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Sevilla-Dedieu C.,MGEN Foundation for Public Health | Kovess-Masfety V.,University of Paris Descartes | Kovess-Masfety V.,EHESP School of Public Health | Haro J.M.,Fundacio Sant Joan de Deu | And 18 more authors.
Canadian Journal of Psychiatry | Year: 2010

Objective: In certain countries, it is not uncommon to turn to professionals outside the conventional health care system for psychological problems. As this situation is not well documented in Europe, we assessed use of nonconventional care for mental health in 6 European countries. Method: A cross-sectional survey was conducted in representative samples of noninstitutionalized adults in 6 European countries. Participants (n = 8796) completed a survey, which included, among other items, the Composite International Diagnostic Interview 3.0 and in-depth questions about lifetime consultations for mental health problems. Results: Among the respondents (n = 2928) who reported having already sought help in their lifetime for psychological problems (20.0%), 8.6% turned to complementary and alternative medicine (CAM) providers, such as chiropractors and herbalists, and a similar proportion (8.4%) to religious advisers such as ministers, priests, or rabbis. Only a small proportion (2.9%) consulted only these professionals for their problems. CAM providers were more frequently used in the Netherlands (13.5%) and Germany (9.4%), while religious advisers were more often consulted in Italy (12.6%) and Germany (11.6%). Multivariate analyses confirmed differences between countries and revealed that people turning to religious advisers tended to be older, foreign born, and with alcohol problems, whereas those consulting CAM providers were younger, wealthier, and more frequently depressed. Conclusions: In Europe, patients who turn to CAM therapists and those who seek help from religious advisers for psychological problems are not exactly the same. In addition, these professionals are not consulted frequently in most countries, and are almost always associated with more traditional follow-up when used.

Durandy J.-P.,University Hospital Cochin | Mir O.,University Hospital Cochin | Coriat R.,University Hospital Cochin | Cessot A.,University Hospital Cochin | And 2 more authors.
Supportive Care in Cancer | Year: 2012

Background Oncologists often overestimate survival of advanced cancer patients. This study aimed to validate a score for survival prediction in terminally ill cancer patients. Methods Between 2004 and 2008, a prospective study was performed in 500 consecutive advanced cancer patients referred to a palliative care unit. Evaluation at admission included physical examination and routine blood tests. On a randomly selected training set, independent factors assessable at inclusion predicting 2-week survival by a multiple logistic regression were assigned integer-rounded weights to develop a risk index score, which was tested on a validation set. Results On the training set (334 patients), predictive factors were: urea >12 mmol/L (weight=5, odds ratio (OR)=3.72, 95% confidence interval (95%CI)=[1.59; 8.71], p=0.002), Karnofsky Performance Status ≤30% (weight=4, OR=3.28, 95%CI=[1.80; 6.01], p<0.001), leucocytes >15 g/L (weight =3, OR=2.49, 95%CI=[1.18; 5.25], p=0.017), transthyretin ≤0.05 g/L (weight=3, OR=2.42, 95%CI=[1.16; 5.04], p= 0.019) and male gender (weight=2, OR=2.25, 95%CI= [1.28; 3.97], p=0.005). On the validation set (166 patients), the Cochin Risk Index Score (CRIS)≥7 identified high-risk patients, with a positive predictive value of 78%. Conclusion We validated the CRIS for survival prediction in terminally ill cancer patients. © Springer-Verlag 2011.

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