Anne-Françoise Gaudin

Prevalence and clinical characteristics of migraine in France

Objective To determine the prevalence and clinical features of migraine and related headache types in France. Methods The authors recruited a population of subjects with headache representative of the national population using a stratified sampling method. They screened 10,585 subjects aged 15 and older who were representative of the general population. They identified 1,486 of these as having headaches, and these subjects were subsequently interviewed for information on clinical features, natural history, and functional impact of headache. The authors categorized subjects based on the International Headache Society (IHS) classification and assessed disability using the MIDAS questionnaire. Results The authors found a standardized prevalence for migraine (IHS categories 1.1 and 1.2) of 7.9% (11.2% for women and 4.0% for men) and 9.1% for migrainous disorder (IHS category 1.7). Migraine attacks were associated with a considerable degree of handicap in activities of daily living, with a MIDAS grade distribution of 74.7% (grade 1), 13.3% (grade 2), 7.7% (grade 3), and 4.3% (grade 4). The prevalence of migraine with MIDAS grade 3 or 4 was 1.6%. Conclusions The prevalence of migraine (IHS categories 1.1 and 1.2) in France is 7.9%, and that of total migraine is 17.0%; this does not seem to have evolved over the past 10 years.

Prevalence and description of chronic daily headache in the general population in France

&NA; The objective of this study was to describe the epidemiology, clinical presentation and consequences of chronic daily headache (CDH) in France. A representative nation‐wide sample of the general population was identified using a stratified sampling method. Ten thousand five hundred and eight‐five subjects were screened in face‐to‐face interviews, and data collected using a standard questionnaire. An overall point prevalence of CDH in the general population of 2.98% was observed. Two‐thirds of these subjects presented migraine‐like features. Severity, functional impact and healthcare consumption were higher than in subjects reporting episodic migraine in the same sample. Of the subjects, 28.2% reported the most severe migraine disability assessment scores (Grades 3 and 4), compared to 12% of episodic migraineurs. A qualité de vie et migraine score of 68.4 was observed, indicating severely attenuated quality of life. Only 6.6% of subjects were taking prophylactic treatment, whilst 88% were using non‐specific acute headache treatments. The frequency of physician consultations and laboratory examinations was significantly higher than in individuals with episodic headache. CDH is thus a relatively prevalent condition in the general French population, associated with an important burden of suffering and with considerable expenditure in the health service. Management of this condition is generally inappropriate.

Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL)

AIMS To assess the impact of irritable bowel syndrome (IBS) on patient-reported health-related quality of life (HRQOL). METHODS Two HRQOL instruments were administered by telephone interviews to a sample of 253 IBS French patients recruited from the general population. IBS was diagnosed according to the Manning, Rome I and Rome II criteria. Patients with organic diseases were excluded from the study. A generic instrument, the Short Form 36 (SF-36), and an IBS disease-specific instrument, the IBSQOL, were used. RESULTS Patients with IBS had statistically significant (P<0.05) lower scores for all SF-36 QOL domains compared with the general French population. Women (N=192) reported significantly (P<0.05) poorer HRQOL on both the SF-36 and the IBSQOL scores than men (N=61) for all domains except energy on the SF36 and the sleep on the IBSQOL. HRQOL deteriorated with time since onset of IBS symptoms for some domains such as diet. For both instruments, a positive correlation was observed between low scores and intensity of pain and discomfort. IBS patients with a predominance of diarrhea (N=72) exhibited significantly greater impairment of HRQOL in the emotional domain than IBS persons with constipation predominance (N=65) (P<or=0.05). CONCLUSION IBS has a significant impact on HRQOL of patients. In addition, specific characteristics such as gender, symptom severity and time since onset of symptoms are predictive of more impaired health-related quality of life.

Impact of Headache on Quality of Life in a General Population Survey in France (GRIM2000 Study)

Objectives.—The objectives of this study were to determine the impact of headache on health‐related quality of life in a nationwide sample of the French general population using a disease‐specific measure, the Qualité de Vie et Migraine (QVM), to compare quality of life in subjects reporting different headache to types, and to evaluate the relationship between quality of life and severity, frequency, associated disability, and treatment responsiveness of headaches.

Prevalence and features of osteoporosis in the French general population: the Instant study.

OBJECTIVES To determine the prevalence of diagnosed osteoporosis, the extent of treatment use and the incidence of fracture in a representative sample of the French general population. METHODS A cross-sectional epidemiological survey of osteoporosis in 2613 women over 45 years in the general population was conducted using a stratified random sampling method and face-to-face interviews. Information was collected on the diagnosis of osteoporosis, fracture history, treatments, clinical and sociodemographic variables. Variables potentially associated with fracture were evaluated using stepwise multivariate logistic regression analysis. RESULTS The overall prevalence of diagnosed osteoporosis was 9.7% [8.6%; 10.9%] and prevalence increased linearly with age. Overall, 155 women (61.0%) received osteoporosis treatment and treatment rates also increased with age. The most frequently prescribed treatments were bisphosphonates, in 50.3% of treated women. The treatment duration was over 2 years for 72.9% of treated women. Overall, 115 (45.3%) reported at least one previous fracture. Vertebral fractures were reported by 101 women (39.8%) and limb fractures by 41 women (16.1%). Multivariate logistic regression analysis identified fracture before the age of 40, menopause before the age of 40, use of sleeping pills, consultation with an eye specialist and history of cardiovascular disease as variables independently associated with fracture. CONCLUSIONS Osteoporosis in France appears to be under-diagnosed and under-treated. Awareness and management of risk factors for osteoporosis and fracture could thus be improved.

Calcium intake and the risk of osteoporosis and fractures in French women

OBJECTIVES To evaluate dietary calcium intake in postmenopausal women over 45 years of age and compare intake according to osteoporosis diagnosis and fracture history. METHODS A cross-sectional epidemiological survey of osteoporosis in postmenopausal women over 45 years in the general population was conducted using a stratified random sampling method and face-to-face interviews. Information was collected on osteoporosis diagnosis, fracture history and risk factors. Information on dietary calcium intake was collected using a validated questionnaire. RESULTS Two thousand six hundred and thirty-one women (mean age: 67.9+/-10.0 years) were included. Two hundred and fifty-four (9.7%) had received a diagnosis of osteoporosis by bone densitometry, of whom 154 (45.3%) reported at least one previous fracture. Total mean daily dietary calcium intake was 754 mg/day, of which dairy products (milk, cheese and others) were the principal source. Overall, 37.2% of the sample consumed<600 mg/day and 20.1% >1000 mg/d. The proportion of women consuming <600 mg/day increased with age (p=0.0028). No difference in mean daily calcium intake was observed between women with or without a diagnosis of osteoporosis or with or without fractures. CONCLUSIONS Mean dietary calcium intake in this population is well below that recommended in current national guidelines (> or =1500 mg/day), notably in those most at risk for fractures, such as women with a diagnosis of osteoporosis or those in older age groups. Intake does not appear to be influenced by osteoporosis diagnosis or fracture experience.

Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment

BackgroundAdherence to anti-osteoporosis treatments is poor, exposing treated women to increased fracture risk. Determinants of poor adherence are poorly understood. The study aims to determine physician- and patient- rated treatment compliance with osteoporosis treatments and to evaluate factors influencing compliance.MethodsThis was an observational, cross-sectional pharmacoepidemiological study with a randomly-selected sample of 420 GPs, 154 rheumatologists and 110 gynaecologists practicing in France. Investigators included post-menopausal women with a diagnosis of osteoporosis and a treatment initiated in the previous six months. Investigators completed a questionnaire on clinical features, treatments and medical history, and on patient compliance. Patients completed a questionnaire on sociodemographic features, lifestyle, attitudes and knowledge about osteoporosis, treatment compliance, treatment satisfaction and quality of life. Treatment compliance was evaluated with the Morisky Medication-taking Adherence Scale. Variables collected in the questionnaires were evaluated for association with compliance using multivariate logistic regression analysis.Results785 women were evaluated. Physicians considered 95.4% of the sample to be compliant, but only 65.5% of women considered themselves compliant. The correlation between patient and physician perceptions of compliance was low (κ: 0.11 [95% CI: 0.06 to 0.16]). Patient-rated compliance was highest for monthly bisphosphonates (79.7%) and lowest for hormone substitution therapy (50.0%). Six variables were associated with compliance: treatment administration frequency, perceptions of long-term treatment acceptability, perceptions of health consequences of osteoporosis, perceptions of knowledge about osteoporosis, exercise and mental quality of life.ConclusionCompliance to anti-osteoporosis treatments is poor. Reduction of dosing regimen frequency and patient education may be useful ways of improving compliance.

Characterisation of Patients with Postmenopausal Osteoporosis in French Primary Healthcare

BackgroundThe public health burden of osteoporosis is high, principally because of increased risk of fractures and associated morbidity, handicap and mortality. Osteoporotic fracture prevention is therefore an important public health goal. General practitioners (GPs) play a key role in the management of osteoporosis, both in ensuring timely diagnosis and in providing treatment. Little information is available on standards of care for postmenopausal women with osteoporosis in general practice.ObjectivesThe primary objective of this study was to describe risk factors and treatment in postmenopausal women with osteoporosis. Secondary objectives were to evaluate treatment compliance and to assess the impact of osteoporosis on quality of life.MethodsThis observational, cross-sectional, pharmacoepidemiological study was performed in a primary-care setting in France. A random sample of GPs recruited postmenopausal women with a diagnosis of osteoporosis who had been followed by the investigator for at least 2 years. At inclusion, investigators completed a questionnaire providing information on patient age, osteoporosis duration, risk factors and treatment history. The first three patients recruited by each investigator completed a questionnaire providing information on sociodemographic features, osteoporosis treatments and quality of life. Treatment compliance was quantified using the Test d’Evaluation de l’Observance and quality of life evaluated using the 12-item Short Form Health Survey (SF-12).ResultsOverall, 389 physicians included 3097 patients, of whom 1053 completed the patient questionnaire. Risk factors for osteoporotic fracture were identified in 2148 patients (69.4%), most frequently personal or maternal antecedents of osteoporotic fracture and a low body mass index. Of these, 946 (44.0%) presented more than one risk factor. At the time of diagnosis, 629 patients (59.7%) presented fractures, which involved the vertebrae in 51.7% of cases, the wrist in 40.5% and the hip in 5.4%. Older patients were more likely to have fractures at the time of diagnosis and to have multiple fractures. After diagnosis, at least one new fracture occurred in 201 patients (19.2%). Multivariate logistic regression analysis identified age >70 years, diagnosis at least 10 years previously, diagnosis based on the presence of a fracture, biochemical and haematological evaluation at the time of diagnosis, and a change in osteoporosis treatment in the previous 2 years as being significantly associated with incident fracture risk. At inclusion, 1019 patients (97.4%) were receiving treatment for osteoporosis, most frequently weekly bisphosphonates (71.6% of treatments). Most patients (81.0%) had been treated for at least 1 year. Treatment compliance was high in 61% of patients and low in <5%. Patient variables associated with high compliance were being retired, prescription of bisphosphonates and, among the bisphosphonate users, prescription of weekly formulations. SF-12 quality-of-life scores were low, ranging from 38.6 (energy/vitality) to 65.1 (social functioning) out of a possible maximum score of 100. Baseline variables associated with SF-12 physical component summary scores included age, height loss since menopause, diagnosis following a fracture, fracture incidence since diagnosis, time since diagnosis and treatment with bisphosphonates.ConclusionsIn this study of postmenopausal osteoporosis in the French primary healthcare setting, many women with osteoporosis were diagnosed following a fracture. Although most were treated with bone-consolidating drugs, compliance was suboptimal in a significant minority. Osteoporotic fracture was associated with reduced quality of life.

Use and Misuse of Triptans in France: Data from the Grim2000 Population Survey

The extent and nature of triptan use for headache relief has been evaluated in a large epidemiological survey in the French general population. Over 25 000 individuals were screened for headache and for triptan use. Of this sample, 290 triptan users were identified from whom extensive data on headache characteristics and healthcare resource consumption were obtained. The use of triptans is relatively infrequent, 0.2% in the general population, with only 7.5% of migraine sufferers using these drugs. The majority of triptan users were female (80%) and presented headache characteristics typical of migraine (80%). The remaining 20% of subjects were thus using triptans for headache types in which the utility of these drugs has not been demonstrated. Among migraineurs, triptan consumers reported more frequent and severe headaches than non-consumers, and reported a higher incidence of nausea and vomiting. The principal determinant of triptan prescription was consultation with a general practitioner (GP), which may itself have been triggered by the severity of the headaches. GPs, rather than specialists, are the primary prescribers of triptans in France.

Factors associated with regular cervical cancer screening

To identify the factors associated with regular cervical screening (CS) in the French female population.