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Study design:Cross-cultural adaptation and reliability study.Objective:To translate, evaluate the reliability and cross-culturally adapt the Skin Management Needs Assessment Checklist (SMnac), a questionnaire evaluating the knowledge on pressure ulcer (PU) prevention measures in persons with spinal cord injury (SCI).Subjects:138 persons with SCI, mean age 45.9 years, mean time since injury 94 months.Material and method:The study was carried out in two stages. First, the questionnaire went through a forward-backward translation process and was cross-culturally adapted, according to a validated methodology for self-reported measures. Then, the test-retest reliability was evaluated on a population of persons with SCIResults:The standardized back-translation and cross-cultural adaptation led to the revised Smack grid, with the addition of seven items representing an update of PU prevention measures. The reliability was excellent (intraclass correlation coefficient: 0.899).Conclusion:The revised SMnac is an adaptation of the SMnac, including therapeutic education frameworks and the latest PU prevention practices. It appears to be a reliable tool for assessing the knowledge and benefits of PU prevention in persons with SCI. Further studies are needed to explore its validity and responsiveness to change. [ABSTRACT FROM AUTHOR]

Aims To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with ≥ 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated. Methods Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5–4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis. Results Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI ( P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7–18.5)]. Low-density lipoprotein cholesterol ≥ 3.35 mmol/l [OR (95% CI) = 7.3; 1.5–34.7] and age > median [OR (95% CI) = 6.0 (1.2–28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides ≥ 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8–8.8)]. Conclusions Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention. Diabet. Med. (2006) [ABSTRACT FROM AUTHOR]

Objective: To assess time trends in symptoms of asthma, allergic rhinitis and atopic eczema among adolescents in Languedoc Roussillon, France. Methods: Two cross-sectional surveys were conducted 7 years apart using the same protocol. School-based samples of 3383 participants in the 1995 survey and 1642 participants in the 2002 survey respectively were recruited. Results: There was a tendency towards stagnation in current symptoms of asthma, rhinoconjunctivitis and eczema. Indices related to lifetime diagnosis of asthma, hay fever and eczema increased. For all the conditions, indices of severity also showed a decrease in the 7-year study period. Conclusions: Our study shows that symptoms of asthma, allergic rhinitis and eczema were stable, supporting the effectiveness of national asthma prevention and management guidelines for such diseases. The increase in indices related to lifetime diagnosis could be the result of increased public and professional awareness of the diseases and changes in diagnostic labelling in recent years. [ABSTRACT FROM AUTHOR]

In order to assess the impact of tobacco smoking on nasal quality of life, a cross-sectional pilot study was carried out on 185 sales representatives from all regions of France during their yearly seminar. Tobacco smoking is thought to induce nasal symptoms which may impair quality-of-life but there is no study which has analyzed the impact of tobacco smoking in normal subjects or patients with allergic rhinitis. Thirty-eight subjects had a previous diagnosis of allergy made by a physician with skin tests and/or serum-specific Immunoglobulin E.

Highlights • After pressure ulcer surgery, the risk of recurrence remains constant during the first 4 years postoperatively in people with spinal cord injury. • The risk of recurrence concerns the surgical site as well as the entire pelvic region. • Local postoperative complications are not related to the risk of recurrence. • Structured long-term follow-up and monitoring is needed after pressure ulcer surgery for people with spinal cord injury. Abstract Background Flap surgery for deep pelvic pressure ulcers (PPUs) has been found effective, but the recurrence rate remains high and few risk factors have been identified. Objective We evaluated risk factors for PU recurrence after primary flap surgery in people with spinal cord injury (SCI). Patients and methods This observational retrospective study based on medical charts included all individuals with SCI who underwent primary flap surgery for a PPU in the Hérault department in France between 2006 and 2014. Overall, 100 biomedical, psychological, socioeconomic and care management factors were studied. The primary outcome was PPU recurrence (surgical site and/or other pelvic site). The secondary outcome was recurrence at the surgical site. Cox proportional hazards regression was used to determine associated factors, estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Results We included 85 patients. Half had a PPU recurrence, and in one-third, the recurrence was at the surgical site. On multivariate analysis, global PPU recurrence was associated with colostomy (HR = 2.79) and living with a partner (HR = 2.29). Non-traumatic SCI and sacral wound were associated with PPU recurrence (HR = 3.39, HR = 0.48) and recurrence at the surgical site (HR = 3.3, HR = 0.3). Conclusion Risk factors of PPU recurrence are based on both biomedical and social models. After primary flap surgery, the risk of recurrence justifies regular follow-up and strict monitoring. [ABSTRACT FROM AUTHOR]

Summary: Objective: The authors had for objective to describe HIV-infected patients treated with ABC (Ziagen®, ABC), and the immune, virological, and clinical treatment outcome between 2003 and 2008. Patients and methods: We performed a retrospective analysis of the Dat’AIDS database on patients who were treated with ABC for the first time between 2003 and 2008. Results: Eight hundred and thirty-six patients were included. Before initiation of ABC, 26.3% has stopped the previous treatment because of immuno-virological failure, 30.5% because of adverse events, and 29.8% for other reasons. Thirteen percent were antiretroviral naive. One third of patients were ranked as CDC class C, and more than 2/3 had a viral load<5 log copies/mL or a CD4 count≥200mm3. ABC was mainly included in a combination containing 2 NRTI and 1 PI (63%), or 1 non-NRTI (16%). Thirty-two percent of patients were still treated with ABC after 2years of treatment and the median of ABC treatment was 11months (IQ 84days–2years). The main causes for stopping ABC were therapeutic simplification (47.4% of patients), intolerance (19.0%), and immuno-virological failure (9.8%). Suspected hypersensitivity reactions were the main cause of discontinuation due to intolerance (27.6%); the rate was 3.8% when ABC had been introduced before the routine use of the screening test HLA-B*5701. The incidence of myocardial infarction was 3.8 per 1000 patient-years; 70.6% of patients received a fixed combination including ABC after discontinuation of ABC as a single agent (Ziagen®). Conclusion: This retrospective analysis confirmed the effectiveness and the good tolerance of ABC in the therapeutic strategy, between 2003 and 2008. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study is to present the history of cancers of the external genital organs of male in Hérault using data from the Hérault tumor register (RTH) over a period of 30 years., Patients and Methods: Using the RTH database, we studied the development of testicular germ cell tumors (TGCT) and penile cancer (PC) over 30 years, from 1987 to 2016. We analyzed the incidence and mortality data for these tumors. We compared these results to French, European and global data., Results: In 30 years of registration we have recorded 725 cases of TGCT and 175 cases of PC. The age standardized incidence rate (ASR) of TGCT has doubled between 1987 and 2016 (4.2 per 100,000 in 1987 and 9.3 per 100,000 in 2016). It was multiplied by 2.63 in the population of patients aged 30 to 44. There is a decrease of the mortality rate with a ASR of 0.8 deaths per 100,000 in 1987, and 0.4/100 000 in 2016. The PC incidence ASR was stable between 1987 and 2016 (0.4-0.9/100,000). Mortality is stable with a ASR between 0.1 and 0.3 deaths per 100,000 between 1987 and 2016., Conclusion: The incidence of TGCT has increased sharply in the Hérault over the past 30 years, while a decrease in mortality has been observed. The proportion of seminomas is increasing; it has gone from 53 % to 60 % in 30 years in the Hérault. The incidence and mortality of PC shows a stability in the Hérault over the past 30 years., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: In 2016, the Herault tumor registry collected 1961cancers in urology (21.4 % from all Herault cancers this year). RHESOU was created to complete RTH' data with specific parameters in onco-urology. The aim of this study is to describe RHESOU and to give some examples with our first results., Material and Methods: In November 2018, RHESOU (Registry HErault Specialised in Onco-Urology) was founded with the same registry recommendations. It collects specific oncologic parameters and also complete RTH's data. For each urological cancer, a specific survey with different choices was performed to collect a maximum of data which could be present in patients' file. These surveys were used for urological cancers cases that live in Herault in 2017., Results: In 2017, we collected 970 prostate cancers, 581 bladder cancers, 212 kidney cancers, 51 upper excretory tract cancers, 28 testicle cancers and 9 penil cancers. Our urological data collection gives many possibilities to create many requests for detailed analysis in urological cancers. In this article, we reported data from kidney, bladder and prostate cancers., Conclusions: RHESOU is a new tool opened to the different urologic corporations (urologists, pathologists, oncologists, radiotherapists, radiologists) that permits an overview in urological cancers in Herault. Finally, one important aim is that this tool will be adapted when new treatments or new important parameters appear in the years ahead., Level of Evidence: 3., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the ability of patients with exudative AMD to detect exudative recurrence. Another objective was to assess if self-monitoring, as currently taught, improves this ability., Materials and Methods: An observational cross-sectional study was carried out in the ophthalmology center of BeauSoleil clinic in Montpellier between March 1 and April 1 2016. Inclusion criteria were presence of neovascular age related macular degeneration treated with the loading dose of three monthly intravitreal anti-VEGF injections, with at least one injection in the past 12 months and at least one exudative recurrence. All patients underwent a visual acuity measurement with ETDRS charts at 4 meters. A questionnaire assessed familiarity with the Amsler grid and its proper use, performance of and type of self-monitoring at home and the subjective feeling of an exudative recurrence at the visit with a 5-level Likert scale., Results: A total of 94 eyes of 70 patients were included in this study with 69.0 % women and a median (interquartile range) age of 83 (77-96) years. Among them, 81 % performed regular self-monitoring, mostly with environmental Amsler tests (70 %). Only 63 % of the patients knew of the Amsler grid, among which 52 % used it correctly. Sensitivity (95 % confidence interval, 95 % CI) and specificity (95 % CI) of the subjective sensation of exudative recurrence were 0.32 (0.14-0.55) and 0.85 (0.74-0.92), respectively, for the entire population. Sensitivity (95 % CI) and specificity (95 % CI) were 0.33 (0.13-0.59) and 0.85 (0.74-0.93); 0.25 (0.0063-0.81) and 0.82 (0.48-0.98), respectively, in patients performing and not performing self-monitoring., Conclusion: Patients' prediction in wet AMD is insufficient in detecting exudative recurrences, even if regular self-monitoring with Amsler grid or environmental Amsler is performed., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: The authors had for objective to describe HIV-infected patients treated with ABC (Ziagen(®), ABC), and the immune, virological, and clinical treatment outcome between 2003 and 2008., Patients and Methods: We performed a retrospective analysis of the Dat'AIDS database on patients who were treated with ABC for the first time between 2003 and 2008., Results: Eight hundred and thirty-six patients were included. Before initiation of ABC, 26.3% has stopped the previous treatment because of immuno-virological failure, 30.5% because of adverse events, and 29.8% for other reasons. Thirteen percent were antiretroviral naive. One third of patients were ranked as CDC class C, and more than 2/3 had a viral load<5 log copies/mL or a CD4 count≥200mm(3). ABC was mainly included in a combination containing 2 NRTI and 1 PI (63%), or 1 non-NRTI (16%). Thirty-two percent of patients were still treated with ABC after 2years of treatment and the median of ABC treatment was 11months (IQ 84days-2years). The main causes for stopping ABC were therapeutic simplification (47.4% of patients), intolerance (19.0%), and immuno-virological failure (9.8%). Suspected hypersensitivity reactions were the main cause of discontinuation due to intolerance (27.6%); the rate was 3.8% when ABC had been introduced before the routine use of the screening test HLA-B*5701. The incidence of myocardial infarction was 3.8 per 1000 patient-years; 70.6% of patients received a fixed combination including ABC after discontinuation of ABC as a single agent (Ziagen(®))., Conclusion: This retrospective analysis confirmed the effectiveness and the good tolerance of ABC in the therapeutic strategy, between 2003 and 2008., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: In France, lung cancer is the third most common cancer and the third leading cause of cancer death in women. The main objective of this study is to analyse specificities of lung cancer in the female population in an administrative district in France, focusing on histology, staging and trends over time., Methods: Incidence data from 1987 to 2004 were extracted from the Hérault cancer registry. The variables of interest considered at diagnosis were stage, histology and age. Mortality data were extracted from the CépiDc-Inserm database for the same period., Results: Among the 6,650 patients studied, 16.8% were women. 18.3% of whom were aged less than 50 at diagnosis, (9.9% of men, p<0.001). Lung cancer incidence is increasing in the female population (+6.4% per year) as well as lung cancer mortality (+3.5% per year). This occurred faster for adenocarcinoma, young women and stages III-IV., Conclusion: This population-based study confirmed the specific features of lung cancer in women: younger age at diagnosis, adenocarcinoma and stage at diagnosis with poor prognosis. These results raise the question of possible differences to lung cancer susceptibility between males and females.

Background: To describe the rate and timing of DMARD start in patients with early inflammatory arthritis in France, and to determine the factors leading to this treatment start., Methods: The ESPOIR cohort study collects data on patients presenting with early arthritis. Baseline characteristics were assessed, and Cox regression analysis was performed to estimate the likelihood of starting DMARD treatment over time, adjusting for patient-, disease- and physician characteristics., Results: Of the 775 analysed patients, 598 (77.2%) received at least 1 DMARD during the follow-up period, after a median time of 4.0 months. In general, a higher tender joint count, involvement of the hands, involvement of more than 3 joint groups, presence of abnormal CRP-levels or CCP-antibodies significantly increased the likelihood of being treated (p<0.01 for all determinants), as well as a positive result on the bilateral foot-squeeze test (p<0.04). In addition, a significant hetero-geneity in therapeutic strategy across the 14 tested French regions was found: adjusted hazard ratios for DMARD start ranged from 1 to 2.15 (p<0.01), depending on the region where a patient was followed. For anti-CCP test and swollen joint count we demonstrated a statistically significant interaction with geographic region, implying that these tests are interpreted differently across regions. The same factors that increased the likelihood to start a DMARD were related to an earlier start., Conclusion: Rate and timing of treatment start with DMARDs in patients with early inflammatory arthritis in France is determined by well known clinical and biochemical variables. Apart from these variables, however, unknown and intangible factors that seem to cluster geographically are responsible for important variations in practice performance.

Aim: To compare the management of colorectal cancer (CRC) before and after the French consensus conferences of rectal cancer (RC) in 1994 and colonic cancer (CC) in 1998., Methods: From 344 CCR incident cases in 1992 and 545 in 2000, patient characteristics, tumor data, and diagnostic and treatment modalities were collected to compare the management of CRC., Results: Post-operative mortality did not change significantly (4% in 1992 and 2.8% in 2000). No trends were observed in disease stage at diagnosis or rate of resection. For patients with CC (n=244 in 1992 and n=396 in 2000), the number of resection specimens with at least 12 lymph nodes increased from 11% in 1992 to 27% in 2000 (p<0.001). For CC with Dukes stage C and D, the use of chemotherapy increased significantly: for Dukes Stage C from 45% in 1992 to 55% in 2000; for Dukes Stage D from 37% in 1992 to 67% in 2000. For patients with RC (n=100 in 1992 and n=149 in 2000), no change in use of adjuvant radiotherapy was observed: 59% in 1992 versus 53.4% in 2000. Preoperative radiotherapy for RC was performed in 63% in 1992 and 75% in 2000 (p=0.7)., Conclusion: The consensus guidelines appear to have moderately influenced management practices. A better diffusion of guidelines to practitioners and a systematic evaluation of actual practices would be helpful to improve their impact.

Objectives: Hepatitis C virus (HCV) infection is a recognized public health issue in France. Institutional networks were created to improve healthcare practices and facilitate multi-disciplinary care for chronic diseases. The electronic medical file is one of the tools used by the networks to optimize patient care., Methods: The main objective of this study was to determine what proportion of general practitioners in the Languedoc-Roussillon region of southern France would be interested in using the electronic medical files for patients with HCV infection. A random sample of 20% of the general practitioners in the region was selected and stratified by administrative district of practice. Among them, a telephone survey identified those interested in the hepatitis electronic medical files and following patients with hepatitis C. A more detailed questionnaire was sent to these interested physicians in order to obtain further information., Results: Thirty-seven percent of the general practitioners concerned by the question followed patients with HCV infection. The advantages and disadvantages the physicians associated with use of these files were mostly related to the physician's age, attendance of continuing education courses and internet access., Conclusion: This study highlighted the fact that a significant number of general practitioners would be interested in accessing electronic medical files for patients with HCV infection. Considering these findings it might be useful to propose a working group including general practitioners and specialists in order to develop a concrete project for implementing electronic medical files for patients with HCV infection.

Objective: To assess nosocomial infection (NI) as a risk factor for death and to estimate the population-attributable risk of death from NI., Design: A prospective cohort study of patients with and without NI., Setting: Nimes University Hospital, Nimes, France., Patients: Patients were recruited from May 7, 2001, to January 10, 2003. Patients in acute care and long-term care units who had NI were enrolled, and patients without NI were randomly selected and matched with patients with NI for age, sex, type of care (acute care vs. long-term care) and length of stay in hospital at study inclusion., Outcome Measures: Vital status within 60 days after study inclusion was assessed. We used conditional logistic regression to estimate the relative death risk from NI after adjusting for comorbidities, severity of the underlying disease, and all other confounding factors. The adjusted population-attributable risk was assessed using the Mantel-Haenszel method., Results: We recruited 1,914 patients with NI and 5,172 patients without NI. The median age of the patients with NI was 73 years; 1,045 (54.6%) were female. NI was associated with death within 60 days (adjusted odds ratio, 1.7 [95% confidence interval {CI}, 1.4-;2.2]; P<.001). The adjusted population-attributable risk of death for all sites of infection was 1.7% (95% CI, 1.4-2.1). If we consider the NI incidence to be 3%-6% in French hospitals, the population-attributable risk of death from NI would range from 2.1% (95% CI, 1.7%-2.5%) to 4.0% (95% CI, 3.3%-4.9%)., Conclusion: In this study, NI appeared to have a significant impact on mortality. Multicenter studies will be needed to confirm these results.

Background: All recent guidelines recommend a search for asthma utilizing both specific interrogation and pulmonary function tests in patients suffering from allergic rhinitis. Although the mandatory place of spirometry has not been confirmed, a self-questionnaire containing nine specific questions on asthma symptoms in different daily life situations was found to be capable of discriminating asthmatics from nonasthmatics in a rhinitic population., Objective: We addressed the questions of prevalence of asthma using a validated self-questionnaire and what might be the risk factors of being asthmatic according to that specific self-questionnaire., Methods: Between April 2003 and September 2004, nearly 12,000 rhinitis patients were enrolled by more than 2300 physicians (78% general practitioners, 22% ear nose and throat specialists). Patients were consulting for an exacerbation of chronic rhinitis and did not have a previous diagnosis of asthma. Both doctors and patients filled out a specific questionnaire on rhinitis and asthma., Results: Almost 30% of the patients had at least three positive answers to the self-questionnaire and could possibly be considered as asthmatics. We found five independent clinical risk factors for having >or=3 positive answers to the self-questionnaire. Severity of rhinitis (moderate-severe vs mild, OR=1.84; 95% CI=1.68-2.00), diagnosis of allergy (yes vs no) (OR=1.86; 95% CI=1.68-2.00), body mass index (30) (OR=0.51; 95% CI=0.39-0.66), type of rhinitis (persistent vs intermittent) (OR=1.25; 95% CI=1.15-1.37), and patient age (47) (OR=0.73; 95% CI=0.65-0.80)., Conclusion: Asthma symptoms are frequent in rhinitics without a prior history of asthma. Several variables were shown to be predictive of asthma in these patients.

Background: Epidemiological and pathophysiologic studies have shown that allergic rhinitis and asthma often occur in combination. The internationally developed ARIA position paper (Allergic Rhinitis and its Impact on Asthma) recently offered recommendations on allergic rhinitis. As part of this new report and prior to its diffusion, we investigated the management of rhinopathies in asthma patients by pulmonologists in their everyday practice., Methods: From March to June 2000, 477 (48%) French pulmonologists in office-based practice participated in the survey. They were asked to include their first five asthmatic adult patients. In addition to descriptive statistics, univariate and multivariate analyzes were performed., Results: We studied 1623 patients with varying severity of asthma (sex ratio 0.9; median age 35 years). The pulmonologists reported rhinopathy in 76.6% of these, with a chronic course in 91%. Among the patients, 67.1% reported rhinopathy. The diagnosis was allergic rhinitis in 66.2% of participants and nasal polyposis in 10.1%. Examination of the nasal cavities was performed by the pulmonologists themselves in 56.2% of patients. Imaging of the sinuses was performed radiographically in 55.3% of enrolled patients and/or by computed tomography in 17.2%. Referral to an ENT specialist occurred for 21.6% of patients, being more common for patients with rhinitis that failed to respond to medical therapy (although some pulmonologists referred their patients routinely)., Conclusions: The high prevalence of rhinopathies in asthma patients requires that these conditions are recognized and managed by pulmonologists. Thus, our findings support one of the central messages contained in the new ARIA guidelines-asthma patients should be investigated routinely for rhinitis and other rhinopathies.

The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15-65 yrs by general practitioners (GPs) in France. To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon. GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions. This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.

Background: We surveyed survival and prognosis factors in tetraplegic spinal cord injured persons (TSCI) after their admission to a physical medicine and rehabilitation center., Methods: This multicenter study included 697 individuals, the entire cohort of patients admitted to three of the principal French centers caring for spinal cord injured persons from 1949 to 1997. The data set was drawn from the medical files and included data on the accident and its complications, social and demographic features, and the characteristics of the spinal injury. Survival data were obtained for all subjects from the official registries of their place of birth. Univariate (Kaplan-Meier) and multivariate (Cox regression) analysis was made to study links between these data and survival., Results: Univariate analysis indicated that the principal variables significantly related to survival were: level of the lesion, age at the time of the accident, the cause of the accident, and the presence of a permanent tracheotomy or a depressive syndrome requiring medical care. Multivariate analysis showed that the risk of dying was 82% lower for persons who did not have a permanent tracheotomy. The risk declined by 92%, 89% and 69% for TSCI aged 20 years or less, 20-39 years and 40-59 years respectively at the time of the accident compared with those aged more than 60 years. This risk was 37% lower for TSCI without depressive syndrome and 52% lower for persons injured at levels C6, C7, C8 compared with those injured at levels C2, C3, C4., Conclusion: Multivariate analysis showed that the principal prognosis factors for survival are the presence of a permanent tracheotomy, the age at the time of the accident, the presence of a depressive syndrome and the level of the lesion. No statistical improvement of survival was observed related with time (corresponding to the year of inclusion) but, over the study period, there was an increasing number of spinal cord injured person who survived with high lesions.

There have been many epidemiological studies of chickenpox but only a few of herpes zoster. We report data from an observational study, conducted in France during a 1-year period, of 9038 patients who presented with acute herpes zoster (n = 8103) or postherpetic neuralgia (PHN; n = 935) at the office practices of 4635 general practitioners or dermatologists. The incidence of herpes zoster in France was found to be similar to that in the literature: from 1.4 to 4.8 cases per 1000 population per year. The patient profiles and clinical patterns were delineated, as well as the management decisions made according to the type of treating physician. The impact of herpes zoster on quality of life was evaluated on the basis of the Medical Outcome Study Short Form 36 (MOS SF 36) scale, which is widely used for assessing quality of life in the field of health. This study provides reference data on the substantial deterioration in quality of life associated with herpes zoster and PHN.

Objective: To investigate the occupational and environmental risk factors related to non-Hodgkin's lymphoma (NHL)., Methods: A case-control study was performed during the 1992-1996 period in Languedoc-Roussillon, southern France. Four hundred and forty-five cases of histologically diagnosed NHL were declared. One thousand and twenty-five randomly selected population controls were interviewed about their medical histories; occupational exposures, such as chemicals, pesticides, and electromagnetic radiation; and toxic habits., Results: The following factors were independently and significantly related to NHL as a result of the multivariate analysis: a previous hematopoietic malignancy (ORa = 11.5, 95% CI 2.4-55.4), a history of hives (ORa = 1.7, 95% CI 1.2-2.2), benzene exposure > 810 days (ORa = 4.6, 95% CI 1.1-19.2), daily welding (ORa = 2.5, 95% CI 1.2-5.0), and activity of radio operator (ORa = 3.1, 95% CI 1.4-6.6). To be an agricultural professional seemed slightly related to NHL in reference to non-professionals (ORa = 1.5, 95% CI 1.0-2.1). All of these results have also been adjusted for age, gender, education level, and urban setting., Conclusions: As some of the reported associations were based on a very small proportion of exposed subjects, further investigations are necessary to confirm our results. However, the findings suggest that factors related to altered immune functions such as a history of hematopoietic malignancy, history of hives, occupational exposure to benzene, or being an agricultural professional might increase the risk of NHL. Currently, underlying mechanisms for these associations are still unclear, and further investigations focused on interactions between immunity alterations and different chemicals would be of great interest.

Objective: The purpose of this study was to describe the diagnostic and therapeutic strategies used by general practitioners (GPs) in patients with lower respiratory tract infections (LRTI)., Methods: Four hundred fifty GPs practicing in France participated in the study; they included 804 patients. The GP recorded social and demographic data and their prescription on a data sheet and responded to a phone questionnaire about their strategy., Results: Most of the LRTI were acute bronchitis (72%); pneumonia and acute exacerbations of chronic bronchitis were observed respectively in 11% of the patients recruited. Diagnostic criteria used by the GPs were generally auscultation signs in patients with fever, cough and expectoration. Specialized advice (always a chest physician) and hospitalization were exceptional. Prescription of complementary exams was strongly related to the diagnosis of pneumonia (OR = 33.3; CI0.95: 15.48-70.4). Sick leaves were related to general symptoms (fever, asthenia). Antibiotics were prescribed in 95.7% of the patients, mainly aminopenicillin (40.4%) and macrolides (33.2%). Nonsteroidal or steroidal antiinflammatory drugs were prescribed in 72.5% of the patients irrespective of the LRTI diagnosis., Discussion: The fact that GPs do not often refer patients to specialists or order hospitalization confirms their important role in setting up recommendations. It would also be necessary to develop an education program on better use of antibiotics targeted to GPs and patients.

Objective: To analyse retrospectively the results of one-stage laparoscopic treatment for common bile duct stones in 19 surgical centers in France., Patients: From January 1991 to July 1996, 612 patients with choledocholithiasis underwent laparoscopic treatment., Results: Overall duct clearance was obtained in 489 of the 612 patients (80%): through the cystic duct in 222 of 380 patients (58.4%), by secondary choledochotomy (after unsuccessful transcystic duct extraction) in 77 of 96 (80%), and in 190 of 232 (82 %) by primary choledochotomy. The overall duct clearance rate increased from 65% in 1991 to 84% in 1996. The use of the choledochotomy approach increased from 43% in 1991 to 69% in 1996 (P<0.01), due to a substantial increase in primary choledochotomy. In contrast, the use of the transcystic approach decreased from 57% to 31% (P<0.01). The mean time for surgery was shorter for cystic duct exploration than for primary choledochotomy (101+/-51 vs. 155+/-62 min, P<0.0001). The mean hospital stay decreased from 7.7+/-3.6 days in 1991 to 4.1+/-2 days in 1996 (P<0.001). The main biliary complications were related to biliary drainage (2,8%) and retained stones (3.1%)., Conclusion: This study confirms that laparoscopy is a good alternative with a low complication rate, a short hospital stay, and is an effective and safe option for the management of common bile duct stones.

A six-month, prospective descriptive study of medical outcomes (including quality of life) and costs was conducted in 20 incident cases of rheumatoid arthritis (RA). Multidisciplinary management was started during an inpatient stay at the beginning of the study. Patients were evaluated on a day-hospital basis three and six months later. The following parameters were studied: quality-of-life scores on a generic scale (the Nottingham Health Profile [NHP]) and two specific scales (Health Assessment Questionnaire [HAQ] and the short-form Arthritis Impact Measurement Scale [AIMS]), pain severity, disease activity assessed by the patient and physician, painful and swollen joint counts, erythrocyte sedimentation rate, and C-reactive protein level. The following costs were evaluated: laboratory tests, plain radiographs, other investigations, physician care (by rheumatologists or other specialists), second-line drug therapy and monitoring for its side effects, care by nurses, physical therapy, and occupational therapy. All patients showed significant improvement three months after initiation of multidisciplinary management. This effect was sustained through the sixth month. Quality-of-life scores improved, with the exceptions of the social isolation subscore on the NHP and the psychological impact, social activity, and occupational activity subscores on the short-form AIMS. Mean total cost for the six-month period was 3429 +/- 880 euros (1 euro = 6.6 FF). Laboratory tests contributed the largest portion of the total cost (39%), followed by rheumatologist care (16%); the other costs accounted for 7.6 to 9.2% of the total cost. This prospective medical and economic study is preliminary. Comparative studies are needed.

Objectives: Information about the incidence of cancer in the national territory is a necessity for decision makers in public health. The aim of this study was to estimate for the first time the incidence of digestive tract cancers in each region of France in 1992 as well as trends in incidence between 1985 and 1995., Methods: The incidence/mortality ratio established by sex, by age group and by localization in the departments covered by a cancer registry was applied to the mortality of each region studied. The mortality data were fit by applying a log linear model., Results: The highest incidence rates of esophageal cancer were found in the North, in Brittany, Normandy and Picardy. The lowest rates were found in the regions of Midi-Pyrénées, Languedoc-Roussillon, Provence-Alpes-Côte d'Azur, Aquitaine and Poitou-Charentes. The incidence of this cancer decreased slightly between 1985 and 1995. Brittany and Normandy were also high risk regions for gastric cancer, while Provence-Alpes-Côte d'Azur, Midi-Pyrénées and Poitou-Charente were low risk regions. The incidence of gastric cancer also decreased more markedly than that of esophageal cancer. Colorectal cancer was more frequent in Alsace, Lorraine and in the North, it was less common in Provence-Alpes-Côte d'Azur, Midi-Pyrénées and Franche-Comté. The incidence of this cancer increased little over the 10 years of the study., Conclusion: There are regional disparities in the incidence and trends of digestive cancer incidence. These are more marked for esophageal cancer and gastric cancer than for colorectal cancer. The data supplied are of use both in the planning of health care and in the study of the causes or the prevention of digestive cancers.

Objective: Increasing prevalence of skin cancer over the past few decades and their relationship with childhood sun exposure, show that educational campaigns on sun protection are urgently needed. The aim of this study is to estimate the degree of children's sun exposure in the south of France (43 degrees latitude north) and to study sun protection behaviors according to phenotypic characteristics., Population and Methods: The population was a randomly selected sample of 573 schoolchildren between 3 and 15 years of age living in Montpellier. The questionnaire provided information about sociodemographic characteristics, summer sun exposure and sun protection. Phenotypic characteristics, reactivity to sunlight and number of sunburns since birth were also reported., Results: Exposure time was very high: half of children spend over 6 hours per day outside in summer. The youngest children were the most protected either by sunscreen, or by shirt. On the beach, sunscreens were used more than half of the time of exposure by 70 p. 100 of the children. At the swimming pool, sunscreens were used by 45 p. 100 of the children and only by 14 p. 100 of them during other outdoor activities. A tee-shirt was only wore by 50 p. 100 of the children when playing on the beach, and by 75 p. 100 of them at the swimming pool. In addition, the application of sunscreen varied by body site. The adolescents, although they were exposed less than the youngest children, were very poorly protected. Light skinned children who do not tan easily had highest risk of sunburns, although they were generally more protected., Conclusion: The parents are able to identify highly sensitive children according to phenotype, but in practice the use of sunscreens and tee-shirt is very low. Parents and adolescents must be the target population but also insufficiently protected children. Health education at school must be an important measure for prevention.

The aim of the study was to assess the incident number of female breast and genital tract cancers for the whole of France. The study focused on the 1983-1987 period and on 9.1% of the French population. The incident number of female breast and genital tract cancers was estimated for each site and for each of eight French administrative regions covered by a cancer registry qualified through the National Committee of Registries (Calvados, Côte-d'Or, Doubs, Hérault, Isère, Bas-Rhin, Somme, Tarn). Information on mortality rates was available at a regional level as well as at a nationwide level. The method estimated the national incidence rate modelizing the regional age-specific incidence rate as a function of corresponding mortality rate. Breast cancer was the leading site with 25,277 new cases per year while female genital tract cancers affected about 13,856 women. The cancer risk, estimated in using cumulative rate 0-74 years, was assessed at 7.1% for breast and at 1.2%, 1.4% and 1.1% for cervix uteri, corpus uteri and ovary respectively. Breast and genital tract cancers constituted 49% of the whole of cancers in women. Observed breast incidence rate was stable through French regions. There were pronounced contrasts in cervix uteri cancer risk, and some french regions displayed a high risk close to the observed European maxima. Interregional contrasts in risk of the other genital tract cancers were less striking. This study emphasized the importance of female breast and genital tract cancers for public health in France. The main aim of the French Cancer Registries Network is to provide a comprehensive description of cancer risk in France and to produce pertinent projection to 2005 horizon, combining the present data and the already accumulated 1988-1992 data.

Background: Descriptive epidemiology of cerebral gliomas has recently been the subject of several studies, indicating a possible increase in brain tumor rates, particularly in the elderly population., Methods: Between 1983 and 1990, 1376 registered patients with diagnoses of malignant astrocytomas, low grade astrocytomas, oligodendrogliomas - mixed oligoastrocytomas, and tumors without histologic confirmation were reviewed in 6 French cancer registries. The incidence rates by histologic type, age, and gender were calculated. The variation of the incidence between 1983 and 1990 was also analyzed., Results: The highest incidence was observed in the malignant astrocytoma group (2.38/100,000/year) followed by the low grade astrocytoma group (0.54/100,000/year) and the oligodendroglioma - mixed oligoastrocytoma group (0.25/100,000/year). A significant male predominance was observed in the malignant astrocytoma group (male/female [M/F] ratio of 1.59; P < 0.001) and in the group without histologic confirmation (M/F ratio of 2.6; P = 0.008). Between 1983 and 1990, an increasing trend of 5% per year was observed in the incidence of malignant astrocytomas in the population older than 65 years., Conclusions: These data confirm the observation made in other countries that the incidence of primary brain tumors (particularly malignant astrocytomas) is increasing in elderly patients.

Objectives: The purpose of this study was to compare the incidence of digestive cancers in 9 French departments and to give an estimate of this incidence for the whole of France, based on this data., Methods: This study focused on the 1983-1987 period. The record quality for the 9 included registries (Calvados, Côted'Or, Doubs, Haute-Garonne, Hérault, Isère, Bas-Rhin, Somme, Tarn) has been assessed by the National Committee of Registries. The crude incidence rates and those standardized according to the world population have been worked out per localization and per sex. Incidence and mortality rates per department as well as mortality rates for the whole of France have enabled the assessment of the incidence and number of new digestive cancer cases per year., Results: Esophagus and liver cancers are distinguished by large incidence disparities, fluctuating in a ratio of 1 to 5, and by a high sex ratio. In other localizations, incidence rates vary in a ratio of 1 to 2. The incidence rates of digestive cancers were especialy high in the Bas-Rhin department. They tended to be higher in Côte-d'Or, Doubs, Calvados and Somme, than in Haute-Garonne. Hérault and Tarn. The estimated number of digestive cancers was 30,071 in males and 19,951 in females: colorectal cancer was particularly frequent, 14,179 cases and 12,228 cases, respectively., Conclusion: There are some geographical variations, from one region to another, in digestive cancer incidence in France more pronounced for esophagus and liver cancers than for other localizations. Because of its frequency, colorectal cancer represents a serious problem for public health.

Objectives and Methods: Therapeutic modalities in rectal cancer were analyzed in a French population based study. This work reviewed all the new cases of rectal adenocarcinoma diagnosed in a one-year period from January 1st to December 31st 1990 among the population of 7 provinces. Thus, 427 new cases of rectal cancer were included in a data base (EUROCARE). The main goal of this study was to provide an up-to-date, unbiased evaluation of the different treatments of rectal cancer according to its stage when diagnosed. The aim was also to point out differences in therapeutic management between these different geographic areas. A three-stage clinico-pathological staging was used to minimize stage migration bias., Results: 77.8% of the patients underwent a rectal excision; among them, 53.9% had a sphincter saving procedure. Adjuvant radiotherapy was associated to rectal resection in 46.2% of the patients and was pre-operative in 45.9%. Only 13.7% of patients had chemotherapy., Conclusions: We demonstrated a significative difference of therapeutic modalities between these different french geographic areas concerning adjuvant radiotherapy and chemotherapy. This work supports the need and the value of population-based study for clinical management, prognostic evaluation and evaluation of public health issues.

A retrospective study was planned in the Hérault (Mediterranean) region of France where bladder cancer mortality and incidence rates are high. In the present paper, variations in bladder cancer risk according to various smoking-related variables, in particular time of exposure and type of tobacco, are examined. This case-control study with 219 male incident cases and 794 male population controls randomized from electoral rolls was carried out in 1987-89. Trained interviewers obtained information on demographics, dietary habits (coffee, alcohol, artificial sweeteners, vegetables, spices, etc.), occupational exposures and detailed history of tobacco smoking (average number of cigarettes per day, number of years of smoking, age at which they began and/or quitted smoking, use of filter-tip and type of tobacco). The odds ratio (OR) for cigarette smokers versus non-smokers was greater than 5. Results for number of cigarettes daily, duration of smoking and lifetime smoking showed a highly significant dose-response relationship, which was confirmed when these variables were treated as continuous in a logistic regression model. Eighty-eight percent of the smokers used black tobacco. Quitting smoking did not result in a significant reduction in bladder cancer risk. Higher risks were associated with starting to smoke at an early age (OR before age 13 versus after age 21 = 3.42; 95% CI 1.07-10.9) and with black tobacco smoking (OR black versus blond = 1.63; 95% CI 0.73-3.64). Results suggest that black tobacco may be more harmful than blond tobacco and may have an early non-reversible role in bladder carcinogenesis.

Objective: To describe early clinical stages in the recovery of consciousness, using selected items from the Glasgow Coma Scale and the Liège Coma Scale., Design: Validation cohort study, conducted in a tertiary care center., Setting: Neurosurgical intensive therapy unit in a university teaching hospital., Patients: Patients (n = 137) with traumatic coma who were selected according to the following criteria: a) coma due to blunt head trauma with an initial Glasgow Coma Score of < or = 7; b) admission to the neurosurgical intensive therapy unit within the first 24 hrs after trauma; c) patients > 14 yrs of age; requiring endotracheal intubation, mechanical ventilation, and the administration of drugs; and d) survival period allowing analysis of the recovery of consciousness., Measurements and Main Results: Arousal, as expressed by stimulated opening of the eyes and recorded as a delay in days, was correlated with the appearance of the localized pain response, capacity to obey commands, blink reflex, and the cessation of drugs in three groups of patients. These groups were defined according to the time in which there was an appearance of the stimulated opening of the eyes: < 8 days (group 1); between 8 and 15 days (group 2); and after 15 days (group 3). When the three groups of patients were compared, significant differences existed between the mean delays of appearance of stimulated eye opening and the appearance of the blink reflex. Extubation coincided with the appearance of spontaneous eye opening, with a mean delay of 13.5 days., Conclusions: This study confirms the classical clinical sequence of arousal and recovery of consciousness, with the appearance of stimulated eye opening and the blink reflex first, followed by spontaneous eye opening, and the capacity to obey commands in intubated, traumatized, coma patients. A direct correlation existed between the delay of arousal and the complete recovery of consciousness. When groups of patients with various mean delays for the appearance of stimulated eye opening are considered, reappearance of the blink reflex did not always coincide with stimulated eye opening, suggesting differing structural and functional brain recovery processes.

The excess of morbidity and mortality for cancers of the bladder in the french department of Hérault (South of France, on the side of the Mediterranean Sea) justified the implementation of a new epidemiologic study. A case-control study was designed, including 219 cases, 196 hospital-controls and 794 population controls. The collected information concerned profession, habits, behaviour (smoking, alcohol and coffee drinking), places of living, since childhood. The study confirms the role of tobacco, with a highly significant dose-effect, for total consumption, daily dose, and duration of consumption (p < 10(-4)). The classical risk of coffee is confirmed, but it seems not to be due to quantity of caffeine, but to the mouldered form of coffee. As far as alcohol is concerned, the sole risk is due to anisis beverages. When one considers the role of either tobacco, or coffee, or alcohol, the risk is strongly increased (p < 0.02) when exposure begins very early in life (childhood or teen age). But the effect does not depend on the beginning-of-exposure age, when the latter is posterior to teen age (p > 0.95). One may indeed think that the carcinogenic action of these factors concerns mainly the induction phase of the disease. Finally, when place of birth and place of living were considered, a North to South increasing effect was strongly suggested by the study.

In the Hérault region of France, vineyards cover an area of 128,000 hectares (60% of agricultural land) and involve more than 93% of farms. A vine-growing exposure matrix was built for assessing pesticide exposure. It is based on information obtained from a survey among 85 vine-growers who lived in Hérault and who had detailed account books. This paper explains how this matrix was built and how to use it. It takes into consideration the calendar time (1950-1988), the type of products (powder, liquid) and the chemical classes. It can estimate the likelihood of exposure and the quantity of pesticide used. Such a matrix could be useful in epidemiological surveys in order to measure vine-growers' exposure to pesticides. Formulae are given to evaluate their mean exposure to these chemicals. Limitations of the matrix are discussed; it does not take into account several factors which might change exposure: temperature, wind speed, methods of application, use of protection, etc.

A large scale mammography breast cancer screening has begun in Herault county on the first of july 1990. The aim of the project was to determine the impact of two-view mammography upon the size of the tumor and later upon mortality from breast cancer. The women aged 40-70 at entry were invited by mail to the first round of mobile breast screening. Between the start and the 8th of march 1991, 5098 (64%) attended the first round. The cancer detection rate was 5.9/1000, the positive detection rate was 7.75%, the benign malignant surgical biopsy ratio was 1:0.7 and the percentage of surgical biopsies positives for malignancy was 42.6%. Two months after this study, the screening specificity was 96.7% and the sensibility was 92.7%. The rate of tumor size less or equal to 1 cm was 72% (for 30 malignancies) and the rate of mastectomies was 43.3%. These friendly results were compared to those of others breast cancers screenings.

A case-control investigation about bladder cancer was carried out in Herault department with 219 incident cases from January 1987 to May 1989 and two control groups: 196 hospital controls randomized from hospital admission lists and 794 population controls randomized from census data. According to the comparison for those two groups, there are few socio-demographic differences; but hospital controls are more exposed to smoking, coffee, alcohol, artificial sweetners. So, the odds ratios with those hospital controls are under-estimated. We can evaluate the resulting biais.