Evaluation of the quality of coding of job episodes collected by self questionnaires among French retired men for use in a job-exposure matrix.

BACKGROUND: and AIMS: The ESPACES study was intended to identify retirees who may have been, according to their job descriptions, exposed to asbestos during their working lives. As part of this study, we analysed the quality of the occupation and activity sector coding as well as its effect on the subjects' exposure status. METHODS: The occupation and activity sector for a sample of 450 retired men were coded twice (with the second coder blinded to the first result), according to the international codes for industries (ISIC-1975) and occupations (ISCO-1968). For each series, linking the information about a job episode (dates, ISIC code, ISCO code) with the matrix allowed attribution of a probability of asbestos exposure to each episode and each subject. The asbestos exposure in the two series was compared by the kappa reproducibility coefficient. RESULTS: The analysis concerned 425 questionnaires. There was at least one difference in the code for either activity sector (ISIC) or occupation (ISCO) in half the episodes (50.2%). The exposure status estimated by the job-exposure matrix did not change between the series for 84.7% of the subjects. The kappa coefficient was 0.64 for all questionnaires, 0.70 when the questionnaire was coded twice by the same coder, and 0.62 when coded by two different coders. CONCLUSIONS: Despite intra- and inter-differences between coders, the coding of job episodes for the ESPACES study appears satisfactory and hence indicates that the assessment of the subjects' asbestos exposure was assessed without major distortions. This study underlines the usefulness of employing coders specifically trained for this technique.

[Three-year follow-up of infraclinical hypothyroidism: course in a cohort of 97 women aged 45 to 70 years attending healthcare screening centers]. / Evolution à trois ans de 97 cas d'hypothyroïdie fruste. Suivi d'une cohorte de femmes de 45 á 70 ans examinées dans les Centres d'Examens de Santé.

Infraclinical hypothyroidism is a recognized entity defined in terms of laboratory results which occurs more readily in women. The appropriateness of thyroid hormone multicentric prospective study initiated in 1997 has established that infraclinical hypothyroidism occurred in about 3% of women over 45 years of age undergoing routine check-ups at eleven health screening centers. Associated clinical signs and laboratory findings were reported. The purpose of the present study was to describe findings in a 3-year follow-up of these women with infraclinical hypothyroidism in order to assess natural history and appropriate care. Ninety-seven women of the 151 women with a TSH level between 4 and 12 mU/l in the 1997 survey were reviewed during the last three months of 2000. Forty-three of them had taken thyroid hormone replacement drugs since 1997. About 44% of the women examined still had infraclinical hypothyroidism or developing hypothyroidism. There was not significant difference between treated (33%) and non-treated (55%) patients. Clinical and biological signs associated with infraclinical hypothyroidism at the initial examination (elevated serum cholesterol, abnormal ECG, eyelid edema, recent weight gain) were unchanged at the second examination, both in treated and not treated women. A logistic model including all these factors demonstrated that the probability of prescription of thyroid hormone replacement therapy increased 5.4-fold when the starting TSH level was above 6 mU/l and 3.2-fold if ECG abnormalities were present. Using a statistical model with anti TPO antibodies, a level above 64 U/l increased the probability of treatment 7-fold, with ECG findings being related to probability of treatment. Age, cholesterol level, use to lipid lowering drugs, presence of eyelid edema or weight gain were not associated with replacement therapy in this model. No consistent conclusion concerning the appropriateness of screening for infraclinical hypothyroidism can be drawn from these three-year follow-up findings. Another examination scheduled for 2003 should provide further precision concerning the natural history of infraclinical hypothyroidism as well as long-term medical practices and therapeutic impact.

[Screening for colorectal cancer. Study of a population attending a public health clinic]. / Dépistage du cancer colorectal. Etude dans la population consultant un centre d'examens de santé.

OBJECTIVES: Screening for colorectal cancer with fecal occult-blood test has been performed in health centers for several years. The aim of this study was to describe participation rate and results in a population attending the Center for preventive medicine at Vandoeuvre-lès-Nancy, France in 1996 and 1997. PATIENTS AND METHODS: Among 19,325 people aged 50-75 years, the screening test was proposed to 17,917 and performed in 15,527. RESULTS: Participation rate was 86.7%. Overall positivity was 3.6% higher in men than in women (4.1% versus 3.0%). In the 440 colonoscopies performed, 22 cancers and 84 adenoma polyps were identified (PPV = 24%). DISCUSSION: These results show good participation rates in a screening program for colorectal cancer during periodic health check-ups. Follow-up for positive subjects was satisfactory but requires good cooperation between specialists and general practitioners to obtain complete information to evaluate the program.

[Iron deficiency in patients over 60 years. Descriptive study in the consultant population of health screening centers]. / Carence martiale chez les sujets de plus de 60 ans.

AIM: The aim of the study was to evaluate the frequency of iron deficiency with serum ferritin in elderly population, and to appreciate the opportunity of early screening according to digestive diseases. SUBJECTS AND METHODS: Data were collected from 3524 men and 3120 women aged 60 to 75 years during a health screening examination. Evaluation of diagnosis and treatment were obtained through questionnaire completed by treating physician. RESULTS: The frequency of hypoferritinemia was about 2.3% in our population (hypoferritinemia was defined by serum ferritin<20 microg/L or between 20-40 microg/L if C reactive protein was > 12 mg/L). Anemia was found in 3.3% of patients. Logistic regression model adjusting for multiple variables was used to examine factors associated with hypoferritinemia. The probability was greater among non-anemic patients with chronic digestive bleeding (odds-ratio: 2.3), or with positive occult blood testing (odds-ratio: 2.3). Information about the medical follow-up was obtained in 81% of patients with hypoferritinemia. A digestive exploration was made in 38 cases. Digestive disease was found among 24.3% patients with hypoferritinemia, and three colorectal cancers were observed. CONCLUSION: The screening of hypoferritinemia in elderly population examined in health screening centres could not be recommended as its frequency was low in this population, despite a strong correlation between hypoferritinemia and digestive diseases.

[Strategy for serum ferritin measurement in 16 to 45 year old women in health screening centers]. / Stratégie de dosage de la ferritine sérique chez les femmes de 16 à 45 ans dans les centres d'examens de santé.

Even in industrialized countries, the iron-deficiency anemia is frequent in menstruating women. However, the systematic measurement of serum ferritin is not justified. In this study, a strategy for ferritin measurement has been determined from data of centers for health screening, obtained in 6,098 menstruating women. This strategy is based on biological results (hemoglobin, MCV, RDW, GGT, ALAT) and on responses to the questions about blood donation, birth country and contraceptive habits. The measurement of serum ferritin is realized in 64% menstruating women and 23% have an hypoferritinemia (< 20 mg/l).

Factors of variation and reference values for TSH in 45-70 year old women.

Thyroid stimulating hormone (TSH) was measured in a sample of 4,403 women, aged 45-70 years in 11 Centers for health screening, to define the interest of this biological indicator for screening subclinical hypothyroidism. The aim of this work was to describe clinical signs, symptoms and medical history linked to TSH variations, to estimate the distribution of this hormone in a general population and reference limits in a selected subgroup. All the participating laboratories used the same third-generation immunoassay on fresh samples. In the general sample population (age mean: 55.2 6.9 yrs), 1.1% presented hyperthyroidism (TSH<0.3 mU/l) and 0.4% had hypothyroidism (TSH>12 mU/l). In the sub-sample of 151 women (3.4%) with TSH between 4-12 mU/l, 131 had subclinical hypothyroidism (FT4>8 ng/l). The TSH mean was significantly lower (- 10 to - 23%) in women presenting a nodular goiter. Inversely, TSH was higher in women with muscle cramps, asthenia, recent weight gain, morning eyelid edema and abnormal electrocardiogram. The reference limits for percentiles 2.5 and 97.5 were 0.43 and 3.71 mU/l on 1 348 subjects after excluding women having one of these symptoms or taking any drug treatment.

[Mammography use among 35-50-year-old women. Descriptive study of a population seeking services at the centers of health tests]. / Pratiques de la mammographie chez les femmes de 35-50 ans. Etude descriptive dans la population consultant les centres d'examens de santé.

OBJECTIVE: The aim of the study was to evaluate mammography rates and indications (diagnosis or screening) among women from 35 to 50 of age, and to search the main factors associated to mammographic screening. DESIGN AND SETTING: The data were collected from 6409 women through a specific questionnaire completed by a nurse. RESULTS: Among women from 35 to 50 years of age, 61% have undergone at least one mammography during their life; 25.6% had undergone a screening mammogram within the last three years. Whatever women's age or indications, the gynecologist was the first physician to prescribe mammography. Logistic regression model adjusting for multiple variables was used to examine factors associated with women who underwent a screening mammography within the last three years. Women more likely to be screened were 45 to 50 years of age (vs 35-40 years of age: adjusted OR 8.9, 95% CI: 7.2 to 11.2), had higher educational level (adjusted OR 1.3, 95% CI: 1.1 to 1.5), had family history of breast cancer (adjusted OR 2.7, 95% CI: 2.1 to 3.4), and used routine gynecologic care (adjusted OR 1.9, 95% CI: 1.6 to 2.4). CONCLUSION: Individual screening by mammography very often occurs after 40 years, Such behaviors may lead public health professionals to question current recommendations for breast cancer mass screening in women 50 years of age and older.

[Changes in the cardiovascular risk indicators in adolescents between 1980 and 1991]. / Evolution des indicateurs de risque cardiovasculaire entre 1980 et 1991 chez l'adolescent.

The aim of this study was to evaluate the trends of indicators of cardiovascular risk (smoking, physical activity, cholesterol, triglycerides...) in adolescents between 14 and 18 years of age. The data was recensed at the Centre of Preventive Medicine of Vandoeuvre-lès-Nancy which was responsible for periodic Social Security health check-ups in 6,974 adolescents in 1980, 1984, 1988 and 1991. The analysis of the trends of the indicators of cardiovascular risk took into consideration the socio-economic changes of the population recruited during this period and the long-term analytical variations of biochemical parameters. Globally, between 1980 and 1991, there was a decrease in the percentage of smokers (21.8% to 13.5%) which was more marked in boys than in girls, an increase in physical activities (46.9% to 57.5%), a linear reduction in serum cholesterol (4.65 mmol/l to 4.33 mmol/l in boys, and 4.94 mmol/l to 4.72 mmol/l in girls), and no significant changes in serum triglycerides. These results confirm those reported by others and are encouraging for cardiovascular disease prevention and should be confirmed in adults groups.

[Future of blood pressure in young adults during a 15-year follow-up]. / Devenir de la pression artérielle chez de jeunes adultes après un suivi de 15 ans.

Tracking of BP and their determinants were investigated among 2,752 young adults, aged 20-35 years (1,209 men and 1,543 women) in a longitudinal study conducted since 1974 at the Center for Preventive Medicine in Nancy-Vandoeuvre. Prevalence of hypertension (BP > 160/95 mmHg or hypertensive drugs) rose over 15 years from 2.1% to 6.8%. Subjects with antihypertensive drugs were about 3.5% after 15 years of follow up (mean age at the fourth examination: 44 years). Coefficients correlation between initial BP and BP at 5, 10 and 15 years were 0.43, 0.38 and 0.35 for systolic BP, 0.28, 0.24 and 0.26 for diastolic BP in population without antihypertensive drugs. The part of variance for BP at the fourth examination explained by variables from previous examinations was low (27% for systolic BP and 13 or 17% according to sex for diastolic BP). The main variable in the regression was always the BP at the third examination; 69.3% of subjects with high BP (> 140/90 mmHg or treated for hypertension) were well classified in a discriminant analysis. These results underline the difficulty to predict BP and hypertension in a general population, suggest to take into account pathogenic predictors in further studies and allow us to propose selective prevention of future hypertensive.

[Changes in blood cholesterol levels over a 10-year period; value of a single sample for predicting future blood cholesterol levels]. / Evolution de la cholestérolémie sur 10 ans; intérêt d'un dosage ponctuel pour prédire la cholestérolémie future.

The aim of this study was to report the serum cholesterol changes over a 10 year period in 12,238 subjects aged 4 to 64 years (mean 28 +/- 14 years) based on 3 health check-ups at an average of 5.5 yearly intervals between 1973 and 1989, and to determine the value of a single sample for predicting the serum cholesterol level at 5 and 10 years, and the influence of blood pressure and Quetelet index on this predictability. After identification of the influencing factors, the different variables were adjusted using a step-by-step regression analysis. The correlation coefficients calculated between the adjusted cholesterol level at the first examination and that measured at 5 and 10 years, were all significant (0.38 to 0.59) and varied with age at the time of the first examination and gender. The positive predictive value of having a cholesterol level higher than the 90th centile at 5 and 10 years when it was already higher than this value at the first examination varied from 26 to 46% respectively with respect to the subgroups. The sensitivity of the test was 25 to 48%. The negative predictive value and specificity were 93 to 95%. The lowering of this threshold to the 80th centile increased the positive predictive value from 35 to 45% and decreased the specificity from 94 to 87% for the whole population. When the first two sampling results, five years apart, were taken into consideration simultaneously, the predictive value of having a raised cholesterol level at 10 years increased from 35 to 61%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Variations in blood lipid levels in adolescents: relation to changes in lifestyle. A longitudinal approach]. / Evolution des lipides sanguins chez les jeunes: relation avec les changements du mode de vie. Approache longitudinale.

In order to assess the relationship between changes in life style (taking up smoking, giving up sporting activity) and plasma lipids, 3,650 young subjects aged 14 to 18 years, from the Lorraine region, were examined on two occasions separated by a 5 year interval. At the second examination, 39% of the boys and 33.8% of the girls had taken up smoking, and 52% of the boys and 68% of the girls had given up strenuous physical activity. These changes in life style were associated with a significant change in total cholesterol in boys and also of triglycerides after adjustment of values for age and variation in body mass: starting smoking or the giving up of sporting activities was associated with a greater increase in cholesterol and triglyceride levels. These results underline need for increasing efforts in the prevention of cardiovascular disease in young subjects, and emphasise the importance of maintaining physical activity and of not smoking.

[Comparison of measurements of cholesterol, glucose and uric acid taken at 5-year intervals in children and adolescents]. / Comparaison à cinq ans d'intervalle des taux de cholestérol, glucose et acide urique chez l'enfant et l'adolescent.

BACKGROUND: There are several reports on cardiovascular disease risk factors but, except for lipids and lipoproteins, there have been few studies tracking blood uric acid and glucose in healthy school children. MATERIAL AND METHODS: Blood specimens were collected from 4,299 children and adolescents for determination of cholesterol, uric acid and glucose. The first samples were collected between 1977 and 1979 from subjects aged 4 to 17 years. The second samples were collected 5 years later. RESULTS: The blood glucose concentrations increased before the age of 10 years; those of uric acid increased during the second decade and those of cholesterol decreased during puberty, to a greater degree in boys. Hypercholesterolemia (cholesterol > 5.9 mmol/l) was found in about 6% of boys and 10% of girls. Eight boys and 3 girls had blood glucose concentrations higher than 6.7 mmol/l at the first collection. 5 years later, the correlation coefficients by sex and by cross section of age were greater than 0.5 for cholesterol and uric acid and were about 0.3 for glucose. CONCLUSIONS: Successive blood values of glucose and uric acid are highly correlated; those of cholesterol are more highly correlated. However, the probability of remaining in the same percentile distribution remains below 50% for subjects whose initial values were above the 80th percentile.

Segregation analysis of height-adjusted weight with generation- and age-dependent effects: the Nancy Family Study.

A segregation analysis using a regressive model with generation- and age-dependent effects was applied to familial data of height-adjusted weight to investigate the major gene hypothesis. The sample included 629 nuclear families with 2,534 members volunteering for a free health check-up in the Preventive Medicine Center of Vandoeuvre-lès-Nancy, France. The familial correlations were 0.094 +/- 0.040 between spouses, 0.198 +/- 0.023 between parent and offspring, and 0.327 +/- 0.034 between siblings. The variability of the trait was higher in parents than in offspring. The most parsimonious genetic model indicated a codominant major effect increasing with age in childhood, then stabilizing in adulthood. The same data were analyzed using the classical mixed model, assuming equality of variances between parents and offspring, no resemblance between spouses, similar parent-offspring and sib-sib correlations, and identical effects in parents and offspring. This analysis indicated a recessive solution. In both analyses, mendelian transmission was rejected. However, the mixture of two distributions in the recessive model, instead of three in the codominant one, was less constraining with respect to the test of transmission probabilities, and the rejection of mendelian transmission was due to a single family in the recessive case, instead of several families in the codominant one. This could possibly explain why previous studies, all using the mixed model, found evidence for a recessive major gene. Although the major gene hypothesis cannot be definitely ruled out from our results, the mechanism appears more complex than the effect of one single gene.

Determinants of plasma retinol, beta-carotene, and alpha-tocopherol during adolescence.

The relationships of plasma retinol, retinol-binding protein (RBP), beta-carotene, and alpha-tocopherol with their potential determinants, plasma cholesterol and triglyceride, body fat, dietary intake, stages of pubertal development, and drugs, were examined in a French sample of 263 boys and 246 girls aged 10-15 y. By use of multiple-regression analysis, plasma retinol concentration was positively related to plasma cholesterol and triglyceride, sexual-maturation index, body fat, and being male. For plasma RBP the same predictors were identified. Plasma beta-carotene was positively related to plasma cholesterol and beta-carotene nutrient density and negatively related to body fat and plasma triglyceride. Three predictors of plasma alpha-tocopherol were identified: plasma cholesterol and vitamin E nutrient density, which were positively related to its concentration, and sexual-maturation index, which was negatively related. These results confirm that physiological developmental age should be considered in epidemiologic studies of plasma fat-soluble vitamins in adolescents.

[The status of blood pressure over a 10-year period]. / Evolution de la pression artérielle à 10 ans d'intervalle.

The aim of this study is to relate the evolution of blood pressure (BP) measured every 5 years during 10 years in 12,824 healthy adults and children from both sexes. At the first evaluation, 2,856 were 4-15 years of age, 1,471 were 15-25, 6,590 were 25-45 and 1,907 were 45-65. The result of BP were adjusted according to possible effects of age, height or year of examination. Correlation coefficients at 5 and 10 years for the male patients are 0.38 and 0.34 (systolic BP and 0.23 and 0.18 (diastolic BP); for the female patients they are 0.36 and 0.31 (systolic BP) and 0.23 and 0.17 (diastolic BP). The reliability of the correlations increases according to age at first examination: for an initial age between 4 and 10 years, the correlation coefficient between first and last evaluation is 0.14 while for an initial age of 45-65 years it is 0.38 (systolic BP). The predictive value of a relatively high BP defined as percentage of patients whose systolic BP is staying in the upper fifth of the BP distribution ten years later is for increasing age group: 28.7%, 31.1%, 39.7%, 42.5%; that means a relative risk moving from 1.34 to 3.17. Sensitivity of detection of male patients whose systolic BP will be in the upper fifth of the distribution varies from 22 to 42% according to age, with a specificity of 86.3 to 82.2%. The results are sensibly similar in the female patients and for diastolic BP.(ABSTRACT TRUNCATED AT 250 WORDS)

Family resemblance in body circumferences and their ratios: the Nancy family study.

The purpose of this study was to investigate the familial resemblance for individual body circumferences (suprailiac, waist, thigh and arm) and for the waist/suprailiac (as surrogate for the waist/hip) and the waist/thigh circumference ratios, in a sample of 216 unselected nuclear families with children aged 10-25 years. Familial correlations were jointly computed, using the maximum-likelihood method. The highest familial resemblance was observed for the waist circumference and for the waist/suprailiac and the waist/thigh circumference ratios. There was no significant difference between father-offspring and mother-offspring correlations when considering individual body circumferences. In contrast, when considering the two ratios there was a stronger mother-child than father-child similarity. Furthermore, there was a higher resemblance of the mother with her daughter than with her son, but no significant sib sex difference in the father-offspring relationship. There was also a heterogeneity of sibling correlations for the two ratios, the like-sex pairs exhibiting higher correlations than the unlike-sex pairs. Lastly, the similarity observed between spouses, of similar magnitude to the father-offspring correlation, suggests the contribution of environmental rather than genetic factors for explaining the familial resemblance of the two ratios. In conclusion, the great family resemblance for the waist/suprailiac and the waist/thigh circumference ratios (correlations ranging from 0.23 to 0.68) appears remarkable, and should be taken in consideration, given the predictive value of these indices for disease in adulthood.

[Young people and cancers. Knowledges, behaviors and attitudes of young people aged from 16 to 25 years with regard to cancers]. / Les jeunes et les cancers. Connaissances, comportements et attitudes des jeunes de 16 à 25 ans à l'égard des cancers.

Knowledge, behavior and attitudes towards cancer were studied by submitting a questionnaire to 247 adolescents and young adults aged 16-24 yr who attended the Vandoeuvre-lès-Nancy Centre of Preventive Medicine. Results of this enquiry showed that these young people were aware of the significant mortality rate by cancer but that they had a poor knowledge of risk factors, early symptoms and screening methods. For 70.4 percent of subjects, cancer was a source of concern and the majority expected society or doctors to provide them with information. The role of the medical practitioner in this health education is discussed.

[Nutrition of adolescent girls in Lorraine]. / Alimentation des adolescentes en Lorraine.

A survey concerning the nutritional habits, using the method of the dietary history, was undertaken among 273 girls aged 10 to 16 and examined at the Preventive Medicine Center in Nancy. The energy amount, on average 2,363 calories/day (9.88 MJ) and the distribution among the various nutriments differed little from the French recommendations. Energy intakes varied with bone ages and the socio-cultural level of parents. No intake changes were found with respect to the degree of overweight or to the growth peak. The study of the distribution of intakes according to the main groups of aliments showed the important place of dairy products (14.6%), breads (13.9%) as well as sweets and pastries (11.8%, 12.9%), distribution independent of age. Lunch represents the most important meal of the day (35.7%). Snacks provide as much energy as breakfast. The latter is insufficient in 20% of cases. However, this insufficiency is compensated during the day.

[Pregnancy and work: apropos of sick leave]. / Grossesse et travail: à propos des arrêts de travail maladie.

A study of sick leave from work during pregnancy has been performed from data collected by Social Security's consulting doctors in 1985. The proportion of sick leave of a duration of less than six months during pregnancy may be estimated to be 18.6% of all the reasons for sick leave for all women aged less than fifty years, and so represents the second highest reason for sick leave after mental diseases. A socio-professional inequality exists with regard to sick leave during pregnancy: the estimated frequency of sick leave for pregnancy is thirteen times higher in workers than in managers, and seven times higher in employees.