Fear of cancer recurrence in Non- and Hodgkin lymphoma survivors during their first three years of survivorship among French patients.

The aim of this study was to measure the prevalence of FCR among a sample of French lymphoma survivors and to determine factors associated with clinical levels of FCR. The study was conducted with two cross-sectional measures: sociodemographic and anxiety, depression as well as health-related quality of life (HRQoL) scores were measured at the baseline of the post-cancer period and FCR was evaluated during the first 3 years of survivorship. The prevalence of clinical levels of FCR (≥13) was evaluated by the Fear of Cancer Recurrence Inventory - Short Form (FCRI-SF) among non- and Hodgkin lymphoma survivors undergoing prior first-line chemotherapy. Among 108 lymphoma survivors with an average follow-up of 1.6 years (range 0.3-3.0 years), clinical levels of FCR (≥13) were observed for 44.4% (n = 48). Multivariate analysis indicated that baseline anxiety and low quality of life were related to clinically significant FCR levels.

Are there variations in adherence to colorectal cancer clinical guidelines depending on treatment place and recommendation novelty? The French EvaCCoR observational study.

BACKGROUND: Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and patients' socioeconomic position (SEP)-related variation in CRC guidelines. METHODS: All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients' SEP was approached by an ecological social deprivation index. RESULTS: We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices. CONCLUSION: Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.

Changes in prevalence, awareness, treatment and control of hypertension in disadvantaged French Caribbean populations, 2003 to 2014.

In 2003, the PHDG (Prevalence of Hypertension among Disadvantaged Guadeloupeans) study highlighted poor management of hypertension in an unemployed French Caribbean population. New processes of health-care coordination and a pay-for-performance system have since been developed. We aimed to assess changes in hypertension characteristics in disadvantaged French Caribbean populations in the last 10 years. Using PHDG 2003 data, in 2014 we undertook a cross-sectional study with identical methods. The source population comprised all Guadeloupeans having undergone periodic heath checks offered by the Social Security insurance at these dates. Only universal health coverage beneficiaries (i.e. in situations of poverty) aged 18-64 were included (2014 in 2014, 1868 in 2003). Hypertension was defined by antihypertensive treatment or a mean of two blood pressure measures ⩾140/90 mm Hg. The 2003 and 2014 data were age adjusted; comparative morbidity factors (CMF) and 95% confidence intervals were calculated to assess changes over time. Hypertension prevalence decreased from 38.3 to 34.5% (CMF 95% CI: 0.83-0.97). The increase in hypertension awareness was greater for women (from 48.3 to 55.3%, CMF 95% CI: 1.00-1.31) than for men (from 28 to 31.1%, NS). Among hypertensive individuals aware of their condition, proportions of those treated increased for women (from 83.1 to 88.3%, NS) but decreased for men (from 80.2 to 75.8%, NS). Controlled hypertension among treated patients increased in women (from 35.2 to 49.2%, CMF 95% CI: 1.07-1.82) and men (from 12.9 to 30.1%, CMF 95% CI: 1.30-4.21). In conclusion, in these poor French Caribbean populations with theoretically adequate access to care, hypertension control remained far below national goals. Neither awareness nor treatment had improved in men.

[Prostate cancer: Quality assessment of clinical management in the Midi-Pyrenean region in 2011]. / Cancer de la prostate : qualité de la prise en charge en Midi-Pyrénées en 2011.

OBJECTIVES: Assessing the quality of the clinical management of prostate cancer in the Midi-Pyrenean region in 2011. METHODS: The study population was randomly selected among new cases of prostate cancer presented in Multidisciplinary Team Meeting (MTM) in 2011. The indicators defined with the professionals have evaluated the quality of the diagnostic care, when treatment started and at the time of the MTM. RESULTS: Six hundred and thirty-three new patients were included (median age at diagnosis=69years, min: 48; max: 93). In diagnostic period, 92% of patients had a prostate biopsy. Performing a pelvic MRI, an abdomino-pelvic CT and bone scintigraphy concerned respectively 53%, 55% and 61% of intermediate or high-risk patients. The Gleason score, surgical margins and pathological stage were included in over 98% patient records treated by radical prostatectomy. A PSA assay in 3months after prostatectomy was found in 59% of surgical patients. The MTM was performed before treatment to 83% of patients. About three-quarters of surgical patients with stage pT≥3 or pN1 or with no healthy margins were discussed in MTM after surgery. CONCLUSION: Most of the studied indicators reach a high level. However, the lower level of realization of complementary examinations may question about their real place, accessibility and traceability. LEVEL OF EVIDENCE: 4.

[The evaluation of pharmacological drugs, medical devices, and non-pharmacological or public health interventions: Experimental design limitations. Moving towards new methods?] / Évaluer les effets d'un médicament, de dispositifs médicaux et d'interventions non médicamenteuses ou de santé publique : limites de l'essai expérimental. Vers de nouvelles méthodes ?

In the field of health, evidence-based medicine and associated methods like randomised controlled trials (RCTs) have become widely used. RCT has become the gold standard for evaluating causal links between interventions and health results. Originating in pharmacology, this method has been progressively expanded to medical devices, non-pharmacological individual interventions, as well as collective public health interventions. Its use in these domains has led to the formulation of several limits, and it has been called into question as an undisputed gold standard. Some of those limits (e.g. confounding biases and external validity) are common to these four different domains, while others are more specific. This paper describes the different limits, as well as several research avenues. Some are methodological reflections aiming at adapting RCT to the complexity of the tested interventions, and at overcoming some of its limits. Others are alternative methods. The objective is not to remove RCT from the range of evaluation methodologies, but to resituate it within this range. The aim is to encourage choosing between different methods according to the features and the level of the intervention to evaluate, thereby calling for methodological pluralism.

The care center influences the management of lymphoma patients in a universal health care system: an observational cohort study.

BACKGROUND: Healthcare providers-related disparities in adherence to the treatment plan among lymphoma patients are found even in a universal healthcare system, but the mechanism remains unclear. We investigated the association between the type of care center and the relative dose intensity and determined whether it persists after adjustment for patients' recruitment differences. METHODS: Prospective observational cohort study of 294 patients treated with standard protocols for diffuse large B-cell lymphoma (DLBCL) in teaching or community public hospitals or in private centers in the French Midi-Pyrénées region from 2006-2013. To test our assumptions, we used multinomial and mixed-effect logistic models progressively adjusted for patients' biomedical characteristics, socio-spatial characteristics and treatment-related toxicity events. RESULTS: Patients treated using standard protocols in the teaching hospital had more advanced stage and poorer initial prognosis without limitation regarding the distance from the residence to the care center. Patients' recruitment profile across the different types of care center failed to explain the difference in relative dose intensity. Low relative dose intensity was less often observed in teaching hospital than elsewhere. CONCLUSION: We showed that even in a universal healthcare system, disparities in the management of DLBCL patients' do exist according to the types of care center. A main issue may be to find and diffuse the reasons of this benefit in cancer management in the teaching hospital to the other centers.

[Consequences of tobacco, cocaine and cannabis consumption during pregnancy on the pregnancy itself, on the newborn and on child development: A review]. / Conséquences potentielles de la consommation de tabac, de cannabis et de cocaïne par la femme enceinte sur la grossesse, le nouveau-né et l'enfant : revue de littérature.

BACKGROUND: Substance use has increased worldwide. Based on these data, we may think that substance use has also increased during pregnancy, but epidemiological data are scarce in this population. The potential consequences of tobacco, cocaine or cannabis use during pregnancy are a major public health concern. The combined use of different substances during pregnancy may have serious consequences on the pregnancy and on child development. METHODS: In this paper, we will describe the potential consequences for the newborn, child and adolescent after being exposed to tobacco, cannabis and cocaine in utero. For this purpose, we will review all retrospective and prospective studies (in English and French) referenced in PubMed reporting on the somatic or psychiatric consequences of alcohol, tobacco and drug consumption by pregnant women on newborn and children. Consumption during pregnancy was assessed in these studies using simple questionnaires, biomarkers analysis or both. RESULTS: Generally speaking, these pregnancies are at high risk for both the mother and the foetus: for example, an increased risk of miscarriage or of reduced length of gestation, an increased risk of uterine apoplexy and placenta praevia, more premature births and/or hypotrophy were reported. The occurrence of a newborn's withdrawal syndrome may be misdiagnosed. Many consequences on child development may be observed such as growth disorders, learning or motor disorders, language disorders, cognitive disorders (attention, memory, executive functions), attention deficit disorders with impulsivity or with hyperactivity (ADHD), and memory disorders. The prevalence of depressive or anxiety disorders may also be increased in these children. The risk of addictive disorders or schizophrenia in children exposed in utero to illicit drugs or tobacco is still unknown. The combined use of different substances increases, consequently it is difficult to disentangle the consequences on child development of each of the drugs used during pregnancy owing to potential interactions between these drugs. The consequences on child development will also depend on the dose and on the time of drug use during pregnancy. DISCUSSION: The National Institute of Drug Abuse reported that 75% of the infants exposed in utero to one or more substances will present medical problems during childhood, as compared to only 27% of the non-exposed infants. However, the medical consequences are still a matter of controversies. Methodological biases, such as the use of different rating scales among studies, and the heterogeneity of the populations included are main limitations. Further studies are needed using larger cohorts and longer follow-up periods.

[First stage in identifying traumatic profil inpatients hospitalised in psychiatry in Martinique]. / Premières identifications d'un profil traumatique chez des patients hospitalisés en psychiatrie en Martinique.

The population hospitalised in psychiatry seems more exposed to traumatic events than the French general population, with particularly more sexual aggressions. The aim of this study is to describe the population hospitalised in psychiatry and more precisely the traumatic history of these patients, their comorbidities (mental diseases and addictions), and socio economical level. This descriptive, cross sectional and retrospective study took place in the Crisis Center in the University Hospital in Martinique (French West Indies), from February to July 2013. A socio-demographic information, the Mini International Neuropsychiatric Interview 5.0, the Trauma History Questionnaire and the Impact Events Scale-Revised were realised with 49 of the 143 patients admitted during this period (34.3%). In this population, we found a mean of 6.5 (standart-deviation=4.2) different types of traumatic event, with 38.8% patients reporting a natural disaster, and 38.8% declaring at least one sexual aggression. In the 25 patients suffering from post-traumatic stress disorder, 66.7% underwent a sexual aggression, significatively during childhood (before 10 years old, P=0.01), and during adolescence (between 10 to 18 years old, P=0.01). These results underline the importance of a systematic screening of the traumatic profile: the characteristics of the traumatic events and its clinical impact.

A spontaneous pre-anastomotic occlusion does not necessarily impair forearm native dialysis fistulas: echo-Doppler, 3D MR angiographic and digital subtraction angiographic imaging.

Renal transplantation is the choice treatment of end-stage renal disease. When it is not indicated or not immediately feasible, hemodialysis must be performed, preferably via a native arteriovenous fistula in the forearm. A pre-anastomotic occlusion of this type of fistula is often accompanied by a thrombosis of its draining vein. In some instances, the venous segment may remain permeable thanks to the development of arterial collateral pathways and may even allow efficient dialysis without any clinical syndrome of distal steal. We present the echo-Doppler, magnetic and angiographic characteristics of three of these collateralized shunts that have remained functional, in one of the cases following a percutaneous dilation.

[Prostate cancer in Luxembourg from 1982 to 2006. Incidence and mortality. Survival of a hospital cohort]. / Le Cancer de la Prostate au Luxembourg de 1982 à 2006. Incidence et mortalité. Survie d'une cohorte hospitalière.

Prostate cancer incidence has tripled in Luxembourg as in many other western countries. From 1982 to 2006, new cases increased from 80 to 309 per year, while the incidence (world stand.pop.) rose from 29.5 to 85 per 100 000 men. Since 1991 prostate cancer is the most frequent male cancer in Luxembourg, exceeding colo-rectal, lung and stomach cancer. Prostate cancer deaths have diminished from 64 in 1982 to 45 in 2006. This represents less than 10% of male cancer related deaths; it represents the third most frequent cancer death, behind lung and colo-rectal cancers. Annual mortality rate has decreased from 29 to 10 per 100 000 men during the same period, this difference between incidence and mortality is explained on the one hand by the widespread use of PSA since the 1990's and on the other hand by a better local control as well as a multidisciplinary approach of advanced disease. The increase of the incidence is particularly important in the 60 to 70 age group, while for men older than 70, the peak incidence was reached in 2002. A lowering of the age at diagnosis is confirmed by the 5-year age group analysis. The hospital cohort consists of 628 patients from the urological department of the Centre Hospitalier de Luxembourg diagnosed with prostate cancer between 1st January 1982 and 31st December 2006; follow-up ended 31st December 2011. During this period, age at diagnosis decreased from 71.5 to 68.9 years whereas the proportion of localized clinical stages increased from 44 to 70%. Median PSA dropped from 14.5 to 9 ng/ml. Furthermore the analysis of cancer specific mortality confirms the negative effects of an advanced clinical stage (10-year survival: 90% for localized disease, 60% for advanced disease) or a high PSA level at diagnosis (10-year survival: 97% if PSA < 4 ng/nl, 94% if 4 < PSA < 10, and 72% if PSA > 10 ng/ml), as well as a poor differentiation (60% 10-year survival compared to 90% for differentiated tumors). Kaplan-Meier curves show that long term surveillance is necessary as even tumors with a good initial prognosis may relapse after 10-12 years.

Dialysis arteriovenous fistulas: the critical role of color doppler ultrasound.

Despite being time-consuming and observer-dependent, CDUS is a method of choice for performing and controlling dialysis shunts. It contributes to increasing the number of native AVFs and enables early detection of lesions therefore allowing quick percutaneous or surgical therapy.

Effects of 5-chloro-2-methyl-4-isothiazolin-3-one and other candidate biodiesel biocides on rat alveolar macrophages and NR8383 cells.

Biocides are added to biodiesels to inhibit and remove microbial growth. The effects of 5-chloro-2-methyl-4-isothiazolin-3-one (CMIT), a candidate biodiesel biocide, were studied using freshly isolated rat alveolar macrophages (AM) and NR8383 cell line. CMIT markedly inhibited phagocytic oxidative burst as measured by zymosan-induced chemiluminescence, and cellular cytokine secretion as measured by zymosan-induced TNF-α secretion. The 50% inhibition concentration (LC(50)) for CMIT was 0.002-0.004 mM for both cellular functions. AM exposed to CMIT for as little as 2 min showed markedly inhibited functions that persisted for at least 5 h. Sodium metabisulfite was able to partially neutralize the inhibitory activity of CMIT. Cysteine and glutathione, when present at a molar ratio of 2-1 or higher against CMIT, were effective neutralizers, while serine, histidine, alanine, and albumin were without effect. When the AM testing system was used to compare the toxicity of CMIT against three other candidate biodiesel biocides, methylene dithiocyanate (MDC) was found to be of comparable toxicity to CMIT, 2-methyl-4-isothiazolin-3-one (MIT) was much less toxic, and dimethyl acetylenedicarboxylate (DMAD) was non-toxic. Because AM is among the first cell-type exposed to inhaled biodiesel aerosols, the result suggested that CMIT present in biodiesel may produce respiratory effects, and further investigations including animal studies are warranted.

[Psychoactive substance use during pregnancy: a review]. / Etat des lieux de la consommation de substances psychoactives par les femmes enceintes.

All around the world, the potential consequences of the increasing use of psychoactive substances during pregnancy are a major public health concern. It is estimated that 20 to 30% of pregnant women use tobacco, 15% use alcohol, 3 to 10% use cannabis and 0.5 to 3% use cocaine. The estimation of tobacco consumption during pregnancy is better known as compared with alcohol and substance use prevalence during pregnancy, which remains under estimated or unknown. For example, in France, the prevalence of cannabis and cocaine use during pregnancy is unknown. In general, the prevalence of drug or alcohol use during pregnancy is estimated by extrapolating data from epidemiological studies conducted in the general population (in France or in other countries). However, drug or alcohol use in the general population may dramatically vary from one country to another. Even if some studies have reported the prevalence of alcohol or substance use in different countries around the world, most of them were based on the mother's interview. In most cases, the mother did not report exactly the amount of drugs or alcohol used. Further studies measuring alcohol or substance use in the mother's blood, hair or in the newborn's meconium are needed. In addition, different methodologies have been used in the literature (different types of interview, with or without biological measurements; different subjects included (in- or out-pregnant women, psychiatric comorbidities or not, different economic status, etc). Despite these methodological biases, the prevalence of drug or alcohol use increases in pregnant women, and in most cases, several drugs are associated. Most of the studies have used structured or semi-structured interviews such as the addiction severity index (ASI) or the alcohol use disorders identification test (AUDIT) to assess alcohol or drug consumption. In addition, the identification of risk factors for substance or alcohol use during pregnancy would allow the early detection of these high-risk pregnancies. Environmental factors such as low economic status or marital status may play an important role. Personality disorders may also contribute to substance or alcohol use during pregnancy. In fact, in most studies the quality of the obstetrical survey is lower in pregnant women using drugs or alcohol but it remains difficult to describe a specific at-risk profile in these pregnant women. Consumption of alcohol or of one or more psychoactive substances during pregnancy may have serious consequences on the pregnancy and on the child's development. Fetal alcoholism syndrome is the main etiology of mental retardation in France. We need to improve our knowledge of alcohol and substance use during pregnancy in order to target information for prevention campaigns and to implement specific mother and child medical care in high-risk populations.

The Emotional Stroop task: a comparison between schizophrenic subjects and controls.

The colour-word Emotional Stroop task (ES task) has been proposed to assess the interferences between emotion and attention. Using this task, first, we examined how attention (using reaction times) can be modified by emotionally relevant words in schizophrenics as compared with controls as a function of the emotional significance of the word; second, we tested the assumption that schizophrenics with the most negative symptoms will show higher impairment in relationship to negative emotional words. In general, schizophrenics were slower to react. In both groups, mean reaction times were slower for emotional as compared with neutral words. No significant differences were observed between negative and positive words either in schizophrenics (n=21) or in controls (n=20). Even in the most negative schizophrenic patients, there were no differences between negative and positive words. There were no significant interactions between type of stimulus and any clinical variables (PANSS negative or non negative categorization, etc.). Also, there were no statistically significant correlations between reaction times and neuroleptic dosage or anhedonia scores. In conclusion, schizophrenia patients showed the same degree of interference from emotional words as compared with controls. Moreover, patients with a higher level of negative symptoms did not differently experience positive and negative words.

Assessment of renal graft obstruction due to ureteral inguinal hernia: US detection and 3D MR confirmation.

In most cases, renal graft obstruction is caused by ureteral stenosis due to ischemia or technical error. Exceptional cases have been published where the obstacle was the result of incarceration of the ureter in an inguinal hernia. We report a case of this type, which prompt assessment was possible due to ultrasound and magnetic resonance imaging with 3D reconstruction.

Short-term number of pecks and feed intake levels: a link with the physical characteristics of feed in four-week-old turkeys.

Short-term reactions of young turkeys to changes in the physical characteristics of their feed sometimes give rise to problems of adaptation in the field. Specific feeders were designed for this study to automatically count the number of pecks given at feed by 4-wk-old male turkeys during 95-min sessions. The lighting program was intermittent (0140L:0100D). In experiment 1, 4 series of 12 birds were tested 4 times/day from 28 to 31 d of age. Four control turkeys were consistently tested with 1 feed, and 8 experimental turkeys ate 1 of 32 commercial feeds (30 as pellets and 2 as crumbs) with a distinct feed for each test (16 replicates/experimental feed). Feed intake, total number of pecks, and pecking efficiency (mg/peck) were recorded for each test and normalized for each turkey. The effects of series, day, and test were not significant for controls. The number of pecks and pecking efficiency differed among feeds (P < 0.001) but not feed intake. Hierarchical Cluster Analysis for these variables distinguished 3 groups of feed: group 3 (6 crumb and small pellets) resulted in high pecking and low efficiency. However, group 1 (10 feeds) were pecked at less but more efficiently than group 2 (16 feeds) for similar feed intake, although the average sizes of the pellets were similar (6.23 and 6.16 mm, respectively), as were the average bulk density, hardness, resistance to abrasion, and color characteristics of the pellets for both groups. Two feeds of each of these 2 groups were compared in a second experiment for 12 turkeys receiving the 4 feeds successively each day over 4 d in varying order. The turkeys consistently pecked the feeds of group 1 less and less efficiently compared with group 2. The automated measurement of pecking, combined with a more detailed image analysis of feed particles, might enhance the evaluation of the effects of feed technology on the behavior of turkeys and thus become a useful tool for the feed industry.

Diagnosis of inguinal bladder hernias: the current role of sonography.

We present a case of inguinal bladder hernia detected initially with sonography in an adult patient. Compared with digestive or omental hernias, inguinocrural bladder herniations are a rarer occurrence (1 to 4% of all cases). Their detection is nevertheless highly imperative in order to avoid inadvertent injury to the bladder during routine hemiorrhaphy. Since the advent of high frequency equipment, ultrasonography has become the essential method of diagnosing vesical hernias. It is simple and fast, totally non-invasive, inexpensive, and widely available.

Suicide attempts in women with bulimia nervosa: frequency and characteristics.

OBJECTIVE: This study aimed to estimate the lifetime frequency of suicide attempts in a large referred population of women with DSM-IV bulimia nervosa (BN), and to compare demographic and clinical characteristics of those who had attempted suicide and those who had not. METHOD: A total of 295 women (202 with BN purging type, 68 with BN non-purging type and 25 with anorexia nervosa binge/eating purging type) were assessed using a semi-structured interview and self-rated questionnaires. RESULTS: Suicide attempts were frequent (27.8% of women), often serious and/or multiple. Women who had attempted suicide differed significantly from those who had not for earlier onset of psychopathology, higher severity of depressive and general symptoms, and more impulsive disordered conducts, but not for the core symptoms or severity of BN. CONCLUSION: Interventions targeting depressive and impulsive features associated with BN are essential to reduce the risk of suicide attempt in women with this disorder.