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The finality of medical research is to improve disease management by identifying the risk factors (epidemiology) and treating the disease or the underlying causes (clinical research). The assessment of the relationship between exposure to a risk factor or a treatment and the disease is a crucial step. As statistical tests provide information only on whether the -association is statistically significant, it is necessary to quantify the strength of the effect using measurements called "effect sizes" in statistics. Several effect sizes (risk difference, relative risk, odds ratio) are commonly used depending on the study design. This statistical note describes how to use and interpret effect sizes when both exposure and disease are dichotomous variables, i.e. the most common situation in practice. [ABSTRACT FROM AUTHOR]

Copyright of Sang Thrombose Vaisseaux is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Using 2016 Census data, we compare the odds of employment (full time or self-employment) for visible minority immigrants in Canada with those of non–visible minority immigrants. Intergenerational comparisons of employment outcomes are made because one would expect second- and third-generation immigrants to be less prone to labour market barriers than first-generation immigrants. Estimates based on a logistic regression of employment probability reveal lower employment odds for four out of 10 identified visible minority immigrant groups in comparison with non–visible minority immigrants for all three generations. For first- and second-generation immigrants, the results were mixed, but third-generation immigrants faced significantly lower employment probabilities in all groups of visible minorities with the exception of Chinese and Japanese. A lack of proficiency in official languages (English or French) lowers the employment probability for all groups. It is estimated that post-secondary education (PSE) acquired outside of Canada has a weaker positive association with employment than PSE acquired within Canada. Pre- and post-immigration labour market experience have a weak association with employment. [ABSTRACT FROM AUTHOR]

Résumé: La prise en charge de la maladie thromboembolique veineuse chez les patients suivis pour un cancer a fait l'objet de recommandations françaises en 2019, réactualisées en 2021. L'anticoagulation peut se faire par héparine de bas poids moléculaire (HBPM), anticoagulant oral direct (AOD) ou antagoniste de la vitamine K (AVK). Les AVK peuvent être utilisés lorsque les HBPM et les AOD ne sont pas accessibles, en particulier en cas d'insuffisance rénale chronique terminale. L'étude CARAVAGGIO comparant l'apixaban et la daltéparine a permis de confirmer à six mois de traitement la non-infériorité de l'apixaban en termes de récidive veineuse thromboembolique et de sécurité sur l'incidence des hémorragies majeures. Ainsi, il est recommandé de traiter pendant au moins six mois les patients atteints de cancer actif et d'un événement thromboembolique veineux soit par une HBPM sans relais par AVK soit par apixaban. Après six mois de traitement anticoagulant pour un événement thromboembolique veineux dans un contexte de cancer, il est recommandé de poursuivre le traitement anticoagulant lorsque le cancer est actif, en réévaluant son indication tous les six mois. Il est suggéré de poursuivre l'HBPM ou l'AOD quand ce traitement est bien toléré, efficace et bien accepté par le patient ; de remplacer l'HBPM par un anticoagulant oral, de préférence un AOD plutôt qu'un AVK, quand le traitement par HBPM est mal accepté ou mal toléré. The management of venous thromboembolic disease in cancer patients was the subject of French recommendations in 2019, updated in 2021. Anticoagulation can be done with low molecular weight heparin (LMWH), direct oral anticoagulant (DOA) or vitamin K antagonist (VKA). VKAs can be used when LMWHs are not available, particularly in cases of chronic end-stage renal disease. The CARAVAGGIO study comparing apixaban and dalteparin confirmed the non-inferiority of apixaban at 6 months of treatment in terms of venous thromboembolic recurrence and incidence of major bleeding. Therefore, it is recommended that patients with active cancer and a venous thromboembolic event be treated for at least six months with either LMWH without VKA therapy or with apixaban. After six months of anticoagulant treatment for a venous thromboembolic event in the context of cancer, it is recommended that anticoagulant treatment be continued when the cancer is active, with a reassessment of the indication every 6 months. It is suggested that LMWH or AOD should be continued when it is well tolerated, effective and well accepted by the patient, and that an oral anticoagulant, preferably an AOD rather than a VKA, should replace LMWH when LMWH treatment is poorly accepted or tolerated. [ABSTRACT FROM AUTHOR]

Référence: Huang J, Lok V, Ngai CH, et al. Worldwide burden of, Risk Factors for, and Trends in Pancreatic Cancer. Gastroenterology 2021 ; 160 : 744-754. [ABSTRACT FROM AUTHOR]

Résumé: Pour améliorer la prévention des cancers, la nutrition dans son ensemble (alimentation, consommation d'alcool, activité physique, surpoids/obésité) est un des facteurs essentiels sur lesquels il est possible d'agir. Les médias diffusent régulièrement des messages sur le sujet, parfois erronés, et la littérature scientifique regorge de données, parfois contradictoires. Des expertises collectives nationales (Institut National du Cancer et Réseau National Nutrition Cancer) et internationales (World Cancer Research Fund et Centre International de Recherche sur le Cancer) permettent de faire régulièrement le point des avancées scientifiques en respectant une méthodologie rigoureuse et élaborer des recommandations basées sur des niveaux suffisants de preuve scientifique. Dans le cas du cancer colorectal, plusieurs facteurs nutritionnels ont ainsi été identifiés comme associés au risque de survenue de ce cancer avec un niveau de preuve « convaincant » ou « probable » : le surpoids et l'obésité, les boissons alcoolisées, la consommation de viandes rouges ou de viandes transformées. À l'inverse, certains facteurs auraient un rôle protecteur : l'activité physique, les aliments riches en fibres et les produits laitiers. Des données scientifiques probantes manquent encore pour confirmer le rôle d'autres facteurs. Suivre les recommandations émises par le Haut Conseil de la Santé Publique et l'Institut National du Cancer pourrait permettre de diminuer le développement de plus de la moitié des cancers colorectaux. Diffuser ces messages auprès des professionnels de Santé et de la population est donc essentiel. In order to improve cancer prevention, nutrition (including: diet, alcohol consumption, physical activity, body fatness) is one of the key factors that can be modified. The media regularly broadcast messages on the topic, sometimes erroneous and the scientific literature is full of data, but sometimes contradictory also. National and international collective expertises regularly review scientific advances using a rigorous methodology to enable recommendations to be made based on sufficient levels of scientific evidence. In the case of colorectal cancer, several nutritional factors have been identified as associated with the risk of developing this cancer with a level of evidence defined as "probable" or "convincing": overweight and obesity, consumption of red and of processed meats, alcoholic beverages. On the other hand, some factors would have a protective role: physical activity, foods containing fibre and dairy products. There is still a lack of scientific evidence to confirm the role of other factors. To follow the recommendations of the French High Council of Public Health and the French National Cancer Institute could reduce the development of more than half of colorectal cancers. Spreading these messages to health professionals and to the public is therefore essential. [ABSTRACT FROM AUTHOR]

Mapping the prevalence and spread of infectious diseases has never been more critical than during the COVID-19 pandemic. A plethora of Web-based GIS dashboards have been created that incorporate basic GIS functionality; these dashboards have served as platforms for rapid data sharing and real-time information, ultimately facilitating decision making. However, many of them have merely focused on presenting and monitoring cumulative or daily incidence of COVID-19 data, disregarding the temporal dimension. In this paper, we review the usefulness of GIS-based dashboards for mapping the prevalence of COVID-19, but also missed opportunities to emphasize the temporal component of the disease (cyclicity, seasonality). We suggest that advanced geovisualization techniques can be used to integrate the temporal component in interactive animated maps illustrating (a) the daily relative risk and the number of days a geographic region has been in a disease cluster, (b) the ratio between the observed and expected number of cases over time, and (c) mortality count dynamics in a space–time cube. We illustrate these approaches by using COVID-19 cases and death counts across the U.S. at the county level from 25 January 2020 to 1 October 2020. We discuss how each of these visualization approaches can promote the understanding of important public health concepts applied to the pandemic such as risk, spread, and mortality. Finally, we suggest future avenues to promote research at the intersection of space–time visualization and infectious diseases. [ABSTRACT FROM AUTHOR]

Référence: Schepers N, Hallensleben N, Besselink M, et al., on behalf of the Dutch Pancreatitis Study Group. Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial. Lancet 2020 ; 396 : 167-176. [ABSTRACT FROM AUTHOR]

Résumé: La maladie thromboembolique veineuse est une cause importante de morbi-mortalité chez les patients suivis pour un cancer et a fait l'objet de nouvelles recommandations en 2019. En prévention primaire, chez les patients suivis pour une néoplasie évolutive et hospitalisés pour un problème médical aigu et/ou avec une réduction de leur mobilité, il est recommandé de débuter une prophylaxie anti-thrombotique en l'absence de saignement ou d'autres contre-indications. De plus, il est recommandé de mettre en place un traitement prophylactique anti-thrombotique prolongé pendant quatre semaines pour tous les patients en péri-opératoire d'une chirurgie abdominale ou pelvienne en l'absence de contre-indication ou de risque élevé de saignement. En prévention secondaire, l'anticoagulation au long cours peut se faire par héparine de bas poids moléculaire (HBPM), anticoagulant oral direct (AOD) ou anti-vitamine K (AVK). Un traitement par HBPM réduit significativement le nombre de récidive thromboembolique par comparaison aux AVK sans différence en termes de complications hémorragiques. Les AOD augmentent le risque de saignement par rapport à un traitement par HBPM, en particulier au cours de cancers gastro-intestinaux et génito-urinaires. Ainsi, il convient de rester prudent quant à l'utilisation des AOD au cours du traitement des thromboses chez les patients suivis pour un cancer gastro-intestinal. Il est proposé d'utiliser les HBPM en première intention chez les patients à haut risque de saignement, incluant les patients avec une tumeur gastro-intestinale. Les AOD restent une alternative acceptable en l'absence d'interaction médicamenteuse, d'insuffisance rénale sévère et en accord avec le patient. Venous thromboembolism (VTE) is an important cause of morbidity and mortality among patients with cancer. Update recommendations on this topic have been proposed in 2019. For VTE prophylaxis, hospitalized patients who have active malignancy and acute medical illness or reduced mobility should be offered pharmacologic thromboprophylaxis in the absence of bleeding or other contraindications. Moreover, all patients with malignant disease undergoing major surgical intervention should be offered pharmacologic thromboprophylaxis that should be continued up to 4 weeks post-operatively for patients undergoing major open or laparoscopic abdominal or pelvic surgery in the absence of high bleeding risk or other contraindications. For treatment of patients with cancer with established VTE, long-term anticoagulation may involve low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). VKAs are inferior but may be used if LMWH or DOACs are not accessible. There is an increase in major bleeding risk with DOACs, particularly in GI malignancies. LMWH should be use for cancer patients with acute diagnosis of VTE and high risk of bleeding, including patients with gastrointestinal cancers. DOACs are acceptable alternatives if there are no drug-drug interactions, no severe renal impairment, incorporating patient preferences. [ABSTRACT FROM AUTHOR]

Résumé: L'adénocarcinome du pancréas (AP) deviendra la deuxième cause de mortalité par cancer d'ici 2030. Si les taux de survie globale à cinq ans restent faibles, des progrès significatifs ont été réalisés au cours des dix dernières années. Pour les patients atteints d'AP opérables, la chimiothérapie adjuvante par FOLFIRINOX a été démontrée supérieure à la gemcitabine. Les stratégies de traitement pré-opératoire (néoadjuvant pour les tumeurs résécables d'emblée, d'induction pour les tumeurs borderline) sont en cours d'évaluation dans le cadre d'essais cliniques. Dans les stades avancés, les stratégies de traitement d'entretien ou de maintenance après une période de contrôle de la maladie sous FOLFIRINOX se développent. Alors qu'aucune thérapie ciblée n'avait jusque-là montré d'efficacité dans l'AP, les inhibiteurs de PARP ont permis d'améliorer significativement la survie sans progression en traitement de maintenance chez des patients porteurs d'une mutation germinale de BRCA (5 % des AP). Les immunothérapies ont été décevantes, à l'exception des rares tumeurs présentant un phénotype d'instabilité des microsatellites (1 %-2 %). Les soins de support occupent une place centrale pour améliorer la qualité de vie des patients. Plusieurs essais cliniques nationaux (PRODIGE) sont en cours. Le chapitre du Thésaurus National de Cancérologie Digestive (TNCD) consacré à l'AP a été récemment réactualisé (Juin 2018) pour tenir compte de ces avancées. Cette revue fait l'état de l'évolution des pratiques dans le traitement médical de l'AP. Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of cancer death by 2030. While overall survival rates at 5 years remains low, significant progress has been made over the last decade. For patients with operable PDAC, adjuvant chemotherapy with FOLFIRINOX has been demonstrated to be superior to gemcitabine. Preoperative treatment strategies (neoadjuvant for upfront resectable tumors, induction for borderline tumors) are currently evaluated in clinical trials. In advanced stages, maintenance treatment strategies after a period of disease control with FOLFIRINOX are emerging. While no targeted therapy had so far shown efficacy in PDAC, PARP inhibitors significantly improved progression-free survival as maintenance therapy in patients with a BRCA germline mutation (5%). Immunotherapies have been disappointing in PDAC, except for tumors with microsatellite instability (1%-2%). Supportive care is central to improving the quality of life of patients. Several national clinical trials (PRODIGE) are in progress. The chapter of the National Thesaurus of Digestive Oncology (TNCD) focusing on PDAC was recently updated (June 2018) to take account of these advances. This review provides an overview of recent practice changes in the medical treatment of PDAC. [ABSTRACT FROM AUTHOR]

In patient with cirrhosis, minimal hepatic encephalopathy (MHE) is defined by the presence of neuropsychological abnormalities detectable by psychometric or neuropsychological tests without any clinical sign of hepatic encephalopathy. Its frequency is high, affecting between 20 and 60% of hospitalized cirrhotic patients. MHE is predictive of the occurrence of clinical hepatic encephalopathy, is a factor of poor prognosis and is associated with higher mortality. MHE also impacts everyday life by increasing traffic and household accidents. Diagnostic methods are complex, require time and a trained practitioner which explains the low screening rate despite the existence of effective therapies. [ABSTRACT FROM AUTHOR]

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Epidemiology, which was initially confined to the distribution of diseases in populations (descriptive epidemiology) and the factors responsible for such distribution (analytical epidemiology), also involves the evaluation of diagnostic and therapeutic strategies, as well as prognostic factors. Epidemiology provides elements that form the basis for medical and public health decisions. Information is collected from systematic records, which include large databases, or through specific surveys. Descriptive studies utilise mortality rates, as well as incidence and prevalence figures. The aim of aetiological epidemiology is to demonstrate a causal relationship between exposure and disease. It is necessary to check that studies do not present any major bias and to seek evidence in favour of causality. The strength of a causal relationship is calculated using relative risk or odds ratio. Other measurements of risk include attributable risk and aetiological fraction. Screening and diagnostic strategies are evaluated using the concepts of sensitivity, specificity, and above all, levels of likelihood that help determine the probability of a given patient becoming ill as a result of his or her personal characteristics and of test results. Evaluation of prognostic factors enables scores to be constructed allowing the probability of a given clinical outcome to be calculated as a function of patient characteristics., (Copyright © 2017. Published by Elsevier Masson SAS.)