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Coste J, Delpierre C, Richard JB, Alleaume C, Gallay A, Tebeka S, Lemogne C, Robineau O, Steichen O, Makovski TT. Prevalence of long COVID in the general adult population according to different definitions and sociodemographic and infection characteristics. A nationwide random sampling survey in France in autumn 2022. Clin Microbiol Infect 2024:S1198-743X(24)00150-2. [PMID: 38527615 DOI: 10.1016/j.cmi.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES Long COVID has been recognized since early 2020, but its definition is not unanimous, which complicates epidemiological assessments. This study estimated the prevalence of long COVID based on several definitions and severity thresholds in the adult population of mainland France and examined variations according to sociodemographic and infection characteristics. METHODS A cross-sectional survey using random sampling was conducted in August-November 2022. Participants declaring SARS-CoV-2 infection were assessed for infection dates and context, post-COVID symptoms (from a list of 31, with onset time, daily functioning impact, and alternative diagnosis), and perceived long COVID. Long COVID prevalence was estimated according to the WHO, National Institute for Health and Care Excellence, United States National Centre for Health Statistics, and United Kingdom Office for National Statistics definitions. RESULTS Of 10 615 participants, 5781 (54.5%) reported SARS-CoV-2 infection, with 123-759 (1.2-13.4%) having long COVID, depending on the definition. The prevalence of WHO post-COVID condition (PCC) was 4.0% (95% CI: 3.6-4.5) in the overall population and 8.0% (95% CI: 7.0-8.9) among infected individuals. Among the latter, the prevalence varied from 5.3% (men) to 14.9% (unemployed) and 18.6% (history of hospitalization for COVID-19). WHO-PCC overlapped poorly with other definitions (kappa ranging from 0.18 to 0.59) and perceived long COVID (reported in only 43% of WHO-PCC). DISCUSSION Regardless of its definition, long COVID remains a significant burden in the French adult population that deserves surveillance, notably for forms that strongly impact daily activities. More standardized definitions will improve integrated surveillance of, and better research on, long COVID.
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Affiliation(s)
- Joël Coste
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France.
| | | | - Jean-Baptiste Richard
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Caroline Alleaume
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Sarah Tebeka
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France; Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neurosciences, Team 1, Paris, France; Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Cédric Lemogne
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Tourcoing, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMR-S 1136, Paris, France
| | - Olivier Steichen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMR-S 1136, Paris, France; AP-HP, Hôpital Tenon, Service de Médecine Interne, Paris, France
| | - Tatjana T Makovski
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
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Makovski TT, Ghattas J, Monnier-Besnard S, Cavillot L, Ambrožová M, Vašinová B, Feteira-Santos R, Bezzegh P, Bollmann FP, Cottam J, Haneef R, Devleesschauwer B, Speybroeck N, Nogueira PJ, Forjaz MJ, Coste J, Carcaillon-Bentata L. Multimorbidity and frailty are associated with poorer SARS-CoV-2-related outcomes: systematic review of population-based studies. Aging Clin Exp Res 2024; 36:40. [PMID: 38353841 PMCID: PMC10866755 DOI: 10.1007/s40520-023-02685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Estimating the risks and impacts of COVID-19 for different health groups at the population level is essential for orienting public health measures. Adopting a population-based approach, we conducted a systematic review to explore: (1) the etiological role of multimorbidity and frailty in developing SARS-CoV-2 infection and COVID-19-related short-term outcomes; and (2) the prognostic role of multimorbidity and frailty in developing short- and long-term outcomes. This review presents the state of the evidence in the early years of the pandemic. It was conducted within the European Union Horizon 2020 program (No: 101018317); Prospero registration: CRD42021249444. METHODS PubMed, Embase, World Health Organisation COVID-19 Global literature on coronavirus disease, and PsycINFO were searched between January 2020 and 7 April 2021 for multimorbidity and 1 February 2022 for frailty. Quantitative peer-reviewed studies published in English with population-representative samples and validated multimorbidity and frailty tools were considered. RESULTS Overall, 9,701 records were screened by title/abstract and 267 with full text. Finally, 14 studies were retained for multimorbidity (etiological role, n = 2; prognostic, n = 13) and 5 for frailty (etiological role, n = 2; prognostic, n = 4). Only short-term outcomes, mainly mortality, were identified. An elevated likelihood of poorer outcomes was associated with an increasing number of diseases, a higher Charlson Comorbidity Index, different disease combinations, and an increasing frailty level. DISCUSSION Future studies, which include the effects of recent virus variants, repeated exposure and vaccination, will be useful for comparing the possible evolution of the associations observed in the earlier waves.
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Affiliation(s)
- Tatjana T Makovski
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé publique France), Saint-Maurice, France.
| | - Jinane Ghattas
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Stéphanie Monnier-Besnard
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé publique France), Saint-Maurice, France
| | - Lisa Cavillot
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Monika Ambrožová
- National screening centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Barbora Vašinová
- National screening centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Rodrigo Feteira-Santos
- Área Disciplinar Autónoma de Bioestatística, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Laboratório Associado TERRA, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Peter Bezzegh
- Directorate for Project Management, National Directorate General for Hospitals, Budapest, Hungary
| | | | - James Cottam
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé publique France), Saint-Maurice, France
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Paulo Jorge Nogueira
- Área Disciplinar Autónoma de Bioestatística, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Laboratório Associado TERRA, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Centro de Investigação Em Saúde Pública, Escola Nacional de Saúde Pública, ENSP, CISP, Comprehensive Health Research Center, CHRC, Universidade NOVA de Lisboa, Lisbon, Portugal
- CIDNUR-Centro de Investigação, Inovação e Desenvolvimento Em Enfermagem de Lisboa Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, 1600-190, Lisbon, Portugal
| | - Maria João Forjaz
- National Center of Epidemiology, Instituto de Salud Carlos III, RICAPPS, Madrid, Spain
| | - Joël Coste
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé publique France), Saint-Maurice, France
| | - Laure Carcaillon-Bentata
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé publique France), Saint-Maurice, France
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Coste J, Mandereau-Bruno L, Carcaillon-Bentata L, Mikaeloff Y, Bouilleret V. Prevalence, demographic and spatial distribution of treated epilepsy in France in 2020: a study based on the French national health data system. J Neurol 2024; 271:519-525. [PMID: 37787813 PMCID: PMC10770219 DOI: 10.1007/s00415-023-11953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Although still incomplete, the epidemiology of epilepsy shows substantial variations in the burden of the condition according to demographic, social and territorial characteristics. This study aimed to estimate the prevalence of treated epilepsy and to investigate its demographic and spatial distribution in 2020 in France, a country where the nationwide epidemiological situation of the condition remains largely unknown. METHODS We used the French national health data system, which covers nearly the entire population residing in France (over 67 million of inhabitants in metropolitan and overseas departments). Prevalent cases were identified using long-term disease status, hospitalisation for epilepsy (ICD-10 codes G40 or G41), and reimbursements for antiseizure medications and electroencephalograms. RESULTS In 2020, we identified 685,122 epilepsy cases, corresponding to an overall prevalence of 10.2 per 1000 inhabitants [95% confidence interval 10.1-10.2], with similar rates in men and women. Estimates were found to increase with age, with an accelerated rise in the second half of the life, which occurred earlier in men than in women. We observed a monotonic gradient of variation with socio-economic deprivation (in non-military metropolitan subjects aged 18-54 years) as well as territorial heterogeneity, with the mountainous centre of France as well as some French overseas departments having the highest prevalence. CONCLUSIONS Our results revise upwards the estimation of epilepsy prevalence in France, showing that it now ranks among the highest in developed countries. Our study also confirms the important socio-territorial heterogeneity of the condition that reflects health inequalities in this country.
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Affiliation(s)
- Joël Coste
- Santé Publique France (French National Public Health Agency), Saint-Maurice, France.
| | | | | | - Yann Mikaeloff
- CPEA, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalo-Universitaire Paris-Saclay, Paris-Saclay University, Paris, France
- CESP-INSERM, Le Kremlin-Bicêtre, France
| | - Viviane Bouilleret
- Neurophysiology and Epileptology Department, Hôpital Bicêtre, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Laboratoire d'Imagerie Biomédicale Multimodale (BioMaps), Service Hospitalier Frédéric Joliot, CEA, CNRS, Inserm, Université Paris-Saclay, Orsay, France
- School of Medicine, Université Paris Saclay, Le Kremlin Bicêtre, France
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Laanani M, Viallon V, Coste J, Rey G. Collider and reporting biases involved in the analyses of cause of death associations in death certificates: an illustration with cancer and suicide. Popul Health Metr 2023; 21:21. [PMID: 38098030 PMCID: PMC10722743 DOI: 10.1186/s12963-023-00320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/03/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Mortality data obtained from death certificates have been studied to explore causal associations between diseases. However, these analyses are subject to collider and reporting biases (selection and information biases, respectively). We aimed to assess to what extent associations of causes of death estimated from individual mortality data can be extrapolated as associations of disease states in the general population. METHODS We used a multistate model to generate populations of individuals and simulate their health states up to death from national health statistics and artificially replicate collider bias. Associations between health states can then be estimated from such simulated deaths by logistic regression and the magnitude of collider bias assessed. Reporting bias can be approximated by comparing the estimates obtained from the observed death certificates (subject to collider and reporting biases) with those obtained from the simulated deaths (subject to collider bias only). As an illustrative example, we estimated the association between cancer and suicide in French death certificates and found that cancer was negatively associated with suicide. Collider bias, due to conditioning inclusion in the study population on death, increasingly downwarded the associations with cancer site lethality. Reporting bias was much stronger than collider bias and depended on the cancer site, but not prognosis. RESULTS The magnitude of the biases ranged from 1.7 to 9.3 for collider bias, and from 4.7 to 64 for reporting bias. CONCLUSIONS These results argue for an assessment of the magnitude of both collider and reporting biases before performing analyses of cause of death associations exclusively from mortality data. If these biases cannot be corrected, results from these analyses should not be extrapolated to the general population.
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Affiliation(s)
- Moussa Laanani
- French Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France.
- Biostatistics and Epidemiology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France.
- Strategy and Research Department, French National Health Insurance, Paris, France.
| | - Vivian Viallon
- Nutritional Methodology and Biostatistics Group (NMB), International Agency for Research on Cancer (IARC) - World Health Organization, Lyon, France
| | - Joël Coste
- Biostatistics and Epidemiology Department, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France
- French National Public Health Agency, Saint-Maurice, France
| | - Grégoire Rey
- French Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
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Tebeka S, Carcaillon-Bentata L, Decio V, Alleaume C, Beltzer N, Gallay A, Lemogne C, Pignon B, Makovski TT, Coste J. Complex association between post-COVID-19 condition and anxiety and depression symptoms. Eur Psychiatry 2023; 67:e1. [PMID: 38088068 DOI: 10.1192/j.eurpsy.2023.2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND To assess the associations between anxiety and depressive symptoms and post-COVID-19 condition (PCC) by exploring the direction of these associations and their relevance in the definition of PCC. METHODS Nationwide survey among French adults, recruited between March and April, 2022, using a quota method to capture a representative sample of the general population with regard to sex, age, socioeconomic status, size of the place of residence, and region. We included all participants who met the World Health Organization (WHO) definition of PCC in addition to a random sample of participants infected with SARS-COV-2 for at least 3 months but without PCC. Self-reported anxiety and depressive symptoms, chronic anxiety and depression (for more than 3 years), and anxiety and depression were measured using the GAD-2 and PHQ-2 questionnaires, respectively. RESULTS In a sample of 1,095 participants with PCC and 1,021 participants infected with SARS-COV-2 without PCC, 21% had self-reported anxiety and 18% self-reported depression, whereas 33% and 20% had current measured symptoms of anxiety and depression, respectively. The high prevalence of these symptoms cannot only be explained by the characterization of PCC, as only 13.4% of anxiety symptoms and 7.6% of depressive symptoms met the WHO criteria for PCC. Only one participant met the WHO criteria based on self-reported anxiety or depressive symptoms alone, as these were always combined with other symptoms in patients with PCC. Chronic symptoms were associated with PCC (aOR 1.27; 95% CI: 1.00-1.61). In addition, measured anxiety was associated with PCC (aOR = 1.29; 95% CI: 1.02-1.62). CONCLUSIONS Pre-COVID-19 chronic anxiety and depression may play a role in the development of PCC or share vulnerability factors with it. Our results challenge the inclusion of anxiety and depression in the definition of PCC.
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Affiliation(s)
- Sarah Tebeka
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
- Institute of Psychiatry and Neurosciences, Team 1, Université Paris Cité, INSERM UMR1266, Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Laure Carcaillon-Bentata
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Valentina Decio
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Caroline Alleaume
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Nathalie Beltzer
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Cédric Lemogne
- Center for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Paris, France
- Service de Psychiatrie de l'Adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Baptiste Pignon
- DMU IMPACT, INSERM U955, IMRB, Translational Neuropsychiatry, Fondation FondaMental, Université Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", Creteil, France
| | - Tatjana T Makovski
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
| | - Joël Coste
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, The National Public Health Agency, Saint-Maurice, France
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Carcaillon-Bentata L, Makovski TT, Alleaume C, Decio V, Beltzer N, Gallay A, Tebeka S, Robineau O, Coste J. Post-Covid-19 condition: A comprehensive analysis of the World Health Organisation definition. J Infect 2023; 87:e83-e87. [PMID: 37604211 DOI: 10.1016/j.jinf.2023.08.006] [Citation(s) in RCA: 1] [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: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Laure Carcaillon-Bentata
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France
| | - Tatjana T Makovski
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France.
| | - Caroline Alleaume
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France
| | - Valentina Decio
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France
| | - Nathalie Beltzer
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France
| | - Sarah Tebeka
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neurosciences, Team 1, Paris, France; Department of Psychiatry, AP-HP, Louis Mourier Hospital, F-92700 Colombes, France
| | - Olivier Robineau
- EA2694, Univ Lille, Centre Hospitalier de Tourcoing, Tourcoing, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Joël Coste
- Department of Non-Communicable Diseases and Injuries, Public Health France, Saint-Maurice, France
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Perez T, Roche N, Nunes H, Burgel PR, Chaouat A, Surpas P, Herengt F, Garcia G, Grosbois JM, Stelianides S, de Rigal P, Guérin P, Arnould B, Coste J. Dyspnea-induced Limitation (DYSLIM), a new self-administered concise questionnaire to evaluate dyspnea-related activity limitation in chronic respiratory diseases. Respir Med 2023; 217:107309. [PMID: 37394196 DOI: 10.1016/j.rmed.2023.107309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND AND AIM Few questionnaires are available for routine assessment of dyspnea. The study aimed to design a self-administered questionnaire assessing the impact of chronic dyspnea on daily activities, named DYSLIM (Dyspnea-induced Limitation). METHODS The development followed 4 steps: 1: selection of relevant activities and related questions (focus groups); 2: clinical study: internal and concurrent validity vs. modified Medical Research Council (mMRC), Baseline Dyspnea Index (BDI) and Saint George Respiratory Questionnaire (SGRQ); 3: item reduction; 4: responsiveness. Eighteen activities (from eating to climbing stairs) were considered with 5 modalities for each: doing the task slowly, taking breaks, seeking assistance, changing habits, and activity avoidance. Each modality was graded from 5 (never) to 1 (very often). Validation study included 194 patients: COPD (FEV1 ≥ 50% pred: n = 40; FEV1 < 50% pred: n = 65); cystic fibrosis (n = 30), interstitial lung disease (n = 30), pulmonary hypertension (n = 29). Responsiveness was evaluated by post-pulmonary rehabilitation data in 52 COPD patients. RESULTS Acceptability was high and short term (7 days) reproducibility was satisfactory (Kappa mostly above 0.7). Concurrent validity was high vs. mMRC (Spearman correlation coefficient, r = 0.71), BDI (r = - 0.75) and SGRQ (r = - 0.79). The reduced questionnaire with 8 activities (from cleaning to climbing stairs) and 3 modalities (slowly, seeking help, changing habits) showed a comparable validity and was chosen as the final short version. Effect size of rehabilitation was good for both the full (0.57) and short (0.51) versions. A significant correlation was also found between changes of SGRQ and DYSLIM post rehabilitation: r = - 0.68 and r = - 0.60 for full and reduced questionnaires, respectively. CONCLUSION The DYSLIM questionnaire appears promising for the evaluation of dyspnea-induced limitations in chronic respiratory diseases and seems suitable for use in various contexts.
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Affiliation(s)
- Thierry Perez
- CHU de Lille, Service de Pneumologie et Immuno-allergologie, Service d'Explorations Fonctionnelles Respiratoires, Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France.
| | - Nicolas Roche
- Hôpital Cochin, Service de Pneumologie, APHP, Paris, France
| | - Hilario Nunes
- Hôpital Avicenne, APHP, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares (site constitutif), Bobigny, France
| | | | - Ari Chaouat
- Département de Pneumologie, CHU de Nancy, Nancy, France
| | | | - Frédéric Herengt
- Centre de réadaptation cardio-respiratoire Dieulefit Santé, Dieulefit, France
| | - Gilles Garcia
- Hôpital du Kremlin Bicêtre, Service de Pneumologie, APHP, Kremlin Bicêtre, France
| | | | - Sandrine Stelianides
- Soins de Suite et Réadaptation en Pneumologie, Hôpital NOVO, Site d'Aincourt, France
| | | | - Philippe Guérin
- Clinique du Souffle « Les Clarines », Riom-es-Montagnes, France
| | | | - Joël Coste
- Biostatistics and Epidemiology Unit, Hôpitaux Universitaires Paris Centre, APHP, Université Paris Cité, Paris, France
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8
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Torres MJ, Coste J, Canouï-Poitrine F, Pouchot J, Rachas A, Carcaillon-Bentata L. Impact of the First COVID-19 Pandemic Wave on Hospitalizations and Deaths Caused by Geriatric Syndromes in France: A Nationwide Study. J Gerontol A Biol Sci Med Sci 2023; 78:1612-1626. [PMID: 36702778 DOI: 10.1093/gerona/glad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The fear of contracting coronavirus disease 2019 (COVID-19) and the preventive measures taken during the health crisis affected both people's lifestyles and the health system. This nationwide study aimed to investigate the impact of the first wave of the COVID-19 pandemic on hospitalizations and mortality related to geriatric syndromes (GS) in older adults in France. METHODS The French National Health Data System was used to compare hospital admissions (excluding the main diagnosis of COVID-19) and mortality rates (using multiple-cause and initial-cause analyses, and both including or excluding confirmed/probable COVID-19) related to 10 different GS (dementia, other cognitive disorders and symptoms, delirium/disorientation, depression, undernutrition/malnutrition, dehydration, pressure ulcer, incontinence, fall/injury and femoral neck fracture) from January to September 2020 to rates observed in previous years. Analyses were stratified by age, sex, place of residence or place of death, and region. RESULTS Hospitalization rates for all GS decreased during the first lockdown compared to the same periods in 2017-19 (from -59% for incontinence to -13% for femoral neck fractures). A dose-response relationship was observed between reduced hospitalizations and COVID-19-related mortality rates. Conversely, for almost all GS studied, excess mortality without COVID-19 was observed during this lockdown compared to 2015-17 (from +74% for delirium/disorientation to +8% for fall/injury), especially in nursing homes and at home. CONCLUSIONS In France, during the first lockdown, a substantial decrease in hospitalizations for GS was accompanied by excess mortality. This decline in the use of services, which persisted beyond lockdown, may have a mid- and long-term impact on older adults' health.
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Affiliation(s)
- Marion J Torres
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Joël Coste
- Santé Publique France (French Public Health Agency), Saint-Maurice, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- APHP, Hôpital Henri-Mondor, Service de Santé Publique, Creteil, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - Antoine Rachas
- Department of Strategy, Studies and Statistics, French National Health Insurance (Cnam), Paris, France
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Coste J, Pérès K, Robine JM, Carcaillon-Bentata L. Dimensionality and invariance of ADL, IADL, BI-M2/WG-SS, and GALI in large surveys in France (2008-2014) and implications for measuring disability in epidemiology. Arch Public Health 2023; 81:141. [PMID: 37544985 PMCID: PMC10405560 DOI: 10.1186/s13690-023-01164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The epidemiological investigation and surveillance of disability requires well-constructed, invariant, and, if possible, exchangeable measures. However, the current or recommended measures have not been thoroughly investigated with respect to these issues. Here we examined the dimensional structure and invariance of four measures across sociodemographic groups: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Budapest Initiative Mark 2 (BI-M2) and Washington Group on Disability Statistics Short Set (WG-SS), and Global Activity Limitation Indicator (GALI). METHODS We used data from three large nationwide representative surveys conducted in France between 2008 and 2014. The surveys included these four measures and classical and modern approaches (correlations, principal component analysis, Rasch modeling) were used to assess their dimensional structure as well as their invariance through differential item functioning (DIF) for sociodemographic characteristics. Polytomous logistic regression models were used to assess gradients in health inequalities associated with these measures. RESULTS For many items of ADL, IADL, and BI-M2/WG-SS, we consistently observed disordered response thresholds, rejection of unidimensionality, and DIF evidence for sociodemographic characteristics across the survey samples. Health inequality gradients were erratic. In addition, it was impossible to identify a common continuum for GALI, ADL, IADL, and BI-M2/WG-SS or their constituent items. CONCLUSION This study warns against the current practice of investigating disability in epidemiology using measures that are unsuitable for epidemiological use, incommensurable, and inadequate regarding the basic requisites of dimensionality and invariance. Developing invariant measures and equating them along a common continuum to enlarge the common bases of measurement should therefore be a priority.
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Affiliation(s)
- Joël Coste
- Santé publique France (French national public health agency), Saint-Maurice, France.
| | - Karine Pérès
- University of Bordeaux, INSERM, Bordeaux Population Health, U1219, Bordeaux, France
| | - Jean-Marie Robine
- 3MMDN, University of Montpellier, EPHE, INSERM, Montpellier, France
- PSL Research University, Paris, France
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Libé R, Pais A, Violon F, Guignat L, Bonnet F, Huillard O, Assié G, Gaillard M, Dousset B, Gaujoux S, Barat M, Dohan A, Sibony M, Bertherat J, Cottereau AS, Tenenbaum F, Coste J, Groussin L. Positive Correlation Between 18 F-FDG Uptake and Tumor-Proliferating Antigen Ki-67 Expression in Adrenocortical Carcinomas. Clin Nucl Med 2023; 48:381-386. [PMID: 36758555 DOI: 10.1097/rlu.0000000000004593] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF THE REPORT Adrenocortical carcinoma (ACC) is an extremely rare endocrine malignancy, which cannot always be diagnosed during conventional radiology and hormonal investigations. 18 F-FDG PET could help predict malignancy, but more data are necessary to support future guidelines. METHODS A cohort of 63 patients with histologically proven ACC (n = 55) or metastatic ACC with steroid oversecretion (n = 8) was assembled. All patients underwent an 18 F-FDG PET, and the SUV max and the adrenal-to-liver SUV max ratio were calculated. The 18 F-FDG PET parameters were compared with clinical, pathological, and outcome data. RESULTS Fifty-six of 63 patients (89%) had an ACC with an adrenal-to-liver SUV max ratio >1.45, which was a previously defined cutoff value to predict malignancy with 100% sensitivity. Seven ACCs (11%) had a lower uptake (adrenal-to-liver SUV max <1.45), most of them with a proliferation marker Ki-67 expression level <10%. A positive correlation between 18 F-FDG PET parameters (SUV max and adrenal-to-liver SUV max ratio) and tumor size, ENSAT (European Network for the Study of Adrenal Tumors) staging, total Weiss score, and the Ki-67 was found. The strong correlation between SUV max and Ki-67 ( r = 0.47, P = 0.0009) suggests a relationship between 18 F-FDG uptake levels and tumor proliferation. No statistically significant associations between outcome parameters (progression-free or overall survival) and 18 F-FDG PET parameters were found. CONCLUSIONS This large cohort study shows that most cases of ACC demonstrate high 18 F-FDG uptake. However, the positive correlation observed between SUV max and Ki-67 expression levels seems to explain the possibility of identifying some ACC with a low or inexistent 18 F-FDG uptake. These findings have practical implications for the management of patients with an adrenal mass.
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Affiliation(s)
- Rossella Libé
- From the Service Endocrinologie, French National Network for Adrenal Cancers ENDOCAN-COMETE
| | - Aurore Pais
- From the Service Endocrinologie, French National Network for Adrenal Cancers ENDOCAN-COMETE
| | | | - Laurence Guignat
- From the Service Endocrinologie, French National Network for Adrenal Cancers ENDOCAN-COMETE
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11
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Trouvin AP, Simunek A, Coste J, Medkour T, Carvès S, Bouhassira D, Perrot S. Mechanisms of chronic pain in inflammatory rheumatism: the role of descending modulation. Pain 2023; 164:605-612. [PMID: 35984362 DOI: 10.1097/j.pain.0000000000002745] [Citation(s) in RCA: 1] [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] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Persistent pain despite satisfactory disease treatment is frequent in rheumatoid arthritis (RA) and spondyloarthritis (Spa) and may result from specific changes in central pain processing. We assessed these mechanisms further by systematically comparing thermal pain thresholds and conditioned pain modulation (CPM) between patients with active RA or Spa and healthy controls. We included 50 patients with RA and 50 patients with Spa and 100 age-matched and sex-matched controls. Heat and cold pain thresholds (HPT-CPT) were measured on the dominant forearm, and CPM was assessed by applying conditioning stimuli (immersion in a cold-water bath) to one foot and the nondominant hand in 2 successive randomized sequences. Descending pain modulation was assessed as the difference in HPTs (in °C) before and after conditioning. Larger HPT differences (ie, a larger CPM effect) reflected more efficient descending inhibition. Potential associations between changes in CPM and clinical data, including disease activity, pain intensity, and psychological and functional variables, were systematically assessed. Heat pain threshold and cold pain threshold were similar in patients and controls. The mean CPM effect was significantly weaker in patients than that in controls for conditioning applied to either the foot (0.25°C ±2.57 vs 2.79°C ±2.31; P < 0.001) or the nondominant hand (0.57°C ±2.74 vs 2.68°C ±2.12; P < 0.001). The smaller CPM effect in patients was correlated with average pain intensity, but not with disease activity or other clinical characteristics, suggesting a significant pathophysiological role for changes in endogenous pain modulation in the mechanisms of chronic pain associated with inflammatory rheumatism.
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Affiliation(s)
- Anne-Priscille Trouvin
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
| | - Arielle Simunek
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Joël Coste
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Biostatistics and Epidemiology Unit, GHU Paris Centre-Cochin, Paris, France
| | - Terkia Medkour
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
| | - Sandrine Carvès
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Didier Bouhassira
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
- Pain Medicine Department, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Serge Perrot
- Pain Medicine Department, GHU Paris Centre-Cochin, Paris, France
- Université Paris Cité, Paris, France
- Inserm U987, UVSQ, Paris-Saclay University, Boulogne Billancourt, France
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12
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Coste J, Tebeka S, Decio V, Makovski T, Alleaume C, Gallay A, Carcaillon-Bentata L. Prevalence of post-COVID-19 condition in the French general population after the first epidemic waves. Infect Dis Now 2023; 53:104631. [PMID: 36368627 PMCID: PMC9642032 DOI: 10.1016/j.idnow.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Affiliation(s)
- J. Coste
- Corresponding author at: Public Health France, 12, rue du Val d’Osne, 94410 Saint-Maurice, France
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Trouvin AP, Carvès S, Rouquette A, Coste J, Meyer S, Colin F, Deleens R, Medkour T, Collet MP, Perrot S, Laroche F. "FastSchool": A single session of an interprofessional pain management program for chronic pain patients inspired by cognitive behavioral therapy. Patient Educ Couns 2022; 105:3509-3514. [PMID: 36115735 DOI: 10.1016/j.pec.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Multidisciplinary approaches to treating chronic pain have been proven effective. Currently, chronic pain patients face lengthy waitlists in pain medicine departments. To overcome this problem, we developed the "FastSchool" program to educate patients about pain management and treatment. In this study, we evaluated the benefit of a "FastSchool" session on pain and catastrophizing in chronic pain patients. METHODS Included patients had chronic non-cancer pain, no more than 2 visits to a pain medicine department. Patients attended a single 3-hour session, conducted by an interprofessional team. Four topics were addressed: chronic pain mechanisms, pharmacological therapies, physical activity, and the management of analgesics. Patients completed questionnaires at baseline and at 3 months post-session to assess pain interference, pain intensity, and catastrophizing. RESULTS The study population included 88 patients; 71 completed the follow-up questionnaires. Pain interference (p = 0.002), average pain intensity (p = 0.013), and catastrophizing (p < 0.001) decreased 3 months after FastSchool. At M3, 35 % of patients felt their pain had improved based on the Patient Global Impression of Change. CONCLUSION FastSchool, an innovative short-term educational program inspired by cognitive behavioral therapy, showed positive results in reducing pain impact. PRACTICE IMPLICATIONS Implementation of FastSchool in pain medicine departments would reduce waitlist times for non-pharmacological treatment.
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Affiliation(s)
| | | | - Alexandra Rouquette
- Department of Epidemiology and Public Health, Bicêtre Universitary Hospital, Le Kremlin-Bicêtre, France
| | - Joël Coste
- Pain Department, GHU Paris Centre-Cochin, Paris, France; Biostatistics and Epidemiology Unit, GHU Paris Centre-Cochin, Paris, France
| | - Sinja Meyer
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
| | - Faustine Colin
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
| | | | | | | | - Serge Perrot
- Pain Department, GHU Paris Centre-Cochin, Paris, France
| | - Françoise Laroche
- Pain Department, Saint-Antoine Sorbonne University Hospital, APHP, Paris, France
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Makovski TT, Decio V, Carcaillon-Bentata L, Alleaume C, Beltzer N, Robineau O, Gallay A, Tebeka S, Coste J. Long COVID in France: prevalence, management and long-term impact. Eur J Public Health 2022. [PMCID: PMC9593843 DOI: 10.1093/eurpub/ckac129.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Certain percentage of population experiences persistent symptoms months after an acute Covid-19 episode (Long-COVID), with a significant impact on daily-life. Few studies exist on its prevalence and its impact among the general population. The main objective of this survey was to estimate the prevalence of Long COVID among the general adult population in France. Secondary objectives were to evaluate Long COVID management and to assess impact of this clinical condition on quality of life and mental health. Cross-sectional study was performed in March-April 2022 using an online self-administered questionnaire. The sample was selected by the quota method from a panel of volunteers. Its representativeness was ensured by appropriate weighting. Three groups were described: Long-COVID, COVID without persistent symptoms, never COVID. Post COVID-19 condition as defined by the WHO was applied for prevalence estimation. The prevalence was calculated by age and sex. Health care consumption and impact of Long COVID on quality of life and mental health will be studied comparing the three groups, using weighted adjusted polytomic regressions. Here, we present preliminary findings on Long COVID prevalence. There were 27,537 respondents, 52% females, mean age (SD) 49 (±16.5). Confirmed or probable COVID-19 was reported by 33.9% of participants; of whom 85.1% had confirmed laboratory test. Majority (65.1%) had COVID-19 <3 months ago. Long COVID concerned 1,086 (4%) participants. Prevalence was higher for females 4.6% vs. 3.3% for males, and among younger population for both sex groups. Overall, prevalence of Long COVID by age group was: 18-34 (6%), 35-49 (4.7%), 50-64 (3.4%), ≥65 (1.8%). This is a first estimation of Long COVID prevalence among the French population. Representativeness of the sample should be interpreted with caution due to a sample based on volunteers’ response. Ongoing analyses will provide clearer understanding of the impact of Long COVID. Key messages • This is a first estimation of Long COVID prevalence among the French population. • There is a significant portion of the French population impacted by persisting or reoccurring symptoms defined by Long COVID; its impact and care management will be further evaluated.
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Affiliation(s)
- TT Makovski
- Department of Non-communicable Diseases, Santé Publique France , Saint-Maurice, France
| | - V Decio
- Department of Non-communicable Diseases, Santé Publique France , Saint-Maurice, France
| | - L Carcaillon-Bentata
- Department of Non-communicable Diseases, Santé Publique France , Saint-Maurice, France
| | - C Alleaume
- Department of Alert and Crisis, Santé Publique France , Saint-Maurice, France
| | - N Beltzer
- Department of Non-communicable Diseases, Santé Publique France , Saint-Maurice, France
| | - O Robineau
- Université, Inserm Sorbonne , Paris, France
- Centre Hospitalier de Tourcoing University Lille, , Tourcoing, France
| | - A Gallay
- Department of Non-communicable Diseases, Santé Publique France , Saint-Maurice, France
| | - S Tebeka
- Department of Non-communicable Diseases, Santé Publique France , Saint-Maurice, France
| | - J Coste
- Department of Non-communicable Diseases, Santé Publique France , Saint-Maurice, France
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15
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Trouvin AP, Simunek A, Coste J, Medkour T, Carvès S, Bouhassira D, Perrot S. POS0018 REDUCTION OF DIFFUSE NOXIOUS INHIBITORY CONTROL IN ACTIVE INFLAMMATORY RHEUMATISM: A DEMONSTRATION OF CENTRAL SENSITISATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn rheumatoid arthritis (RA) and spondyloarthritis (Spa), persistent pain remains challenging. It is thought to result from central pain sensitisation, which can be measured by quantitative sensory testing (QST) and conditioned pain modulation (CPM).ObjectivesThe main objective of the RAPID (Rheumatism Pain Inhibitory Descending pathways) study, was to assess descending pain modulation (through CPM paradigms) in patients with RA or Spa, comparing these patients with healthy sex- and age-matched controls. The secondary objectives were the measurement pain thresholds (heat and cold) in a non-articular, non-painful area in patients and controls as a means of detecting possible widespread hyperalgesia as another index of central sensitisation in our patients.MethodsWe included 50 RA and 50 Spa patients and 100 age- and sex-matched controls. We assessed clinical disease variables for patients, together with responses to various psychological questionnaires. All participants underwent QST with the determination of heat and cold pain thresholds (HPT-CPT) and CPM. In CPM, a conditioning stimulus was applied to a foot and the non-dominant hand in a randomised sequence. Descending pain control was assessed as the change in HPT (in °C) following a conditioning stimulus: the higher the CPM effect, the more efficient the inhibitory control.ResultsHPT and CPT were similar in patients and controls. Mean CPM effect was significantly weaker in patients than controls: 0.25°C (±2.57) and 2.79°C (±2.31) for patients and controls, respectively (p<0.0001) for conditioning on the foot; 0.57°C (±2.74) and 2.68°C (±2.12) (p<0.0001), respectively, for conditioning on the hand. The heat pain threshold was 42.35°C (± 3.68°C) for patients and 41.54°C (± 3.34°C) for healthy controls; this difference was not statistically significant. The cold pain threshold was 13.11°C (± 10.04°C) for patients and 13.28°C (± 9.34°C) for healthy controls; this difference was not significant. The weaker CPM effect in patients was associated with higher pain intensity. In all participants, a weak CPM effect was associated with high Central Sensitisation Inventory score, anxiety, depression, sleep disturbance and pain catastrophising.ConclusionDiffuse noxious inhibitory control is weaker in patients with active chronic inflammatory rheumatism than in healthy subjects, supporting the hypothesis of central sensitisation.Figure 1.Disclosure of InterestsNone declared
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Hoisnard L, Laanani M, Passeri T, Duranteau L, Coste J, Zureik M, Froelich S, Weill A. Risk of intracranial meningioma with three potent progestogens: a population-based case-control study. Eur J Neurol 2022; 29:2801-2809. [PMID: 35621369 PMCID: PMC9543130 DOI: 10.1111/ene.15423] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022]
Abstract
Background and purpose A dose‐dependent association between the use of cyproterone acetate (CPA) and intracranial meningioma has been identified but data for other potent progestogens are scarce. The association was assessed between intracranial meningioma surgery and exposure to three potent progestogens: CPA (≥25 mg/day), nomegestrol acetate (NOMAC) (3.75–5 mg/day) and chlormadinone acetate (CMA) (2–10 mg/day). Methods In this nationwide population‐based case–control study, cases underwent surgery for intracranial meningioma in France from 2009 to 2018. They were matched to five control subjects for sex, year of birth and area of residence. Progestogen exposure was defined as progestogen use within the year before surgery for cases or the same date for their controls. Results In total, 25,216 cases were included (75% women, median age 58 years). Progestogen exposure was noted for 9.9% of cases (2497/25,216) and 1.9% (2382/126,080) of controls, with an odds ratio (OR) of 6.7 (95% confidence interval [CI] 6.3–7.1). The OR was 1.2 (1.0–1.4) for short‐term use (<1 year) and 9.5 (8.8–10.2) for prolonged use. A strong association was identified for prolonged use of CPA (OR = 22.7, 95% CI 19.5–26.4), NOMAC (OR = 6.5, 95% CI 5.8–7.2) and CMA (OR = 4.7, 95% CI 4.5–5.3). Progestogen exposure increased the risk of meningioma for all histological grades and anatomical sites, particularly for the anterior and middle skull base: OR = 35.7 (95% CI 26.5–48.2) and 23.9 (95% CI 17.8–32.2) for CPA. The estimated number of attributable cases was 2124 (95% CI 2028–2220) (212/year). Conclusion A strong association between prolonged exposure to potent progestogens and surgery for meningioma was observed. The risk increased from CMA to NOMAC to CPA. Individuals should be informed of this risk. This study highlights a strong association between prolonged use of nomegestrol and chlormadinone acetate (two potent progestogens) and intracranial meningioma, although weaker than that of cyproterone acetate. The estimated number of cases was higher than 2000 in France over 10 years.
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Affiliation(s)
- Léa Hoisnard
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, 93200, Saint-Denis, France
| | - Moussa Laanani
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, 93200, Saint-Denis, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, 75010, Paris, France
| | - Lise Duranteau
- Department of Medical Gynaecology, Bicêtre Hospital, AP-HP, University Paris Saclay, 94270, Le Kremlin-Bicêtre, France
| | - Joël Coste
- Biostatistics and Epidemiology Unit - Cochin Hospital, AP-, HP, 75010, Paris, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, 93200, Saint-Denis, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, 75010, Paris, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, French National Health Insurance, 93200, Saint-Denis, France
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Coste J, Valderas JM, Carcaillon-Bentata L. The epidemiology of multimorbidity in France: Variations by gender, age and socioeconomic factors, and implications for surveillance and prevention. PLoS One 2022; 17:e0265842. [PMID: 35385501 PMCID: PMC8986023 DOI: 10.1371/journal.pone.0265842] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Robust public health and health system response to the increasing burden of multimorbidity worldwide requires detailed epidemiological examination of its key sociodemographic and geographic determinants. We investigated the role of gender, age and socioeconomic and geographic factors on multimorbidity (i.e., having two or more conditions) in the adult population in France and examined implications for surveillance and prevention. Methods We used data from two large nationwide representative surveys with cross-sectional and longitudinal health and socio-demographic indicators, conducted in France between 2008 and 2014. Morbidity counts and frequent dyads/triads of conditions independently impacting mortality, activity limitations, and perceived health were investigated with regard to differences in gender, age, socioeconomic (education, occupation and income) and geography (size of the urban unit and region). Results The component conditions of multimorbidity varied with gender and age. Women experienced multimorbidity 23–31% more frequently and at a younger age (5–15 years earlier) than men. Multimorbidity increased with age while its associations with most health indicators weakened with it. Multimorbidity was strongly and independently associated with socioeconomic indicators, with a strong inverse dose-response relationship with education, but less consistently with geographic factors. Conclusions Multimorbidity has diverse and variable components and impacts across gender and age. It is strongly associated with socioeconomic factors, notably educational level, for which causality appears likely. Consideration of this diversity and variability, its common occurrence in dyads and triads, and its impact on health outcomes according to age and gender may contribute to efficient surveillance and support the identification of prevention strategies targeting middle-aged men and women.
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Affiliation(s)
- Joël Coste
- Public Health France, Saint-Maurice, France
- * E-mail:
| | - José M. Valderas
- Department of Family Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Coste J, Mandereau-Bruno L, Carcaillon-Bentata L. Identification des maladies chroniques dans le Système national des données de santé : recensement des algorithmes publiés et faisabilité de leur implémentation pour la surveillance épidémiologique. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.01.110] [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: 11/27/2022] Open
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Affiliation(s)
- Joël Coste
- Biostatistics and Epidemiology Unit, Cochin Hospital, Paris University, 75014 Paris, France
| | - Terkia Medkour
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Jean-Yves Maigne
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Marc Pérez
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Françoise Laroche
- Pain Department, Saint-Antoine University Hospital and Medical University Sorbonne, Paris, France
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
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Carcaillon-Bentata L, Soullier N, Beltzer N, Coste J. Alteration in perceived health status of those aged 55 to 65 between 2010 and 2017 in France: role of socioeconomic determinants. BMC Public Health 2021; 21:1804. [PMID: 34620145 PMCID: PMC8499534 DOI: 10.1186/s12889-021-11774-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While life expectancy increases, it is necessary to evaluate whether the additional years are lived in good health, particularly in order to adapt the health care provision and social measures available to support these individuals. Since the 1990s, improvements in perceived health and capacities have been observed among older people, however the changes appear to be far less favourable among the working-age population and, in particular, the generation of people approaching retirement age. The aim of this study was to examine the change in the perceived health status of those aged 55 to 65 in France and investigate the role of socioeconomic factors in this change. METHODS Self-reported health (SRH), chronic condition and activity limitation were assessed in 2010 and in 2017 in the French Health Barometer, a general population phone survey conducted on over 25,000 persons living in the community. The prevalence of all three indicators in 2017, and their evolution between 2010 and 2017 were studied according to the main socioeconomic determinants. RESULTS Between 2010 and 2017, there was a sharp increase in the proportion of individuals aged 55-65 reporting poor SRH, chronic condition or activity limitation. A much more marked deterioration was observed in the three indicators among those aged 55-65 than in older age groups, as well as different changes according to socioeconomic determinants. The category of workers with an average level of education was particularly affected by the deterioration. CONCLUSIONS This study confirms that the generation approaching retirement age presents a more significant deterioration in health status than those of previous generations. The question of how these trends will be reflected in terms of the burden of dependency at later ages remains open and should encourage increased monitoring of and prevention among this population in future years.
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Affiliation(s)
| | - Noémie Soullier
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
| | - Nathalie Beltzer
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
| | - Joël Coste
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
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Garratt AM, Coste J, Rouquette A, Valderas JM. The Norwegian PROMIS-29: psychometric validation in the general population for Norway. J Patient Rep Outcomes 2021; 5:86. [PMID: 34499288 PMCID: PMC8427163 DOI: 10.1186/s41687-021-00357-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
Background The Patient Reported Outcome Measurement Information System profile instruments include “high information” items drawn from large item banks following the application of modern psychometric criteria. The shortest adult profile, PROMIS-29, looks set to replace existing short-form instruments in research and clinical practice. The objective of this study was to undertake the first psychometric evaluation of the Norwegian PROMIS-29, following a postal survey of a random sample of 12,790 Norwegians identified through the National Registry of the Norwegian Tax Administration. Confirmatory factor analysis was used to assess structural validity. Fit to the Rasch partial credit model and differential item functioning (DIF) were assessed in relation to age, gender, and education. PROMIS-29 scores were compared to those for the EQ-5D-5L and the Self-assessed Comorbidity Questionnaire (SCQ), for purposes of assessing validity based on a priori hypotheses. Results There were 3200 (25.9%) respondents with a mean age (SD) of 51 (20.7, range 18 to 97 years) and 55% were female. The PROMIS-29 showed satisfactory structural validity and acceptable fit to Rasch model including unidimensionality, and measurement invariance across age and education levels. One pain interference item had uniform DIF for gender but splitting gave satisfactory fit. Domain reliability estimates ranged from 0.85 to 0.95. Correlations between PROMIS-29 domain, SCQ and EQ-5D scores were largely as expected, the largest being for scores assessing very similar aspects of health. Conclusions The Norwegian version of the PROMIS-29 is a reliable and valid generic self-reported measure of health in the Norwegian general population. The instrument is recommended for further application, but the analysis should be replicated and responsiveness to change assessed in future studies before it can be recommended for clinical and health services evaluation in Norway. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00357-3.
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Affiliation(s)
- Andrew M Garratt
- Division for Health Services, Norwegian Institute of Public Health, Post Box 4404, 0403, Nydalen, Oslo, Norway.
| | - Joël Coste
- Biostatistics and Epidemiology Unit, Cochin Hospital, AP-HP, 27 rue du faubourg Saint-Jacques, 75014, Paris, France.,Paris University, 75014, Paris, France
| | - Alexandra Rouquette
- Université Paris-Saclay, UVSQ, Inserm, CESP, 75014, Paris, France.,Public Health and Epidemiology Department, AP-HP Paris-Saclay, 94276, Le Kremlin-Bicêtre Cedex, France
| | - José M Valderas
- Health Services and Policy Research Group (HSPRG), Exeter Collaboration for Academic Primary Care (APEx), and NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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22
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Sbidian E, Mezzarobba M, Shourick J, Billionnet C, Coste J, Weill A, Rudant J, Chosidow O, Hollestein L, Nijsten T. Choice of Systemic Drugs for the Management of Moderate-to-severe Psoriasis: A Cross-country Comparison Based on National Health Insurance Data. Acta Derm Venereol 2021; 101:adv00473. [PMID: 33585948 PMCID: PMC9380268 DOI: 10.2340/00015555-3765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Current management of moderate-to-severe psoriasis may be heterogeneous between European countries, probably due to differences in the organization of care. The aim of this study was to compare the utilization of systemic treatments for psoriasis between 2 countries. All adults with psoriasis who were registered in the French (SNDS) and the Dutch (VEKTIS) national health insurance databases between 2012 and 2016 were eligible for inclusion. In France, 105,035 (15%) of 684,156 patients and, in the Netherlands, 37,405 (28.6%) of 130,822 patients received at least a systemic agent. In France, the proportion of patients treated with systemic agents was constant, while the type of drugs dispensed shifted from non-biological to biological agents. In the Netherlands, the first systemic treatment was methotrexate and, in France, acitretin. In France, the choice of the first biologic was much more variable than it was in the Netherlands, where a large proportion of patients were dispensed ustekinumab. This study highlights discrepancies between France and the Netherlands concerning the choice of first non-biologic agent and first biologic agent for patients with psoriasis. These discrepancies may be due to differences in the healthcare systems between the 2 countries.
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Affiliation(s)
- Emilie Sbidian
- Department of Dermatology, Hôpital Henri-Mondor, 51, av du Maréchal de Lattre de Tassigny, FR-94010 Créteil Cedex, France. E-mail:
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Madelaine T, Cour M, Roy P, Vivien B, Charpentier J, Dumas F, Deye N, Bonnefoy E, Gueugniaud PY, Coste J, Cariou A, Argaud L. Prediction of Brain Death After Out-of-Hospital Cardiac Arrest: Development and Validation of the Brain Death After Cardiac Arrest Score. Chest 2021; 160:139-147. [PMID: 34116828 DOI: 10.1016/j.chest.2021.01.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/09/2020] [Accepted: 01/03/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Among patients successfully resuscitated after an out-of-hospital cardiac arrest (OHCA), 10% to 15% evolve toward brain death (BD), thus becoming potential organ donors. RESEARCH QUESTION Is it possible to establish a score for early estimation of BD risk after OHCA? STUDY DESIGN AND METHODS The BD after cardiac arrest (BDCA) score was developed from data available within 24 hours after OHCA from two OHCA trials: Cyclosporine in Cardiac Arrest Resuscitation and Erythropoietin After OHCA. The BDCA score was then validated in another large prospective multicenter data set. The main outcome was the occurrence of BD. Independent prognostic covariates for BD were identified using a binomial two-stage adaptive least absolute shrinkage and selection operator procedure. RESULTS The development cohort included 569 patients alive 24 hours after OHCA, among whom 84 (14.8%) experienced BD. Independent predictors of BD used to build the BDCA score were being female (4 points), nonshockable rhythm (24 points), cardiac cause of OHCA (-6 points), neurological cause of OHCA (45 points), natremia at 24 hours (natremia in millimoles per liter minus 140 points), and vasoactive drug at admission (4 points) and at 24 hours (6 points). The area under the curve (AUC) of the BDCA score was 0.82 (95% CI, 0.77-0.86), and the discrimination value in the validation cohort (n = 487) was consistent (AUC, 0.81; 95% CI, 0.76-0.86). In the validation cohort, BD occurred in 4.0%, 20.4%, and 67.7% of patients with scores of < 20, 20 to 50, and > 50, respectively. INTERPRETATION The BDCA score allows early detection of patients with a high probability of experiencing BD, which may help increase organ donation after OHCA. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT01595958, and ClinicalTrials.gov; No.: NCT00999583; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Thomas Madelaine
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Martin Cour
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM UMR1060 (CarMeN), Université de Lyon, Lyon, France
| | - Pascal Roy
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Benoît Vivien
- SAMU de Paris, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Julien Charpentier
- Service de réanimation médicale, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Florence Dumas
- Service des Urgences, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Nicolas Deye
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Eric Bonnefoy
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | | | - Joël Coste
- Unité de Biostatistique et d'Epidémiologie, Hôtel-Dieu de Paris, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Alain Cariou
- Service de réanimation médicale, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris Paris, France
| | - Laurent Argaud
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM UMR1060 (CarMeN), Université de Lyon, Lyon, France.
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Lemaire JJ, Pontier B, Chaix R, El Ouadih Y, Khalil T, Sinardet D, Achim V, Postelnicu A, Coste J, Germain V, Sarret C, Sontheimer A. Neural correlates of consciousness and related disorders: From phenotypic descriptors of behavioral and relative consciousness to cortico-subcortical circuitry. Neurochirurgie 2021; 68:212-222. [PMID: 34051246 DOI: 10.1016/j.neuchi.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/13/2021] [Accepted: 05/09/2021] [Indexed: 01/01/2023]
Abstract
We report a review of medical aspects of the consciousness. The behavioral dimension, phenotypic descriptors, relative consciousness and neural correlates of consciousness and related disorders were addressed successively in a holistic and chronological approach. Consciousness is relative, specific to each individual across time and space. Historically defined as the perception of the self and the environment, it cannot be separated from behaviors, entailing an idea of conscious behavior with metapractic and metagnostic aspects. Observation of spontaneous and evoked overt behavior distinguishes three main types of disorder of consciousness (DoC): coma, vegetative state or unresponsive wakefulness, and minimally conscious or relationally impoverished state. Modern functional exploration techniques, such as imaging, increase the understanding of DoCs and consciousness. Whether consciousness is a superior function and/or an instrumental function is discussed. Neural correlates can be subdivided into two wakefulness pathways (superior thalamic cholinergic and inferior extra-thalamic), and cortico-subcortical circuitry. The deep brain structures are those described in the well-known sensorimotor, associative and limbic loops, as illustrated in the mesolimbic model of DoC. The cortices can be segregated into several overlapping networks: (1) a global workspace including thalamo-cortical loops; (2) the default mode network (DMN) and related intrinsic connectivity networks (i.e., central executive, medial DMN and salience networks); (3) a 3-fold network comprising the fronto-parietal control system and its dorsal and ventral attentional sub-networks, the fronto-parietal executive control network, and the cingulo-opercular salience network; (4) the internal and external cortices, respectively medial, turned toward the self, and lateral, turned toward the environment. The network dynamics is the reflection of consciousness, notably anticorrelations such as the decrease in activity of the posterior cingulate-precuneus regions during attentional tasks. Thanks to recent advances in DoC pathophysiology, further significative therapeutic progress is expected, taking into account the societal context. This depends notably on the dissemination of medical knowledge and its transfer to a wider public.
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Affiliation(s)
- J-J Lemaire
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France.
| | - B Pontier
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - R Chaix
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Y El Ouadih
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - D Sinardet
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - V Achim
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - A Postelnicu
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J Coste
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - V Germain
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - C Sarret
- Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - A Sontheimer
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
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Coste J, Medkour T, Maigne JY, Pérez M, Laroche F, Perrot S. Osteopathic medicine for fibromyalgia: a sham-controlled randomized clinical trial. Ther Adv Musculoskelet Dis 2021; 13:1759720X211009017. [PMID: 33948127 PMCID: PMC8053754 DOI: 10.1177/1759720x211009017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Patients with fibromyalgia (FM) frequently resort to osteopathic or chiropractic treatment, despite very weak supporting evidence. We aimed to assess the efficacy of osteopathic manipulation in FM in a properly controlled and powered randomized clinical trial. Methods: Patients were randomized to osteopathic or sham treatment. Treatment was administered by experienced physical medicine physicians, and consisted of six sessions per patient, over 6 weeks. Treatment credibility and expectancy were repeatedly evaluated. Patients completed standardized questionnaires at baseline, during treatment, and at 6, 12, 24, and 52 weeks after randomization. The primary outcome was pain intensity (100-mm visual analog scale) during the treatment period. Secondary outcomes included fatigue, functioning, and health-related quality of life. We performed primarily intention-to-treat analyses adjusted for credibility, using multiple imputation for missing data. Results: In total, 101 patients (94% women) were included. Osteopathic treatment did not significantly decrease pain relative to sham treatment (mean difference during treatment: −2.2 mm; 95% confidence interval, −9.1 to 4.6 mm). No significant differences were observed for secondary outcomes. No serious adverse events were observed, despite a likely rebound in pain and altered functioning at week 12 in patients treated by osteopathy. Patient expectancy was predictive of pain during treatment, with a decrease of 12.9 mm (4.4–21.5 mm) per 10 points on the 0–30 scale. Treatment credibility and expectancy were also predictive of several secondary outcomes. Conclusion: Osteopathy conferred no benefit over sham treatment for pain, fatigue, functioning, and quality of life in patients with FM. These findings do not support the use of osteopathy to treat these patients. More attention should be paid to the expectancy of patients in FM management.
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Affiliation(s)
- Joël Coste
- Biostatistics and Epidemiology Unit, Cochin Hospital, Paris University, 27 rue du faubourg Saint-Jacques, Paris, 75014, France
| | - Terkia Medkour
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Jean-Yves Maigne
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Marc Pérez
- Physical Medicine and Rehabilitation Unit, Cochin Hospital, Paris, France
| | - Françoise Laroche
- Pain Department, Saint-Antoine University Hospital and Medical University Sorbonne, Paris, France
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
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Coste J, Valderas JM, Carcaillon-Bentata L. Estimating and characterizing the burden of multimorbidity in the community: A comprehensive multistep analysis of two large nationwide representative surveys in France. PLoS Med 2021; 18:e1003584. [PMID: 33901171 PMCID: PMC8109815 DOI: 10.1371/journal.pmed.1003584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/10/2021] [Accepted: 03/12/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Given the increasing burden of chronic conditions, multimorbidity is now a priority for healthcare and public health systems worldwide. Appropriate methodological approaches for assessing the phenomenon have not yet been established, resulting in inconsistent and incomplete descriptions. We aimed to estimate and characterize the burden of multimorbidity in the adult population in France in terms of number and type of conditions, type of underlying mechanisms, and analysis of the joint effects for identifying combinations with the most deleterious interaction effects on health status. METHODS AND FINDINGS We used a multistep approach to analyze cross-sectional and longitudinal data from 2 large nationwide representative surveys: 2010/2014 waves of the Health, Health Care, and Insurance Survey (ESPS 2010-2014) and Disability Healthcare Household Survey 2008 (HSM 2008), that collected similar data on 61 chronic or recurrent conditions. Adults aged ≥25 years in either ESPS 2010 (14,875) or HSM 2008 (23,348) were considered (participation rates were 65% and 62%, respectively). Longitudinal analyses included 7,438 participants of ESPS 2010 with follow-up for mortality (97%) of whom 3,798 were reinterviewed in 2014 (52%). Mortality, activity limitation, self-reported health, difficulties in activities/instrumental activities of daily living, and Medical Outcomes Study Short-Form 12-Item Health Survey were the health status measures. Multiple regression models were used to estimate the impact of chronic or recurrent conditions and multimorbid associations (dyads, triads, and tetrads) on health status. Etiological pathways explaining associations were investigated, and joint effects and interactions between conditions on health status measures were evaluated using both additive and multiplicative scales. Forty-eight chronic or recurrent conditions had an independent impact on mortality, activity limitations, or perceived heath. Multimorbidity prevalence varied between 30% (1-year time frame) and 39% (lifetime frame), and more markedly according to sex (higher in women), age (with greatest increases in middle-aged), and socioeconomic status (higher in less educated and low-income individuals and manual workers). We identified various multimorbid combinations, mostly involving vasculometabolic and musculoskeletal conditions and mental disorders, which could be explained by direct causation, shared or associated risk factors, or less frequently, confounding or chance. Combinations with the highest health impacts included diseases with complications but also associations of conditions affecting systems involved in locomotion and sensorial functions (impact on activity limitations), and associations including mental disorders (impact on perceived health). The interaction effects of the associated conditions varied on a continuum from subadditive and additive (associations involving cardiometabolic conditions, low back pain, osteoporosis, injury sequelae, depression, and anxiety) to multiplicative and supermultiplicative (associations involving obesity, chronic obstructive pulmonary disease, migraine, and certain osteoarticular pathologies). Study limitations included self-reported information on chronic conditions and the insufficient power of some analyses. CONCLUSIONS Multimorbidity assessments should move beyond simply counting conditions and take into account the variable impacts on health status, etiological pathways, and joint effects of associated conditions. In particular, the multimorbid combinations with substantial health impacts or shared risk factors deserve closer attention. Our findings also suggest that multimorbidity assessment and management may be beneficial already in midlife and probably earlier in disadvantaged groups.
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Affiliation(s)
- Joël Coste
- Public Health France, Saint-Maurice, France
- * E-mail:
| | - José M. Valderas
- APEx Collaboration for Academic Primary Care, Health Services and Policy Research Group, University of Exeter, Exeter, United Kingdom
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Weill A, Nguyen P, Labidi M, Cadier B, Passeri T, Duranteau L, Bernat AL, Yoldjian I, Fontanel S, Froelich S, Coste J. Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study. BMJ 2021; 372:n37. [PMID: 33536184 DOI: 10.1136/bmj.n37] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 12/18/2022]
Abstract
OBJECTIVE To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism. DESIGN Observational cohort study. SETTING Data from SNDS, the French administrative healthcare database, between 2007 and 2015. PARTICIPANTS 253 777 girls and women aged 7-70 years living in France who started cyproterone acetate between 2007 and 2014. Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139 222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114 555 participants). 10 876 transgender participants (male to female) were included in an additional analysis. MAIN OUTCOME MEASURE Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas. RESULTS Overall, 69 meningiomas in the exposed group (during 289 544 person years of follow-up) and 20 meningiomas in the control group (during 439 949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100 000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123 997 already using cyproterone acetate in 2006 (risk of 383 per 100 000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14 460 person years; 20.7 per 100 000 person years). CONCLUSIONS A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.
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Affiliation(s)
- Alain Weill
- Department of Public Health Studies, French National Health Insurance, Paris, France
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
| | - Pierre Nguyen
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
- French National Agency for the Safety of Medicines and Health Products (ANSM), Saint-Denis, France
| | - Moujahed Labidi
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Benjamin Cadier
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Lise Duranteau
- Gynaecology Unit and Reference Center for Rare Diseases of Genital Development, AP-HP, University Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Isabelle Yoldjian
- French National Agency for the Safety of Medicines and Health Products (ANSM), Saint-Denis, France
| | | | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance, Paris, France
- Biostatistics and Epidemiology Unit, Cochin Hospital, AP-HP, Paris, France
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Giral P, Neumann A, Weill A, Coste J. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France. Eur Heart J 2020; 40:3516-3525. [PMID: 31362307 PMCID: PMC6855142 DOI: 10.1093/eurheartj/ehz458] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/08/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
Aims The role of statin therapy in primary prevention of cardiovascular disease in persons older than 75 years remains a subject of debate with little evidence to support or exclude the benefit of this treatment. We assessed the effect of statin discontinuation on cardiovascular outcomes in previously adherent 75-year-olds treated for primary prevention. Methods and results A population-based cohort study using French national healthcare databases was performed, studying all subjects who turned 75 in 2012–14, with no history of cardiovascular disease and with a statin medication possession ratio ≥80% in each of the previous 2 years. Statin discontinuation was defined as three consecutive months without exposure. The outcome was hospital admission for cardiovascular event. The hazard ratio comparing statin discontinuation with continuation was estimated using a marginal structural model adjusting for both baseline and time-varying covariates (cardiovascular drug use, comorbidities, and frailty indicators). A total of 120 173 subjects were followed for an average of 2.4 years, of whom 17 204 (14.3%) discontinued statins and 5396 (4.5%) were admitted for a cardiovascular event. The adjusted hazard ratios for statin discontinuation were 1.33 [95% confidence interval (CI) 1.18–1.50] (any cardiovascular event), 1.46 (95% CI 1.21–1.75) (coronary event), 1.26 (95% CI 1.05–1.51) (cerebrovascular event), and 1.02 (95% CI 0.74–1.40) (other vascular event). Conclusion Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year-old primary prevention patients. Future studies, including randomized studies, are needed to confirm these findings and support updating and clarification of guidelines on the use of statins for primary prevention in the elderly. ![]()
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Affiliation(s)
- Philippe Giral
- Department of Endocrinology, Metabolism and Prevention of Cardiovascular Diseases, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anke Neumann
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale d'assurance maladie, Cnam), Paris, France
| | - Alain Weill
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale d'assurance maladie, Cnam), Paris, France
| | - Joël Coste
- Department of Studies in Public Health, French National Health Insurance (Caisse nationale d'assurance maladie, Cnam), Paris, France.,Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, 27 rue du faubourg Saint-Jacques, Paris, France
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Roux CH, Coste J, Roger C, Fontas E, Rat AC, Guillemin F. Impact of smoking on femorotibial and hip osteoarthritis progression: 3-year follow-up data from the KHOALA cohort. Joint Bone Spine 2020; 88:105077. [PMID: 32950705 DOI: 10.1016/j.jbspin.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the clinical and structural impact of smoking on knee and hip osteoarthritis at baseline and after 3years. METHODS Observational data on the progressive effects of smoking at baseline and after 3years were collected from The Knee and Hip Osteoarthritis Long-Term Assessment cohort comprising a French population of patients aged 40-75years with symptomatic lower limb osteoarthritis. Clinical (the Western Ontario and McMaster Universities Arthritis Index and Harris scores) and structural (radiography for osteophyte detection and joint-space narrowing assessment) were conducted. The tobacco usage categories were 'never smoker', 'former smoker', and 'current smoker'. RESULTS Of the 873 subjects included, 215 (25%) were former smokers and 119 (14%) were current smokers. Multivariate analyses revealed that former and current smokers had fewer knee osteophytes in the medial compartment at baseline (odds ratio [OR]=0.64 [0.41-0.99] and 0.63 [0.36-1.11], respectively), lower osteophyte development in the lateral condyle after 3years (OR=011 [0.03-0.45] and 0.15 [0.03-0.97]), and lower osteophyte development in the lateral tibial plateau after 3years (OR=0.22 [0.06-0.75] and 0.68 [0.14-3.35]). Higher tobacco consumption and longer duration of consumption were significantly associated with fewer knee osteophytes at baseline and lower osteophyte development at 3years. CONCLUSION Although cigarette smoking did not influence knee function, pain, or the need for replacement surgery, current and former smokers developed fewer osteophytes. This relationship may be linked to the quantity and duration of consumption. Our results provide further insight into the smoking-related pathophysiology of osteoarthritis.
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Affiliation(s)
- Christian Hubert Roux
- Rheumatology Department, University Nice Sophia Antipolis, LAMHESS, EA 6312, CHU Nice, Nice, France.
| | - Joël Coste
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France
| | - Coralie Roger
- Department of Clinical Research and Innovation, University Hospital of Nice, Nice, France
| | - Eric Fontas
- Department of Clinical Research and Innovation, University Hospital of Nice, Nice, France
| | - Anne-Christine Rat
- CIC 1433 Clinical Epidemiology, Inserm, CHRU University of Lorraine, Nancy, France
| | - Francis Guillemin
- CIC 1433 Clinical Epidemiology, Inserm, CHRU University of Lorraine, Nancy, France
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Coste J, Bizouarn P, Leplège A. [The troubled epistemology of the first wave of research on Covid-19]. Rev Epidemiol Sante Publique 2020; 68:269-271. [PMID: 32948361 PMCID: PMC7486037 DOI: 10.1016/j.respe.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- J Coste
- SAPRAT EA 4116, école pratique des hautes études, université PSL et université de Paris, 75014 Paris, France.
| | - P Bizouarn
- Service d'anesthésie-réanimation, hôpital Laennec, CHU, Nantes, et laboratoire SPHERE, université Paris Diderot-CNRS, UMR 7219, 75007 Paris, France
| | - A Leplège
- Département d'histoire et de philosophie des sciences, IHSS, université de Paris, 75013 Paris, France
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Laanani M, Imbaud C, Tuppin P, Poulalhon C, Jollant F, Coste J, Rey G. Contacts with health services during the year prior to suicide death in France (2013-2015). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study was designed to describe contacts with health services during the year before suicide death in France, and to compare the prevalent mental and physical conditions in these people to those of the general population.
Methods
Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals, national health insurance general scheme beneficiaries (i.e. 76% of the population living in France), aged 15 years or older, who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population.
Results
The study included 19,144 suicide decedents. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room (46.2% of suicide decedents consulted a general practitioner during the month before death, 16.7% attended an emergency room). During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold (SPR 95% CI: 7.7-8.1) more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3, 95% CI: 3.1-3.6) and epilepsy (SPR=2.7, 95% CI: 2.4-3.0).
Conclusions
General practitioners and emergency departments have frequent contacts with suicide decedents during the last weeks before death and are at the forefront of suicide risk identification and prevention in individuals with mental, but also physical conditions.
Key messages
Mental and physical conditions are more common among suicide decedents than in the general population, and contacts with primary care services are frequent in the last weeks prior to suicide. Primary care services (general practitioners and emergency rooms) should be targeted for suicide preventive interventions.
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Affiliation(s)
- M Laanani
- French Centre for Epidemiology on Medical Causes of Death, CépiDc-Inserm, Le Kremlin-Bicêtre, France
- Strategy and Research Department, French National Health Insurance, Paris, France
| | - C Imbaud
- French Centre for Epidemiology on Medical Causes of Death, CépiDc-Inserm, Le Kremlin-Bicêtre, France
| | - P Tuppin
- Strategy and Research Department, French National Health Insurance, Paris, France
| | - C Poulalhon
- Centre of Research in Epidemiology and Statistics, Inserm, Villejuif, France
| | - F Jollant
- Université de Paris, Paris, France
- GHU Paris Psychiatrie et Neurosciences, Sainte-Anne hospital, Paris, France
- McGill Group for suicide studies, McGill University, Montréal, Canada
| | - J Coste
- Université de Paris, Paris, France
- Biostatistics and Epidemiology unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- French National Public Health Agency, Saint-Maurice, France
| | - G Rey
- French Centre for Epidemiology on Medical Causes of Death, CépiDc-Inserm, Le Kremlin-Bicêtre, France
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Laanani M, Imbaud C, Tuppin P, Poulalhon C, Jollant F, Coste J, Rey G. Contacts with Health Services During the Year Prior to Suicide Death and Prevalent Conditions A Nationwide Study. J Affect Disord 2020; 274:174-182. [PMID: 32469801 DOI: 10.1016/j.jad.2020.05.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 02/12/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study was designed to describe contacts with health services during the year before suicide death in France, and prevalent mental and physical conditions. METHODS Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals aged ≥15 years who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population. RESULTS The study included 19,144 individuals. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room. During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3) and epilepsy (SPR=2.7). LIMITATIONS The study population was restricted to national health insurance general scheme beneficiaries (76% of the population living in France). CONCLUSIONS Suicide decedents have frequent contacts with general practitioners and emergency departments during the last weeks before death. Improving suicide risk identification and prevention in these somatic healthcare settings is needed.
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Affiliation(s)
- Moussa Laanani
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France; Strategy and Research Department, French National Health Insurance, Paris, France.
| | - Claire Imbaud
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
| | - Philippe Tuppin
- Strategy and Research Department, French National Health Insurance, Paris, France
| | - Claire Poulalhon
- Centre of Research in Epidemiology and Statistics, Inserm, Villejuif, France
| | - Fabrice Jollant
- Université de Paris, Paris, France; GHU Paris Psychiatrie et Neurosciences, Sainte-Anne hospital, Paris, France; McGill Group for suicide studies, McGill University, Montréal, Canada; Nîmes university hospital (CHU), Nîmes, France
| | - Joël Coste
- Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Biostatistics and Epidemiology unit, Cochin Hospital, Paris, France; French National Public Health Agency, Saint-Maurice, France
| | - Grégoire Rey
- Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
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Sävendahl L, Cooke R, Tidblad A, Beckers D, Butler G, Cianfarani S, Clayton P, Coste J, Hokken-Koelega ACS, Kiess W, Kuehni CE, Albertsson-Wikland K, Deodati A, Ecosse E, Gausche R, Giacomozzi C, Konrad D, Landier F, Pfaeffle R, Sommer G, Thomas M, Tollerfield S, Zandwijken GRJ, Carel JC, Swerdlow AJ. Long-term mortality after childhood growth hormone treatment: the SAGhE cohort study. Lancet Diabetes Endocrinol 2020; 8:683-692. [PMID: 32707116 DOI: 10.1016/s2213-8587(20)30163-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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] [Received: 02/13/2020] [Revised: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Recombinant human growth hormone has been used for more than 30 years and its indications have increased worldwide. There is concern that this treatment might increase mortality, but published data are scarce. We present data from the entire dataset of all eight countries of the Safety and Appropriateness of Growth hormone treatments in Europe (SAGhE) consortium, with the aim of studying long-term overall and cause-specific mortality in young adult patients treated with recombinant human growth hormone during childhood and relating this to the underlying diagnosis. METHODS This cohort study was done in eight European countries (Belgium, France, Germany, Italy, The Netherlands, Sweden, Switzerland, and the UK). Patients were classified a priori based on pre-treatment perceived mortality risk from their underlying disease and followed up for cause-specific mortality. Person-years at risk of mortality and expected rates from general population data were used to calculate standardised mortality ratios (SMRs). FINDINGS The cohort comprised 24 232 patients treated with recombinant human growth hormone during childhood, with more than 400 000 patient-years of follow-up. In low-risk patients with isolated growth hormone deficiency or idiopathic short stature, all-cause mortality was not significantly increased (SMR 1·1, 95% CI 0·9-1·3). In children born small for gestational age, all-cause mortality was significantly increased when analysed for all countries (SMR 1·5, CI 1·1-1·9), but this result was driven by the French subcohort. In patients at moderate or high risk, mortality was increased (SMR 3·8, 3·3-4·4; and 17·1, 15·6-18·7, respectively). Mortality was not associated with mean daily or cumulative doses of recombinant human growth hormone for any of the risk groups. Cause-specific mortality from diseases of the circulatory and haematological systems was increased in all risk groups. INTERPRETATION In this cohort, the largest, to our knowledge, with long-term follow-up of patients treated with recombinant human growth hormone during childhood, all-cause mortality was associated with underlying diagnosis. In patients with isolated growth hormone deficiency or idiopathic short stature, recombinant human growth hormone treatment was not associated with increased all-cause mortality. However, mortality from certain causes was increased, emphasising the need for further long-term surveillance. FUNDING European Union.
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Affiliation(s)
- Lars Sävendahl
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Pediatric Endocrinology Unit, Karolinska University Hospital, Solna, Sweden.
| | | | - Anders Tidblad
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Pediatric Endocrinology Unit, Karolinska University Hospital, Solna, Sweden
| | - Dominique Beckers
- Université Catholique de Louvain, Yvoir, Belgium; Belgian Society for Pediatric Endocrinology and Diabetology, Brussels, Belgium
| | | | - Stefano Cianfarani
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; University of Rome Tor Vergata-Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Joël Coste
- Paris Descartes University, Paris, France
| | | | | | - Claudia E Kuehni
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Annalisa Deodati
- UCL Institute of Child Health, London, UK; University of Rome Tor Vergata-Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Claudio Giacomozzi
- Centre for Pediatric Endocrinology, Pediatric Unit, Carlo Poma Hospital, Mantua, Italy
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | | | | | - Grit Sommer
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Muriel Thomas
- Belgian Society for Pediatric Endocrinology and Diabetology, Brussels, Belgium
| | | | - Gladys R J Zandwijken
- Erasmus University Medical Center and Dutch Growth Research Foundation, Rotterdam, Netherlands
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Blotière PO, Miranda S, Weill A, Mikaeloff Y, Peyre H, Ramus F, Mahmoud Z, Coste J, Dray-Spira R. Risk of early neurodevelopmental outcomes associated with prenatal exposure to the antiepileptic drugs most commonly used during pregnancy: a French nationwide population-based cohort study. BMJ Open 2020; 10:e034829. [PMID: 32513880 PMCID: PMC7282331 DOI: 10.1136/bmjopen-2019-034829] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the association between prenatal exposure to monotherapy with the antiepileptic drugs (AEDs) most commonly used during pregnancy and the risk of various neurodevelopmental outcomes compared with lamotrigine. DESIGN Nationwide population-based cohort study. SETTING French national healthcare databases. PARTICIPANTS Children born alive between 2011 and 2014 and prenatally exposed to AED monotherapy. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes included neurodevelopmental disorders (NDD), defined by International Classification of Diseases, 10th Revision codes F70-F98-pervasive developmental disorders (PDD, F84) and mental retardation (MR, F70-F79) were studied separately-and visits to speech therapists. The reference group comprised children prenatally exposed to lamotrigine. Children were followed until outcome, loss to follow-up, death or 31 December 2016. We performed inverse probability of treatment weighting analyses using the propensity score, which included maternal and infant characteristics. Hazard ratios (HRs) were calculated using Cox models. RESULTS The cohort comprised 9034 children, 2916 of which were exposed to lamotrigine, 1627 to pregabalin, 1246 to clonazepam, 991 to valproic acid (VPA), 621 to levetiracetam, 502 to carbamazepine, 477 to topiramate, 378 to gabapentin and 143 to oxcarbazepine. None of these AEDs, except VPA, was associated with an increased risk of any of the four neurodevelopmental outcomes investigated. Exposure to VPA was associated with increased risks of NDDs (HR=2.7, 95% CI (1.8 to 4.0)), PDD (HR=4.4 (2.1 to 9.3)), MR (HR=3.1 (1.5 to 6.2)) and visits to speech therapists (HR=1.5 (1.1 to 1.9)), with a dose-response relationship. CONCLUSIONS No increased risk of any of the neurodevelopmental outcomes investigated in this study was observed with prenatal exposure to levetiracetam, pregabalin, oxcarbazepine, topiramate, gabapentin, clonazepam or carbamazepine, compared with lamotrigine. However, this study corroborates the well-known association between maternal use of VPA during pregnancy and the risk of neurodevelopmental disorders in the offspring. Longer follow-up is necessary to confirm these findings.
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Affiliation(s)
- Pierre-Olivier Blotière
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
- Apemac, EA 4360, Université de Lorraine, Université Paris-Descartes, Nancy, France
| | - Sara Miranda
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Alain Weill
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
| | - Yann Mikaeloff
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre, France
- CESP, Faculté de médecine-Université Paris-Sud, Faculté de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Hugo Peyre
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, EHESS, CNRS, PSL University, Paris, France
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
- INSERM UMR 1141, Paris Diderot University, Paris, France
| | - Franck Ramus
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, EHESS, CNRS, PSL University, Paris, France
| | - Zureik Mahmoud
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
- Biostatistics and Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, Paris, France
| | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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Guillemet L, Jamme M, Bougouin W, Geri G, Deye N, Vivien B, Varenne O, Pène F, Mira JP, Barat F, Treluyer JM, Hermine O, Carli P, Coste J, Cariou A. Effects of early high-dose erythropoietin on acute kidney injury following cardiac arrest: exploratory post hoc analyses from an open-label randomized trial. Clin Kidney J 2020; 13:413-420. [PMID: 32699621 PMCID: PMC7367106 DOI: 10.1093/ckj/sfz068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent in patients resuscitated from cardiac arrest (CA) and may worsen outcome. Experimental data suggest a renoprotective effect by treating these patients with a high dose of erythropoietin (Epo) analogues. We aimed to evaluate the efficacy of epoetin alpha treatment on renal outcome after CA. METHODS We did a post hoc analysis of the Epo-ACR-02 trial, which randomized patients with a persistent coma after a witnessed out-of-hospital CA. Only patients admitted in one intensive care unit were analysed. In the intervention group, patients received five intravenous injections of Epo spaced 12 h apart during the first 48 h, started as soon as possible after resuscitation. In the control group, patients received standard care without Epo. The main endpoint was the proportion of patients with persistent AKI defined by Kidney Disease: Improving Global Outcomes criteria at Day 2. Secondary endpoints included the occurrence of AKI through Day 7, estimated glomerular filtration rate (eGFR) at Day 28, haematological indices and adverse events. RESULTS A total of 162 patients were included in the primary analysis (74 in the Epo group, 88 in the control group). Baseline characteristics were similar in the two groups. At Day 2, 52.8% of the patients (38/72) in the intervention group had an AKI, as compared with 54.4% of the patients (46/83) in the control group (P = 0.74). There was no significant difference between the two groups regarding the proportion of patients with AKI through Day 7. Among patients with persistent AKI at Day 2, 33% (4/12) in the intervention group had an eGFR <75 mL/min/1.73 m2 compared with 25% (3/12) in the control group at Day 28 (P = 0.99). We found no significant differences in haematological indices or adverse events. CONCLUSION After CA, early administration of Epo did not confer any renal protective effect as compared with standard therapy.
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Affiliation(s)
- Lucie Guillemet
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Matthieu Jamme
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
| | - Wulfran Bougouin
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
| | - Nicolas Deye
- Medical Intensive Care Unit, Lariboisière Hospital (AP-HP) and INSERM U942, Paris, France
| | - Benoît Vivien
- Paris Descartes University, Paris, France
- SAMU 75, Necker Hospital (AP-HP), Paris, France
| | - Olivier Varenne
- Paris Descartes University, Paris, France
- Cardiology Department, Cochin University Hospital (AP-HP), Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Florence Barat
- Clinical Trial Unit, Central Pharmacy, AP-HP, Paris, France
| | - Jean-Marc Treluyer
- Paris Descartes University, Paris, France
- Clinical Research Unit, Paris Centre and Paris Descartes University, Paris, France
| | - Olivier Hermine
- Paris Descartes University, Paris, France
- Hematology Department, Necker Hospital (AP-HP)—Imagine institute—INSERM U1123 CNRS erl 8654 - Labex des Globules Rouges Grex, Paris, France
| | - Pierre Carli
- Paris Descartes University, Paris, France
- SAMU 75, Necker Hospital (AP-HP), Paris, France
| | - Joël Coste
- Paris Descartes University, Paris, France
- Biostatistics and Epidemiology Unit, Hôtel-Dieu Hospital (AP-HP), Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
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Coste J, Tarquinio C, Rouquette A, Montel S, Pouchot J. Cross-cultural adaptation and validation of the French version of the credibility/expectancy questionnaire. Further insights into the measured concepts and their relationships. Psychologie Française 2020. [DOI: 10.1016/j.psfr.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wieczorek M, Rotonda C, Coste J, Pouchot J, Saraux A, Guillemin F, Rat AC. Trajectory analysis combining pain and physical function in individuals with knee and hip osteoarthritis: results from the French KHOALA cohort. Rheumatology (Oxford) 2020; 59:3488-3498. [DOI: 10.1093/rheumatology/keaa148] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The aims of this study were to identify homogeneous subgroups of knee and/or hip OA patients with distinct trajectories of the combination of pain and physical function (PF) over time and to determine the baseline factors associated with these trajectories.
Methods
We used data from the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) cohort, a French population-based cohort of 878 patients with symptomatic knee and/or hip OA. Pain and PF were measured annually over 5 years with the Medical Outcomes Study Short Form 36 questionnaire. First, trajectory models were estimated with varying numbers of groups for each of the outcomes separately then fitted into a multi-trajectory model. We used multinomial logistic regression to determine the baseline characteristics associated with each trajectory.
Results
Univariate four-class models were identified as most appropriate for pain and PF. Comparison of separate trajectories showed that 41% of patients included in the severe functional limitations trajectory did not belong to the more severe pain trajectory (Cramér’s V statistic = 0.45). Group-based multi-trajectory modelling revealed four distinct trajectories of pain and PF. On multivariate analyses, female sex, older age, high Kellgren grade, low physical activity intensity, low psychosocial distress score (high distress) and low vitality score were associated with the more severe symptoms trajectory.
Conclusion
Over 5 years, we identified four distinct trajectories combining pain and PF. Management of weight, fatigue and psychosocial distress and the practice of physical activity seem important to maintain function and limit pain in patients with lower-limb OA.
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Affiliation(s)
| | | | - Joël Coste
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris
| | - Jacques Pouchot
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Paris
| | - Alain Saraux
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Cavale Blanche University Hospital, Brest
- UMR 1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU, Brest, LabEx IGO, Brest
| | - Francis Guillemin
- EA4360 Apemac, Université de Lorraine, Nancy
- ICIC-1433 Epidémiologie Clinique, CHRU Nancy, Université de Lorraine, Inserm, Nancy
| | - Anne-Christine Rat
- EA4360 Apemac, Université de Lorraine, Nancy
- Department of Rheumatology, CHU Caen, Caen, France
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Weill A, Nguyen P, Yoldjian I, Fontanel S, Froelich S, Coste J. Exposition prolongée à de fortes doses d’acétate de cyprotérone et risque de méningiome chez la femme : une recherche-action de santé publique en France. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Neumann A, Giral P, Weill A, Coste J. Estimation de l’effet de l’arrêt d’un traitement préventif chez les sujets âgés à partir des données médico-administratives : exploration de l’utilisation des modèles structuraux marginaux sur l’exemple des statines. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.054] [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: 11/25/2022] Open
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Grave C, Boucheron P, Rudant J, Mikaeloff Y, Tubert-Bitter P, Escolano S, Hocine MN, Coste J, Weill A. Seasonal influenza vaccine and Guillain-Barré syndrome: A self-controlled case series study. Neurology 2020; 94:e2168-e2179. [PMID: 32098853 DOI: 10.1212/wnl.0000000000009180] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the risk of Guillain-Barré syndrome (GBS) following seasonal influenza vaccination based on French nationwide data. METHODS All cases of GBS occurring in metropolitan France between September 1 and March 31 from 2010 to 2014 were identified from the French national health data system. Data were analyzed according to the self-controlled case series method. The risk period started 1 day after the patient received vaccine (D1) until 42 days after vaccination (D42). The incidence of GBS during this risk period was compared to that of the control period (D43-March 31). The incidence rate ratio (IRR) was estimated after adjusting for seasonality and presence or not of acute infections. RESULTS Between September and March, of the 2010/2011 to 2013/2014 influenza vaccination seasons, 3,523 cases of GBS occurred in metropolitan France and were included in the study. Among them, 15% (527 patients) had received influenza vaccination. A total of 140 patients developed GBS during the 42 days following influenza vaccination. The crude risk of developing GBS was not significantly increased during the 42 days following influenza vaccination (IRR, 1.02; 95% confidence interval [CI], 0.83-1.25; p = 0.85). This result remained nonsignificant after adjustment for calendar months and the incidence of acute gastrointestinal and respiratory tract infections (IRR, 1.10; 95% CI, 0.89-1.37; p = 0.38). In contrast, the risk of GBS was fourfold higher after acute respiratory tract infection (IRR, 3.89; 95% CI, 3.52-4.30; p < 0.0001) or gastrointestinal infection (IRR, 3.64; 95% CI, 3.01-4.40; p < 0.0001). CONCLUSIONS No association between seasonal influenza vaccination and GBS was shown during the 42 days following vaccination.
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Affiliation(s)
- Clémence Grave
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France.
| | - Pauline Boucheron
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Jérémie Rudant
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Yann Mikaeloff
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Pascale Tubert-Bitter
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Sylvie Escolano
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Mounia N Hocine
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Joël Coste
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
| | - Alain Weill
- From the Department of Studies in Public Health (C.G., P.B., J.R., J.C., A.W.), French National Health Insurance, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Unité de Rééducation Neurologique Infantile, Hôpital Bicêtre; CESP, Faculté de Médecine-Université Paris-Sud (Y.M.), Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif; Biostatistics and Pharmacoepidemiology (P.T.-B., S.E.), Inserm U1181 (B2PHI), UVSQ, University Paris Saclay, Institut Pasteur; and Laboratoire Modélisation (M.N.H.), Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire National des Arts et Métiers, Paris, France
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Laanani M, Weill A, Blotière PO, Pouchot J, Carbonnel F, Coste J. Factors associated with mechanical and systemic adverse events after colonoscopy (France, 2010-2015). Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
More than one million colonoscopies are performed every year in France. They are associated with risks of mechanical and systemic serious adverse events (SAEs) which can be associated with patient, procedure, endoscopist, and facility characteristics. We tried to identify the factors associated with colonic perforation, gastrointestinal bleeding, splenic injury, shock, myocardial infarction, stroke, pulmonary embolism, acute renal failure, and urolithiasis after colonoscopy.
Methods
We analysed data from the French national claims databases (SNDS). A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy between 2010 and 2015 were identified. SAE rates were estimated, and risk factors associated with SAEs were identified using multilevel logistic regression models, adjusted for patient, colonoscopy, endoscopist, and facility characteristics.
Results
Increasing age was associated with an increasing incidence of mechanical and systemic SAEs. Cancer and cardiovascular comorbidities were associated with mechanical SAEs, and a higher number of pre-existing conditions was associated with shock and acute renal failure. Polypectomy, especially of polyps larger than 1 cm, was associated with an increased risk of perforation (OR = 4.1; 95% CI, 3.4-5.0) and bleeding (OR = 13.3; 95% CI, 11.7-15.1). Mechanical SAEs were associated with the endoscopist’s experience, while systemic SAEs were more frequent in public hospitals than in private clinics.
Conclusions
SAEs related to colonoscopy were more frequent in older patients and in those with comorbidities. Mechanical SAEs were more frequent when colonoscopy was performed by less experienced endoscopists. Systemic SAEs were more frequent in public hospitals, reflecting patient selection processes. The risk of both mechanical and systemic SAEs should be taken into account when deciding to perform colonoscopy, particularly in older patients with multiple pre-existing conditions.
Key messages
Systemic SAEs are not uncommon after colonoscopy and, together with intestinal SAEs, should be considered when considering the need for colonoscopy. Patients at risk of SAEs should be identified and colonoscopy should be performed by experienced endoscopists in these patients. Less invasive alternatives should also be considered in these patients.
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Affiliation(s)
- M Laanani
- EPI-PHARE, Saint-Denis, France
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - A Weill
- EPI-PHARE, Saint-Denis, France
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - P O Blotière
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - J Pouchot
- Internal Medicine unit, Georges Pompidou European Hospital APHP, University Paris Descartes, Paris, France
| | - F Carbonnel
- Gastroenterology Unit, Paris Sud University Hospitals, APHP, Le Kremlin-Bicêtre, France
| | - J Coste
- Department of Public Health Studies, French National Health Insurance, Paris, France
- Biostatistics and Epidemiology Unit, Cochin Hospital APHP, University Paris Descartes, Paris, France
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Rudant J, Dupont A, Mikaeloff Y, Bolgert F, Coste J, Weill A. Author response: Surgery and risk of Guillain-Barré syndrome: A French nationwide epidemiologic study. Neurology 2019; 93:818. [PMID: 31659138 DOI: 10.1212/wnl.0000000000008406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Laroche F, Azoulay D, Trouvin AP, Coste J, Perrot S. Fibromyalgia in the workplace: risk factors for sick leave are related to professional context rather than fibromyalgia characteristics- a French national survey of 955 patients. BMC Rheumatol 2019; 3:44. [PMID: 31673681 PMCID: PMC6815377 DOI: 10.1186/s41927-019-0089-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/26/2019] [Indexed: 12/28/2022] Open
Abstract
Background Work and workplace factors are important in fibromyalgia management. We investigated factors associated with sick leave in professionally active women living with fibromyalgia. Methods A questionnaire for fibromyalgia patients in employment was developed by pain and occupational physicians and patients' organizations. Women in full-time work, screened for fibromyalgia with the FiRST questionnaire, were recruited for a national online survey. Sick leave over the preceding year was analyzed. Results In 5 months, we recruited 955 women, with a mean of 37 days of sick leave in the previous year: no sick leave (36%), up to 1 month (38%), 1 to 2 months (14%), more than 2 months (12%). In the groups displayed no differences in demographic characteristics, fibromyalgia symptoms, functional severity and psychological distress were observed. However, they differed in workplace characteristics, commute time, stress and difficulties at work, repetitive work, noisy conditions, career progression problems and lack of recognition, which were strong independent risk factors for longer sick leave. Sedentary positions, an extended sitting position, heavy loads, exposure to thermal disturbances and the use of vibrating tools did not increase the risk of sick leave. Conclusions Women with fibromyalgia frequently take sick leave, the risk factors for which are related to the workplace rather than fibromyalgia characteristics. Perspective This is the first study to assess the impact of occupational and clinical factors on sick leave in women living with fibromyalgia. Risk factors were found to be related to the workplace rather than fibromyalgia and personal characteristics. Workplace interventions should be developed for women with fibromyalgia.
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Affiliation(s)
- F Laroche
- 1Pain department, Paris Medicine Sorbonne University and Saint-Antoine Hospital, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - D Azoulay
- 1Pain department, Paris Medicine Sorbonne University and Saint-Antoine Hospital, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - A P Trouvin
- 2Pain department, Cochin Hospital, Paris Descartes University, INSERM U987, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - J Coste
- Biostatistics, Cochin Hospital, Paris Descartes University, Paris, France
| | - S Perrot
- 2Pain department, Cochin Hospital, Paris Descartes University, INSERM U987, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Coste J, Bertagna X, Zureik M, Nicolas P, Ramez P, Hill C, Schlumberger M. [Are the two formulas of Levothyrox bioequivalent?]. Rev Prat 2019; 69:831-837. [PMID: 32237644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Joël Coste
- Unité de biostatistique et d'épidémiologie, hôpital Cochin, Paris
- Faculté de médecine Paris-Descartes, université Paris-Descartes
| | - Xavier Bertagna
- Faculté de médecine Paris-Descartes, université Paris-Descartes
| | | | - Patrick Nicolas
- Service de biochimie, unité de pharmacologie bioclinique, centre hospitalier universitaire Avicenne, Bobigny
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Coste J, Karras A, Rudnichi A, Dray-Spira R, Pouchot J, Giral P, Zureik M. Statins for primary prevention of cardiovascular disease and the risk of acute kidney injury. Pharmacoepidemiol Drug Saf 2019; 28:1583-1590. [PMID: 31517431 PMCID: PMC6916201 DOI: 10.1002/pds.4898] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/02/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate the risk of acute kidney injury (AKI) in subjects initiating statin therapy for primary prevention of cardiovascular disease (CVD). Methods A nationwide cohort study using French hospital discharge and claims databases was performed, studying subjects from the general population aged 40 to 75 years in 2009, with no history of CVD and no lipid‐lowering drugs during the preceding 3‐year period, followed for up to 7 years. Exposure to statins (type, dose, and time since first use) and to other drugs for CVD risk was assessed. The primary outcome was hospital admission for AKI. Results The cohort included 8 236 279 subjects, 818 432 of whom initiated a statin for primary prevention. During 598 487 785 person‐months exposed to statins, 700 events were observed, corresponding to an incidence of AKI of 4.59 per 10 000 person‐years (7.01 in men, 3.01 in women). AKI mainly occurred in the context of organ failure, sepsis, and genitourinary disease. A 19% increased rate of AKI (hazard ratio = 1.19, 95%CI: 1.08‐1.31) was observed in men exposed to statins, whereas no increase in the overall risk of AKI was observed in women. However, exposure to high‐potency statins was associated with a 72% to 116% increased risk in both genders and a dose‐effect relationship observed for rosuvastatin and atorvastatin. No temporal pattern of occurrence nor interaction with drugs for CVD risk was observed. Conclusions Although the overall risk of AKI appears moderately increased, more attention should be paid to renal function in subjects taking statins for primary prevention both in clinical practice and from a research viewpoint.
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Affiliation(s)
- Joël Coste
- Department of Public Health Studies, French National Health Insurance Fund (CNAM), Paris, France.,Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.,Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Alexandre Karras
- Nephrology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Annie Rudnichi
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Jacques Pouchot
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Philippe Giral
- Department of Endocrinology-Metabolism, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié, Paris, France
| | - Mahmoud Zureik
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.,Versailles Saint-Quentin-en-Yvelines University, Versailles, France
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Meyer A, Rudant J, Drouin J, Coste J, Carbonnel F, Weill A. The effectiveness and safety of infliximab compared with biosimilar CT-P13, in 3112 patients with ulcerative colitis. Aliment Pharmacol Ther 2019; 50:269-277. [PMID: 31115919 PMCID: PMC6767082 DOI: 10.1111/apt.15323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/20/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND CT-P13, a biosimilar of the reference product infliximab, has been approved for the treatment of ulcerative colitis on the basis of the results of trials conducted in patients with spondyloarthritis and rheumatoid arthritis. AIM To compare the effectiveness and safety of CT-P13 and the reference product in infliximab-naive patients with ulcerative colitis METHODS: A comparative real-life equivalence cohort study was conducted using the French nationwide health administrative database. Infliximab-naive patients with ulcerative colitis over 15 years of age who started infliximab with no other indications for infliximab were included. The primary outcome was a composite endpoint (death, ulcerative colitis-related surgery, all-cause hospitalisation and reimbursement for other biologics). Equivalence was defined as a 95% CI of the hazard ratio (HR) of CT-P13 vs the reference product, in a multivariable marginal Cox model situated within prespecified margins of (0.80-1.25). RESULTS A total of 3112 patients were included between 1 January 2015 and 30 June 2017: 1434 received the reference product, 1678 received CT-P13. Overall, 710 patients in the reference product group and 743 patients in the CT-P13 group met the composite endpoint. In multivariable analysis of the primary outcome, CT-P13 was equivalent to the reference product (HR 1.04; 95% CI: 0.94-1.15). The number of serious infections was lower in the CT-P13 group (HR 0.65; 95% CI: 0.48-0.88). There was no difference in the incidence of solid or haematologic malignancy (HR 0.81; 95% CI: 0.41-1.60). CONCLUSIONS The effectiveness of CT-P13 is equivalent and the risk of serious infections could be lower than that of the reference product for infliximab-naive patients with ulcerative colitis.
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Affiliation(s)
- Antoine Meyer
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance,Service de gastroentérologie, BicêtreAssistance Publique-Hôpitaux de ParisLe Kremlin BicêtreFrance,Université Paris SudLe Kremlin BicêtreFrance
| | - Jérémie Rudant
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
| | - Jérôme Drouin
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
| | - Joël Coste
- Biostatistique et EpidémiologieHôtel-Dieu, Assistance Publique-Hôpitaux de ParisParisFrance
| | - Franck Carbonnel
- Service de gastroentérologie, BicêtreAssistance Publique-Hôpitaux de ParisLe Kremlin BicêtreFrance,Université Paris SudLe Kremlin BicêtreFrance
| | - Alain Weill
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
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Blotière PO, Raguideau F, Weill A, Elefant E, Perthus I, Goulet V, Rouget F, Zureik M, Coste J, Dray-Spira R. Risks of 23 specific malformations associated with prenatal exposure to 10 antiepileptic drugs. Neurology 2019; 93:e167-e180. [PMID: 31189695 DOI: 10.1212/wnl.0000000000007696] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the association between exposure to monotherapy with 10 different antiepileptic drugs (AEDs) during the first 2 months of pregnancy and the risk of 23 major congenital malformations (MCMs). METHODS This nationwide cohort study, based on the French health care databases, included all pregnancies ≥20 weeks and ending between January 2011 and March 2015. Women were considered to be exposed when an AED had been dispensed between 1 month before and 2 months after the beginning of pregnancy. The reference group included pregnant women with no reimbursement for AEDs. MCMs were detected up to 12 months after birth (24 months for microcephaly, hypospadias, and epispadias). Odds ratios (ORs) were adjusted for potential confounders for MCMs with at least 5 cases. Otherwise, we calculated crude ORs with exact confidence intervals (CIs). RESULTS The cohort included 1,886,825 pregnancies, 2,997 of which were exposed to lamotrigine, 1,671 to pregabalin, 980 to clonazepam, 913 to valproic acid, 579 to levetiracetam, 517 to topiramate, 512 to carbamazepine, 365 to gabapentin, 139 to oxcarbazepine, and 80 to phenobarbital. Exposure to valproic acid was associated with 8 specific types of MCMs (e.g., spina bifida, OR 19.4, 95% CI 8.6-43.5), and exposure to topiramate was associated with an increased risk of cleft lip (6.8, 95% CI 1.4-20.0). We identified 3 other signals. We found no significant association for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin. CONCLUSIONS These results confirm the teratogenicity of valproic acid and topiramate. Because of the small numbers of cases and possible confounding, the other 3 signals should be interpreted with appropriate caution.
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Affiliation(s)
- Pierre-Olivier Blotière
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France.
| | - Fanny Raguideau
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Alain Weill
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Elisabeth Elefant
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Isabelle Perthus
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Véronique Goulet
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Florence Rouget
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Mahmoud Zureik
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Joël Coste
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
| | - Rosemary Dray-Spira
- From the Department of Studies in Public Health (P.-O.B., A.W., J.C.), French National Health Insurance (CNAM), Paris; Université de Lorraine (P.-O.B.), Université Paris-Descartes, Apemac, Nancy; Department of Epidemiology of Health Products (F. Raguideau, M.Z., R.D.-S.), French National Agency for Medicines and Health Products Safety, Saint-Denis; Reference Center on Teratogenic Agents (E.E.), Hôpital Trousseau, Groupe Hospitalo-Universitaire Est Parisien, Assistance Publique Hôpitaux de Paris; Auvergne Registry of Congenital Malformations (I.P.), Centre de référence des Anomalies du Développement et des maladies rares, Service de génétique médicale, CHU Clermont-Ferrand; Department of Chronic Diseases and Injuries (V.G.), French Public Health Agency, Saint Maurice; Brittany Registry of Congenital Malformations (F. Rouget), Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085; Versailles Saint-Quentin University (M.Z.); and Biostatistics and Epidemiology Unit (J.C.), Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, France
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Laroche F, Guérin J, Coste J, Trouvin AP, Perrot S. Importance of feelings of injustice in fibromyalgia, large internet survey on experiences of 4516 French patients. Joint Bone Spine 2019; 86:808-810. [PMID: 31067504 DOI: 10.1016/j.jbspin.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Françoise Laroche
- Pain department, Saint-Antoine University Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Medical University Sorbonne, 75012 Paris, France; Inserm - N°UMRS 938, 75012 Paris, France.
| | - Julien Guérin
- Pain department, Saint-Antoine University Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Medical University Sorbonne, 75012 Paris, France
| | - Joël Coste
- Pain department, Paris Descartes University, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques 75014 Paris, France
| | | | - Serge Perrot
- Pain department, Paris Descartes University, 75014 Paris, France
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Geri G, Grimaldi D, Seguin T, Lamhaut L, Marin N, Chiche JD, Pène F, Bouglé A, Daviaud F, Morichau-Beauchant T, Arnaout M, Champigneulle B, Zafrani L, Bourcier S, Nguyen YL, Charpentier J, Mira JP, Coste J, Vinsonneau C, Cariou A. Hemodynamic efficiency of hemodialysis treatment with high cut-off membrane during the early period of post-resuscitation shock: The HYPERDIA trial. Resuscitation 2019; 140:170-177. [PMID: 30974188 DOI: 10.1016/j.resuscitation.2019.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND After resuscitation of cardiac arrest (CA), an acute circulatory failure occurs in about 50% of cases, which shares many characteristics with septic shock. Most frequently, supportive treatments are poorly efficient to prevent multiple organ failure and death. We evaluated whether an early plasma removal of inflammatory mediators using high cut-off continuous veno-venous hemodialysis (HCO-CVVHD) could improve hemodynamic status and outcome of these patients. PATIENTS AND METHODS We performed a randomized open-label trial. Patients with post-cardiac arrest shock (defined as requirement of norepinephrine or epinephrine infusion > 1 mg/h) were included. The experimental group received 2 distinct sessions of HCO-CVVHD during the first 48 h following ICU admission. The control group received continuous veno-venous hemofiltration (CVVH) with standard membranes if needed. The primary endpoint was the delay to shock resolution asssessed by the length of catecholamine infusion. Number of vasopressors-free days at day 28, arterial blood pressure measures every 6-hours, daily fluid balance and mortality (ICU and day-28) were evaluated as secondary endpoints. RESULTS 35 patients were included: 17 (median age 68.4, 59% male) in the HCO-CVVHD group and 18 (median age 66.3, 83% male) in the control group. Baseline characteristics did not differ between the two groups. Day-28 mortality rate was 64.7% and 72.2% in the HCO-CVVHD and control group, respectively (p = 0.72). Probability of vasopressors discontinuation over time was similar in the two groups (p for logrank test = 0.67). Number of day-28 catecholamine-free days was 25.1 [0, 26.5] and 24.5 [0, 26.2] in the HCO-CVVHD and control group, respectively (p = 0.65). No difference was observed regarding the daily-dose of vasopressors, arterial pressure profile and fluid balance. CONCLUSION In cardiac arrest patients, HCO-CVVHD did not decrease the lenght of post-resuscitation shock and had no significant effect on hemodynamic profile. REGISTRATION NCT00780299.
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Affiliation(s)
- Guillaume Geri
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - David Grimaldi
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Thierry Seguin
- Medical-surgical Intensive Care Unit, Toulouse-Rangueil Hospital, Toulouse, France
| | - Lionel Lamhaut
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France; SAMU 75, Necker University Hospital, APHP, Paris, France
| | - Nathalie Marin
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Jean-Daniel Chiche
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Adrien Bouglé
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Fabrice Daviaud
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | | | - Michel Arnaout
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | | | - Lara Zafrani
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Simon Bourcier
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Yen-Lan Nguyen
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Julien Charpentier
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Joël Coste
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Biostatistics and Epidemiology Unit, Hôtel Dieu, APHP, Paris, France
| | | | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France.
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Laanani M, Coste J, Blotière PO, Carbonnel F, Weill A. Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies. Clin Gastroenterol Hepatol 2019; 17:719-727.e13. [PMID: 30099110 DOI: 10.1016/j.cgh.2018.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 01/25/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated perforations, bleeding, and splenic injuries after screening or diagnostic colonoscopies to identify patient-, procedure-, endoscopist-, and facility-associated risk factors. METHODS We analyzed data from the SNIIRAM-PMSI national claims databases in France. A total of 4,088,799 patients, 30 years or older, undergoing a first screening or diagnostic colonoscopy from 2010 through 2015 were identified. Rates of severe adverse events (SAEs) were estimated using stringent and broad definitions. Risk factors associated with perforations and major bleeding were estimated using multilevel logistic regression models, adjusted for patient, colonoscopy, and endoscopist characteristics. RESULTS Perforation rates ranged from 3.5 (stringent definition) to 7.3 (broad definition) per 10,000 procedures, bleeding rates ranged from 6.5 to 23.1 per 10,000 procedures, and splenic injury rates ranged from 0.20 to 0.34 per 10,000 procedures. Rates of 30-day mortality were 13.2 per 1000 bleeds, 29.2 per 1000 perforations, and 36.1 per 1000 splenic injuries (stringent definitions). Patient characteristics associated with SAEs were increasing age (especially for perforation), cancer, and cardiovascular comorbidities. Procedure characteristics associated with SAEs included polypectomy-especially of polyps larger than 1 cm with an increased risk of perforation (odds ratio, 4.1; 95% CI, 3.4-5.0) and bleeding (odds ratio, 13.3; 95% CI, 11.7-15.1). Less-experienced endoscopists and endoscopists who performed a smaller number of colonoscopies were independently associated with a risk of SAEs. CONCLUSION In an analysis of national claims databases in France, we found SAEs related to screening and diagnostic colonoscopies to be more frequent in older patients, in patients with comorbidities, and with less-experienced endoscopists. Patients at risk of SAE should be identified and colonoscopies should be performed or supervised by experienced endoscopists.
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Affiliation(s)
- Moussa Laanani
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | | | - Franck Carbonnel
- Gastroenterology unit, Hôpitaux Universitaires Paris Sud, Université Paris-Sud and Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Alain Weill
- Department of Public Health Studies, French National Health Insurance, Paris, France.
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