[Evaluation of medical information systems as a mean of identification of incident cases of colorectal cancer]. / Evaluation du PMSI comme moyen d'identification des cas incidents de cancer colorectal.

BACKGROUND: Cancer registries are a reliable source of data to estimate national cancer incidence rates, but they are not always available in all regions. This study assessed the value of medical information systems (PMSI) to identify incident cases of colorectal cancer METHODS: Two algorithms were elaborated to identify these incident cases in the PMSI database. The first algorithm was based on diagnosis and medical procedure codes and the second algorithm was based exclusively on diagnoses and the absence of diagnoses over the last five years. The results obtained for two departments were compared with those derived from two cancer registries, constituting the reference data. We then elaborated two multivariate logistic regression models to correct the national number of incident cases estimated by the algorithm adopted after evaluation of the results. RESULTS: The first algorithm provided results that were very close to those derived from the regional registries (646 vs 645 cases) with a good sensitivity and positive predictive value of 75%. The second algorithm overestimated the incidence by about 50% with a positive predictive value of 60% and was therefore not adopted for the national estimation. By applying the first algorithm to the national PMSI MCO database (medicine, surgery, obstetrics), and after modelling, the estimated incidence differed by only 2.34% compared to that observed by all 14 registries. The national estimation of cancer incidence was 39,122 [37,020; 41,224] cases for 2005, which is consistent with the figure published by the Francim national registry network (37,413). CONCLUSION: This study demonstrates the value of PMSI data for estimation of national incidence rates for certain cancers in the absence of cancer registries. However, raw data must be corrected and can be achieved by the method proposed here.

Comparison of British and French expatriate doctors' characteristics and motivations.

OBJECTIVE: The aim of this study was to analyse the migration of doctors between the UK and France, in an attempt to identify the reasons for these migrations. DESIGN: This was a cross-sectional study conducted using a self-completed questionnaire. SETTING: The questionnaire was sent to all British doctors practising in France and to all French doctors practising in the UK. PARTICIPANTS: The doctors were identified, thanks to official data of the National Medical Councils. There were 244 French doctors practising in the UK and 86 British doctors practising in France. OUTCOME MEASURES: A questionnaire was specifically developed for the study to determine the reasons why doctors moved to the other country and their level of satisfaction with regard to their expatriation. RESULTS: A total of 98 French doctors (of 244) and 40 British doctors (of 86) returned the questionnaire. The motivations of the two studied populations were different: French doctors were attracted by the conditions offered by the National Health Service, whereas British doctors were more interested in opportunities for career advancement, moved to join a husband or wife or to benefit from favourable environmental conditions. Overall, the doctors who responded considered the expatriation a satisfactory experience. After expatriation, 84% of French doctors were satisfied with their new professional situation compared with only 58% of British doctors. CONCLUSIONS: This study, which is the first of its kind and based on representative samples, has led to a clearer understanding of the migration of doctors between France and the UK.

Chronic viral hepatitis and risk of lymphoid malignancies: a retrospective twelve-year population-based cohort study in Côte d'Or, France.

BACKGROUND: The association between hepatitis C infection and lymphoid malignancies is still a matter of debate. The hypothesis of a relationship between hepatitis B and lymphoid neoplasms is more recent and has been far less thoroughly explored. AIM: The aim of this study was to evaluate the association between hepatitis C and B infections and B cell non-Hodgkin and Hodgkin lymphomas. METHODS: We took advantage of the co-existence in the French administrative area of Côte d'Or of two specialized registries - one for viral hepatitis and one for haematological diseases - to conduct a population-based, cohort study covering a 12-year period. The databases were anonymized and then linked using a probabilistic model. RESULTS: There were 8234 person-years at risk in the hepatitis C cohort and 2784 in the hepatitis B cohort. We found 6 cases of non-Hodgkin lymphoma in the hepatitis C cohort, resulting in an overall adjusted standardized incidence ratio of 3.42 (CI: 1.25-7.45). Three of these 6 cases were diffuse-large-B-cell-lymphoma. Cirrhosis was associated with a higher risk of non-Hodgkin lymphoma in the hepatitis C cohort (relative risk=8.4, p<0.01, using a Poisson regression). We found one case of chronic lymphocytic leukaemia amongst the hepatitis B carriers. CONCLUSION: Hepatitis C carriers are at a higher risk of developing non-Hodgkin lymphoma than the general population. The role of cirrhosis and the association between hepatitis B and lymphoid malignancies deserve to be further assessed.

Environmental justice in a French industrial region: are polluting industrial facilities equally distributed?

Recent studies have suggested that minority or deprived groups are subject to the additional burden of a polluted living environment. Our goal is to determine whether such environmental inequalities occur in France's leading industrial region, using detailed socio-economic data and advanced Bayesian methods. Associations between proximity to hazardous facilities (i.e., within a 2 km radius) and the socio-economic characteristics of populations are analyzed at fine geographical scales. Noxious facilities are disproportionately located in higher foreign-born communities after controlling for deprivation (Townsend score), population density and rural/urban status. High deprivation also appears as a predictive factor, although less strongly and less consistently.

Active trachoma among children in Mali: Clustering and environmental risk factors.

BACKGROUND: Active trachoma is not uniformly distributed in endemic areas, and local environmental factors influencing its prevalence are not yet adequately understood. Determining whether clustering is a consistent phenomenon may help predict likely modes of transmission and help to determine the appropriate level at which to target control interventions. The aims of this study were, therefore, to disentangle the relative importance of clustering at different levels and to assess the respective role of individual, socio-demographic, and environmental factors on active trachoma prevalence among children in Mali. METHODOLOGY/PRINCIPAL FINDINGS: We used anonymous data collected during the Mali national trachoma survey (1996-1997) at different levels of the traditional social structure (14,627 children under 10 years of age, 6,251 caretakers, 2,269 households, 203 villages). Besides field-collected data, environmental variables were retrieved later from various databases at the village level. Bayesian hierarchical logistic models were fit to these prevalence and exposure data. Clustering revealed significant results at four hierarchical levels. The higher proportion of the variation in the occurrence of active trachoma was attributable to the village level (36.7%), followed by household (25.3%), and child (24.7%) levels. Beyond some well-established individual risk factors (age between 3 and 5, dirty face, and flies on the face), we showed that caretaker-level (wiping after body washing), household-level (common ownership of radio, and motorbike), and village-level (presence of a women's association, average monthly maximal temperature and sunshine fraction, average annual mean temperature, presence of rainy days) features were associated with reduced active trachoma prevalence. CONCLUSIONS/SIGNIFICANCE: This study clearly indicates the importance of directing control efforts both at children with active trachoma as well as those with close contact, and at communities. The results support facial cleanliness and environmental improvements (the SAFE strategy) as population-health initiatives to combat blinding trachoma.

Dioxin emissions from a municipal solid waste incinerator and risk of invasive breast cancer: a population-based case-control study with GIS-derived exposure.

BACKGROUND: To date, few epidemiologic studies have examined the relationship between environmental PCDD/F exposure and breast cancer in human populations. Dioxin emissions from municipal solid waste incinerators (MSWIs) are one of the major sources of environmental dioxins and are therefore an exposure source of public concern. The purpose of this study was to examine the association between dioxins emitted from a polluting MSWI and invasive breast cancer risk among women residing in the area under direct influence of the facility. METHODS: We compared 434 incident cases of invasive breast cancer diagnosed between 1996 and 2002, and 2170 controls randomly selected from the 1999 population census. A validated dispersion model was used as a proxy for dioxin exposure, yielding four exposure categories. The latter were linked to individual places of residence, using Geographic Information System technology. RESULTS: The age distribution at diagnosis for all cases combined showed a bimodal pattern with incidence peaks near 50 and 70 years old. This prompted us to run models separately for women aged 20-59 years, and women aged 60 years or older. Among women younger than 60 years old, no increased or decreased risk was found for any dioxin exposure category. Conversely, women over 60 years old living in the highest exposed zone were 0.31 time less likely (95% confidence interval, 0.08-0.89) to develop invasive breast cancer. CONCLUSION: Before speculating that this decreased risk reflects a dioxin anti-estrogenic activity with greater effect on late-onset acquired breast cancer, some residual confounding must be envisaged.