Rural–urban inequalities in detection rates of colorectal tumours in the population

Abstract Background Because few data are available on this topic, we investigated the influence of geographical determinants on colorectal adenoma detection and cancer incidence rates. Methods Between 1990 and 1999, 6220 Cote d’Or inhabitants (France) were first-diagnosed with a colorectal adenoma, and 2389 with an invasive adenocarcinoma. The impact of the rural–urban place of residence and of a physician location in municipalities on adenoma and cancer detection rates was studied using Poisson regression. Results World-standardized adenoma detection rate was significantly higher in urban areas (102 [95%CI: 97–107]) than in rural areas (78 [95%CI: 72–84]). The impact of the absence of phys…

Low preoperative cholesterol level is a risk factor of sepsis and poor clinical outcome in patients undergoing cardiac surgery with cardiopulmonary bypass.

Systemic inflammatory response syndrome and sepsis frequently occur after cardiac surgery with cardiopulmonary bypass. The aim of the present study was to investigate whether preoperative cholesterol levels can predict sepsis onset and postoperative complications in patients undergoing cardiac surgery with cardiopulmonary bypass.Prospective observational study.Surgical ICU of a French university hospital.Two hundred and seventeen consecutive patients older than 18 years admitted for planned cardiac surgery with cardiopulmonary bypass.Measurements of plasma blood lipids and inflammation markers before anesthesia induction (baseline), at cardiopulmonary bypass start, at cardiopulmonary bypass…

Social deprivation and 1‐year survival after stroke: a prospective cohort study

BACKGROUND Social deprivation may have a deleterious influence on post-stroke outcomes, but available data in the literature are mixed. AIM The aim of this cohort study was to evaluate the impact of social deprivation on 1-year survival in patients with first-ever stroke. METHODS Social deprivation was assessed at individual level with the EPICES score, a validated multidimensional questionnaire, in 1312 patients with ischemic stroke and 228 patients with spontaneous intracerebral hemorrhage, who were prospectively enrolled in six French study centers. Baseline characteristics including stroke severity and pre-stroke functional status were collected. Multivariable Cox models were generated …

Post-Stroke Cognitive Impairment: High Prevalence and Determining Factors in a Cohort of Mild Stroke

BACKGROUND Because of the aging population and a rise in the number of stroke survivors, the prevalence of post-stroke cognitive impairment (PSCI) is increasing. OBJECTIVE To identify the factors associated with 3-month PSCI. METHODS All consecutive stroke patients without pre-stroke dementia, mild cognitive disorders, or severe aphasia hospitalized in the Neurology Department of Dijon, University Hospital, France (November 2010 - February 2012) were included in this prospective cohort study. Demographics, vascular risk factors, and stroke data were collected. A first cognitive evaluation was performed during the hospitalization using the Mini-Mental State Exam (MMSE) and the Montreal Cogni…

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

International audience; INTRODUCTION: Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. METHODS: The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital i…

Empirical study of the dependence of the results of multivariable flexible survival analyses on model selection strategy

Flexible survival models, which avoid assumptions about hazards proportionality (PH) or linearity of continuous covariates effects, bring the issues of model selection to a new level of complexity. Each ‘candidate covariate’ requires inter-dependent decisions regarding (i) its inclusion in the model, and representation of its effects on the log hazard as (ii) either constant over time or time-dependent (TD) and, for continuous covariates, (iii) either loglinear or non-loglinear (NL). Moreover, ‘optimal’ decisions for one covariate depend on the decisions regarding others. Thus, some efficient model-building strategy is necessary. We carried out an empirical study of the impact of the model …

Impact du tabagisme sur le pronostic fonctionnel après AVC ischémiques en fonction de la précarité, une étude de cohorte prospective

Etat de la question Bien que le tabagisme soit un facteur de risque connu des accidents vasculaires cerebraux (AVC) ischemiques, son influence sur le pronostic post-AVC demeure controverse. Ces disparites peuvent etre expliquees par la presence de facteurs de confusion insuffisamment pris en compte, notamment la precarite. Cette etude visait a evaluer l’impact conjoint de la precarite et du tabagisme sur le pronostic fonctionnel apres un AVC ischemique en s’appuyant sur les donnees de l’etude de cohorte prospective INDIA (Inegalites sociales et pronostic des patients hospitalises pour AVC dans quatre departements francais contrastes). Materiel et methodes De 2010 a 2014, 1536 patients avec …

Cost-effectiveness of screening for colorectal cancer in France using a guaiac test versus an immunochemical test

Objectives: The aim of this study was to compare the cost and the effectiveness of two biennial fecal occult blood screening tests for colorectal cancer: a guaiac nonrehydrated test (G-FOBT) and an immunochemical test (I-FOBT) with the absence of screening.Methods: A Markov model was developed to compare these strategies in a general population of subjects aged 50 to 74 over a 20-year period.Results: Compared with the absence of screening, G-FOBT and I-FOBT were associated with a decrease in colorectal cancer mortality of 17.4 percent and 25.2 percent, respectively. With regard to cost-effectiveness, expressed as cost per life-year gained, I-FOBT was the most effective and most costly alter…

Mitochondrial D310 mutations in colorectal adenomas: an early but not causative genetic event during colorectal carcinogenesis.

Somatic mutations of the D310 sequence of the mitochondrial DNA are reported in human cancers, including colorectal cancers (CRC). The presence of these mutations at early or late steps of colorectal carcinogenesis is unknown. Their prevalence increased significantly with the number of cytosines in the D310 sequence of the matched normal tissue (D310 polymorphism), suggesting that this polymorphism could be a risk factor for CRC. The aim of this study was (i) to investigate the prevalence of D310 mutations in 64 colorectal adenomas and 36 liver metastases from 15 CRC patients, (ii) to assess the relation between D310 polymorphism and the risk of colorectal adenoma in a case-control study in…

Colonoscopic screening of first-degree relatives of patients with large adenomas: increased risk of colorectal tumors.

International audience; Background & Aims: The risk of developing colorectal neoplasia is not well established among family members of individuals with large adenomas and screening strategies remain under debate in this population. This study aimed at quantifying the risk of colorectal adenomas and cancers using colonoscopic screening in first-degree relatives of patients with large adenomas. Methods: This case-control study was performed in 18 endoscopic units of French non-University Hospitals. A colonoscopy was offered to first-degree relatives of 306 index cases with adenomas ≥ 10 mm, if they were alive, aged 40-75 and could be contacted by the index case. Among 674 relatives meeting th…

Dietary patterns and the risk of colorectal adenoma recurrence in a European intervention trial

The relations between individual foods and nutrients to colorectal tumours are conflicting. Few studies have taken into account the interdependence between individual components of diet and their possible interactions. The aim of the study was to examine the associations between dietary patterns and the risk of colorectal adenoma recurrence in the European fibre-calcium intervention trial. Among the 640 patients with confirmed adenomas at the index colonoscopy, 592 had an initial dietary assessment using a diet history questionnaire. The present analysis was restricted to 277 men and 165 women without history of adenoma prior to the index colonoscopy and who completed the study. The main en…

Long-term effect of faecal occult blood screening on incidence and mortality from colorectal cancer

Abstract Background Several randomized trials have shown a reduction of colorectal cancer mortality by screening using guaiac-based faecal occult blood tests. However, little is known on the long-term effect of screening at the population level in everyday practice. Methods Small-sized geographic areas including a total of 91,199 individuals were allocated to either biennal screening using the Hemoccult-II test or no screening. The expected mortality and incidence in the cohort invited to screening was determined using mortality and incidence in the non-screened population. Results Colorectal cancer mortality was significantly lower in the population invited to screening than in the non-scr…

Disparités du taux de détection des adénomes colorectaux en fonction du lieu de domicile et de la distance aux médecins en Côte-d’Or, entre 1990 et 1999

Contribution of molecular analyses in diagnosing Marfan syndrome and type I fibrillinopathies: an international study of 1009 probands.

International audience; BACKGROUND: The diagnosis of Marfan syndrome (MFS) is usually initially based on clinical criteria according to the number of major and minor systems affected following international nosology. The number of FBN1 mutation carriers, at risk of aortic complications who would not be properly diagnosed based only on clinical grounds, is of growing importance owing to the increased availability of molecular screening. The aim of the study was to identify patients who should be considered for FBN1 mutation screening. METHODS: Our international series included 1009 probands with a known FBN1 mutation. Patients were classified as either fulfilling or not fulfilling "clinical"…

Les facteurs pronostiques du traumatisme sévère en fonction de la sévérité de l’atteinte thoracique

Etat de la question Le traumatisme severe est associe a un risque eleve de morbidite et de mortalite. L’atteinte thoracique est souvent presente. Le but de l’etude etait de determiner si les facteurs pronostiques du traumatisme severe sont modifies par la severite de l’atteinte thoracique. Materiel et methodes Une analyse ancillaire de l’etude FIRST, une cohorte multicentrique incluant des patients ayant un traumatisme severe necessitant une admission a dans l’une des reanimations des centres hospitalo-universitaires (CHU) participants dans les 72 heures post-traumatiques. Les patients admis initialement dans un hopital general ont ete exclus. Resultats Parmi les 2052 patients analyses, 583…

Analyse de l’impact des facteurs socioéconomiques sur la sévérité initiale des accidents vasculaires cérébraux en France métropolitaine et aux Antilles (étude INDIA)

Introduction Malgre un systeme de sante tres favorable, les inegalites sociales de sante se sont creusees en France au cours des deux dernieres decennies. En depit de cette situation, l’impact des facteurs socioeconomiques a ete peu etudie a l’echelle individuelle sur le territoire francais et les donnees a meme de mobiliser les acteurs restent insuffisantes. Par ailleurs le retentissement des AVC sur l’etat de sante des francais est considerable : premiere cause de handicap de l’adulte, deuxieme cause de demence, troisieme cause de mortalite. De plus, le niveau socioeconomique, par son impact sur les facteurs de risque d’AVC, est susceptible d’affecter les manifestations cliniques initiale…

Flexible statistical models provided new insights into the role of quantitative prognostic factors for mortality in gastric cancer.

Abstract Objectives To reassess the effects of prognostic factors on mortality in gastric cancers, and to illustrate the advantages of flexible modeling. Study Design and Setting A prospective population-based cohort of persons diagnosed with gastric cancers in 1976 to 1995 in Burgundy, France, was followed for 5 years since diagnosis. Multivariable survival analyses, stratified by cancer stage, involved both conventional Cox's model and its flexible generalization, which permitted testing the underlying assumptions and accounting for changes over time in the effects of prognostic factors. Results Conventional assumptions of proportional hazards (PH) (P = 0.003) and linear increase in risk …

Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

International audience; IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used…

Impact of emergency medical helicopter transport directly to a university hospital trauma center on mortality of severe blunt trauma patients until discharge

International audience; IntroductionThe benefits of transporting severely injured patients by helicopter remain controversial. This study aimed to analyze the impact on mortality of helicopter compared to ground transport directly from the scene to a University hospital trauma center.MethodsThe French Intensive Care Research for Severe Trauma cohort study enrolled 2,703 patients with severe blunt trauma requiring admission to University hospital intensive care units within 72 hours. Pre-hospital and hospital clinical data, including the mode of transport, (helicopter (HMICU) versus ground (GMICU), both with medical teams), were recorded. The analysis was restricted to patients admitted dire…

Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

BACKGROUND: Congenital toxoplasmosis (CT) can elicit severe damage to several organs, especially the eye, and may be manifested at birth or later. We assessed the long-term ocular prognosis in a cohort of congenitally infected children treated according to a standardized protocol and monitored for up to 22 years. METHODS: This prospective study included confirmed cases of CT, which were identified by obligatory antenatal screening at the Lyon (France) reference center between 1987 and 2008. Data obtained through ocular examinations were recorded on a standardized form and confirmed by an independent external committee. Risk factors for retinochoroiditis were identified by using a multivari…

High prevalence of arrhythmic and myocardial complications in patients with cardiac glycogenosis due to PRKAG2 mutations

International audience; AIMS: Mutations in PRKAG2, the gene encoding for the γ2 subunit of 5'-AMP-activated protein kinase (AMPK), are responsible for an autosomal dominant glycogenosis with a cardiac presentation, associating hypertrophic cardiomyopathy (HCM), ventricular pre-excitation (VPE), and progressive heart block. The aim of this study was to perform a retrospective time-to-event study of the clinical manifestations associated with PRKAG2 mutations.METHODS AND RESULTS: A cohort of 34 patients from 9 families was recruited between 2001 and 2010. DNA were sequenced on all exons and flanking sequences of the PRKAG2 gene using Sanger sequencing. Overall, four families carried the recur…

Dietary fatty acids and recurrence of colorectal adenomas in a European intervention trial.

Epidemiological studies have provided inconsistent data about the role of dietary fatty acids in colorectal cancer, and few studies have addressed their role in colorectal adenoma. The aim of the study was to assess the risk of overall adenoma recurrence associated with dietary consumption of total fat, subtypes of fat, and specific fatty acids (oleic acid, linoleic acid, alpha-linolenic acid). The study sample was composed of 523 patients with confirmed adenomas at the index colonoscopy, 35 to 75 yr old, who completed the European fiber-calcium intervention trial and had an initial dietary assessment using a qualitative and quantitative food questionnaire. The overall 3-yr recurrence rate …

Rural–urban differences in the long-term risk of colorectal cancer after adenoma removal: A population-based study

Abstract Background We investigated the impact of municipality of residence on colonoscopic surveillance and colorectal cancer risk after adenoma resection in a French well-defined administrative area. Methods This registry-based study included all patients residing in Cote d’Or (n = 5769) first diagnosed with colorectal adenomas between January 1, 1990, and December 31, 1999. Information about colonoscopic surveillance and colorectal cancer incidence was collected until December 31, 2003. Results A rural place of residence reduced the probability of colonoscopic surveillance in men [HR = 0.89 (95%CI: 0.79–0.99), p = 0.041] and in patients without family history of colorectal cancer [HR = 0…

The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients.

Abstract Purpose We tested the hypothesis that the motor component of the Glasgow Coma Scale (GCS) conveys most of the predictive information of triage scores (Triage Revised Trauma Score [T-RTS] and the Mechanism, GCS, Age, arterial Pressure score [MGAP]) in trauma patients. Method We conducted a multicenter prospective observational study and evaluated 1690 trauma patients in 14 centers. We compared the GCS, T-RTS, MGAP, and Trauma Related Injury Severity Score (reference standard) using the full GCS or its motor component only using logistic regression model, area under the receiver operating characteristic curve, and reclassification technique. Results Although some changes were noted f…

How do gastroenterologists follow patients with colorectal cancer after curative surgical resection? A three-year population-based study

Summary Objectives To assess the contribution of gastroenterologists (GEs) to the surveillance of colorectal cancer after curative surgery. Patients and methods This registry-based study included 407 patients residing in two French administrative areas diagnosed with newly diagnosed colorectal cancer in 1998 and free of disease six months after curative surgery. All surveillance examinations performed either in the three years after surgery or until death or recurrence were collected retrospectively. Results One hundred nine patients (27%) had a regular clinical check-up with a GE at least once a year. Factors independently associated with GE follow-up were young age (P=0.004), use of adjuv…

Determinants of helicopter benefit for the transport of severe trauma patients

Recently, Galvagno commented on the paper of Andruszkow and colleagues and summarized the studies using multivariate logistic regression to compare helicopter transport (HT) versus ground transport of trauma patients [1,2]. The authors did not mention our analysis of 1,958 trauma patients (26% transported by HT) specifically performed to investigate the influence of the mode of transport from the database of the French Intensive care Recorded in Severe Trauma study [3,4]. Compared with ground transport, HT patients were more intensively treated in the prehospital phase. The need for emergency surgical procedures and overall head surgical procedures until discharge from hospital were higher …