Benzodiazepine hypnotics bear a higher risk of high dose dependence than benzodiazepine anxiolytics, according to a recent study in Luxemburg. This article summarizes the main indications of these molecules and the current treatment recommendations. It provides an overview of public health actions of the past and the future to reduce their excessive consumption.
Over a short period of one month we undertook a systematic review of all medications of our residents in the nursing home. Prior to this we examined the patients with great care and where necessary, laboratory tests or other further investigations took place. By the end of this procedure, we analysed the medications prescribed and on the recommendations of the program Stopp and Start, several adaptations were done. In summary, some medications increased, mainly for osteoporosis prevention and some other could be reduced, mainly the psychotropic drugs. A systematic review for patients in nursing homes, twice a year seems sufficient for the adaptations of chronically used medications. Psycho-Geriatric patients - Medications - Stopp and Start programme.
The psychological and neuropsychological characteristics of gifted children andadolescents are analysed, as well as the emotional and behavioural risks linkedto this condition.A prospective follow-up study of N=93 highly gifted students suffering fromschool failure at the beginning of adolescence was implemented. They weretreated with an integrated form of music psychotherapy and verbal psychotherapyin 5 separate groups. The methodology of treatment combined active musicalimprovisation with the writing of stories or the production of drawings undermusical induction, followed by verbal elaboration in the cognitive-psychodynamicpsychotherapeutic tradition.The evaluation was based on a mixed-methods design, combining psychometricscales, projective tests and expressive tests. Comparative pretest-posttest,correlational and multidimensional analyses were computed, using non-parametricstatistical procedures adapted to small samples and data belonging to a mixedlevel of measurement. We present a meta-analysis of the confirmatory results in5 subgroups.There was a significant increase in the capacity of concentration, the capacityof imaginary and symbolic elaboration, the pictorial and literary creativity,self-esteem, the quality of coping strategies, as well as in school marks. Therewas a significant decrease in defensive functioning and in embitterment andresignation. The latent dimensions extracted with Optimal Scaling proceduresfrom the correlational matrixes of the Delta values of TAT and TSD-Z weremeaningful at the light of the state-of-the-arts.The results of the study confirm a prior theoretical modelization coming out ofthe preparatory stage of the research project. They are interpreted at the light ofrecent findings in developmental and clinical psychology of adolescence and theyopen many tracks for future research.
Savoy, annexed by the French Revolution from 1792 to 1815, became again Sardinian within the kingdom of Piedmont-Sardinia until 1860, the year of annexation to France. These changes have not prevented many students from Savoy to come to France for their medical studies, mostly in Paris. While disorganized by the Revolution, medical training and education systems were put in order as of 1803. The Theses of 142 Savoy students (found largely thanks to foreign students in Paris file prepared by Pierre Moulinier) could be consulted in the archives of the Bibliothèque interuniversitaire de santé de Paris. Accordingly, were studied the geographical origin of candidates, thesis topics, age of the students, the philanthropic Savoisienne society of Paris, the Savoy students who exercised in Paris, the students who were former militaries and the doctors who had a local or national political mandate. A similar study at the Faculty of Turin would allow to better understand the migratory flows of these students.
Regular practice of physical activity (PA) has many health benefits in both healthy individuals and in people with non-communicable diseases (NCDs). In order to disseminate this evidence and to strengthen the promotion of PA in people with NCDs, the Sport-Santé project was created in Luxembourg and officially launched in April 2015. In 2014, a stocktaking of the different organizations offering PA for people with NCDs was realized in order to develop the Sport-Santé project. Different communication tools were used to promote Sport-Santé as well as the aforementioned organizations. The present study aimed to re-evaluate the offers of PA for people with NCDs in Luxembourg one year after the launch of the project. The organizations offering PA for people with NCDs (orthopaedics, obesity and overweight, neurology and rare diseases, oncology and cardiology) were screened in 2014 and in 2016. The number of weekly offered hours of PA for people with NCDs were collected and the participation rate was observed. Participants (192 in 2014 and 196 in 2016) volunteered to answer a survey, which contained questions regarding their age, sex, time since enrolment, travel distance, former and current PA participation, and type of recruitment. Additional items regarding prescription and refund were explored only in 2016. In 2016, more than 55 hours per week of PA were offered for people with NCDs in Luxembourg (≈44 hours per week were identified in 2014). However, this increase was not statistically significant. No difference was observed between 2014 and 2016 regarding the participation rate (2014: 8.9 ± 5.1 participants per hour; 2016: 8.4 ± 5.7 participants per hour). Participants were younger in 2016 than in 2014. The time since enrolment was shorter in 2016 than in 2014. No difference between 2014 and 2016 was observed for travel distance, sex distribution, former and current PA participation, and type of recruitment. Participants were mainly recruited by the healthcare professionals. More than 69 % of the participants would like to receive a medical prescription for the PA. Fifty-two percent of the participants would appreciate a refund of the participation fees by their health insurance. The increasing efforts of Sport-Santé and the organizations offering PA for people with NCDs lead to increase the offer. However, the participation rate remains unchanged. The decrease in age and in time since enrolment observed in 2016 could be explained by the creation of new activities, a larger participant's turnover or high number of withdrawals among long-term participants. Even if participants are mainly recruited by healthcare professionals, this type of recruitment can be attributed to very few idealists. All healthcare professionals should be aware of the offers of Sport-Santé and advise their patients to participate in a PA program. It is now time to advance the idea of prescription of PA as a privileged treatment option and to convince the policymakers to take action against sedentary behaviours in Luxembourg. Nevertheless, this type of promotion is not enough to increase the number of participants and additional strategies must be explored and developed. The best sustainable strategies are always those that approach the problem from different viewpoints.
The diagnosis of neurocognitive disorders such as mild cognitive impairments and dementia is a challenging endeavour. On behalf of the neuropsychologists of the Luxembourgish Society of Psychology (SLP), the authors develop a common framework for the neuropsychological diagnosis of dementia in the Luxembourgish context (NP-DiaDem) and promote the role of the neuropsychologist in this process. The paper's aim is threefold: (I) highlighting the role of the neuropsychological evaluation to support the medical diagnosis of neurodegenerative cognitive disorders; (II) providing recommendations for the neuropsychological assessment, based on recently published international guidelines; and (III) providing a new diagnostic process, facilitating the differentiation between mild and more severe states of cognitive decline. An important heterogeneity in the evaluation of cognitive performances and assessments instruments exists, partly due to the multicultural and multilingual context of the population living in Luxembourg. Prior applying the present recommendations, a note on the specific Luxembourgish context is provided as it influences directly the diagnostic process. The absence of validated and culturally adapted assessment tools for the Luxembourgish context is a serious problem in the diagnosis of cognitive deficits of either origin. The taskforce therefore strongly recommends and supports the development of a large database of cognitive performance data and hence population-specific norms for some of the most basic diagnostic tools.
BACKGROUND:The benefits of cardiac rehabilitation are well accepted. However, there still remains a debate concerning the risk of cardiac events, especially arrhythmias, during exercise training. The goal of the study was to retrospectively analyze events, including arrhythmias, in the cardiac rehabilitation unit of the Centre Hospitalier de Luxembourg during 2014-2015 and to identify if there was a link between patients stratified as high-risk patients and events.METHODS:This analysis included each patient that participated in cardiac rehabilitation at the Centre Hospitalier de Luxembourg during 2014 and 2015. Major and minor cardiac events during exercise training in this period were retraced by retrospectively looking at patient files. These events were related to the potential risk of the patients, assessed by the "Risk stratification for cardiac events", edited by the American Association of Cardiovascular and Pulmonary Rehabilitation.RESULTS:628 patients were recruited for cardiac rehabilitation at the Centre Hospitalier de Luxembourg during 2014 and 2015. They exercised for a combined total of 15065 training hours. There were no major cardiac events during exercise training in this period; the number of minor events was low (n=24; 1 minor event/628 training hours). About two thirds of our patients are considered as low risk patients, one third of the patients were at intermediate or high risk. We found no relationship between events and risk stratification.CONCLUSION:There were no major cardiac events in our patients and the rate of minor cardiac events was low and not related to risk stratification.
Wernicke’s encephalopathy (WE) is a very rare complication of surgicalintervention, especially among patients with no liver dysfunction and no history ofalcohol abuse. In a surgical setting, Wernicke’s syndrome was mostly associatedwith abdominal surgery (bariatric, e.g. gastric bypass, splenectomy) but there areno papers in the literature dealing with such a complication among spine patients.
Over a short period of one month we undertook a systematic review of all medications of our residents in the nursing home. Prior to this we examined the patients with great care and where necessary, laboratory tests or other further investigations took place. By the end of this procedure, we analysed the medications prescribed and on the recommendations of the program Stopp and Start, several adaptations were done. In summary, some medications increased, mainly for osteoporosis prevention and some other could be reduced, mainly the psychotropic drugs. A systematic review for patients in nursing homes, twice a year seems sufficient for the adaptations of chronically used medications. Psycho-Geriatric patients - Medications - Stopp and Start programme.
Our study set out to monitor all admissions admitted to an oncology ward overa period of 60 days between 20/10/14 and 18/12/14. We wanted to analyse thereasons for admission, in order to identify treatment related complications andother preventable causes for inpatient admission.
This is the report on the case of a 74 year old male patient who was admitted to hospital emergency because of a distended bladder, which was detected on an MRI. This MRI was performed because of an acute paralysis of the patient’s left leg. After various examinations we could conclude that the patient’s neurological symptoms were not due to metastases of a solid tumour as we expected, but to a primary spinal diffuse B-cell lymphoma. The central nervous system, and especially the spinal cord, are an extremely rare location for primary B-Cell lymphoma.
After an outline on the hypocrisy of the Catholic Church towards jewish doctors,the author list some arguments to explain why Jewish doctors were that soughtafter. He then concentrates on the situation in Luxembourg - on indigenousdoctors and migrants, finishing with a parallel between asylum seekers fromyesterday and today.
OBJECTIVETo assess the risk factors the precipitates ulcerations.MATERIAL AND METHODSIn this study a group of 100 patients were selected from November 2007 till October 2008 who were coming for treatment at the Diabetes center of Cluj Napoca, Romania for treatment. 50 cases were patients with ulcerations and 50 without any ulceration.RESULTSMost important results were: (Age, sex type, biological parameters like HDL, total cholesterol, creatinine ESR, polyneuropathy, arteriopathy, diabetic foot type, diabetes duration). We obtained these results using different statical methods.CONCLUSIONUlcerations in diabetic neuropathy are caused by a whole combination of several factors which should be monitored by a meticulous examination and careful follow up of diabetic patients. This in turn will be beneficiary for patients as well as economically interesting reduce the amount of money which is used to treat ulcerations.
30 years of organized ambulatory heart sport in Luxembourg Promoter of health sports. For more than 30 years both mortality and morbidity due to coronary artery disease (CAD) are significantly decreasing (> 70%) in the western world. This achievement is due to multiple interventions in the direct treatment of CAD and, especially, in fighting its risk factors: smoking, high blood pressure, hypercholesterolemia and physical inactivity. In 1984 the first ambulatory heart sport group (phase 3 of cardiac reeducation) was founded in Luxembourg City, followed in 1991 by a section in Esch/Alzette and in 2002 by a 3ème section in Ettelbrück. These phase 3 cardiac sport groups (= chronic phase) are organized by some committed patients working on a voluntary basis and performing a professional job. Paradoxically these phase 3 groups preceded the phases 1 and 2 (= "in hospital" and subacute) of cardiac rehabilitation. However, in a parallel way ambulatory phase 2 physical activity (PA) was started in the main hospitals in Luxembourg City (Centrum), Esch/Alzette (South) and Ettelbrück ( North). In 2002 a cornerstone study by Myers et al proved that physical fitness is the most determinant of survival both for healthy people and for cardiac patients: The better the fitness, quantified in METs, the better the prognosis and this fact is the basis for the application of sports therapy in cardiac and most other patients. An important epidemiological study published in 2012 by Lee et al in Lancet analyzed the effects of physical inactivity (PI) all over the world: 4 important diseases were studied: CAD, breast cancer, colon cancer and type 2 diabetes. The effects of PI are most pronounced in colon cancer followed by diabetes 2, breast cancer and then CAD. As a mean about 9% of all deaths -5.9 million in 57 million deaths/year worldwide- are caused by PI and for Luxembourg 12.9%. This cornerstone study can serve as rationale for physical therapy (PT) intervention in oncology, diabetes and CAD. It is noteworthy that the basic RF are more or less the same for the chronic diseases investigated in this study. Since the beginning of the new century PT has become an integral part of the strategies for cancer prevention and treatment. This option has been studied thoroughly first in breast cancer, later also in colon, prostate, and bronchial cancers etc. In primary prevention regular medium intensity training decreases the incidence of cancers by about 20-30%. For patients with proven cancers the application of PA as treatment option is more complicated compared to patients with cardiac problems since cancer patients often have to undergo surgery, then chemo- and/or irradiation therapy. All these interventions and their side effects have to be considered before applying PA. Above the physical alterations most cancer patients have to face anxiety and depression problems. PT improves the outcome between 15-25% and plays an important role in improving the psychological problems of the cancer patients. Since 10 years several oncologists in Luxembourg became interested in PA as a therapeutic option for their patients. They contacted the cardiologists and physiotherapists in charge of cardiac reeducation and progressively programs for PA in oncology were launched also in Luxembourg. Meanwhile several groups of cancer patients offer regular PT programs. In 2014 a stock concerning the different health sport activities in Luxembourg was taken by a young researcher of the Luxembourg Institute of health (LIH). 11 different associations are active; the most important and best organized are the cardiac sports groups, but there are also several oncologic, neurologic and orthopedic sports groups. A target for the coming years is to confer a robust infrastructure to all these associations following the model used by the cardiac groups. For the next year all these groups should be integrated into the Federation of Health Sports of the national Olympic Committee.
We are a European academic group of family doctors and we propose a definition of flexibility in family medicine. A review of the literature shows that flexibility and complexity are emerging concepts in the field of family practice. The outcomes of a workshop at the WONCA-Europe congress in 2014 are discussed. The flexibility is a capability of the general practitioner to deal with complex clinical situations in a biomedical and societal changing world. Flexibility is framed by ethics. It could improve the quality of care, be useful against burnout and used in medical research. In conclusion, family medicine should adopt a specific definition of the flexibility describing its specificity, a useful and teachable capacity.
BACKGROUND:Since years it was suspected that a large number and possibly inappropriate medicines were prescribed to patients > 65y.OBJECTIVE:The objective of this study was the inventory of polypharmacy and the inappropriate drugs prescribed to patients of 65 years and older during the year 2008 in Luxembourg.DESIGN:For this study anonymized data were used from the data base of the medical control administration of the social security CMSS ("administration du contrôle médical de la sécurité sociale").RESULTS:580 general practitioners (GPs) had written 399 401 prescriptions for 58 592 patients.1080 medical specialists had written 272 197 prescriptions for 50 609 patients. Drug therapies prescribed by GPs cost 641,26 € per patient and prescribed by medical specialists 559,12 € per patient in 2008. Quantitative polypharmacy was prescribed to 17, 91% of patients (19, 99% to women and 14, 83% to men) by GPs. Medical specialists prescribed polypharmacy to 8,65% of patients (7,98% to women and 9,59% to men) by GPs. Among the 20 most prescribed drugs, inappropriate medicines for seniors were observed in the group of GPs as well as in the group of medical specialists. Family doctors prescribed inappropriate drugs to 13, 69% of patients and medical specialists to 5,46% of patients. In both groups lorazepam, zolpidem and lormetazepam have been identified as inappropriate active pharmaceutical ingredient (API).CONCLUSION:The pivotal role of the GPs in drug therapy of the elderly could be established. Polypharmacy as well as inappropriate drug prescriptions were more frequently observed in the group of GPs than in the group of medical specialists. Benzodiazepines and analogues are the most prescribed inappropriate medications to the elderly.
Noninvasive prenatal testing (NIPT) has marked a revolution in aneuploidy screening because it allows a simple maternal blood test to detect trisomy 21, 18 and 13 in a foetus with a very high level of accuracy. After one year of NIPT utilisation with 683 samples, we analyzed retrospectively the performance of the test for 2014 : 3 positive samples (2 trisomies 21 and 1 trisomy 18) were correctly detected (100% sensitivity) and no foetal aneuploidy was missed for the pregnancies having already resulted in delivery by decembre 2014 (280 true negatif, 100% specificity). However, the additionnally available analysis of the sex chromosomes resulted in 2 erronous results: 1 uncorrect sex determination (1 male resulting in a female phenotype at birth) and 1 result suggesting a Turner syndrome was not confirmed by amniocentesis. The failure rate leading to a resampling was at 1.46% (10/683). The test used was the NIFTY of the BGI laboratory in Hong-Kong. By comparison to the year 2013, the utilisation of NIPT lead to a significant diminution of invasive samples performed by amniocentesis or choriocentesis 144 vs. 239 (- 63%). We confirmed that NIPT is a high-performance tool for the screening of the main foetal aneuploidies and report that during its first year of utilisation, 63% of invasive samples collected could be avoided. The test is expensive, not reimboursed by Luxembourg social security and therefore prohibitive for a number of women and their families.
After a short overview on the development of diagnostic tools in clinical biology at an international level from Antiquity towards today, a history of the clinical biology including public and private institutions in Luxembourg will be outlined.
