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Serum concentrations of psychotropic drugs were measured in 363 drivers injured in road accidents and admitted to the emergency department of Angers regional university hospital. The figures obtained were correlated to the presumed responsibility of each driver in the accident. Benzodiazepines and phenobarbitone were found in the serum of 39 drivers, and responsibility was significantly increased in this group. The role played by these medicines in road accidents has often been alluded to in the literature, but the value of these previous studies was limited by the lack of quantitative assays. Measuring serum concentrations has permitted a more accurate analysis of the relationship between responsibility for road accident and consumption of psychotropic drugs, including barbiturates. This has prompted the authors to organize a regional information campaign intended for the general public and doctors and aimed at drawing attention to the higher risk of accident among road users taking these drugs.

During the last 50 years the increase of life expectancy has been dramatic in all Western countries. In France, the life expectancy in 1988 was 80.6 years for women and 72.3 years for men. In 1980, the life expectancy at the age of 60 was more than 20 years in women and 16 years in men. Side by side with this increase of life expectancy there has been a change in the structure of the causes of death. Cardiovascular diseases accounted for 15.6 percent of all causes in 1930, 31 percent in 1950 and 37.4 percent in 1980. Cardiovascular diseases therefore rank very high among the causes of mortality, and one of the principal reasons for this is ageing of the population. Studying the epidemiology of cardiovascular ageing is tantamount to determining the part played by prevention in these diseases. There are wide fluctuations in cardiovascular mortality rate according to some demographic variables: men are more affected than women, the poorer subjects more than the richer subjects, and people living in the North of France more than those living in the South. These disparities are real, irrespective of age, and they can be explained, at least partly, by differences in the prevalence of well-known risk factors. Cardiovascular ageing plays a role, probably important, in the genesis of physical and mental disabilities, but markers that would measure them precisely are lacking. The development of such indicators is a major line of research which should make it possible to evaluate the prospective results of a policy of prevention in a segment of the population where people aged 60 or more accounted for 19.1 percent in 1990 and will account for 25 percent in the year 2020.

The clinical submission syndrome is well known by the general population, but too frequently ignored by physicians.A 23 year-old woman was drugged by a third person wishing to sexually abuse of her. The diagnosis was proved biologically after the judicial enquiry.The diagnosis of clinical submission is difficult to make because of the frequent delays in emergency consultations and the difficulties in biological assays, since the doses of drugs administered are often very low and infra-therapeutic. Over a period of one year, we evoked the diagnosis four times and it was confirmed only once. It sometimes leads to diagnostic peregrinations. Close cooperation between the physicians and the police is required so that a judicial enquiry can be rapidly set-up.

In the French population aged 35-64, cancer mortality increased yearly by 1 percent in males and decreased yearly by 0.6 percent in females between 1950 and 1989. In males, the increase is mostly due to the sites associated with tobacco and alcohol. The important increase of lung cancer is related to the increase in tobacco consumption from 4.7 g per adult per day in 1950 to 6.3 g in 1976. The increase observed in head and neck cancers is related to tobacco and alcohol. In females, the moderate decrease is due to the decrease observed in uterine cervix and stomach cancer mortality, uncompensated by the increase in breast cancer. Contrary to what is observed in the USA, there is no marked increase in lung cancer mortality for women.

In this prospective study the nutritional profiles of 21 consecutive male hospital in-patients with primary dilated cardiomyopathy were evaluated in order to determine whether these profiles differed from those foodstuff consumed during on week and recording of the daily consumption of alcoholic beverages during the year preceding hospitalisation. The duration of dangerous alcohol consumption (more than 60 g/day) was also recorded. In these 21 patients the mean calorie intake was 3,600 kcal/day, including 500 kcal/day provided by alcohol. The mean nutrient intakes were: proteins 90 g/day, fats 100 g/day and carbohydrates 300 g/day. The daily alcohol consumption exceeded 20 years. Compared with the control population, the patients with primary dilated cardiomyopathy had a diet that was not lacking in calories but showed insufficient fat intake. Alcohol consumption was unquestionably excessive and constituted a major risk factor for this particular disease.

Over a 2-year period (1981-1982), blood alcohol levels were measured in 1371 post-mortem examinations performed at the medico-legal Institute of Lyon. These levels were higher in men, in subjects who died between 9 p.m. and 3 a.m., in corpses found in water and in subjects killed by a fall or in a fire. Among the 4 main types of death (homicide, suicide, accident and natural death), those by homicide had the highest, and those by suicide the lowest blood alcohol concentrations.

Twenty to forty percent of all patients admitted to the emergency ward are positive for blood alcohol. Devices which measure alcohol in expired breath have been increasingly used in these units. This study was conducted to compare the results of breath alcohol analyzers with the classical laboratory methods based on enzyme assay and gas phase chromatography.All patients with suspected acute ethanol intoxication at admission to the emergency room were included if blood alcohol had been ordered (enzyme assay and gas phase chromatography).There were 204 patients (151 men (74%) and 53 women (26%); mean age 43 +/- 12.7 years, range 14-80). The coefficient of correlation between blood alcohol level determined by gas phase chromatography (GC) and breath alcohol was 0.96 (r2 = 0.92, p < 10(-4)). The coefficient of correlation between breath alcohol and blood alcohol level determined by enzyme assay was 0.96 (r2 = 0.92, p < 10(-4)). Comparing the coefficients of correlation GC/blood (r2 = 0.92) versus GC/enzyme assay (r2 = 0.96) demonstrated a statistically significant difference (p < 10(-3)).In our 204 patients, the breath alcohol analyzer gave 3 false positives and 3 false negatives (2.94%). Even though breath alcohol levels are 21.1% lower than the levels given by gas phase chromatography, it is an instantaneous nonaggressive method well correlated with classical blood tests. Nevertheless, this method could not be used in 19.6% of emergency patients due to physical impossibility or refusal, justifying laboratory tests.

In a study of 2.021 injured persons (accidents at home or at work, road accidents), qualitative assays of serum benzodiazepines by the EMIT method were positive in 9.6 per cent of the cases, including 3.2 per cent who had blood alcohol levels in excess of 0.10 g/l. Benzodiazepines were more frequently found in accidents at home and on roads than in accidents at work. These results raise the question of the role played by benzodiazepines as a possible risk factor of accidents, notably road accidents.

Healthy sleeping habits is a complex balance between behaviour, environment and circadian rhythm. The quality of sleep can be improved by behaviour, e.g. eating tryptophan and carbohydrate rich foods, physical exercise in the afternoon or a cold shower just before going to bed. Total sleep time is maximal in thermoneutrality and decreases above and below the thermoneutrality zone. Thermoneutrality is reached for an environmental temperature of 30-32 degrees C without night clothing or of 16-19 degrees with a pyjama and at least one sheet. Noise also modifies sleep structure and above 50dB shortens total sleeping time. Although subjects do become subjectively accustomed to noise, vegetative cardiovascular reactivity to environmental noise remains unchanged. The spontaneous circadian awake/sleep cycle is 25 hours, slightly longer than the body temperature cycle, but when subjects are exposed to environmental synchronization, the two cycles coincide. In individuals undergoing temporal isolation, the two rhythms become independent often leading to subjective discomfort and fatigue. Certain factors including age can favour internal desynchronization. Other factors may include social contact, stress due to mental work load, and constant lighting which could lengthen the awake/sleep cycle. Caffeine blocks the receptors of adenosine, and thus its effects of inhibiting neurotransmission. Intake 30 to 60 minutes before sleeping shortens total sleep time and increases the duration of stage 2 and shortens stage 3 and 4. Alcohol may act as a relaxing, sedative agent when consumed just before sleeping but can also lead to night-time awakening due to sympathetic activation which does not return to baseline levels until the blood alcohol levels have returned to 0. Nicotine has a biphasic effect on sleep: at low concentrations, it leads to relaxation and sedation and at high concentrations inhibits sleep. A careful study of sleeping habits is the first step in evaluating complains of insomnia or hypersomnia. Before relying on drugs, treatment should start with attention to the sleep environment and personal habits.

A concerted study of the clinical and electrophysiologic effects of tianeptine was conducted in alcoholic patients hospitalized for 5 weeks for alcohol withdrawal cures and subsequent depression. Because of the well known manifestations of infraclinical cognition impairment, sleep disorders and greater susceptibility to undesirable effects of psychotropic drugs, which hinder health care in this type of patient, the authors investigated changes in cognitive functions and the effect of tianeptine on sleep organization and daytime vigilance. Results after 4 weeks treatment (3 times 12.5 mg/day) included: besides its antidepressant effect, tianeptine reduces the manifestations of anxiety, without sedation effects, either clinical or electrophysiologic; tianeptine has no deleterious effect on cognitive functions, on the contrary, it appears to favour recovery when they are impaired; tianeptine does not modify sleep structure, notably in paradoxal sleep; tianeptine is an antidepressant which has a good acceptability, even for a population at "risk".