Author: "François, Alla" / Publisher: hal ccsd - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"François, Alla"' showing total 68 results

Start Over Author "François, Alla" Publisher hal ccsd

68 results on '"François, Alla"'

1. Emotional Exhaustion, a Proxy for Burnout, Is Associated with Sleep Health in French Healthcare Workers without Anxiety or Depressive Symptoms: A Cross‐Sectional Study

Author: Julien Coelho, Jacques Taillard, Adèle Bernard, Régis Lopez, Guillaume Fond, Laurent Boyer, Guillaume Lucas, François Alla, Daniel J. Buysse, Meredith L. Wallace, Catherine Verdun-Esquer, Pierre-Alexis Geoffroy, Emmanuel d’Incau, Pierre Philip, Jean-Arthur Micoulaud-Franchi, Sommeil, Addiction et Neuropsychiatrie [Bordeaux] (SANPSY), Université de Bordeaux (UB)-CHU de Bordeaux Pellegrin [Bordeaux]-Centre National de la Recherche Scientifique (CNRS), CHU Bordeaux [Bordeaux], Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Fondation FondaMental [Créteil], Santé publique, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), University of Pittsburgh (PITT), Pennsylvania Commonwealth System of Higher Education (PCSHE), GHU Paris Psychiatrie et Neurosciences, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Maladies neurodéveloppementales et neurovasculaires (NeuroDiderot (UMR_S_1141 / U1141)), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)
Subjects: Cross-sectional, Burnout, Healthcare workers, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], General Medicine, Sleep health
Abstract: International audience; Burnout is frequent among healthcare workers, and sleep problems are suspected risk factors. The sleep health framework provides a new approach to the promotion of sleep as a health benefit. The aim of this study was to assess good sleep health in a large sample of healthcare workers and to investigate its relationship with the absence of burnout among healthcare workers while considering anxiety and depressive symptoms. A cross-sectional Internet-based survey of French healthcare workers was conducted in summer 2020, at the end of the first COVID-19 lockdown in France (March to May 2020). Sleep health was assessed using the RU-SATED v2.0 scale (RegUlarity, Satisfaction, Alertness, Timing, Efficiency, Duration). Emotional exhaustion was used as a proxy for overall burnout. Of 1069 participating French healthcare workers, 474 (44.3%) reported good sleep health (RU-SATED > 8) and 143 (13.4%) reported emotional exhaustion. Males and nurses had a lower likelihood of emotional exhaustion than females and physicians, respectively. Good sleep health was associated with a 2.5-fold lower likelihood of emotional exhaustion and associations persisted among healthcare workers without significant anxiety and depressive symptoms. Longitudinal studies are needed to explore the preventive role of sleep health promotion in terms of the reduction in burnout risk.
Published: 2023

2. L’innovation au service de la transformation du système de santé et du « virage préventif »

Author: N. Stevens, Linda Cambon, François Alla, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Administration de la santé publique, Innovation dissemination, Public Health Systems Research, Epidemiology, Public Health, Environmental and Occupational Health, 030501 epidemiology, Prevention and control, 03 medical and health sciences, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Preventive Medicine, Prévention et contrôle, Médecine préventive, Recherche sur les systèmes de santé publique, 0305 other medical science, Public Health Administration, Diffusion des innovations
Abstract: Given today's evolution of the healthcare system, organizational transformations, technological developments and major challenges, innovation has taken on primordial importance. In this context and with considerable support, many experimentations have taken place. Unfortunately, few have managed to scale up. What results is a congeries of innovations without a future, possibly avoidable squandering of resources, a number of missed opportunities, and the grim prospect of inventor burnout. As regards prevention, innovation is at the heart of an anticipated "preventive transition" of the health system that has yet to achieve operational status. In this article we attempt to redesign the contours of innovation in health, considering it first and foremost in regard to its social utility. We will go on to explore the limitations of innovative practices that delay the arrival of advances in health. Four types of obstacles appear: faulty evaluation; insufficient dialogue between researchers, stakeholders and decision-makers; lack of visibility and, finally, conceptions and perceptions of innovation characterized by tunnel vision. In the concluding section of this paper, we will present several tracks through which the innovation process could be impelled to drive health system transformation. They consist in: (i) incorporating an evaluative and comprehensive research into innovation processes, (ii) elaborating "bottom-up" approaches giving special consideration to innovations instigated by stakeholders and brought to fruition under real-life conditions, (iii) breaking from standardization by thinking from the outset of the adaptability of innovations and, finally, (iv) tying in the experimental approach with a decision-making process.; L’évolution actuelle du système de santé, les transformations organisationnelles et développements technologiques, et les nombreux défis auxquels le système de santé est confronté, confèrent un rôle central à l’innovation. Fortement encouragée, de nombreuses expérimentations voient le jour. Pourtant peu d’entre elles parviennent à une mise à l’échelle. Il en résulte un éparpillement d’innovations sans lendemain, une déperdition considérable de ressources, certainement de nombreux « progrès manqués » et un épuisement des acteurs de l’innovation. Dans le champ de la prévention, l’innovation est également au cœur du « virage préventif » du système de santé qui, bien que fortement attendu, peine à s’opérationnaliser. Cet article propose de redéfinir les contours de la notion d’innovation en santé, en la considérant avant tout sous l’angle du service rendu à la population. Il s’agit ensuite d’explorer les limites des pratiques actuelles d’innovation qui entravent l’avènement de nombreux progrès pour la santé. Quatre types de failles apparaissent : un défaut d’évaluation; un dialogue insuffisant entre chercheurs, acteurs et décideurs; un manque de visibilité des innovations et enfin des conceptions et perceptions rigides des innovations. Pour finir, plusieurs pistes sont présentées permettant d’assurer que le processus d’innovation est moteur de la transformation de notre système de santé. Il s’agit (i) d’intégrer une démarche de recherche évaluative et compréhensive dans les processus d’innovation, (ii) de développer les approches « bottom-up » en accordant une attention particulière aux innovations portées par les acteurs et développées en conditions de vie réelle, (iii) de se défaire de la standardisation en pensant dès leur construction l’adaptabilité des innovations et enfin, (iv) de conditionner le processus expérimental à une décision.
Published: 2021

3. Quand la réponse mondiale à la pandémie de COVID-19 se fait sans la promotion de la santé

Author: Valéry Ridde, Linda Cambon, Henri Bergeron, Patrick Castel, François Alla, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Actions for OnCogenesis understanding and Target Identification in ONcology (ACTION), Institut Bergonié [Bordeaux], UNICANCER-UNICANCER-Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de sociologie des organisations (Sciences Po, CNRS) (CSO), Sciences Po (Sciences Po)-Centre National de la Recherche Scientifique (CNRS), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), ISED (ISED), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2-Institut Bergonié [Bordeaux], UNICANCER-UNICANCER, Centre de sociologie des organisations (CSO), and Institut de Recherche pour le Développement (IRD)-Université de Paris (UP)
Subjects: 2019-20 coronavirus outbreak, inégalités de santé, [SHS.SOCIO]Humanities and Social Sciences/Sociology, Coronavirus disease 2019 (COVID-19), promotion de la santé, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Public Health, Environmental and Occupational Health, [SHS.SCIPO]Humanities and Social Sciences/Political science, 03 medical and health sciences, 0302 clinical medicine, covid-19, santé publique, Political science, 030212 general & internal medicine, Humanities, 030217 neurology & neurosurgery
Abstract: International audience; Plus d’un an après les premiers cas déclarés de COVID-19, le monde est toujours plongé dans le marasme de la pandémie. Cet éditorial défend l'idée qu'un certain nombre de principes clés de la santé publique ont été oubliés lors de la réponse que les pays ont apportée à la pandémie du coronavirus.
Published: 2021

4. COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics

Author: Michaël Schwarzinger, Verity Watson, Stéphane Luchini, François Alla, Pierre Arwidson, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Aberdeen, Santé publique France - French National Public Health Agency [Saint-Maurice, France], Aix-Marseille Sciences Economiques (AMSE), École des hautes études en sciences sociales (EHESS)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), French Public Health Agency (Santé Publique France), École des hautes études en sciences sociales (EHESS)-Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), Admin, Oskar, and ANR-20-COVI-0102,TRACTRUST (Tracking Trust),Surveiller la confiance et la méfiance: analyser les médias sociaux pour soutenir la réponse de santé publique au Covid-19(2020)
Subjects: medicine.medical_specialty, Cross-sectional study, Population, Pharmacy, Computer-assisted web interviewing, 01 natural sciences, Herd immunity, 03 medical and health sciences, 0302 clinical medicine, [SDV.IMM.VAC] Life Sciences [q-bio]/Immunology/Vaccinology, Medicine, 030212 general & internal medicine, 0101 mathematics, Young adult, education, education.field_of_study, business.industry, lcsh:Public aspects of medicine, Public health, 010102 general mathematics, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, 3. Good health, Vaccination, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.IMM.VAC]Life Sciences [q-bio]/Immunology/Vaccinology, business, Demography
Abstract: International audience; BACKGROUND: Opinion polls on vaccination intentions suggest that COVID-19 vaccine hesitancy is increasing worldwide; however, the usefulness of opinion polls to prepare mass vaccination campaigns for specific new vaccines and to estimate acceptance in a country's population is limited. We therefore aimed to assess the effects of vaccine characteristics, information on herd immunity, and general practitioner (GP) recommendation on vaccine hesitancy in a representative working-age population in France.METHODS: In this survey experiment, adults aged 18-64 years residing in France, with no history of SARS-CoV-2 infection, were randomly selected from an online survey research panel in July, 2020, stratified by gender, age, education, household size, and region and area of residence to be representative of the French population. Participants completed an online questionnaire on their background and vaccination behaviour-related variables (including past vaccine compliance, risk factors for severe COVID-19, and COVID-19 perceptions and experience), and were then randomly assigned according to a full factorial design to one of three groups to receive differing information on herd immunity (>50% of adults aged 18-64 years must be immunised [either by vaccination or infection]; >50% of adults must be immunised [either by vaccination or infection]; or no information on herd immunity) and to one of two groups regarding GP recommendation of vaccination (GP recommends vaccination or expresses no opinion). Participants then completed a series of eight discrete choice tasks designed to assess vaccine acceptance or refusal based on hypothetical vaccine characteristics (efficacy [50%, 80%, 90%, or 100%], risk of serious side-effects [1 in 10 000 or 1 in 100 000], location of manufacture [EU, USA, or China], and place of administration [GP practice, local pharmacy, or mass vaccination centre]). Responses were analysed with a two-part model to disentangle outright vaccine refusal (irrespective of vaccine characteristics, defined as opting for no vaccination in all eight tasks) from vaccine hesitancy (acceptance depending on vaccine characteristics).FINDINGS: Survey responses were collected from 1942 working-age adults, of whom 560 (28·8%) opted for no vaccination in all eight tasks (outright vaccine refusal) and 1382 (71·2%) did not. In our model, outright vaccine refusal and vaccine hesitancy were both significantly associated with female gender, age (with an inverted U-shaped relationship), lower educational level, poor compliance with recommended vaccinations in the past, and no report of specified chronic conditions (ie, no hypertension [for vaccine hesitancy] or no chronic conditions other than hypertension [for outright vaccine refusal]). Outright vaccine refusal was also associated with a lower perceived severity of COVID-19, whereas vaccine hesitancy was lower when herd immunity benefits were communicated and in working versus non-working individuals, and those with experience of COVID-19 (had symptoms or knew someone with COVID-19). For a mass vaccination campaign involving mass vaccination centres and communication of herd immunity benefits, our model predicted outright vaccine refusal in 29·4% (95% CI 28·6-30·2) of the French working-age population. Predicted hesitancy was highest for vaccines manufactured in China with 50% efficacy and a 1 in 10 000 risk of serious side-effects (vaccine acceptance 27·4% [26·8-28·0]), and lowest for a vaccine manufactured in the EU with 90% efficacy and a 1 in 100 000 risk of serious side-effects (vaccine acceptance 61·3% [60·5-62·1]).INTERPRETATION: COVID-19 vaccine acceptance depends on the characteristics of new vaccines and the national vaccination strategy, among various other factors, in the working-age population in France. FUNDING: French Public Health Agency (Santé Publique France).
Published: 2021

5. Understanding the complexity of population health interventions: assessing intervention system theory (ISyT)

Author: François Alla, Linda Cambon, Admin, Oskar, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: System, Computer science, Psychological intervention, Systems Theory, Population health, Health administration, 03 medical and health sciences, 0302 clinical medicine, Intervention (counseling), Black box, Humans, Theory, 030212 general & internal medicine, Evaluation, Health policy, Public health, Population Health, Management science, 030503 health policy & services, Health Policy, Health services research, Causal theory of reference, Research Design, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Commentary, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Public aspects of medicine, RA1-1270, 0305 other medical science
Abstract: Given their inherent complexity, we need a better understanding of what is happening inside the “black box” of population health interventions. The theory-driven intervention/evaluation paradigm is one approach to addressing this question. However, barriers related to semantic or practical issues stand in the way of its complete integration into evaluation designs. In this paper, we attempt to clarify how various theories, models and frameworks can contribute to developing a context-dependent theory, helping us to understand the black box of population health interventions and to acknowledge their complexity. To achieve this goal, we clarify what could be referred to as “theory” in the theory-driven evaluation of the interventional system, distinguishing it from other models, frameworks and classical theories. In order to evaluate the interventional system with a theory-driven paradigm, we put forward the concept of interventional system theory (ISyT), which combines a causal theory and an action model. We suggest that an ISyT could guide evaluation processes, whatever evaluation design is applied, and illustrate this alternative method through different examples of studies. We believe that such a clarification can help to promote the use of theories in complex intervention evaluations, and to identify ways of considering the transferability and scalability of interventions.
Published: 2021

6. Second-hand tobacco exposure in children: evidence for action

Author: François Alla, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Admin, Oskar
Subjects: 0303 health sciences, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, business.industry, Smoking, Public Health, Environmental and Occupational Health, MEDLINE, 03 medical and health sciences, [SDV.MHEP.PED] Life Sciences [q-bio]/Human health and pathology/Pediatrics, 0302 clinical medicine, Action (philosophy), [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Tobacco exposure, Environmental health, Tobacco, Humans, Medicine, Tobacco Smoke Pollution, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, Public aspects of medicine, RA1-1270, Child, business, ComputingMilieux_MISCELLANEOUS, 030304 developmental biology
Abstract: International audience
Published: 2021

7. Supporting parents by combatting social inequalities in health: a realist evaluation

Author: Laurence Fond-Harmant, Annabelle Pierron, François Alla, Malbec, Odile, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire éducations et promotion de la santé (LEPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Sorbonne Paris Nord, and Laboratoire Educations et Pratiques de Santé (LEPS)
Subjects: medicine.medical_specialty, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Psychological intervention, Mothers, Context (language use), Body of knowledge, 03 medical and health sciences, Social determinants of health, 0302 clinical medicine, Humans, Medicine, Social inequality, Theory, 030212 general & internal medicine, Child, Intervention research, media_common, 030505 public health, Parenting, business.industry, Public health, Public Health, Environmental and Occupational Health, Complexity, Public relations, Focus group, Europe, [SDV] Life Sciences [q-bio], Socioeconomic Factors, Child, Preschool, Female, Health status disparities, Public aspects of medicine, RA1-1270, 0305 other medical science, business, Research Article, Diversity (politics)
Abstract: Background To reduce social inequities in health, the World Health Organization’s Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period. Methods To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires. Results The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents’ behavior, aiming to empower them but without giving them the means to do so. Conclusions This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents’ needs.
Published: 2021

8. Health services research in France: bridging the gap between academia and policymaking

Author: Marine Spaak, François Alla, Daniel Benamouzig, Marion Cipriano, Centre de sociologie des organisations (CSO), Sciences Po (Sciences Po)-Centre National de la Recherche Scientifique (CNRS), and Centre de sociologie des organisations (Sciences Po, CNRS) (CSO)
Subjects: medicine.medical_specialty, Bridging (networking), [SDV]Life Sciences [q-bio], academia (organization), Disease cluster, [SHS]Humanities and Social Sciences, Critical mass (sociodynamics), 03 medical and health sciences, 0302 clinical medicine, Political science, medicine, Humans, 030212 general & internal medicine, Policy Making, Publication, ComputingMilieux_MISCELLANEOUS, Publishing, business.industry, Public health, Public Health, Environmental and Occupational Health, Health services research, gray literature, Grey literature, Public relations, health services research, 3. Good health, Work (electrical), interdisciplinary research, public health medicine, France, Health Services Research, Public Health, business, 030217 neurology & neurosurgery
Abstract: Background—We aimed to identify the knowledge producers, the knowledge that they produce and the main areas of interest for health services research (HSR) in France, which is one of the priorities for public health research planning.Methods—A two-phase approach comprising a bibliometric analysis and semi-structured interviews with 20 researchers and 13 staff members of public health bodies was used.Results—In France today, interdisciplinary research teams are being organized in the main cities despite a lack of critical mass. The interviews showed that the term ‘health services research’ is vague with fuzzy boundaries between research, scientific expertise and evaluation. A keyword cluster analysis showed that French HSR is more hospital-centric compared to those countries that publish most frequently. The analysis also revealed a lack of research on methodological aspects.Conclusions—We analyzed the structure of HSR in France and the specificity of the French publications in this field, compared with other countries. The results indicate the obstacles faced by researchers and decision-makers and offer insight into how these barriers may be removed.
Published: 2020

9. Eur J Public Health

Author: François Alla, Linda Cambon, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Physician-Patient Relations, 03 medical and health sciences, Policy, 0302 clinical medicine, 030220 oncology & carcinogenesis, Public Health, Environmental and Occupational Health, Humans, MRISP, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Business, 030217 neurology & neurosurgery, 3. Good health
Abstract: For the second year, the number of smokers in France is falling. The results are obvious: 1.6 million fewer smokers between 2016 and 2018, the prevalence of daily smoking among adults fell from 29.4% to 25.4% over this period.1This dramatic change is the result of an ambitious and structured national policy: the National Tobacco Reduction Programme, launched in 2014, followed and strengthened by a National Tobacco Control Programme, launched in 2018 and strongly supported by the Minister of Health. This programme includes 28 actions covering all levels of health promotion, including measures that are known to be very effective, such as increasing the price of tobacco products...
Published: 2020

10. Quelle place pour les registres de morbidité à l'ère des données massives de santé ?

Author: Florence Francis, C. Persoz, J.-M. Gagliolo, C. Terroba, François Alla, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: National health, medicine.medical_specialty, Epidemiology, business.industry, Technological change, media_common.quotation_subject, Public health, Public Health, Environmental and Occupational Health, Context (language use), MRISP, 030501 epidemiology, Data science, Data warehouse, 3. Good health, 03 medical and health sciences, Political science, medicine, Quality (business), [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 0305 other medical science, Human resources, business, media_common
Abstract: The recent opening of massive health databases, as well as the development of methods and tools adapted to their data processing, questions the French model of “morbidity registry”. In France in 2019, nearly 61 health registries were operating. As defined by law, these registries identify exhaustively all patients with a given disease in a given territory. Established several decades ago, these registries are part of the French surveillance system that is used for research and evaluation purposes. Since the advent of recent technological progress, large-scale databases are made available to researchers and it is possible with these databases to answer questions initially assigned to the registries. What is the place of such registries in this new context: are they obsolete or still useful? Should they be opposed to the new tools or are they complementary to them, and if so, what is their place in the new French public health ecosystem? The objective of this work was to assess the roles and missions of existing registries and to reflect on their positioning in this new environment. The French model of registry is sometimes questioned because of the complexity of its circuits, requiring a significant amount of human resources. However, the data that constitute them, validated by cross-checking information from several sources, are of very high quality, and make it possible to validate the data in the new databases (National Health Data System (NSDS) or Hospital Data Warehouses). Registries and new databases are in fact complementary, and far from jeopardizing this model, the recent opening of these databases represents an opportunity for registries to modernize their operations and respond to new missions.; La mise à disposition récente de bases de données massives en santé, ainsi que le développement de méthodes et d’outils adaptés à leurs traitements, vient remettre en question le modèle français des registres de morbidité. Mis en place il y a plusieurs dizaines d’années, ils font partie intégrante du système de surveillance et répondent à des missions de recherche et d’évaluation. Sous l’influence d’avancées technologiques récentes, des bases de données massives sont rendues accessibles aux chercheurs et permettent ou permettraient de répondre à des questions initialement dévolues aux registres. Quelle est la place des registres dans ce nouveau contexte : sont-ils obsolètes ou toujours utiles, doit-on les opposer aux nouveaux outils ou en sont-ils complémentaires, et le cas échéant, quelle est désormais leur place dans le nouvel écosystème de la santé publique française ? L’objectif de ce travail a été de réaliser un bilan des rôles et missions des registres existants et de réfléchir à leur positionnement dans ce nouvel environnement. Le modèle français des registres est parfois remis en question pour la lourdeur de ses circuits, nécessitant de nombreux moyens humains. Cependant, les données qui les constituent, validées par un recoupement d’informations à partir de plusieurs sources, sont d’une très grande qualité et permettent de valider les données des nouvelles bases (Système national des données de santé (SNDS) ou entrepôts de données hospitaliers). Registres et nouvelles bases de données sont en fait complémentaires, et loin de mettre en péril ce modèle, l’ouverture récente de ces bases constitue pour les registres, une opportunité de moderniser leur fonctionnement et de répondre à de nouvelles missions.
Published: 2020

11. BMJ Open

Author: Cédric Baumann, Anne Pasquereau, Pierre Arwidson, Linda Cambon, Pierre Bergman, François Alla, Anne-Laurence Le Faou, Aurélie Affret, Amandine Luc, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, medicine.medical_specialty, media_common.quotation_subject, medicine.medical_treatment, Prevalence, 050109 social psychology, preventive medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intervention (counseling), medicine, Tobacco Smoking, Humans, 0501 psychology and cognitive sciences, 030212 general & internal medicine, media_common, Preventive healthcare, Text Messaging, clinical trials, business.industry, Public health, 05 social sciences, Smoking, MRISP, General Medicine, Abstinence, 16. Peace & justice, 3. Good health, Clinical trial, Physical therapy, Medicine, Smoking cessation, Smoking Cessation, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Public Health, business
Abstract: ObjectiveTo compare the effectiveness of the mobile e-Tabac Info Service (e-TIS) application (app) for helping adult smokers quit smoking with current practices.DesignPragmatic randomised controlled trial with a 1-year follow-up (2017–2018).SettingFrance, population-wide level.Participants2806 adult smokers who wished to quit smoking were recruited via the website of the French National Mandatory Health Insurance fund. Of them, 1400 were randomised to the e-TIS app arm and 1406 were randomised to the current practices arm (control).InterventionThe app involved personalised interactive contacts that included questionnaires, advice, activities and text messages. All contacts were individually tailored and based on each smoker’s progress.In the control group, recommended practices for quitting smoking were described on a non-interactive website.Primary and secondary outcomes measuresThe primary outcome was 7-day point prevalence abstinence (PPA) at 6 months. The secondary outcomes included continuous abstinence rates at 6 and 12 months, minimum 24-hour point abstinence at 3 months, minimum 30-day point abstinence at 12 months and number and duration of quit attempts.ResultsThere was no difference between the e-TIS and control arms for the primary outcome (12.6% vs 13.7% for 7-day PPA at 6 months, p=0.3949, intention-to-treat analysis). However, e-TIS participants with high levels of exposure to the app, which was defined by the completion of at least eight activities or questionnaires, showed higher rates of smoking cessation than the control participants (17.6% vs 12.9% for 7-day PPA at 6 months, p=0.0169, per-protocol analysis).ConclusionUse of the e-TIS app was not associated with a higher rate of smoking cessation. However, high level of exposure to the e-TIS app may have been more effective than current practices.Trial registration numberNCT02841683.
Published: 2020

12. How to implement a successful smoking cessation intervention for adolescents

Author: François Alla, A Vallata, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), and Vialaron, Sylvie
Subjects: medicine.medical_specialty, business.industry, 4. Education, Smoking, Public Health, Environmental and Occupational Health, Smoking cessation intervention, Guidelines, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Implementation, Physical therapy, medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, ComputingMilieux_MISCELLANEOUS
Abstract: Background Policies and programs implemented to promote smoking cessation among youth present disparate results. These variations are explained by interventions themselves but also by context, population and implementation characteristics. Our objective was to analyze these factors, related to enrollment and participation in a smoking cessation program, implemented in vocational or technical schools. Methods Population factors were studied by a systematic review about determinants of smoking cessation among 10-24 years old, updating a previous one. Contextual and implementation factors were identified by a qualitative multiple cases study. A smoking cessation program, TABADO, had been implemented in 3 regions in France, in 10 vocational or technical schools (1 school/1 case). Data collection included 51 observations, 46 semi-structured interviews, and 3 interdisciplinary seminars. Results The review identified 46 factors probably or possibly related to a successful smoking cessation, both individual (e.g. smoking frequency) and collective (e.g. relationship smoking status, anti-tobacco legislation). The case study allowed us to objectify positive or negative factors that influence the enrollment and the participation in the program (e.g. presence of a referent in the school, combination with the school program). Finally, we identified prerequisites to gather before starting such a program. Conclusions This mixt design highlights factors on which we must focus to increase the success of a smoking cessation program for youth. A key factor is to tailor intervention and implementation modalities to the local context. Results enabled us to product a pragmatic guide, TABADO 2, which is now used in a national scaling process. They also will be used to build an intervention theory, which could be used for any smoking cessation intervention for youth. Acknowledgments: The TABADO IDF study group, Inca, the région Lorraine and the ARS Nouvelle-Aquitaine for their financial support. Key messages A smoking cessation program must be a global strategy, considering contextual, population and organizational factors. Instead of trying to strictly apply a protocol, a complex intervention must be tailored to the context in which it is implemented.
Published: 2019

13. Adherence to ESC guideline‐recommended medications over a 36‐month follow‐up period after hospitalization for heart failure: Results from the EPICAL2 cohort study

Author: Sarah Bitar, François Alla, Nathalie Thilly, Alexandre Mebazaa, Patrick Rossignol, Nelly Agrinier, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Université Paris Diderot - Paris 7 (UPD7), Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Plateforme d'Aide à la Recherche Clinique [CHRU Nancy] (PARC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'Epidémiologie Clinique (CIC-EC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Male, associated factors, trajectories of medication prescriptions, medicine.medical_specialty, pharmacoepidemiology, Epidemiology, 030226 pharmacology & pharmacy, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, Pharmacology (medical), heart failure with reduced ejection fraction, 030212 general & internal medicine, Prospective Studies, Medical prescription, Practice Patterns, Physicians', Asthma, Aged, Aged, 80 and over, Heart Failure, COPD, business.industry, Cardiovascular Agents, Stroke Volume, Guideline, Pharmacoepidemiology, medicine.disease, 3. Good health, Europe, Hospitalization, adherence to guideline-recommended medications, Heart failure, Practice Guidelines as Topic, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Guideline Adherence, business, Cohort study, Kidney disease, Follow-Up Studies
Abstract: International audience; PURPOSE: The purpose of the study is to describe the trajectories of oral medication prescriptions in patients with heart failure with reduced ejection fraction (HFrEF) over 3 years after discharge from hospitalization for heart failure. We then evaluated the adherence of these prescriptions to the European Society of Cardiology (ESC) guideline-recommended medications and identified patient characteristics associated with nonadherence.METHODS: We used data from the EPICAL2 cohort study. HFrEF patients who had completed prescriptions at discharge and at 6-month follow-up were included and followed for 36 months. The following medication agents were considered adherent to guidelines: renin-angiotensin system (RAS) blockers [angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin-receptor blocker (ARB)] plus a β-blocker (BB) or RAS blocker plus BB plus mineralocorticoid receptor antagonists (MRAs). The evolution of drug prescriptions and the adherence to ESC guidelines were assessed by using sequence analysis and clustering approaches. Patient characteristics associated with nonadherence were identified by logistic regression analyses.RESULTS: A typology of four therapeutic clusters was obtained, among which two clusters were adherent to recommendations and two were not. The adherent clusters consisted of bitherapy (RAS blockers-BB) and tritherapy (RAS blockers-BB-MRA) for about 64% of patients and remain stable over time. The nonadherent clusters consisted of nonprescription of BB for about 22% of patients or nonprescription of RAS blocker for about 14%. The main reason for nonprescription of BB was a concomitant obstructive airway disease (asthma or COPD) but was a concomitant chronic kidney disease for nonprescription of RAS blocker.CONCLUSION: Adherence to guideline-recommended medications while being hospitalized is of great importance because prescriptions are quite stable over time after discharge. HFrEF patients are most often older, with various comorbidities, such as chronic kidney disease or asthma/COPD, which importantly limit physicians' ability to prescribe recommended drugs, leading to suboptimal adherence to guidelines.
Published: 2019

14. Population health intervention research: the place of theories

Author: Graham, Moore, Linda, Cambon, Susan, Michie, Pierre, Arwidson, Grégory, Ninot, Christine, Ferron, Louise, Potvin, Nadir, Kellou, Julie, Charlesworth, François, Alla, Lehana, Thabane, Department of Crop Genetics, John Innes Centre [Norwich], Université de Bordeaux (UB), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), University College of London [London] (UCL), Institut National de Prévention et d'Education pour la Santé (INPES), Dynamique des capacités humaines et des conduites de santé (EPSYLON), Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UPVM)-Université de Montpellier (UM), Université de Montpellier (UM), Fédération Nationale d'Education et de promotion de la Santé (FNES), Ecole de Santé Publique de l'Université de Montréal, Université de Montréal (UdeM), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Guével, Marie-Renée, and Biotechnology and Biological Sciences Research Council (BBSRC)-Biotechnology and Biological Sciences Research Council (BBSRC)
Subjects: Biomedical Research, Psychological intervention, Medicine (miscellaneous), Social Theory, Population health, complex intervention, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Intervention theory, Pharmacology (medical), 030212 general & internal medicine, Public health policy, intervention research, lcsh:R5-920, Population Health, business.industry, Subject (documents), process evaluation, 3. Good health, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, General partnership, Intervention research, Commentary, Engineering ethics, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Health Services Research, lcsh:Medicine (General), business, 030217 neurology & neurosurgery, Social theory
Abstract: Background:\udAn international workshop on population health intervention research (PHIR) was organized to foster exchanges between experts from different disciplines and different fields. This paper aims to summarize the discussions around some of the issues addressed: (1) the place of theories in PHIR, (2) why theories can be useful, and (3) how to choose and use the most relevant of them in evaluating PHIR.\ud\udMethods:\udThe workshop included formal presentations by participants and moderated discussions. An oral synthesis was produced by a rapporteur to validate, through an expert consensus, the key points of the discussion and the recommendations. All discussions were recorded and have been fully transcribed.\udResults:\udThe following recommendations were generated through a consensus in the workshop discussions: (i) The evaluation of interventions, like their development, could be improved through better use of theory. (ii) The referenced theory and framework must be clarified. (iii) An intervention theory should be developed by a partnership of researchers and practitioners. (iv) More use of social theory is recommended. (v) Frameworks and a common language are helpful in selecting and communicating a theory. (vi) Better reporting of interventions and theories is needed.\ud\udConclusion:\udTheory-driven interventions and evaluations are key in PHIR as they facilitate the understanding of mechanisms of change. There are many challenges in developing the most appropriate theories for interventions and evaluations. With the wealth of information now being generated, this subject is of increasing importance at many levels, including for public health policy. It is, therefore, timely to consider how to build on the experiences of many different disciplines to enable the development of better theories and facilitate evidence-based decisions.
Published: 2019

15. Using surgical risk scores in nonsurgically treated infective endocarditis patients

Author: Xavier Duval, Jean-François Obadia, Vincent Le Moing, Bruno Hoen, Thanh Lecompte, Pierre Tattevin, François Alla, Catherine Chirouze, Andrea Perrotti, François Delahaye, Sidney Chocron, Bernard Iung, Giuseppe Gatti, University of Trieste, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), CIC Hôpital Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Laboratoire Chrono-environnement - CNRS - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), service de maladies infectieuses CHU J Minjoz Besancon, Hôpital Jean Minjoz, Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Département maladies infectieuses et tropicales [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, University hospital of Trieste, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Hospices Civils de Lyon (HCL), CIC epidémiologie clinique/ essais cliniques, Hôpital Bichat - Claude Bernard, Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France, Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), University Hospital , Pointe-à-Pitre, Guadeloupe, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), 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 ), Infectious Diseases Department, University Hospital, Montpellier Cedex 5, France, Dr. Xavier Duval received grants from Pfizer Inc., New York, USA, outside the submitted work., Cholley, Pascal, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), 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 Lyon, CHU Pointe-à-Pitre/Abymes [Guadeloupe], Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, education, 030204 cardiovascular system & hematology, Risk Assessment, Discriminatory power, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Humans, Medicine, Hospital Mortality, 030212 general & internal medicine, Cardiac Surgical Procedures, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Framingham Risk Score, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Endocarditis, Receiver operating characteristic, Medical treatment, business.industry, valvular heart disease, Endocarditis, Bacterial, medicine.disease, Valvular heart disease, Surgical risk, 3. Good health, Cardiac surgery, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Risk factors, lcsh:RC666-701, Infective endocarditis, Quality of care improvement, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Mortality/Survival, Cardiology and Cardiovascular Medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Background: The accuracy of surgical scores in predicting in-hospital mortality for nonsurgically treated patients with infective endocarditis (IE) has not yet been explored.Methods: Patients with definite IE who did not undergo valve surgery were selected from the database of seven French administrative areas (Association pour l'Étude et la Prévention de l'Endocardite Infectieuse [AEPEI] Registry, 2008). The patients were scored using (a) six systems specifically devised to predict in-hospital mortality after surgery for IE, (b) three commonly used risk scores for heart surgery, and (c) a risk score for predicting six-month mortality in IE after either surgery or medical therapy. Calibration (Hosmer-Lemeshow test) and discriminatory power (receiver operating characteristic [ROC] analysis) were assessed for each score. Areas under ROC curves were compared one-to-one (Hanley-McNeil method).Results: A total of 192 patients (mean age, 65.2±15.2 years) were considered for analysis. There were 38 (19.8%) in-hospital deaths. Age >70 years (p=0.001), Staphylococcus aureus as causal agent (p=0.05), and severe sepsis (p=0.027) were independent predictors of in-hospital mortality. Despite many differences in the number and type of variables, all but two of the investigated scores showed good calibration (p>0.66). However, discriminatory power was satisfactory (area under ROC curve >0.70) only for three of the scores specific for IE and two of the scores used to predict mortality after cardiac surgery.Conclusions: Among the 10 surgical scores evaluated in this study, five could be adopted to predict in-hospital mortality even for IE patients receiving medical treatment only.
Published: 2019

16. Possible relationship between antiphospholipid antibodies and embolic events in infective endocarditis

Author: Christine, Selton-Suty, Charles-Henry, Maigrat, Jean, Devignes, François, Goehringer, Marie-Line, Erpelding, François, Alla, Carine, Thivilier, Olivier, Huttin, Clément, Venner, Yves, Juilliere, Thanh, Doco-Lecompte, Thomas, Lecompte, Catherine, Campagnac, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [CHRU Nancy], Service de Cardiologie [Institut Lorrain du Cœur et des Vaisseaux], Service de Cardiologie [CHRU Nancy], Division of Haematology (Div Haemato - GENEVE), and Hôpitaux Universitaires de Genève (HUG)
Subjects: Adult, Male, medicine.medical_specialty, Embolism, 030204 cardiovascular system & hematology, Asymptomatic, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, medicine, Endocarditis, Humans, 030212 general & internal medicine, Platelet activation, Correlation of Data, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Creatinine, business.industry, Middle Aged, medicine.disease, Platelet Activation, stroke, 3. Good health, chemistry, Predictive value of tests, Infective endocarditis, Antibodies, Antiphospholipid, endocarditis, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, medicine.symptom, Cardiology and Cardiovascular Medicine, business, neurologic events
Abstract: ObjectiveAntiphospholipid (aPL) antibodies may activate platelets and contribute to vegetation growth and embolisation in infective endocarditis (IE). We aimed to determine the value of aPL as predictors of embolic events (EE) in IE.MethodsWe studied 186 patients with definite IE (Duke-Li criteria, all types of IE) from the Nanc-IE prospective registry (2007–2012) who all had a frozen blood sample and at least one imaging procedure to detect asymptomatic or confirm symptomatic EE. Anticardiolipin (aCL) and anti-β2-glycoprotein I (β2GPI) antibodies (IgG and IgM) were assessed after the end of patients’ inclusion. The relationship between antibodies and the detection of EE after IE diagnosis were studied with Kaplan-Meier and Cox multivariate analyses.ResultsAt least one EE was detected in 118 (63%) patients (52 cerebral, 95 other locations) after IE diagnosis in 80 (time interval between IE and EE diagnosis: 5.9±11.3 days). At least one aPL antibody was found in 31 patients (17%).Detection of EE over time after IE diagnosis was more frequent among patients with anti-β2GPI IgM (log-rank P=0.0036) and that of cerebral embolisms, among patients with aCL IgM and anti-β2GPI IgM (log-rank P=0.002 and PFactors predictive of EE were anti-β2GPI IgM (HR=3.45 (1.47–8.08), P=0.0045), creatinine (2.74 (1.55–4.84), P=0.0005) and vegetation size (2.41 (1.41–4.12), P=0.0014). Those of cerebral embolism were aCL IgM (2.84 (1.22–6.62), P=0.016) and anti-β2GPI IgM (4.77 (1.79–12.74), P=0.0018).ConclusionThe presence of aCL and anti-β2GPI IgM was associated with EE, particularly cerebral ones, and could contribute to assess the embolic risk of IE.
Published: 2018

17. Transformation of health systems: contribution of population health intervention research

Author: Linda Cambon, François Alla, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département des sciences humaines et sociales (SHS), and Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Promotion de la santé, Prévention, business.industry, Public Health, Environmental and Occupational Health, MEDLINE, Medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Humanities, Hôpital, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2018

18. Élaboration des normes de prévention : une réflexion éthique nécessaire

Author: Victoria Pagani, Linda Cambon, Frédérique Claudot, François Alla, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, CIC Bordeaux, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Plateforme d'Aide à la Recherche Clinique [CHRU Nancy] (PARC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), and Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 03 medical and health sciences, 030505 public health, 0302 clinical medicine, Prévention, Political science, Ethique, Public Health, Environmental and Occupational Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, 0305 other medical science, Humanities, Santé publique, Norme
Abstract: International audience; Introduction : La santé publique tenterait de modifier les normes sociales existantes en mettant en place des stratégies favorisant l’émergence de normes plus propices à son objectif de bonne santé et de bien-être. Les politiques de prévention et les interventions qui en découlent, en s’intéressant aux comportements de santé, chercheraient à modifier les « habitus » des individus et contribueraient à définir de nouvelles manières d’être, d’agir et de vivre. La prévention met ainsi en jeu de nombreuses valeurs personnelles, culturelles, sociétales et collectives. Ces démarches ne peuvent ainsi s’affranchir d’un questionnement éthique sur leur sens, leur bien-fondé et leur justice. L’objectif de cette étude est de caractériser la prise en compte d’une réflexion éthique lors de la création de la norme de santé publique.Méthodes : Pour répondre à l’objectif, une revue narrative a été conduite. Elle a été effectuée à partir de la base de données Web of Science, celle-ci permettant de couvrir des revues des différents champs disciplinaires concernés.Résultats : Trente-quatre publications ont été retenues qui objectivent de nombreuses définitions et types de normes utilisées par la santé publique dans ses stratégies d’intervention. Un grand nombre d’acteurs intervient dans le processus de création d’une norme de santé publique : spécialistes, leaders d’opinion, acteurs sociaux. Enfin, si certaines publications mettent en avant que l’utilisation de la norme en prévention soulève certains questionnements éthiques, aucune publication ne fait référence à la présence d’une réflexion éthique structurée dans ce processus.Conclusion : Les interventions de prévention et les outils utilisés ne peuvent se passer d’une réflexion éthique. Comment faire pour « bien » faire ? Comment gérer les conflits de valeurs ? Ces questionnements sont nécessaires lorsque l’on conduit des politiques ou des programmes et peuvent orienter plus justement leurs stratégies et contribuer à favoriser leur acceptabilité et leur efficacité auprès des populations.
Published: 2018

19. Addressing complexity in population health intervention research: the context/intervention interface

Author: Linda Cambon, Louise Potvin, Laetitia Minary, François Alla, Joëlle Kivits, Université de Montréal (UdeM), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Ecole de Santé Publique [Nancy], Faculté de Médecine [Nancy], Université de Lorraine (UL)-Université de Lorraine (UL), Fondation ARC pour la Recherche sur le Cancer, Ligue Contre le Cancer, Canadian Institutes of Health Research, Institut National Du Cancer, Institut de Recherche en Santé Publique, Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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 ), Université de Montréal [Montréal], Centre d'investigation clinique plurithématique Pierre Drouin ( CIC-P ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lorraine ( UL ), École des Hautes Études en Santé Publique [EHESP] ( EHESP ), Centre de Recherches sur l'Action Politique en Europe ( ARENES ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -Centre National de la Recherche Scientifique ( CNRS ), Université de Lorraine ( UL ) -Université de Lorraine ( UL ), and Kivits, Joëlle
Subjects: Theory and Methods, Knowledge management, Public Health Systems Research, [SHS.SOCIO] Humanities and Social Sciences/Sociology, Epidemiology, Interface (Java), health promotion, Psychological intervention, Context (language use), Population health, 03 medical and health sciences, 0302 clinical medicine, Fuzzy Logic, Intervention (counseling), Humans, Medicine, 030212 general & internal medicine, 030505 public health, [SHS.SOCIO]Humanities and Social Sciences/Sociology, Population Health, Scope (project management), business.industry, public health, Public Health, Environmental and Occupational Health, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, methodology, [ SHS.SOCIO ] Humanities and Social Sciences/Sociology, Identification (information), Health promotion, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 0305 other medical science, business
Abstract: BackgroundPublic health interventions are increasingly being recognised as complex and context dependent. Related to this is the need for a systemic and dynamic conception of interventions that raises the question of delineating the scope and contours of interventions in complex systems. This means identifying which elements belong to the intervention (and therefore participate in its effects and can be transferred), which ones belong to the context and interact with the former to influence results (and therefore must be taken into account when transferring the intervention) and which contextual elements are irrelevant to the intervention.DiscussionThis paper, from which derives criteria based on a network framework, operationalises how the context and intervention systems interact and identify what needs to be replicated as interventions are implemented in different contexts. Representing interventions as networks (composed of human and non-human entities), we introduce the idea that the density of interconnections among the various entities provides a criterion for distinguishing core intervention from intervention context without disconnecting the two systems. This differentiates endogenous and exogenous intervention contexts and the mediators that connect them, which form the fuzzy and constantly changing intervention/context interface.ConclusionWe propose that a network framework representing intervention/context systems constitutes a promising approach for deriving empirical criteria to delineate the scope and contour of what is replicable in an intervention. This approach should allow better identification and description of the entities that have to be transferred to ensure the potential effectiveness of an intervention in a specific context.
Published: 2018

20. Impact of the interruption of a large heart failure regional disease management program on hospital admission rate: a population-based study

Author: Faiez Zannad, François Alla, Nelly Agrinier, Marc Lavielle, Jean-Marc Boivin, Damien Gonthier, Patrick Rossignol, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Modélisation en pharmacologie de population (XPOP), Centre de Mathématiques Appliquées - Ecole Polytechnique (CMAP), École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), École polytechnique (X)-Centre National de la Recherche Scientifique (CNRS), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Faculté de Médecine [Nancy], and Lavielle, Marc
Subjects: Male, medicine.medical_specialty, Regional Disease, Management programme, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, [MATH.MATH-ST]Mathematics [math]/Statistics [math.ST], Humans, Medicine, 030212 general & internal medicine, Program Development, [MATH.MATH-ST] Mathematics [math]/Statistics [math.ST], ComputingMilieux_MISCELLANEOUS, Aged, Heart Failure, business.industry, medicine.disease, Europe, Hospitalization, Population based study, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Population Surveillance, Heart failure, Hospital admission, Emergency medicine, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, Cardiology and Cardiovascular Medicine, business
Abstract: International audience
Published: 2018

21. Staphylococcus aureus CC30 Lineage and Absence of sed,j,r-Harboring Plasmid Predict Embolism in Infective Endocarditis

Author: Jean-Philippe Rasigade, Amélie Leclère, François Alla, Adrien Tessier, Michèle Bes, Catherine Lechiche, Véronique Vernet-Garnier, Cédric Laouénan, François Vandenesch, Catherine Leport, The AEPEI Study Group, B. Hoen, X. Duval, F. Alla, A. Bouvet, S. Briancxon, E. Cambau, M. Celard, C. Chirouze, N. Danchin, T. Doco-Lecompte, F. Delahaye, J. Etienne, B. Iung, V. Le Moing, J. F. Obadia, C. Leport, C. Poyart, M. Revest, C. Selton-Suty, C. Strady, P. Tattevin, F. Vandenesch, Y. Bernard, S. Chocron, P. Plesiat, I. Abouliatim, C. De Place, P. Y. Donnio, J. P. Carteaux, C. Lion, N. Aissa, B. Baehrel, R. Jaussaud, P. Nazeyrollas, V. Vernet, P. Nataf, C. Chidiac, H. Aumaître, J. M. Frappier, E. Oziol, A. Sotto, C. Sportouch, M. Bes, P. Abassade, E. Abrial, C. Acar, J. F. Alexandra, N. Amireche, D. Amrein, P. Andre, M. Appriou, M. A. Arnould, P. Assayag, A. Atoui, F. Aziza, N. Baille, N. Bajolle, P. Battistella, S. Baumard, A. Ben Ali, J. Bertrand, S. Bialek, M. Bois Grosse, M. Boixados, F. Borlot, A. Bouchachi, O. Bouche, S. Bouchemal, J. L. Bourdon, L. Brasme, F. Bricaire, E. Brochet, F. J. Bruntz, A. Cady, J. Cailhol, M. P. Caplan, B. Carette, O. Cartry, C. Cazorla, H. Chamagne, H. Champagne, G. Chanques, J. Chastre, B. Chevalier, F. Chometon, C. Christophe, A. Cohen, N. Colin de Verdiere, V. Daneluzzi, L. David, P. De Lentdecker, V. Delcey, P. Deleuze, E. Donal, B. Deroure, V. Descotes-Genon, K. Didier Petit, A. Dinh, V. Doat, F. Duchene, F. Duhoux, M. Dupont, S. Ederhy, O. Epaulard, M. Evest, J. F. Faucher, B. Fantin, E. Fauveau, T. Ferry, M. Fillod, T. Floch, T. Fraisse, J. M. Frapier, L. Freysz, B. Fumery, B. Gachot, S. Gallien, I. Gandjbach, P. Garcon, A. Gaubert, J. L. Genoud, S. Ghiglione, C. Godreuil, A. Grentzinger, L. Groben, D. Gherissi, P. Gue'ret, A. Hagege, N. Hammoudi, F. Heliot, P. Henry, S. Herson, P. Houriez, L. Hustache-Mathieu, O. Huttin, S. Imbert, S. Jaureguiberry, M. Kaaki, A. Konate, J. M. Kuhn, S. Kural Menasche, A. Lafitte, B. Lafon, F. Lanternier, V. Le Chenault, C. Lechiche, S. Lefèvre-Thibaut, A. Lefort, A. Leguerrier, J. Lemoine, L. Lepage, C. Lepouse', J. Leroy, P. Lesprit, L. Letranchant, D. Loisance, G. Loncar, C. Lorentz, P. Mabo, I. Magnin-Poull, T. May, A. Makinson, H. Man, M. Mansouri, O. Marcxon, J. P. Maroni, V. Masse, F. Maurier, M. C. Meyohas, P. L. Michel, C. Michelet, F. Mechaï, O. Merceron, D. Messika-Zeitoun, Z. Metref, V. Meyssonnier, C. Mezher, S. Micheli, M. Monsigny, S. Mouly, B. Mourvillier, O. Nallet, V. Noel, T. Papo, B. Payet, A. Pelletier, P. Perez, J. S. Petit, F. Philippart, E. Piet, C. Plainvert, B. Popovic, J. M. Porte, P. Pradier, R. Ramadan, J. Richemond, M. Rodermann, M. Roncato, I. Roigt, O. Ruyer, M. Saada, J. Schwartz, M. Simon, B. Simorre, S. Skalli, F. Spatz, J. Sudrial, L. Tartiere, A. Terrier De La Chaise, M. C. Thiercelin, D. Thomas, M. Thomas, L. Toko, F. Tournoux, A. Tristan, J. L. Trouillet, L. Tual, A. Vahanian, F. Verdier, V. Vernet Garnier, V. Vidal, P. Weyne, M. Wolff, A. Wynckel, N. Zannad, P. Y. Zinzius, Pathogénie des Staphylocoques – Staphylococcal Pathogenesis (StaPath), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre National de Reference des Staphylocoques, Université de Lyon, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Service des maladies infectieuses et tropicales, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Entérobactéries Résistance Acquise - EA 4687 (ERA), Université de Reims Champagne-Ardenne (URCA)-SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne (URCA)-Université de Reims Champagne-Ardenne (URCA), Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)
Subjects: 0301 basic medicine, Microbiology (medical), Immunology, lcsh:QR1-502, MRSA, medicine.disease_cause, Staphylococcal infections, Microbiology, lcsh:Microbiology, superantigen, 03 medical and health sciences, plasmid, medicine, Endocarditis, business.industry, infective endocarditis, SCCmec, Odds ratio, medicine.disease, S. aureus, Methicillin-resistant Staphylococcus aureus, stroke, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 3. Good health, 030104 developmental biology, Infectious Diseases, Embolism, Staphylococcus aureus, Infective endocarditis, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, CC30, [SDV.IMM]Life Sciences [q-bio]/Immunology, business, enterotoxin
Abstract: International audience; Staphylococcus aureus induces severe infective endocarditis (IE) where embolic complications are a major cause of death. Risk factors for embolism have been reported such as a younger age or larger IE vegetations, while methicillin resistance conferred by the mecA gene appeared as a protective factor. It is unclear, however, whether embolism is influenced by other S. aureus characteristics such as clonal complex (CC) or virulence pattern. We examined clinical and microbiological predictors of embolism in a prospective multicentric cohort of 98 French patients with monomicrobial S. aureus IE. The genomic contents of causative isolates were characterized using DNA array. To preserve statistical power, genotypic predictors were restricted to CC, secreted virulence factors and virulence regulators. Multivariate regularized logistic regression identified three independent predictors of embolism. Patients at higher risk were younger than the cohort median age of 62.5 y (adjusted odds ratio [OR] 0.14; 95% confidence interval [CI] 0.05-0.36). S. aureus characteristics predicting embolism were a CC30 genetic background (adjusted OR 9.734; 95% CI 1.53-192.8) and the absence of pIB485-like plasmid-borne enterotoxin-encoding genes sed, sej, and ser (sedjr; adjusted OR 0.07; 95% CI 0.004-0.457). CC30 S. aureus has been repeatedly reported to exhibit enhanced fitness in bloodstream infections, which might impact its ability to cause embolism. sedjr-encoded enterotoxins, whose superantigenic activity is unlikely to protect against embolism, possibly acted as a proxy to others genes of the pIB485-like plasmid found in genetically unrelated isolates from mostly embolism-free patients. mecA did not independently predict embolism but was strongly associated with sedjr. This mecA-sedjr association might have driven previous reports of a negative association of mecA and embolism. Collectively, our results suggest that the influence of S. aureus genotypic features on the risk of embolism may be stronger than previously suspected and independent of clinical risk factors.
Published: 2018

22. Transformation of health systems: contribution of population health intervention research

Author: François Alla, Linda Cambon, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, and École des Hautes Études en Santé Publique [EHESP] (EHESP)
Subjects: Research design, Population health intervention, MEDLINE, Health Promotion, Population health, 030204 cardiovascular system & hematology, Transformation (music), Transformation, 03 medical and health sciences, 0302 clinical medicine, Health systems, Nursing, Humans, 030212 general & internal medicine, Population Health, lcsh:Public aspects of medicine, Research, Public Health, Environmental and Occupational Health, Health services research, lcsh:RA1-1270, 3. Good health, Health promotion, Research Design, Intervention research, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Health Services Research, Psychology, Delivery of Health Care, Healthcare system
Abstract: International audience; The growing prevalence of chronic diseases is a major challenge in the sustainability of health systems. There is a need to transform health systems by increasing prevention and by implementating innovative organisations in management of these diseases. This transformation will require development and analysis of research-based and field-based interventions and organisations. Health system transformation also requires the transfer of innovative models into public decisions and practices, and requires these actions to occur across health systems. (Intro.)
Published: 2017

23. Evaluation of a knowledge transfer scheme to improve policy making and practices in health promotion and disease prevention setting in French regions: a realist study protocol

Author: Audrey Petit, François Alla, Jeanine Pommier, Laetitia Minary, Linda Cambon, Christine Ferron, Valéry Ridde, Christian Dagenais, Marion Porcherie, Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), University of Montreal Public Health Research Institute (IRSPUM), Département de médecine sociale et préventive [ESPUM-Montréal] (ESPUM), Université de Montréal (UdeM), Department of Psychology [Montréal], McGill University = Université McGill [Montréal, Canada], Fédération Nationale d'Education et de promotion de la Santé (FNES), 2016 general call for projects – Prevention strand, CAMBON-AAP16-PREV-11., IRESP, and Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Complex intervention, Knowledge transfer, Prevention, Public health, Realist evaluation, medicine.medical_specialty, Health Informatics, Health Promotion, Health informatics, Health administration, Study Protocol, 03 medical and health sciences, 0302 clinical medicine, Nursing, Preventive Health Services, Humans, Medicine, 030212 general & internal medicine, Policy Making, Health policy, lcsh:R5-920, Information Dissemination, business.industry, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, Health services research, General Medicine, Public relations, 3. Good health, Cross-Sectional Studies, Health promotion, Research Design, Health education, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Health Services Research, lcsh:Medicine (General), 0305 other medical science, business
Abstract: International audience; Background - Evidence-based decision-making and practice are pivotal in public health. However, barriers do persist and they relate to evidence properties, organisations and contexts. To address these major knowledge transfer (KT) issues, we need to rethink how knowledge is produced and used, to enhance our understanding of decision-making processes, logics and mechanisms and to examine the ability of public health services to integrate research findings into their decisions and operations. This article presents a realist evaluation protocol to assess a KT scheme in prevention policy and practice at local level in France. Methods/design - This study is a comparative multiple case study, using a realist approach, to assess a KT scheme in regional health agencies (ARS) and regional non-profit organisations for health education and promotion (IREPS), by analysing the configurations contexts/mechanisms/outcomes of it. The KT scheme assessed is designed for the use of six reviews of systematic reviews concerning the following themes: nutrition, alcohol, tobacco smoking, physical activity, emotional and sexual life and psychosocial skills. It combines the following activities: supporting the access to and the adaptation of scientific and usable evidences; strengthening professionals' skills to analyse, adopt and use the evidences in the course of their practices and their decision-making process; facilitating the use of evidence in the organisations and processes. RAMESE II reporting standards for realist evaluations was used. Discussion - The aims of this study are to experiment and characterise the factors related to the scheme's ability to enable public health stakeholders to address the challenges of KT and to integrate scientific knowledge into policy and practice. We will use the realist approach in order to document the parameters of successful KT strategies in the specific contexts of preventive health services in France, while seeking to determine the transferability of such strategies.
Published: 2017

24. Reply to Raoult

Author: Sarah Millot, Bruno Hoen, François Alla, Christine Selton-Suty, D Thomas, Christophe Strady, Vanessa Moby, Pierre Tattevin, Nelly Agrinier, Catherine Chirouze, Edouard Euvrard, Xavier Duval, CIC Hôpital Bichat, AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'Odontologie [CHRU Nancy], Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Médecine Interne, Infectiologie et Pathologie des voyages, Polyclinique Saint André, Centre d'Investigation Clinique CIC-1431, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), CIC 1433 Epidémiologie clinique, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Institut National de la Santé et de la Recherche Médicale ( INSERM ) -UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre de recherche sur l'inflamation - UMR 1149, Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Centre d'Investigation Clinique Antilles-Guyane ( CIC - Antilles Guyane ), CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université des Antilles et de la Guyane ( UAG ), Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique de Besançon (Inserm CIC 1431), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-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), CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale (INSERM)-Université des Antilles et de la Guyane (UAG), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Laboratoire Chrono-environnement (UMR 6249) (LCE), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), 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), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)
Subjects: Microbiology (medical), medicine.medical_specialty, media_common.quotation_subject, [SDV]Life Sciences [q-bio], MEDLINE, Raoult's law, 01 natural sciences, Oral hygiene, Habits, 03 medical and health sciences, 0302 clinical medicine, Hygiene, Humans, Medicine, 030212 general & internal medicine, 0101 mathematics, ComputingMilieux_MISCELLANEOUS, media_common, Endocarditis, [ SDV ] Life Sciences [q-bio], business.industry, 010102 general mathematics, Oral Hygiene, Infectious Diseases, Case-Control Studies, Family medicine, Immunology, business
Abstract: International audience
Published: 2017

25. Prognostic factors associated with 15-year mortality in patients with hospitalized systolic HF: Results of the observational community-based EPICAL cohort study

Author: Faiez Zannad, Jean-Pierre Villemot, François Alla, Nelly Agrinier, Nathalie Thilly, Serge Briançon, Paul-Michel Mertes, Yves Juillière, CIC 1433 Epidémiologie clinique, Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Université Paris Descartes - Paris 5 (UPD5), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), Nouvel Hôpital Civil, Hospices Civils de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Service de Chirurgie Cardio-vasculaire [CHRU Nancy], EPICAL, Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)
Subjects: Male, Survival rate, Time Factors, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Severity of Illness Index, Cohort Studies, 0302 clinical medicine, Cause of Death, 030212 general & internal medicine, Prospective Studies, Survivors, Prospective cohort study, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Ejection fraction, Age Factors, Middle Aged, Prognosis, 3. Good health, Hospitalization, Female, France, Cardiology and Cardiovascular Medicine, Cohort study, medicine.medical_specialty, Population, Heart failure, Prognostic factors, Risk Assessment, 03 medical and health sciences, Sex Factors, Predictive Value of Tests, Internal medicine, medicine, Humans, education, Aged, Proportional Hazards Models, Proportional hazards model, business.industry, medicine.disease, Comorbidity, Survival Analysis, Multivariate Analysis, Physical therapy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Heart Failure, Systolic
Abstract: Aims Little data on very long-term survival and associated prognostic factors in heart failure (HF) are available. The aim was to describe 15-year survival and to identify the baseline prognostic factors associated with mortality in a community-based sample of patients hospitalized for systolic HF. Methods Vital status was collected 15years after inclusion of 352 patients hospitalized for systolic HF born in France from the prospective cohort EPICAL. The prognostic value of baseline socioeconomic, clinical and biological characteristics on 15-year mortality was assessed using Cox models. Results The mean (±SD) age was 63.9 (±10.8)years, 76% of the patients were male, median left ventricular ejection fraction (LVEF) was 23% IR [18–27]. Overall, the mean (±SD) follow-up was 1826 (±111)days. A total of 290 (82.4%) deaths and 22 heart transplantations occurred during the follow-up. The 15-year survival rate was 13.2% (95% CI [9.0–16.3]), i.e. 4.7 times lower than the one observed in the general population. Baseline characteristics associated with 15-year mortality were: age older than 65years (HR=1.48, CI 95% [1.15–1.90]), diabetes mellitus (1.31 [1.00–1.72]), chronic kidney disease (1.73 [1.23–2.43]), serious comorbidity (1.29 [1.02–1.64]), time from first HF diagnosis exceeding 1year at inclusion (1.68 [1.26–2.24]), HF hospitalization during the previous 12months (1.36 [1.04–1.78]), heart rate higher than 110 beats per minute (1.87 [1.26–2.76]), LVEF % (0.88 per quartile increase [0.80–1.98]), and serum sodium below 130mmol/L (3.14 [1.76–5.61]. Conclusions Only 13% of patients hospitalized for HF survived at 15years. The usual mid-term prognostic factors are also predictive of very long-term survival.
Published: 2017

26. Time interval between infective endocarditis first symptoms and diagnosis: relationship to infective endocarditis characteristics, microorganisms and prognosis

Author: Xavier Duval, Bruno Hoen, Coralie Bouchiat, François Alla, Christine Selton-Suty, François Delahaye, Marie-Line Erpelding, Yohan Nguyen, Matthieu Saada, Matthieu Revest, Christophe Strady, Catherine Chirouze, Service de Médecine interne, Maladies Infectieuses et Immunologie Clinique [Reims], Centre Hospitalier Universitaire de Reims (CHU Reims), Service de médecine interne [CHU Reims], CIC Hôpital Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service des maladies infectieuses et réanimation médicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service des maladies infectieuses et tropicales [CH Perpignan 20], Centre Hospitalier Saint Jean de Perpignan, Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHRU Nancy], Centre National de Reference des Staphylocoques, Université de Lyon, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Polyclinique Saint André, Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Université des Antilles - UFR des sciences médicales Hyacinthe Bastaraud (UA UFR SM), Université des Antilles (UA), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], and CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale (INSERM)-Université des Antilles et de la Guyane (UAG)
Subjects: Male, Time Factors, Valve surgery, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, 0302 clinical medicine, Epidemiology, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Stroke, ComputingMilieux_MISCELLANEOUS, education.field_of_study, Endocarditis, Mortality rate, acute, General Medicine, Middle Aged, Staphylococcal Infections, Surgical Instruments, stroke, 3. Good health, Cardiac surgery, chronic, Heart Valve Prosthesis, Infective endocarditis, Female, France, cardiac surgery, Staphylococcus aureus, medicine.medical_specialty, Population, 03 medical and health sciences, Internal medicine, medicine, Humans, education, Aged, business.industry, Septic shock, Endocarditis, Bacterial, medicine.disease, mortality, Surgery, Early Diagnosis, septic shock, prognosis, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; OBJECTIVE: To analyze the characteristics and outcome of infective endocarditis (IE) according to the time interval between IE first symptoms and diagnosis.METHODS: Among the IE cases of a French population-based epidemiological survey, patients having early-diagnosed IE (diagnosis of IE within 1 month of first symptoms) were compared with those having late-diagnosed IE (diagnosis of IE more than 1 month after first symptoms).RESULTS: Among the 486 definite-IE, 124 (25%) had late-diagnosed IE whereas others had early-diagnosed IE. Early-diagnosed IE were independently associated with female gender (OR = 1.8; 95% CI [1.0-3.0]), prosthetic valve (OR= 2.6; 95% CI [1.4-5.0]) and staphylococci as causative pathogen (OR = 3.7; 95% CI [2.2-6.2]). Cardiac surgery theoretical indication rates were not different between early and late-diagnosed IE (56.3% vs 58.9%), whereas valve surgery performance was lower in early-diagnosed IE (41% vs 53%; p = .03). In-hospital mortality rates were higher in early-diagnosed IE than in late-diagnosed IE (25.1% vs 16.1%; p
Published: 2016

27. Factors associated with 12 week case-fatality in Staphylococcus aureus bacteraemia: a prospective cohort study

Author: P. Braquet, F. Alla, C. Cornu, F. Goehringer, L. Piroth, C. Chirouze, M. Revest, C. Lechiche, X. Duval, V. Le Moing, Catherine Chirouze, Elodie Curlier, Cécile Descottes-Genon, Bruno Hoen, Isabelle Patry, Lucie Vettoretti, Pascal Chavanet, Jean-Christophe Eicher, Marie-Christine Greusard, Catherine Neuwirth, André Péchinot, Lionel Piroth, Marie Célard, Catherine Cornu, François Delahaye, Malika Hadid, Pascale Rausch, Audrey Coma, Florence Galtier, Philippe Géraud, Hélène Jean-Pierre, Vincent Le Moing, Catherine Sportouch, Jacques Reynes, Nejla Aissa, Thanh Doco-Lecompte, François Goehringer, Nathalie Keil, Lorraine Letranchant, Hepher Malela, Thierry May, Christine Selton-Suty, Nathalie Bedos, Jean-Philippe Lavigne, Catherine Lechiche, Albert Sotto, Xavier Duval, Emila Ilic Habensus, Bernard Iung, Catherine Leport, Pascale Longuet, Raymond Ruimy, Eric Bellissant, Pierre-Yves Donnio, Fabienne Le Gac, Christian Michelet, Matthieu Revest, Pierre Tattevin, Elise Thebault, François Alla, Pierre Braquet, Marie-Line Erpelding, Laetitia Minary, Michèle Bès, Jérôme Etienne, Anne Tristan, François Vandenesch, Alex Van Belkum, Willem Vanwamel, CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), CIC CHU Lyon (inserm), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département d'infectiologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Agroécologie [Dijon], Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Fonction, structure et inactivation d'ARN bactériens, 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 ), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERA CIC, Hôpital Bichat - Claude Bernard, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Recherches Translationnelles sur le VIH et les maladies infectieuses ( TransVIHMI ), Université de Montpellier ( UM ) -Universtié Yaoundé 1 [Cameroun]-Université Cheikh Anta Diop ( UCAD ) -Université Montpellier 1 ( UM1 ) -Institut de Recherche pour le Développement ( IRD ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre d'Investigation Clinique - Innovation Technologique ( CIC-IT ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Laboratoire de Biométrie et Biologie Evolutive ( LBBE ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Centre National de la Recherche Scientifique ( CNRS ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Institut National de la Recherche Agronomique ( INRA ) -Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, 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 ), Service des maladies infectieuses et réanimation médicale, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, 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 ), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), 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), 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 ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Centre d'Investigation Clinique - Innovation Technologique (CIC-IT), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), and Jonchère, Laurent
Subjects: 0301 basic medicine, Microbiology (medical), Male, medicine.medical_specialty, Staphylococcus aureus, medicine.drug_class, 030106 microbiology, Antibiotics, Bacteremia, Penicillins, Prognostic factors, Tertiary Care Centers, 03 medical and health sciences, Interquartile range, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Vancomycin, Internal medicine, Case fatality rate, medicine, Humans, Blood culture, Prospective Studies, Prospective cohort study, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Aged, Antistaphylococcal penicillins, Cross Infection, medicine.diagnostic_test, business.industry, Septic shock, General Medicine, Middle Aged, Staphylococcal Infections, medicine.disease, Prognosis, Survival Analysis, 3. Good health, Surgery, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Bacteraemia, Antistaphylococcal penicillin, Female, France, business, medicine.drug
Abstract: International audience; Staphylococcus aureus bacteraemia (SAB) is a frequent and deadly disease. Given the lack of a randomized trial, optimal first-line antibiotic treatment is still debated. Our aim was to identify prognostic factors in SAB patients and to analyse the impact of first-line antibiotics. The VIRSTA prospective cohort study was conducted in eight tertiary care centres in France. Consecutive incident adults in whom a blood culture drawn in participating centres grew S. aureus between April 2009 and October 2011 were prospectively followed for 12 weeks. Factors associated with 12-week case-fatality were identified by multivariate logistic regression. We enrolled 2091 patients and analysed survival in 1972 (median age 67.8 years, interquartile range 55.5–78.9; females 692/1972, 35.1%). SAB was nosocomial or healthcare-related in 1372/1972 (69.6%) of cases and the primary focus was unknown in 414/1972 (21.0%) of cases. Week 12 case-fatality rate was 671/1972 (34.0%). The main independent prognostic factors on multivariate analysis were age (adjusted OR by 10-year increment 1.56; 95% CI 1.44–1.69), septic shock (OR 5.11; 95% CI 3.84–6.80), metastatic cancer (OR 4.28; 95% CI 2.88–6.38), and unknown primary focus (OR 2.62; 95% CI 2.02–3.41). In the 1538 patients with methicillin-sensitive S. aureus (MSSA) bacteraemia, first-line empiric antistaphylococcal penicillins (OR 0.40; 95% CI 0.17–0.95) and vancomycin (OR 0.37; 95% CI 0.17–0.83), alone or combined with an aminoglycoside, were associated with better outcome compared with other antibiotics. There are few modifiable prognostic factors for SAB. Initiating empiric antibiotics with antistaphylococcal penicillins or vancomycin may be associated with better outcome in MSSA bacteraemia. © 2016 European Society of Clinical Microbiology and Infectious Diseases
Published: 2016

28. The VIRSTA score, a prediction score to estimate risk of infective endocarditis and determine priority for echocardiography in patients with Staphylococcus aureus bacteremia

Author: Pierre Tattevin, Vincent Le Moing, Jean-Philippe Lavigne, Xavier Duval, Bruno Hoen, François Alla, François Vandenesch, Marie-Line Erpelding, Bernard Iung, Lionel Piroth, Catherine Chirouze, François Delahaye, Christine Selton-Suty, Sarah Tubiana, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), CIC Hôpital Bichat, AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), 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), Service des maladies infectieuses et réanimation médicale, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Fonction, structure et inactivation d'ARN bactériens, 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 ), Hopital Cardio-Thoracique et Vasculaire Louis Pradel, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Département d'infectiologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Agroécologie [Dijon], Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Virulence bactérienne et maladies infectieuses (VBMI), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU de Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Programme hospitalier de Recherche clinique (PHRC, French ministry of Health) and Inserm., Cholley, Pascal, Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], 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 ), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), 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 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, 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 ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Institut National de la Recherche Agronomique ( INRA ) -Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Virulence bactérienne et maladies infectieuses, Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre International de Recherche en Infectiologie ( CIRI ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-École normale supérieure - Lyon ( ENS Lyon ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, medicine.medical_treatment, Bacteremia, Hospitals, University, 0302 clinical medicine, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Interquartile range, Vertebral osteomyelitis, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Child, biology, Endocarditis, Heart, Middle Aged, Staphylococcal Infections, Implantable cardioverter-defibrillator, 3. Good health, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Echocardiography, Infective endocarditis, Child, Preschool, Prognostic score, France, Meningitis, VIRSTA score, Microbiology (medical), Adult, medicine.medical_specialty, Staphylococcus aureus, Adolescent, 030106 microbiology, Risk Assessment, Decision Support Techniques, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Humans, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, Aged, business.industry, C-reactive protein, medicine.disease, Confidence interval, Surgery, biology.protein, Staphylococcus aureus bacteremia, business
Abstract: International audience; Objectives - To develop and validate a prediction score, to quantify, within 48 h of Staphylococcus aureus bacteremia (SAB) diagnosis, the risk of IE, and therefore determine priority for urgent echocardiography. Methods - Consecutive adult patients with SAB in 8 French university hospitals between 2009 and 2011 were prospectively enrolled and followed-up 3 months. A predictive model was developed and internally validated using bootstrap procedures. Results - Among the 2008 patients enrolled, 221 (11.0%) had definite IE of whom 39 (17.6%) underwent valve surgery, 25% of them within 6 days of SAB diagnosis. Ten predictors independently associated with IE were used to build up the prediction score: intracardiac device or previous IE, native valve disease, intravenous drug use, community or non-nosocomial-acquisition, cerebral or extracerebral emboli, vertebral osteomyelitis, severe sepsis, meningitis, C-reactive protein above 190 mg/L, and H48-persistent bacteremia. Patients with a score ≤2 (n = 792, 39.4%) were at low IE-risk (1.1%; negative predictive value: 98.8% (95% CI, 98.4-99.4)) compared to those ≥3 who were at higher risk (17.4%). Conclusions - Physicians must be strongly encouraged to urgently perform echocardiography in SAB patients with a score ≥3 to establish IE diagnosis, to orient antimicrobial therapy and to help determine the need for valvular surgery.
Published: 2016

29. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices

Author: Thanh Doco-Lecompte, Sidney Chocron, Claire Poyart, Emmanuelle Cambau, Catherine Chirouze, Jean-François Obadia, Vincent Le Moing, Pierre Tattevin, Bruno Hoen, Christophe Strady, F. Delahaye, Xavier Duval, François Alla, Bernard Iung, Service de cardiologie [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité, Hôpitaux Universitaires de Genève (HUG), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Médecine Interne, Infectiologie et Pathologie des voyages, Polyclinique Saint André, Hopital Cardio-Thoracique et Vasculaire Louis Pradel, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre national de Référence des Streptocoques (CNR), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Barrières et Pathogènes (équipe FRM (Fondation pour la Recherche Médicale)), [Institut Cochin] Departement Infection, immunité, inflammation, Centre National de la Recherche Scientifique (CNRS)-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 Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Cochin (IC UM3 (UMR 8104 / U1016)), Centre National de la Recherche Scientifique (CNRS)-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 Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Fonction, structure et inactivation d'ARN bactériens, 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 ), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Service de chirurgie cardiaque, Hospices Civils de Lyon (HCL)-Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), CIC Hôpital Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale (INSERM)-Université des Antilles et de la Guyane (UAG), French Ministry of Health, Société Française de Cardiologie, the European Society of Clinical Microbiology and Infectious Diseases, Novartis Laboratories, Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) ( PCVP / CARDIO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université de Franche-Comté ( UFC ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), VIH/SIDA et maladies associées, Université Montpellier 1 ( UM1 ), Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP), Barrières et Pathogènes ( équipe FRM (Fondation pour la Recherche Médicale) ), 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 Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut Cochin ( UM3 (UMR 8104 / U1016) ), 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 Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] ( Pôle S2R ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 ( UPD7 ), Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, 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 ), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Hospices Civils de Lyon ( HCL ) -Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon ( HCL ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre d'Investigation Clinique Antilles-Guyane ( CIC - Antilles Guyane ), CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université des Antilles et de la Guyane ( UAG ), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), 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 Descartes - Paris 5 (UPD5)-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)-Centre National de la Recherche Scientifique (CNRS)-Institut Cochin (IC UM3 (UMR 8104 / U1016)), 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 Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), 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 ), Laboratoire Chrono-environnement (UMR 6249) (LCE), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ), Université des Antilles et de la Guyane ( UAG ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, and AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], Embolism, Population, 030204 cardiovascular system & hematology, Guidelines, 03 medical and health sciences, Cardiologists, 0302 clinical medicine, Pregnancy, Internal medicine, Humans, Medicine, Endocarditis, In patient, Acute infective endocarditis, Prospective Studies, 030212 general & internal medicine, Cardiac Surgical Procedures, Practice Patterns, Physicians', education, Contraindication, Societies, Medical, Heart Failure, education.field_of_study, Valvular surgery, [ SDV ] Life Sciences [q-bio], business.industry, Patient Selection, Endocarditis, Bacterial, Middle Aged, medicine.disease, 3. Good health, Cardiac surgery, Europe, Cardiac Surgery procedures, Infective endocarditis, Acute Disease, Practice Guidelines as Topic, Cardiology, Female, Guideline Adherence, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; AIMS: Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well known. We analysed the agreement between the patient's attending physicians and European Society of Cardiology guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had an indication. METHODS AND RESULTS: From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and (ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate between attending physicians and guidelines (kappa 0.41-0.59) and between indication according to guidelines and the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite indication, contraindication to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year survival was 76% in patients with indication and surgery performed (n = 131), 69% in patients without indication and no surgery (n = 74), 56% in patients with identified indication and contraindication to surgery (n = 42), and 60% in patients with no identified indication (n = 48; P = 0.059). CONCLUSION: Cardiac surgery during acute IE was recommended in almost three out of four patients, although fewer than half were actually operated. Indication was not acknowledged by the attending physicians in one out of six patients
Published: 2016

30. The Best Use of the Charlson Comorbidity Index With Electronic Health Care Database to Predict Mortality

Author: Pierre-Olivier Blotière, Christophe Chaignot, Aurélie Bannay, François Alla, Alain Weill, Philippe Ricordeau, Mickael Basson, Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)-Institut National de Recherche en Informatique et en Automatique (Inria), Faculté de Médecine [Nancy], Université de Lorraine (UL), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), K team (Data Science, Knowledge, Reasoning and Engineering), Department of Natural Language Processing & Knowledge Discovery (LORIA - NLPKD), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), and Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, Insurance Claim Review, Charlson index, MESH: Comorbidity, Comorbidity, 0302 clinical medicine, Administrative database, Health care, Electronic Health Records, 030212 general & internal medicine, MESH: Electronic Health Records, MESH: Aged, MESH: Middle Aged, Middle Aged, Prognosis, 3. Good health, MESH: International Classification of Diseases, 030220 oncology & carcinogenesis, Female, Risk Adjustment, France, Adult, medicine.medical_specialty, MEDLINE, MESH: Prognosis, 03 medical and health sciences, International Classification of Diseases, health services administration, medicine, Humans, Mortality, MESH: Insurance Claim Review, MESH: Risk Adjustment, Aged, MESH: Humans, MESH: Mortality, business.industry, Public Health, Environmental and Occupational Health, MESH: Adult, Risk adjustment, medicine.disease, MESH: Male, MESH: France, Charlson comorbidity index, Emergency medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract: International audience; BACKGROUND:The most used score to measure comorbidity is the Charlson index. Its application to a health care administrative database including International Classification of Diseases, 10th edition (ICD-10) codes, medical procedures, and medication required studying its properties on survival. Our objectives were to adapt the Charlson comorbidity index to the French National Health Insurance database to predict 1-year mortality of discharged patients and to compare discrimination and calibration of different versions of the Charlson index.METHODS:Our cohort included all adults discharged from a hospital stay in France in 2010 registered in the French National Health Insurance general scheme. The pathologies of the Charlson index were identified through ICD-10 codes of discharge diagnoses and long-term disease, specific medical procedures, and reimbursement of specific medications in the past 12 months before inclusion.RESULTS:We included 6,602,641 subjects at the date of their first discharge from medical, surgical, or obstetrical department in 2010. One-year survival was 94.88%, decreasing from 98.41% for Charlson index of 0-71.64% for Charlson index of ≥5. With a discrimination of 0.91 and an appropriate calibration curve, we retained the crude Cox model including the age-adjusted Charlson index as a 4-level score.CONCLUSIONS:Our study is the first to adapt the Charlson index to a large health care database including >6 million of inpatients. When mortality is the outcome, we recommended using the age-adjusted Charlson index as 4-level score to take into account comorbidities.
Published: 2016

31. Evaluating complex interventions: Perspectives and issues for health behaviour change interventions

Author: François Alla, Laetitia Minary, Joëlle Kivits, Cyril Tarquinio, Joël Coste, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Laboratoire de Psychologie, UFR Lettre et Sciences Humaines, Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Ecole de Santé Publique [Nancy], Faculté de Médecine [Nancy], Université de Lorraine (UL)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Equipe de Recherche en Signal et Imagerie Medicale (ERIM-ERI 14), Université d'Auvergne - Clermont-Ferrand I (UdA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Université de Lorraine ( UL ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Equipe de Recherche en Signal et Imagerie Medicale ( ERIM-ERI 14 ), and Université d'Auvergne - Clermont-Ferrand I ( UdA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )
Subjects: Psychotherapist, bias, health promotion, Health Behavior, Applied psychology, Psychological intervention, [SHS.PSY]Humanities and Social Sciences/Psychology, Context (language use), psychology, law.invention, evaluation studies, Randomized controlled trial, complex interventions, law, Multidisciplinary approach, health education, Humans, Applied Psychology, ComputingMilieux_MISCELLANEOUS, Randomized Controlled Trials as Topic, [SHS.SOCIO]Humanities and Social Sciences/Sociology, public health, Public Health, Environmental and Occupational Health, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, General Chemistry, [ SHS.SOCIO ] Humanities and Social Sciences/Sociology, 3. Good health, behaviour, Clinical trial, Health promotion, Health education, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Psychology, randomised controlled trial, Program Evaluation, Patient education
Abstract: International audience; Objective: Health behaviour change interventions (HBCIs), used in health education, health promotion, patient education and psychotherapy areas, are considered complex interventions. The objective of this article is to discuss the value and limitations of using randomised clinical trials (RCTs) to asses HBCIs. Methods: A scoping review of the literature was conducted to identify the main challenges of using RCTs for evaluating HBCIs. The issues were illustrated by case studies selected from research conducted by our multidisciplinary team. Results: In complex interventions, effects are produced not only by the intervention , but are strongly linked to context. Issues relating to transferability of results are therefore critical, and require adjustments to the RCT model. Sampling bias, biases related to the experimental conditions and biases due to the absence of double-blindness were examined and illustrated by case studies. Conclusion: The results underline the importance of a multidisciplinary approach. They call for adapted or alternative evaluation models that overcome the limitations of RCTs.
Published: 2015

32. Staphylococcus aureus Bloodstream Infection and Endocarditis―A Prospective Cohort Study

Author: Vincent Le Moing, François Alla, Thanh Doco-Lecompte, François Delahaye, Lionel Piroth, Catherine Chirouze, Pierre Tattevin, Jean-Philippe Lavigne, Marie-Line Erpelding, Bruno Hoen, François Vandenesch, Xavier Duval, VIRSTA study group, CHU de Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hopital Cardio-Thoracique et Vasculaire Louis Pradel, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Département d'infectiologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Agroécologie [Dijon], Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Fonction, structure et inactivation d'ARN bactériens, 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 ), Virulence bactérienne et maladies infectieuses (VBMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Pathogénie des Staphylocoques – Staphylococcal Pathogenesis (StaPath), Centre International de Recherche en Infectiologie - UMR (CIRI), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Centre National de Reference des Staphylocoques, Université de Lyon, Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), CIC Hôpital Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire Chrono-environnement (UMR 6249) (LCE), 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 ), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Institut National de la Recherche Agronomique ( INRA ) -Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, 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 ), Virulence bactérienne et maladies infectieuses, Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre International de Recherche en Infectiologie ( CIRI ), École normale supérieure - Lyon ( ENS Lyon ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Jonchère, Laurent, École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, and Pathogénie des Staphylocoques – Staphylococcal Pathogenesis
Subjects: Adult, Male, Staphylococcus aureus, lcsh:Medicine, Bacteremia, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Pneumonia, Staphylococcal, 80 and over, Humans, Prospective Studies, Hospital Mortality, lcsh:Science, Aged, Aged, 80 and over, Endocarditis, lcsh:R, Bacterial, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Endocarditis, Bacterial, Pneumonia, Middle Aged, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Staphylococcal, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, lcsh:Q, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Research Article
Abstract: Equipe CHU UB (EA) Pôle MERS CT3 Hors Enjeu The VIRSTA Study Group : Clinical centres: Besançon: Catherine Chirouze, Elodie Curlier, Cécile Descottes-Genon, Bruno Hoen, Isabelle Patry, Lucie Vettoretti. Dijon: Pascal Chavanet, Jean-Christophe Eicher, Sandrine Gohier-Treuvelot, Marie-Christine Greusard, Catherine Neuwirth, André Péchinot, Lionel Piroth. Lyon: Marie Célard, Catherine Cornu, François Delahaye, Malika Hadid, Pascale Rausch. Montpellier: Audrey Coma, Florence Galtier, Philippe Géraud, Hélène Jean-Pierre, Vincent Le Moing, Catherine Sportouch, Jacques Reynes. Nancy: Nejla Aissa, Thanh Doco- Lecompte, François Goehringer, Nathalie Keil, Lorraine Letranchant, Hepher Malela, Thierry May, Christine Selton-Suty. Nîmes: Nathalie Bedos, Jean-Philippe Lavigne, Catherine Lechiche, Albert Sotto. Paris: Xavier Duval, Emila Ilic Habensus, Bernard Iung, Catherine Leport, Pascale Longuet, Raymond Ruimy. Rennes: Eric Bellissant, Pierre-Yves Donnio, Fabienne Le Gac, Christian Michelet, Matthieu Revest, Pierre Tattevin, Elise Thebault. Coordination and statistical analyses: François Alla, Pierre Braquet, Marie-Line Erpelding, Laetitia Minary, Sarah Tubiana. Centre National de Référence des staphylocoques: Michèle Bès, Jérôme Etienne, Anne Tristan, François Vandenesch. Sponsor CHU de Montpellier: Sandrine Barbas, Christine Delonca, Virginie Sussmuth, Anne Verchère. Alain Makinson reviewed the manuscript for English correctness.; International audience; OBJECTIVES: To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).METHODS: All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France. RESULTS: SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).CONCLUSION: SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions
Published: 2015

33. Intervention research in public health. Methodological and legal aspects of collective interventions

Author: François Alla, Laetitia Minary, Frédérique Claudot, 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 ), Centre d'Epidémiologie Clinique ( CIC-EC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] ( Pôle S2R ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Pratiques professionnelles : aspects méthodologiques, éthiques et juridiques ( ETHOS ), Université de Lorraine ( UL ), Service de Médecine légale et de Droit de la Santé, Faculté de Médecine [Nancy], Université de Lorraine ( UL ) -Université de Lorraine ( UL ), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Epidémiologie Clinique (CIC-EC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Pratiques professionnelles : aspects méthodologiques, éthiques et juridiques (ETHOS), Université de Lorraine (UL), Université de Lorraine (UL)-Université de Lorraine (UL), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), and Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: MESH: Humans, business.industry, MESH: Biomedical Research, MESH : Humans, MESH : Public Health, Library science, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, 030204 cardiovascular system & hematology, 16. Peace & justice, MESH: France, 03 medical and health sciences, 0302 clinical medicine, MESH : Informed Consent, MESH: Informed Consent, Medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, business, MESH: Public Health, MESH : France, MESH : Biomedical Research, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2014

34. Relationships between sex, early valve surgery and mortality in patients with left-sided infective endocarditis analysed in a population-based cohort study

Author: Xavier Duval, François Alla, Christine Selton-Suty, Bruno Hoen, Laetitia Minary, Lucile Schubel, Thanh Doco-Lecompte, Catherine Chirouze, Elodie Curlier, Marie-Line Erpelding, CHU Pointe-à-Pitre/Abymes [Guadeloupe], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERA CIC, Hôpital Bichat - Claude Bernard, Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université de Lorraine ( UL ) -Université Paris Descartes - Paris 5 ( UPD5 ), Laboratoire Chrono-environnement ( LCE ), and Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC )
Subjects: Male, Time Factors, MESH : Retrospective Studies, Heart Valve Diseases, Logistic regression, MESH: Risk Assessment, MESH: Proportional Hazards Models, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Epidemiology, MESH : Population Surveillance, Medicine, MESH : Female, Hospital Mortality, MESH : Heart Valve Prosthesis Implantation, MESH : Endocarditis, Bacterial, MESH : Risk Assessment, MESH : Sex Distribution, Heart Valve Prosthesis Implantation, education.field_of_study, MESH : Prognosis, MESH: Middle Aged, MESH: Sex Distribution, MESH: Follow-Up Studies, Middle Aged, Prognosis, MESH : Survival Rate, MESH : Heart Valve Diseases, Survival Rate, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Aortic Valve, Population Surveillance, Infective endocarditis, MESH : Aortic Valve, Population study, Female, France, Cardiology and Cardiovascular Medicine, MESH : Time Factors, MESH: Heart Valve Prosthesis Implantation, medicine.medical_specialty, MESH: Survival Rate, MESH : Sex Factors, MESH : Male, Population, Risk Assessment, MESH: Prognosis, MESH: Population Surveillance, MESH : Hospital Mortality, Sex Factors, MESH: Sex Factors, Internal medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Humans, Endocarditis, MESH : Middle Aged, MESH: Endocarditis, Bacterial, MESH: Hospital Mortality, Sex Distribution, education, MESH : France, Proportional Hazards Models, Retrospective Studies, MESH: Humans, business.industry, Proportional hazards model, MESH : Humans, MESH: Time Factors, Retrospective cohort study, MESH : Follow-Up Studies, MESH: Retrospective Studies, Endocarditis, Bacterial, MESH: Heart Valve Diseases, medicine.disease, MESH : Proportional Hazards Models, MESH: Male, Surgery, MESH: France, business, MESH: Aortic Valve, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract: Objective Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE. Methods Demographic and baseline characteristics, complications and outcome were compared in men and women with Duke-definite left-sided IE. A propensity model for EVS was constructed using multivariate logistic regression. Factors associated with 1-year mortality were identified using multivariate Cox models adjusted for EVS factors. Results The study population included 466 (75%) men and 154 (25%) women. Compared with men, women were older (p=0.005), were more often on haemodialysis (p=0.04), more often had a mitral valve IE (50.0% vs 35.8%, p=0.02), less often developed a septic shock (p=0.05), less often underwent EVS (p=0.001) yet had comparable inhospital mortality rates (20.1% vs 20.0%, p=0.96) and similar 1-year survival probability (logrank p=0.68). Female sex was neither associated with EVS (OR 0.76 (95% CI 0.49 to 1.16)) nor mortality (HR 1.17 (95% CI 0.80 to 1.69)). However EVS was associated with an increased risk of death in women in the early postoperative period (HR 8.72 (95% CI 3.42 to 22.24), p= Conclusions Women underwent EVS less often than men. However female sex was independently associated with neither EVS nor 1-year mortality. The reasons for a higher risk of early postoperative mortality in women must still be elucidated.
Published: 2014

35. Socioeconomic factors and mortality in diastolic heart failure

Author: Nathalie Thilly, Yves Juillière, François Alla, Matthieu Schockmel, Jean-Christophe Eicher, Nicolas Danchin, Nelly Agrinier, Justine Druelle, Patrice Coulon, Patrick Jourdain, Geneviève Mulak, Centre d'Epidémiologie Clinique ( CIC-EC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), 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 ), Centre Hospitalier René Dubos [Pontoise], Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre Hospitalier de Sarrebourg Saint-Nicolas et Hoff ( CH Sarrebourg ), CHU Saint-Antoine [APHP], Société française de cardiologie, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Centre d'Epidémiologie Clinique (CIC-EC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier de Sarrebourg Saint-Nicolas et Hoff (CH Sarrebourg), Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)
Subjects: Male, heart failure with preserved ejection fraction, medicine.medical_specialty, Clinical Biochemistry, Biochemistry, Cohort Studies, Internal medicine, medicine, cohort study, Humans, Intensive care medicine, Aged, Heart Failure, Diastolic, Ejection fraction, Proportional hazards model, business.industry, Confounding, Diastolic heart failure, Activities of daily living, living alone, Single Person, Stroke Volume, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, medicine.disease, 3. Good health, all‐cause mortality, Socioeconomic Factors, Heart failure, Cohort, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Heart failure with preserved ejection fraction, business, Cohort study
Abstract: Background Mortality in patients with heart failure with preserved ejection fraction (HFPEF) has remained stable over recent decades. Few studies have explored prognostic characteristics specifically in HFPEF, and none of them has assessed the potential impact of socioeconomic factors. We aimed to evaluate the impact of socioeconomic factors on all-cause and cardiovascular mortality in HFPEF patients. Materials and methods We used data from the French ODIN cohort. All patients with heart failure and a left ventricular ejection fraction (LVEF) > 45%, included in ODIN between July 2007 and July 2010, were eligible here. Socioeconomic, demographic, clinical, biological and therapeutic data were collected at inclusion. The endpoints were all-cause and cardiovascular mortality between inclusion and 30 September 2011. The impact of patient socioeconomic characteristics on mortality was assessed using Cox regression models. Results Of 575 HFPEF patients considered, 58·6% were male; their mean age was 71·1 ± 13·5 years, and their mean LVEF was 58·1 ± 8·5%. After adjustment for confounders, living alone and limitations on activities of daily living were associated with all-cause mortality [HR = 1·77, 95%CI(1·11–2·81) and 2·61(1·35–5·03), respectively] and cardiovascular mortality [2·26 (1·24–4·10) and 3·16 (1·33–7·54), respectively]. Having a professional occupation was associated with a lower cardiovascular mortality only [0·37(0·15–0·94)]. Conclusions Poor social conditions impair survival in patients with HFPEF. These findings may shed new light on how best to detect HFPEF patients with high health-care needs.
Published: 2014

36. Stakeholders' perceptions of transferability criteria for health promotion interventions: a case study

Author: Justine Trompette, François Alla, Joëlle Kivits, Linda Cambon, Laetitia Minary, Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Ecole de Santé Publique [Nancy], Faculté de Médecine [Nancy], Université de Lorraine ( UL ) -Université de Lorraine ( UL ), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de Recherches sur l'Action Politique en Europe ( ARENES ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -Centre National de la Recherche Scientifique ( CNRS ), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Université de Lorraine (UL)-Université de Lorraine (UL), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), and Kivits, Joëlle
Subjects: Pediatric Obesity, medicine.medical_specialty, [SHS.SOCIO] Humanities and Social Sciences/Sociology, Population, Psychological intervention, Intervention, Interviews as Topic, 03 medical and health sciences, Organizational Case Studies, Technology Transfer, 0302 clinical medicine, Environmental health, Humans, Medicine, 030212 general & internal medicine, Program Development, education, education.field_of_study, Evidence-Based Medicine, 030505 public health, Modalities, [SHS.SOCIO]Humanities and Social Sciences/Sociology, business.industry, Public health, Public Health, Environmental and Occupational Health, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, [ SHS.SOCIO ] Humanities and Social Sciences/Sociology, Public relations, Evidence-based health promotion, Health promotion, Transferability, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Implementation, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Thematic analysis, 0305 other medical science, business, Construct (philosophy), Research Article
Abstract: Background The effects of health promotion interventions are the result not only of the interventions themselves, but also of the contexts in which they unfold. The objective of this study was to analyze, through stakeholders’ discourse, the characteristics of an intervention that can influence its outcomes. Methods This case study was based on semi-structured interviews with health promotion stakeholders involved in a regional program (PRALIMAP). General hypotheses on transferability and on how the intervention is presumed to produce its effects were used to construct an interview guide. Interviews were analyzed using thematic coding. Results Twenty-three stakeholders were interviewed. Results showed stakeholders made few references to population and environment characteristics. Three themes emerged as significant for the stakeholders: implementation modalities and methodology, modalities used to mobilize actors; and transferability-promoting factors and barriers. Conclusion Our work contributes to a better understanding not only of transferability factors, but also of stakeholders’ perceptions of them, which are just as important, because those perceptions themselves are a factor in mobilization of actors, implementation, and transferability.
Published: 2014

37. ASTAIRE: Tool for the analysis of the transferability and facilitation of the adaptation of interventions in health promotion

Author: Linda Cambon, Laetitia Minary, Valérie Ridde, François Alla, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Agence régionale de santé Picardie, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), 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 ), and Centre de recherche du Centre Hospitalier de l'Université de Montréal ( CRCHUM )
Subjects: 030505 public health, MESH: Humans, MESH : Diffusion of Innovation, MESH : Information Dissemination, Transferability, MESH : Humans, Public Health, Environmental and Occupational Health, MESH: Guidelines as Topic, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Information Dissemination, MESH: Diffusion of Innovation, MESH: Technology Transfer, 03 medical and health sciences, 0302 clinical medicine, Health promotion, Political science, MESH : Health Promotion, MESH : Technology Transfer, MESH: Health Promotion, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, 0305 other medical science, Humanities, MESH : Guidelines as Topic, ComputingMilieux_MISCELLANEOUS
Abstract: La complexite des interventions en promotion de la sante pose la question de la transferabilite de leurs resultats d’un contexte a l’autre. Un outil a ete developpe et valide : ASTAIRE (AnalySe de la Transferabilite et Accompagnement a l’adaptation des InteRventions en promotion de la santE). L’objectif de cet article est de presenter la version en langue francaise de cet outil afin de permettre aux acteurs et chercheurs francophones de se l’approprier et d’en faire usage dans une perspective de developpement de la promotion de la sante basee sur les preuves. ASTAIRE comprend 23 criteres de transferabilite structures en quatre categories : population, environnement, mise en œuvre, accompagnement au transfert. Il se compose de deux grilles, l’une pour le reporting des interventions initiales selon des criteres de transferabilite, et l’autre pour analyser la comparabilite des contextes et accompagner le transfert. Il a pour objectifs de soutenir le choix d’une intervention la plus adaptee au contexte et d’en accompagner le transfert. Son utilisation peut favoriser le developpement des demarches fondees sur les preuves sur la base d’une logique adaptative des interventions. Il permet ainsi de distinguer, par son utilisation collective dans les logiques de projet, les fonctions-cles des interventions, qui fondent leur efficacite et doivent etre transferees, des aspects lies a la forme, qui elle, peut etre adaptee au contexte.
Published: 2014

38. A tool to analyze the transferability of health promotion interventions

Author: François Alla, Laetitia Minary, Linda Cambon, Valéry Ridde, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Department of Social and Preventive Medicine, CRCHUM-Montreal School of Public Health, Institut national de prevention et d'éducation pour la santé (INPES) and by the Institut national du cancer (INCa, grant reference: RI 2011)., Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] ( Pôle S2R ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), and BMC, Ed.
Subjects: Knowledge management, Population, Psychological intervention, Knowledge transfer, Intervention, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Humans, Medicine, Relevance (information retrieval), 030212 general & internal medicine, Program Development, education, Health policy, education.field_of_study, 030505 public health, business.industry, Concept map, Public Health, Environmental and Occupational Health, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Evidence-based health promotion, Project team, Health promotion, Transferability, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Implementation, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Diffusion of Innovation, 0305 other medical science, business, Research Article
Abstract: International audience; BACKGROUND: Health promotion interventions are often complex and not easily transferable from one setting to another. The objective of this article is to present the development of a tool to analyze the transferability of these interventions and to support their development and adaptation to new settings. METHODS: The concept mapping (CM) method was used. CM is helpful for generating a list of ideas associated with a concept and grouping them statistically. Researchers and stakeholders in the health promotion field were mobilized to participate in CM and generated a first list of transferability criteria. Duplicates were eliminated, and the shortened list was returned to the experts, scored for relevance and grouped into categories. Concept maps were created, then the project team selected the definitive map. From the final list of criteria thus structured, a tool to analyze transferability was created. This tool was subsequently tested by 15 project leaders and nine experts. RESULTS: In all, 18 experts participated in CM. After testing, a tool, named ASTAIRE, contained 23 criteria structured into four categories: population, environment, implementation, and support for transfer. It consists of two tools--one for reporting data from primary interventions and one for analyzing interventions' transferability and supporting their adaptation to new settings. CONCLUSION: The tool is helpful for selecting the intervention to transfer into the setting being considered and for supporting its adaptation. It also facilitates new interventions to be produced with more explicit transferability criteria.
Published: 2013

39. Effectiveness of a multidimensional home nurse led heart failure disease management program-A French nationwide time-series comparison

Author: Faiez Zannad, Daniela Dobre, Christelle Altieri, François Alla, Nelly Agrinier, Nathalie Thilly, Nicolas Jay, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Knowledge representation, reasonning (ORPAILLEUR), Inria Nancy - Grand Est, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Department of Natural Language Processing & Knowledge Discovery (LORIA - NLPKD), Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Service de Cardiologie [CHRU Nancy], Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] ( Pôle S2R ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Centre d'Epidémiologie Clinique ( CIC-EC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Knowledge representation, reasonning ( ORPAILLEUR ), Institut National de Recherche en Informatique et en Automatique ( Inria ) -Institut National de Recherche en Informatique et en Automatique ( Inria ) -Department of Natural Language Processing & Knowledge Discovery ( LORIA - NLPKD ), Laboratoire Lorrain de Recherche en Informatique et ses Applications ( LORIA ), Institut National de Recherche en Informatique et en Automatique ( Inria ) -Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut National de Recherche en Informatique et en Automatique ( Inria ) -Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ) -Laboratoire Lorrain de Recherche en Informatique et ses Applications ( LORIA ), Institut National de Recherche en Informatique et en Automatique ( Inria ) -Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ), Centre d'investigation clinique plurithématique Pierre Drouin ( CIC-P ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lorraine ( UL ), Centre d'Epidémiologie Clinique (CIC-EC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'investigation clinique plurithématique Pierre Drouin (CIC-P), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)
Subjects: Male, Pediatrics, medicine.medical_specialty, Cost, Cost-Benefit Analysis, Population, Heart failure, 030204 cardiovascular system & hematology, Nurses, Community Health, Nyha class, Cohort Studies, 03 medical and health sciences, Nurse led, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Disease management, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Disease management (health), education, Aged, Aged, 80 and over, education.field_of_study, Series (stratigraphy), business.industry, Incidence (epidemiology), Mortality rate, Home-monitoring, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine.disease, 3. Good health, Treatment Outcome, Population Surveillance, Time and Motion Studies, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: International audience; BACKGROUND: The purpose of this study was to assess the effectiveness of a disease management program (DMP) in heart failure (HF) on the incidence of HF hospitalizations and related costs in a real-world population-based setting. METHODS: Insuffisance CArdiaque en LORraine (ICALOR), a DMP for HF was established in 2006 in the French region of Lorraine. Patients were enrolled after an index HF hospitalization. They received educational and home-visit monitoring programs by HF-trained nurses. General physicians received automatic alerts about patients' significant clinical or biological changes. We used the ICALOR and the national diagnostic related group databases to conduct a comparison of time-series trends in HF hospitalizations in France. The economic impact was obtained using the national scale of costs in France. RESULTS: The median age of the 1222 patients recruited before 2010 was 76years, and 65% were male. Upon enrollment, patients essentially presented with NYHA class II (n=537, 48%) or class III (n=359, 32%) symptoms. One-year mortality rate was 20.3%. The implementation of the ICALOR program was associated with a reduction in HF hospitalizations in Lorraine estimated by an absolute difference between the number of hospitalizations observed in the Lorraine region and that expected had it been similar to that observed in the whole country of -7.19% in 2010. The estimated annual hospital cost saved by ICALOR was €1,927,648 in 2010. CONCLUSION: Coordinated DMP of HF might improve outcome cost-effectively when implemented in a real-world population setting, and was associated in Lorraine with a substantial modification of the trend of HF hospitalizations.
Published: 2013

40. Health needs and public health functions addressed in scientific publications in Francophone sub-Saharan Africa

Author: Olivier Grimaud, J. Benie-Bi, Linda Cambon, Joëlle Kivits, François Alla, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Université de Cocody, Instance régionale d’éducation et de promotion de la santé de Lorraine (IREPS Lorraine ), IREPS, École des Hautes Études en Santé Publique [EHESP] (EHESP), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)
Subjects: MESH: Health Services Needs and Demand, medicine.medical_specialty, Biomedical Research, Bibliometry, Scopus, Alternative medicine, Distribution (economics), Legislation, Francophone sub-Saharan Africa, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, MESH: Africa South of the Sahara, Health needs, Africa South of the Sahara, Literature review, Health Services Needs and Demand, MESH: Humans, MESH: Bibliometrics, business.industry, Public health research, Public health, MESH: Biomedical Research, 05 social sciences, Public Health, Environmental and Occupational Health, French, General Medicine, language.human_language, 3. Good health, Health promotion, Bibliometrics, Family medicine, language, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Public Health, 0509 other social sciences, 050904 information & library sciences, business, MESH: Public Health
Abstract: International audience; OBJECTIVE:To describe the reporting of public health research in Francophone sub-Saharan Africa (FSA).STUDY DESIGN:A bibliometric research study of scientific public health publications in FSA, which includes 24 countries and approximately 260 million people.METHODS:Two researchers analysed original articles published in 2007 in the medical or social sciences fields and indexed in Scopus. At least one co-author of articles had to be based in FSA. The analysis focused on research field, public health function (WHO classification), FSA country author's affiliation, language, journal type and global burden of disease (WHO classification).RESULTS:Of 1047 articles retrieved by the search, 212 were from the public health field. The number of articles per country varied from 0 to 36. Public health functions examined were health service research (24.5%), health monitoring (27.4%), prevention (15%) and legislation (0.5%). The distribution of health needs described in the articles was close to that of the WHO data for Africa for 2004: infectious and parasitic diseases (70% vs 54%), maternal and perinatal conditions (15% vs 17%), non-communicable diseases (15.6% vs 21%), and injuries (0.5% vs 8%).CONCLUSION:The areas reported in published articles from sub-Saharan Africa reflect the health needs distribution in Africa; however, the number of publications is low, particularly for prevention. In light of the current focus on evidence-based public health, this study questions whether the international scientific community adequately considers the expertise and perspectives of African researchers and professionals.
Published: 2013

41. Correlation Between Peripheral Blood Pressure and Pulse-Wave Velocity Values in the Institutionalized Elderly Persons 80 Years of Age and Older: The PARTAGE Study

Author: Christine Perret-Guillaume, Marie Line Erpelding, François Alla, Paolo Salvi, Darko Miljkovic, Athanase Benetos, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service de Gériatrie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'Epidémiologie Clinique (CIC-EC), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Activities of daily living, Blood Pressure, 030204 cardiovascular system & hematology, MESH: Vascular Stiffness, Cohort Studies, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Prospective cohort study, MESH: Longitudinal Studies, Pulse wave velocity, MESH: Cohort Studies, Aged, 80 and over, MESH: Pulse Wave Analysis, Age Factors, MESH: Blood Pressure, MESH: Predictive Value of Tests, 3. Good health, Pulse pressure, Femoral Artery, Carotid Arteries, Italy, Cardiovascular Diseases, Predictive value of tests, Cardiology, Female, France, Cohort study, circulatory and respiratory physiology, MESH: Femoral Artery, medicine.medical_specialty, Pulse Wave Analysis, 03 medical and health sciences, Sex Factors, Vascular Stiffness, MESH: Sex Factors, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Predictive Value of Tests, Internal medicine, Internal Medicine, medicine, Humans, cardiovascular diseases, Antihypertensive Agents, MESH: Age Factors, MESH: Antihypertensive Agents, MESH: Humans, MESH: Carotid Arteries, business.industry, MESH: Italy, MESH: Cardiovascular Diseases, medicine.disease, MESH: Male, MESH: Prospective Studies, Nursing Homes, MESH: France, Blood pressure, MESH: Nursing Homes, Physical therapy, Arterial stiffness, business, MESH: Female
Abstract: International audience; BACKGROUND:Carotid-femoral pulse-wave velocity (PWV) provides a comprehensive noninvasive indication of arterial stiffness, and is now established as a strong marker of cardiovascular disease (CVD). The correlation between peripheral blood pressure (BP) and PWV and their respective influences on mortality have been poorly studied in the elderly. Our objective was to analyze this correlation in nursing-home residents over 80 years of age, with the view that the results of this could ultimately be helpful in implementing strategies for the diagnosis and long-term follow-up of CVD and mortality in the very elderly population.METHODS:The Predictive Value of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population (PARTAGE) study is a 2-year cohort study of 1,130 subjects living in 72 nursing homes in France and Italy. The correlation between baseline systolic and diastolic blood pressure (SBP and DBP, respectively) and baseline PWV (measured with a PulsePen® tonometer) was studied in 1,071 subjects for whom PWV measurements were available.RESULTS:Correlations between peripheral BP and PWV were significant but weak, with r = 0.24 for self-measured SBP, r = 0.30 for casual SBP, r = 0.11 for self-measured DBP, r = 0.14 for casual DBP, and r = 0.26 for casual pulse pressure (PP). A trend toward a weaker correlation was observed in the older age group for self-measured SBP and in the group with a lower level of activities of daily living (ADL) for self-measured SBP and DBP.CONCLUSIONS:These findings suggest that SBP, DBP, and PWV provide different information in the very elderly. The results of the prospective, longitudinal, long-term PARTAGE study will allow further insight into this and provide additional in-depth information about the respective prognostic value of the measurement of peripheral BP and PWV.
Published: 2013

42. First hospitalization for heart failure in France in 2009: patient characteristics and 30-day follow-up

Author: Anne Fagot-Campagna, Albert Hagège, Alain Leizorovicz, François Alla, Christine de Peretti, Milou-Daniel Drici, Guillaume Jondeau, Anne Cuerq, Patrick Jourdain, Hubert Allemand, Fred Paccaud, Yves Juillière, Nicolas Danchin, Christophe Bauters, Philippe Tuppin, Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, Pediatrics, medicine.medical_specialty, Time Factors, SNIIRAM, [SDV]Life Sciences [q-bio], Population, Heart failure, Comorbidity, 030204 cardiovascular system & hematology, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Hospitalisation, Humans, 030212 general & internal medicine, Hospital Mortality, education, Aged, Aged, 80 and over, education.field_of_study, business.industry, Mortality rate, Incidence (epidemiology), Incidence, Cardiovascular Agents, General Medicine, Length of Stay, Middle Aged, medicine.disease, Patient Discharge, 3. Good health, Hospitalization, Insuffisance cardiaque, Treatment Outcome, Relative risk, Case-Control Studies, Cardiovascular agent, Population study, Drug Therapy, Combination, Female, France, business, Cardiology and Cardiovascular Medicine
Abstract: Background The incidence of heart failure (HF) is stable in industrialized countries, but its prevalence continues to increase, especially due to the ageing of the population, and mortality remains high. Objective To estimate the incidence in France and describe the management and short-term outcome of patients hospitalized for HF for the first time. Method The study population comprised French national health insurance general scheme beneficiaries (77% of the French population) hospitalized in 2009 with a principal diagnosis of HF after exclusion of those hospitalized for HF between 2006 and 2008 or with a chronic disease status for HF. Data were collected from the national health insurance information system (SNIIRAM). Results A total of 69,958 patients (mean age 78 years; 48% men) were included. The incidence of first hospitalization for HF was 0.14% (≥ 55 years, 0.5%; ≥ 90 years, 3.1%). Compared with controls without HF, patients more frequently presented cardiovascular or other co-morbidities. The hospital mortality rate was 6.4% and the mortality rate during the 30 days after discharge was 4.4% (3.4% without readmission). Among 30-day survivors, all-cause and HF 30-day readmission rates were 18% (
Published: 2013

43. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey

Author: Christine Selton-Suty, Claire POYART, Tristan Ferry, Albert HAGEGE, Bernard Iung, Cellier Christophe, Francois Vandenesch, Anne TRISTAN, Francois Philippart, BRUNO MOURVILLIER, Vincent Le Moing, François Alla, Céline Plainvert, Patrick Assayag, Nataf Patrick, Catherine Sportouch, Albert Sotto, Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), services de maladies infectieuses, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), CHU Pontchaillou [Rennes], Centre National de référence des Staphylocoques, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL), Centre d'Epidémiologie Clinique (CIC-EC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - CHU Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, AEPEI Study Group, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Université Montpellier 1 (UM1)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), 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)-Université Paris Diderot - Paris 7 (UPD7), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Recherches Translationnelles sur le VIH et les maladies infectieuses ( TransVIHMI ), Université de Montpellier ( UM ) -Universtié Yaoundé 1 [Cameroun]-Université Cheikh Anta Diop ( UCAD ) -Université Montpellier 1 ( UM1 ) -Institut de Recherche pour le Développement ( IRD ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ), Centre d'Epidémiologie Clinique ( CIC-EC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Université Montpellier 1 ( UM1 ) -Université Cheikh Anta Diop ( UCAD ) -Universtié Yaoundé 1 (Cameroun)-Université de Montpellier ( UM ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Male, Staphylococcus, [SDV]Life Sciences [q-bio], MESH : Aged, 030204 cardiovascular system & hematology, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, MESH : Population Surveillance, MESH: Staphylococcus aureus, MESH : Female, 030212 general & internal medicine, MESH: Incidence, Young adult, MESH : Endocarditis, Bacterial, Aged, 80 and over, MESH: Aged, education.field_of_study, Cross Infection, MESH : Prognosis, MESH: Middle Aged, Incidence (epidemiology), Incidence, MESH : Staphylococcus aureus, Hazard ratio, MESH: Staphylococcus, Middle Aged, Staphylococcal Infections, MESH : Adult, Prognosis, MESH: Hospitals, MESH : Risk Factors, Hospitals, MESH : Incidence, 3. Good health, Community-Acquired Infections, MESH : Hospitals, Infectious Diseases, MESH: Community-Acquired Infections, MESH: Young Adult, Infective endocarditis, Population Surveillance, Female, France, MESH : Cross Infection, Microbiology (medical), Adult, MESH : Community-Acquired Infections, medicine.medical_specialty, Staphylococcus aureus, Adolescent, MESH : Male, Population, MESH : Young Adult, MESH: Staphylococcal Infections, [SDU.STU.PE]Sciences of the Universe [physics]/Earth Sciences/Petrography, MESH: Prognosis, MESH: Population Surveillance, 03 medical and health sciences, Young Adult, Internal medicine, MESH : Adolescent, medicine, Endocarditis, Humans, MESH : Middle Aged, MESH: Endocarditis, Bacterial, education, MESH : Aged, 80 and over, MESH : France, Aged, MESH : Staphylococcus, [ SDU.STU.PE ] Sciences of the Universe [physics]/Earth Sciences/Petrography, MESH: Adolescent, MESH: Humans, [ SDV ] Life Sciences [q-bio], business.industry, Proportional hazards model, MESH : Humans, MESH: Cross Infection, MESH: Adult, Endocarditis, Bacterial, medicine.disease, Confidence interval, MESH: Male, Surgery, MESH: France, MESH : Staphylococcal Infections, business, MESH: Female
Abstract: International audience; BACKGROUND: Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE. METHODS: A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li-definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death. RESULTS: The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of community-acquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]). CONCLUSIONS: S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease.
Published: 2012

44. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices

Author: David Gordon, Emilio Bouza, Víctor José González Ramallo, Christine Selton-Suty, Francesc Marco, Eugene Athan, Emanuele Durante-Mangoni, Anna Lisa Chamis, Zainab Samad, Nuria Fernández-Hidalgo, Carlos Cervera, Jorge Solis, Corentine ALAUZET, François Alla, Sarah Israel, Hussien Rizk, Patricia Carmen Muñoz García, Andrew Wang, Juan M Pericas, Souha Kanj, Carlos Falces, Pierre-Edouard Fournier, Assoc Prof Margaret J Henry, Asunción Moreno Camacho, Martin Stryjewski, Antonio Toniolo, Didier Raoult, Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Monaldi Hospital, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Département de Cardiologie, Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Madrid, Spain - Spanish Network for Research in Infectious Diseases (REIPI RD06/0008), ICE-PCS Investigators, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), and Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE)
Subjects: Male, Pacemaker, Artificial, MESH: Endocarditis, MESH : Prevalence, [SDV]Life Sciences [q-bio], Heart Valve Diseases, MESH : Aged, MESH : Prospective Studies, MESH: Hospitalization, 030204 cardiovascular system & hematology, 0302 clinical medicine, prevention, MESH: Tricuspid Valve, Interquartile range, MESH : Device Removal, Prevalence, MESH : Female, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Endocarditis, prosthesis, infection, etiology, survival, Prospective cohort study, MESH: Treatment Outcome, MESH: Aged, Cross Infection, MESH: Middle Aged, Infective endocarditis, Impalntable cardiac device, Mortality rate, Hazard ratio, General Medicine, Middle Aged, Staphylococcal Infections, MESH : Tricuspid Valve, MESH : Endocarditis, Defibrillators, Implantable, 3. Good health, MESH : Heart Valve Diseases, Hospitalization, Treatment Outcome, MESH: Survival Analysis, MESH: Pacemaker, Artificial, MESH : Hospitalization, Female, Tricuspid Valve, MESH : Cross Infection, Cohort study, medicine.medical_specialty, MESH : Male, MESH: Staphylococcal Infections, [SDU.STU.PE]Sciences of the Universe [physics]/Earth Sciences/Petrography, Context (language use), MESH : Treatment Outcome, MESH: Defibrillators, Implantable, MESH : Hospital Mortality, 03 medical and health sciences, Internal medicine, medicine, Humans, MESH : Middle Aged, MESH: Hospital Mortality, MESH: Device Removal, Device Removal, MESH: Prevalence, Aged, [ SDU.STU.PE ] Sciences of the Universe [physics]/Earth Sciences/Petrography, MESH: Humans, [ SDV ] Life Sciences [q-bio], business.industry, MESH : Pacemaker, Artificial, MESH : Humans, MESH: Cross Infection, MESH: Heart Valve Diseases, medicine.disease, Survival Analysis, MESH: Male, MESH: Prospective Studies, Surgery, MESH : Staphylococcal Infections, MESH : Survival Analysis, business, MESH: Female, MESH : Defibrillators, Implantable
Abstract: International audience; CONTEXT: Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs. OBJECTIVES: To describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome. DESIGN, SETTING, AND PATIENTS: Prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria. MAIN OUTCOME MEASURES: In-hospital and 1-year mortality. RESULTS: CDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%-44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22-0.82]). CONCLUSIONS: Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year.
Published: 2012

45. Diabetes mellitus and infective endocarditis: the insulin factor in patient morbidity and mortality

Author: Marie Célard, Xavier Duval, Jean-Luc Mainardi, Patrick Plésiat, Thanh Doco-Lecompte, François Delahaye, François Alla, Catherine Leport, Bruno Hoen, Vincent Le Moing, Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Hôpital Bichat - Claude Bernard, Service Médecine légale et Droit de la Santé, Nancy Université, Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Ecole de santé publique, Université Paris Descartes - Paris 5 (UPD5)-Nancy Université, 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), 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), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Laboratoire de recherche en pathologie infectieuse, 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)-Université Paris Diderot - Paris 7 (UPD7), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] ( Pôle S2R ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Université Paris Descartes - Paris 5 ( UPD5 ) -Nancy Université, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Agents pathogènes et inflammation - UFC (EA 4266) ( API ), Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), service de cardiologie, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Université Paris Diderot - Paris 7 (UPD7) - Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5) - Nancy Université, Hospices Civils de Lyon (HCL) - Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon) - Hôpital Saint-Jacques, and Assistance publique - Hôpitaux de Paris (AP-HP) - AP-HP - Hôpital Bichat - Claude Bernard [Paris] - Université Paris Diderot - Paris 7 (UPD7)
Subjects: Male, medicine.medical_treatment, MESH : Insulin, MESH: Diabetic Angiopathies, MESH : Aged, MESH : Prospective Studies, 030204 cardiovascular system & hematology, Gastroenterology, MESH : Diabetes Mellitus, Type 1, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Insulin, MESH : Female, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, MESH : Endocarditis, Bacterial, Prospective cohort study, Abscess, MESH: Aged, MESH : Prognosis, Prognosis, 3. Good health, Cardiac surgery, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Infective endocarditis, Female, Cardiology and Cardiovascular Medicine, MESH: Diabetes Mellitus, Type 1, medicine.medical_specialty, MESH : Male, MESH: Insulin, MESH: Prognosis, MESH : Hospital Mortality, 03 medical and health sciences, Internal medicine, Diabetes mellitus, MESH: Hypoglycemic Agents, medicine, Endocarditis, Humans, Hypoglycemic Agents, MESH: Endocarditis, Bacterial, MESH: Hospital Mortality, Aged, MESH: Humans, business.industry, MESH : Diabetic Angiopathies, MESH : Humans, Endocarditis, Bacterial, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, MESH : Hypoglycemic Agents, MESH: Prospective Studies, MESH: Male, Surgery, Diabetes Mellitus, Type 1, Heart failure, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, business, MESH: Female, Diabetic Angiopathies
Abstract: International audience; AIMS: To analyse the characteristics of infective endocarditis (IE) in patients with diabetes mellitus (DM), and to evaluate the prognostic significance of DM according to insulin use. METHODS AND RESULTS: A total of 559 patients with definite IE including 75 patients (13%) with DM (insulin use n = 22; oral antidiabetic n = 53) were evaluated. Comparison of insulin-DM, oral-DM, and non-DM patients showed an older age (66 +/- 13, 66 +/- 10, 58 +/- 17, respectively; P = 0.004) in DM patients, and more frequent IE on prosthetic valves (32, 11, and 15%, respectively; P = 0.068) in insulin-DM patients. Oral streptococci (0, 8, and 18%, respectively; P = 0.016) were less frequently the causative organism than staphylococci (64, 26, and 29%, respectively; P = 0.002) in insulin-DM patients. Vegetations, dehiscence, abscess, and regurgitation rates did not differ among the three groups, nor did cardiac surgery rates (32, 47, and 48%, respectively; P = 0.334), but in-hospital mortality was higher in insulin-DM patients (50, 19, and 15%; P < 0.001). In multivariable analysis, independently of other determinants of death (age, IE location, Staphylococcus aureus, history of heart failure, immunosuppression, creatinine serum), insulin-DM was a predictor of death (OR, 4.69; 95% CI, 1.77-12.44), whereas oral-DM was not. CONCLUSION: IE prognosis in insulin-DM patients is poor due to the coexistence of host and pathogen factors. Insulin-DM patients with IE may require specific management.
Published: 2007

46. In-hospital mortality of infective endocarditis: prognostic factors and evolution over an 8-year period

Author: François Delahaye, François Alla, Isabelle Béguinot, Patrice Bruneval, Thanh Doco-Lecompte, Flore Lacassin, Christine Selton-Suty, François Vandenesch, Véronique Vernet, Bruno Hoen, null FOR THE AEPEI GROUP, Service Médecine légale et Droit de la Santé, Nancy Université, Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] (Pôle S2R), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Ecole de santé publique, Université Paris Descartes - Paris 5 (UPD5)-Nancy Université, Immunité infection vaccination (I2V), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR128-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Laboratoire de Bactériologie, Hospices Civils de Lyon (HCL), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy] ( Pôle S2R ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Université Paris Descartes - Paris 5 ( UPD5 ) -Nancy Université, Immunité infection vaccination ( I2V ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-IFR128-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hospices Civils de Lyon ( HCL ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-IFR128-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), and Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC )
Subjects: Male, MESH : Aged, 030204 cardiovascular system & hematology, MESH : Diabetes Mellitus, Type 1, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, MESH : Female, Hospital Mortality, 030212 general & internal medicine, MESH: Incidence, MESH : Endocarditis, Bacterial, Aged, 80 and over, MESH: Aged, education.field_of_study, MESH : Prognosis, MESH: Middle Aged, Incidence, Mortality rate, MESH: Immunosuppression, General Medicine, Middle Aged, MESH : Adult, Prognosis, Shock, Septic, MESH : Risk Factors, MESH : Incidence, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Infectious Diseases, Infective endocarditis, Cohort, Female, MESH: Diabetes Mellitus, Type 1, Adult, Microbiology (medical), medicine.medical_specialty, MESH : Male, Population, MESH: Shock, Septic, MESH: Multivariate Analysis, MESH: Prognosis, MESH : Hospital Mortality, 03 medical and health sciences, MESH : Shock, Septic, Internal medicine, Humans, Endocarditis, MESH : Middle Aged, MESH: Endocarditis, Bacterial, MESH: Hospital Mortality, MESH : Aged, 80 and over, education, Aged, Heart Failure, Immunosuppression Therapy, MESH: Humans, General Immunology and Microbiology, business.industry, Septic shock, MESH : Humans, Glasgow Coma Scale, MESH : Multivariate Analysis, MESH: Adult, Endocarditis, Bacterial, Odds ratio, medicine.disease, MESH: Male, Surgery, Diabetes Mellitus, Type 1, Multivariate Analysis, MESH : Immunosuppression, MESH: Heart Failure, MESH : Heart Failure, business, MESH: Female
Abstract: International audience; Infective endocarditis (IE) remains severe. Few predictors of prognosis have been identified. It is not known whether mortality of IE has decreased during recent decades. 559 definite cases of IE were collected in a prospective population-based survey in 1999 in France. In-hospital death rate was 17%. It was lower in operated patients (14.4% vs 19.3%), although not significantly so. In multivariate analysis, the following variables were independent and significant predictors of mortality: history of heart failure (odds ratio: 2.65), history of immunosuppression (OR: 3.34), insulin-requiring diabetes mellitus (OR: 7.82), left-sided IE (OR: 1.97), heart failure (OR: 2.19), septic shock (OR: 4.33), lower Glasgow coma scale score (OR: 4.09), cerebral haemorrhage (OR: 9.46), and higher C-reactive protein level (OR: 2.60). Adjusted mortality was significantly lower in 1999 than in 1991 (22%): OR: 0.64 (p = 0.03). Thus, in a large and unselected cohort of patients hospitalized for IE in 1999, in-hospital mortality rate was lower than in 1991. Multivariate analysis identified factors classically known as having an impact on mortality. However, other factors, such as age and responsibility of Staphylococcus aureus, were not retained in the model.
Published: 2007

47. ERTLA6 - Epreuves de Repérage des Troubles du Langage et des Apprentissage chez des enfants de 6 ans

Author: Brigitte, Roy, Christine, Maeder, Agnès, Kipffer-Piquard, François, Alla, Jean-Paul, Blanc, and Piquard-Kipffer, Agnès
Subjects: repérage, prévention précoce, orthophonie, troubles du langage et des apprentissages, pédiatrie, Bilan de l'enfant de 6 ans, [SDV.NEU.SC] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Cognitive Sciences
Abstract: Test utilisé par des médecins scolaires de l'Education Nationale et leurs équipes ainsi que par des pédiatres dans le cadre du bilan de l'enfant de 6 ans lors de l'entrée au CP
Published: 2007

48. Residents’ engagement in the « MBSR » program (for mindfulness-based stress reduction), offered at the Bordeaux’s university hospital: a qualitative approach

Author: Billiet, Louis, UB, Médecine, Université de Bordeaux (UB), François Alla, and François Tison
Subjects: Operations Research, Prévention, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Internat et résidence, Prevention, [SDV]Life Sciences [q-bio], Psychosocial Support Systems, Internship and Residency, Systèmes de soutien psychosocial, [SDV] Life Sciences [q-bio], Professional, Burnout, Pleine conscience, Épuisement professionnel, Mindfulness, Recherche opérationnelle, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Tools to prevent troubles linked to psychosocial risks in healthcare residents seem to be lacking. However, interventions based on mindfulness meditation such as the « mindfulness-based stress reduction » (MBSR) program have proven their effectiveness among such troubles. Therefore, it seems appropriate wanting to deliver this type of program to residents, as it has been experienced and positively reported in medical literature in recent years. However, the residents’ commitment into such a program sometimes seems limited. A complementary approach of the evaluation about the program’s theoretical effectiveness seemed appropriated, among the specific context of the program, as offered by the University Hospital Center of Bordeaux, in order to explain the factors influencing this commitment. We led individuals semi-directive interviews with residents who participated, planned to participate or didn’t plan to participate in this program to investigate such dimensions of commitment. The thematic analysis of these interviews’ content revealed five major themes, considered as majorly influencing this commitment: the program environment, the perceived benefits of the program, the knowledge and experience the resident links to the program, other facilitators or brakes having internals origins and other facilitators or brakes having externals origins. We tried to make a model of the influence of these factors in the form of three “ideal types”: the refractory, the hesitant and the committed. All the identified factors interact with each other, and cannot be considered out of the context in which they exist. Hence, it seems necessary to consider at the same time, according to the means the team has, organizing this kind of intervention. Dedicated prior information campaigns, as well as an a posteriori evaluation of the steps in this work, seem to cover the major part of the reported elements by the residents surveyed., Les moyens de prévention pour éviter les troubles liés aux risques psychosociaux chez les internes semblent manquer. Or les interventions basées sur la méditation pleine conscience tels que le programme « mindfulness-based stress reduction » (MBSR) ont prouvé leur efficacité dans cette optique. Il semble donc adapté de vouloir proposer ce type de programme aux internes, comme cela a été expérimenté et rapporté dans littérature médicale ces dernières années. Toutefois, l’engagement des internes dans un tel programme semble parfois limité. Une approche complémentaire de l’évaluation portant sur l’efficacité théorique du programme nous a donc semblé appropriée, dans le cadre de ce qui est proposé au sein du centre hospitalier universitaire (CHU) de Bordeaux, pour expliquer les facteurs influant sur cet engagement. Nous nous sommes appuyés sur des entretiens individuels semi-dirigés auprès d’internes ayant participé, envisageant de participer ou n’envisageant pas de participer à ce programme. L’analyse thématique du contenu de ces entretiens a fait émerger 5 thèmes majeurs, comme influant sur cet engagement : l’environnement du programme, les bénéfices perçus du programme, les connaissances et expériences que l’interne rapporte au programme, les autres moteurs ou freins d’origine interne et les autres moteurs ou freins d’origine externe. Nous avons tenté de modéliser l’influence de ces facteurs sous la forme de trois « idéaux-types » : le réfractaire, l’hésitant et l’engagé. Tous les facteurs identifiés interagissent entre eux, et ne peuvent être considérés que dans le contexte dans lequel ils s’ancrent. Il semble donc nécessaire de les prendre en considération de manière conjointe, au regard des moyens dont disposent les équipes organisant ce type d’intervention. Des campagnes d’information préalables dédiées ainsi qu’une démarche d’évaluation a posteriori semblent couvrir la majeure partie des éléments rapportés pas les internes enquêtés.
Published: 2021

49. Administrative claims databases: from epidemiology to pharmacoviligance

Author: Bannay, Aurélie, Bannay, Aurelie, Data Science, Knowledge, Reasoning and Engineering (K Team), Department of Natural Language Processing & Knowledge Discovery (LORIA - NLPKD), Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Université de Lorraine (UL), Université de Lorraine (UL), Nancy, FRA., Nicolas Jay, François Alla, K team (Data Science, Knowledge, Reasoning and Engineering), and Université de Lorraine
Subjects: base médico-administrative, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, pharmacovigilance, administrative claims database, épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, epidemiology, secondary use of data, utilisation secondaire de données, Système National des Données de Santé
Abstract: The availability and the volume of data in administrative claims databases could offer a powerful tool for research. However, the origin and the financial purpose of these data require an adaptation of the classical epidemiological approaches. Indeed, the secondary use of these data raises several issues that need to be carefully addressed. The aim of this thesis work was to assess the contribution of claims databases in epidemiology and in pharmacovigilance. The first section discusses the definition of the administrative claims databases and their scope through international examples and then focuses on French claims databases that collect inpatient care data (Programme de médicalisation des systèmes d’information, PMSI) and outpatient care data (datamart de consommation inter-régime, DCIR). The second section discusses methodological issues to take into account the specificities of administrative claims databases: definition and assessment of a prognostic score (Charlson’s comorbidity index) applied to the SNDS database, and the management of missing data. Two approaches were used: i) the development of a proxy applied to the concept of planned hospital stay, and ii) the enhancement of claims data with clinical data from a hospital warehouse. The third section illustrates, through use cases, how claims data could be useful in epidemiology and pharmacovigilance: wide exposure window (maternal comorbidities collected in the 6 years before the conception date), exhaustive recruitment especially for rare pathologies (patients with inflammatory bowel disease and myocardial infarction), and improved screening of eligible patients and data collection especially during a health crisis (patients admitted to the intensive care unit for COVID-19). Finally, the limitations due to the secondary use of these data are discussed: their volume that might lead to statistical overpowered studies, their delayed access due to technical and legal restrictions, the effort required to understand these data that is often underestimated by users who are not always data producers. To conclude, our work highlights the interest of the secondary use of data from claims database in research while underlining the potential pitfalls. The integration and the secondary use of multisource data in healthcare research could solve part of these issues., La disponibilité et le volume des données issues de bases médico-administratives (BMA) en font un outil de plus en plus utilisé en recherche. Cependant, la nature et la finalité financière de ces données rendent nécessaire une adaptation des méthodes d’épidémiologie classique. En effet, la réutilisation de ces données a soulevé des objections qu’il convient de prendre en compte. L’objectif de cette thèse était de montrer quel pouvait être l’apport des données issues de BMA en épidémiologie et en pharmacovigilance. Dans une première partie introductive sur les BMA, nous nous sommes attachés à en rechercher une définition, à illustrer leur périmètre, au travers d’exemples internationaux, et, à décrire le contenu des bases disponibles en France : les données hospitalières (Programme de médicalisation des systèmes d’information, PMSI) et les données de remboursement extra-hospitalières (datamart de consommation inter-régime, DCIR). Dans une deuxième partie, nous avons présenté des travaux méthodologiques prenant en compte les spécificités des données issues des BMA : la définition et l’évaluation d’un score pronostique (score de comorbidités de Charlson) calculé à partir des données disponibles dans les BMA, la gestion des données absentes des BMA. Deux approches ont été explorées : i) le développement d’un proxy appliqué à la notion d’hospitalisation programmée, ii) l’enrichissement de données de BMA par un appariement à des données issues d’un entrepôt de données hospitalières. Dans une troisième partie, nous avons illustré, au travers de cas d’usage, l’intérêt des données médico-administratives en épidémiologie et en pharmacovigilance : une fenêtre d’exposition étendue (recueil de comorbidités maternelles dans les 6 ans précédant une grossesse), un recrutement quasi-exhaustif en particulier dans le cadre de pathologies rares (sujets atteints de MICI et d’un syndrome coronarien), l’accélération du recrutement de sujets et du recueil de données (sujets atteints de COVID-19 pris en charge en réanimation) notamment en situation de crise sanitaire. Nous avons ensuite discuté les limites qui subsistent dans la réutilisation de ces données : leur volumétrie qui peut conduire à une situation de surpuissance statistique, leurs délais d’accès réglementaire et technique, l’investissement nécessaire à la compréhension de ces données, incomplètement mesuré par les utilisateurs de ces données qui n’en sont pas forcément les producteurs. En conclusion, nos travaux ont fait ressortir l’intérêt de la réutilisation des données issues de bases médico- administratives en recherche tout en soulignant les écueils qui pouvaient en résulter. L’intégration et la réutilisation de données multisources en santé permettrait de pallier un certain nombre de ces difficultés.
Published: 2021

50. Assessment of behaviours and practices of private general practitioners on establishing the cervical cancer organised screening and its impact on their daily practice

Author: Faverolle, Cécile, Hachaguer, Lucile, UB -, BU Carreire, Université de Bordeaux (UB), and François Alla
Subjects: Cancer du col de l’utérus, Dépistage organisé, Prévention, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Organised screening, Prevention, Médecine générale, Cervical cancer, General medicine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Introduction: cervical cancer can be considered « avoidable » through vaccination and vaginal smears. The slowdown of beneficial effects of these prevention measures and a stable and low national coverage rate for patients eligible for pap smears have led to a new organised screening in Nouvelle-Aquitaine through the summer of 2020. The main objective of our study was to evaluate the behaviours and practices of private general practitioners in the departments of Gironde and Pyrénées-Atlantiques on the implementation of the cervical cancer organised screening and its impact on their daily practice. Methods: we performed a qualitative study through individual and semi-guided interviews on 20 private general practitioners in Gironde and Pyrénées-Atlantiques. Results: even though most general practitioners had not read the letter of information at the time of the study, they seemed to welcome the screening fairly well. They sense a probable increase in screening promotion by sending letters and reminders at the patient’s home, by simplifying the process, by networking about screening and being more actively involved, and by systematically receiving their patient’s test results. However, there still are some obstacles: doctor-patient closeness, insufficient training, lack of time or complicated planning, fluctuating involvement and commitment from doctors, lack of equipment and weakness of the network. Some tools were suggested to face these obstacles: self-induced swab, promote screening, better training since internship, reorganisation of the practice, increase in salary. Conclusion: the implementation of cervical cancer organised screening is well accepted by the general practitioners in Nouvelle-Aquitaine. However, a lot of practitioners do not feel like they will take a bigger part in the screening by only keeping the pap smears in place. It will be necessary to implement new practical measures., Introduction : le cancer du col de l’utérus est un cancer que l’on peut considérer comme « évitable » de par la vaccination et le dépistage par frottis. Le ralentissement des effets bénéfiques de ces mesures préventives jusque-là existantes, et un taux de couverture national relativement stable et faible des patientes éligibles au FCU, ont fait émerger un nouveau dépistage organisé, qui a été mis en place en région Nouvelle-Aquitaine durant l’été 2020. Notre étude avait pour objectif principal d’évaluer les attitudes et pratiques des médecins généralistes libéraux des départements de la Gironde et des Pyrénées-Atlantiques sur la mise en place du programme de dépistage organisé du cancer du col de l’utérus et son impact dans leur pratique quotidienne. Matériel et méthode : nous avons réalisé une étude qualitative par entretiens individuels semi-dirigés auprès de 20 médecins généralistes libéraux de la Gironde et des Pyrénées-Atlantiques. Résultats : malgré le fait que la plupart des médecins généralistes n’aient pas lu la lettre d’information au moment de notre étude, ils semblent plutôt bien accueillir ce dépistage. Ils relèvent une très probable majoration de la promotion au dépistage par l’envoi des lettres et relances au domicile des patientes, une simplification du protocole, une mise en réseau du dépistage et une implication plus importante de leur part, via la réception systématique des résultats d’examen de leurs patientes. Cependant, il persiste plusieurs obstacles (intimité de la relation médecin-patiente, formation insuffisante, manque de temps ou organisation compliquée, implication et investissement fluctuants des médecins, absence de matériel et précarité du réseau) pour lesquels des leviers ont été proposés (apport de l’auto-prélèvement, accentuation de la promotion au dépistage, amélioration de la formation dès l’internat, réorganisation de la pratique, majoration de la rémunération). Conclusion : la mise en place du dépistage organisé du cancer du col de l’utérus est bien acceptée par les médecins généralistes de la région Nouvelle-Aquitaine. Toutefois, principalement par le maintien de la méthode du frottis, beaucoup ne s’estimeront pas plus « acteurs » dans ce dépistage. Cela nécessiterait certainement la mise en place de nouvelles mesures pratiques.
Published: 2021

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Database

68 results on '"François, Alla"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources