Karine Baumstarck-Barrau

Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study

Background  Recombinant human TSH (rhTSH) has become the modality of choice for radioiodine remnant ablation (RRA) in low‐risk thyroid cancer patients.

Patient characteristics and determinants of quality of life in an international population with multiple sclerosis: Assessment using the MusiQoL and SF-36 questionnaires

Background: Multiple sclerosis (MS) can have psychological and socioeconomic consequences that affect patients’ health-related quality of life (HRQoL) as much as physical disability. Objective: To determine the clinical and sociodemographic factors affecting HRQoL in a large international study using the MS International QoL (MusiQoL) questionnaire. Methods: Patients aged >18 years with a diagnosis of MS for >6 months or clinically isolated syndrome (CIS) were enrolled. Sociodemographic and clinical data were recorded, and patients completed the MusiQoL and 36-item short form (SF-36) health survey questionnaires. Results: In total, 1992 patients from 15 countries were enrolled (mean [standard deviation] age: 42.3 [12.5] years; 70.5% women; 70.4% with relapsing–remitting MS). Multivariate multiple regression analyses identified lower educational level, higher Expanded Disability Status Scale (EDSS) score, cognitive impairment, being single and shorter time since last relapse as significant predictors of lower MusiQoL global index scores (p < 0.05). Older age, female sex, higher EDSS score, shorter time since last relapse and receiving current MS treatment were significant predictors of lower SF-36 physical component summary scores (p < 0.05). The SF-36 mental component summary score was linked to occupational status, inpatient/outpatient status, time since last relapse, and whether the patient was receiving MS treatment (p < 0.05). Conclusion: Sociodemographic and clinical factors are linked to HRQoL in patients with MS. Interventions that affect these factors might be expected to influence HRQoL.

Cognitive function and quality of life in multiple sclerosis patients: a cross-sectional study

BackgroundNearly half of all patients diagnosed with multiple sclerosis (MS) will develop cognitive dysfunction. Studies highlighted from no/weak impact to a strong impact of cognitive impairment on quality of life (QoL). The aim of this study was to assess the impact of cognitive dysfunction on self-reported QoL in MS patients while considering key confounding factors.MethodsDesign: cross-sectional study. Inclusion criteria: MS patients of any disease subtype. Data collection: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, disease duration); MS disability (Expanded Disability Status Scale, EDSS); depression (Beck Depression Inventory); fatigue (Modified Fatigue Impact Scale); QoL (SF36 and MusiQoL); and neuropsychological performance (Brief Repeatable Battery of Neuropsychological Tests, BRB-N). Statistical analysis: multiple linear regressions (forward-stepwise selection).ResultsOne hundred and twenty-four patients were enrolled. Performance on BRB-N subtests varied widely (6% to 70% abnormal). The BRB-N classified 37-78% of the patients as cognitively impaired, depending on the definition of cognitive impairment. No links were found between the MusiQoL index and cognitive subtests, whereas marital status, EDSS, and depression were found to be independent predictive factors.ConclusionsThe present study demonstrated the weak and scarce association between cognitive impairment and QoL, when the key confounding factors were considered. These results need to be confirmed with larger samples and more accurate tests of cognitive function.

Iodine Biokinetics and Radioiodine Exposure after Recombinant Human Thyrotropin-Assisted Remnant Ablation in Comparison with Thyroid Hormone Withdrawal

CONTEXT A few prospective studies have evaluated the use of recombinant human TSH (rhTSH) for radioiodine remnant ablation. OBJECTIVE Our objective was to compare the effects of the both TSH regimens on iodine biokinetics in the thyroid remnant, dosimetry, and radiation protection. DESIGN We conducted a prospective randomized study. MATERIALS AND METHODS Eighty-eight patients were enrolled for radioiodine ablation to either the hypothyroid or rhTSH arms. A whole-body scan was performed at 48 and 144 h after therapy. Dose rates were assessed at 24, 48, and 144 h. Urinary samples were obtained during the first 48 h. Thyroglobulin was assessed before and after therapy. Iodine biokinetics in the remnants were calculated from gamma-count rates. Radiation-absorbed dose was calculated using OLINDA software. Exposure estimation was based on a validated model. RESULTS The effective half-life in the remnant thyroid tissue was significantly longer after rhTSH than during hypothyroidism (P = 0.01), whereas 48-h (131)I uptakes and residence times were similar. After therapy, thyroglobulin release (a marker of cell damage) was lower in the rhTSH arm. The mean total-body effective half-life and residence time were shorter in patients treated after rhTSH. Residence time was also lower for the colon and stomach. Absorbed dose estimates were lower in the rhTSH arm for the lower large intestine, breasts, ovaries, and the bone marrow. Dose rates at the time of discharge were lower in the rhTSH group with a reduction in cumulative radiation exposure to contact persons. CONCLUSIONS In comparison with thyroid hormone withdrawal, rhTSH is associated with longer remnant half-life of radioactive iodine while also reducing radiation exposure to the rest of the body and also to the general public who come in contact with such patients.

Mental Disorders Among Homeless People Admitted to a French Psychiatric Emergency Service

OBJECTIVE The aim of this study was to identify factors associated with homelessness status among patients admitted to the psychiatric emergency ward of a French public teaching hospital over a six-year study period (2001-2006). METHODS The study was based on a retrospective review of the psychiatric emergency wards administrative and medical computer databases. Each emergency care episode had accompanying data that included demographic, financial, clinical, and management information. RESULTS During this six-year study, the psychiatric service recorded 16,754 care episodes for 8,860 different patients, of which 591 were homeless (6.7%) and 8,269 were nonhomeless (93.3%). The mean+/-SD number of visits to the psychiatric emergency service was higher for homeless patients (4.9+/-12.3) than for nonhomeless patients (1.7+/-2.4) (p<.001). A total of 331 homeless patients (56.0%) had more than one care episode, whereas 2,180 (26.4%) of nonhomeless patients had more than one care episode. Factors associated with homelessness included being male, being single, and receiving financial assistance through government social programs. Schizophrenia (43.7%) and substance use disorders (31.0%) were the most common disorders among homeless patients. Aggressive behavior and violence were reported equally among homeless patients (3.5%) and nonhomeless patients (3.2%). Homeless patients were less likely than nonhomeless patients to be hospitalized after receiving care in the emergency ward (47.8% versus 51.1%) (p=.002). CONCLUSIONS Although there is near-universal access to free mental health care in France, study findings suggest that the quality and adequacy of subsequent care are not guaranteed. Multidisciplinary and collaborative solutions are needed to improve the management of mental health care for homeless patients.

Quality of Life in Alopecia Areata: A Study of 60 Cases

TO THE EDITOR Alopecia areata (AA) is a chronically relapsing skin disorder characterized by a sudden loss of hair. Because the perception of patients may differ significantly from those of their health-care providers, quality of life (Qol) appears to be a more relevant criterion to assess the severity of this disease than clinical evaluation such as AA extension. To our knowledge, only one Turkish study investigated the impact of AA on Qol using short form 36 (SF36), indicating lower Qol levels compared with sex-matched individuals (Gulec et al., 2004). In this study, Qol was assessed using a generic instrument. Because only three dimensions were affected and results may be linked to the specific culture, a confirmation was needed. We used an approach combining generic and specific measures to assess the impact of AA on French patients’ Qol, to compare Qol levels with those observed in the general population and in other dermatological conditions, and finally to determine the impact of clinical characteristics and sociodemographic factors on Qol. Subjects were aged over 16 years, presenting with a minimum of 8 weeks AA history, having given informed consent to participate, and having the French language as their native language. Sociodemographic data and characteristics of the disease (duration and course, treatments in the recent period, affected surfaces on the scalp and other areas involved) were recorded. The severity of each AA was reported using visual analogical scales (0–10) by reference to (i) all the AA cases seen in daily practice; (ii) all cases of all skin disorders. Three selfadministered questionnaires were used to assess Qol: the generic and worldwide-used SF36 (Leplege et al., 1998, 2001; Coste, 2001), and two ‘‘chronic skin disorders’’-specific Qol instruments with French validated available versions, the VQ-Dermato (Grob et al., 1999, 2009) and the Skindex (Chren et al., 1996, 1997; Leplege et al., 2003). To better figure out the level of QoL in AA, we compared AA scores with those available in literature related to the French population: (1) rare dermatological diseases including hidradenitis suppurativa (Wolkenstein et al., 2007) and neurofibromatosis type 1 (Wolkenstein et al., 2001); (2) chronic/frequent dermatological diseases including psoriasis, chronic idiopathic urticaria, and atopic dermatitis (Grob et al., 2005); (3) general population: French ageand sex-matched controls (Leplege et al., 2001). This study was conducted in adherence to the Helsinki guidelines. Institutional approval was not required for experiments. After having given their inform consent, 60 patients were included (39 women and 21 men); their mean age was 40.1 years (SD 15.2) and median AA duration was 6 years (2 months to 60 years). Course of the disease was stable in 25 subjects and unstable in 35. The median of the scalp surface involved was 77%. The median of severity score was 6.5 (range 4.0–9.0) by reference to the AA patients and 3.5 (range 2.0–6.0) by reference to the patients presenting any skin disorder. Mental health and vitality were the most altered SF36 dimensions, whereas physical functioning, role physical and body pain were the least ones. Regarding VQ-Dermato, daily life, leisure activity, and physical discomfort were the least altered dimensions. For Skindex, emotions dimension was the most affected and symptoms the least one. Compared with the general population and with patients suffering from other dermatological conditions (Table 1), AA patients presented significantly altered Qol for almost all the SF36 dimensions. For VQ-Dermato, AA patients reported (i) significantly better (mood state, leisure activity, daily life, and physical discomfort) or worse scores (self-perception) than psoriasis, chronic idiopathic urticaria, and atopic dermatitis patients; (ii) being less bothered to treatment-induced restrictions than psoriasis, but more than chronic idioAbbreviations: AA, alopecia areata; Qol, quality of life; SF36, short form 36

Frequent Visits to a French Psychiatric Emergency Service: Diagnostic Variability in Psychotic Disorders

OBJECTIVE This study examined characteristics of frequent visitors to a psychiatric emergency service in a French public teaching hospital over six years. Diagnostic variability of psychotic disorders was documented. METHODS A retrospective review of the services administrative and medical databases identified 1,285 patients with more than one visit during the period who were given at least one diagnosis of a psychotic disorder. A total of 317 patients with six or more visits (frequent visitors) were compared with 968 patients with between two and five visits (occasional visitors). RESULTS Frequent visitors were significantly more likely to be single and homeless and to have diagnostic variability, substance use disorders, and personality disorders. A total of 177 patients experienced diagnostic variability, which was found mainly in three diagnostic categories: schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features. CONCLUSIONS Future studies should further examine the link between increased use of emergency services and diagnostic variability.

Validation française du Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL)

INTRODUCTION Health-related quality of life (HRQL) measurements have become an important outcome both for population health assessment and for evaluating treatments and care management. HRQL indicators require completion of a well-validated questionnaire. Few specific questionnaires are available for French multiple sclerosis (MS) patients. The Multiple Sclerosis International Quality of Life questionnaire (MusiQoL), a self-administered and multidimensional questionnaire, was co-developed and validated in 17 countries, including France. We report the main results of the French clinical validity of this instrument. METHODS The French patients were recruited between January 2004 and February 2005. The main inclusion criteria were: diagnosis of MS according to McDonald criteria, age over 18 years, having given informed consent. The self-administered survey materials that were completed by the patients included the MusiQoL, the generic HRQL questionnaire SF36, and one checklist of 14 MS-specific symptoms reported by the patients. MusiQoL comprises 31 items describing nine dimensions: activity of daily living (eight items), psychological well-being (four), symptoms (three), friends relationships (four), family relationships (three), satisfaction with health care (three), sentimental and sexual life (two), coping (two), and rejection (two). A global index score is computed. Patients were evaluated at inclusion (T0), and retested 21±7 days later (T1). At T0, an experienced neurologist collected sociodemographic data, clinical history related or unrelated to the MS condition, treatments. At T1, change in the patients health status from T0 was reported. RESULTS The analyses were performed with data from 179 subjects. The mean patient age was 44.1 years (SD: 11.5); there were 120 women and 59 men, 58.1% were unemployed, 13.6% had a tertiary educational level. MS clinical forms were 69 relapsing-remitting, 47 secondary-progressive, 37 primary-progressive, and nine clinically isolated syndrome. The EDSS median was 4.5 (25-75(th) percentiles: 2.5-6.0). The final French version showed satisfactory psychometric properties (external validity, internal consistency, reliability, reproducibility, and acceptability). CONCLUSION The availability of a reliable and valid French version of MusiQoL, a self-administered and multidimensional questionnaire, co-developed in different countries, enables evaluation of QoL in French MS patients that are eligible for international multicenter studies.

Validation of the spanish version of the multiple sclerosis international quality of life (musiqol) questionnaire

BackgroundThe Multiple Sclerosis International Quality Of Life (MusiQoL) questionnaire, a 31-item, multidimensional, self-administrated questionnaire that is available in 14 languages including Spanish, has been validated using a large international sample. We investigated the validity and reliability of the Spanish version of MusiQoL in Spain.MethodsConsecutive patients with different types and severities of multiple sclerosis (MS) were recruited from 22 centres across Spain. All patients completed the MusiQoL questionnaire, the 36-Item Short Form (SF-36) health survey, and a symptoms checklist at baseline and 21 days later. External validity, internal consistency, reliability and reproducibility were tested.ResultsA total of 224 Spanish patients were evaluated. Dimensions of MusiQoL generally demonstrated a high internal consistency (Cronbachs alpha: 0.70-0.92 for all but two MusiQoL domain scores). External validity testing revealed that the MusiQoL index score correlated significantly with all SF-36 dimension scores (Pearsons correlation: 0.46-0.76), reproducibility was satisfactory (intraclass correlation coefficient: 0.60-0.91), acceptability was high, and the time taken to complete the 31-item questionnaire was reasonable (mean [standard deviation]: 9.8 [11.8] minutes).ConclusionsThe Spanish version of the MusiQoL questionnaire appears to be a valid and reliable instrument for measuring quality of life in patients with MS in Spain and constitutes a useful instrument to measure health-related quality of life in the clinical setting.