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Background: Over the past few decades, the incidence of thyroid cancer has dramatically increased in many countries. This increase was mainly seen in papillary cancer. The role of diagnostic practices and the effects of other risk factors were suggested to explain this increase. We provide a descriptive analysis in terms of changes in incidence, geographical distribution, and survival to check the relevance of assumptions about the increase. Methods: A detailed analysis of changes in incidence recorded in French cancer registries between 1982 and 2010 was performed taking into account age, period, and birth cohort. The geographical distribution of the incidence in the 2006-2010 period was estimated from the standardized incidence ratios. The net survival was estimated to evaluate the effects of sex, age, and period of diagnosis in patients diagnosed between 1989 and 2004 and followed-up until 2013. Results: The incidence of papillary cancer has increased sharply over the 1982-2010 period; the average annual rate of increase was 7.8% in men and 7.2% in women. The increase has slowed in the recent period in people aged less than 50 at the time of diagnosis. It has also slowed in the cohorts born 1945 and after. There was a strong geographic disparity in incidence between areas covered by cancer registries. Finally, the net survival was very high; the 10-year net survival was 96% and improved progressively from 82% in patients diagnosed between 1989 and 1993 to 95% in those diagnosed between 1999 and 2004. Conclusion: The increased incidence results most probably from the effect of medical practice, although other risk factors seem also involved, but to a lesser extent. The increase seems to have slowed down in the recent years, especially in the youngest age groups. This observation suggests a recent trend towards saturation of the effects of medical practices in post-1945 cohorts associated with an effect of the gradual dissemination of the recommendations relative to the management of thyroid nodules. [ABSTRACT FROM AUTHOR]

Abstract: Background: We investigated factors explaining low breast cancer screening programme (BCSP) attendance taking into account a European transnational ecological Deprivation Index. Patients and methods: Data of 13,565 women aged 51–74years old invited to attend an organised mammography screening session between 2010 and 2011 in thirteen French departments were randomly selected. Information on the women's participation in BCSP, their individual characteristics and the characteristics of their area of residence were recorded and analysed in a multilevel model. Results: Between 2010 and 2012, 7121 (52.5%) women of the studied population had their mammography examination after they received the invitation. Women living in the most deprived neighbourhood were less likely than those living in the most affluent neighbourhood to participate in BCSP (OR 95%CI=0.84[0.78–0.92]) as were those living in rural areas compared with those living in urban areas (OR 95%CI=0.87[0.80–0.95]). Being self-employed (p <0.0001) or living more than 15min away from an accredited screening centre (p =0.02) was also a barrier to participation in BCSP. Conclusion: Despite the classless delivery of BCSP, inequalities in uptake remain. To take advantage of prevention and to avoid exacerbating disparities in cancer mortality, BCSP should be adapted to women's personal and contextual characteristics. [Copyright &y& Elsevier]

Background Reasons for asthma hospitalizations are dynamic and complex. Comorbid conditions are important contributors to most chronic diseases today. We aim to characterize and describe risk factors associated with hospitalizations due to asthma in the Languedoc-Roussillon region (France) in 2009. Methods Programme de Médicalisation des Systèmes d'Information ( PMSI) data records from 2009 were sorted using selected International Classification of Diseases ( ICD10) codes eliciting three groups of asthma hospitalizations according to acute severity. All available data including demographics, comorbid conditions, past hospitalizations either related or unrelated to asthma, seasonality and distance to medical facilities were used to compare the subjects within the three groups. Results One thousand two hundred and eighty-nine hospitalizations due to asthma exacerbation were found, concerning 1122 patients. We observed significant differences within the groups, using univariate analysis, concerning duration of hospitalizations (mean ± SD, 4.9 ± 5.9 days vs 6.4 ± 6.8 vs 15.8 ± 16.8, P < 0.001), deaths (percentage, 0.03% vs 1.50% vs 9.20%, P < 0.001) and numbers of comorbid conditions (0.80 ± 0.95 vs 0.75 ± 0.97 vs 1.74 ± 1.36, P < 0.001). Recurrent admissions for asthma during the period 2006-2008 were significantly more frequent in the more severe group (1.93 ± 3.91 vs 2.56 ± 4.47 vs 2.81 ± 3.97, P = 0.006). In the multivariate model, age and number of comorbid conditions were independently associated with severe hospitalizations and deaths. Conclusions Asthma hospitalizations can be appropriately assessed using PMSI coding databases. In this study, age and the presence of comorbid conditions are the major risk factors for asthma hospitalizations and deaths. [ABSTRACT FROM AUTHOR]

The article presents a study which determines the incident of multiple sclerosis (MS) in France from November 2000 to October 2007. The study uses Bayesian approach, statistical analysis, and disease mapping to estimate the incidence of MS and its geographic variations. Results show that the notification rate was higher in north-eastern France than in Atlantic coast, Alps, and Rhône River.

The knowledge of Mycobacterium avium complex (MAC) genotypes responsible for lymphadenitis is limited. We retrospectively characterized all of the MAC isolates made in our laboratory in the last 18 years by sequence-based identification and genotyping, and compared the clinical and laboratory data for lymphadenitis-associated and non-lymphadenitis-associated MAC isolates. Of 67 MAC-infected patients, 25 lymphadenitis patients were significantly younger than 42 non-lymphadenitis patients, while the male/female ratio did not significantly differ between the two groups. Cervical topography found in 76.5% of lymphadenitis patients was significantly more frequent in non-immunocompromised patients ( p = 0.04). M. avium subsp. hominissuis was identified in 53 patients (24 lymphadenitis, 29 non-lymphadenitis), M. colombiense in six patients (five non-lymphadenitis, one lymphadenitis), M. intracellulare in four non-lymphadenitis patients, and M. chimaera in three non-lymphadenitis patients, while negative controls remained negative. M. hominissuis was significantly associated with lymphadenitis ( p = 0.03). M. hominissuis isolates yielded 15 genotypes in 29 non-lymphadenitis isolates (molecular diversity, 0.622) versus 11 genotypes in 24 lymphadenitis isolates (molecular diversity, 0.578), demonstrating a non-significant lower diversity of M. hominissuis isolates cultured from lymphadenitis. The genotypes did not correlate with the clinical features. These data suggest the presence of several environmental reservoirs for M. hominissuis causing lymphadenitis in France. [ABSTRACT FROM AUTHOR]

Abstract: This article aimed to detect clusters of amyotrophic lateral sclerosis (ALS) and their relationships with exposure of the population to various environmental factors in the Limousin region of France. Methods used were extensively described. We adopted a geographical approach that revealed variations in the incidence of ALS and permitted us to identify three regional clusters and their spatial spread. We considered environmental factors and the potent locations or source of substances or activities hypothesized to be associated with ALS. Notably, we determined which industrial activities seem to affect the incidence of ALS in Limousin. The results were interpreted at a regional level. Among the 50 factors this article considered, paper paste and water treatment plants were particularly geostatistically significant and deserve special attention in the ongoing investigations into high resolution spatial clusters (geographical and epidemiological studies). [Copyright &y& Elsevier]

OBJECTIVE: To analyze, at a population level, the relation between the incidences of benign thyroid diseases in patients submitted to surgery and that of thyroid cancers based on their respective geographical distributions. METHODS: The study included 3169 cases (691 cancers and 2478 benign diseases) operated on in 2002 in the Rhône-Alpes région, which is subdivided into eight départements and 311 cantons. RESULTS: The total thyroid intervention rate was 54.6/100 000 (23.4 and 86.4), and the annual cancer incidence was 11.9/100 000 (4.7 and 13.8) for men and women respectively. The prevalence of cancer among thyroid surgery was 21.8% and that of cancer discovered in goiters increased with age (44% at 60 years). Intervention rates varied from départment to département. In women, the incidence of microcancers was correlated to the thyroid intervention for benign pathologies rate. In men, the incidence of supracentimetric cancers was related to the TIBR. At the canton level, the relative risk of benign diseases was correlated to that of cancers. TIBR and incidence of cancers were higher in urban cantons than in nonurban ones. The density of endocrinologists influenced the prevalence of cancers among all the cases submitted to surgery. CONCLUSION: In the Rhône-Alpes population with high rates of thyroid cancer incidence and of thyroid surgery, a number of correlations were found according to gender and tumor size. However, the general incidence of cancer was not directly related to surgical activity. Geographical variability may be related to the heterogeneous medical and pathological practices. [ABSTRACT FROM AUTHOR]

Abstract: Lindane is a persistent organochlorine insecticide and the use of this insecticide in agriculture was banned in France in 1998. In this study we investigated the concentrations of lindane in topsoil in Northern France and used robust geostatistics to map the geographical distribution of lindane. The study was based on a 16km×16km grid covering an area of ca 25000km2. Lindane was found in all soils, even those from non-agricultural-application areas. Very low ratios of α-/γ-HCH and δ-/γ-HCH suggested that a long time had passed since technical HCH was used in the studied area, or that emission sources of lindane were still present. A strong gradient in lindane concentration was observed, with the highest lindane concentrations in an area located in the northern region. Results suggested that some of the lindane observed in the high concentration area may have come from volatilization of old lindane applied to intensively cultivated areas, which was then transported by prevailing winds coming from the south-west and deposited in a densely inhabited depression. [Copyright &y& Elsevier]

OBJECTIVE: The aim of the present study was to determine recent trends in thyroid cancer incidence rates and to analyze histopathological characteristics and geographical distribution. METHODS: Histologically proven 5367 cases were collected over the period 1998–2006 in France from the Rhône-Alpes thyroid cancer registry. Geographical variations of incidence were analyzed using a mixed Poisson model. RESULTS: The average incidence rates, age standardized to the world population, were 3.9/100 000 in men and 12.3/100 000 in women, higher than those previously reported in France. After an initial increase during the first 3 years, a steady level of incidence was observed for the period 2001–2006. The annual incidence rate of microcarcinomas was correlated with that of all cancers in men and women (r=0.78 and 0.89; P<0.01) respectively. Papillary microcarcinomas represented 38% of tumors and two-thirds of them measured less than 5 mm in diameter. They were fortuitously discovered after thyroidectomy for benign diseases in 64% of cases. Histological marks of aggressiveness differed according to the size of the tumor. Despite recent advances in diagnosis, 13% of tumors were diagnosed at advanced stage especially in men. Geographical distribution of incidence based on subregional administrative entities showed lower incidence rates in rural than in urban zones in men (relative rate: 0.72; 95% CI: 0.62–0.84) and women (relative rate: 0.85; 95% CI: 0.73–0.93). CONCLUSION: The present study suggests that the rise in thyroid cancer incidence is now abating. It could reflect standardization in diagnostic procedures. Further studies, performed on a more prolonged period, are necessary to confirm these data. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Examiner la consommation de soins et la qualité de vie (utilité) sur un échantillon de patients présentant tout l’éventail des caractéristiques de la maladie, des modalités de prise en charge et de leur répartition géographique. Méthodes: Les informations sur la démographie, les paramètres de la maladie, la capacité à travailler et la consommation de ressources (au cours du dernier mois, ou des trois ou 12 derniers mois selon les cas) ont été collectées par un sondage anonyme envoyé par courrier à tous les membres d’une association nationale de patients (ANDAR). Les résultats sont présentés pour l’échantillon et par niveau de capacité fonctionnelle et sont exprimés en euros (€) pour l’année 2005. Résultats: Mille quatre cent quatre-vingt-sept patients ont été inclus dans l’analyse (taux de réponse 49 %). L’âge moyen était de 62,7 ans et 83,5 % des personnes ayant répondu étaient des femmes. La durée moyenne de la maladie était de 18 ans ; la moyenne du score du health assessment questionnaire (HAQ) était de 1,42 ; la fatigue et la douleur étaient respectivement classées à 5,6 et à 4,8 sur une échelle de 0 à 10. Parmi les patients de moins de 60 ans, 34 % ont pris leur retraite prématurément à cause de la PR, et seulement 15 % des patients avec un HAQ de 2 ou plus travaillaient. La perte de productivité a été estimée à 5 076€, dont le paiement des indemnités couvrait 1944€. Les coûts des soins de santé directs étaient de 11757€ du point de vue de la société et de 9 216€ selon l’Assurance maladie. Les coûts non médicaux directs (incluant les soins informels) étaient, respectivement, de 4857 et 136€. Les coûts pour la société passaient de 9 400€ dans le cas d’une maladie modérée à 40 700€ en cas de pathologie sévère, et pour les services publics de 6000 à 19 000€. L’utilité diminuait simultanément de 0,80 à 0,06. Conclusion: Cette étude confirme les conclusions générales obtenues au cours d’autres études dans différents pays et apporte une première estimation des coûts globaux selon le degré de sévérité de la maladie en France. [Copyright &y& Elsevier]

This article broadly positions the successful establishment of the field of French tropical geography in the immediate postwar period against developments stemming from a longer history of French colonial engagement in Africa, Asia and South America, and clarifies the seemingly late timing of, and paradoxes involved in, the creation of a body of French scientific knowledge about the tropics. Colonial scientific research did not develop in France until the end of the nineteenth century. However, the colonial geography appearing at this time did not rely on fieldwork but, rather, catered to the demands of the business class for overseas expansion and to public curiosity. Even while the medical geography of tropical areas and knowledge of tropical soils and ecology progressed greatly between 1900 and 1940, there were still only a few French geographers working in the tropics. With the advent of the Second World War, when “big science” appeared in France and its colonial empire, the number of French geographers involved in tropical research grew rapidly. The field of tropical geography built up by Pierre Gourou was a synthesis of approaches developed in South America, Africa and Indochina. Although it soon came under strong criticism for its pessimistic view of prospects for industrialisation and urbanisation in the tropics, it seduced French geographers because it matched the contemporary interest in zonality and relied on a genre de vie analysis of, typically, rural areas. Thus, the postwar blossoming of tropical geography shaped by Gourou was more a response to various internal dynamics within French geography than an exercise in imperialism. Its demise was not due to the eclipse of French colonialism but, rather, its inability to deal with the modernisation of tropical societies. [ABSTRACT FROM AUTHOR]

Focuses on the development of medical geography in France. History of the use of the term medical geography; Fundamental questions about the geographical associations of diseases; Problems confronting the development of geography by French-language authors.

Abstract: The incidence of adult brain cancer was previously shown to be higher in countries where the parasite Toxoplasma gondii is common, suggesting that this brain protozoan could potentially increase the risk of tumor formation. Using countries as replicates has, however, several potential confounding factors, particularly because detection rates vary with country wealth. Using an independent dataset entirely within France, we further establish the significance of the association between T. gondii and brain cancer and find additional demographic resolution. In adult age classes 55years and older, regional mortality rates due to brain cancer correlated positively with the local seroprevalence of T. gondii. This effect was particularly strong for men. While this novel evidence of a significant statistical association between T. gondii infection and brain cancer does not demonstrate causation, these results suggest that investigations at the scale of the individual are merited. [Copyright &y& Elsevier]

AbstractA precise assessment of the epidemiological extent of equine Lyme disease is not well established in metropolitan France, French Guiana, and Africa (Chad, Djibouti, Ivory Coast, Gabon, and Democratic Republic of Congo). Blood samples were obtained from 570 horses. The samples were tested for Borrelia burgdorferiinfection by a commercial ELISA Dot-Blot method (SNAP®4 Dx; IDEXX S. Laboratory). Lyme disease antibodies were only detected in metropolitan France, specifically in the eastern and center-western regions (48% and 31%). The geographical distribution of the disease follows the distribution of the vector. [ABSTRACT FROM AUTHOR]

Objective: To compare rates of pediatric hospital utilization across seven European countries., Methods: Secondary data from WHO's European Hospital Morbidity Database from 2009 to 2012. Cross- country comparison of rates of admissions and bed days per 100 person-years by clinical service. We tabulated counts of admissions and bed days by principal diagnosis and age group for Ireland, Austria, Hungary, Belgium, Spain, Germany, and France. ICD 9 or ICD 10 or ISHMT diagnosis codes were allocated to clinical services. Normal newborn admissions were excluded from the analysis. Simple linear regression models, weighted by pediatric population size, were constructed to estimate the relationships between health care utilization and factors that may influence variation in care., Results: Hospital admission across the seven countries ranged from 9.41 (Spain) to 19.59 (Germany) admissions per 100 person-years. Bed days ranged from a low of 52.50 (Spain) to 135.44 (Germany) per 100 person-years. General pediatrics and neonatology led in clinical volume across all countries. Infectious disease admissions were the third most common. Bed supply and nurse supply were positively associated with health care utilization. Out-of-pocket payment was inversely associated with health care utilization CONCLUSIONS: A wide range of utilization of pediatric inpatient care was observed across seven European countries that have universal coverage. Variation in the provision of effective, supply-sensitive, and preference-sensitive care may explain some of the variations. Our study shows that it is probable that preventable hospital admissions are occurring in the pediatric population., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In teasing out the diverse origins of our "modern, ecological understanding of epidemic disease" (Mendelsohn, in: Lawrence and Weisz (eds) Greater than the parts: holism in biomedicine, 1920-1950, Oxford University Press, Oxford, 1998), historians have downplayed the importance of parasitology in the development of a natural history perspective on disease. The present article reassesses the significance of parasitology for the "invention" of medical ecology in post-war France. Focussing on the works of microbiologist Charles Nicolle (1866-1936) and on that of physician and zoologist Hervé Harant (1901-1986), I argue that French "medical ecology" was not professionally (or cognitively) insulated from some major trends in parasitology, especially in Tunis where disciplinary borders in the medical sciences collapsed. This argument supports the claim that ecological perspectives of disease developed in colonial context (Anderson in Osiris 19: 39-61, 2004) but I show that parasitologists such as Harant built on the works of medical geographers who had called attention to the dynamic and complex biological relations between health and environment in fashioning the field of medical ecology in the mid-1950s. As the network of scientists who contributed to the global emergence of "disease ecology" is widening, both medical geography and parasitology stand out as relevant sites of inquiries for a broader historical understanding of the multiple "ecological visions" in twentieth-century biomedical sciences. [ABSTRACT FROM AUTHOR]

The Eurasian wild boar (Sus scrofa) is increasingly considered as a relevant actor in the epidemiology of animal tuberculosis (TB). Therefore, monitoring TB in wild boar becomes a key tool for establishing comprehensive control schemes for this disease. To estimate the exposure of free living wild boar to Mycobacterium tuberculosis complex (MTC) in France, a bovine-purified protein derivative based ELISA was used to test 2,080 archived serum samples of hunter-harvested animals in 58 French “départements”. Two cut-off values were used for diagnostic interpretation: 0.2, recommended by the manufacturer (specificity: 96.43%; sensitivity: 72.6%), and 0.5 (specificity: 100%; sensitivity: 64%). During the same period, at the 0.2 cut-off, global true seroprevalence was 5.9% (IC95%: 4.3%-7.7%) and 76% of the sampled “départements” had seropositive wild boar, including seven cattle TB-free “départements. At the 0.5 cut-off, global true seroprevalence was 2.2% (IC95%: 1.5-3.2) and positive wild boar belonged to 21% of the “départements”. All but one of these positive “départements” had reported at least one cattle TB outbreak since 2000. A good consistence between seropositive wild boar and TB outbreaks in cattle was found, especially at the 0.5 cut-off value (the mean distance to the nearest cattle TB outbreak was 13km and 27km for seropositive and seronegative wild boar, respectively; P<0.05). The use of an ELISA to detect MTC antibodies in wild boar has permitted the description of the geographic distribution of MTC contact in wild boar in France. Our results suggest that the ELISA could be used as a first screening tool to conduct TB surveillance in wild boar at a population level. High-risk wild boar populations (e.g. overabundant) could be tested and if identified positive by ELISA they should be surveyed in detail by combining pathology and culture. [ABSTRACT FROM AUTHOR]

Summary: Aedes albopictus (Tiger mosquito) lives mostly in urban areas. The females lay their eggs in containers close to the stagnant water. Aedes albopictus is spreading worldwide, helped by international transports of tires. In metropolitan France, it has settled down in the French Riviera since 2004, in Corsica since 2006. It is also present in other Mediterranean countries like Italy and Spain. Since Italian outbreak in summer 2007, the risk to acquire an autochthonous chikungunya or dengue diseases in France is high. To limit that risk, the French Health Ministry elaborated in 2006, a national programme. This plan includes preventive actions for patients suspected of chikungunya or dengue after having come back from a tropical area. [Copyright &y& Elsevier]