Parkinson's disease incidence and prevalence assessment in France using the national healthcare insurance database.

BACKGROUND AND PURPOSE: The incidence and prevalence of Parkinson's disease are important for public health planning yet there is a lack of representative, up-to-date estimations for France. METHODS: For this cross-sectional study, subjects with suspected Parkinson's were identified in the EGB database, a 1/97 random sample of the national healthcare insurance database, linked to the national hospital-discharge summary database. Incidence and prevalence were estimated using a specific definition that included those with a diagnosis (hospitalization or listed as a long-term chronic disease for full reimbursement) and a sensitive definition that also included those with an indicative drug reimbursement profile. Estimations were extrapolated to the national population, standardizing on age and gender. RESULTS: According to either the specific or the sensitive definitions, the annual incidence of Parkinson's disease during the study period was respectively 36 and 49 per 100,000 person-years and prevalence in 2010 was 308-410 per 100,000 persons in the population as a whole. According to the age groups 55-64, 65-74, 75-84 and ≥85 years incidence was respectively 33-46, 139-172, 301-363 and 442-560 per 100,000 person-years amongst men and 32-55, 81-117, 203-270 and 251-313 per 100,000 person-years amongst women. The 2010 prevalence stratified by the same age groups was 293-376, 898-1161, 2524-3011 and 3760-4578 per 100,000 persons amongst men and 199-351, 618-889, 1910-2433 and 2504-3263 per 100,000 persons amongst women. CONCLUSIONS: The specific and sensitive definitions of disease bracket the true values; the relatively small range indicates that the current study provides good estimations of incidence and prevalence of Parkinson's disease for recent years in France.

[Screening for diabetes in France: data from the 2000-2001 cohort of the national medical insurance system]. / Dépistage du diabète: les données de l'Echantillon Permanent des Assurés Sociaux, 2000-2001.

BACKGROUND: Type 2 diabetes mellitus may go undiagnosed for several Years while complications are silently developing. In France, from 2 to 3.7% of adults aged 35-65 are unaware they have diabetes. Nevertheless fasting serum glucose is a simple diagnostic test. METHODS: We described people who underwent opportunist diabetes screening (serum glucose) within 2 Years (2000-2001). We used the administrative EPAS cohort from the employee National Health Insurance System which covers 70% of the total population in France. The data are based on reimbursements of glucose testing and hospitalization among people who did not received reimbursements of treatment for diabetes but used medical services during the 2 Years. RESULTS: The opportunistic screening rate within 2 Years was 48.6% overall and increased with age. Among those 45 Years old or older, it was 71.2%. The screening rate was higher among women than men. CONCLUSION: Opportunistic screening for diabetes is commonly practised in France, despite the lack of official guidelines. Several hypotheses may explain the discrepancy between common opportunist screening and high prevalence of undiagnosed diabetes: 1). undiagnosed diabetes is mostly present in people who do not use medical services; 2). opportunistic screening is not performed among the most at-risk population; 3). testing is not performed on fasting samples or results are neglected; 4). results of testing are overlooked by doctors/patients; 5). epidemiological studies based on self-report of diagnosis and only one testing overestimate undiagnosed diabetes.

Suicidal thoughts among adolescents: an intercultural approach.

Two epidemiological surveys of suicidal ideation were conducted among adolescents, aged 15-18, in France and the Canadian province of Quebec. The results suggest that, in both countries, suicidal ideation was linked to drug use (especially tobacco, illicit drugs, and psychotropic medicine), nonspecific somatic complaints (especially tiredness, sleep difficulties, depression, and feeling tense), a lack of self-esteem (pessimism, instability, boredom), and dissatisfaction with family relationships. There was no relationship between suicidal ideation and sports activities in either country. The implications for prevention are discussed.

Early assessment of a new anticancer drug analogue--are the historical comparisons obsolete? The French experience with pirarubicin.

Data of all phase II studies of pirarubicin (THP-doxorubicin) have been analysed for toxicity or activity in breast cancer and compared with published reports on doxorubicin, epirubicin or mitoxantrone used as single drugs. A graph of the 95% confidence intervals for each event was used. The results suggest that pirarubicin is as effective as other intercalating drugs in breast cancer and grossly better tolerated than doxorubicin, especially alopecia and cumulative cardiotoxicity. The equimyelotoxic doses of each drug were also estimated. The methodology and the validity of such historical comparisons is discussed: they cannot replace prospective randomised phase III studies, and do not allow definitive conclusions. However, most comparative trials of anticancer drug analogues cannot answer the right questions because their objectives are not adequate (especially for equiefficacy). But early evaluation by historical comparisons can help the conception of phase III studies.

A pharmacokinetic and pharmacodynamic study of the new anthracycline pirarubicin in breast cancer patients.

We evaluated the pharmacokinetics of pirarubicin during 16 courses of therapy in 4 patients suffering from breast cancer who were treated with an association of pirarubicin (30-60 mg/m2 according to the hematologic tolerance to the previous course, the first course being given at a dose of 40 mg/m2) and continuous infusions of 5-fluorouracil (750 mg/m2 daily for 5 days). Pirarubicin's pharmacokinetics and metabolism were linear within this dose range; the metabolites identified were pirarubicinol, doxorubicin and doxorubicinol (AUC ratios of metabolite/pirarubicin were 0.6, 0.64 and 0.57 respectively). Pirarubicin's decay from plasma followed a two-compartmental pattern, showing half-lives of 15.6 min and 16.6 h; the total plasma clearance of the drug was 140 l/h-1/m-2, and the total volume of distribution was 2,830 l/m2. A relationship was observed between some pharmacokinetic parameters and the toxic effects of the drug: the percentage of survival of granulocytes was significantly correlated with the AUC values for doxorubicin and doxorubicinol, whereas that of platelets was significantly correlated with the AUC values for pirarubicin and pirarubicinol. This is the first study to demonstrate a pharmacokinetic/pharmacodynamic relationship for pirarubicin.

[Results of a multicenter study on tolerance of a semi-elemental diet administered enterally]. / Résultats d'une étude multicentrique de tolérance d'une diète semi-élémentaire administrée par voie entérale.

An important aim of our study was to prove the effectiveness and tolerance of a semi-elemental diet (Tipeptid) infused continuously through a nasogastric feeding tube for 8 days. 383 patients entered the study. This study shows a positive nitrogen balance for 57.6 p. cent of the patients. Tolerance is good, however, incidence of diarrhoea is only 12 p. cent per treatment day among patients without digestive disease and 20 p. cent in the opposite case.