Off-label utilization of antidepressants

Rapport de synthèse : De nombreuses études sont effectuées sur les antidépresseurs avant leur mise sur le marché, puis des règles précises sont établies pour leur prescription dans des indications délimitées. Leur utilisation dans des indications «off-label » (hors indication officiellement admise) manque souvent de validation par des bases de données scientifiques et leur prescription se base le plus souvent sur un consensus proposé par des experts. Le but du présent travail a été d'étudier les habitudes de prescription de psychiatres d'hôpitaux en ce qui concerne les antidépresseurs, en comparant des patients traités pour une dépression et des troubles anxieux avec des patients recevant un traitement «off-label ». Pour cette étude, les données d'utilisation de médicaments sont celles recueillies lors de 6 jours de référence, entre avril 1999 et novembre 2001, à l'hôpital psychiatrique de Lausanne (Suisse) comprenant 98 lits. La prescription de médicaments chez 174 patients a été prise en compte. Tandis que le diagnostic n'influençait pas le choix entre des nouveaux et anciens antidépresseurs, les patients présentant un trouble anxieux avaient un risque 4.5 fois (p < 0.05) plus élevé et les patients présentant un autre diagnostic 8 fois plus élevé de recevoir une comédication antipsychotique, en comparaison avec des patients dont le diagnostic primaire était un trouble dépressif. De plus, les patients recevant comme comédication un hypnotique non-benzodiazépine avaient moins de risque que l'on prescrive un ancien antidépresseur (p < 0.05). Alors que les patients avec un trouble anxieux et ceux souffrant d'une dépression majeure recevaient un antidépresseur à des doses comparables, les patients répondant à une indication off-label étaient de préférence traités avec des doses plus faibles. Les résultats de cette étude suggèrent que les psychiatres d'hôpitaux développent des préférences en ce qui concerne le choix de la classe d'antidépresseurs, et qu'ils les utilisent alors aussi bien dans des indications reconnues que non-reconnues. Puis ils semblent adapter la dose et la comédication en tenant compte du diagnostic, ce qui confirme l'hypothèse initiale de l'étude,

Unlicensed and off-label drug use in a Swiss paediatric university hospital.

BACKGROUND: Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. OBJECTIVES: The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. METHODS: This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. RESULTS: Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. CONCLUSION: The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".

The effect of mountain bike suspensions on vibrations and off-road uphill performance.

AIM: This study evaluates the effect of front suspension (FS) and dual suspension (DS) mountain-bike on performance and vibrations during off-road uphill riding. METHODS: Thirteen male cyclists (27+/-5 years, 70+/-6 kg, VO(2max)59+/-6 mL.kg(-1).min(-1), mean+/-SD) performed, in a random sequence, at their lactate threshold, an off-road uphill course (1.69 km, 212 m elevation gain) with both type of bicycles. Variable measured: a) VO(2) consumption (K4b2 analyzer, Cosmed), b) power output (SRM) c) gain in altitude and d) 3-D accelerations under the saddle and at the wheel (Physilog, EPFL, Switzerland). Power spectral analy- sis (Fourier) was performed from the vertical acceleration data. RESULTS: Respectively for the FS and DS mountain bike: speed amounted to 7.5+/-0.7 km.h(-1) and 7.4+/-0.8 km.h(-1), (NS), energy expenditure 1.39+/-0.16 kW and 1.38+/-0.18, (NS), gross efficiency 0.161+/-0.013 and 0.159+/-0.013, (NS), peak frequency of vibration under the saddle 4.78+/-2.85 Hz and 2.27+/-0.2 Hz (P<0.01) and median-frequency of vertical displacements of the saddle 9.41+/-1.47 Hz and 5.78+/-2.27 Hz (P<0.01). CONCLUSION: Vibrations at the saddle level of the DS bike are of low frequencies whereas those of the FS bike are mostly of high frequencies. In the DS bike, the torque produced by the cyclist at the pedal level may generate low frequency vibrations. We conclude that the DS bike absorbs more high frequency vibrations, is more comfortable and performs as well as the FS bicycle.

Prevalence and determinants of obesity in children in public schools of Sintra, Portugal

OBJECTIVE: To assess the prevalence of and the factors related to overweight and obesity in a sample of children from the region of Sintra, Portugal. METHODS AND PROCEDURES: Cross-sectional study, stratified for freguesia with random selection of schools. Height, weight, triceps skinfold, upper arm and waist circumferences were measured, and overweight/obesity defined according to international criteria. Breast-feeding, number of daily meals and parents' height and weight data were also collected. RESULTS: One thousand two hundred and twenty-five children aged 6-10 years were assessed. Overall prevalence of overweight and obesity was 35.6% (23% overweight and 12.6% obesity). Overweight or obese children had higher triceps skinfold, upper arm circumference, arm muscle area, and waist circumference than their normal weight counterparts (P < 0.001). On multivariate analysis, relatively to a child without obese progenitors, a child with one obese progenitor had an obesity risk multiplied by 2.78 (95% confidence interval (CI): 1.76-4.38), while a child with two obese progenitors had a risk multiplied by 6.47 (95% CI: 5.59-16.19). Conversely, being picky was significantly related with a smaller risk of obesity: for boys, odds ratio (OR) = 0.15 (95% CI: 0.04-0.63); for girls, OR = 0.19 (95% CI: 0.06-0.64). Finally, no relationships were found between obesity, birth weight, birth height or breast-feeding. DISCUSSION: Prevalence of overweight and obesity are elevated among children of the Sintra region in Portugal compared to most other regions of Europe. The relationship with the parents' nutritional state stresses the need to target families for preventing obesity.

Dyslexia in a French-Spanish bilingual girl: behavioural and neural modulations following a visual attention span intervention.

We report the case study of a French-Spanish bilingual dyslexic girl, MP, who exhibited a severe visual attention (VA) span deficit but preserved phonological skills. Behavioural investigation showed a severe reduction of reading speed for both single items (words and pseudo-words) and texts in the two languages. However, performance was more affected in French than in Spanish. MP was administered an intensive VA span intervention programme. Pre-post intervention comparison revealed a positive effect of intervention on her VA span abilities. The intervention further transferred to reading. It primarily resulted in faster identification of the regular and irregular words in French. The effect of intervention was rather modest in Spanish that only showed a tendency for faster word reading. Text reading improved in the two languages with a stronger effect in French but pseudo-word reading did not improve in either French or Spanish. The overall results suggest that VA span intervention may primarily enhance the fast global reading procedure, with stronger effects in French than in Spanish. MP underwent two fMRI sessions to explore her brain activations before and after VA span training. Prior to the intervention, fMRI assessment showed that the striate and extrastriate visual cortices alone were activated but none of the regions typically involved in VA span. Post-training fMRI revealed increased activation of the superior and inferior parietal cortices. Comparison of pre- and post-training activations revealed significant activation increase of the superior parietal lobes (BA 7) bilaterally. Thus, we show that a specific VA span intervention not only modulates reading performance but further results in increased brain activity within the superior parietal lobes known to housing VA span abilities. Furthermore, positive effects of VA span intervention on reading suggest that the ability to process multiple visual elements simultaneously is one cause of successful reading acquisition.

Off-axis low-coherence interferometry for surface topology measurement.

In this communication we introduce a low or reduced coherence interferometry technique that can be used to retrieve surface topology on samples with high roughness. Moreover, we will show that the approach enables surface topology measurement also at the interface of so-called turbid media, where multiple scattering inside tissues can be a major issue, preventing accurate measurements.

Prevalence of overweight and underweight in public and private schools in the Seychelles.

Abstract Objective. We compared the prevalence of body weight categories between public and private schools in the Seychelles, a rapidly developing small island state in the African region. Methods. In 2004-2006, weight and height were measured and self-reported information on physical activity collected in children of three selected grades in all schools in the country. Overweight, obesity and thinness were defined according to standard criteria. Results. Based on 8 462 students (377 in private schools), the prevalence of overweight (including obesity) was markedly higher in private than public schools (boys: 37% [95% CI: 31-44] vs. 15% [14-16]; girls: 33% [26-41] vs. 20% [19-22]). The prevalence of thinness grade 1 was lower in private than public schools (boys: 9% [5-13] vs. 20% [19-21]; girls: 13% [8-18] vs. 19% [18-20]). Students in private schools reported more physical activity at leisure time while students in public schools reported larger weekly walking time. Conclusions. Our findings suggest that school type may be a useful indicator for assessing the association between socio-economic status and overweight in children, and that overweight affects wealthy children more often than others in developing countries.