are responsible for the recurrent chest pains. These spasms usually respond to treatment with drugs known as vasodilators. The acetylcholine test (ACH-test) has been recommended by the European Society of Cardiology and the American College of Cardiology as a diagnostic test. This test can reveal whether the coronary blood vessels have a tendency to go into spasm. The investigators plan in this study to carry out the test in patients who have chest pains suggestive of coronary narrowings but are found to have normal or only mildly narrowed coronary arteries on angiography. A positive test -indicating a tendency for spasm- may help guiding therapy with vasodilators, which are often very effective to prevent coronary spasms. The investigators would also like to take blood samples during the test (before and after) from every patient to measure blood markers and see if there is a relation between these markers and the result of the ACH-test.

Observatory of Screening Aneurysms of the Abdominal Aorta During Echocardiography. National Epidemiological Survey (E2T3A)

Study of the prevalence of Abdominal Aortic Aneurysms (AAA) (> 3 cm) in patients with echocardiography (transthoracic or) during a specific day, with cardiologists in France. This is a cross-sectional epidemiological investigation, assembling evidence from a routine ultrasound screening for AAA at the waning of echocardiograms performed during a specific day. The study will be offered a list of centers selected by the Scientific Committee in the complete list of locations being in France, the subsidiary of echocardiography Echocardiography of French Society of Cardiology. These centers will be 500 in number representative of the French centers, geographically and by type of centers.

Latest Journal Publications

Archives of Gerontology and Geriatrics

The more support elderly people have from their family, the less likely they are to suffer from chronic diseases. The objective of this study is to investigate how family support affects the PA middle-aged and elderly people engage in before and after they suffer from chronic diseases. We interviewed 428 middle-aged and elderly people using a structured questionnaire to measure their aerobic PA. Eighteen percent of middle-aged and elderly people did participate in PA after suffering from chronic diseases. Using multivariate logistic regression models, we found that middle-aged and elderly people who rely on family members when they are sick (OR=1.87, 95%CI=1.08–3.25) and who are accompanied by family members (OR=2.09, 95%CI=1.20–3.62) when they are healthy are more likely to exercise. The more middle-aged and elderly people are supported by their family, the more likely they are to exercise. Strengthening family relationships should help reduce the prevalence of chronic diseases among middle-aged and elderly people.

Archives of Gerontology and Geriatrics

Malnutrition is a frequent complication for elderly demented patients even if they live at their own home with the assistance of a caregiver. The present study evaluates nutritional characteristics of a population of 130 non-institutionalized demented patients. The results show that the mini nutritional assessment (MNA) total score is inversely related with the neuro-psychiatric inventory (NPI) score and that the level of cognitive impairment is related with the nutritional status: patients with mild cognitive impairment (MCI) showed a mean MNA score higher than patients affected by Alzheimer's disease (AD) or vascular dementia (VaD). Moreover, patients depressed, with hallucinations or with behavioral disturbs are more exposed to underfeeding than only cognitively impaired subjects. In conclusion, an appropriated evaluation of nutritional status could prevent and treat nutrition-related problems even in the elderly demented patients living at home.