Impact of stopping sending colorectal cancer screening test kits by regular mail.

OBJECTIVE: From 2009 to 2013, the French colorectal cancer screening program (CRCSP) provided for a medical phase and a phase of systematic mailing of the test kit (SMTK) to people who could not participate in the medical phase. After 2013, the SMTK was abandoned in most districts. This study aims to analyze the impact of this termination. STUDY DESIGN: This was a descriptive and cohort study. METHODS: The study concerned a cohort of 143,989 people (aged 50-74 years) living in Seine-Saint-Denis (France), invited to participate in the 2013 campaign (with SMTK) and in the 2015 campaign (without SMTK). The impact of SMTK termination was analyzed in terms of the difference between the participation rates and between the delay (expected vs observed) in performing the screening test in 2015. These differences were described based on previous solicitation in the CRCSP. Expected rates and expected delay were estimated in a Monte Carlo simulation. RESULTS: The participation rate observed (20.0%) was higher than expected (16.1% [15.9-16.3]). People who have never had a SMTK between 2007 and 2013 (80.0% [79.3-80.7] vs 69.6%) and those who participated in all campaigns before 2015 (97.0% [96.7-97.3] vs 82.6%) had an observed rate lower than expected. The delay observed (4.2 months) was longer than expected (2.5 months). CONCLUSION: The sudden termination certainly contributed to the extension of the delay. However, it did not have a major impact on the participation rate, partly due to information campaigns on the new screening test. In this cohort, the low participation would be explained better by the behavior in the previous campaigns than by the lack of SMTK.

[Reporting and interviewing delays in contact investigation of tuberculosis, Seine-Saint-Denis, from April to June 2008]. / Délais de signalement et d'entretien dans l'enquête autour d'un cas de tuberculose, Seine-Saint-Denis, avril-juin 2008.

BACKGROUND: In France, one of the main components of the tuberculosis control program is contact investigation around all tuberculosis cases. For this purpose, all cases of tuberculosis are to be reported to the health authorities (Centre de lutte antituberculeuse) within 48 hours of diagnosis. The Centre then conducts an initial patient interview within three days of the report in order to establish a list of contacts requiring evaluation. Given that a delay in action may play a role in the continued disease transmission, it appeared necessary to study more precisely this subject in a French area with a high annual new case rate, the Seine-Saint-Denis. METHODS: A descriptive and retrospective study included all tuberculosis cases reported and received between April and June 2008. The two periods were statistically analyzed with socio-demographic, clinical-biological and investigations data. RESULTS: For the 148 cases reported during this period, a first interview was required for 123. The average time period between initiation of anti-tuberculosis therapy and reception of the report was 11.08 days. The overly long delay could be explained in part by the inappropriate use of the notification form (45.5%) designed for non-urgent collection of epidemiological data, and in part by the underuse of telephone reporting (8.1%). The first interview was not performed for 19 cases and the average time between reception of the notification and the patient interview was 6.58 days. Having the patient's phone number appeared essential to meet the deadline (odds ratio: 5.3; 95% confidence interval [1.7-16.9]). Few interviews were made in person. Shortage in financial and human resources and the delayed case reporting could be part of the explanations. Deadlines were met much better for cases of pleuro-pulmonary tuberculosis compared with other localizations, for reporting (39.2% versus 13.5%, p<0.01) and for the first interview (48.8% versus 28.6%, p=0.03). CONCLUSION: This study reports some risk factors associated with delayed action and highlights the need for improved reporting of tuberculosis cases and contact investigations.

[Evaluation of a cervical cancer screening campaign: reflections on the experience in Martinique]. / Dispositifs d'évaluation d'une campagne de dépistage du cancer du col de l'utérus: réflexions à partir de l'expérience martiniquaise. Comité de Pilotage de la Campagne de dépistage.

A pilot cervix cancer screening is organized in Martinique since 1991, as part of the programmes of the Fonds National de Prévention d'Education et d'Information Sanitaire of CNAMTS. Evaluation of the programme is conducted by the cancer registry, which includes the measurement of the impact, quality of the Pap smear test, quality of action and efficiency of the programme. Evaluation is a key part that allows to manage the screening programme. According to the results of the organized screening in Martinique, modalities of the evaluation will be discussed with respect to the pilot programme organization, involvement of participants, indicators to collect and the organism in charge of the evaluation.

EPIMART: prospective incidence study of epileptic seizures in newly referred patients in a French Carribean island (Martinique).

PURPOSE: To identify, in the population living in the island of Martinique, persons who had their first epileptic seizure or first came to medical attention because of an epileptic seizure. METHODS: Between May 1, 1994, and April 30, 1995, we collected all suspected cases of provoked and unprovoked epileptic seizures admitted to the hospitals or addressed to the private neurologists or pediatricians of the island. RESULTS: Three hundred nine cases were collected. Rate of initial diagnosis of provoked and nonprovoked seizures (standardized to the U.S. population): 77.7/100,000, with a bimodal distribution of the cases with age (86 in 0- to 10-year age group and 203 in patients older than 60 years). Sixty-three cases were classified as provoked seizures (incidence, 16.4/100,000). Alcohol consumption, stroke, and cranial trauma were the most frequent causes (30.1, 20.6, and 18.7%, respectively). Two hundred forty-six cases were classified as unprovoked seizures (incidence, 64.1): seizures with a stable condition, 74 cases (I, 19.3); seizures with an evolutive condition, 17 cases (I, 4.5); seizures of unknown etiology, 155 cases (I, 40.4). These figures must be considered as the minimal rate. CONCLUSIONS: The global incidence rate of newly referred persons with a diagnosis of epileptic seizures in this study is clearly higher than those observed in industrialized countries but lower than those in developing countries. The major risk factors are represented by alcohol consumption, followed by stroke, cranial trauma, and infectious diseases.

[Epileptic seizures, epilepsy and risk factors. Experiences with an investigation in Martinique. Epimart Group]. / Crises épileptiques, épilepsies et facteurs de risque. Expérience d'une enquête en Martinique. Le Groupe Epimart.

A prospective incidence study was carried out in the French Caribbean island of Martinique between May 1st 1994 and April 31st 1995. incidence was 80.6 (77.7 when standardized with 1990 U.S. population). This incidence was higher than that observed in the Swiss canton of Geneva where the same methodology was used. The individualized risk factors of first provoked and unprovoked seizures in Martinique were alcoholism, head trauma and cerebro-vascular accidents.

[Prostate cancer screening (II): is prostate cancer a public health problem? Update of incidence and mortality figures in France from 1982 to 1990]. / Dépistage du cancer de la prostate (II): Le cancer de la prostate est-il un problème de santé publique? Actualisation des chiffres d'incidence et de mortalité en France de 1982 à 1990.

OBJECTIVE: To describe the epidemiological situation of prostatic cancer in France on the basis on a large population sample. MATERIAL AND METHODS: This study uses incidence data derived from French cancer registers, and mortality data obtained from death certificates. Crude rates and rates standardized for the world population are calculated. The variation of these rates is analysed by a log-linear model (adjusted for age, department and period). RESULTS: The incidence of prostatic cancer in France in 1990 was 200 to 300/100,000 between the ages of 60 and 70 years and more than 600/100,000 after the age of 70 years. 73% of cases were diagnosed after the age of 70 years. The incidence increased annually by 8.76% between 1982 and 1990. An estimated 22,600 cases were diagnosed in France in 1990. The increased incidence of localized or local stages is due to the use of diagnostic tests (PSA and ultrasound-guided biopsies), as this increase accelerated after 1987. The crude mortality rate was 33.4/100,000 (384/100,000 between the ages of 75 and 85 years). It increased by 2.56% per annum from 1982 to 1990, but essentially for men over the age of 75 years. CONCLUSION: These findings tend to make prostatic cancer a public health priority, but this affirmation must be moderated by the fact that this disease has a low impact on loss of life expectancy.