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PubMed1999

[Dirofilariasis, an emerging and underestimated zoonoses in France].

A total of 71 cases of dirofilariasis due to Dirofilaria repens and two cases of pulmonary dirofilariasis due to Dirofilaria have been reported in France. As a result France ranks second after Italy in the incidence of this emerging zoonoses that has been given little attention (48 p. 100 of cases in the last ten years). Most human infections (80 p. 100) have occurred in Mediterranean areas but in the last ten years a few cases have been reported in Southwestern France and at least one case was documented in a northern area (Alsace). The epidemiological profile of human dirofilariasis in France is consistent with usual data showing highest incidence in adults and no gender preference. More than 50 p. 100 of superficial nodules are located on the head with the most common site being the conjuctiva and orbit (29.4 p. 100). Nodules on the breast and male genitals as well as pulmonary nodules require differential diagnosis to rule out neoplasm. Intra-abdominal forms are usually discovered incidentally. Identification is rarely based on detection of a whole adult worm but rather on observation of a nematode segment on histological sections. In most cases it is an unexpected finding. Data concerning canine heartworm in France is available but the extent of infestation is probably underestimated and will require further study. In addition, data on other animal reservoirs should be updated.

Adult↗
PubMed2001

[Regional management of arterial hypertension in France. Report of a survey of general practitioners].

A survey was conducted in 14 regional samples of general practitioners (GPs) included in Gallup-up poll. 2,423 GPs contributed to the study and had to include all patients > 18 years old over a period of one week. Patients were considered hypertensives if the mean of two recorded BP measurements was > or = 140/90 mmHg and/or < 140/90 mmHg if they were under antihypertensive treatment. Hypertensives were considered as controlled if there BP levels were overall < 140/90 mmHg under treatment. The risk factors associated with hypertension were collected in order to evaluate the cardiovascular risk, according to 1999 ISH-OMS recommendations. 156,470 patients recruited by 2423 GPs were included in the study representing 14 different French regions: Ile-de-France I (1), Ile-de-France II (2), Ile-de-France-Pays-de-la-Loire (3), Bretagne (4), Normandie-Picardie (5), Nord-Pas-de-Calais (6), Alsace-Lorraine (7), Bourgogne-Franche Comté (8), Rhônes-Alpes (9), Provence-Côte d'Azur (10), Languedoc-Provence (11), Limousin-Auvergne (12), Midi-Pyrénées (13), Aquitaine (14). Among 70,073 hypertensives, 23,054 had never received antihypertensive treatment, and 32,059 (47%) had a high or a very high cardiovascular risk. 67% of hypertensives (47,019) were treated, and 32.8% of treated hypertensives (15,422) had a BP < 140/90 mmHg. The study illustrated few differences in prevalence and control of hypertension in the different French regions: BP control at the 140/90 mmHg threshold vary from 28.5 to 36.6% among treated hypertensives and % of patients at high cardiovascular risk from 42.1% (South-France) to 49.7% (East-France).

Cardiovascular Diseases↗
PubMed2001

[Epidemiology and costs of lung cancer in France].

There were 21,850 cases of newly diagnosed lung cancers in France in 1995. This figure corresponds to an incidence rate (standardized to the population of Europe) of 66.5 per 100,000 men and 8.9 per 100,000 women. The incidence is age-related and reaches a peak between 70 and 74 years of age for men and between 75 and 79 years of age for women. The incidence also varies by region and the highest rates were observed in east of France. Non-small-cell lung cancers represent 80% of all lung cancers. Between 1985 and 1995, as a result of changes in tobacco consumption, the incidence rates increased by 56% in women and by 5% in men under the age of 65. The incidence rates in France are close to the average rates observed in Europe. In 1995, lung cancers led to 23,900 deaths in France (mortality rate standardized to Europe: 36.6 per 100,000). 85% of deaths due to lung cancer occurred among men. Prognosis of lung cancer remains poor and has not improved appreciably over the last two decades. 58% of all patients died during the first year and 82% during the three years following lung cancer diagnosis. Survival rates appear to be better for patients with non small cell lung cancer than for patients with small cell lung cancer. Few studies have addressed the economics of lung cancer in France. Cost-of-illness studies of lung cancer were published mainly in Canada, the Netherlands and Australia. These analyses have included descriptive works as well as economic models based on theoretical diagnostic and treatment algorithms.

Age Factors↗
PubMed2002

Analysis of the geographical distribution of sporadic Creutzfeldt-Jakob disease in France between 1992 and 1998.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a rare fatal dementia caused by a transmissible agent. However, the mechanism leading to the disease is unknown in the majority of cases. The presence of geographically clustered cases might indicate a common environmental exposure to the transmissible agent, or case-to-case transmission of the agent. This study sought evidence of clustering of cases of sporadic CJD in France. METHODS: A total of 402 individuals who died from definite or probable sporadic CJD in France between 1992 and 1998 were analysed. The geographical distribution of cases was analysed using three different clustering methods. An analysis of the distribution of the distances between pairs was performed to look for evidence of clustering. Then, two methods of cluster detection were used to identify the locations of clusters. RESULTS: Each of our analyses found some evidence of clustering, though the extent of that clustering differed between approaches. The strongest evidence, statistically, related to three cases living in a small rural area in South-West France (P = 0.001). Two of the three cases lived in the same area throughout life. They had also both undergone surgery on several occasions. Little information is available on the third case. CONCLUSION: Some sporadic CJD cases in France may be aetiologically linked. There was strong evidence that three cases in South-West France formed a cluster but the precise mechanism underlying this cluster of cases remains unclear. The potentially long incubation period of the disease makes the identification of links between such cases difficult.

Adult↗
PubMed1992

Prevalence of obesity: a comparative survey in France, the United Kingdom and the United States.

We investigated the differences in the prevalence of obesity between France, the United Kingdom and the United States in 1988. The analysis was made on a total sample of 5580 subjects, representative of the population aged 16-50 years in the three countries. The same questionnaire was used in all three countries. Body mass index (kg/m2) was used to assess corpulence. Significant differences in the prevalence of obesity were observed among the three countries: 7% of the population in France was obese, 9% in the UK and 15% in the USA (P less than 0.001). There was a strikingly high percentage of very obese women (more than 50% overweight) in the USA (8% of the population) as compared to the two European countries (2% in France and 3% in the UK). In all three countries, obesity was related to sex, age, level of education, marital status, physical exercise and smoking. An inverse association was found between obesity and alcohol consumption in the USA, but not in France nor in the UK. In men, prevalence of obesity remained significantly higher in the USA than in France or in the UK when adjusting for the obesity-related factors. In women, differences in prevalence of obesity between the three countries varied according to the level of exercise, income and alcohol consumption.

Adolescent↗
PubMed2003

[The cost of screening for breast and cervical cancer in France].

This article presents existing data on the cost of breast cancer and cervical screening programmes in France. The average direct cost of breast cancer screening was estimated at 57.77-60.51 Euro per woman attending for screening. Organisational costs account for 15-24% of total costs and the efficiency of existing screening programmes has improved over time. There is little available data on the cost of cervical cancer screening in France. The decentralised model of screening followed for both cervical and breast cancer programmes in France is more costly than the centralised model adopted by most other European countries. The best way to improve the economic value of screening programmes is to increase attendance rates. Attendance is currently inadequate for both screening programmes in France. For cervical screening, it is more cost-effective to increase screening attendance than to increase the frequency of screening. As long as screening attendance remains low, the impact of existing screening programmes will be suboptimal. Thus any new allocation of resources towards cervical and breast cancer screening in France should be assessed with caution.

Breast Neoplasms↗
PubMed2006

Outbreak of Salmonella enterica serotype Manhattan infection associated with meat products, France, 2005.

Between August 2005 and March 2006 in France, 69 cases of Salmonella enterica serotype Manhattan (Salmonella Manhattan) were reported, 51 (74%) of them from southeastern France. At the time of the alert (November 2005), 13 cases and 33 controls were interviewed. Cases were more likely than controls to have eaten pork sausages (OR=5.9, confidence interval CI [1.3; 26.9]) and beef (OR=9.3, CI [1.3; 68.6]). At the same time, 19 strains of Salmonella Manhattan isolated from meat products in southeastern France, reported to the French food safety agency (Afssa, Agence francaise de securite sanitaire des aliments) in September and November 2005, had an indistinguishable PFGE profile to the 7 human isolates of Salmonella Manhattan from the outbreak in southeastern France. Trace-back investigations revealed that pork samples came from one wholesaler whose pork products had tested positive for S. Manhattan during routine food testing in August 2005. This wholesaler supplied retail outlets in southeastern France. Additionally, a slaughterhouse supplying the wholesaler was inspected and widespread contamination with Salmonella spp. and S. Manhattan was found. Cooperation between the national agencies in charge of human health (Institut de veille sanitaire, InVS) and food safety (Afssa) allowed us to determine the most probable source of contamination and to take appropriate control measures.

Adult↗
PubMed1998

[End-stage renal insufficiency associated with Chinese herbal consumption in France].

In May 1994 in Toulouse, there were two cases of end-stage renal failure (ESRF) related to Chinese herbs similar to those incriminated in the case series reported in Belgium in 1992-93, they led to an epidemiologic investigation aimed at evaluating the risk linked to these plants in France. Studies carried out by the Pharmacy Inspection showed that powders labelled Stephania Tetrandra, but consisting instead of Aristolochia Fangji and containing aristolochic acid, were sold in France between 1989 and May 1994. A systematic attempt to ascertain cases of ESRF associated with ingesting Chinese herbs was carried out by analysing data from the ERA-EDTA Registry of ESRF as well as from the French adverse drug reaction monitoring system. Registry data showed no significant increase over previous years in the number of new ESRF cases caused by tubulo-interstitial nephritis (TIN) between 1990 and 1993. In eight regions of France, the files of 85 ESRF cases were examined, and all patients whose nephropathy began after 1989 were interviewed using a very detailed questionnaire. No association with Chinese herb use was found in any of these cases. In 1996, two new ESRF cases were reported in Nice; the regional adverse drug reaction monitoring center considered the relationship with Aristolochia Fangji to be as possible (I2) for one case and dubious (I1) for the other. Despite a lack of sensitivity of the methods used to detect cases, it seems clear that no phenomenon as extensive as that observed in Belgium occurred in France, although the same drugs prescribed at the same doses have been widely distributed in our country. A possible explantation for the difference in the number of cases in Belgium and France is that of an unrecognised factor, promoting the toxicity of aristolochic acid or peculiar to the Belgian clinic and causative. The precautionary principle led the authorities to ban Stephania Tetrandra and Aristolochia Fangji from the market permanently.

Adult↗
PubMed2002

Budget impact model for determining the costs of introducing inhaled salmeterol/fluticasone propionate combination for the management of persistent asthma in France.

A budget impact model was used to estimate the effect of introducing inhaled salmeterol/fluticasone propionate combination on asthma drug-related costs in France. The model is based on disease prevalence, drug use, drug acquisition cost and sales forecasting data specific to France. It takes the perspective of social security and has a time horizon of 1 year. All drug acquisition costs are adjusted for the average rate of reimbursement of asthma medications in France (77.3%). All costs are expressed in euros. The model shows that if patients receiving concurrent salmeterol plus fluticasone propionate (or budesonide plus formoterol switch to combined salmeterol/fluticasone propionate, the anticipated annual savings would be 2,691,580 and 1,916,966 euros, respectively. On a fixed budget 4067 additional patients could be treated if salmeterol/fluticasone propionate is substituted for concurrent salmeterol plus fluticasone propionate and an additional 2939 patients if the combination is used to replace concurrent budesonide plus formoterol. Overall, using sales forecasting data to estimate how many patients will switch to the new combination from their current therapy, it is estimated that the introduction of salmeterol/fluticasone propionate will increase the national expenditure in France on asthma medications by a maximum of 3%. This budget impact model shows that the introduction of inhaled salmeterol/fluticasone propionate combination is likely to have minimal impact on asthma-related medication costs in France. Moreover, the available data on the salmeterol/fluticasone propionate combination suggest that it is clinically effective, cost-effective and affordable to the French healthcare system.

Journal Article↗
PubMed2004

[Epidemiology of tuberculosis in Ile-de-France in 2001].

INTRODUCTION: The incidence of tuberculosis in France is stable at around 10 per 100,000 per year since 1997. However in the Ile-de-France (which includes Paris and its suburbs) high population density, social deprivation and large numbers of immigrants result in the region providing more than half of the total number of cases notified in France. METHODS: Retrospective analysis using data from the mandatory notification forms of patients diagnosed in 2001. RESULTS: The incidence of tuberculosis in 2001 was 27.2 cases per 100,000 in the Ile-de-France region and 48.4 per 100,000 in the Paris area. The incidence was particularly high amongst young immigrants, especially those from Sub-Saharian countries. Pulmonary tuberculosis was the most commonly observed disease form (72% of cases). HIV infection was documented in 7.5% of subjects. Local tuberculosis control services were asked to intervene in only 30% of overall cases, and in only 50% of pulmonary cases living in crowded housing. CONCLUSION: More resource is needed for the surveillance of tuberculosis and the implementation of public health initiatives in the Ile-de-France to strengthen the fight against tuberculosis.

Adolescent↗
PubMed1988

Are differences in FSH concentrations involved in the control of ovulation rate in Romanov and Ile-de-France ewes?

Despite differences in FSH concentrations ranging from 1.5 ng/ml (Romanov ewes) to 4 ng/ml (Ile-de-France ewes) between the follicular and luteal phases, follicular growth (numbers of follicles growing, growth rates, maximum size reached) was morphologically similar between the two stages of the cycle. Injection of 750 i.u. hCG at Day 6 or 16 of the cycle triggered ovulation of 4.1 +/- 0.7 and 4.0 +/- 1.3 follicles in Romanov and 2.2 +/- 0.5 and 1.7 +/- 0.5 follicles in Ile-de-France ewes, respectively, demonstrating that functional differentiation was similar between the two stages of the cycle. As gonadotrophin environment differs between these two stages of the cycle, this suggests that there is a wide flexibility in the amount of gonadotrophins required to trigger terminal follicular growth and that ovarian requirements for gonadotrophins might work through thresholds. When Romanov and Ile-de-France ewes were given similar amounts of exogenous gonadotrophins (1250 i.u. PMSG, 750 i.u. hCG) after hypophysectomy, ovulation rates were close to the usual values (Romanov, 5.5 +/- 3.9; Ile-de-France, 1.4 +/- 0.5), demonstrating that differences in gonadotrophin concentrations during the follicular phase do not play a major role in the high ovulation of the Romanov compared to the Ile-de-France ewes.

Animals↗
PubMedDate not supplied

Resistance of Santa Inês and Ile de France suckling lambs to gastrointestinal nematode infections.

A trial was carried out to determine the resistance to natural infection by gastrointestinal nematodes in 12 Santa Inês and nine Ile de France lambs before weaning. Faecal samples were obtained for faecal nematode egg counts (FEC). Blood samples were collected to determine packed cell volume (PCV), total plasma protein levels and peripheral eosinophil counts. Most Ile de France lambs (77.8%) were treated with an anthelmintic at 43 days of age, while 50% off Santa Inês lambs were treated at weaning, 57 days of age. The mean PCV values were normal in Santa Inês lambs, while in Ile de France lambs showed lower values reaching 22.3% at 43 days of age. The lowest mean plasma protein values were observed in Ile de France lambs (4.13 g/dl) at 43 days of age and in Santa Inês lambs (5.0 g/dl) at 57 days of age. Before weaning, Santa Inês lambs were susceptible to natural infections by gastrointestinal nematodes but with a greater capacity to stand the adverse effects of parasitism compared to Ile de France lambs.

Animals↗
PubMed1997

Oesophageal cancer in France: potential importance of hot alcoholic drinks.

In France, major geographic variation exists in the incidence of oesophageal cancer, the highest incidence being reported in Normandy and Brittany. The role of alcohol in the risk of oesophageal cancer is well established in Western countries. One possible explanation for geographical variation of incidence is that higher incidence of oesophageal cancer is due to specific local alcoholic beverages. The aim of this study was to determine whether different types of alcoholic beverages exert different effects on the risk of oesophageal cancer, and whether the variation of incidence in France is due to variation in local drinking behaviour. We conducted a multicentre case-control study in 3 regions of France (Normandy, Burgundy and Midi-Pyrenees), among which there is a 5-fold variation in incidence. We selected 208 cases and 399 controls, all males. During the interview, the subject's entire alcohol history was reconstituted, noting each type of alcoholic beverage consumed throughout life. The link between the risk of oesophageal cancer and alcohol varies greatly according to the type of alcoholic beverage, with aniseed aperitifs, hot spirits (especially hot Calvados) and beer carrying the highest risk. Consumption of hot Calvados appeared to explain about 2/3 of the inter-regional and urban/rural differences in incidence, whereas total alcohol intake explained less than 1/5. Even after adjustment for all other alcoholic beverages, consumption of hot calvados explained almost half of the peak in incidence of oesophageal cancer in the Northwest of France, as well as half of the urban/rural differences in incidence.

Aged↗
PubMed1984

Antibodies to HTLV-I p24 in sera of blood donors, elderly people and patients with hemopoietic diseases in France and in French West Indies.

Human T-cell lymphoma/leukemia virus type I (HTLV-I) is a type-C retrovirus originally isolated from patients with leukemia or lymphoma involving mature T lymphocytes. Epidemiological studies have shown that HTLV-I infection occurs not only in leukemic but also in normal people in at least two areas of the world: the Caribbean basin and the South-West of Japan. We report here the results of a large seroepidemiological study of HTLV-I infection in normal French blood donors, elderly subjects living in institutions and patients with various malignant hemopathies, obtained by the classical HTLV-I p24 radioimmunoassay. We were unable to demonstrate antibodies to HTLV-I in 510 sera from French volunteer blood donors born and living in continental France or in sera from 262 blood donors born in other countries (mainly in Europe and North Africa) and living in continental France at the time of collection. In contrast, among 131 sera from blood donors born in French overseas territories (French Guiana, French West Indies, and Reunion) but living at the time of collection in continental France, 2 (1.5%) were found to possess anti-HTLV-I antibodies. In a sample of 2,597 blood donors from Martinique, 39 (1.5%) were positive. A positive correlation with age was observed whereas no statistical relationship was found between HTLV-I antibodies and sex, red cell blood groups or the place of residence in Martinique. On the other hand, a very high level of positive values was observed in Martinique among old people living in institutions, 14% of those aged over 60 years being positive. HTLV-I-associated hematological malignancies have not been observed in patients born and living in continental France whereas a large number exist in the French West Indies. In the same area, the presence of anti-HTLV-I antibodies in 12% of patients with myeloma, a typical B-cell disease, merits attention.

Adolescent↗
PubMed2005

Comparison of the use of amniocentesis in two countries with different policies for prenatal testing: the case of France and the United States.

OBJECTIVE: To compare maternal age- and education-specific use of amniocentesis in France and the United States. METHODS: We used two nationally representative datasets, National Perinatal Survey of 1998 in France (n = 12 816) and National Center for Health Statistics birth data for 1997 in the United States (n = 3 799 975). Analyses included binomial regression with test of interactions between country, maternal age and education. RESULTS: Amniocentesis use was more than threefold greater in France than in the United States (Risk Ratio (RR) 3.2, 95% CI, 3.1-3.4). This was true across maternal age and education groups. Differences in use of amniocentesis were greatest, however, for women with lower levels of education and older (>/=38 years) women. CONCLUSION: Our results suggest greater use and lesser disparities in maternal age- and education-specific use of amniocentesis in France as compared to that in the United States. These differences may be due to several factors, including differences in women's cultural values and preferences. They may also represent barriers to effective access to prenatal testing, particularly for women in lower socioeconomic groups, in the United States.

Amniocentesis↗
PubMed1995

The prevalence of homosexual behavior and attraction in the United States, the United Kingdom and France: results of national population-based samples.

Researchers determining the prevalence of homosexuality in nationally representative samples have focused upon determining the prevalence of homosexual behavior, ignoring those individuals whose sexual attraction to the same sex had not resulted in sexual behavior. We examine the use of sexual attraction as well as sexual behavior to estimate the prevalence of homosexuality in the United States, the United Kingdom, and France using the Project HOPE International Survey of AIDS-Risk Behaviors. We find that 8.7, 7.9, and 8.5% of males and 11.1, 8.6, and 11.7% of females in the United States, the United Kingdom, and France, respectively, report some homosexual attraction but no homosexual behavior since age 15. Further, considering homosexual behavior and homosexual attraction as different but overlapping dimensions of homosexuality, we find 20.8, 16.3, and 18.5% of males, and 17.8, 18.6, and 18.5% of females in the United States, the United Kingdom, and France report either homosexual behavior or homosexual attraction since age 15. Examination of homosexual behavior separately finds that 6.2, 4.5, and 10.7% of males and 3.6, 2.1, and 3.3% of females in the United States, the United Kingdom, and France, respectively, report having had sexual contact with someone of the same sex in the previous 5 years. Our findings highlight the importance of using more than just homosexual behavior to examine the prevalence of homosexuality.

Adolescent↗
PubMed1993

Epidemiology, development and treatment of end-stage renal failure in type 2 (non-insulin-dependent) diabetes mellitus. The case of mainland France and of overseas French territories.

The prevalence of diabetes mellitus among patients treated for end-stage renal failure by dialysis in France was studied in two stages (UREMIDIAB Study). The first stage consisted of a questionnaire which was mailed to all dialysis centres in mainland France. The response rate was 80.8%, resulting in a study population of 12,903 patients. Of these patients 884 were declared diabetic (6.9%). Later 295 of them were interviewed by seven specially-trained physicians who checked the medical records together with the nephrologist in charge. Plasma C-peptide was measured in almost all of the patients. Effectively, 1.4% were found to have Type 1 diabetes and 5.5%, Type 2. Diabetic nephropathy was found to be the only primary renal diagnosis among 93.9% of Type 1 diabetic patients and 36.8% of Type 2. Of the latter 51.6% had a non-diabetic cause of renal failure. In the second stage a survey was later conducted in 13 of 14 dialysis centres located in the remote overseas French territories. Among 934 patients 1.04% were Type 1 diabetic and 19.67% Type 2 (22.9% altogether). Type 2 diabetic patients treated overseas were essentially non-Caucasians (92.6%). The sex ratio was 0.54 in the overseas territories vs 1.4 in the mainland. We conclude that the prevalence of diabetes among people on dialysis is low in mainland France. But there are striking differences in the prevalence of Type 2 diabetes among dialysis patients in mainland France and its overseas territories. These differences are not related to access to dialysis facilities.

Adult↗
PubMed2006

Molecular epidemiology of European brown hare syndrome virus in France between 1989 and 2003.

Genetic diversity between French European brown hare syndrome (EBHS) viruses since the disease appeared has been evaluated. Nucleotide sequencing of the partial capsid protein genes of 169 EBHS viruses collected from various parts of France between 1989 and 2003, three reference strains, and a Greek EBHSV collected in 2002 revealed a maximum nucleotide divergence of 11.7%, indicating a high level of conservation between viruses. Two major groups were identified. The first group contained EBHS viruses collected since 1989 from different parts of France, the reference strains, and all of the viruses located in the far north of France. In this group, three genogroups were clearly identified as mainly related to their geographic origin. The distribution of the viruses suggests that the early viruses have not disappeared and have slowly evolved in their area of origin. The second group, supported by a significant bootstrap value, contained the Greek EBHSV with the French EBHS viruses collected between 1999 and 2003 from regions of southern France. It constitutes a newly identified genogroup. Our results demonstrate strong differences in genetic evolution between EBHSV and rabbit haemorrhagic disease virus, with persistence of the earlier EBHS viruses and interaction between the geographical and temporal distributions.

Animals↗