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45 results on '"MESH: Cause of Death"'

1. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in the elderly: A case-controlled, multicenter study

Author

Alyami, Mohammad, Lundberg, Peter, Kepenekian, Vahan, Goere, Diane, Bereder, Jean-Marc, Msika, Simon, Lorimier, Gérard, Quenet, François, Ferron, Gwenaël, Thibaudeau, Emilie, Abboud, Karine, Lo Dico, Réa, Delroeux, Delphine, Brigand, Cécile, Arvieux, Catherine, Marchal , Frédéric, Tuech, Jean-Jacques, Guilloit, Jean-Marc, Guyon, Frédéric, Peyrat, Patrice, Pezet, Denis, Ortega-Deballon, Pablo, Zinzindohoué, Franck, de Chaisemartin, Cécile, Kianmanesh, Reza, Glehen, Olivier, Passot, Guillaume, Group, BIG-RENAPE, Group, RENAPE, Service d'Oncologie Médicale [Centre hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Département de chirurgie générale [Gustave Roussy], Institut Gustave Roussy (IGR), Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Département de chirurgie, CRLCC Val d'Aurelle - Paul Lamarque, Institut Claudius Regaud, Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), UNICANCER, CHU Saint-Etienne, Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital de Hautepierre [Strasbourg], CHU Grenoble, Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), Service de chirurgie digestive [CHU Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), Institut Bergonié [Bordeaux], UNICANCER-UNICANCER, Centre Léon Bérard [Lyon], CHU Clermont-Ferrand, Service de Chirurgie Digestive, Cancérologique, Générale, Endocrinienne et Urgences (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de chirurgie digestive, générale et cancérologique [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre Hospitalier Universitaire de Reims (CHU Reims), Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon

Subjects
Male, MESH: Combined Modality Therapy, Health Status, 030230 surgery, MESH: Cause of Death, 0302 clinical medicine, MESH: Aged, 80 and over, Cause of Death, Antineoplastic Combined Chemotherapy Protocols, MESH: Peritoneal Neoplasms, Young adult, Peritoneal Neoplasms, MESH: Health Status, Cause of death, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Age Factors, Cytoreduction Surgical Procedures, Middle Aged, Combined Modality Therapy, MESH: Case-Control Studies, 3. Good health, MESH: Antineoplastic Combined Chemotherapy Protocols, Oncology, Failure to Rescue, Health Care, Cardiovascular Diseases, MESH: Young Adult, 030220 oncology & carcinogenesis, Cohort, Hyperthermic intraperitoneal chemotherapy, Female, Adult, medicine.medical_specialty, Adolescent, MESH: Failure to Rescue, Health Care, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, Young Adult, medicine, Humans, MESH: Cytoreduction Surgical Procedures, MESH: Hyperthermia, Induced, Aged, Retrospective Studies, MESH: Adolescent, MESH: Age Factors, MESH: Humans, business.industry, Case-control study, MESH: Cardiovascular Diseases, Retrospective cohort study, MESH: Adult, MESH: Retrospective Studies, Hyperthermia, Induced, MESH: Male, Surgery, Case-Control Studies, Conventional PCI, Peritoneal Cancer Index, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; OBJECTIVE:This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC).BACKGROUND:Major surgery is associated with higher morbidity and mortality in elderly patients. For PC, CRS and HIPEC is the only current potential curative therapy, but the risks inherent to this patient population have called its benefits into question.METHODS:We retrospectively analyzed a multi-center database from 1989 to 2015. All patients who underwent CRS and HIPEC for PC were selected and patients older than 70 years were matched 1:4 with a younger cohort according to cancer origin, peritoneal cancer index (PCI), and completeness of cytoreduction. Major morbidity and mortality were analyzed.RESULTS:Of 2328 patients, 188 patients older than aged 70 years were matched with 704 younger patients. Patients older than aged 70 years demonstrated a higher American Society of Anesthesiologist score (≥ASA III 10.8 vs. 6.6 %, p = 0.008). There was no difference in overall 90-day morbidity (≥70: 45.7 % vs. 7 (95 % CI 1.051-5.798, p = 0.038) and HIPEC duration (95 % CI 1.106-6.235, p = 0.028) were independent factors associated with morbidity in elderly patients.CONCLUSIONS:CRS and HIPEC appear feasible for selected patients older than aged 70 years, albeit with a higher risk of medical complications associated with increased mortality.

Published
2016
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2. Evaluation of the Incremental Prognostic Utility of Increasingly Complex Testing in Chronic Heart FailureCLINICAL PERSPECTIVE

Author

Ahmad, Tariq, O'Brien, Emily, Schulte, Phillip, Stevens, Susanna, Fiuzat, Mona, Kitzman, Dalane, Adams, Kirkwood, Kraus, William, Piña, Ileana, Donahue, Mark, Zannad, Faiez, Whellan, David, O'Connor, Christopher, Felker, G Michael, Yale University School of Medicine, Duke Clinical Research Institute (DCRI), Duke University [Durham], Duke University Medical Center, Wake Forest University, University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), Montefiore Medical Center, Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Thomas Jefferson University, and Inova Heart and Vascular Institute

Subjects
MESH: Diagnostic Techniques, Cardiovascular, brain, heart failure, MESH: Hospitalization, MESH: Risk Assessment, MESH: Stroke Volume, MESH: Prognosis, MESH: Ventricular Function, Left, MESH: Cause of Death, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: Risk Factors, echocardiography, MESH: Natriuretic Peptide, Brain, MESH: Surveys and Questionnaires, MESH: Peptide Fragments, MESH: Aged, MESH: Humans, MESH: Middle Aged, natriuretic peptide, MESH: Chronic Disease, MESH: Quality of Life, MESH: Male, MESH: Predictive Value of Tests, quality of life, MESH: Heart Failure, MESH: Biomarkers, MESH: Echocardiography, MESH: Exercise Test, MESH: Female, hospitalization
Abstract

International audience; BACKGROUND:Current heart failure (HF) risk prediction models do not consider how individual patient assessments occur in incremental steps; furthermore, each additional diagnostic evaluation may add cost, complexity, and potential morbidity.METHODS AND RESULTS:Using a cohort of well-treated ambulatory HF patients with reduced ejection fraction who had complete clinical, laboratory, health-related quality of life, imaging, and exercise testing data, we estimated incremental prognostic information provided by 5 assessment categories, performing an additional analysis on those with available N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. We compared the incremental value of each additional assessment (quality of life screen, laboratory testing, echocardiography, and exercise testing) to baseline clinical assessment for predicting clinical outcomes (all-cause mortality, all-cause mortality/hospitalization, and cardiovascular death/HF hospitalizations), gauging incremental improvements in prognostic ability with more information using area under the curve and reclassification improvement (net reclassification index), with and without NT-proBNP availability. Of 2331 participants, 1631 patients had complete clinical data; of these, 1023 had baseline NT-proBNP. For prediction of all-cause mortality, models with incremental assessments sans NT-proBNP showed improvements in C-indices (0.72 [clinical model alone]-0.77 [complete model]). Compared with baseline clinical assessment alone, net reclassification index improved from 0.035 (w/laboratory data) to 0.085 (complete model). These improvements were significantly attenuated for models in the subset with measured NT-proBNP data (c-indices: 0.80 [w/laboratory data]-0.81 [full model]); net reclassification index improvements were similarly marginal (0.091→0.096); prediction of other clinical outcomes had similar findings.CONCLUSIONS:In chronic HF patients with reduced ejection fraction, the marginal benefit of complex prognostic evaluations should be weighed against potential patient discomfort and cost escalation.CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.

Published
2015
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3. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

2013 Mortality and Causes of Death Collaborators, GBD, Aboyans, Victor, Grelier, Elisabeth, Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), and Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
MESH: Adolescent, MESH: Aged, MESH: Humans, MESH: Middle Aged, MESH: Mortality, MESH: Infant, Newborn, MESH: Sex Distribution, MESH: Child, Preschool, MESH: Child Mortality, MESH: Adult, MESH: Global Health, MESH: Infant, MESH: Databases, Factual, MESH: Life Tables, MESH: Male, MESH: Cause of Death, MESH: Aged, 80 and over, MESH: Young Adult, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Child, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Life Expectancy, MESH: Female, MESH: Models, Statistical
Abstract

International audience; Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade. Bill & Melinda Gates Foundation.

Published
2015

4. Description of the SAGhE Cohort: A Large European Study of Mortality and Cancer Incidence Risks after Childhood Treatment with Recombinant Growth Hormone

Author

Swerdlow , Anthony, Cooke , Rosie, Albertsson-Wikland , Kerstin, Borgström , Birgit, Butler , Gary, Cianfarani , Stefano, Clayton , Peter, Coste , Joël, Deodati , Annalisa, Ecosse , Emmanuel, Gausche , Ruth, Giacomozzi , Claudio, Kiess , Wieland, Hokken-Koelega , Anita, Kuehni , Claudia, Landier , Fabienne, Maes , Marc, Mullis , Primus-E, Pfaffle , Roland, Sävendahl , Lars, Sommer , Grit, Thomas , Muriel, Tollerfield , Sally, Zandwijken , Gladys, Carel , Jean-Claude, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Unité d'endocrinologie pédiatrique, Institute of Cancer Research - ICR [London, U.K.], Sahlgrenska Academy at University of Gothenburg [Göteborg], Karolinska Institutet [Stockholm], Institute of Child Health [London], University College of London [London] (UCL), University College London Hospitals (UCLH), IRCCS Ospedale Pediatrico Bambino Gesù [Roma], Royal Manchester Children's Hospital, University of Manchester [Manchester], Unité d’Epidémiologie et de Biostatistiques [APHP Cochin-Broca-Hôtel Dieu], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Universität Leipzig [Leipzig], Erasmus University Medical Center [Rotterdam] (Erasmus MC), Sophia Children's Hospital, Institute of Social and Preventive Medicine [Bern] (ISPM), Universität Bern [Bern], Centre de Référence des Maladies Endocriniennes Rares de la Croissance [APHP Robert Debré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Service d'endocrinologie diabétologie pédiatrique [CHU Debré], AP-HP Hôpital universitaire Robert-Debré [Paris], Université Paris Diderot - Paris 7 (UPD7), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Hopital Robert Debre, Institut National de la Santé et de la Recherche Médicale (INSERM), Cliniques universitaires St Luc [Bruxelles], Inselspital Bern, Belgian Study Group for Pediatric Endocrinology (BSGPE), Universitair Ziekenhuis Brussel, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), University College of London [London] ( UCL ), University College London Hospitals ( UCLH ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Erasmus Medical Center / Dutch Growth Research Foundation, Erasmus University Medical Center [Rotterdam], Institute of Social and Preventive Medicine [Bern] ( ISPM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 ( UPD7 ), Université Paris Diderot - Paris 7 ( UPD7 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Belgian Study Group for Pediatric Endocrinology ( BSGPE ), and Pediatrics

Subjects
Male, MESH : Risk, MESH : Child, Preschool, Cohort Studies, MESH: Cause of Death, MESH: Recombinant Proteins, MESH : Child, Cause of Death, Neoplasms, MESH: Child, MESH: Human Growth Hormone, MESH : Female, MESH: Neoplasms, MESH: Incidence, Child, MESH: Cohort Studies, Growth Disorders, Cancer, MESH: Risk, Human Growth Hormone, Incidence, MESH: Infant, Newborn, Cohort, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Follow-Up Studies, MESH: Growth Disorders, MESH: Infant, MESH : Incidence, Recombinant Proteins, Europe, MESH: Young Adult, Child, Preschool, Female, Risk, Adolescent, MESH : Recombinant Proteins, MESH : Male, MESH : Europe, MESH : Young Adult, MESH : Cohort Studies, 610 Medicine & health, MESH : Infant, Newborn, Young Adult, SDG 3 - Good Health and Well-being, 360 Social problems & social services, MESH : Adolescent, Humans, MESH : Growth Disorders, MESH : Human Growth Hormone, Mortality, Growth hormone, MESH : Cause of Death, Settore MED/38 - Pediatria Generale e Specialistica, MESH: Adolescent, Original Paper, MESH: Humans, MESH : Humans, MESH: Child, Preschool, Infant, Newborn, Infant, MESH : Follow-Up Studies, MESH : Neoplasms, MESH: Male, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, MESH: Female, Follow-Up Studies
Abstract

International audience; BACKGROUND:The long-term safety of growth hormone treatment is uncertain. Raised risks of death and certain cancers have been reported inconsistently, based on limited data or short-term follow-up by pharmaceutical companies.PATIENTS AND METHODS:The SAGhE (Safety and Appropriateness of Growth Hormone Treatments in Europe) study assembled cohorts of patients treated in childhood with recombinant human growth hormone (r-hGH) in 8 European countries since the first use of this treatment in 1984 and followed them for cause-specific mortality and cancer incidence. Expected rates were obtained from national and local general population data. The cohort consisted of 24,232 patients, most commonly treated for isolated growth failure (53%), Turner syndrome (13%) and growth hormone deficiency linked to neoplasia (12%). This paper describes in detail the study design, methods and data collection and discusses the strengths, biases and weaknesses consequent on this.CONCLUSION:The SAGhE cohort is the largest and longest follow-up cohort study of growth hormone-treated patients with follow-up and analysis independent of industry. It forms a major resource for investigating cancer and mortality risks in r-hGH patients. The interpretation of SAGhE results, however, will need to take account of the methods of cohort assembly and follow-up in each country.

Published
2015
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5. Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery

Author

Engsig, F. N., Zangerle, R., Katsarou, O., Dabis, F., Reiss, P., Gill, J., Porter, K., Sabin, C., Riordan, A., Fatkenheuer, G., Gutierrez, F., Raffi, F., Kirk, O., Mary-Krause, M., Stephan, C., de Olalla, P. G., Guest, J., Samji, H., Castagna, A., d'Arminio Monforte, A., Skaletz-Rorowski, A., Ramos, J., Lapadula, G., Mussini, C., Force, L., Meyer, L., Lampe, F., Boufassa, F., Bucher, H. C., De Wit, S., Burkholder, G. A., Teira, R., Justice, A. C., Sterling, T. R., M. Crane, H., Gerstoft, J., Grarup, J., May, M., Chene, G., Ingle, S. M., Sterne, J., Obel, N., Burkholder, G., Justice, A., R Sterling, T., Crane, H. M., Boulle, A., Brodt, H.-R., Casabona, J., Cavassini, M., Costagliola, D., D'Arminio Monforte, A., del Amo, J., Van Sighem, A., Hans-Ulrich Haerry, D., Hogg, R., Mocroft, A., Kitahata, M., Saag, M., Williams, M., Ingle, S., Touloumi, G., Warszawski, J., Krause, M. M., Ghosn, J., Leport, C., Wit, F., Prins, M., Gibb, D., Del Amo, J., Thorne, C., Perez-Hoyos, S., Hamouda, O., Gussenheimer-Bartmeyer, B., Noguera-Julian, A., Antinori, A., Brockmeyer, N., Battegay, M., Rauch, A., Tookey, P., Miro, J. M., de Wit, S., Goetghebuer, T., Torti, C., Garrido, M., Judd, A., Conejo, P. R., Haerry, D., Weller, I., d'Arminio-Monforte, A., Colin, C., Schwimmer, C., Termote, M., Kjaer, J., Campbell, M., Raben, D., Bohlius, J., Bouteloup, V., Bucher, H., Cozzi-Lepri, A., Dorrucci, M., Egger, M., Engsig, F., Furrer, H., Lambotte, O., Lewden, C., Lodi, S., Lodwick, R., Matheron, S., Miro, J., Monge, S., Nakagawa, F., Paredes, R., Phillips, A., Puoti, M., Reekie, J., Scherrer, A., Smit, C., Thiebaut, R., Wittkop, L., 2nd Blood Transfusion Center and Hemophilia Center, 'Laiko' General Hospital, Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Structures et propriétés d'architectures moléculaire (SPRAM - UMR 5819), Institut Nanosciences et Cryogénie (INAC), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Observatoire des Micro et Nano Technologies (OMNT - UMS 2920), Laboratoire d'Electronique et des Technologies de l'Information (CEA-LETI), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Southern Alberta Clinic, Research Department of Infection and Population Health [London], University College of London [London] (UCL), Equipe Perception et design sonores, Sciences et Technologies de la Musique et du Son (STMS), Université Pierre et Marie Curie - Paris 6 (UPMC)-IRCAM-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-IRCAM-Centre National de la Recherche Scientifique (CNRS), Equipe Interactions musicales temps-réel, Maladies infectieuses et tropicales, Université Pierre et Marie Curie - Paris 6 (UPMC), Institute of Biology, Neuchatel, Université de Neuchâtel (UNINE), School of Psychology, St Andrews, University of St Andrews [Scotland], Infectious Diseases, San Raffaele Scientific Institute, EA 4100, Histoire culturelle et sociale de l'art (HiCSA), Université Panthéon-Sorbonne (UP1)-Université Panthéon-Sorbonne (UP1), Laboratory of Inorganic Chemistry, Eidgenössische Technische Hochschule - Swiss Federal Institute of Technology in Zürich [Zürich] (ETH Zürich), Princeton University, Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Population Sciences, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Paläontologisches Institut und Museum, Universität Zürich [Zürich] (UZH), Laboratory, GD Deventer, Rigshospitalet [Copenhagen], Department of Social Medicine, University of Bristol [Bristol], Department of Infectious Diseases, Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Commissariat à l'énergie atomique et aux énergies alternatives - Laboratoire d'Electronique et de Technologie de l'Information (CEA-LETI), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche et Coordination Acoustique/Musique (IRCAM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche et Coordination Acoustique/Musique (IRCAM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), School of Psychology and Neuroscience [University of St. Andrews], Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 1 Panthéon-Sorbonne (UP1), Eidgenössische Technische Hochschule - Swiss Federal Institute of Technology [Zürich] (ETH Zürich), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Universität Zürich [Zürich] = University of Zurich (UZH), Royal GD [Deventer], Copenhagen University Hospital, Copenhagen University Hospital-Copenhagen University Hospital, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Engsig, F. N., Zangerle, R., Katsarou, O., Dabis, F., Reiss, P., Gill, J., Porter, K., Sabin, C., Riordan, A., Fatkenheuer, G., Gutierrez, F., Raffi, F., Kirk, O., Mary-Krause, M., Stephan, C., De Olalla, P. G., Guest, J., Samji, H., Castagna, A., D'arminio Monforte, A., Skaletz-Rorowski, A., Ramos, J., Lapadula, G., Mussini, C., Force, L., Meyer, L., Lampe, F., Boufassa, F., Bucher, H. C., De Wit, S., Burkholder, G. A., Teira, R., Justice, A. C., Sterling, T. R., M. Crane, H., Gerstoft, J., Grarup, J., May, M., Chene, G., Ingle, S. M., Sterne, J., Obel, N., Engsig, F, Zangerle, R, Katsarou, O, Dabis, F, Reiss, P, Gill, J, Porter, K, Sabin, C, Riordan, A, Fatkenheuer, G, Gutierrez, F, Raffi, F, Kirk, O, Mary-Krause, M, Stephan, C, De Olalla, P, Guest, J, Samji, H, Castagna, A, D'arminio Monforte, A, Skaletz-Rorowski, A, Ramos, J, Lapadula, G, Mussini, C, Force, L, Meyer, L, Lampe, F, Boufassa, F, Bucher, H, De Wit, S, Burkholder, G, Teira, R, Justice, A, Sterling, T, M. Crane, H, Gerstoft, J, Grarup, J, May, M, Chene, G, Ingle, S, Sterne, J, Obel, N, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, and Infectious diseases

Subjects
Male, Oncology, MESH: CD4 Lymphocyte Count, [SDV]Life Sciences [q-bio], HIV Infections, MESH: Logistic Models, Cohort Studies, MESH: Cause of Death, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Cause of Death, Medicine, HIV Infection, 030212 general & internal medicine, MESH: Anti-HIV Agents, MESH: Cohort Studies, Immunodeficiency, Cause of death, 0303 health sciences, MESH: Middle Aged, Hazard ratio, MESH: HIV Infections, Middle Aged, Viral Load, 3. Good health, Infectious Diseases, MESH: Substance-Related Disorders, HIV/AIDS, Female, MESH: Viral Load, Viral load, MESH: Heterosexuality, Human, Adult, Microbiology (medical), Cart, medicine.medical_specialty, Logistic Model, Anti-HIV Agents, Substance-Related Disorders, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Internal medicine, Humans, sustained viral suppression, Heterosexuality, 030304 developmental biology, MESH: Humans, business.industry, Proportional hazards model, Risk Factor, Anti-HIV Agent, HIV, MESH: Adult, Substance-Related Disorder, medicine.disease, mortality, CD4 cell recovery, Confidence interval, MESH: Male, CD4 Lymphocyte Count, Logistic Models, Immunology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Cohort Studie, business, MESH: Female
Abstract

Background. Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/μL after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality.Methods. We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression (≤500 HIV type 1 RNA copies/mL) for >3 years with CD4 count ≤200 cells/μL at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery (≤200 cells/μL) and Cox regression to identify associations with mortality.Results. Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/μL after 3 years of suppression. Increasing age, lower initial CD4 count, male heterosexual and injection drug use transmission, cART initiation after 1998, and longer time from initiation of cART to start of the virally suppressed period were risk factors for not achieving a CD4 count >200 cells/μL. Individuals with CD4 ≤200 cells/μL after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with those who achieved CD4 count >200 cells/μL. The increased mortality was seen across different patient groups and for all causes of death.Conclusions. Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/μL have substantially increased long-term mortality. © The Author 2014.

Published
2014

6. At-risk drinking is independently associated with ICU and one-year mortality in critically ill nontrauma patients*

Author

P. Fillâtre, Jean Marc Tadié, Elise Sauvadet, Julien Letheulle, Pierre Bouju, Yves Le Tulzo, Fabrice Uhel, Arnaud Gacouin, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, health care facilities, manpower, and services, Alcohol abuse, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, outcomes, intensive care unit, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, MESH: Length of Stay, law.invention, survival analysis, Hospitals, University, MESH: Cause of Death, 0302 clinical medicine, cohort studies, Risk Factors, law, MESH: Risk Factors, Cause of Death, Prospective Studies, 030212 general & internal medicine, MESH: APACHE, Prospective cohort study, APACHE, Cause of death, MESH: Aged, education.field_of_study, MESH: Middle Aged, Hazard ratio, Age Factors, Middle Aged, Intensive care unit, 3. Good health, Alcoholism, Intensive Care Units, at-risk drinking, MESH: Survival Analysis, MESH: Critical Illness, Female, Cohort study, medicine.medical_specialty, Critical Illness, Population, 03 medical and health sciences, Sex Factors, MESH: Sex Factors, MESH: Alcoholism, medicine, Humans, Intensive care medicine, education, Aged, MESH: Age Factors, MESH: Hospitals, University, MESH: Humans, business.industry, Odds ratio, Length of Stay, medicine.disease, mortality, MESH: Male, MESH: Prospective Studies, Emergency medicine, MESH: Intensive Care Units, business, MESH: Female
Abstract

International audience; OBJECTIVES: The impact of at-risk drinking on the outcomes of nontrauma patients is not well characterized. The aim of this study was to determine whether at-risk drinking is independently associated with the survival of nontrauma patients in an ICU and within 1 year following ICU discharge. DESIGN: Observational cohort study. SETTING: A 21-bed mixed ICU in a university hospital. PATIENTS: A total of 662 patients who experienced an ICU stay of 3 days or more and for whom alcohol consumption could be assessed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: ICU-related variables were collected prospectively, and a 1-year follow-up was determined retrospectively. Analyses were adjusted based on prognostic determinants of short- and long-term outcomes, as previously described in ICU patients and alcohol abusers. Two hundred and eight patients (33%) were identified as at-risk drinkers according to the National Institute on Alcohol Abuse and Alcoholism criteria. Additionally, 111 patients (17%) died in the ICU, and 97 (15%) died after ICU discharge. From the ICU admission until the end of the 1-year follow-up period, the at-risk drinkers exhibited poorer survival than the non-at-risk drinkers (p = 0.0004, as determined by the log-rank test). More specifically, 50 at-risk drinkers (24%) versus 61 non-at-risk drinkers (13%) died in the ICU (p = 0.0009 for the comparison). After adjustment, at-risk drinking remained independently associated with mortality in the ICU (adjusted odds ratio of 1.83; 95% CI of 1.16-2.89; p = 0.01) and with mortality within the year following ICU discharge (adjusted hazard ratio of 1.70; 95% CI of 1.15-2.52; p = 0.008). The causes of death in the at-risk and non-at-risk drinkers were similar. CONCLUSIONS: In this population of critically ill nontrauma patients, at-risk drinking was independently associated with death in the ICU and within the year following ICU discharge.

Published
2014
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7. A time series study on the effects of heat on mortality and evaluation of heterogeneity into European and Eastern-Southern Mediterranean cities: results of EU CIRCE project

Author

Francesca De' Donato, Tanja Wolf, Xavier Basagaña, Manuela De Sario, Klea Katsouyanni, Antonis Analitis, Michela Leone, Bettina Menne, Paola Michelozzi, Zeynep Dörtbudak, Elsa Casimiro, Daniela D’Ippoliti, Chava Peretz, Carmen Iñiguez, Afif Ben Salah, Dörbudak, Zeynep, Leone, Michela, D'Ippoliti, Daniela, De Sario, Manuela, Analitis, Antonis, Menne, Bettina, Katsouyanni, Klea, de'Donato, Francesca K., Basagana, Xavier, Ben Salah, Afif, Casimiro, Elsa, Iniguez, Carmen, Peretz, Chava, Wolf, Tanja, Michelozzi, Paola, School of Medicine, Lazio Regional Health Service [Rome], University of Athens Medical School [Athens], WHO European Centre for Environment and Health [Bonn] (ECEH), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), IMIM-Hospital del Mar, Generalitat de Catalunya, Center for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra [Barcelona] (UPF)-Catalunya ministerio de salud, CIBER de Epidemiología y Salud Pública (CIBERESP), Laboratoire d'Epidémiologie Médicale, Institut Pasteur de Tunis, Institut Pasteur de Tunis, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), University of Lisboa, Koç University, Universidad de Valencia, Center for Public Health Research [Valencia] (CSISP), Tel Aviv University [Tel Aviv], This article has been written for the CIRCE project that was funded by the Commission of the European Communities, Research Directorate General (6th Framework Program, Priority 1.1.6.3 Global Change and Ecosystem, Contract N° GOCE-036961), and Authors would like to thank all the institutions and colleagues who provided health and environmental data. The health part of the CIRCE project was coordinated by WHO Regional Office for Europe.

Subjects
Mediterranean climate, Male, MESH: Urban Health, Hot Temperature, Time Factors, Climate, Health, Toxicology and Mutagenesis, Vulnerability, 010501 environmental sciences, 01 natural sciences, Mediterranean Basin, MESH: Regression Analysis, MESH: Cause of Death, 0302 clinical medicine, Africa, Northern, MESH: Child, Cause of Death, 11. Sustainability, 030212 general & internal medicine, Mediterranean region, Socioeconomics, Child, MESH: Aged, [SDV.EE]Life Sciences [q-bio]/Ecology, environment, Middle East, MESH: Middle Aged, MESH: Infant, Newborn, 1. No poverty, Age Factors, Middle Aged, MESH: Climate, MESH: Middle East/epidemiology, MESH: Infant, 3. Good health, Geography, MESH: Young Adult, Child, Preschool, 8. Economic growth, Regression Analysis, Female, Seasons, Adult, medicine.medical_specialty, Adolescent, Climate change, Heat Stress Disorders, MESH: Mediterranean Region/epidemiology, 03 medical and health sciences, Young Adult, medicine, MESH: Cities, Humans, Cities, Mortality, MESH: Heat Stress Disorders/mortality, 0105 earth and related environmental sciences, MESH: Hot Temperature/adverse effects, Aged, Estimation, MESH: Adolescent, MESH: Age Factors, MESH: Heat Stress Disorders/etiology, MESH: Humans, Public health, Research, MESH: Child, Preschool, MESH: Time Factors, Infant, Newborn, Urban Health, Public Health, Environmental and Occupational Health, MESH: Africa, Northern/epidemiology, Infant, MESH: Adult, MESH: Male, Apparent temperature, 13. Climate action, Hot temperature, Heterogeneity, Age groups, Public Health, TIME series analysis, Older people, Unemployment statistics, Climatic changes, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Mortality/trends, MESH: Female, MESH: Seasons, Medicine, Geriatrics
Abstract

Background: The Mediterranean region is particularly vulnerable to the effect of summer temperature. Within the CIRCE project this time-series study aims to quantify for the first time the effect of summer temperature in Eastern-Southern Mediterranean cities and compared it with European cities around the Mediterranean basin, evaluating city characteristics that explain between-city heterogeneity. Methods: The city-specific effect of maximum apparent temperature (Tappmax) was assessed by Generalized Estimation Equations, assuming a linear threshold model. Then, city-specific estimates were included in a random effect meta-regression analysis to investigate the effect modification by several city characteristics. Results: Heterogeneity in the temperature-mortality relationship was observed among cities. Thresholds recorded higher values in the warmest cities of Tunis (35.5 degrees C) and Tel-Aviv (32.8 degrees C) while the effect of Tappmax above threshold was greater in the European cities. In Eastern-Southern Mediterranean cities a higher effect was observed among younger age groups (0-14 in Tunis and 15-64 in Tel-Aviv and Istanbul) in contrast with the European cities where the elderly population was more vulnerable. Climate conditions explained most of the observed heterogeneity and among socio-demographic and economic characteristics only health expenditure and unemployment rate were identified as effect modifiers. Conclusions: The high vulnerability observed in the young populations in Eastern-Southern Mediterranean cities represent a major public health problem. Considering the large political and economic changes occurring in this region as well future temperature increase due to climate change, it is important to strengthen research and public health efforts in these Mediterranean countries., Commission of the European Communities, Research Directorate General (6th Framework Program, Priority 1.1.6.3 Global Change and Ecosystem)

Published
2013
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8. Usefulness of a single-item measure of depression to predict mortality: the GAZEL prospective cohort study

Author

Lefèvre, Thomas, Singh-Manoux, Archana, Stringhini, Silvia, Dugravot, Aline, Lemogne, Cédric, Consoli, Silla, Goldberg, Marcel, Zins, Marie, Nabi, Hermann, Laboratoire de Traitement de l'Information Medicale (LaTIM), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Epidemiology and Public Health, University College of London [London] (UCL), Centre de Gérontologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Sainte Perine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Service Universitaire de Psychiatrie de l'Adulte et du sujet âgé, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Emotion, Université Pierre et Marie Curie - Paris 6 (UPMC)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS), The GAZEL cohort study was funded by EDF-GDF and INSERM, and received grants from the Cohortes Santé TGIR Program. ASM is supported by a EUYRI award from the European Science Foundation and the National Institute on Aging, NIH (R01AG013196, and R01AG034454).

Subjects
MESH: Psychiatric Status Rating Scales, MESH: Socioeconomic Factors, MESH: Humans, MESH: Middle Aged, MESH: Depression, MESH: Questionnaires, MESH: Health Behavior, MESH: Adult, MESH: Follow-Up Studies, mortality, MESH: Predictive Value of Tests, MESH: Prospective Studies, MESH: Male, MESH: Cause of Death, MESH: Proportional Hazards Models, MESH: France, MESH: Risk Factors, depression, single-item, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract

International audience; BACKGROUND: It remains unknown whether short measures of depression perform as well as long measures in predicting adverse outcomes such as mortality. The present study aims to examine the predictive value of a single-item measure of depression for mortality. METHODS: A total of 14,185 participants of the GAZEL cohort completed the 20-item Center-for-Epidemiologic-Studies-Depression (CES-D) scale in 1996. One of these items (I felt depressed) was used as a single-item measure of depression. All-cause mortality data were available until 30 September 2009, a mean follow-up period of 12.7 years with a total of 650 deaths. RESULTS: In Cox regression model adjusted for baseline socio-demographic characteristics, a one-unit increase in the single-item score (range 0-3) was associated with a 25% higher risk of all-cause mortality (95% CI: 13-37%, P

Published
2012
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9. Independent association of urinary F2-isoprostanes with survival in pulmonary arterial hypertension

Author

Jean-Charles Renversez, Jean-Luc Cracowski, Ari Chaouat, Patrice Faure, Luigi Iuliano, François Chabot, José Labarère, Claire Cracowski, Edzard Schwedhelm, Azzedine Yaici, Carole Schwebel, Martine Reynaud-Gaubert, Bruno Degano, Denis Monneret, Gérald Simonneau, Olivier Sitbon, Marc Humbert, Renke Maas, Hypoxie et physiopathologies cardiovasculaire et respiratoire, Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie cardiovasculaire et prévention, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Département de physiologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), BCM, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble, VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Department of Medico-Surgical Sciences & Biotechnologies, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Service de Réanimation Médicale [Grenoble], CHU Grenoble-Hôpital Michallon, Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de chirurgie thoracique, Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital nord, Département de biologie intégrée, Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique, Centre chirurgical Marie Lannelongue-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de pneumologie [Béclère], AP-HP - Hôpital Antoine Béclère [Clamart], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
Male, Isoprostane, medicine.medical_treatment, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, MESH: Lipid Peroxidation, MESH: Cause of Death, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Cause of Death, Familial Primary Pulmonary Hypertension, Cause of death, F2-Isoprostanes, MESH: Middle Aged, Hazard ratio, MESH: Enzyme-Linked Immunosorbent Assay, Venous blood, MESH: Follow-Up Studies, Middle Aged, Prognosis, 3. Good health, Survival Rate, Cardiology, Female, MESH: F2-Isoprostanes, France, Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, medicine.medical_specialty, MESH: Survival Rate, Hypertension, Pulmonary, Enzyme-Linked Immunosorbent Assay, Gas Chromatography-Mass Spectrometry, MESH: Prognosis, 03 medical and health sciences, Internal medicine, medicine, Lung transplantation, Humans, Survival rate, MESH: Kaplan-Meier Estimate, Retrospective Studies, MESH: Humans, MESH: Hypertension, Pulmonary, business.industry, MESH: Biological Markers, MESH: Retrospective Studies, medicine.disease, Pulmonary hypertension, MESH: Male, Surgery, MESH: Gas Chromatography-Mass Spectrometry, MESH: France, 030228 respiratory system, chemistry, Heart catheterization, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Lipid Peroxidation, business, MESH: Female, Biomarkers, Follow-Up Studies
Abstract

International audience; OBJECTIVES: Within the past decade, biochemical markers have emerged as attractive tools to assess pulmonary arterial hypertension (PAH) prognosis, being noninvasive and easily repeatable.The objective of this study was to determine whether biomarkers measured at initial diagnostic right-sided heart catheterization predict 3-year all-cause mortality for incident cases of PAH independently of clinical and hemodynamic parameters. METHODS: Patients with incident PAH were enrolled between December 2003 and April 2006 in six centers from the French Network on Pulmonary Hypertension and followed for 3 years.Venous blood samples were taken during right-sided heart catheterization, and analyses were centralized. RESULTS: Among 110 enrolled patients, 11 underwent lung or heart/lung transplantation, and 27 died during follow-up. The Kaplan-Meier estimates of survival were 91%, 78%, and 75% at 1, 2, and 3 years, respectively. Plasma big endothelin-1 (hazard ratio [HR] per 1-SD increase, 1.48; 95% CI,1.14-1.92), serum troponin T . 0.01 mg/L (HR, 2.35; 95% CI, 1.05-5.29), and urinary F 2 -isoprostanes(15-F2t -isoprostane) (HR per 1-SD increase, 1.76; 95% CI, 1.31-2.36) were associated with increased unadjusted hazard of death. In multivariate analysis adjusting for patient characteristics, the level of urinary F 2 -isoprostanes was the only biomarker that remained independently associated with increased hazard of death (HR per 1-SD increase, 1.82; 95% CI, 1.28-2.60). CONCLUSIONS: This study shows that levels of urinary F 2 -isoprostane, a biomarker of lipid peroxidation,quantified at initial diagnostic right-sided heart catheterization are independently associated with mortality in a cohort of patients with incident PAH.

Published
2012
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10. Mortality differences between the foreign-born and locally-born population in France (2004-2007)

Author

Grégoire Rey, Eric Jougla, Yves Breem, Roxane Boulogne, Anton E. Kunst, Centre d'épidémiologie sur les causes médicales de décès (CépiDc), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département des Statistiques, des Etudes et de la Documentation, Division Enquêtes et Etudes Statistiques, Ministère de l'Immigration, de l'Intégration, de l'Identité Nationale et du Développement Solidaire, Department of Public Health, University of Amsterdam [Amsterdam] (UvA), INSERM, APH - Amsterdam Public Health, Public and occupational health, and Camelin, Laurence

Subjects
Male, MESH: Urban Health, Health (social science), Immigration, Poison control, MESH: Risk Assessment, MESH: Cause of Death, 0302 clinical medicine, MESH: Child, 030212 general & internal medicine, Europe, Eastern, 10. No inequality, Child, Cause of death, media_common, MESH: Aged, education.field_of_study, MESH: Europe, Eastern, MESH: Middle Aged, MESH: Asia, Mortality differential, MESH: Sex Distribution, Middle Aged, MESH: Emigrants and Immigrants, MESH: Asia, Central, 3. Good health, Morocco, Geography, MESH: Young Adult, Child, Preschool, Asia, Central, Female, France, 0305 other medical science, Adult, Asia, Adolescent, media_common.quotation_subject, Population, Emigrants and Immigrants, Risk Assessment, 03 medical and health sciences, Young Adult, Foreign born, Age Distribution, History and Philosophy of Science, Country of birth, Injury prevention, Healthy migrant effect, MESH: United States, Humans, Mortality, Sex Distribution, education, Socioeconomic status, MESH: Age Distribution, Aged, MESH: Adolescent, 030505 public health, MESH: Humans, MESH: Mortality, MESH: Child, Preschool, Urban Health, MESH: Adult, Country of origin, United States, MESH: Male, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Morocco, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, Demography
Abstract

International audience; In contrast to the situation in many European countries, the mortality of immigrants in France has been little studied. The main reasons for the lack of studies are based on ethical and ideological considerations. The objective of this study is to explore mortality by country of birth in Metropolitan (i.e. 'mainland') France. Complete mortality data were used to study the relative risks of mortality of the foreign- and locally-born populations by gender, age and cause of death for the period 2004-2007 in Metropolitan France. Analyses were conducted by countries of birth grouped into geographic areas and by the Human Development Index (HDI). The differentials in mortality between foreign-born and locally-born populations were not homogeneous. The figures varied by age (higher foreign-born mortality for the young; lower mortality for migrants aged 15-64 years), gender (female migrants more frequently had higher relative mortality than men migrants), country of birth (Eastern European-born migrants had higher mortality, while those born in Morocco, Central Asia, 'other Asian countries' and America had lower mortality) and cause of death (migrant mortality was higher overall for deaths caused by infectious diseases and diabetes, and lower for violent death and neoplasm). Moreover, mortality relative risks for male, violent deaths and cancer were positively associated with country-of-birth HDI, while female mortality and infectious disease mortality were negatively associated with country-of-birth HDI. Some important caveats have to be considered because the study did not control for individuals socioeconomic position in France, or length of residence in the host country. A strong healthy migrant effect was suggested and its intensity varies with age and gender (which may reflect different reasons for migration). For some specific causes of death, a lifestyle effect seems to explain mortality differentials. The associations between HDI and mortality show that mortality trends are partly related to the educational, sanitary and economic conditions of the country of birth. Further studies would enrich the differential analysis of mortality by country of birth by contributing additional detailed data on socioeconomic and living conditions in the host country as well as in the country of origin.

Published
2012
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11. Younger donor's age and upfront tandem are two independent prognostic factors for survival in multiple myeloma patients treated by tandem autologous-allogeneic stem cell transplantation: a retrospective study from the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

Author

Jean-Henri Bourhis, Frédéric Garban, Mohamad Mohty, Nathalie Contentin, Gérard Socié, Sylvie François, Mauricette Michallet, Nathalie Fegueux, Madalina Uzunov, Serge Koscielny, Natacha Maillard, Ibrahim Yakoub-Agha, Simona Lapusan, Didier Blaise, Claire Fabre, Reza Tabrizi, Hématopoïèse normale et pathologique, Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'hématologie et oncologie médicale, Hôpital Lapeyronie-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hôpital Haut-Lévêque, Université Sciences et Technologies - Bordeaux 1-CHU Bordeaux [Bordeaux], Service Hématologie, Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Hôpital Jean Bernard, Service d'hématologie [Hôpital Edouard Herriot - HCL], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'hématologie greffe [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), UAM Allogreffes de CSH, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), TheREx, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Département de cancérologie et d'hématologie, and CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon

Subjects
Male, Oncology, MESH: Tissue Donors, MESH: Registries, MESH: Multiple Myeloma, [SDV.IMM.II]Life Sciences [q-bio]/Immunology/Innate immunity, MESH: Cause of Death, 0302 clinical medicine, Recurrence, Cause of Death, Registries, Prospective cohort study, Multiple myeloma, Cause of death, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, Mortality rate, Age Factors, Hematopoietic Stem Cell Transplantation, Hematology, Middle Aged, Prognosis, Tissue Donors, MESH: Transplantation, Autologous, 3. Good health, Treatment Outcome, MESH: Young Adult, 030220 oncology & carcinogenesis, MESH: Survival Analysis, Female, Multiple Myeloma, Adult, medicine.medical_specialty, Transplantation, Autologous, MESH: Prognosis, Young Adult, 03 medical and health sciences, Internal medicine, medicine, MESH: Transplantation, Homologous, Humans, Transplantation, Homologous, Autologous transplantation, Survival analysis, MESH: Hematopoietic Stem Cell Transplantation, Aged, Retrospective Studies, MESH: Age Factors, MESH: Humans, business.industry, Retrospective cohort study, MESH: Adult, MESH: Retrospective Studies, medicine.disease, Survival Analysis, MESH: Male, Surgery, MESH: Recurrence, Transplantation, MESH: Morbidity, Original Articles and Brief Reports, Morbidity, business, MESH: Female, 030215 immunology
Abstract

International audience; BACKGROUND: How tandem autologous-allogeneic stem cell transplantation should be integrated in the treatment of multiple myeloma remains controversial. We examined the long-term outcome of patients with multiple myeloma managed with tandem autologous-allogeneic stem cell transplantation and present a prognostic factor analysis based on the experience of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC). DESIGN AND METHODS: This French, retrospective, registry-based study included 146 patients who had undergone tandem autologous-allogeneic transplantation for multiple myeloma at 20 SFGM-TC centers between 1998 and 2010. The patients included in the study had fully completed the two steps of a planned tandem autologous-allogeneic transplantation. No treatment had to be administered between the autologous and allogeneic parts of the tandem procedure. RESULTS: Seventy-seven patients (53%) underwent tandem autologous-allogeneic transplantation as part of upfront treatment, i.e. after a single line of treatment not including autologous transplantation. The median follow-up from the allogeneic transplant was 47.5 months (range, 1.2-132 months). At 4 years, the overall survival and event-free survival rates were 48% (95% CI 39-57 %) and 27% (95% CI 19-36), respectively. Eighteen patients (12%) experienced grade III-IV acute graft-versus-host disease and 43 patients (30%) had chronic graft-versus-host disease. The transplant-related mortality rate at 1 year was 15% (95% CI 10-22). Patients receiving tandem transplantation as upfront treatment had significantly improved event-free survival (36% versus 11%; P=0.005) and overall survival (56% versus 34%; P=0.02). Donor's age ≤ 50 years was associated with improved event-free survival (35% versus 16%; P=0.005) and overall survival (54% versus 41%; P=0.02). In the multivariable analysis, upfront tandem transplantation, donor's age ≤ 50 years and full chimerism were independent prognostic factors for better outcome. CONCLUSIONS: We confirmed the feasibility of tandem autologour-allogeneic transplantation in heavily treated patients with multiple myeloma. We identified younger donor's age and upfront tandem transplantation as two independent prognostic factors for survival which could be further explored in prospective studies.

Published
2012
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12. Neuroticism and cardiovascular disease mortality: socioeconomic status modifies the risk in women (UK Health and Lifestyle Survey)

Author

Séverine Sabia, Archana Singh-Manoux, Alexis Elbaz, David Boniface, Ian J. Deary, Gareth Hagger-Johnson, G. David Batty, Beverly A. Roberts, Department of Epidemiology and Public Health, University College of London [London] (UCL), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Dept of Psychology, University of Edinburgh, SZTAJNBOK, Pascale, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
Male, Gerontology, Neurotic Disorders, Personality Inventory, Health Behavior, MESH: Cause of Death, MESH: Proportional Hazards Models, 0302 clinical medicine, MESH: Health Surveys, Risk Factors, MESH: Risk Factors, Cause of Death, Prospective Studies, 030212 general & internal medicine, Big Five personality traits, 10. No inequality, Applied Psychology, MESH: Aged, MESH: Middle Aged, Hazard ratio, Middle Aged, Neuroticism, 3. Good health, Psychiatry and Mental health, Cardiovascular Diseases, population characteristics, MESH: Great Britain, Female, Psychology, Adult, MESH: Health Behavior, MESH: Social Class, MESH: Women, 03 medical and health sciences, mental disorders, Humans, Women, Risk factor, Socioeconomic status, Aged, Proportional Hazards Models, MESH: Neurotic Disorders, Extraversion and introversion, MESH: Humans, MESH: Cardiovascular Diseases, MESH: Adult, social sciences, Health Surveys, United Kingdom, Confidence interval, Eysenck Personality Questionnaire, MESH: Male, MESH: Prospective Studies, MESH: Personality Inventory, Social Class, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, 030217 neurology & neurosurgery, Demography
Abstract

International audience; The association between personality traits and mortality might differ as a function of socioeconomic status (SES). Our aim was to evaluate the all-cause, cardiovascular disease (CVD), and cancer mortality risk associated with neuroticism or extraversion and their interactions with SES in a representative sample of the UK adult population. A total of 5450 participants (2505 men) from the Health and Lifestyle Survey completed the Eysenck Personality Inventory at baseline and were monitored for vital status over 25 years. SES was defined as a latent variable comprising occupational social class, educational attainment, and income. A significant neuroticism-by-SES-by-sex interaction (p = .04) for CVD mortality revealed a neuroticism-by-SES interaction specific to women. Compared to women with average SES, those with both high neuroticism and low SES were at an increased risk for CVD mortality (hazard ratio = 2.02, 95% confidence interval = 1.45-2.80), whereas those with high neuroticism and high SES combined were at a decreased risk for CVD mortality (hazard ratio = 0.61, 95% confidence interval = 0.38-0.97, p for interaction = 0.003). The interaction term was not explained by health behaviors (10% attenuation) and physiological variables (11% attenuation). This interaction was not observed for all-cause and cancer mortality risks or among men for CVD mortality. High neuroticism is a risk factor for cardiovascular mortality in women with low SES, whereas in women with higher SES, it is protective. Further research is needed to replicate this finding and identify the mechanisms behind the modifying effect of SES on neuroticism.

Published
2012
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13. Effect of intensity and type of physical activity on mortality: results from the Whitehall II cohort study

Author

Eric J. Brunner, Archana Singh-Manoux, Mika Kivimäki, Séverine Sabia, Aline Dugravot, Martin J. Shipley, Schmaus, Annie, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Epidemiology and Public Health, University College of London [London] (UCL), Centre de Gérontologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Funding sources: AS-M is supported by a 'European Young Investigator Award' from the European Science Foundation, MK is supported by the BUPA Foundation, UK and the Academy of Finland, and MJS is supported by the British Heart Foundation. The Whitehall II study has been supported by grants from the British Medical Research Council (MRC), the British Heart Foundation, the British Health and Safety Executive, the British Department of Health, the National Heart, Lung, and Blood Institute (R01HL036310), the National Institute on Aging (R01AG013196 and R01AG034454)., and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
Adult, Male, 030204 cardiovascular system & hematology, Lower risk, Cohort Studies, MESH: Cause of Death, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, Surveys and Questionnaires, London, Humans, Medicine, Longitudinal Studies, Prospective Studies, 030212 general & internal medicine, Mortality, Exercise physiology, Prospective cohort study, MESH: Longitudinal Studies, Exercise, MESH: Cohort Studies, Aged, Cause of death, MESH: Aged, MESH: Middle Aged, MESH: Humans, MESH: Mortality, business.industry, MESH: Questionnaires, Hazard ratio, Public Health, Environmental and Occupational Health, MESH: Adult, MESH: Follow-Up Studies, Middle Aged, MESH: London, Confidence interval, MESH: Male, MESH: Prospective Studies, Intensity (physics), [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Exercise, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Follow-Up Studies, Demography, Cohort study
Abstract

Objectives. We examined the association of intensity and type of physical activity with mortality. Methods. We assessed the duration of physical activity by intensity level and type in 7456 men and women from the Whitehall II Study by questionnaire in 1997–1999 (mean ±SD age = 55.9 ±6.0 years) and 5 years later. All-cause mortality was assessed until April 2009. Results. A total of 317 participants died during the mean follow-up of 9.6 years (SD = 2.7). Reporting at least 1 hour per week of moderate activity was associated with a 33% (95% confidence interval [CI] = 14%, 45%) lower risk of mortality compared with less than 1 hour. For all physical activity types examined, except housework, a duration of physical activity greater than 0 (≥ 3.5 hours for walking) was associated with lower mortality in age-adjusted analyses, but only the associations with sports (hazard ratio [HR] = 0.71; 95% CI = 0.56, 0.91) and do-it-yourself activity (HR = 0.68; 95% CI = 0.53, 0.98) remained in fully adjusted analyses. Conclusions. It is important to consider both intensity and type of physical activity when examining associations with mortality.

Published
2012
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14. Usefulness of a single-item measure of depression to predict mortality: the GAZEL prospective cohort study.: single-item of depression and mortality

Author

Lefèvre, Thomas, Singh-Manoux, Archana, Stringhini, Silvia, Dugravot, Aline, Lemogne, Cédric, Consoli, Silla, Goldberg, Marcel, Zins, Marie, Nabi, Hermann, Schmaus, Annie, Laboratoire de Traitement de l'Information Medicale (LaTIM), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Epidemiology and Public Health, University College of London [London] (UCL), Centre de Gérontologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Sainte Perine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Service Universitaire de Psychiatrie de l'Adulte et du sujet âgé, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Emotion, Université Pierre et Marie Curie - Paris 6 (UPMC)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), The GAZEL cohort study was funded by EDF-GDF and INSERM, and received grants from the Cohortes Santé TGIR Program. ASM is supported by a EUYRI award from the European Science Foundation and the National Institute on Aging, NIH (R01AG013196, and R01AG034454).

Subjects
MESH: Psychiatric Status Rating Scales, MESH: Socioeconomic Factors, MESH: Humans, MESH: Middle Aged, MESH: Depression, MESH: Questionnaires, MESH: Health Behavior, MESH: Adult, MESH: Follow-Up Studies, mortality, MESH: Predictive Value of Tests, MESH: Prospective Studies, MESH: Male, MESH: Cause of Death, MESH: Proportional Hazards Models, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Risk Factors, depression, single-item, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract

International audience; BACKGROUND: It remains unknown whether short measures of depression perform as well as long measures in predicting adverse outcomes such as mortality. The present study aims to examine the predictive value of a single-item measure of depression for mortality. METHODS: A total of 14,185 participants of the GAZEL cohort completed the 20-item Center-for-Epidemiologic-Studies-Depression (CES-D) scale in 1996. One of these items (I felt depressed) was used as a single-item measure of depression. All-cause mortality data were available until 30 September 2009, a mean follow-up period of 12.7 years with a total of 650 deaths. RESULTS: In Cox regression model adjusted for baseline socio-demographic characteristics, a one-unit increase in the single-item score (range 0-3) was associated with a 25% higher risk of all-cause mortality (95% CI: 13-37%, P

Published
2012
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15. Overtime work and incident coronary heart disease: the Whitehall II prospective cohort study

Author

Marianna Virtanen, Michael Marmot, Jussi Vahtera, Martin J. Shipley, Mika Kivimäki, Archana Singh-Manoux, Jane E. Ferrie, Finnish Institute of Occupational Health, Department of Epidemiology and Public Health, University College of London [London] (UCL), Centre de Gérontologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Sainte Perine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Public Health, Turku University Hospital (TYKS)-University of Turku-Finnish Institute of Occupational Health, The Whitehall II study has been supported by grants from the Medical Research Council, British Heart Foundation, Health and Safety Executive, Department of Health, National Heart Lung and Blood Institute (HL36310), US, NIH: National Institute on Aging (AG13196 and AG34454), US, NIH, Agency for Health Care Policy Research (HS06516), the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health, and the BUPA Foundation, UK. MK and JV are supported by the Academy of Finland (Projects no. #124271, #124322, #129262 and #132944), MK is additionally supported by the BUPA Foundation Specialist research grant, AS-M is supported by a 'EURYI' award from the European Science Foundation, MJS is supported by the British Heart Foundation and MGM is supported by a MRC Research Professorship., European Project: 38533,EURYI, Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Kaniewski, Nadine, Conférence : European Business Summit 2004 - Research and Innovation : A European Strategy for more growth and jobes - EURYI - 38533 - OLD, and University of Turku-Finnish Institute of Occupational Health-Turku University Hospital (TYKS)

Subjects
Male, Multivariate analysis, Coronary Disease, MESH: Angina Pectoris, Angina, MESH: Cause of Death, stress, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Cause of Death, Work Schedule Tolerance, Epidemiology, London, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Prospective cohort study, Cause of death, MESH: Aged, Incidence (epidemiology), Prognosis, 030210 environmental & occupational health, 3. Good health, Occupational Diseases, MESH: Myocardial Infarction, myocardial infarction, Female, Cardiology and Cardiovascular Medicine, Cohort study, Adult, MESH: Occupational Diseases, medicine.medical_specialty, working hours, MESH: Prognosis, Angina Pectoris, angina, 03 medical and health sciences, Clinical Research, Internal medicine, medicine, Humans, middle-aged, Aged, MESH: Work Schedule Tolerance, MESH: Humans, business.industry, MESH: Adult, prospective, MESH: London, medicine.disease, MESH: Prospective Studies, MESH: Male, CHD, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Physical therapy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Coronary Disease, business, MESH: Female
Abstract

International audience; AIMS: To examine the association between overtime work and incident coronary heart disease (CHD) among middle-aged employees. METHODS AND RESULTS: Six thousand and fourteen British civil servants (4262 men and 1752 women), aged 39-61 years who were free from CHD and worked full time at baseline (1991-1994), were followed until 2002-2004, an average of 11 years. The outcome measure was incident fatal CHD, clinically verified incident non-fatal myocardial infarction (MI), or definite angina (a total of 369 events). Cox proportional hazard models adjusted for sociodemographic characteristics showed that 3-4 h overtime work per day was associated with 1.60-fold (95% CI 1.15-2.23) increased risk of incident CHD compared with employees with no overtime work. Adjustment for all 21 cardiovascular risk factors measured made little difference to these estimates (HR 1.56, 95% CI 1.11-2.19). This association was replicated in multivariate analysis with only fatal cardiovascular disease and incident non-fatal MI as the outcome (HR 1.67, 95% CI 1.02-2.76). CONCLUSION: Overtime work is related to increased risk of incident CHD independently of conventional risk factors. These findings suggest that overtime work adversely affects coronary health.

Published
2010
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16. Causes of death in HIV-infected women: persistent role of AIDS. The 'Mortalité 2000 & 2005' Surveys (ANRS EN19)

Author

Charlotte Lewden, Philippe Morlat, Thierry May, Dominique Salmon, Mojgan Hessamfar-Bonarek, Eric Rosenthal, Fabrice Bonnet, Patrice Cacoub, Geneviève Chêne, Dominique Costagliola, Service de médecine interne et maladies infectieuses [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Saint-André, Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hépatotoxicité et xénobiotiques, Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Segalen - Bordeaux 2-Service de médecine interne et maladies infectieuses [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Saint-André-CHU Bordeaux [Bordeaux]-Groupe hospitalier Saint-André-Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de médecine interne [Nice], Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Epidémiologie, stratégies thérapeutiques et virologie cliniques dans l'infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut de Santé Publique, d'Epidémiologie et de Développement ( ISPED ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Service de médecine interne [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Foie, métabolismes et cancer, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ) -CHU Nice-Hôpital l'Archet, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université Nice Sophia Antipolis (... - 2019) (UNS)

Subjects
Male, Time Factors, Epidemiology, HIV Infections, MESH: Comorbidity, Comorbidity, Disease, Logistic regression, MESH: Cause of Death, 0302 clinical medicine, MESH: Health Surveys, Risk Factors, MESH: Risk Factors, Cause of Death, MESH : Socioeconomic Factors, MESH : Female, 030212 general & internal medicine, Sida, Cause of death, 0303 health sciences, MESH: Middle Aged, biology, MESH : Acquired Immunodeficiency Syndrome, Smoking, Age Factors, General Medicine, MESH: HIV Infections, Middle Aged, MESH : Adult, MESH : Risk Factors, 3. Good health, MESH : Smoking, AIDS, Infectious Diseases, MESH : Comorbidity, Female, [ SDV.MHEP.HEG ] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Viral disease, women, MESH : Time Factors, Adult, medicine.medical_specialty, MESH: Smoking, MESH: Socioeconomic Factors, Alcohol Drinking, MESH : Male, MESH : Sex Factors, MESH : Health Surveys, causes of death, 03 medical and health sciences, Sex Factors, Acquired immunodeficiency syndrome (AIDS), MESH: Sex Factors, medicine, MESH : HIV Infections, Humans, MESH : Middle Aged, MESH : Cause of Death, MESH: Acquired Immunodeficiency Syndrome, MESH: Age Factors, Acquired Immunodeficiency Syndrome, MESH: Humans, 030306 microbiology, business.industry, Public health, MESH : Humans, MESH: Time Factors, MESH: Adult, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, biology.organism_classification, HIV infection, Health Surveys, MESH: Male, Surgery, MESH : Alcohol Drinking, Socioeconomic Factors, MESH : Age Factors, business, MESH: Female, MESH: Alcohol Drinking, Demography
Abstract

International audience; BACKGROUND: Little is known about the causes of death in human immunodeficiency virus (HIV)-infected women in the era of combination antiretroviral therapy (ART). METHODS: In the French nationwide Mortalité 2000 and 2005 surveys, physicians reported causes of deaths in HIV-infected adults in 2000 and 2005, using a standardized questionnaire. We used multivariate logistic regression models to study the association between gender and AIDS-defining causes of death, adjusting for other characteristics. RESULTS: Of the 1013 HIV-infected adults who died in 2005, 247 (24%) were women. Half of women were infected through heterosexual contacts, compared with 25% men. In 2005, the proportion of AIDS-defining causes of death was higher in women than in men (43 vs 34%; P = 0.01), whereas it had been the same in 2000 (47% in women and men). In 2005, women died less frequently than men from respiratory malignancies (lung, ear/nose/throat) and cardiovascular disease (9% of all causes of death in women compared with 16% in men; P = 0.004), and suicides or accidents (4 vs 9%; P = 0.02). Socio-economic precariousness, younger age, less alcohol and tobacco consumption and lack of prior ART explained the higher proportion of deaths from AIDS in women compared with men. CONCLUSIONS: The higher proportion of AIDS-related deaths in women is probably explained by two factors: (i) some HIV-infected women, especially migrants in poor socio-economic conditions, may not have access to optimal care; and (ii) a lower prevalence of risk factors for respiratory, cardiovascular and violent deaths means that the risk of dying from non-AIDS causes may be lower in women.

Published
2010
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17. Venous thromboembolism during pregnancy, postpartum or during contraceptive use

Author

A, Blanco-Molina, L L, Rota, P, Di Micco, B, Brenner, J, Trujillo-Santos, A, Ruiz-Gamietea, M, Monreal, A, Visona, Department of Internal Medicine (DIM - Rio de Janeiro), Federal University of Rio de Janeiro, Department of Internal Medicine (DIM - Cartagena), Hospital Universitario Santa Maria de Rosell, Servicio de Medicina Interna (SMI), Hopital Universitario Germans Trias i Pujol, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)

Subjects
Adult, MESH: Pulmonary Embolism, MESH: Humans, MESH: Registries, Postpartum Period, Pregnancy Complications, Cardiovascular, MESH: Contraceptive Agents, MESH: Adult, MESH: Retrospective Studies, MESH: Pregnancy Complications, Cardiovascular, Venous Thromboembolism, MESH: Venous Thromboembolism, MESH: Cause of Death, MESH: Postpartum Period, MESH: Pregnancy, Contraceptive Agents, Pregnancy, Cause of Death, Humans, Female, Registries, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Retrospective Studies
Abstract

International audience; Venous thromboembolism (VTE) is a leading cause of maternal death during pregnancy or postpartum, and in women using hormonal contraceptives. However, important issues concerning its natural history and therapy remain unsolved, and most of the protocols for treatment of VTE in this patient population are based on data extrapolated from other populations. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We examined the clinical characteristics and three-month outcome of all enrolled women with pregnancy, postpartum or using hormonal contraceptives. As of December 2008, 173 pregnant women, 135 postpartum, and 798 contraceptive users were enrolled. Of these, 438 (40%) presented with pulmonary embolism (PE) and 668 with deep-vein thrombosis (DVT). Most women with acute PE had dyspnea (72%) or chest pain (75%), but only 2.0% had hypoxaemia. During the three-month study period, five women (0.45%; 95% CI: 0.17-1.00) died (3 had fatal PE), 13 (1.18%; 95% CI: 0.66-1.95) had VTE recurrences, and seven (0.63%; 95% CI: 0.28-1.25) major bleeding. Two of the three women with fatal PE died during the first few hours after arriving at the emergency ward, with no time to start any therapy. The outcome of pregnant or postpartum women with VTE is similar to that in contraceptive users, even though the treatment is different. The non-specific nature of PE signs may have caused some delay in PE diagnosis.

Published
2010
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18. Does sickness absence due to psychiatric disorder predict cause-specific mortality? A 16-year follow-up of the GAZEL occupational cohort study

Author

Hugo Westerlund, Maria Melchior, Marcel Goldberg, Jussi Vahtera, Jenny Head, Jane E. Ferrie, Kristina Alexanderson, Mika Kivimäki, Archana Singh-Manoux, Marie Zins, Kaniewski, Nadine, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Epidemiology and Public Health, University College of London [London] (UCL), Division of Insurance Medicine, Karolinska Institutet [Stockholm], Department of Public Health, Turku University Hospital (TYKS)-University of Turku-Finnish Institute of Occupational Health, Stress Research Institute, Stockholm University, Equipe RPPC, CETAF, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
Male, Epidemiology, Original Contributions, absenteeism, Cohort Studies, MESH: Cause of Death, cause of death, 0302 clinical medicine, Neoplasms, Medicine, longitudinal studies, MESH: Neoplasms, 030212 general & internal medicine, MESH: Cohort Studies, Depression (differential diagnoses), Cause of death, MESH: Middle Aged, Mental Disorders, Hazard ratio, Smoking, Absolute risk reduction, Middle Aged, 3. Good health, Suicide, Cardiovascular Diseases, depression, Female, Cohort study, Adult, medicine.medical_specialty, MESH: Smoking, Alcohol Drinking, 03 medical and health sciences, work, Humans, MESH: Mental Disorders, Risk factor, Occupations, Psychiatry, MESH: Occupations, MESH: Humans, Proportional hazards model, business.industry, MESH: Cardiovascular Diseases, MESH: Adult, mortality, MESH: Male, 030227 psychiatry, MESH: Absenteeism, MESH: Suicide, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, MESH: Alcohol Drinking
Abstract

International audience; Mental disorders are a frequent cause of morbidity and sickness absence in working populations; however, the status of psychiatric sickness absence as a predictor of mortality is not established. The authors tested the hypothesis that psychiatric sickness absence predicts mortality from leading medical causes. Data were derived from the French GAZEL cohort study (n = 19,962). Physician-certified sickness absence records were extracted from administrative files (1990-1992) and were linked to mortality data from France's national registry of mortality (1993-2008, mean follow-up: 15.5 years). Analyses were conducted by using Cox regression models. Compared with workers with no sickness absence, those absent due to psychiatric disorder were at increased risk of cause-specific mortality (hazard ratios (HRs) adjusted for age, gender, occupational grade, other sickness absence-suicide: 6.01, 95% confidence interval (CI): 3.07, 11.75; cardiovascular disease: 1.84, 95% CI: 1.10, 3.08; and smoking-related cancer: 1.65, 95% CI: 1.07, 2.53). After full adjustment, the excess risk of suicide remained significant (HR = 5.13, 95% CI: 2.60, 10.13) but failed to reach statistical significance for fatal cardiovascular disease (HR = 1.59, 95% CI: 0.95, 2.66) and smoking-related cancer (HR = 1.31, 95% CI: 0.85, 2.03). Psychiatric sickness absence records could help identify individuals at risk of premature mortality and serve to monitor workers' health.

Published
2010
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19. Cardiorespiratory risk factors as predictors of 40-year mortality in women and men

Author

Martin J. Shipley, Elizabeth Breeze, Jane E. Ferrie, Jennifer S. Mindell, Mika Kivimäki, Archana Singh-Manoux, George Davey Smith, Department of Epidemiology and Public Health, University College of London [London] (UCL), Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Social Medicine, and University of Bristol [Bristol]

Subjects
Male, Respiratory Tract Diseases, Blood Pressure, MESH: Respiratory Function Tests, 030204 cardiovascular system & hematology, Body Mass Index, Cohort Studies, MESH: Cause of Death, 0302 clinical medicine, 1960s, MESH: Risk Factors, Cause of Death, Epidemiology, risk factors, 030212 general & internal medicine, Prospective cohort study, Stroke, MESH: Cohort Studies, cardiorespiratory mortality, MESH: Aged, MESH: Middle Aged, MESH: Heart Diseases, Hazard ratio, Smoking, MESH: Blood Pressure, Middle Aged, 3. Good health, Respiratory Function Tests, Female, Cardiology and Cardiovascular Medicine, Cohort study, Adult, medicine.medical_specialty, MESH: Smoking, Heart Diseases, Article, MESH: Body Mass Index, 03 medical and health sciences, medicine, Humans, 40-year mortality, Risk factor, Aged, MESH: Humans, business.industry, Cardiorespiratory fitness, MESH: Adult, medicine.disease, MESH: Male, Blood pressure, Physical therapy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Respiratory Tract Diseases, business, MESH: Female, Demography
Abstract

International audience; OBJECTIVE: Most historical studies of cardiorespiratory risk factors as predictors of mortality have been based on men. This study examines whether they predict mortality over long periods in women and men. DESIGN: Prospective cohort study. SETTING: Participants were employees of the General Post Office. METHODS: Risk factor data were collected via clinical examination and questionnaire, 1966-7. Associations between cardiorespiratory risk factors and 40-year mortality were determined for 644 women and 1272 men aged 35-70 at examination. MAIN OUTCOME MEASURES: All-cause, cardiovascular (CVD), cancer and respiratory mortality. RESULTS: Associations between systolic blood pressure and all-cause and stroke mortality were equally strong for women and men, hazard ratio (95% confidence interval) 1.25 (1.1 to 1.4) and 1.18 (1.1 to 1.3); and 2.17 (1.7 to 2.8) and 1.69 (1.4 to 2.1), respectively. Cholesterol was higher in women and was associated with all-cause 1.22 (1.1 to 1.4) and CVD 1.39 (1.2 to 1.7) mortality, while associations between 2-hour glucose and all-cause 1.15 (1.1 to 1.2), coronary heart disease (CHD) 1.25 (1.1 to 1.4) and respiratory mortality 1.21 (1.0 to 1.5) were observed in men. Obesity was associated with stroke in women (2.42 (1.12 to 5.24)) and CHD in men (1.59 (1.02 to 2.49)), while ECG ischaemia was associated with CVD in both sexes. The strongest, most consistent predictor of mortality was smoking in women and poor lung function in men. However, evidence of sex differences in associations between the cardiorespiratory risk factors measured and mortality was sparse. CONCLUSIONS: Data from a 40-year follow-up period show remarkably persistent associations between risk factors and cardiorespiratory and all-cause mortality in women and men.

Published
2009
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20. Cardiorespiratory risk factors as predictors of 40-year mortality in women and men

Author

Ferrie, Jane, Singh-Manoux, Archana, Kivimaki, Mika, Mindell, Jennifer, Breeze, Elizabeth, Davey Smith, George, Shipley, Martin, Department of Epidemiology and Public Health, University College of London [London] (UCL), Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Social Medicine, and University of Bristol [Bristol]

Subjects
MESH: Aged, MESH: Smoking, MESH: Middle Aged, MESH: Humans, MESH: Heart Diseases, MESH: Adult, MESH: Respiratory Function Tests, MESH: Blood Pressure, MESH: Male, MESH: Body Mass Index, MESH: Cause of Death, 1960s, MESH: Risk Factors, risk factors, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 40-year mortality, MESH: Respiratory Tract Diseases, MESH: Cohort Studies, MESH: Female, cardiorespiratory mortality
Abstract

International audience; OBJECTIVE: Most historical studies of cardiorespiratory risk factors as predictors of mortality have been based on men. This study examines whether they predict mortality over long periods in women and men. DESIGN: Prospective cohort study. SETTING: Participants were employees of the General Post Office. METHODS: Risk factor data were collected via clinical examination and questionnaire, 1966-7. Associations between cardiorespiratory risk factors and 40-year mortality were determined for 644 women and 1272 men aged 35-70 at examination. MAIN OUTCOME MEASURES: All-cause, cardiovascular (CVD), cancer and respiratory mortality. RESULTS: Associations between systolic blood pressure and all-cause and stroke mortality were equally strong for women and men, hazard ratio (95% confidence interval) 1.25 (1.1 to 1.4) and 1.18 (1.1 to 1.3); and 2.17 (1.7 to 2.8) and 1.69 (1.4 to 2.1), respectively. Cholesterol was higher in women and was associated with all-cause 1.22 (1.1 to 1.4) and CVD 1.39 (1.2 to 1.7) mortality, while associations between 2-hour glucose and all-cause 1.15 (1.1 to 1.2), coronary heart disease (CHD) 1.25 (1.1 to 1.4) and respiratory mortality 1.21 (1.0 to 1.5) were observed in men. Obesity was associated with stroke in women (2.42 (1.12 to 5.24)) and CHD in men (1.59 (1.02 to 2.49)), while ECG ischaemia was associated with CVD in both sexes. The strongest, most consistent predictor of mortality was smoking in women and poor lung function in men. However, evidence of sex differences in associations between the cardiorespiratory risk factors measured and mortality was sparse. CONCLUSIONS: Data from a 40-year follow-up period show remarkably persistent associations between risk factors and cardiorespiratory and all-cause mortality in women and men.

Published
2009
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21. Non-response to baseline, non-response to follow-up and mortality in the Whitehall II cohort

Author

Marko Elovainio, Roberto De Vogli, Alison L. Shortt, Pekka Martikainen, Archana Singh-Manoux, Mika Kivimäki, Martin J. Shipley, Jenny Head, David Gimeno, Jane E. Ferrie, Michael Marmot, Department of Epidemiology and Public Health, University College of London [London] (UCL), Unit of Excellence for Psychosocial Factors, Finnish Institute of Occupational Health, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Helsinki Collegium for Advanced Studies, Kaniewski, Nadine, and Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Gerontology, Male, Epidemiology, Health Behavior, Cohort Studies, MESH: Cause of Death, 0302 clinical medicine, MESH: Health Surveys, Surveys and Questionnaires, Cause of Death, Medicine, Socioeconomic inequalities, 030212 general & internal medicine, MESH: Cohort Studies, Cause of death, MESH: Middle Aged, medicine.diagnostic_test, White-collar, Absolute risk reduction, General Medicine, Middle Aged, All-cause mortality, 3. Good health, Occupational cohort, Cohort, Female, 0305 other medical science, Risk assessment, Cohort study, Adult, medicine.medical_specialty, MESH: Socioeconomic Factors, MESH: Health Behavior, Non-response to follow-up, Physical examination, 03 medical and health sciences, MESH: Analysis of Variance, Humans, Socioeconomic status, Partial response, Analysis of Variance, 030505 public health, MESH: Humans, business.industry, MESH: Questionnaires, Methodology, MESH: Adult, Health Surveys, MESH: Male, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography
Abstract

International audience; BACKGROUND: Little is known about the associations between non-response to follow-up surveys and mortality, or differences in these associations by socioeconomic position in studies with repeat data collections. METHODS: The Whitehall II study of socioeconomic inequalities in health provided response status from five data collection surveys; Phase 1 (1985-88, n = 10 308), Phase 5 (1997-99, n = 6533), and all-cause mortality to 2006. Odd-numbered phases included a medical examination in addition to a questionnaire. RESULTS: Non-response to baseline and to follow-up phases that included a medical examination was associated with a doubling of the mortality hazard in analyses adjusted for age and sex. Compared with complete responders, responders who missed one or more phases, but completed the last possible phase before they died, had a 38% excess risk of mortality. However, those who missed one or more phases including the last possible phase before death had an excess risk of 127%. There was no evidence that these associations differed by socioeconomic position. CONCLUSION: In studies with repeat data collections, non-response to follow-up is associated with the same doubling of the mortality risk as non-response to baseline; an association that is not modified by socioeconomic position.

Published
2009
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22. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study

Author

Vincent Cloutier, Pierre I. Karakiewicz, Elie Antebi, Francesco Montorsi, Shahrokh F. Shariat, Claudio Jeldres, Jean Jacques Patard, Laurent Zini, Hendrik Isbarn, Paul Perrotte, Umberto Capitanio, Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcome Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcomes Unit, Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), De Villemeur, Hervé, Capitanio, Umberto, Cloutier, Vincent, Zini, Laurent, Isbarn, Hendrik, Jeldres, Claudio, Shariat Shahrokh, F., Perrotte, Paul, Antebi, Elie, Patard Jean, Jacque, Montorsi, Francesco, and Karakiewicz Pierre, I.

Subjects
Oncology, Male, Pathology, MESH: Carcinoma, Papillary, medicine.medical_treatment, 030232 urology & nephrology, Chromophobe cell, MESH: Epidemiologic Methods, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Cause of Death, 0302 clinical medicine, MESH: Aged, 80 and over, Renal cell carcinoma, Cause of Death, MESH: Child, Child, Aged, 80 and over, MESH: Aged, education.field_of_study, MESH: Middle Aged, MESH: Neoplasm Staging, MESH: Carcinoma, Renal Cell, Middle Aged, Prognosis, Nephrectomy, Kidney Neoplasms, 3. Good health, MESH: Young Adult, 030220 oncology & carcinogenesis, Child, Preschool, Female, Adult, medicine.medical_specialty, Adolescent, Urology, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH: Prognosis, 03 medical and health sciences, Young Adult, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, medicine, Carcinoma, Humans, education, Carcinoma, Renal Cell, Aged, Neoplasm Staging, MESH: Adolescent, MESH: Humans, Proportional hazards model, business.industry, MESH: Child, Preschool, MESH: Adult, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Carcinoma, Papillary, MESH: Male, MESH: Kidney Neoplasms, business, Epidemiologic Methods, Kidney cancer, MESH: Female, Clear cell
Abstract

International audience; OBJECTIVE To assess the magnitude of the effect of histological subtype (HS, the three most common being clear cell, papillary and chromophobe) on cause-specific mortality (CSM) from renal cell carcinoma (RCC). PATIENTS AND METHODS Univariable and multivariable Cox regression models included data from 11 618 patients treated with nephrectomy between 1988 and 2004 in nine Surveillance Epidemiology and End Results registries. We tested whether HS represents an independent predictor of CSM, and whether HS adds to the ability of other variables to predict CSM. The covariates comprised age, year of surgery, T stage, nodal status, M stage and Fuhrman grade. RESULTS In a multivariable model predicting CSM, HS was an independent predictor (P = 0.03), but failed to improve the accuracy of the model (+0.1% gain when HS was included in the model). CONCLUSION Although we confirmed that HS is an independent predictor for CSM, there was no gain in accuracy when HS was added to standard predictors of CSM. From a practical perspective, this implies that patients with clear cell, papillary and chromophobe HS share similar natural histories after nephrectomy, provided that other cancer characteristics are accounted for. From a statistical perspective, in multivariable models of CSM, the clear cell, papillary and chromophobe HS might be included as a single entity.

Published
2009
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23. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006)

Author

Leroy , Olivier, Gangneux , Jean-Pierre, Montravers , Philippe, Mira , Jean-Paul, Gouin , François, Sollet , Jean-Pierre, Carlet , Jean, Reynes , Jacques, Rosenheim , Michel, Regnier , Bernard, Lortholary , Olivier, Renseigné , Non, Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Signalisation et Réponses aux Agents Infectieux et Chimiques ( SeRAIC ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140, Régulations des équilibres fonctionnels du foie normal et pathologique, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département anesthésie-réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Cochin ( UMR_S567 / UMR 8104 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), service de réanimation polyvalente, Centre Hospitalier Victor Dupuy, Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Groupe Hospitalier Paris Saint-Joseph (hpsj), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1)

Subjects
Male, critically ill, MESH : Aged, MESH : Prospective Studies, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Case fatality rate, Hospital Mortality, Prospective Studies, MESH: Incidence, Fungemia, MESH: Treatment Outcome, Cause of death, Aged, 80 and over, Cross Infection, 0303 health sciences, MESH: Middle Aged, Incidence, Candidiasis, MESH: Follow-Up Studies, MESH : Incidence, 3. Good health, Survival Rate, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Young Adult, MESH: Critical Illness, MESH : Intensive Care Units, MESH : Cross Infection, medicine.medical_specialty, MESH: Probability, Critical Illness, MESH : Young Adult, MESH : Cohort Studies, Statistics, Nonparametric, MESH : Hospital Mortality, 03 medical and health sciences, MESH: Critical Care, MESH: Fungemia, Intensive care, MESH : Adolescent, Humans, MESH : Middle Aged, MESH: Hospital Mortality, MESH : Aged, 80 and over, Mycosis, Aged, MESH: Adolescent, MESH: Humans, 030306 microbiology, MESH : Humans, MESH: Adult, MESH : Follow-Up Studies, MESH: Antifungal Agents, medicine.disease, chemistry, MESH: Female, Fluconazole, Antifungal Agents, MESH : Critical Illness, Cohort Studies, MESH: Cause of Death, chemistry.chemical_compound, MESH : Candidiasis, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Cause of Death, MESH : Female, 030212 general & internal medicine, MESH: Cohort Studies, MESH : Critical Care, Candida, intensive care, MESH: Aged, MESH: Statistics, Nonparametric, fungemia, Middle Aged, MESH : Adult, MESH : Survival Rate, MESH : Risk Factors, MESH: Candidiasis, Intensive Care Units, Treatment Outcome, Female, epidemiology, France, medicine.drug, Adult, Adolescent, Critical Care, MESH: Survival Rate, MESH : Male, MESH : Probability, MESH : Antifungal Agents, MESH : Treatment Outcome, Young Adult, Internal medicine, medicine, MESH : France, MESH : Statistics, Nonparametric, Probability, MESH : Cause of Death, Voriconazole, business.industry, MESH: Cross Infection, MESH: Male, MESH: Prospective Studies, Surgery, MESH: France, MESH : Fungemia, MESH: Intensive Care Units, Caspofungin, business, Follow-Up Studies
Abstract

International audience; OBJECTIVE: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). DESIGN: Prospective, observational, national, multicenter study. SETTING: One hundred eighty ICUs in France. PATIENTS: Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008). CONCLUSIONS: More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.

Published
2009
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24. Immediate listing for liver transplantation versus standard care for Child-Pugh stage B alcoholic cirrhosis: a randomized trial

Author

Claire Vanlemmens, Vincent Di Martino, Chantal Milan, Michel Messner, Anne Minello, Christophe Duvoux, Poynard, Jean-Marc Perarnau, Marie-Anne Astrid Piquet, Georges-Philippe Pageaux, Sébastien Dharancy, Christine Silvain, Sophie Hillaire, Gérard Thiefin, Jean-Pierre Vinel, Patrick Hillon, Estelle Collin, Georges Mantion, Jean-Philippe Miguet, Non Renseigné, Humbert, Murielle, Service d'Hépato-Gastroentérologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Agents pathogènes et inflammation - UFC (EA 4266) ( API ), Université de Franche-Comté ( UFC ), Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Université de Lille, Droit et Santé, Hôpital Duriez, Service des Maladies de l'Appareil digestif et de la Nutrition, Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Institut de médecine moléculaire de Rangueil ( I2MR ), Université Paul Sabatier - Toulouse 3 ( UPS ) -IFR31-IFR150-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de Gastro-entérologie et Nutrition[Rangueil], CHU Toulouse [Toulouse]-Hôpital de Rangueil, Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse], Service d'hépato-gastroentérologie et cancérologie digestive (CHU de Dijon), and Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)

Subjects
Male, Alcoholic liver disease, Time Factors, medicine.medical_treatment, MESH : Aged, Liver transplantation, Severity of Illness Index, MESH: Cause of Death, MESH: Risk Factors, Liver Cirrhosis, Alcoholic, Risk Factors, Cause of Death, Neoplasms, MESH: Neoplasms, MESH : Female, MESH: Treatment Outcome, MESH: Aged, [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, MESH: Middle Aged, MESH: Liver Cirrhosis, Alcoholic, Standard treatment, Hazard ratio, General Medicine, Middle Aged, MESH : Adult, MESH : Risk Factors, Treatment Outcome, MESH: Waiting Lists, MESH: Young Adult, MESH: Survival Analysis, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Female, MESH : Severity of Illness Index, France, MESH : Waiting Lists, MESH : Time Factors, Adult, MESH: Liver Transplantation, medicine.medical_specialty, Adolescent, Waiting Lists, MESH : Male, MESH : Young Adult, Alcoholic hepatitis, MESH : Treatment Outcome, [ SDV.MP.VIR ] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Young Adult, MESH: Severity of Illness Index, Internal medicine, MESH : Adolescent, Internal Medicine, medicine, Humans, MESH : Middle Aged, MESH : France, Survival rate, Contraindication, Aged, MESH : Cause of Death, MESH: Adolescent, MESH: Humans, business.industry, MESH: Time Factors, MESH : Humans, MESH: Adult, MESH : Liver Cirrhosis, Alcoholic, medicine.disease, Survival Analysis, MESH : Neoplasms, MESH: Male, Surgery, Liver Transplantation, MESH: France, Transplantation, MESH : Survival Analysis, MESH : Liver Transplantation, business, MESH: Female
Abstract

International audience; BACKGROUND: Liver transplantation improves survival of patients with end-stage (Child-Pugh stage C) alcoholic cirrhosis, but its benefit for patients with stage B disease is uncertain. OBJECTIVE: To compare the outcomes of patients with Child-Pugh stage B alcoholic cirrhosis who are immediately listed for liver transplantation with those of patients assigned to standard treatment with delay of transplantation until progression to stage C disease. DESIGN: Randomized, controlled trial. SETTING: 13 liver transplantation programs in France. PATIENTS: 120 patients with Child-Pugh stage B alcoholic cirrhosis and no viral hepatitis, cancer, or contraindication to transplantation. INTERVENTIONS: Patients were randomly assigned to immediate listing for liver transplantation (60 patients) or standard care (60 patients). MEASUREMENTS: Overall and cancer-free survival over 5 years. RESULTS: Sixty-eight percent of patients assigned to immediate listing for liver transplantation and 25% of those assigned to standard care received a liver transplant. All-cause death and cirrhosis-related death did not statistically differ between the 2 groups: 5-year survival was 58% (95% CI, 43% to 70%) for those assigned to immediate listing versus 69% (CI, 54% to 80%) for those assigned to standard care. In multivariate analysis, independent predictors of long-term survival were absence of ongoing alcohol consumption (hazard ratio, 7.604 [CI, 2.395 to 24.154]), recovery from Child-Pugh stage C (hazard ratio, 7.633 [CI, 2.392 to 24.390]), and baseline Child-Pugh score less than 8 (hazard ratio, 2.664 [CI, 1.052 to 6.746]). Immediate listing for transplantation was associated with an increased risk for extrahepatic cancer: The 5-year cancer-free survival rate was 63% (CI, 43% to 77%) for patients who were immediately listed and 94% (CI, 81% to 98%) for those who received standard care. LIMITATION: Restriction of the study sample to alcoholic patients may limit the generalizability of results to other settings. CONCLUSION: Immediate listing for liver transplantation did not show a survival benefit compared with standard care for Child-Pugh stage B alcoholic cirrhosis. In addition, immediate listing for transplantation increased the risk for extrahepatic cancer. FUNDING: The French National Program for Clinical Research.

Published
2009

25. Cardiorespiratory risk factors as predictors of 40-year mortality in women and men

Author

Ferrie, Jane, Singh-Manoux, Archana, Kivimaki, Mika, Mindell, Jennifer, Breeze, Elizabeth, Davey Smith, George, Shipley, Martin, Kaniewski, Nadine, Department of Epidemiology and Public Health, University College of London [London] (UCL), Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Social Medicine, and University of Bristol [Bristol]

Subjects
MESH: Aged, MESH: Smoking, MESH: Middle Aged, MESH: Humans, MESH: Heart Diseases, MESH: Adult, MESH: Respiratory Function Tests, MESH: Blood Pressure, MESH: Male, MESH: Body Mass Index, MESH: Cause of Death, 1960s, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Risk Factors, risk factors, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 40-year mortality, MESH: Respiratory Tract Diseases, MESH: Cohort Studies, MESH: Female, cardiorespiratory mortality
Abstract

International audience; OBJECTIVE: Most historical studies of cardiorespiratory risk factors as predictors of mortality have been based on men. This study examines whether they predict mortality over long periods in women and men. DESIGN: Prospective cohort study. SETTING: Participants were employees of the General Post Office. METHODS: Risk factor data were collected via clinical examination and questionnaire, 1966-7. Associations between cardiorespiratory risk factors and 40-year mortality were determined for 644 women and 1272 men aged 35-70 at examination. MAIN OUTCOME MEASURES: All-cause, cardiovascular (CVD), cancer and respiratory mortality. RESULTS: Associations between systolic blood pressure and all-cause and stroke mortality were equally strong for women and men, hazard ratio (95% confidence interval) 1.25 (1.1 to 1.4) and 1.18 (1.1 to 1.3); and 2.17 (1.7 to 2.8) and 1.69 (1.4 to 2.1), respectively. Cholesterol was higher in women and was associated with all-cause 1.22 (1.1 to 1.4) and CVD 1.39 (1.2 to 1.7) mortality, while associations between 2-hour glucose and all-cause 1.15 (1.1 to 1.2), coronary heart disease (CHD) 1.25 (1.1 to 1.4) and respiratory mortality 1.21 (1.0 to 1.5) were observed in men. Obesity was associated with stroke in women (2.42 (1.12 to 5.24)) and CHD in men (1.59 (1.02 to 2.49)), while ECG ischaemia was associated with CVD in both sexes. The strongest, most consistent predictor of mortality was smoking in women and poor lung function in men. However, evidence of sex differences in associations between the cardiorespiratory risk factors measured and mortality was sparse. CONCLUSIONS: Data from a 40-year follow-up period show remarkably persistent associations between risk factors and cardiorespiratory and all-cause mortality in women and men.

Published
2009
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26. Survival in patients with uveal melanoma in Europe

Author

Maria Cecilia Cercato, Pascale Grosclaude, Michel Coleman, Laura Ciccolallo, Mariano Santaquilani, Valerio Ramazzotti, Emanuele Crocetti, Stefano Ferretti, Gemma Gatta, Gianni Virgili, Laufey Tryggvadottir, Franco Berrino, Hans Storm, Paolo Baili, Evaluative Epidemiology Unit, Fondazione IRCCS, Department of Statistics 'G. Parenti', University of Florence and Biostatistics Unit ISPO (Institute for Cancer Prevention and Research), Registre Genevois des Tumeurs, CHU Genève, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Università degli Studi di Firenze = University of Florence [Firenze] (UNIFI), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)

Subjects
Male, MESH : Retrospective Studies, MESH : Aged, MESH: Risk Assessment, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, 0302 clinical medicine, 80 and over, MESH: Incidence, Melanoma, Cause of death, Aged, 80 and over, MESH: Middle Aged, Incidence, MESH: Sex Distribution, Prognosis, MESH : Incidence, MESH: International Classification of Diseases, 3. Good health, MESH : Uveal Neoplasms, 030220 oncology & carcinogenesis, Cohort study, medicine.medical_specialty, MESH: Melanoma, MESH: Probability, Survival - uveal melanoma - Europe, Socio-culturale, MESH : Cohort Studies, Risk Assessment, MESH: Prognosis, Disease-Free Survival, Europe/epidemiology, 03 medical and health sciences, Uveal Neoplasms/diagnosis/mortality/therapy, MESH : Adolescent, MESH : International Classification of Diseases, Humans, Melanoma/diagnosis/mortality/therapy, MESH : Middle Aged, MESH : Aged, 80 and over, MESH: Age Distribution, Survival analysis, Aged, Retrospective Studies, MESH: Adolescent, MESH: Humans, MESH : Humans, MESH: Adult, MESH: Retrospective Studies, Survival Analysis, Cancer registry, Ophthalmology, MESH: Disease-Free Survival, 030221 ophthalmology & optometry, MESH: Female, Uveal Neoplasms, MESH: Registries, MESH : Age Distribution, MESH : Analysis of Variance, MESH: Cause of Death, Cohort Studies, MESH: Aged, 80 and over, Cause of Death, MESH : Female, Registries, MESH : Risk Assessment, MESH: Cohort Studies, MESH : Sex Distribution, MESH: Aged, MESH : Prognosis, Relative survival, Incidence (epidemiology), Absolute risk reduction, Middle Aged, MESH : Adult, Europe, MESH: Survival Analysis, MESH : Disease-Free Survival, Female, Adult, Adolescent, MESH : Male, MESH : Probability, MESH : Europe, MESH : Melanoma, [SDV.CAN]Life Sciences [q-bio]/Cancer, Age Distribution, Analysis of Variance, International Classification of Diseases, Multivariate Analysis, Probability, Sex Distribution, MESH: Multivariate Analysis, MESH: Analysis of Variance, Internal medicine, medicine, ddc:613, MESH : Cause of Death, business.industry, MESH : Multivariate Analysis, Retrospective cohort study, MESH: Male, Surgery, MESH: Uveal Neoplasms, MESH: Europe, MESH : Survival Analysis, business, MESH : Registries
Abstract

International audience; OBJECTIVE: To estimate survival in patients in whom uveal melanoma was diagnosed between January 1, 1983, and December 31, 1994, in Europe. METHODS: Survival analysis of data from 32 cancer registries in 16 European countries adhering to the European Cancer Registry for 5788 patients with uveal melanoma diagnosed between January 1, 1983, and December 31, 1994, with follow-up to 1999. RESULTS: Five-year relative survival was 68.9% overall and remained stable with the period of diagnosis. Relative excess risk of death was 2.45 (95% confidence interval [CI], 2.10-2.86) in patients aged 75 years or older compared with patients aged 54 years or younger and was slightly higher in male patients (relative excess risk, 1.10; 95% CI, 1.02-1.19) than in female patients. Survival was similar in Nordic countries (relative excess risk, 1.03; 95% CI, 0.87-1.21) compared with the United Kingdom (reference country) and was lower in eastern and western European countries (1.26; 1.05-1.52, and 1.25; 0.90-1.60, respectively) compared with the reference country. CONCLUSIONS: In this large series of patients with uveal melanoma, 5-year relative survival remained stable with the introduction of conservative treatment in individuals in whom uveal melanoma was diagnosed between 1983 and 1994. We found differences in survival between sexes and in European areas that should be investigated in studies that consider tumor characteristics at the individual level.

Published
2008
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27. Asthma-related mortality in France, 1980-2005: decline since the last decade

Author

P. Godard, Isabella Annesi-Maesano, Jean-Pierre Piau, Jean Bousquet, S. Tual, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Tual S, P Godard, JP Piau, Bousquet J, and Annesi-Maesano je .

Subjects
Adult, Male, MESH: Asthma, Immunology, MEDLINE, Death Certificates, MESH: Cause of Death, Age Distribution, Risk Factors, Environmental protection, MESH: Risk Factors, Cause of Death, Environmental health, Asthma mortality, Humans, Immunology and Allergy, Medicine, Mortality, Sex Distribution, Mortality trends, MESH: Age Distribution, ComputingMilieux_MISCELLANEOUS, Aged, Asthma, Cause of death, MESH: Aged, MESH: Middle Aged, MESH: Humans, MESH: Mortality, business.industry, MESH: Sex Distribution, MESH: Adult, Middle Aged, medicine.disease, MESH: Male, MESH: France, MESH: Death Certificates, Female, Age distribution, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, MESH: Female
Abstract

International audience

Published
2008
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28. Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people

Author

Carriere, Isabelle, Dupuy, Anne-Marie, Lacroux, Annie, Cristol, Jean-Paul, Delcourt, Cécile, Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de biochimie [Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Equipe associée, Université Montpellier 1 (UM1), Épidémiologie et prévention : environnement et efficacité des interventions (EPIPREV), Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Fondation de France, Fondation pour la recherche Médicale, Région Languedoc-Roussillon, Association Retina France, Rhones Poulenc, Essilor, Specia, Horiba ABX Montpellier, Centre de Recherche et d'Information Nutritionnelle, Villebrun, Dominique, and Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)

Subjects
Male, MESH: Risk Assessment, MESH: Proportional Hazards Models, MESH: Cause of Death, MESH: Health Surveys, MESH: Aged, 80 and over, MESH: Cholesterol, Reference Values, Cause of Death, Neoplasms, Prealbumin, MESH: Neoplasms, Prospective Studies, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, [SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Age Factors, MESH: Reference Values, Orosomucoid, MESH: Follow-Up Studies, Middle Aged, C-Reactive Protein, Cholesterol, Cardiovascular Diseases, MESH: Orosomucoid, Female, France, Inflammation Mediators, MESH: Inflammation Mediators, MESH: Serum Albumin, Protein-Energy Malnutrition, Risk Assessment, Article, Sex Factors, MESH: Sex Factors, MESH: Prealbumin, MESH: C-Reactive Protein, Humans, Serum Albumin, Aged, Proportional Hazards Models, MESH: Age Factors, MESH: Humans, MESH: Cardiovascular Diseases, Health Surveys, MESH: Male, MESH: Prospective Studies, MESH: Protein-Energy Malnutrition, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, Follow-Up Studies
Abstract

International audience; OBJECTIVES: To determine whether malnutrition and biomarkers of inflammation predict all-cause, cancer, and cardiovascular mortality in healthy elderly subjects. DESIGN: Population-based study, prospective cohort. SETTING: S?, on the French Mediterranean coast. PARTICIPANTS: Five hundred and fifty-three men and 888 women aged 60 and older from the Pathologies Oculaires Li? ?'Age cohort free of known comorbidities. MEASUREMENTS: Plasma levels of cholesterol, albumin, transthyretin (TTR), C-reactive protein (CRP), and alpha 1-acid glycoprotein (AAG) were measured at baseline. To investigate the risks of 5-year (early) and 5- to 9-year (late) mortality, hazard ratios (HR) were evaluated using Cox models. RESULTS: In men, early death was associated with high CRP and AAG and low albumin and TTR. In women, early death was associated with high AAG, low TTR and low cholesterol. For late death, the only significant association was with CRP in men. A synergistic effect was observed between biomarkers of inflammation and malnutrition. In men, the adjusted HR of early death was 4.98 (95% confidence interval (CI)=2.25-11.01) for both CRP in the highest quartile and albumin in the lowest. In men, this risk was greatest for both AAG in the highest quartile and TTR in the lowest (HR=6.86, 95% CI=3.20-14.71). In women, this risk was greatest for both AAG in the highest quartile and TTR in the lowest (HR=4.64, 95% CI=1.79-12.05). Cancer mortality was greater for high CRP and AAG and for low albumin and TTR in men but not in women. CONCLUSION: Biomarkers of inflammation and malnutrition together predict early mortality. In healthy elderly subjects, TTR and AAG could be helpful in identifying elderly subjects at higher risk of death.

Published
2008
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29. Neglected psychiatric comorbidity in people with epilepsy in developing countries--response to Tellez-Zenteno et al

Author

Pierre-Marie Preux, Mitchell G. Weiss, Peter Odermatt, Victor Doku, Swiss Tropical Institute (STI), Department Public Health and Epidemiology, Neuroépidémiologie Tropicale et Comparée (NETEC), Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM), Laboratoire de Biostatistique et d'Informatique Médicale, Université de Limoges (UNILIM), Service de l'Information Médicale et de l'Évaluation [CHU Limoges] (SIME), CHU Limoges, Kintampo Surveillance Demographic System, and Kintampo Health Research Centre, Ghana

Subjects
medicine.medical_specialty, MESH: Poverty, 030231 tropical medicine, MESH: Depressive Disorder, MESH: Delivery of Health Care, Poison control, Developing country, MESH: Comorbidity, Suicide prevention, Occupational safety and health, MESH: Cause of Death, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Injury prevention, Medicine, MESH: Mental Disorders, Psychiatry, MESH: Developing Countries, ComputingMilieux_MISCELLANEOUS, MESH: Prevalence, MESH: Humans, business.industry, MESH: Research Design, Human factors and ergonomics, medicine.disease, Comorbidity, MESH: Suicide, Neurology, MESH: Epilepsy, MESH: Anxiety Disorders, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), Medical emergency, business, 030217 neurology & neurosurgery
Abstract

International audience

Published
2008
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30. Association of physical job demands, smoking and alcohol abuse with subsequent premature mortality: a 9-year follow-up population-based study

Author

Francis Guillemin, Carmen Otero Sierra, N. Massin, Nearkasen Chau, Lahoucine Benamghar, Jean-Marc Fontana, J.P. Meyer, Pascal Wild, Jean-Marie Mur, Eve Bourgkard, Jean-François Ravaud, Département épidémiologie en entreprise (EE), Institut national de recherche et de sécurité (Vandoeuvre lès Nancy) (INRS ( Vandoeuvre lès Nancy)), WHO Collaborative centre, World Health Organization (WH0), Département Homme au Travail (HT), Epidémiologie, santé, travail, Institut National de la Santé et de la Recherche Médicale (INSERM), CERMES - Centre de recherche Médecine, Science, Santé Société (CERMES - UMR 8169 / U750), Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Faculté de Médecine [Nancy], Université de Lorraine (UL), Troubles du comportement alimentaire de l'adolescent (UMR_S 669), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), Ravaud, Jean-François, Centre de recherche Médecine, Science, Santé et Société (CERMES), Université Paris-Sud - Paris 11 (UP11) - École des hautes études en sciences sociales (EHESS) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Université Paris-Sud - Paris 11 (UP11), and Université Paris-Sud - Paris 11 (UP11)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Health Status, Alcohol abuse, Poison control, MESH: Cause of Death, MESH: Health Surveys, Cause of Death, Work Schedule Tolerance, Odds Ratio, Longitudinal Studies, MESH: Longitudinal Studies, MESH: Workload, MESH: Health Status, MESH: Aged, education.field_of_study, MESH: Middle Aged, Mortality rate, Smoking, MESH: Follow-Up Studies, Middle Aged, Occupational Diseases, Alcoholism, symbols, Female, Medical emergency, France, Adult, MESH: Occupational Diseases, MESH: Smoking, MESH: Socioeconomic Factors, Adolescent, Population, Workload, symbols.namesake, MESH: Alcoholism, Injury prevention, medicine, Humans, Poisson regression, Mortality, education, Aged, MESH: Work Schedule Tolerance, MESH: Adolescent, MESH: Humans, MESH: Mortality, business.industry, Public Health, Environmental and Occupational Health, MESH: Adult, Odds ratio, medicine.disease, Health Surveys, MESH: Male, MESH: Odds Ratio, MESH: France, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Relative risk, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography, Follow-Up Studies
Abstract

International audience; This study assessed the relationships of physical job demands (PJD), smoking, and alcohol abuse, with premature mortality before age 70 (PM-70) among the working or inactive population. The sample included 4,268 subjects aged 15 or more randomly selected in north-eastern France. They completed a mailed questionnaire (birth date, sex, weight, height, job, PJD, smoking habit, alcohol abuse (Deta questionnaire)) in 1996 and were followed for mortality until 2004 (9 yr). PJD score was defined by the cumulative number of the following high job demands at work: hammer, vibrating platform, pneumatic tools, other vibrating hand tools, screwdriver, handling objects, awkward posture, tasks at heights, machine tools, pace, working on a production line, standing about and walking. The data were analyzed using the Poisson regression model. Those with PM-70 were 126 (3.81 per 1,000 person-years). The leading causes of death were cancers (46.4% in men, 57.1% in women), cardiovascular diseases (20.2% and 11.9%), suicide (9.5% and 7.1%), respiratory diseases (6.0% and 4.8%), and digestive diseases (2.4% and 4.8%). PJD3, smoker, and alcohol abuse had adjusted risk ratios of 1.71 (95% CI 1.02-2.88), 1.76 (1.08-2.88), and 2.07 (1.31-3.26) respectively for all-cause mortality. Manual workers had a risk ratio of 1.84 (1.00-3.37) compared to the higher socio-economic classes. The men had a two-fold higher mortality rate than the women; this difference became non-significant when controlling for job, PJD, smoker and alcohol abuse. For cancer mortality the factors PJD3, smoker, and alcohol abuse had adjusted risk ratios of 2.00 (1.00-3.99), 2.34 (1.19-4.63), and 2.22 (1.17-4.20), respectively. Health promotion efforts should be directed at structural measures of task redesign and they should also concern lifestyle.

Published
2008

31. The impact of major heat waves on all-cause and cause-specific mortality in France from 1971 to 2003

Author

Pierre Bessemoulin, Eric Jougla, Grégoire Rey, Philippe Frayssinet, Jacqueline Clavel, Anne Fouillet, Gérard Pavillon, Denis Hémon, Epidémiologie environnementale des cancers, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'épidémiologie sur les causes médicales de décès (CépiDc), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Météo-France [Paris], Météo France, Registre National des Hémopathies malignes de l'Enfant (RNHE), Institut de Veille Sanitaire (INVS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Météo-France, and Secretariat, U754

Subjects
Male, Hot Temperature, Poison control, 010501 environmental sciences, 01 natural sciences, MESH: Cause of Death, 0302 clinical medicine, Cause of Death, Epidemiology, 030212 general & internal medicine, Cause of death, 2. Zero hunger, MESH: Aged, education.field_of_study, MESH: Middle Aged, Mortality rate, Age Factors, Heatstroke, Middle Aged, 3. Good health, Female, France, Hyperthermia, Adult, medicine.medical_specialty, Population, MESH: Heat, Article, 03 medical and health sciences, Sex Factors, MESH: Sex Factors, Injury prevention, medicine, Humans, Mortality, education, 0105 earth and related environmental sciences, Aged, MESH: Age Factors, MESH: Humans, MESH: Mortality, business.industry, Public Health, Environmental and Occupational Health, MESH: Adult, medicine.disease, MESH: Male, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography
Abstract

International audience; OBJECTIVES: The aim of the study was to identify the major heat waves (HW) that occurred in France from 1971 to 2003 and describe their impact on all-cause and cause-specific mortality. METHODS: Heat waves were defined as periods of at least three consecutive days when the maximum and the minimum temperature, averaged over the whole France, were simultaneously greater than their respective 95th percentile. The underlying causes of death were regrouped into 18 categories. Heatstroke, hyperthermia and dehydration were assigned to the "heat-related causes" (HRC) category. The numbers of deaths observed (O) during the identified HW were compared to those expected (E) on the basis of the mortality rates reported for the three preceding years. RESULTS: Six HW were identified from the period 1971 to 2003. They were associated with great excess mortality (from 1,300 to 13,700 deaths). The observations are compatible with a moderate harvesting effect for four of the six HW. The mortality ratios increased with age for subjects aged over 55 years and were higher for women than for men over 75 years. For the six HW, the excess mortality was significant for almost all the causes of death: (1) the greatest excess mortality (O-E) were observed for cardiovascular diseases, neoplasms, respiratory system diseases, HRC, ill-defined conditions and injury and poisoning, and (2) the mortality ratios (O/E) were highest for HRC, respiratory diseases, nervous system diseases, mental disorders, infectious diseases, and endocrine and nutritional diseases. CONCLUSIONS: Heat waves associated with excess mortality are not rare events in this temperate-climate country. The excess mortality is much greater than HRC mortality. Some populations are particularly vulnerable to HW: the elderly, women and people with some specific diseases. However, no segment of the population may be considered protected from the risks associated with HW.

Published
2007
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32. Particulate matter, science and EU policy

Author

Annesi-Maesano, Isabella, Forastiere, F., Kunzli, N., Brunekref, B., Renseigné, Non, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Social and Preventive Medecine, University of Basel (Unibas), Annesi-Maesano I, Forastière F, N Kunzli, Brunekref B, and l'environnement et le Comité de la santé de la Société respiratoire européenne .

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, 010504 meteorology & atmospheric sciences, Respiratory Tract Diseases, Air pollution, medicine.disease_cause, 01 natural sciences, MESH: Cause of Death, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, Environmental health, Epidemiology, medicine, MESH: United States, Humans, 030212 general & internal medicine, MESH: Particle Size, Particle Size, ComputingMilieux_MISCELLANEOUS, 0105 earth and related environmental sciences, MESH: Humans, business.industry, Metropolitan area, MESH: Respiratory Tract Neoplasms, Respiratory Tract Neoplasms, United States, Confidence interval, 3. Good health, MESH: Lung Neoplasms, Europe, Risk Estimate, MESH: Particulate Matter, 13. Climate action, Cohort, Particulate Matter, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, MESH: Respiratory Tract Diseases, business, Cohort study, Environmental epidemiology
Abstract

Several new research findings regarding the health effects of airborne particulate matter (PM) (usually studied by the size of the particles, e.g. PM10, particles with a 50% cut-off aerodynamic diameter of 10 μm, and PM2.5, particles with a 50% cut-off aerodynamic diameter of 2.5 μm) have been presented at two important scientific meetings held in September 2006: the Conference of the European Respiratory Society (ERS), in Munich, and the joint Conference of the International Society for Environmental Epidemiology (ISEE) and the International Society for Exposure Analysis (ISEA) in Paris. This is not surprising, since: 1) the health effects of air pollution are among the largest environmental problems worldwide 1; 2) several scientific questions are still open; and 3) common research efforts from the epidemiological, toxicological and clinical worlds are under way. A brief review of the evidence follows. The initial suggestion that mortality increases due to long-term, low-level exposure to PM was provided by the Harvard Six Cities study 2. These findings were confirmed in the long-term follow-up (1982–1998) of the American Cancer Society (ACS) II cohort, consisting of ∼500,000 adults from metropolitan areas throughout the USA 3, 4. In the latter study, each 10 μg·m−3 elevation in PM2.5 was associated with approximately a 6, 9 and 14% increased risk of all-cause, cardiopulmonary and lung cancer mortality, respectively. A recent report from Los Angeles 5, which included a large proportion of the ACS II cohort from that area, has indicated that a more refined method for assessing exposure produces a higher risk estimate of mortality increase (17% increase; 95% confidence interval 5–30%) for an increase of 10 μg·m−3 in PM2.5. Well-conducted cohort studies in Europe, which have estimated air pollution exposure at individual residences, confirm the findings from the USA …

Published
2007
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33. Prognosis of lung cancer patients with life-threatening complications

Author

Jorge I. F. Salluh, Elie Azoulay, Nelson Spector, Guillaume Thiery, Michael Darmon, Carlos Gil Ferreira, Benoît Schlemmer, Marcio Soares, Intensive Care Unit, Instituto Nacional de Câncer, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Clinical Research, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), and Vesin, Aurélien

Subjects
Male, Lung Neoplasms, MESH: Comorbidity, Comorbidity, Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, MESH: Cause of Death, 0302 clinical medicine, Risk Factors, law, MESH: Risk Factors, Carcinoma, Non-Small-Cell Lung, Cause of Death, Hospital Mortality, Carcinoma, Small Cell, MESH: Respiration, Artificial, MESH: Multiple Organ Failure, MESH: Cohort Studies, Cause of death, MESH: Aged, MESH: Middle Aged, Respiratory disease, MESH: Carcinoma, Small Cell, Middle Aged, Prognosis, Shock, Septic, Intensive care unit, 3. Good health, Intensive Care Units, 030220 oncology & carcinogenesis, MESH: Survival Analysis, MESH: Critical Illness, Disease Progression, Female, MESH: Disease Progression, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, Brazil, Cohort study, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Illness, Multiple Organ Failure, MESH: Shock, Septic, MESH: Prognosis, 03 medical and health sciences, Intensive care, Internal medicine, medicine, Humans, MESH: Hospital Mortality, Lung cancer, Intensive care medicine, Aged, MESH: Humans, business.industry, Cancer, medicine.disease, Respiration, Artificial, Survival Analysis, MESH: Male, MESH: Lung Neoplasms, 030228 respiratory system, Respiratory failure, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Intensive Care Units, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Brazil, MESH: Female, MESH: Respiratory Insufficiency, MESH: Carcinoma, Non-Small-Cell Lung
Abstract

International audience; BACKGROUND: The management of patients with lung cancer has improved recently, and many of them will require admission to the ICU. The aims of this study were to determine hospital mortality and to identify risk factors for death in a large cohort of critically ill patients. METHODS: Cohort study in two ICUs specialized in the management of patients with cancer, in France and Brazil. RESULTS: Of the 143 patients (mean age, 61.6 +/- 9.9 years [+/- SD]), 25 patients (17%) had small cell lung cancer and 118 patients (83%) had non-small cell lung cancer. The main reasons for ICU admission were sepsis (44%) and acute respiratory failure (31%). Mechanical ventilation (MV) was used in 100 patients (70%), including 38 patients in whom lung cancer was considered a reason for MV. Hospital mortality was 59% overall and 69% in patients receiving MV. By multivariate logistic regression, airway infiltration or obstruction by cancer, number of organ failures, cancer recurrence or progression, and severity of comorbidities were associated with increased mortality. CONCLUSIONS: The improved survival previously reported in patients with cancer admitted to the ICU seems to extend to patients with lung cancer, including those who need MV. Mortality increased with the number of organ failures, severity of comorbidities, and presence of respiratory failure due to cancer progression. The type of the cancer per se was not associated with mortality and, therefore, should not be factored into ICU triage decisions.

Published
2007
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34. Mortality in patients with Parkinson's disease treated by stimulation of the subthalamic nucleus

Author

Luc Mallet, A. M. Bonnet, Valérie Mesnage, Walter A. Rocca, Yves Agid, Brandon R. Grossardt, Marie-Laure Welter, Michael Schüpbach, David Maltête, Alexis Elbaz, Jean-Luc Houeto, Alain Mallet, Neurologie et thérapeutique expérimentale, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR70-Université Pierre et Marie Curie - Paris 6 (UPMC), Neuroépidémiologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Health Sciences Research [Mayo Clinic] (HSR), Mayo Clinic, Department of Neurology, Mayo Clinic College of Medicine, Département de Biostatistique, Santé Publique et Information Médicale [CHU Pitié-Salpêtrière] (BIOSPIM ), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR70-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Tzourio, Christophe

Subjects
Male, Parkinson's disease, medicine.medical_treatment, Deep Brain Stimulation, Neuropsychological Tests, MESH: Cause of Death, 0302 clinical medicine, MESH: Postoperative Period, Cause of Death, 030212 general & internal medicine, Postoperative Period, Cause of death, MESH: Aged, education.field_of_study, MESH: Middle Aged, Hazard ratio, Parkinson Disease, MESH: Neuropsychological Tests, MESH: Follow-Up Studies, Middle Aged, MESH: Predictive Value of Tests, 3. Good health, Survival Rate, Subthalamic nucleus, Neurology, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Adult, medicine.medical_specialty, Deep brain stimulation, MESH: Survival Rate, Population, 03 medical and health sciences, Predictive Value of Tests, Subthalamic Nucleus, Internal medicine, medicine, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], education, Survival rate, Aged, MESH: Subthalamic Nucleus, MESH: Humans, business.industry, MESH: Adult, medicine.disease, MESH: Male, Surgery, MESH: Cognition Disorders, Standardized mortality ratio, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), MESH: Deep Brain Stimulation, business, Cognition Disorders, MESH: Female, 030217 neurology & neurosurgery, MESH: Parkinson Disease, Follow-Up Studies
Abstract

International audience; Subthalamic nucleus (STN) stimulation improves motor disability and quality of life in patients with advanced Parkinson's disease (PD). Short-term mortality is low, but little is known about long-term mortality. We assessed mortality and causes of death in 171 consecutive PD patients treated by STN stimulation. Surgery was performed after a median lagtime of 13 years from PD onset at a median age of 57 years. The median follow-up after surgery was 41 months. Sixteen patients died 8 to 83 months after neurosurgery. Poorer cognitive function was the only predictive factor for mortality (standardized mortality ratio = 2.9; 95% confidence interval [CI], 1.6-4.7; P < 0.0001). Based on a historical comparison of 118 operated patients with 39 nonoperated patients from a different population, survival among operated patients was not better (hazard ratio = 1.2; 95% CI, 0.7-2.1).

Published
2007
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35. Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis

Author

Arnaud de Lassence, Samir Jamali, Yves Cohen, Elie Azoulay, Maité Garrouste-Orgeas, Dany Toledano, Christophe Adrie, Isabelle Zaccaria, Christophe Clec’h, François Vincent, Corinne Alberti, Jean-François Timsit, Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de bactériologie, virologie, parasitologie et hygiène, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Unité d'épidémiologie clinique, Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'enzymologie et biochimie structurales (LEBS), Centre National de la Recherche Scientifique (CNRS), Medical-Surgical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Service de soins intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Louis Mourier - AP-HP [Colombes], Hôpital de Gonesse, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service de réanimation chirurgicale [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Institut de Biologie du Développement de Marseille (IBDM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Institut de Physique du Globe de Paris (IPGP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-IPG PARIS-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Centre National de la Recherche Scientifique (CNRS), Groupe de Recherche Sur Le Cancer du Poumon : Bases Moléculaires de la Progression Tumorale, Dépistage et Thérapie Génique, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de bactériologie, virologie, parasitologie et hygiène [CHU Necker], Institut national des sciences de l'Univers (INSU - CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Institut de Physique du Globe de Paris (IPG Paris)-Centre National de la Recherche Scientifique (CNRS), Vesin, Aurélien, Université Paris 13 ( UP13 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Avicenne, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire d'enzymologie et biochimie structurales ( LEBS ), Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -Hôpital Saint Joseph, Assistance publique - Hôpitaux de Paris (AP-HP)-Hopital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Albert Michallon, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Antoine Béclère, Institut de Biologie du Développement de Marseille ( IBDM ), Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Physique du Globe de Paris ( IPGP ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -IPG PARIS-Université Paris Diderot - Paris 7 ( UPD7 ) -Université de la Réunion ( UR ) -Centre National de la Recherche Scientifique ( CNRS ), and Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Male, Time Factors, medicine.medical_treatment, MESH : Prospective Studies, MESH : Aged, MESH: Logistic Models, MESH : Critical Illness, Critical Care and Intensive Care Medicine, Logistic regression, MESH : Intensive Care, law.invention, MESH: Cause of Death, MESH : Tracheostomy, MESH: Selection Bias, Tracheostomy, 0302 clinical medicine, MESH: Tracheostomy, Risk Factors, law, MESH: Risk Factors, Cause of Death, MESH : Female, Hospital Mortality, Prospective Studies, MESH: APACHE, MESH: Respiration, Artificial, APACHE, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, Confounding Factors, Epidemiologic, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Selection Bias, Middle Aged, MESH : Adult, MESH : Risk Factors, Intensive care unit, Treatment Outcome, MESH: Survival Analysis, MESH: Critical Illness, Female, France, MESH : APACHE, MESH : Time Factors, Cohort study, Adult, medicine.medical_specialty, Critical Care, Critical Illness, MESH : Male, MESH : Treatment Outcome, MESH: Multivariate Analysis, MESH : Hospital Mortality, 03 medical and health sciences, Intensive care, medicine, Humans, MESH : Middle Aged, MESH: Patient Selection, MESH: Intensive Care, MESH: Hospital Mortality, MESH : Respiration, Artificial, MESH : Confounding Factors (Epidemiology), MESH : France, Selection Bias, Aged, MESH : Cause of Death, Mechanical ventilation, MESH: Humans, business.industry, Patient Selection, MESH : Humans, MESH: Time Factors, MESH: Confounding Factors (Epidemiology), MESH : Multivariate Analysis, 030208 emergency & critical care medicine, MESH: Adult, Odds ratio, MESH : Patient Selection, Respiration, Artificial, Survival Analysis, Confidence interval, MESH: Male, MESH: Prospective Studies, Surgery, MESH: France, Logistic Models, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Multivariate Analysis, Propensity score matching, Emergency medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Survival Analysis, business, MESH: Female, MESH : Logistic Models
Abstract

International audience; OBJECTIVE: To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN: Prospective, observational, cohort study. SETTING: Twelve French medical or surgical intensive care units. PATIENTS: Unselected patients requiring mechanical ventilation for > or =48 hrs enrolled between 1997 and 2004. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two models of propensity scores for tracheostomy were built using multivariate logistic regression. After matching on these propensity scores, the association of tracheostomy with outcomes was assessed using multivariate conditional logistic regression. Results obtained with the two models were compared. Of the 2,186 patients included, 177 (8.1%) received a tracheostomy. Both models led to similar results. Tracheostomy did not improve intensive care unit survival (model 1: odds ratio, 0.94; 95% confidence interval, 0.63-1.39; p = .74; model 2: odds ratio, 1.12; 95% confidence interval, 0.75-1.67; p = .59). There was no difference whether tracheostomy was performed early (within 7 days of ventilation) or late (after 7 days of ventilation). In patients discharged free from mechanical ventilation, tracheostomy was associated with increased postintensive care unit mortality when the tracheostomy tube was left in place (model 1: odds ratio, 3.73; 95% confidence interval, 1.41-9.83; p = .008; model 2: odds ratio, 4.63; 95% confidence interval, 1.68-12.72, p = .003). CONCLUSIONS: Tracheostomy does not seem to reduce intensive care unit mortality when performed in unselected patients but may represent a burden after intensive care unit discharge.

Published
2007
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36. Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: a multicenter study of 412 patients

Author

Thomas Decaens, Françoise Roudot-Thoraval, Olivier Boillot, François Durand, Solange Bresson-Hadni, Yvon Calmus, Christian Ducerf, Daniel Cherqui, Christophe Duvoux, Pierre-Henri Bernard, Georges Philippe Pageaux, Philippe Compagnon, Sébastien Dharancy, Olivier Chazouillères, Carole Meyer, Jean Hardwigsen, Jean Gugenheim, Service de santé publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Service de Chirurgie Digestive / Centre de Transplantation Hépatique [CHU Nice], Centre Hospitalier Universitaire de Nice (CHU Nice), Laboratoire Adaptation et pathogénie des micro-organismes [Grenoble] (LAPM), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Service d'Hépato-Gastro-Entérologie, CHU Bordeaux [Bordeaux]-Hôpital Saint-André, Service de Chirurgie Digestive, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Université de Lille, Droit et Santé, Hôpital Duriez, Service des Maladies de l'Appareil digestif et de la Nutrition, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet II, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Laboratoire Adaptation et pathogénie des micro-organismes [Grenoble] ( LAPM ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Centre National de la Recherche Scientifique ( CNRS ), CHU Cochin [AP-HP], Hôpital de la Conception [CHU - APHM] ( LA CONCEPTION ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), and Grenouillet, Frédéric

Subjects
Oncology, Pathology, MESH : Liver Neoplasms, medicine.medical_treatment, MESH : Analysis of Variance, Liver transplantation, MESH: Proportional Hazards Models, MESH: Cause of Death, 0302 clinical medicine, MESH: Liver Neoplasms, Cause of Death, MESH: Carcinoma, Hepatocellular, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, Cause of death, MESH : Neoplasm Recurrence, Local, Liver Neoplasms, Gastroenterology, MESH: Immunosuppression, Immunosuppression, General Medicine, MESH: Predictive Value of Tests, 3. Good health, surgical procedures, operative, 030220 oncology & carcinogenesis, Predictive value of tests, Hepatocellular carcinoma, MESH: Survival Analysis, MESH : Disease-Free Survival, 030211 gastroenterology & hepatology, MESH: Neoplasm Recurrence, Local, Rapid Communication, MESH : Carcinoma, Hepatocellular, medicine.medical_specialty, MESH: Liver Transplantation, Carcinoma, Hepatocellular, Disease-Free Survival, MESH: Multivariate Analysis, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, MESH: Analysis of Variance, medicine, Carcinoma, Humans, MESH : Predictive Value of Tests, Survival analysis, Proportional Hazards Models, MESH : Cause of Death, Immunosuppression Therapy, Analysis of Variance, MESH: Humans, business.industry, Proportional hazards model, MESH : Humans, MESH : Multivariate Analysis, medicine.disease, MESH : Proportional Hazards Models, Survival Analysis, [SDV.MP.MYC] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, digestive system diseases, Liver Transplantation, Multivariate Analysis, MESH : Immunosuppression, MESH: Disease-Free Survival, Neoplasm Recurrence, Local, MESH : Survival Analysis, MESH : Liver Transplantation, business
Abstract

International audience; AIM: To assess pre-orthotopic liver transplantation (OLT) factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma (HCC) recurrence and disease-free survival after liver transplantation (LT). METHODS: Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS: Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were: presence of cirrhosis (P = 0.001), etiology of liver disease (P = 0.03), alpha fetoprotein level (< 200, 200 to 2000, or > 2000; P < 0.0001), gamma-GT activity (N, N to 2N or > 2N; P = 0.02), the number of nodules (1, 2-3 or > or = 4; P = 0.02), maximal diameter of the largest nodule (< 3 cm, 3 to 5 cm or > 5 cm; P < 0.0001), the sum of the diameter of the nodules (< 3 cm, 3 to 5 cm, 5 to 10 cm or > 10 cm; P < 0.0001), bi-lobar location (P = 0.01), preoperative portal thrombosis (P < 0.0001), peri-operative treatment of the tumor (P = 0.002) and chemoembolization (P = 0.03), tumor differentiation (P = 0.01), initial type of calcineurin inhibitor (P = 0.003), the use of antilymphocyte antibodies (P = 0.02), rejection episodes (P = 0.003) and period of LT (P < 0.0001). By multivariate analysis, 6 variables were independently associated with HCC recurrence: maximal diameter of the largest nodule (P < 0.0001), time of LT (P < 0.0001), tumor differentiation (P < 0.0001), use of anti-lymphocyte antibody (ATG) or anti-CD3 antibody (OKT3) (P = 0.005), preoperative portal thrombosis (P = 0.06) and the number of nodules (P = 0.06). CONCLUSION: This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recurrence, and confirms the prognostic value of tumor differentiation.

Published
2006

37. Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden

Author

Juan Merlo, Martin Lindström, John Lynch, Basile Chaix, Maria Rosvall, Chaix, Basile, Department of Health Sciences, Lund University [Lund]-Malmö University Hospital, Department of Clinical Sciences, ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Epidemiology, Biostatistics and Occupational Health [Montréal], McGill University = Université McGill [Montréal, Canada], This investigation was supported by a ALF Government Grant Dnr M:B 39923/2005 (Maria Rosvall), by a postdoctoral grant from Le Fondation pour la Recherche Médicale (Basile Chaix), by a ALF Government Grant Dnr M:B 1003/2004 (Martin Lindström), by the Swedish Council for Working Life and Social Research (PI Juan Merlo, Dnr: 2003 - 05809) and the Swedish Research Council (PI Juan Merlo, Dnr 2004-6155), Malmö University Hospital-Lund University [Lund], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Rosvall, Maria, Lynch, John W, Lindstrom, Martin, and Merlo, Juan

Subjects
Male, Gerontology, Disease, MESH: Cause of Death, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, Cause of Death, Neoplasms, MESH: Child, Epidemiology, Health Status Indicators, Medicine, MESH: Neoplasms, MESH: Social Justice, Longitudinal Studies, 030212 general & internal medicine, Child, MESH: Longitudinal Studies, Cause of death, Aged, 80 and over, MESH: Aged, education.field_of_study, MESH: Middle Aged, Mortality rate, lcsh:Public aspects of medicine, MESH: Infant, Newborn, Middle Aged, MESH: Infant, 3. Good health, Stroke, Cardiovascular Diseases, Child, Preschool, 8. Economic growth, MESH: Sweden, Female, 0305 other medical science, Research Article, Adult, medicine.medical_specialty, MESH: Socioeconomic Factors, Adolescent, Population, Social class, MESH: Stroke, MESH: Social Class, 03 medical and health sciences, Social Justice, MESH: Health Status Indicators, Humans, Social inequality, Mortality, Occupations, education, Socioeconomic status, Aged, Sweden, MESH: Adolescent, 030505 public health, MESH: Humans, MESH: Occupations, MESH: Mortality, business.industry, MESH: Child, Preschool, Infant, Newborn, Public Health, Environmental and Occupational Health, Infant, MESH: Cardiovascular Diseases, MESH: Adult, lcsh:RA1-1270, MESH: Male, Social Class, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography
Abstract

BackgroundTo more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to social inequalities in mortality in each age group in the whole population of Scania, Sweden.MethodsData from LOMAS (Longitudinal Multilevel Analysis in Skåne) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position (SEP) and workforce participation in 975,938 men and women aged 0 to 80 years, during 1991–2002.ResultsThe results generally showed increasing absolute mortality differences between those holding manual and non-manual occupations with increasing age, while there were inverted u-shaped associations when using relative inequality measures. Cardiovascular diseases (CVD) contributed to 52% of the male socioeconomic difference in overall mortality, cancer to 18%, external causes to 4% and psychiatric disorders to 3%. The corresponding contributions in women were 55%, 21%, 2% and 3%. Additionally, those outside the workforce (i.e., students, housewives, disability pensioners, and the unemployed) showed a strongly increased risk of future mortality in all age groups compared to those inside the workforce. Even though coronary heart disease (CHD) played a major contributing role to the mortality differences seen, stroke and other types of cardiovascular diseases also made substantial contributions. Furthermore, while the most common types of cancers made substantial contributions to the socioeconomic mortality differences, in some age groups more than half of the differences in cancer mortality could be attributed to rarer cancers.ConclusionCHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health.

Published
2006
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38. Twenty five year mortality and air pollution: results from the French PAARC survey

Author

N. Le Moual, D. Charpin, I. Annesi-Maesano, Christophe Declercq, Isabelle Baldi, L. Filleul, Daniel Vervloet, Christophe Paris, Stéphanie Vandentorren, Françoise Neukirch, Anne Cantagrel, J-F Tessier, F Kauffmann, Patrick Brochard, Virginie Rondeau, Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Recherche Agronomique (INRA), Centre Régional de la Recherche Agronomique de Kénitra (CRRAK), Inram, Bousquet J, Annesi-Maesano I, F Carat, Léger D, M Rugina, C Pribil, El Hasnaoui A, je Chanal ., Unité de Glycobiologie Structurale et Fonctionnelle UMR 8576 (UGSF), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Laboratoire santé, travail et environnement, Université Bordeaux Segalen - Bordeaux 2, Equipe de Biostatistique, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Nord [CHU - APHM], Observatoire Régional de la Santé Nord Pas-de-Calais, ORS Pas-De-Calais, Mécanismes physiopathologiques de l'insuffisance respiratoire et des complications de l'anesthésie, Institut National de la Santé et de la Recherche Médicale (INSERM), Service de santé au travail et pathologie professionnelle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Institut National de la Recherche Agronomique (INRA)-Université de Lille-Centre National de la Recherche Scientifique (CNRS), and Rondeau, Virginie

Subjects
Male, Lung Neoplasms, Urban Population, MESH: Asthma, Air pollution, 010501 environmental sciences, medicine.disease_cause, MESH: Epidemiologic Methods, 01 natural sciences, Body Mass Index, MESH: Cause of Death, chemistry.chemical_compound, 0302 clinical medicine, Environmental protection, Cause of Death, 11. Sustainability, Epidemiology, MESH: Animals, 030212 general & internal medicine, MESH: Conjunctivitis, Allergic, Vehicle Emissions, 2. Zero hunger, MESH: Middle Aged, MESH: Rhinitis, Smoking, MESH: Sex Distribution, MESH: Immunoglobulin E, Environmental exposure, 3. Good health, MESH: Urban Population, MESH: Vehicle Emissions, Cardiovascular Diseases, Epidemiological Monitoring, Female, France, MESH: Environmental Monitoring, Environmental Monitoring, Adult, medicine.medical_specialty, MESH: Air Pollution, MESH: Smoking, MESH: Allergens, MESH: Environmental Exposure, MESH: Mites, Black smoke, MESH: Body Mass Index, 03 medical and health sciences, Age Distribution, MESH: Cross-Sectional Studies, MESH: Skin Tests, Air Pollution, Environmental health, medicine, Humans, Nitrogen dioxide, Mortality, Sex Distribution, MESH: Age Distribution, 0105 earth and related environmental sciences, MESH: Adolescent, MESH: Humans, MESH: Rhinitis, Allergic, Perennial, MESH: Mortality, Proportional hazards model, business.industry, Public Health, Environmental and Occupational Health, MESH: Cardiovascular Diseases, MESH: Adult, MESH: Rhinitis, Allergic, Seasonal, Environmental Exposure, MESH: Male, MESH: Lung Neoplasms, MESH: France, chemistry, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 13. Climate action, Relative risk, MESH: Pollen, Commentary, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Epidemiologic Methods, business, Body mass index, MESH: Female
Abstract

International audience; AIMS AND METHODS: Long term effects of air pollution on mortality were studied in 14,284 adults who resided in 24 areas from seven French cities when enrolled in the PAARC survey (air pollution and chronic respiratory diseases) in 1974. Daily measurements of sulphur dioxide, total suspended particles, black smoke, nitrogen dioxide, and nitric oxide were made in 24 areas for three years (1974-76). Cox proportional hazards models controlling for individual confounders (smoking, educational level, body mass index, occupational exposure) were applied, and frailty models used to take into account spatial correlation. Indicators of air pollution were the mean concentration. RESULTS: Models were run before and after exclusion of six area monitors influenced by local traffic (NO/NO2 >3 in ppb). After exclusion of these areas, analyses showed that adjusted risk ratios (95% CI) for TSP, BS, NO2, and NO for non-accidental mortality were 1.05 (1.02 to 1.08), 1.07 (1.03 to 1.10), 1.14 (1.03 to 1.25), and 1.11 (1.05 to 1.17) for 10 microg/m3 respectively. Consistent patterns for lung cancer and cardiopulmonary causes were observed. CONCLUSIONS: Urban air pollution assessed in the 1970s was associated with increased mortality over 25 years in France.

Published
2005
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39. The impact of epilepsy surgery on mortality

Author

Philippe Ryvlin, Montavont, A., Kahane, P., Deransart, Colin, Unité de Neurologie Fonctionnelle et d'Épileptologie, Hospices Civils de Lyon (HCL)-Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Department of Epileptology, CHU Grenoble-Hôpital Michallon, Service de neurophysiopathologie de l'épilepsie, and CHU Grenoble

Subjects
MESH: Cause of Death, Epilepsy, MESH: Humans, Cause of Death, MESH: Epilepsy, Drug Resistance, MESH: Drug Resistance, Humans, MESH: Temporal Lobe, MESH: Neurosurgical Procedures, Neurosurgical Procedures, Temporal Lobe
Abstract

International audience; Patients with refractory epilepsy suffer from an increased risk of death, primarily due to seizure-related fatalities including sudden unexpected death (SUDEP), which could be conceivably avoided by surgical cure of the epilepsy. Several series have addressed this issue by comparing the mortality rate between medically and surgically treated drug resistant populations, as well as between patients, seizure free and non seizure free post-operatively. Results from some studies suggest that successful temporal lobe surgery reduced the risk of death to that observed in the normal population, whereas patients who continue to suffer recurrent seizures still present an increased standardized mortality ratio (SMR). However, other series have failed to replicate this finding, or found no difference in the overall mortality and SUDEP rates between operated and medically treated patients. All the above studies suffer various types of methodological limitations, hampering any definite conclusion regarding the impact of epilepsy surgery on mortality. However, part of the apparently discordant reported findings might be reconciled through the following framework. Patients who will eventually respond favourably or unfavourably to an anterior temporal lobectomy might already differ in the risk of seizure-related death, pre-operatively. Specifically, patients whose temporal lobe epileptogenic network extends to the perisylvian region (temporal plus epilepsy) appear to be at higher risk of failed TLE surgery, secondary generalised tonic-clonic seizures, ictal apnoea or insula-driven severe cardiac arrhytmias. This population might carry most of the SUDEP burden, both pre- and post-operatively, accounting for the lack of an obvious net reduction of seizure related deaths after temporal lobe surgery. A multicentric study has recently been launched in order to test this hypothesis, and will hopefully help to conclude on the impact of epilepsy surgery on mortality outcome.

Published
2005

40. Polycyclic aromatic hydrocarbons and fatal ischemic heart disease

Author

Burstyn, I., Kromhout, H., Partanen, T.J., Svane, O., Langard, S., Ahrens, W., Kauppinen, T., Stucker, I., Shaham, J., Heederik, D.J.J., Ferro, G., Heikkila, P., Hooiveld, M., Johansen, C., Randem, B., Boffetta, P., Faculteit Diergeneeskunde, Secretariat, U754, Unit of Environment Cancer Epidemiology, IARC, Division of Occupational and Environmental Health, Institute for Risk Assessment (IRAS), Utrecht University [Utrecht], Department of Public Health Sciences, University of Alberta, Unit of Excellence for Psychosocial Factors, Finnish Institute of Occupational Health, Central American Institute for Studies on Toxic Substances, Universidad National, Danish Working Environment Service, Centre for Occupational and Environmental Medicine, Riskhospitalet University Hospital, Bremen Institute for Prevention Research and Social Medicine, Recherches épidémiologiques et statistiques sur l'environnement et la santé., Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Occupational Cancer Department, National Institute of Occupational and Environmental Health, Institute of Cancer Epidemiology, Danish Cancer Society, Burstyn, I., Kromhout, H., Partanen, T., Svane, O., Langård, S., Ahrens, W., Kauppinen, T., Stücker, I., Shaham, J., Heederik, D., Ferro, G., Heikkila, P., Hooiveld, M., Johansen, C., Randem, B.G., Boffetta, P., and Faculteit Diergeneeskunde

Subjects
Male, Epidemiology, Denmark, Myocardial Ischemia, MESH: Occupational Exposure, MESH: Cause of Death, chemistry.chemical_compound, Risk Factors, MESH: Risk Factors, Cause of Death, Germany, Determinants in Health and Disease [EBP 1], Israel, Polycyclic Aromatic Hydrocarbons, Finland, MESH: Finland, Confounding, Smoking, Absolute risk reduction, MESH: Israel, Confounding Factors, Epidemiologic, Occupational Diseases, Cohort, Benzopyrene, MESH: Myocardial Ischemia, France, MESH: Occupational Diseases, medicine.medical_specialty, MESH: Smoking, Ischemic heart disease, Coronacrisis-Taverne, Occupational medicine, MESH: Polycyclic Hydrocarbons, Aromatic, Interventional oncology [UMCN 1.5], Environmental health, Occupational Exposure, medicine, Humans, cardiovascular diseases, Risk factor, MESH: Germany, MESH: Denmark, MESH: Humans, business.industry, MESH: Confounding Factors (Epidemiology), MESH: Male, MESH: France, chemistry, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Relative risk, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Background: Several toxicologic and epidemiologic studies have produced evidence that occupational exposure to polycyclic aromatic hydrocarbons (PAH) is a risk factor for ischemic heart disease (IHD). However, a clear exposure-response relation has not been demonstrated. Methods: We studied a relation between exposure to PAH and mortality from IHD (418 cases) in a cohort of 12,367 male asphalt workers from Denmark, Finland, France, Germany, Israel, The Netherlands and Norway. The earliest follow up (country-specific) started in 1953 and the latest ended in 2000, averaging 17 years. Exposures to benzo(a)pyrene were assessed quantitatively using measurement-driven exposure models. Exposure to coal tar was assessed in a semiquantitative manner on the basis of information supplied by company representatives. We carried out sensitivity analyses to assess potential confounding by tobacco smoking. Results: Both cumulative and average exposure indices for benzo(a)pyrene were positively associated with mortality from IHD. The highest relative risk for fatal IHD was observed for average benzo(a)pyrene exposures of 273 ng/m 3 or higher, for which the relative risk was 1.64 (95% confidence interval = 1.13-2.38). Similar results were obtained for coal tar exposure. Sensitivity analysis indicated that even in a realistic scenario of confounding by smoking, we would observe approximately 20% to 40% excess risk in IHD in the highest PAH-exposure categories. Conclusions: Our results lend support to the hypothesis that occupational PAH exposure causes fatal IHD and demonstrate a consistent exposure-response relation for this association. Copyright © 2005 by Lippincott Williams & Wilkins.

Published
2005

41. Cancer mortality among European asphalt workers: An international epidemiological study. I. Results of the analysis based on job titles

Author

Boffetta, Paolo, Burstyn, Igor, Partanen, Timo, Kromhout, Hans, Svane, Ole, Langård, Sverre, Järvholm, Bengt, Frentzel-Beyme, Rainer, Kauppinen, Timo, Stücker, Isabelle, Shaham, Judith, Heederik, Dick, Ahrens, Wolfgang, Bergdahl, Ingvar, Cénée, Sylvie, Ferro, Gilles, Heikkilä, Pirjo, Hooiveld, Mariëtte, Johansen, Christoffer, Randem, Britt, Schill, Walter, Universiteit Utrecht, Faculteit Diergeneeskunde, Unit of Environment Cancer Epidemiology, IARC, Division of Occupational and Environmental Health, Institute for Risk Assessment (IRAS), Utrecht University [Utrecht], Unit of Excellence for Psychosocial Factors, Finnish Institute of Occupational Health, Danish Working Environment Service, Centre for Occupational and Environmental Medicine, Riskhospitalet University Hospital, Occupational Medicine, Department of Public Health and Clinical Medicine, Umea University Hospital, Bremen Institute for Prevention Research and Social Medicine, Recherches épidémiologiques et statistiques sur l'environnement et la santé., Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Occupational Cancer Department, National Institute of Occupational and Environmental Health, Institute of Cancer Epidemiology, Danish Cancer Society, and Secretariat, U754

Subjects
MESH: Occupational Diseases, Adult, Male, Lung Neoplasms, Coronacrisis-Taverne, road paving, occupational exposures, lung neoplasms, MESH: Occupational Exposure, MESH: Cause of Death, Cohort Studies, Interventional oncology [UMCN 1.5], Cause of Death, Neoplasms, Occupational Exposure, MESH: Hydrocarbons, Determinants in Health and Disease [EBP 1], Humans, MESH: Neoplasms, Occupations, MESH: Cohort Studies, Inhalation Exposure, MESH: Occupations, MESH: Humans, MESH: Confounding Factors (Epidemiology), MESH: Adult, Confounding Factors, Epidemiologic, roofing, mortality, MESH: Male, Hydrocarbons, MESH: Lung Neoplasms, Europe, Occupational Diseases, asphalt, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, epidemiology, MESH: Europe, MESH: Inhalation Exposure
Abstract

Background Inhalation of bitumen fumes is potentially carcinogenic to humans. Methods We conducted a study of 29,820 male workers exposed to bitumen in road paving, asphalt mixing and roofing, 32,245 ground and building construction workers unexposed to bitumen, and 17,757 workers not classifiable as bitumen workers, from Denmark, Finland, France, Germany, Israel, the Netherlands, Norway, and Sweden, with mortality follow‐up during 1953–2000. We calculated standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) based on national mortality rates. Poisson regression analyses compared mortality of bitumen workers to that of building or ground construction workers. Results The overall mortality was below expectation in the total cohort (SMR 0.92, 95% CI 0.90–0.94) and in each group of workers. The SMR of lung cancer was higher among bitumen workers (1.17, 95% CI 1.04–1.30) than among workers in ground and building construction (SMR 1.01, 95% CI 0.89–1.15). In the internal comparison, the relative risk (RR) of lung cancer mortality among bitumen workers was 1.09 (95% CI 0.89–1.34). The results of cancer of the head and neck were similar to those of lung cancer, based on a smaller number of deaths. There was no suggestion of an association between employment in bitumen jobs and other cancers. Conclusions European workers employed in road paving, asphalt mixing and other jobs entailing exposure to bitumen fume might have experienced a small increase in lung cancer mortality risk, compared to workers in ground and building construction. However, exposure assessment was limited and confounding from exposure to carcinogens in other industries, tobacco smoking, and other lifestyle factors cannot be ruled out. Am. J. Ind. Med. 43:18–27, 2003. © 2003 Wiley‐Liss, Inc.

Published
2003
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42. Two hour plasma glucose is not unequivocally predictive for early death in men with impaired fasting glucose: more results from the Paris Prospective Study

Author

B. Balkau, E. Eschwege, Anne Forhan, Epidémiologie cardiovasculaire et métabolique, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Kaniewski, Nadine

Subjects
Blood Glucose, Male, Time Factors, endocrine system diseases, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Blood Pressure, 030204 cardiovascular system & hematology, Cohort Studies, MESH: Cause of Death, chemistry.chemical_compound, 0302 clinical medicine, MESH: Cholesterol, Reference Values, Cause of Death, Neoplasms, Insulin, MESH: Neoplasms, Prospective Studies, Prospective cohort study, MESH: Cohort Studies, Cause of death, Glucose tolerance test, MESH: Middle Aged, medicine.diagnostic_test, Smoking, MESH: Paris, MESH: Comparative Study, MESH: Blood Pressure, Middle Aged, 3. Good health, Survival Rate, Cholesterol, Cardiovascular Diseases, Predictive value of tests, Paris, medicine.medical_specialty, MESH: Diabetes Mellitus, MESH: Glucose Tolerance Test, 030209 endocrinology & metabolism, MESH: Insulin, 03 medical and health sciences, Predictive Value of Tests, Diabetes mellitus, Internal medicine, Glucose Intolerance, Diabetes Mellitus, Internal Medicine, medicine, Humans, MESH: Glucose Intolerance, MESH: Humans, business.industry, nutritional and metabolic diseases, MESH: Cardiovascular Diseases, Glucose Tolerance Test, medicine.disease, Impaired fasting glucose, MESH: Male, carbohydrates (lipids), Endocrinology, chemistry, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Blood Glucose, MESH: Predictive Value, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

AIMS/HYPOTHESIS: We examined whether the 2-h plasma glucose (2 hPG) concentration after a 75 g OGTT is predictive of death in men with a diabetic, an impaired or a normal fasting plasma glucose concentration (DM-FPG: > or =7.0 mmol/l; IFG: 6.1-6.9 mmol/l; normal-FPG

Published
2002
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43. Changes over calendar time in the risk of specific first AIDS-defining events following HIV seroconversion, adjusting for competing risks

Author

Babiker, Abdel, Darbyshire, Janet, Pezzotti, Patrizio, Porter, Kholoud, Rezza, Giovanni, Walker, Sarah A, Beral, Valerie, Coutinho, Roel, del Amo, Julia, Gill, Noël, Lee, Christine, Meyer, Laurence, Tyrer, Freya, Dabis, François, Thiébaut, Rodolphe, Lawson-Aye, Sylvie, Boufassa, Faroudy, Hamouda, Osamah, Fischer, Klaus, Touloumi, Giota, Hatzakis, Angelos, Karafoulidou, Anastasia, Katsarou, Olga, Brettle, Ray, del Romero, Jorge, Prins, Maria, van Benthem, Birgit, Kirk, Ole, Pederson, Court, Hernández Aguado, Idelfonso, Pérez-Hoyos, Santiago, Eskild, Anne, Bruun, Johan N, Sannes, Mette, Sabin, Caroline, Johnson, Anne M, Phillips, Andrew N, Francioli, Patrick, Vanhems, Philippe, Egger, Mathias, Rickenbach, Martin, Cooper, David, Kaldor, John, Ashton, Lesley, Vizzard, Jeanette, Muga, Roberto, Day, Nicholas E, de Angelis, Daniela, Mouillet, Evelyne, Epidémiologie, santé publique et développement, and Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED

Subjects
MESH: Acquired Immunodeficiency Syndrome, MESH: Adolescent, MESH: Aged, MESH: Humans, MESH: Middle Aged, MESH: AIDS-Related Opportunistic Infections, MESH: Time Factors, MESH: Adult, MESH: Risk Assessment, MESH: Male, MESH: HIV Wasting Syndrome, MESH: HIV-1, MESH: Proportional Hazards Models, MESH: Cause of Death, MESH: HIV Seropositivity, MESH: Aged, 80 and over, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Risk Factors, MESH: Acute Disease, MESH: Disease Progression, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, MESH: Cohort Studies
Abstract

International audience; BACKGROUND: Although studies have reported large reductions in the risks of AIDS and death since the introduction of potent anti-retroviral therapies, few have evaluated whether this has been similar for all AIDS-defining diseases. We wished to evaluate changes over time in the risk of specific AIDS-defining diseases, as first events, using data from individuals with known dates of HIV seroconversion. METHODS: Using a competing risks proportional hazards model on pooled data from 20 cohorts (CASCADE), we evaluated time from HIV seroconversion to each first AIDS-defining disease (16 groups) and to death without AIDS for four calendar periods, adjusting for exposure category, age, sex, acute infection, and stratifying by cohort. We compared results to those obtained from a cause-specific hazards model. RESULTS: Of 6,941, 2,021 (29%) developed AIDS and 437 (6%) died without AIDS. The risk of AIDS or death remained constant to 1996 then reduced; relative hazard = 0.89 (95% CI: 0.77-1.03); 0.90 (95% CI: 0.81-1.01); and 0.32 (95% CI: 0.28-0.37) for 1979-1990, 1991-1993, and 1997-2001, respectively, compared to 1994-1996. Significant risk reductions in 1997-2001 were observed in all but two AIDS-defining groups and death without AIDS in a competing risks model (with similar results from a cause-specific model). There was significant heterogeneity in the risk reduction across events; from 96% for cryptosporidiosis, to 17% for death without AIDS (P < 0.0001). CONCLUSION: These findings suggest that studies reporting a stable trend for particular AIDS diseases over the period 1979-2001 may not have accounted for the competing risks among other events or lack the power to detect smaller trends.

Published
2002

44. Validity of subjective assessment of changes in respiratory health status: a 30 year epidemiological study of workers in Paris

Author

J Chwalow, I Annesi, Francine Kauffmann, Groupe de Recherche en Informatique, Image et Instrumentation de Caen (GREYC), Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), Normandie Université (NU)-Normandie Université (NU)-Université de Caen Normandie (UNICAEN), Normandie Université (NU), Kauffmann F, Annesi I, J Chwalow, Annesi-Maesano, Isabella, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-École Nationale Supérieure d'Ingénieurs de Caen (ENSICAEN), and Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Gerontology, Longitudinal study, Time Factors, Cross-sectional study, Health Status, Rate ratio, MESH: Occupational Exposure, MESH: Cause of Death, 0302 clinical medicine, Quality of life, Risk Factors, MESH: Risk Factors, Cause of Death, Epidemiology, Longitudinal Studies, 030212 general & internal medicine, MESH: Longitudinal Studies, MESH: Health Status, MESH: Aged, MESH: Middle Aged, Smoking, MESH: Paris, Middle Aged, Occupational Diseases, MESH: Reproducibility of Results, Convergent validity, Adult, Pulmonary and Respiratory Medicine, Predictive validity, MESH: Occupational Diseases, Paris, medicine.medical_specialty, MESH: Smoking, 03 medical and health sciences, MESH: Cross-Sectional Studies, Occupational Exposure, MESH: Lung Diseases, Obstructive, medicine, Humans, Lung Diseases, Obstructive, Aged, MESH: Humans, business.industry, Public health, MESH: Time Factors, Reproducibility of Results, MESH: Quality of Life, MESH: Adult, MESH: Male, Cross-Sectional Studies, 030228 respiratory system, Spirometry, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Emergency medicine, Quality of Life, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Spirometry, business
Abstract

International audience; The validity of scales used for subjective assessment of health, particularly transitional indices, is under discussion. The aim of the present study was to assess the concurrent and predictive validity of a simple estimate of long-term subjective assessment of respiratory health changes. A longitudinal study of 915 workers was conducted over 30 yrs, with both retrospective self-assessment of respiratory health changes and objective measurements of spirometric values 12 yrs apart. An assessment of the reason for death during the subsequent 20 yrs was performed. Subjective assessment of respiratory deterioration over 12 yrs was significantly related to both cross-sectional lung function values and longitudinal lung function changes (forced expiratory volume in one second (FEV1) decline), an association which remained after adjustment for FEV1 level. It was also related to the same risk factors as decline in FEV1 (smoking, occupational exposure). Self-evaluation of respiratory deterioration was significantly predictive of death from all causes, with the highest (but nonsignificant) rate ratio for respiratory causes. Asthmatics exhibited greater long-term variability (objective and subjective) than nonasthmatics. Independent of dyspnoea, self-assessment of respiratory health deterioration was significantly related to FEV1. Subjective assessment of long-term changes in respiratory health provides valid information.

Published
1997

45. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire

Author

Simonneau, Gérald, Sors, H., Charbonnier, B., Page, Y., Laaban, J. P., Azarian, R., Laurent, M., Hirsch, J. L., Ferrari, Emile, Bosson, Jean-Luc, Mottier, Dominique, Beau, B., Centre National de Référence de l'Hypertension Artérielle Pulmonaire (UPRES - EA2705), Université Paris-Sud - Paris 11 (UP11), CIC - Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)

Subjects
Male, MESH: Pulmonary Embolism, MESH: Heparin, Hemorrhage, MESH: Anticoagulants, MESH: Cause of Death, Tinzaparin, Fibrinolytic Agents, Recurrence, Cause of Death, Thromboembolism, Humans, MESH: Fibrinolytic Agents, MESH: Heparin, Low-Molecular-Weight, Radionuclide Imaging, Aged, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, MESH: Humans, Heparin, Anticoagulants, Heparin, Low-Molecular-Weight, Middle Aged, MESH: Male, MESH: Recurrence, Treatment Outcome, MESH: Thromboembolism, Acute Disease, MESH: Acute Disease, Female, Pulmonary Embolism, MESH: Female, MESH: Hemorrhage, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: Low-molecular-weight heparin appears to be at least as effective and safe as standard, unfractionated heparin for the treatment of deep-vein thrombosis, but only limited data are available on the use of low-molecular-weight heparin to treat acute symptomatic pulmonary embolism. METHODS: We randomly assigned 612 patients with symptomatic pulmonary embolism who did not require thrombolytic therapy or embolectomy to either subcutaneous low-molecular-weight heparin (tinzaparin) given once daily in a fixed dose or adjusted-dose, intravenous unfractionated heparin. Oral anticoagulant therapy was begun between the first and the third day and was given for at least three months. We compared the treatments at day 8 and day 90 with respect to a combined end point of recurrent thromboembolism, major bleeding, and death. RESULTS: In the first eight days of treatment, 9 of 308 patients assigned to receive unfractionated heparin (2.9 percent) reached at least one of the end points, as compared,with 9 of 304 patients assigned to low-molecular-weight heparin (3.0 percent; absolute difference, 0.1 percentage point; 95 percent confidence interval, -2.7 to 2.6). By day 90, 22 patients assigned to unfractionated heparin (7.1 percent) and 18 patients assigned to low-molecular-weight heparin (5.9 percent) had reached at least one end point (P=0.54; absolute difference, 1.2 percentage points; 95 percent confidence interval, -2.7 to 5.1). The risk of major bleeding was similar in the two treatment groups throughout the study. CONCLUSIONS: Under the conditions of this study, initial subcutaneous therapy with the low-molecular-weight heparin tinzaparin appeared to be as effective and safe as intravenous unfractionated heparin in patients with acute pulmonary embolism.

Published
1997
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