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Background: A number of clinical trials have been undertaken to determine the efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals. However, the reported differences in patient populations, treatment duration, and study endpoints make comparisons difficult. An assessment of the efficacy of treatment with acamprosate was, therefore, undertaken using meta-analytical techniques.

This study presents the results of a multicenter investigation of the efficacy of acamprosate in the treatment of patients with chronic or episodic alcohol dependence. One hundred eighteen patients were randomly assigned to either placebo or acamprosate, and both groups were stratified for concomitant voluntary use of disulfiram.

Objective: To investigate the relative effects of hormonal and relationship factors on female sexual function during the natural menopausal transition. Design: Prospective population-based questionnaire study. Setting: Interviews were conducted in the patients' homes. Patient(s): Four hundred thirty-eight Australian-born women aged 45-55 years who were still menstruating at baseline. Eight years of longitudinal data were available for 336 of these women, none of whom were hysterectomized. Intervention(s): Hormonal levels, age, menopausal status, partner status, and feelings for partner were measured and evaluated with longitudinal structural equation modeling. Main Outcome Measure(s): Short personal experiences questionnaire. Result(s): Sexual response was predicted by prior level of sexual function, change in partner status, feelings for partner, and E 2 level (R 2 ϭ .65); dyspareunia was predicted by prior level of dyspareunia and E 2 level (R 2 ϭ .53); and frequency of sexual activities was predicted by prior level of sexual function, change in partner status, feelings for partner, and level of sexual response (R 2 ϭ .52). The minimum effective dose needed to increase sexual response by 10% (700 pmol/L E 2 ) is twice that needed to decrease dyspareunia. Prior function and relationship factors are more important than hormonal determinants of sexual function of women in midlife. (Fertil Steril 2005

DOPAC/DA, dihydroxyphenyl acetic acid/dopamine DREM, direct REM sleep onset from wakefulness ECG, electrocardiogram EDS, excessive daytime sleepiness EEG, electroencephalogram EMG, electromyogram ESS, Epworth sleepiness scale HA, histamine KO, knockout MHPG/NA, 4-hydroxy-3-methoxy-phenylglycol/noradrenaline MSLT, multiple sleep latency tests MWT, maintenance of wakefulness test REM, rapid eye movement SWS, slow wave sleep t-MeHA, tele-methylhistamine WASO, wake-up episodes after sleep onset WT, wild-type 2

We investigated whether metformin hydrochloride has sustained beneficial metabolic and (cardio) vascular effects in patients with type 2 diabetes mellitus (DM2). We studied 390 patients treated with insulin in the outpatient clinics of 3 hospitals in a randomized, placebo-controlled trial with a follow-up period of 4.3 years. Either metformin hydrochloride, 850 mg, or placebo (1-3 times daily) was added to insulin therapy. The primary end point was an aggregate of microvascular and macrovascular morbidity and mortality. The secondary end points were microvascular and macrovascular morbidity and mortality, as separate aggregate scores. In addition, effects on hemoglobin A 1c (HbA 1c ), insulin requirement, lipid levels, blood pressure, body weight, and body mass index were analyzed. Results: Metformin treatment prevented weight gain (mean weight gain, -3.07 kg [range, -3.85 to -2.28 kg]; PϽ.001), improved glycemic control (mean reduction in HbA 1c level, 0.4% percentage point [95% CI, 0.55-0.25]; P Ͻ .001) (where CI indicates confidence interval), despite the aim of similar glycemic control in both groups, and reduced insulin requirements (mean reduction, 19.63 IU/d [95% CI, 24.91-14.36 IU/d]; P Ͻ.001). Metformin was not associated with an improvement in the primary end point. It was, however, associated with an improvement in the secondary, macrovascular end point (hazard ratio, 0.61 (95% CI, 0.40-0.94; P = .02), which was partly explained by the difference in weight. The number needed to treat to prevent 1 macrovascular end point was 16.1 (95% CI, 9.2-66.6). Conclusions: Metformin, added to insulin in patients with DM2, improved body weight, glycemic control, and insulin requirements but did not improve the primary end point. Metformin did, however, reduce the risk of macrovascular disease after a follow-up period of 4.3 years. These sustained beneficial effects support the policy to continue metformin treatment after the introduction of insulin in any patient with DM2, unless contraindicated.

To evaluate the efficacy and safety of two dosage strengths of a singletablet metformin-glibenclamide (glyburide) combination, compared with the respective monotherapies, in patients with Type 2 diabetes mellitus (DM) inadequately controlled by metformin monotherapy.

Objective: There has been controversy about the relative effects on various health outcomes of hormonal, psychosocial, and lifestyle changes during the menopausal transition. In previous studies the risk factors for one particular health endpoint have been analyzed separately. Separate analyses do not provide an overall view of the relationships between all the variables or the relative importance of different factors. Thus, the objective of this study was to provide an overall analysis of the influence of hormonal changes during the menopausal transition on a range of health outcomes while simultaneously considering all the available predictors and all the endpoints and to test the hypothesis that prior health status predicts current health status.

Rationale: Acamprosate is a proven effective intervention in the treatment of alcohol dependence. However, acamprosate prevents lapses or relapses only in a minority of patients. An important question, therefore, is whether there is a specific subgroup of patients who respond particularly well to acamprosate. Objectives: To identify predictors of acamprosate efficacy. Based upon the available evidence and hypotheses about the mechanisms underlying acamprosate's effects on drinking behavior, the following variables were considered to be potential positive predictors: high physiological dependence at baseline, negative family history of alcoholism, late ageof-onset, serious anxiety symptomatology at baseline, severe craving at baseline, and female gender. Method: Potential predictors of acamprosate's efficacy were analyzed in a pooled analysis of data from seven randomized placebo-controlled trials involving a total of 1485 patients with alcohol dependence. Outcome is measured in terms of cumulative abstinence duration (CAD), continuous abstinence (ABST), and time to first relapse (TFR). Results: CAD and ABST were predicted by baseline measures of craving and anxiety, as well as by study and treatment condition. Acamprosate efficacy was not differentially associated with any of the predictor variables. Importantly, the hypotheses were rejected despite the large sample size and sufficient statistical power. Comment: The most straight-forward clinical implication of this study is that acamprosate can be considered as a potentially effective pharmacotherapy for all patients with alcohol dependence. The effect size of acamprosate alone is, however, moderate. Some evidence indicates that the combination of acamprosate with naltrexone or disulfiram leads to substantially better outcomes.

We provide further validation of a Parkinson's disease (PD) home diary and explore implications for practical use in clinical trials. We previously developed and published a home PD diary that includes the categories ASLEEP, off, on without dyskinesia, on with nontroublesome dyskinesia, and on with troublesome dyskinesia [Hauser et al., J Clin Neuropharmacol 2000;23:75-81] and demonstrated that patients generally consider off time and on time with troublesome dyskinesia "bad time" and on time without dyskinesia or with nontroublesome dyskinesia "good time". We suggested that that on time without dyskinesia or with nontroublesome dyskinesia would be an appropriate outcome measure in clinical trials of advanced PD patients. In the current study, PD patients with motor fluctuations and dyskinesia (present more than 25% of the awake day and at least moderately disabling) completed daily diaries on 3 consecutive days in each of 2 consecutive weeks. In addition, patients provided responses to five questions regarding dyskinesia and their motor response through the day on visual analog scales (VAS). Three hundred two patients from 10 countries participated. Eighty-three percent (n ϭ 252) completed six diaries without missing or duplicate entries.

Ponction folliculaire ; Anti-inflammatoire non stéroïdien ; Kétoprofène ; Fécondation in vitro Résumé Buts.-Les protocoles antalgiques administrés avant la ponction folliculaire sous anesthésie locale ont une capacité antalgique supérieure s'ils comprennent des AINS mais on ne connaît pas l'impact de ces molécules sur le pronostic de la fécondation in vitro (FIV). Matériels et méthodes.-Une étude rétrospective comprenant deux cohortes temporelles consécutives de patientes a été réalisée afin de comparer deux protocoles antalgiques : le paracétamol/alprazolam (P/A), puis le néfopam/kétoprofène (N/K). Résultats.-Nous avons mis en évidence que le taux de grossesses biochimiques ainsi que les critères de jugement usuels de technique de reproduction assistée ne sont pas significativement influencés par le type de protocole antalgique considéré. Conclusion.-Le protocole N/K permet d'optimiser le confort des patientes sans nuire aux taux de réussite en FIV.

Objectives: To evaluate the effect of current smoking and lifetime illicit drug use on alcoholism treatment outcomes and to assess whether these factors influence acamprosate efficacy. Methods: This is a secondary analysis of data from the intentionto-treat population (N ϭ 601) in a 6-month, randomized, placebocontrolled US trial of acamprosate (2 or 3 g/d). Patients met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for alcohol dependence and no other dependence disorders other than nicotine or cannabis, although patients with recent substance use were included. Baseline severities of current nicotine dependence and lifetime drug use were determined using the Fagerström test of nicotine dependence and the illicit drug use inventory, respectively. The primary endpoint was rate of good response (abstinence from alcohol for Ն90% of trial). Secondary endpoints were rate of controlled drinking (Յ5 drinks/d for Ն90% of trial), percent days abstinent, and percent days controlled drinking. The effect of smoking, drug use, treatment, and any interactions on study endpoints was assessed by a backward selection process to eliminate nonsignificant variables. Results: In the intention-to-treat population, 44.9% of patients were current smokers and 78.7% reported lifetime illicit drug use. Current nicotine dependence and lifetime illicit drug use were significant negative predictors of rates of good response (nicotine: odds ratio [OR] ϭ 0.56, 95% confidence interval [CI] ϭ 0.35-0.88, P ϭ 0.01; illicit drugs: OR ϭ 0.47, 95% CI ϭ 0.31-0.71, P Ͻ 0.01) and all other secondary outcomes. Acamprosate had a significant positive effect on rate of good response (OR ϭ 1.65, 95% CI ϭ 1.08-2.52, P ϭ 0.020) and all other secondary outcomes. Conclusions: Current nicotine dependence and lifetime illicit drug use were found to have a significant negative impact on alcoholism treatment outcomes, but no impact on the significant positive effects of acamprosate. The effect sizes of smoking, drug use, and acam-prosate are equivalent and thus, treatment with acamprosate may offset some of the negative effects of smoking or drug use on alcoholism treatment outcomes.

Objectives: To evaluate the effect of current smoking and lifetime illicit drug use on alcoholism treatment outcomes and to assess whether these factors influence acamprosate efficacy. Methods: This is a secondary analysis of data from the intentionto-treat population (N ϭ 601) in a 6-month, randomized, placebocontrolled US trial of acamprosate (2 or 3 g/d). Patients met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for alcohol dependence and no other dependence disorders other than nicotine or cannabis, although patients with recent substance use were included. Baseline severities of current nicotine dependence and lifetime drug use were determined using the Fagerström test of nicotine dependence and the illicit drug use inventory, respectively. The primary endpoint was rate of good response (abstinence from alcohol for Ն90% of trial). Secondary endpoints were rate of controlled drinking (Յ5 drinks/d for Ն90% of trial), percent days abstinent, and percent days controlled drinking. The effect of smoking, drug use, treatment, and any interactions on study endpoints was assessed by a backward selection process to eliminate nonsignificant variables. Results: In the intention-to-treat population, 44.9% of patients were current smokers and 78.7% reported lifetime illicit drug use. Current nicotine dependence and lifetime illicit drug use were significant negative predictors of rates of good response (nicotine: odds ratio [OR] ϭ 0.56, 95% confidence interval [CI] ϭ 0.35-0.88, P ϭ 0.01; illicit drugs: OR ϭ 0.47, 95% CI ϭ 0.31-0.71, P Ͻ 0.01) and all other secondary outcomes. Acamprosate had a significant positive effect on rate of good response (OR ϭ 1.65, 95% CI ϭ 1.08-2.52, P ϭ 0.020) and all other secondary outcomes. Conclusions: Current nicotine dependence and lifetime illicit drug use were found to have a significant negative impact on alcoholism treatment outcomes, but no impact on the significant positive effects of acamprosate. The effect sizes of smoking, drug use, and acam-prosate are equivalent and thus, treatment with acamprosate may offset some of the negative effects of smoking or drug use on alcoholism treatment outcomes.

This secondary analysis of the first U.S. acamprosate trial (N = 601) for alcohol dependence examines the effects of subsyndromal psychiatric symptoms or history of severe psychopathology on alcoholism treatment outcomes and any mitigating effects of acamprosate. Psychiatric antecedents were documented using a protocol-specific interview. Current psychiatric symptoms were assessed using Hamilton Anxiety and Depression (HAM-A, HAM-D) rating scales. Predictors of good response, defined as abstinence for ≥90% of trial duration, were identified using logistic regression. Subsyndromal anxiety (as determined by HAM-A "Anxious Mood" item) and the presence of ≥1 psychiatric antecedent were significant negative predictors of good response. Lower pretreatment drinking intensity, baseline motivation to have abstinence as a goal, and treatment with acamprosate were significant positive predictors of good response. No significant interactions among predictors were detected, indicating that they are independent, additive factors. Thus, the beneficial effects of acamprosate treatment in combination with motivational therapy may offset the liabilities for alcoholism recovery that are associated with current anxiety symptoms and/or a significant past psychiatric history.

Isolating the homophily effect from the socialization process is crucial in understanding the links between student achievement and peer performance. Then, the combined effects on student achievement of peer performance and of student centrality within a network have been scarcely studied. While friendship links have been addressed, researches rarely investigated instrumental ties. In this paper, 120 college students were asked about their friends and about their advisors. Results show a selection effect (i.e., students reassemble with friends sharing same levels of performance), and a socialization process (i.e., peer performance is significantly associated with later student achievement). While the centrality univariate effects are significant for student performance, only being a prestigious friend remains important when peer performance is taken into account. ciation between college student performance and the performance of friends (e.g.,