Recommandations de pratique clinique dans la schizophrénie: de la théorie à la mise en application = Clinical practice guidelines for the treatment of schizophrenia: from theory to practice

Dans le cadre d'une étude rétrospective au sein d'une unité de réhabilitation, nous avons cherché à examiner le degré de respect de recommandations de pratique clinique (RPC) abordant le traitement pharmacologique au long cours de la schizophrénie, par des médecins qui n'en ont qu'une connaissance indirecte. The Expert Consensus Guideline for the treatment of schizophrenia (ECGTS) a été retenu comme référence sur la base d'une comparaison avec cinq autres RPC principales. Sur un collectif de 20 patients, les recommandations de l'ECGTS sont totalement respectées dans 65 % des cas, partiellement respectées dans 10 % et non respectées dans 25 %, démontrant ainsi que la pratique clinique est clairement perfectible (principalement dans le traitement des symptômes psychotiques et dépressifs). Cependant, le respect des RPC ne garantit pas forcément la résolution de tous les problèmes cliniques rencontrés : 12 patients sur 20 présentent des effets secondaires à l'évaluation clinique et pour huit d'entre eux, les recommandations à ce niveau, sont respectées. Notre étude montre cependant que le choix et l'application d'une RPC ne sont pas simples. Les RPC actuelles donnent peu ou pas d'instruments de mesure, ni de critères précis pour évaluer les problèmes cliniques auxquels elles font référence. L'avenir appartient donc à des RPC qui proposent, outre les recommandations cliniques elles-mêmes, les moyens de leur vérification et de leur application sur le terrain.

Cost of Illness and Contingent Valuation : Controlling for the Motivations of Expressed Preferences in an Attempt to Avoid Double-Counting

This paper addresses the issue of double counting of health impacts in the context of cost of illness valuation. Double counting occurs when estimates are jointly used, which rely on valuation techniques that overlap. As a solution, we propose to limit the scope of each of the valuation method to a specific range of impacts. In order to limit the contingentvaluation method to the exclusive valuation of intangible costs, we propose a three steps approach : (1) leave the respondents free to valuate the consequences which matter to them, (2) elicit respondent's motivations, (3) control for the influence motivations have on elicited values. This procedure was applied in a Swiss contingent-valuation. An econometric treatment was applied in order to limit the scope of the estimates of the contingent valuation method to intangibles,therefore the possibility to a combination of methods with the risk of double-counting and underestimating costs being kept to a minimum.

Re: Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study.

Rapid response to: Ortegón M, Lim S, Chisholm D, Mendis S. Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012 Mar 2;344:e607. doi: 10.1136/bmj.e607. PMID: 22389337.

Hemispheric asymmetry and theory of mind: Is there an association?

Introduction. In autism and schizophrenia attenuated/atypical functional hemispheric asymmetry and theory of mind impairments have been reported, suggesting common underlying neuroscientific correlates. We here investigated whether impaired theory of mind performance is associated with attenuated/atypical hemispheric asymmetry. An association may explain the co-occurrence of both dysfunctions in psychiatric populations. Methods. Healthy participants (n 129) performed a left hemisphere (lateralised lexical decision task) and right hemisphere (lateralised face decision task) dominant task as well as a visual cartoon task to assess theory of mind performance. Results. Linear regression analyses revealed inconsistent associations between theory of mind performance and functional hemisphere asymmetry: enhanced theory of mind performance was only associated with (1) faster right hemisphere language processing, and (2) reduced right hemisphere dominance for face processing (men only). Conclusions. The majority of non-significant findings suggest that theory of mind and functional hemispheric asymmetry are unrelated. Instead of ''overinterpreting'' the two significant results, discrepancies in the previous literature relating to the problem of the theory of mind concept, the variety of tasks, and the lack of normative data are discussed. We also suggest how future studies could explore a possible link between hemispheric asymmetry and theory of mind.

Divorce in the barn owl: securing a compatible or better mate entails the cost of re-pairing with a less ornamented female mate.

Two nonmutually exclusive hypotheses can explain why divorce is an adaptive strategy to improve reproductive success. Under the 'better option hypothesis', only one of the two partners initiates divorce to secure a higher-quality partner and increases reproductive success after divorce. Under the 'incompatibility hypothesis', partners are incompatible and hence they may both increase reproductive success after divorce. In a long-term study of the barn owl (Tyto alba), we address the question of whether one or the two partners derive fitness benefits by divorcing. Our results support the hypothesis that divorce is adaptive: after a poor reproductive season, at least one of the two divorcees increase breeding success up to the level of faithful pairs. By breeding more often together, faithful pairs improve coordination and thereby gain in their efficiency to produce successful fledglings. Males would divorce to obtain a compatible mate rather than a mate of higher quality: a heritable melanin-based signal of female quality did not predict divorce (indicating that female absolute quality may not be the cause of divorce), but the new mate of divorced males was less melanic than their previous mate. This suggests that, at least for males, a cost of divorce may be to secure a lower-quality but compatible mate. The better option hypothesis could not be formally rejected, as only one of the two divorcing partners commonly succeeded in obtaining a higher reproductive success after divorce. In conclusion, incompatible partners divorce to restore reproductive success, and by breeding more often together, faithful partners improve coordination.

Comparison of HIV-infected patients' characteristics, healthcare resources use and cost between native and migrant patients

OBJECTIVES: To assess whether patients' characteristics and healthcare resources consumption and costs were different between native and migrant populations in Switzerland. METHODS: All adult patients followed-up in the Swiss HIV-cohort study in our institution during 2000-2003 were considered. Patients' characteristics were retrieved from the cohort database. Hospital and outpatient resource use were extracted from individual charts and valued with 2002 tariffs. RESULTS: The 66 migrants were younger (29 +/- 8 years versus 37 +/- 11, p < 0.001), less often of male gender (38 % versus 70 %, p < 0.001), predominantly infected via heterosexual contact (87 % versus 52 %, p < 0.01), with lower mean CD4 level at enrollment (326 +/- 235 versus 437 +/- 305, p = 0.002) than their 200 native counterparts. Migrants had fewer hospitalizations, more frequent outpatient visits, laboratory tests, and lower total cost of care per year of follow-up (<euro> 2'215 +/- 4'206 versus 4'155 +/- 12'304, p = 0.037). Resource use and costs were significantly higher in people with < 200 CD4 cell counts in both groups. CONCLUSIONS: Migrant population had more advanced disease, more outpatient visits but less hospitalizations, resulting in lower costs of care when compared with native population.