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Rabilloud ML, Bajeux E, Siproudhis L, Hamonic S, Pagenault M, Brochard C, Gerfaud A, Dabadie A, Viel JF, Tron I, Robaszkiewicz M, Bretagne JF, Bouguen G. Long-term outcomes and predictors of disabling disease in a population-based cohort of patients with incident Crohn's disease diagnosed between 1994 and 1997. Clin Res Hepatol Gastroenterol 2022; 46:101974. [PMID: 35691599 DOI: 10.1016/j.clinre.2022.101974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The identification of early prognostic factors during Crohn's disease (CD) remains needed for physician decision-making to minimize structural bowel damage, which this study aimed to assess in a population-based setting. METHODS All incident cases of CD were prospectively registered from 1994 to 1997 in Brittany, a limited area of France. All charts of patients were reviewed from the diagnosis to the last clinic visit in 2015. Disabling CD course was defined according to the Saint-Antoine criteria. RESULTS Among the 331 incident cases of CD, 272 (82%) were followed-up for a median time of 12.8 years. The cumulative probability of developing stricturing or fistulizing CD was 66% at 15 years, and 107 (39%) patients underwent surgery. The cumulative probabilities of immunosuppressant and TNF antagonist use at 15 years were 37% and 22%, respectively. The cumulative risks for disabling disease and bowel damage were 74% and 71% at 15 years, respectively. Systemic symptoms and perianal lesions at diagnosis were independently associated with a disabling disease course. Perianal disease and short disease extension were associated with the onset of bowel damage. Deep ulcers was not predictive of any outcome. CONCLUSIONS A disabling disease course and bowel damage occurred early in the course of CD, which suggests the need for early diagnosis and early treatment, particularly for patients with systematic symptoms and perianal disease.
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Affiliation(s)
| | - Emma Bajeux
- Department of Public Health, University Hospital of Pontchaillou, Rennes, France
| | - Laurent Siproudhis
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
| | - Stéphanie Hamonic
- Department of Public Health, University Hospital of Pontchaillou, Rennes, France
| | | | - Charlène Brochard
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
| | - Agathe Gerfaud
- CHU Rennes, Paediatric unit, Hôpital Sud, Rennes, France
| | - Alain Dabadie
- CHU Rennes, Paediatric unit, Hôpital Sud, Rennes, France
| | - Jean-François Viel
- Department of Public Health, University Hospital of Pontchaillou, Rennes, France
| | - Isabelle Tron
- Observatoire Regional De Santé Bretagne, Rennes, France
| | | | | | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France.
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Desandes E, Brugieres L, Laurence V, Berger C, Kanold J, Tron I, Clavel J, Lacour B. Survival of adolescents with cancer treated at pediatric versus adult oncology treatment centers in France. Pediatr Blood Cancer 2017; 64. [PMID: 27860291 DOI: 10.1002/pbc.26326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND In France, although children aged less than 15 years with cancer are usually referred to pediatric oncology centers, adolescents may be treated at pediatric or adult oncology centers. The objective was to compare survival according to their site of treatment. PROCEDURE Using population-based registration, 15- to 19-year-old patients diagnosed with cancer in 2006 or 2007 and living in six French regions (accounting for 41% of the French population) were included. RESULTS Of the 594 patients included, 33% of the French adolescents were treated at a pediatric oncology center. Compared with those treated at a pediatric center, adolescents treated at an adult center were older, were more likely to have carcinoma and germ-cell tumor, had a longer time to diagnosis, and were less likely to be enrolled in a clinical trial. In addition, the decisions for their management were less likely to be taken in the context of multidisciplinary team meetings. In multivariate analysis, adolescent patients treated at a pediatric center did not have significantly different overall survival (OS) compared with those treated at an adult center (5-year OS: 84.1% [95% confidence interval: 78.6-90.0] versus 87.7% [95% confidence interval: 84.2-91.3]; P = 0.25). CONCLUSIONS The outcomes of French adolescents with cancer have begun to improve, with 81.2% survival in 2006-2007, with no difference between the types of treatment center. However, for this unique group of diseases, survival is not the unique endpoint. In order to ensure good quality of life after cancer, management of those patients requires specific approaches, designed to reduce the late effects of cancer treatment and improve supportive care.
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Affiliation(s)
- Emmanuel Desandes
- French National Registry of Childhood Cancer-French National Registry of Childhood Solid Tumors, University Hospital Centre of Nancy, Vandoeuvre-lès-Nancy, France.,Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France
| | - Laurence Brugieres
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | | | - Claire Berger
- Rhône-Alpes Childhood Cancer Registry, University Hospital Centre of St-Etienne, St-Etienne, France
| | - Justyna Kanold
- Childhood Cancer Registry of Auvergne/Limousin, Inserm CIC 501, University Hospital Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Tron
- Childhood Cancer Registry of Bretagne, ORS Rennes, Rennes, France
| | - Jacqueline Clavel
- Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France.,French National Registry of Childhood Cancer-French National Registry of Childhood Hematological Malignancies, Villejuif, France
| | - Brigitte Lacour
- French National Registry of Childhood Cancer-French National Registry of Childhood Solid Tumors, University Hospital Centre of Nancy, Vandoeuvre-lès-Nancy, France.,Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France
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Yaouanq J, Tron I, Kerbrat A, Leray E, Hamonic S, Merienne M, Hinault P, Edan G. Register-based incidence of multiple sclerosis in Brittany (north-western France), 2000-2001. Acta Neurol Scand 2015; 131:321-8. [PMID: 25313028 DOI: 10.1111/ane.12332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report on multiple sclerosis (MS) incidence in Brittany, north-western France. MATERIALS & METHODS From 2000, we set up a population-based register for patients presenting a putative incident MS (PIMS), that is first symptoms compatible with MS onset. We used 3 medical sources of case ascertainment (neurologists, CSF, regional MS-Clinic). Eligibility criteria required both clinical onset and being permanent resident of Brittany in 2000 or 2001. From 2010, all medical records were tracked, the 10-year follow-up allowing previously reported data to be updated. RESULTS Of 313 eligible PIMS, there were 208 definite MS (both McDonald and Poser criteria), 41 CIS-probable MS (Poser criteria), 32 CIS-possible MS and 32 non-MS. Our incident cohort of 249 MS cases with definite/probable MS (sex ratio 2.95) gave a crude annual incidence of 4.28 per 100,000 inhabitants (6.22 for women, 2.23 for men), and age-standardized rates (adjustment to the European population) of 4.41 [3.32-5.51], 6.68 [4.75-8.60], and 2.21 [1.12-3.31], respectively. Age-specific rates by gender and initial course showed that attack onset MS peaked at 25-29 years and progressive onset MS at 40-44 years in women (20-24 years and 45-49 years in men, respectively). CONCLUSIONS Brittany is confirmed a high-risk region for MS. Our data show marked differences in sex-specific pattern of MS incidence by clinical course and point out 25- to 29-year-old women as having the highest MS risk. While temporal variations cannot be excluded, comparison with overall French data suggests that other factors rather than latitude may influence the MS risk in France.
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Affiliation(s)
- J. Yaouanq
- Department of Epidemiology and Public Health University Hospital Rennes France
- CIC‐P 0203 Inserm University Hospital Rennes France
- West Neuroscience Network of Excellence (WENNE) Brittany France
| | - I. Tron
- Brittany Public Health Observatory (ORS Bretagne) Rennes France
| | - A. Kerbrat
- CIC‐P 0203 Inserm University Hospital Rennes France
- West Neuroscience Network of Excellence (WENNE) Brittany France
- Department of Neurology University Hospital Rennes France
| | - E. Leray
- CIC‐P 0203 Inserm University Hospital Rennes France
- West Neuroscience Network of Excellence (WENNE) Brittany France
- Epidemiology Department EHESP School of Public Health Rennes France
| | - S. Hamonic
- Department of Epidemiology and Public Health University Hospital Rennes France
| | - M. Merienne
- West Neuroscience Network of Excellence (WENNE) Brittany France
| | - P. Hinault
- West Neuroscience Network of Excellence (WENNE) Brittany France
| | - G. Edan
- CIC‐P 0203 Inserm University Hospital Rennes France
- West Neuroscience Network of Excellence (WENNE) Brittany France
- Department of Neurology University Hospital Rennes France
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Kerbrat A, Hamonic S, Leray E, Tron I, Edan G, Yaouanq J. Ten-year prognosis in multiple sclerosis: a better outcome in relapsing−remitting patients but not in primary progressive patients. Eur J Neurol 2014; 22:507-e35. [DOI: 10.1111/ene.12600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A. Kerbrat
- Department of Neurology; University Hospital; Rennes France
- WENNE; Grand-Ouest France
| | - S. Hamonic
- Department of Epidemiology and Public Health; University Hospital; Rennes France
| | - E. Leray
- WENNE; Grand-Ouest France
- Epidemiology Department; EHESP School of Public Health; Rennes France
- CIC-P 1414 INSERM; University Hospital; Rennes France
| | - I. Tron
- Public Health Observatory (ORSB); Rennes France
| | - G. Edan
- Department of Neurology; University Hospital; Rennes France
- WENNE; Grand-Ouest France
- CIC-P 1414 INSERM; University Hospital; Rennes France
| | - J. Yaouanq
- Department of Epidemiology and Public Health; University Hospital; Rennes France
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5
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Moulart C, Rienmeyer H, Tron I. Nutrition des personnes âgées brûlées en SSR. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gagnière B, Tron I, Guillois-Bécel Y, Gourvellec G, Le Gall E, Gandemer V. Incidence des cancers de l’enfant en Bretagne entre 1991 et 2005. Rev Epidemiol Sante Publique 2012; 60:213-20. [DOI: 10.1016/j.respe.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/28/2011] [Accepted: 11/14/2011] [Indexed: 11/26/2022] Open
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Desandes E, Bonnay S, Berger C, Brugieres L, Demeocq F, Laurence V, Sommelet D, Tron I, Clavel J, Lacour B. Pathways of care for adolescent patients with cancer in France from 2006 to 2007. Pediatr Blood Cancer 2012; 58:924-9. [PMID: 22180332 DOI: 10.1002/pbc.24032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 11/09/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND In France, as in other countries, there is a need for a population-based view of access to care and modalities of treatment for adolescents with cancer. PROCEDURE Using a population-based registration, we report pathways of care for 15-19-year-old patients, diagnosed with cancer in 2006 and 2007, living in six French regions, accounting for 41% of the French population. RESULTS The median times (inter-quartile range) for diagnosis and treatment of the 594 included adolescents were 8 weeks (3-17) and 3 days (0-16), respectively. First physicians met by the patients were mostly general practitioners (59%). Seventeen percent of patients were firstly seen on emergency wards. Most of the patients (82%) were treated in an adult environment. Management decisions were taken within the context of a multi-disciplinary team (MDT) in 54% of cases. Twenty-seven percent of patients were included in randomized or non-randomized clinical studies: percentage depended on the tumor type and on the number of on-going trials at the study period. Fifteen percent of patients were included in pediatric studies, 7% in adult studies, and 5% in studies including both adults and children. CONCLUSIONS The pathways of care for French adolescent patients with cancer are heterogeneous. Our results reveal differences in MDT meetings according to tumor types and a lack of effective collaboration between pediatric and adult wards. Efforts must be made to develop cancer networks to ensure that adolescents receive the optimal care in a suitable environment.
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Desandes E, Bonnay S, Berger C, Brugieres L, Isfan F, Laurence V, Mignot L, Olive-Sommelet D, Tron I, Clavel J, Lacour B. Pathways of care for adolescents with cancer in France. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Desandes E, Berger C, Tron I, Demeocq F, Bellec S, Blouin P, Casagranda L, De Lumley L, Freycon F, Goubin A, Le Gall E, Sommelet D, Lacour B, Clavel J. Childhood cancer survival in France, 1990–1999. Eur J Cancer 2008; 44:205-15. [DOI: 10.1016/j.ejca.2007.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 11/07/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
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10
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Desandes E, Clavel J, Berger C, Bernard JL, Blouin P, de Lumley L, Demeocq F, Freycon F, Gembara P, Goubin A, Le Gall E, Pillon P, Sommelet D, Tron I, Lacour B. Cancer incidence among children in France, 1990-1999. Pediatr Blood Cancer 2004; 43:749-57. [PMID: 15390289 DOI: 10.1002/pbc.20148] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cancer is the second most important cause of death for children aged less than 15 years in France, unintentional injuries being the leading cause. The aim of the present study was to estimate the incidence of childhood cancer from six Childhood Cancer Registries covering 32% of France. PROCEDURE Incident cancer cases diagnosed between 1990 and 1999 in children (0-14 years) resident in the administrative areas covered by each Registry were included. Annual age-standardized rates (ASRs) were adjusted by the world population. The estimated annual percent change (EAPC) was used to measure trend towards changes in the annual age-standardized incidence rate. RESULTS With 4234 registered cases, the ASRs per million children were 137.5 for all cancers combined, 42.3 for leukemia, 29.1 for central-nervous-system tumors, 15.6 for lymphomas, 14.1 for sympathetic-nervous-system tumors, and 9.1 for renal tumors. The ASR of all cancers combined was slightly higher in males (145.8 per million children) than in females (128.7 per million children) with an M/F ratio of 1.2. No significant incidence trend was observed, with an EAPC of +0.2% [IC 95% (-2.5; +3.0); P = 0.89]. CONCLUSIONS The estimated incidence rates are similar to those reported in previous studies in European and North American countries. These results will contribute to the development of National Registration of Childhood Cancer in France and support the national research program on childhood cancer.
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Affiliation(s)
- Emmanuel Desandes
- French National Registry of Childhood Solid Tumors, Vandoeuvre-lès-Nancy, France
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Heresbach D, Alexandre JL, Bretagne JF, Cruchant E, Dabadie A, Dartois-Hoguin M, Girardot PM, Jouanolle H, Kerneis J, Le Verger JC, Louvain V, Pennognon L, Richecoeur M, Politis J, Robaszkiewicz M, Seyrig JA, Tron I. Crohn's disease in the over-60 age group: a population based study. Eur J Gastroenterol Hepatol 2004; 16:657-64. [PMID: 15201578 DOI: 10.1097/01.meg.0000108337.41221.08] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Late-onset Crohn's disease (CD) may show a distinctive pattern of expression. The aim of our study was to describe the incidence or presentation of CD in the elderly and compare the outcomes in patients < 60 years or > or = 60 years at diagnosis. METHODS The study included a population based inception cohort of all incident CD cases diagnosed in Brittany (France) between 1994 and 1997. Sixty-three patients were > or = 60 years and 201 were < 60 years at diagnosis. The physicians managing the patients used standardized questionnaires to collect the study data. The questionnaires on outcomes and treatments were completed in 2002. RESULTS In patients > or = 60 years, the annual incidence was 2.5 per 10 persons and clinical features were similar to those in younger patients, except for a higher rate of colon involvement. Among older patients, those with diverticula (29/63, 46%) were more likely to have granulomas (58% vs 33% of patients without diverticula, P < 0.04), but the diagnosis of CD was confirmed by lesions remote from the diverticula in most cases (23/29). Early resection rates were not higher in older patients, who were less likely to require immunosuppressants or re-admission for CD flares, as compared to younger patients. Five year mortality in older patients was 16% but was unrelated to CD. CONCLUSIONS In Brittany, the age specific incidence, clinical features, and prognosis of CD among the elderly are comparable to those in younger individuals. Colon involvement is more common. Concomitant diverticular disease is common and should prompt a search for CD lesions at other sites to confirm the diagnosis. Older patients are less likely to require immunosuppressants or admission for flares.
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Affiliation(s)
- Denis Heresbach
- Service des Maladies de l'Appareil Digestif, Hôpital Pontchillou, Rennes, France.
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12
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Dabadie A, Tourtelier Y, Alexandre JL, Robaskiewicz M, Cruchant E, Seyrig JA, Heresbach D, Tron I, Bretagne JF. [Outcome of unclassified colitis in the ABERMAD register (inflammatory bowel disease). Effect of follow-up on incidence. Breton Association for Study and Research on Digestive System Diseases]. Arch Pediatr 2000; 7:1011. [PMID: 11028214 DOI: 10.1016/s0929-693x(00)90025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Tourtelier Y, Dabadie A, Tron I, Alexandre JL, Robaskiewicz M, Cruchant E, Seyrig JA, Heresbach D, Bretagne JF. [Incidence of inflammatory bowel disease in children in Brittany (1994-1997). Breton association of study and research on digestive system diseases (Abermad)]. Arch Pediatr 2000; 7:377-84. [PMID: 10793924 DOI: 10.1016/s0929-693x(00)88832-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this work was to determine in Brittany the incidence and main clinical pattern of inflammatory bowel disease (IBD) occurring during childhood. These data are compared to the previous epidemiologic data available from the Northern France registry or around the world. METHODS Private and public Brittany gastroenterologists (2,836,418 inhabitants including 618,049 children under 17 years of age) referred all patients consulting for inflammatory bowel disease from January 1994 to December 1997. An interviewer-practitioner completed at the gastroenterologist's office a standard questionnaire for each patient. Each case was independently reviewed by four experts in a blind manner and made a final diagnosis of Crohn's disease (CD), ulcerative colitis (UC), or ulcerative proctitis and acute colitis (onset of symptoms < 6 weeks) or unclassified chronic colitis. RESULTS Among 1,309 cases recorded, 88 were under 17 years of age (6.7%): 43 (49%) had CD (including three possible cases), 14 (16%) had UC (including three proctitis), 24 (27%) acute colitis and 7 (8%) unclassified chronic colitis. The crude mean annual incidence (per 100,000 children) based on definite and probable cases only was 2.5 for IBD, 1.6 for CD and 0.57 for UC, without variation between 1994 and 1997. The male/female ratio was 2.3 for CD and 1.3 for UC. The mean time between onset of disease and diagnosis was equal to 7.2 and 8.6 months for CD and UC respectively (median: 3 and 5 months). A familial history of IBD was present in 5 cases (8%). In CD, the small and large bowel were involved in 58% of patients, whereas an isolated involvement of small or large bowel occurred in 15% and 23% of cases. Among the 14 UC, there were three proctitis and four pancolitis. Among 43 CD, a granuloma was present in 48% of cases. CONCLUSIONS In Brittany the incidence of CD and UC in childhood was similar to the published data from Northern France. Clinical presentation and symptoms were not different. However, the rate of acute colitis was higher and the accurate incidence of IBD could be underestimated, requiring a follow-up to classify these cases.
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Affiliation(s)
- Y Tourtelier
- Département de médecine de l'enfant et de l'adolescent, Hôpital Sud, Rennes, France
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14
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Pagenault M, Tron I, Alexandre JL, Cruchant E, Dabadie A, Chaperon J, Robaszkiewicz M, Bretagne JF. [Incidence of inflammatory bowel diseases in Bretagne (1994-1995). ABERMAD. Association Bertonne d'Etude et de Recherche des Maladies de l'Appareil Digesif]. Gastroenterol Clin Biol 1997; 21:483-90. [PMID: 9295976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of the study was to determine the incidence and the main clinical data of inflammatory bowel disease in Brittany. METHODS According to EPIMAD registry's methodology, private and public gastroenterologists (n = 139) of Brittany (2836418 inhabitants) referred all patients consulting for the first time, in 1994 and 1995 with clinical symptoms compatible with inflammatory bowel disease. An interviewer practitioner completed at the gastroenterologist's consulting room a standard questionnaire for each patient. Each case was reviewed separately by four experts to assign a diagnosis of definite, probable, possible Crohn's disease, ulcerative colitis, unclassifiable chronic colitis, or acute colitis (onset of symptoms < 6 weeks). RESULTS 657 cases were recorded: 205 Crohn's disease (31%), 165 ulcerative colitis (25%) including 75 ulcerative proctitis (46%), 42 unclassifiable chronic colitis (7%), 245 acute colitis (37%). The crude mean annual incidence (per 10(5) inhabitants) based on definite and probable cases only was 2.8 for Crohn's disease and 2.9 for ulcerative colitis. The female/male ratio was 0.9 for Crohn's disease and 0.5 for ulcerative colitis. The median age at time of diagnosis was 27 for Crohn's disease and 36 for ulcerative colitis. The median time between onset of symptoms and diagnosis was equal to 3 months for Crohn's disease and ulcerative colitis. CONCLUSION In Brittany the observed incidence of ulcerative colitis is similar to that of Crohn's disease and close to that observed in northern France. The incidence of Crohn's disease is lower. However, the real incidence of inflammatory bowel disease is currently underestimated due to the large number of acute colitis requiring a follow up and the cases of Crohn's disease classified as possible not taken into account.
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Affiliation(s)
- M Pagenault
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes
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15
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Dabadie A, Tourtelier Y, Tron I, Cruchant E, Alexandre J, Robaszkiewicz M, Bretagne J, Abernad. Incidence des maladies inflammatoires du tube digestif (MITD) chez l'enfant en Bretagne. Arch Pediatr 1996. [DOI: 10.1016/s0929-693x(96)89615-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Batt A, Tron I, Depoivre C, Trehony A. [Suicide attempts in Brittany (France). Distribution at the regional level]. Encephale 1993; 19:619-25. [PMID: 12404781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
UNLABELLED A prospective study on para-suicide has been conducted in all 4 "départements" of a french region, Brittany. This paper analyses the distribution of the sociodemographic data collected in one of the "département" of the region, Ille-et-Vilaine. The comparison between urban and rural areas is presented. METHODS INCLUSION CRITERIA Parasuicide was defined as any autoaggressive act which required to be taken in charge either medically or surgically, independently of the nature and seriousness of the somatic consequences. Patients included in the study were over ten years of age. ANALYSIS Three types of ratios have been calculated: the crude incidence ratios obtained by dividing the total number of events of parasuicide (including repeated admissions for the same individual) by the number of individuals in the catchment area; the age-specific ratios, for which the denominator consists of all the persons of particular age-group in the area and the standardized ratios, for which the total number of parasuicide events in each "département" has been reported to the french population (general population census 1990) taken as a reference, in order to eliminate the influence of the age structure. Comparisons between the general population and the one of parasuicidal patients in the area, were done using a chi-square test. GEOGRAPHICAL COMPARISON: Crude incidence rates of parasuicides calculated for each "département" in Brittany are compared with recent figures published for other parts of France. RESULTS 2,040 persons domiciled in the "département" were admitted in one of the emergency wards of Ille-et-Vilaine during the year 1990. The crude incidence rates of parasuicides in Ille-et-Villaine was of 2.4/1,000 for men and 3.8/1,000 for women, 3.7/1,000 for men and 5.4/1,000 for women residing in the town of Rennes. The sex ratio is 1.8 female/male in the "département" and 1.7 in town. DEMOGRAPHIC DATA: In the male group, the incidence ratio was maximum for the 25-34 years old (4.2/1,000). In the female group, there was no significant difference between the ratio for the 15-24 and the 25-34 years old (5.9/1,000). For each age group, the ratios are higher for the women. The specific rates of parasuicide calculated in the breton towns of more than 50,000 inhabitants are twice as high as those calculated for the whole region. MARITAL STATUS: The marital status is correlated to the incidence rates of parasuicide events for both sexes (p < 0.001). The incidence of parasuicide is higher for married, single and/or divorced women than for men. One notes the high impact of divorce on parasuicide events for men (10.1/1/1,000) and women (11.8/1,000). The correlation is significative (p < 0.001). In contrast, rates of parasuicides are higher for widows than for widowers. OCCUPATION: The incidence rate of parasuicide is 8 times higher for unemployed men and twice as high for unemployed women than for those having an occupation (regular or temporary). Unemployment is significatively linked with the occurrence of parasuicides (p < 0.001). PLACE OF ABODE: Comparative rates in towns (calculated for both sexes together) and twice as high as those observed in rural districts. GEOGRAPHICAL COMPARISON: The crude incidence rates in various french "département" vary from 0.8 to 2.4/1,000 for men and from 1.7 to 3.8/1,000 for women. The highest rates are observed for both sexes in Ille-et-Vilaine. In Rennes, the standardized ratios of parasuicide among men are maximum for the 35-44 years old (7.68/1,000) and decrease drastically after the age of 45. Among the women, the ratios are nearly identical for the 25-34 and the 35-44 years old (9.90 and 9.87/1,000). CONCLUSION The survey conducted in 1990 confirms the overall conclusions drawn in previous surveys on parasuicide in France or in other countries. The distribution of the incidence rates of parasuicide among single and unemployed and the percentages of single or unemployed persons is weak but not at random. An increase of the incidence rates among single women and unemployed men is concomitant with higher percentages of single women and unemployed men in the general population. One cannot infer the existence of a cause effect relationship, and these indicators may only be confounding factors.
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Affiliation(s)
- A Batt
- INSERM, Département de Santé Publique, Faculté de Médecine, 35043 Rennes
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