Search

Introduction Tocilizumab randomized clinical trial results are heterogeneous because of the heterogenous population included in them. Methods We conducted a meta-analysis with subgroup meta-analysis (PRISMA guidelines) between severe and non-severe COVID-19. Results We included nine trials. Overall, the mortality rate was 24.5% (821/3357) in the tocilizumab group and 29.1% (908/3125) in the control group at day 28–30 (pooled OR, 0.85; 95% CI 0.76–0.96; p = 0.006). Considering the subgroup analysis, this benefit on mortality was confirmed and amplified in the severe COVID-19 group (pooled OR, 0.82; 95% CI 0.73–0.93; p = 0.001) but not in the non-severe COVID-19 group (pooled OR, 1.46; 95% CI 0.91–2.34; p = 0.12). For patients who were not mechanically ventilated at baseline (5523/6482), the pooled OR (0.74; 95% CI 0.64–0.85; p

The study investigated the prospective memory (PM) functioning among patients with brain metastases (BM), eligible for neurosurgy/radiosurgery, and its relationships with depression and quality of life (QoL). This case-healthy-control, cross-sectional study, comprised 160 participants, including 49 patients with BM from various cancers treated with neurosurgery or radiosurgery. They were compared with 111 matched controls on a set of neuropsychological tests, including the MoCA global cognitive test and an experimental PM task ‘PROMESSE’. Participants also completed a depression scale (BDI-II), a generic (SF-12) and a specific (QLQ-C30) QoL instrument for cancer patients. Multivariate analyses were conducted on various PM outcomes, in particular on event-based (EBPM) and time-based (TBPM) PM performances. After adjusting for age and socio-cultural level, patients with BM performed worse than the control on the PM task (p

We have read with great interest the study conducted by Ramiro et al 1 entitled ‘Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study’. This study was among the first publications showing benefit of tocilizumab administration in patients with severe COVID-19-associated cytokine storm syndrome, in July 2020.1 In the same way, we observed a benefit of tocilizumab administration in a cohort of 206 patients during the first wave of the pandemic, in June 2020.2 We have now more ‘evidence-based medicine’ to discuss tocilizumab’s place in COVID-19. Thus, nine randomised clinical trials (RCTs)3–11 have been published about tocilizumab administration in COVID-19; however, the effects on mortality remain heterogeneous in these trials.12 We recently made a …

Les Interventions Non Medicamenteuses (INM) sont devenues des solutions incontournables pour ameliorer la qualite de vie et la sante. Elles presentent dans certains cas un impact positif sur la duree de vie et des benefices sociaux et economiques. Leur usage augmente sans cesse. Une plateforme universitaire collaborative basee a Montpellier, la Plateforme CEPS, reflechit aux manieres de les evaluer. Cet article presente plus en detail ses activites.

International audience; Background: The aims of this study were (i) to define the relationship between a physical reconditioning cycle using balance exercises and muscular-articular stress and the balance capabilities of sedentary older adults and (ii) to assess whether older adults with weaker equilibrium abilities have a significantly limited progression. Our sample consisted of 338 people (263 women, 75 men) with an age, weight and height of 74.4 years (+/- 8.6), 67 kg (+/- 13.6) and 161.4 cm (+/- 8) and with a body mass index of 25.6 (+/- 4.3). The functional evaluations consisted of individual motor profile tests, monopodal eyes open and eyes closed for 30 s, a Timed Up and Go test (TUG) and stabilometric measurements on hard ground with eyes open for a duration of 25.6 s. The physical repackaging protocol was based on the 12-week Posture-Balance-Motricity and Health Education (PBM-ES) method with two 90-min weekly group sessions.Results: The evolution of the "posture" and "balance" variables was significantly associated with the equilibration capacities (p

Article disponible en ligne à l'adresse : http://hdl.handle.net/2042/65114; International audience; La multiplication des interventions non médicamenteuses (INM) et des doutes résiduels de leur efficacité imposent aujourd’hui de ne plus se cantonner à leur appellation générale et disciplinaire (psychothérapie, thérapie manuelle, complément alimentaire, activité physique adaptée, solution e-santé…) mais d’accéder à leur véritable contenu. Décrite de manière précise, chaque INM pourra être mieux évaluée par la science, surveillée par les professionnels et expliquée au patient. Pour ce faire, il est nécessaire de construire une modélisation de l’ensemble des connaissances scientifiques et d’usage sous la forme d’une ontologie informatique. Cette ontologie des INM facilitera les recherches bibliographiques, les statistiques d’usage et l’amélioration des bonnes pratiques. Une première version de cette classification internationale évolutive est disponible sur le site Internet de la Plateforme universitaire CEPS en accès libre.

Background Diesel motor exhaust is a recognised risk factor for lung cancer, but few studies have investigated the effect of diesel emissions on other parts of the respiratory tract. We used data from the ICARE study, a French population-based case-control study, to investigate the associations between exposure to diesel motor exhaust and the risk of cancer of the oral cavity, pharynx and larynx. Methods The analysis was restricted to men and included cases of squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx (350, 543, 383 and 454 cases, respectively) and 2780 controls. Detailed information on lifetime occupational history, tobacco smoking and alcohol drinking was collected by interview. We assessed occupational exposure to diesel motor exhaust from questionnaire responses. We used logistic regression to estimate odds ratios (OR) and their 95% confidence intervals (CI), adjusted for age, residence area, smoking, alcohol drinking and asbestos exposure. Results No association was found between exposure to diesel motor exhaust and cancer of the oral cavity (OR=0.88, CI=0.65–1.18), oropharynx (OR=0.83, CI=0.65–1.10), hypopharynx (OR=0.84, CI=0.65–1.18) or larynx (OR=1.11, CI=0.86–1.43). There was no indication of increasing risk with increasing duration of exposure, for any of the cancer sites. Conclusion These findings do not provide evidence that occupational exposure to diesel motor exhaust increases the risk of oral, pharyngeal or laryngeal cancer.

International audience

International audience; Congress organisation: Public Health Research Institute (IReSP), Alliance for life sciences and health (Aviesan), National Research Agency on AIDS and viral hepatitis (ANRS), National Cancer Institute (INCa). Integrated and Comprehensive Health Interventions (ICHIs), also called Non Pharmacological Interventions (NPIs), have become essential solutions to improve health, quality of life and, often, life expectancy. Recent studies have also highlighted the positive social and economic impact. "ICHIs are non-invasive methods of care (programs, products or services) whose efficacy in improving the health and quality of life of human beings has been proven. Their effects on health and quality of life markers are observable (with measured risks and benefits beyond mere user opinions) and can be linked to identify biological and/or psychological processes. They can also have a positive impact on health behaviours and socio-economic indicators” (CEPS Platform, 2016). Many authors (e.g., Ioannidis, 2015) and health authorities argue that what has been brought forth is merely proof of concept (e.g., French Health Authority, 2011). They note the lack of a consensus paradigm of validation and surveillance, such as the standards in drug development. They highlight the methodology problems due to rapid obsolescence of ICHI using a digital solution (e.g., Mobile Apps). As a result, policy makers and health decision-makers remain skeptical of the impact of ICHIs. These key players are encouraging innovators to come forward with additional evidence for the efficacy and the cost/effectiveness of ICHIs in order to improve their visibility, and, ultimately, to garner more substantive private and public financial support for them. ICHIs need to be compared and optimized, as well as targeted to the right health problem at the right time. The first step will be to develop a collaborative top-down strategy to identify and classify these health interventions. The communication presents our strategy supported by French State, Occitanie Region, and Montpellier Metropole. The CEPS Platform: An European Academic Platform Dedicated to Research Methodology For NPIs / Universities of Montpellier, France / www.cepsplatform.eu

Objectives To investigate the associations between occupational exposure to refractory ceramic fibres (RCF) and the risk of lung and head and neck cancer. Methods We used data from ICARE, a population based case-control study conducted in France. Detailed lifetime tobacco and alcohol consumptions as well as complete occupational history were collected. Analyses were restricted to men and included 1867 cases of head and neck squamous cell carcinomas, 2276 lung cancer cases and 2780 controls. Occupational exposure to RCF was assessed through a specific job-exposure matrix. We estimated odds ratios (ORs) and 95% confidence intervals (CI), adjusted for age, residence area, tobacco smoking, alcohol drinking and cumulative exposure to asbestos with logistic models. Results Exposure to RCF was not associated with the risk of lung (OR = 0.9, CI = 0.7–1.2) or head and neck cancer overall (OR = 0.8, CI = 0.6–1.1) or for any of the cancer sites. There was no suggestion of a dose-response relationship with cumulative exposure. When we excluded subjects with the lowest probability of exposure, a non-significantly elevated risk was observed for lung cancer only (OR = 1.3, CI = 0.8–2.2). Co-exposure to asbestos and RCF did not increase the risk of respiratory cancer. For men exposed to both asbestos and RCF, the ORs were 1.8 (CI = 1.4–2.3) for lung cancer and 1.6 (1.2–2.0) for head and neck cancer, compared to respectively 1.7 (CI = 1.5–2.0) and 1.8 (CI = 1.5–2.1) for men exposed to asbestos alone. Since nearly all subjects exposed to RCF were also exposed to asbestos, an independent role of exposure to RCF could not be evaluated. Conclusion Even if a small excess risk cannot be excluded, our results do not provide evidence that exposure to RCF increases the risk of respiratory cancer.

Objectif Evaluer la relation entre l’exposition professionnelle aux fibres ceramiques refractaires (FCR) et le risque de cancer des voies aerodigestives superieures (VADS) et du poumon, en analysant les donnees d’une etude cas-temoins en population, l’etude Icare. Sujets et methodes Les analyses ont ete restreintes aux hommes, soit 1867 cas de cancer des VADS, 2276 cas de cancer du poumon et 2780 temoins. Les sujets ont ete interroges en face a face, a l’aide d’un questionnaire standardise comportant notamment les caracteristiques sociodemographiques, les consommations de tabac et d’alcool et l’histoire professionnelle complete. Les expositions professionnelles aux FCR et a l’amiante ont ete evaluees a l’aide de matrices emplois-expositions. Plusieurs variables d’exposition ont ete utilisees (probabilite, duree, exposition cumulee). Les odds ratios (OR) et les intervalles de confiance a 95 % (IC95 %) ont ete estimes par regression logistique, avec ajustement sur l’âge, les consommations de tabac et d’alcool et l’exposition a l’amiante. Resultats L’exposition professionnelle aux FCR n’est pas significativement associee au risque de cancer des VADS (OR = 0,83 ; IC95 % = 0,64–1,10) ou de cancer du poumon (OR = 0,91 ; IC95 % = 0,72–1,16). Apres exclusion des probabilites d’exposition les plus faibles, un OR non significativement augmente est observe pour le cancer du poumon uniquement (OR = 1,3 ; IC95 % = 0,8–2,2). Aucune relation n’est observee avec l’exposition cumulee. La prise en compte d’un temps de latence de 5, 10 ou 20 ans ne modifie pas les resultats. Il n’y a pas de difference significative entre les sous-localisations de cancer des VADS. L’effet d’une exposition exclusive aux FCR est difficile a evaluer, la quasi-totalite des sujets exposes aux FCR ayant ete egalement exposes a l’amiante. Le risque de cancer des VADS ou du poumon n’est cependant pas plus eleve chez les sujets exposes a la fois a l’amiante et aux FCR que chez les sujets exposes uniquement a l’amiante. Conclusion Globalement, meme si une augmentation moderee du risque ne peut pas etre exclue, les resultats ne sont pas en faveur d’une association entre exposition aux FCR et survenue de cancer des VADS ou du poumon.