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Biomedical subjects

F Grémy

Publications and source records attributed to F Grémy.

At least 19 recordsLinked to original sources
PubMed2004

[Development of health care networks: ethical and political contexts].

The operation of our health care system is in the midst of a major crisis. There is a significantly unacceptable level of health inequities and access to care, high premature mortality rates, lack of a coherent health policy, a weakness in the professional demographic projections, increasing financial deficits, quasi-revolt of professionals, complete disregard for the law (Parliament's vote on the National Insurance's budget)--these are just a few of the symptoms of chaos which have embedded themselves right before our very eyes. This article aims to offer a glimmer of light on this gloomy horizon. It is the first outcome of a new working group which was originally referred to as "les Vignerons d'Uzès", a title which could be seen as lacking substance and has therefore become "The Transdisciplinary Working Group on the Organisation of Health and Care". The group's purpose and objective is to reflect upon the values, practices, regulations, evaluation and what is at stake in the context of our health care system.

Community Networks↗
PubMed2001

Ethical problems in health information systems.

OBJECTIVES: To introduce term and concept of infoethics and to argue on its importance for health information systems. METHODS: To argue about our viewpoint of the dominance of the human component, which has been discussed at an IMIA working conference held in Helsinki, Finland (February 1998) devoted to the evaluation of health information systems. RESULTS AND CONCLUSIONS: Any technology sets a relationship between human beings and their environment, both physical and human. No technology can be seen as merely instrumental. This is especially relevant when dealing with large automatic information systems, developed to contribute to the management and integration of large organizations, such as hospitals. In such a context, the environment is mainly made up of humans. In evaluating such information systems, human factors preside over merely technical factors. Even if satisfying the latter is mandatory, they are never really sufficient. A perfect hard- and software system can be an absolute failure in everyday use. In any information system, the human factor is, of course, human-computer interaction, which always occurs when one person interacts with the machinery. However, in a simultaneous multi-user context, human-human interaction is the main question to tackle. The evaluation of large information systems, such as those found in hospitals, is founded in the whole concept of inter-human relationships which underlie the design and use of the system. Indeed, such an information system predominately appears as a social system, with its psychological, sociological and ethical features.

Ethics↗
PubMed2000

[Security of healthcare data networks used for epidemiological studies].

Record linkage, for compiling sameperson records from various source files, can improve the feasibility of epidemiological research using populationbased studies. The question is comply with the European legislation on data privacy and data security. For example, a computerized record hash coding and linkage procedure is described to link medical information within the framework of epidemiological followup. Before their extraction, files are rendered anonymous using a oneway hash coding based on the standard hash algorithm (SHA) function. Once rendered anonymous using the software ANONYMAT, the linkage of patient information can be accomplished by means of a mixture model, taking into account several identification variables. An application of this anonymous record linkage procedure was carried out in order to link medical files on cancer, from 3 hospitals of the French RhôneAlpes region. This application stresses how the use of the ANONYMAT software allows compliance with the legislation on data confidentiality without entailing problems on data availability.

Computer Communication Networks↗
PubMed2000

[Life expectancy in health: major indicators of health in a population].

The concepts of life expectation, life expectation without disability, are explained. Their importance for defining a health policy and a healthcare policy is emphasized. A concrete example is given: the inequalities in life expectancy without disability follow the same pattern as the inequalities in mortality.

Adolescent↗
PubMed1999

Random reflections on science, art and technique applied to medicine and its evaluation.

Science is aimed at universal knowledge. Art is aimed at action for solving concrete and local problems. Can medical practice therefore ever be a science even when employing important aspects of scientific practice such as precise concepts and vocabulary, and a demand for well-validated facts together with rational reasoning? Evaluation of medical and clinical practices in general has an ambiguous status. According to the domain to be evaluated, it can reach a level of science in providing results of universal value but more often it is closer to art, the results remaining of local interest. There is no strict correlation between the universal-local axis and the practical interest for public health. Epidemiologists should consider these matters very seriously and aim to contribute to, rather than discard, their significance for the advancement of clinical practice.

Clinical Medicine↗
PubMed1995

[Predictive values of the usual biologic tests for the detection of human immunodeficiency virus infection. Consequences for screening].

This paper tries to review what is scientifically known about the predictive values of biological tests of HIV infection. The epidemiological situation for that infection is characterized by two facts: the very high values of sensitivity and specificity which are close to unity; the prevalence of seropositivity which is on average--at least in western countries--, very low (except for some small specific groups). Under those conditions, Negative Predictive Values are always very close to unity, and the percentage of false negative tests is extremely low. Things are quite different for Positive Predictive Value, which varies very rapidly with very small shifts or uncertainties about specificity and prevalence. In the case when prevalence is very low (general population screening) and at the same time specificity is not excellent (that means < 0.99 or even < 0.995), Positive Predictive Value is very poor and the proportion of false positive tests rather important. Indeed the analysis of scientific literature, using the method of "best synthesis evidence", reveals numerous discrepancies as to the value of specificity among different tests. Figures vary a lot from one study to another. It is not obvious which screening strategies are concerned by the results, which finally entail a strong statistical uncertainty. Finally, the figures published in the literature are given by high standard laboratories. One may fear the tests realized in routine laboratories are less reliable. As a conclusion, let us say that despite their very good quality, the biological tests, when used separately, should not be trusted without strong previous criticism when applied to samples of the general population. Any biological screening should be preceded by a clinical examination, including a precise inquiry, in order to detect people at risk, that means with a high prior probability. Clinical dialogue has moreover another great interest: it allows health consulting and education, and calls for personal responsibility for both seropositive and negative subjects. It is the best choice of method to reach a high preventive effectiveness.

HIV Infections↗
PubMed1994

Relative importance of risk factors in bladder carcinogenesis: some new results about Mediterranean habits.

In the Mediterranean region of France where bladder cancer mortality and incidence are high, a case-control study with 219 male incident cases and 794 randomized, male population-controls was carried out in 1987-89 to investigate bladder cancer risk factors and more specifically, regional factors. A stepwise logistic regression was applied to the data. This investigation confirms the role of tobacco and of certain occupational exposures in bladder carcinogenesis. There was a significant dose-response relationship with lifelong coffee drinking and alcohol consumption; however the risk estimates were only significantly elevated for the heaviest drinkers. The intake of saccharin was not associated with risk of bladder cancer. Infrequent consumption of carrots, spinach, and marrows conferred an increased risk, suggesting a protective effect of vitamin A. Finally, this investigation results in some new hypotheses. The study of residences and birthplaces has revealed a lower risk for those who have lived in a non-Mediterranean area and a higher risk for those born in a Mediterranean area. These features might be explained by some Mediterranean dietary habits, such as a high consumption of spices (odds ratio = 3.64, 95 percent confidence interval = 2.21-5.98).

Age Factors↗
PubMed1993

[Risk factors in bladder cancer. A case-control study in the department of Hérault, France].

The excess of morbidity and mortality for cancers of the bladder in the french department of Hérault (South of France, on the side of the Mediterranean Sea) justified the implementation of a new epidemiologic study. A case-control study was designed, including 219 cases, 196 hospital-controls and 794 population controls. The collected information concerned profession, habits, behaviour (smoking, alcohol and coffee drinking), places of living, since childhood. The study confirms the role of tobacco, with a highly significant dose-effect, for total consumption, daily dose, and duration of consumption (p < 10(-4)). The classical risk of coffee is confirmed, but it seems not to be due to quantity of caffeine, but to the mouldered form of coffee. As far as alcohol is concerned, the sole risk is due to anisis beverages. When one considers the role of either tobacco, or coffee, or alcohol, the risk is strongly increased (p < 0.02) when exposure begins very early in life (childhood or teen age). But the effect does not depend on the beginning-of-exposure age, when the latter is posterior to teen age (p > 0.95). One may indeed think that the carcinogenic action of these factors concerns mainly the induction phase of the disease. Finally, when place of birth and place of living were considered, a North to South increasing effect was strongly suggested by the study.

Case-Control Studies↗
PubMed1991

Morpho-semantic analysis and translation of medical compound terms.

This paper describes an automatic procedure for morphosemantic analysis and translation of compound medical terms. This analysis is of interest for the automatic indexation of medical discharge reports and summaries. Since words with the suffix -osis may have many different semantic interpretations, such -osis forms are taken as examples for a general method that avoids the difficulties in interpreting medical terms as reported in other studies.

Algorithms↗
PubMed1989

Crisis of meaning and medical informatics education: a burden and/or a relief?

Starting with the quotation by Paul Ricoeur: Man needs love indeed; he needs justice still more; but most of all he needs meaning, this paper states that in this present situation medical education does not prepare students to deal with human needs, neither their own nor those of their patients. This is due to the almost exclusive devotion to hard sciences, contaminated by unscientific ideological drift, which tends to negate subjectivity and to suppress any significance of human destiny. Although medical informatics, by definition, eliminates meaning and knowledge, it can - if properly used as a complement and not as a competitor of human intelligence - help to renovate medical education, introduce true humanistic dimensions, and restore the element of human subjectivity.

Artificial Intelligence↗