Cluster of serogroup W invasive meningococcal disease in a university campus.

INTRODUCTION: In France, the expansion of an hypervirulent strain causing serogroup W invasive meningococcal disease (MenW) has been observed since 2015/16. We describe a cluster of three MenW cases, causing two deaths, at the end of 2016 in a university campus, and the vaccination campaign which was consequently organized. METHODS: Epidemiological and microbiological analyses led a multidisciplinary expertise group to recommend the organization of a mass vaccination campaign using ACWY vaccine targeting more than 30,000 students and staff in the university campus. Individual data on vaccination was collected using the lists of students and staff registered at the university to estimate vaccine coverage. RESULTS: Three MenW cases occurred within a 2-month period among students in different academic courses. All three isolates were identical and belonged to the "UK-2013 strain" phylogenetic branch. The attack rate was 10.8/100,000 students. The vaccination campaign was organized only 15 days after the third case occurred. In total, 13,198 persons were vaccinated. Vaccine coverage was estimated at 41% for students of the university and 35% for university staff. CONCLUSION: Timely notification of cases to health authorities was essential for the detection of the cluster and the rapid implementation of the vaccination campaign. No further cases occurred in the campus in the year following the vaccination campaign. This episode is the second cluster of MenW caused by the "UK-2013 strain" in a university since 2016.

Effect of age, period of diagnosis and birth cohort on large bowel cancer incidence in a well-defined French population, 1976-1995.

The objective of this study was to present trends in colorectal cancer incidence by sex and subsite in a well-defined French population. All of the 4486 large bowel cancer cases registered between 1976 and 1995 in the Burgundy registry of digestive tract cancers was included in this study. Time trends in colorectal cancer incidence were analysed over the 1976-95 period. The effects of age, period and cohort were evaluated using a log-linear Poisson model. The incidence rates for right colon cancer increased over time: + 21.6% (95% CI: + 13.5; + 29.7) per 5-year period in males and +10.4% (95% CI: + 3.4; + 17.3) in females. Left colon cancer rates increased in males (+ 10.6% 95% CI: + 4.6; + 16.6). Left colon cancer in females and rectal cancer incidence rates did not significantly change. Between the 1901 cohort to the 1941 cohort, estimated cumulative risks for right colon cancer increased sharply. The increase was less marked for left colon and the cumulative risk for rectal cancer remained almost stable. Temporal trends were different by subsites and sexes. In conclusion, our results confirm the existence of different trends in colorectal cancer incidence between subsites and sexes. These differences probably reflect aetiological distinctions.

Trends in gastric cancer incidence in a well-defined French population by time period and birth cohort.

Epidemiological studies have shown a marked decline in gastric cancer incidence and opposite patterns between proximal and distal sites among different populations. Little is known about trends by histological type. The aim of this study was to analyse the change in gastric cancer incidence patterns by investigating the role of temporal components as determinants of such trends in the population of the Côte d'Or area (France) registered between 1976 and 1995. Gastric cancer incidence decreased over time. There was a decrease in incidence rates for distal cancers (-3.5% P < 0.001 per year in men and -4.6% P < 0.01 in women). In contrast, there was a non-significant increase of proximal cancer incidence in men and in women. Rates of adenocarcinomas decreased, whereas the incidence rates of undifferentiated carcinomas and of other histological types remained quite stable. There was a decrease in cumulative risk throughout the studied cohorts, whereas risk for proximal cancer remained stable and decreased slightly for distal localization. For adenocarcinomas, earlier birth cohorts showed a slight decrease in rates, whereas there was an increase for recent cohorts. Subsite and histological-specific analysis, in revealing different time trends in incidence, suggest, at least partly, different aetiologies for gastric cancer, and future aetiological studies must distinguish proximal and distal cancers.

Chemotherapy for colon cancer in a well-defined French population: is it under- or over-prescribed?

BACKGROUND: It has been demonstrated that adjuvant chemotherapy in TNM stage III and palliative chemotherapy are effective treatments for colon cancer. AIM: To determine changes over a 10-year period in the practice of adjuvant and palliative chemotherapy for colon cancer in a well-defined French population. METHODS: Some 4093 patients with colon adenocarcinoma diagnosed between 1989 and 1998 were studied. To estimate the independent effect of the studied variables, a non-conditional logistical regression was performed. RESULTS: The proportion of patients with stage II disease treated with adjuvant chemotherapy increased from 2.3% (1989-90) to 20.5% (1997-98). The corresponding figures for stage III patients were 7.1% and 54.9%. This increase was particularly marked in younger patients, with 47.3% of stage II and 86.1% of stage III patients under the age of 65 years being treated in the 1997-98 period, compared with 4.9% and 24.4% of those over 75 years for the same period (P < 0.0001). The use of palliative chemotherapy increased over time from 13.6% (1989-90) to 38.9% (1997-98). Again, this increase was more dramatic in the younger age group. CONCLUSIONS: The use of adjuvant chemotherapy has increased for stage II disease despite the absence of proven effectiveness. Both adjuvant and palliative chemotherapy are still under-prescribed in patients over the age of 75 years.

Colorectal adenocarcinoma in patients under 45 years of age: comparison with older patients in a well-defined French population.

PURPOSE: Little is known about colorectal cancer in young patients at a population level, and the behavior, characteristics, and prognosis of such tumors continue to be debated. METHODS: A population-based series of 4,643 new cases of colorectal adenocarcinomas diagnosed between 1976 and 1996 in C te d'Or, France, was used to describe time trends in incidence, predisposing conditions, location, stage, and treatment and to evaluate the prognosis of such tumors in patients under 45 years of age (n = 146). Prognosis was determined using relative survival rates and predictive factors using a multivariate relative survival model. RESULTS: Before the age of 45 years, age-standardized incidence rates were 1.9 per 100,000 in males and 1.4 per 100,000 in females. Incidence rates almost doubled from 1976 to 1982 and from 1983 to 1989 in both genders and stabilized thereafter. The frequency of predisposing conditions was significantly higher before the age of 45 years (11.7 vs. 0.4 percent; P < 0.001). TNM Stage III tumors were more frequent in younger patients, and Stage II tumors were more frequent in older patients. The postoperative mortality rate was lower in the 0-to-44 age group, 2.1 percent, compared with 8.4 percent for the 45-and-over age group (P = 0.004). Five-year relative survival rates were 51.9, 49.2, and 41.4 percent, respectively. In both overall and stage-for-stage comparisons, patients before the age of 45 years had a better survival rate than older patients. Gender and stage at diagnosis were the only independent prognostic factors of survival for young patients. CONCLUSIONS: This study confirms the high frequency of predisposing conditions in young patients and that young age is not a poor prognostic factor for colorectal cancer. This underlines the importance of family screening, aggressive surveillance, and treatment in the young with known predisposing conditions.

Non-steroidal anti-inflammatory drug prescribing patterns in general practice: comparison of a general practitioner-based survey and a pharmacy-based survey in France.

PURPOSE: In order to assess biases occurring in primary care prescription studies, we compared non-steroidal anti-inflammatory drug (NSAID) prescribing patterns reported by general practitioners directly (GP-based survey) and from a pharmacy-based survey of general practitioner prescribing (pharmacy-based survey). METHODS: Volunteer GPs of the administrative area of Côte d'Or (France) returned a mailed questionnaire on NSAID prescribing patterns for consecutive patients seen during a 2-month period. In order to obtain a reference basis, pharmacies of the same administrative area provided all prescriptions that included NSAIDs during a 1-week period originating in general practice. RESULTS: The rate of participation was 25% for the GPs and 40% for the pharmacies. Participant GPs were representative of GPs of the area with regard to sex, year of graduation and practice area but pharmacies from rural areas were over-represented. The GP-based survey and the pharmacy-based survey provided respectively 770 and 1050 prescriptions. There were no differences between either survey in the type of NSAIDs prescribed and in the most frequently associated drugs. GPs who volunteered in the GP survey prescribed NSAIDs more frequently orally and at higher doses than GPs involved in the pharmacy-based survey. They also prescribed more gastroprotective drugs, especially in the elderly. None of these results could be explained by differences in patient characteristics and GP practice areas. CONCLUSION: GPs who actively participate in prescription surveys exhibit prescribing patterns that fit better with official recommendations than the average. Although selection biases cannot be ruled out, it is suggested that some changes in GP prescription habits may have been induced by the survey itself.

Non-steroidal anti-inflammatory and cytoprotective drug co-prescription in general practice. A general practitioner-based survey in France.

BACKGROUND AND AIM: Non-steroidal anti-inflammatory drugs (NSAIDs) represent one of the most frequently prescribed drugs. Gastrointestinal damage, the most common side effect of NSAIDs. can be limited by the prescription of cytoprotective agents. In order to assess determinants of NSAID-associated cytoprotective agent prescriptions in primary care practice, we performed a general practitioner (GP)-based study. METHODS: After a 2-month intensive information campaign, the participation of all GPs of the Côte d'Or (France) administrative area was requested. During a 2-month period, GPs had to return a mailed questionnaire on NSAID prescription for up to ten consecutive patients aged over 18 years who required NSAIDs. This 30-item questionnaire included questions about the patient, the type of NSAID and the GP. RESULTS: GP participation rate was 24%, and 791 prescriptions were provided. GPs who participated in the study were representative of GPs of the area in terms of sex, time elapsed since graduation and GP practice area. Around 80% of the patients included in the study were under the age of 65 years. The proportion of prescriptions combining NSAIDs and gastroprotective agents was 29.5%. Omeprazole accounted for 58% of the coprescriptions and misoprostol for 29%. Independent determinants associated with the co-prescription of a cytoprotective agent were age [odds ratio (OR) 4.1; confidence interval (CI) 95% 2.3 7.4], previous history of poor NSAID tolerance (OR 10.4; CI 95% 5.8-18.6), previous history of moderate to severe digestive disorders (OR 13.4; CI 95% 5.1 35.4) and indication for chronic illness (OR 1.8, CI 95% 1.1-3.1). Prescriptions of cytoprotective drugs were in conformity with official guidelines for 78.3% of the patients. Although around 60% of the patients with risk factors for poor tolerance received a gastroprotective drug, 50% of the patients over 65 years did not receive it. Conversely, nearly 12% of the patients with no risk factors were prescribed cytoprotective agents. Patient history was the main reason put forward by GPs for prescribing cytoprotective drugs. CONCLUSION: Although a large majority of GP prescriptions were in accordance with official recommendations, inadequate NSAID prescription practices remain relatively frequent especially with regard to the elderly.

Colorectal cancer prevalence in France.

Cancer prevalence is a crucial indicator that allows the magnitude of the problem of colorectal cancer to be monitored. Population-based cancer registries with long-standing activity are the most appropriate tools for providing prevalence data. All colorectal cases registered between 1976 and 1995 in the Côte d'Or Cancer Registry have been considered in this study. Total prevalence (20 years) was the number of patients with a previously diagnosed colorectal cancer, alive on 31 December 1995. Cumulative recurrence rates up to 5 years after diagnosis were calculated and applied to the number of prevalent cases to estimate the number of recurrences by one-year intervals up to 5 years. The overall age-standardized prevalence rate was 170.8/100000, which yielded an estimated 185857 French people alive with a history of colorectal cancer. The 5-year prevalence rates were 149.4/100000, which represented 46.4% of prevalent cases. Five-year prevalence rates regularly increased with periods of diagnosis. These results represent useful indicators for monitoring the colorectal cancer problem and for health care planning.

[The characteristics of patients with hepatitis C virus antibodies followed in specialized university hospital units are different from those of patients in the general population. The Research Group of the REBOHC]. / Les caractéristiques des malades ayant des anticorps dirigés contre le virus de l'hépatite C sont différentes en service spécialisé hospitalo-universitaire et dans la population générale. Groupe de Recherche du REBOHC.

OBJECTIVES: To compare the characteristics of patients with anti-hepatitis C virus antibodies followed in a University Hospital Department of Hepatogastroenterology with those in patients who received medical care elsewhere. METHODS: Since 1994, a specialized viral hepatitis register has recorded since 1994 all new cases of anti-hepatitis C virus antibodies diagnosed in inhabitants of the French department of Côte-d'Or (493931). The factors correlated with the type of medical care in patients followed in the University Department were studied by logistical regression. RESULTS: One hundred of the 498 new patients with anti-hepatitis C virus antibodies diagnosed in the Côte-d'Or between 1994 and 1996 were followed in a University Hospital Department. Multivariate analysis showed that age (<60), contamination due to transfusion, elevated ALT levels and no excessive alcohol consumption were factors significantly correlated with follow-up at the University Department. Liver biopsy was more often performed (66%) and a treatment was more often prescribed (34%) in patients followed in a University Department of Hepatogastroenterology patients than in other patients (20.4%; P <0.0001 et 7.5%; P <0.0001 respectively). CONCLUSIONS: This study shows that patients with anti-hepatitis C virus antibodies who are followed by a specialised University Department are a selected group; these patients are more likely to be treated than others. This study emphasizes that the greatest care must be taken when extending the extension of results of hospital series to a non-selected population.

Residential magnetic field measurements in France: comparison of indoor and outdoor measurements.

Residential magnetic field (MF) measurements were performed for the first time in a representative sample of French dwellings. Exposure levels were assessed by two methods: indoor and outdoor measurements. Linear and logistic regression models were used to determine factors associated with the time-weighted average (TWA) home MF. TWA magnetic field magnitudes were approximately log-normally distributed with geometric means under 0.010 microT for both indoor and outdoor measurements. Only 5% of the dwellings presented indoor MF levels greater than 0.120 microT (1.2 mG). Both indoor and outdoor MF variations were explained by three factors: wiring configuration, the dwelling's location (i.e., urban or rural), and housing characteristics (individual houses or apartment building). The reliability of outdoor spot measurements with 30-min bedroom recordings was assessed by an intraclass correlation coefficient. The measurements were accurate in rural areas and small towns. In urban centers, local MF variations spoil the outdoor measurement's reliability. If indoor measurements are taken as the reference method, the use of outdoor instead of indoor measurement leads to an important decrease in statistical power. Further assessment of MF near high power transmission lines is necessary to evaluate the usefulness of outdoor spot recordings near such lines. The urban MF environment also has to be explored to identify extraneous sources.

Time trends and age-period-cohort effects on the incidence of primary liver cancer in a well-defined French population: 1976-1995.

BACKGROUND/AIMS: There is growing interest worldwide in primary liver cancer. The aim of this study was to describe the incidence of this cancer over a 20-year period in a well-defined French population. METHODS: Time trends by 4-year period were studied by sex, age group, place of residence, histological type and associated cirrhosis. Trends were also analysed using the age-period-cohort model. RESULTS: Primary liver cancer incidence in men increased from 7.5/100000 for the period 1976-79 to 10.2/100000 for the period 1992-95. The mean annual variation was +2.2%, (p<0.05). The increase in incidence was seen mainly in the 55-64 and 65-74 age groups and concerned hepatocellular carcinomas. In men, the increase in incidence rates with time was observed mainly in rural areas, whereas incidence rates in urban areas remained stable. The rise in incidence was due mostly to an increase in primary liver cancer with cirrhosis, in relation to a progressive increase in post-hepatitic cirrhosis and a recent increase in alcoholic cirrhosis. The estimated cumulative risk for the life span 30-74 years increased from 0.8% for the 1904-1908 cohort to 2.1% for the 1934-1938 cohort. There was no significant trend in female rates. CONCLUSIONS: In France, incidence rates for primary liver cancer are increasing in men, whilst they are remaining stable in women. Our data confirm the primary importance of alcohol in the aetiology of this cancer. Further studies are necessary to unravel the respective roles of alcohol and hepatitis C virus in the increasing incidence of primary liver cancer.